The gna certification is a Maryland-specific credential for nursing assistants who work in long-term care settings. Required by Maryland statute, the Geriatric Nursing Assistant designation goes beyond the standard CNA credential — it addresses the particular knowledge and skills needed to provide safe, respectful care to older adults in nursing homes and geriatric facilities. The Maryland Board of Nursing oversees the certification process, which includes both a written knowledge examination and a practical skills evaluation. Practice with the free GNA - Geriatric Nursing Assistant practice test on PracticeTestGeeks (11 questions with answer explanations).
Candidates who pass the GNA exam demonstrate competency across a range of topics: understanding the physical and cognitive changes that accompany aging, providing person-centered care that preserves resident dignity and autonomy, assisting with activities of daily living, preventing common complications such as falls and pressure injuries, and communicating effectively with the interdisciplinary care team. The exam is designed to ensure that GNAs entering the workforce are prepared for the specific demands of geriatric long-term care, not just general nursing assistant duties.
Printing your practice test materials is one of the most straightforward ways to build exam readiness. A printed PDF lets you simulate test conditions away from a computer, annotate questions as you work through them, and review your errors with a pen in hand — a method many nursing students find more effective for retaining clinical details than screen-based review. This free GNA practice test PDF is formatted for standard letter-size paper and covers the full range of knowledge areas tested on the Maryland exam.
Facts verified Oct 17, 2026 against Maryland Board of Nursing; approved testing vendors Credentia and D&S Diversified Technologies–Headmaster. Dates that have passed are removed automatically.
Facts verified Oct 17, 2026 against Maryland Board of Nursing; approved testing vendors Credentia and D&S Diversified Technologies–Headmaster. Dates that have passed are removed automatically.
| Item | Detail | Official source |
|---|---|---|
| Number of questions (Credentia NNAAP — Written) | 70 multiple-choice questions | kb-maryland.credentia.com |
| Time limit (Credentia NNAAP — Skills) | 30 minutes for five skills | kb-maryland.credentia.com |
| Time limit (Headmaster — Knowledge) | 60 minutes | hdmaster.com |
| Time limit (Headmaster — Skills) | 30 minutes | hdmaster.com |
| Passing score (Credentia NNAAP — Skills) | Satisfactory on all five skills | kb-maryland.credentia.com |
| Retake policy | At least 45 calendar days between attempts | regs.maryland.gov |
| Renewal (CNA-I, formerly GNA) | 16 hours of paid nursing assistant employment in the preceding two years | regs.maryland.gov |
| Delivery (Credentia NNAAP — Written or Oral) | Online proctoring available | credentia.com |
| Eligibility (Credentia NNAAP) | Board-approved training or equivalent | kb-maryland.credentia.com |
| Score release (Credentia NNAAP) | Generally within hours after the testing event ends | kb-maryland.credentia.com |
| Registration deadline (Credentia NNAAP — Online Written or Oral) | Next-day scheduling may be available | kb-maryland.credentia.com |
Facts verified Oct 17, 2026 against Maryland Board of Nursing; approved testing vendors Credentia and D&S Diversified Technologies–Headmaster. Dates that have passed are removed automatically.
Interactive GNA - Geriatric Nursing Assistant resources on PracticeTestGeeks, free to start:
The Maryland GNA exam draws from several interconnected knowledge domains. Familiarity with each area helps you approach both the written test and the skills demonstration with confidence.
Person-centered care is a foundational principle of geriatric nursing. The GNA exam tests your understanding of how to preserve each resident's dignity, respect their individuality, and support their autonomy — even when cognitive impairment or physical limitations require significant assistance. This means knocking before entering a room, addressing residents by their preferred name, explaining every procedure before performing it, and incorporating personal preferences into daily care routines. Person-centered care is not a single task but an attitude that shapes every interaction.
GNA candidates must distinguish normal age-related changes from signs of disease or decline. The cardiovascular system changes with age — cardiac output decreases, vessels stiffen, and blood pressure regulation becomes less responsive. Respiratory reserve diminishes. Musculoskeletal changes include reduced muscle mass, decreased bone density, and slower reflexes. Neurological changes affect memory, processing speed, and sleep patterns. Sensory changes include diminished vision (particularly in low light), reduced hearing acuity, decreased taste and smell sensitivity, and reduced skin sensitivity that increases injury risk. Understanding these normal changes prevents overreaction to typical aging while keeping GNAs alert to genuinely abnormal findings.
Dementia, including Alzheimer's disease, is among the most prevalent conditions GNAs encounter. The exam tests practical care strategies: using simple, direct communication; maintaining consistent routines to reduce agitation; redirecting rather than arguing with confused residents; and creating a calm, low-stimulation environment. Fall prevention is a major focus because falls in older adults frequently cause serious injury. Risk factors — including polypharmacy, impaired vision, orthostatic hypotension, and environmental hazards — are all tested. Other conditions frequently covered include urinary incontinence, pressure injuries (staging, prevention, and documentation), dehydration (signs, prevention, and the role of the GNA in encouraging fluid intake), and the complications of polypharmacy in older adults.
The skills evaluation portion of the GNA exam requires candidates to perform personal care procedures correctly and safely. Personal care tasks include bathing (complete bed bath, partial bath, perineal care), dressing and undressing with attention to affected limbs, grooming (hair care, shaving), and oral hygiene including denture care. Mobility skills cover safe transfer techniques — bed to chair, chair to toilet, using a gait belt — proper positioning in bed (supine, lateral, Fowler's), and ambulation assistance with walkers and canes. Nutrition skills include proper feeding assistance, recognizing the signs of dysphagia, and preparing thickened liquids to the correct consistency for residents on modified diets. Vital signs measurement — temperature, pulse, respirations, blood pressure, and oxygen saturation — must be performed accurately. Elimination care includes catheter care, emptying urinary drainage bags, and assisting with bedpans and commodes. Safety skills include applying restraint alternatives, implementing fall prevention protocols, and using wandering prevention strategies for residents with dementia.
The Omnibus Budget Reconciliation Act (OBRA) of 1987 established a comprehensive set of rights for residents of long-term care facilities. GNAs are required to understand and uphold these rights in daily practice. Core rights include the right to be treated with dignity and respect, the right to privacy, the right to make choices about daily life, the right to be free from abuse and restraint, and the right to voice grievances without retaliation. The OBRA nursing home reform provisions also established minimum staffing standards and quality-of-care requirements. GNA candidates should understand the grievance process and know how to respond when a resident reports a concern about their care.
GNAs are frequently the first to notice changes in a resident's condition because they provide hands-on care multiple times per day. Accurate, timely reporting is a professional and legal obligation. The exam tests knowledge of what changes to report immediately — sudden confusion, new pain, skin breakdown, changes in vital signs, refusal to eat — and how to document observations clearly. SBAR (Situation, Background, Assessment, Recommendation) is the standard communication framework used in long-term care settings and is tested on the GNA exam. GNAs must also understand advance directives — including Do Not Resuscitate orders — and how to respond appropriately when a resident's directive is relevant to the care situation.
Print the PDF on letter-size paper and set aside a quiet block of time — aim for at least 45 minutes per session so you can work through a meaningful number of questions without rushing. Read each question carefully; GNA exam questions often include clinical details (a resident's behavior, a measurement result, a care situation) that change which answer is correct. Rushing past those details is one of the most common reasons candidates miss questions they actually know.
After completing a practice set, go back through every question — not just the ones you answered incorrectly. For the ones you got right, confirm that you chose the answer for the right reason, not because you guessed or eliminated down to one option. For the ones you missed, identify which content area the question tested and schedule a focused review of that topic before your next practice session.
For the skills portion of the exam, written practice questions help with the knowledge component, but hands-on repetition is essential. If you have access to a lab or simulation environment through your training program, use it as much as possible. Practice transfers with a partner, set up vital signs measurement drills, and walk through the steps of each personal care procedure out loud before the test date. The skills evaluators are watching for safe technique, correct sequencing, and respectful interaction with the "resident" — all things that become natural with repetition.
Combine this free PDF with any study guides or materials provided through your GNA training program. The Maryland Board of Nursing publishes a candidate handbook that outlines exactly what the written and skills portions of the exam cover — reading it before you begin your study plan ensures you focus on the right content from the start.
Try these questions from our free GNA - Geriatric Nursing Assistant practice tests. The correct answer and an explanation follow each question.
A GNA is caring for a resident who is actively dying. Which of the following are common physical signs that death is approaching?
Answer: C. Irregular breathing patterns (like Cheyne-Stokes) and mottling of the skin.
As the body's systems begin to shut down, circulation slows, causing a blotchy, purplish discoloration of the skin called mottling, particularly in the extremities. [6, 11] Breathing patterns often become irregular, with periods of rapid breathing followed by periods of no breathing (apnea), a pattern known as Cheyne-Stokes respirations. [10, 15] The other options describe signs of health and vitality.
The nurse visits the home of an older person with chronic lung disease. which observation indicates that the person is engaged in health improvement activities?
Answer: A. Walks a pet twice a day
Walking a pet twice daily provides regular, moderate physical activity, which improves lung function, circulation, and overall endurance in someone with chronic lung disease. Preparing pasta, talking with family once a week, and sleeping in a recliner do not represent active health improvement behaviors and the recliner position can actually worsen respiratory function.
The nurse visits the home of an older person recovering from an exacerbation of a chronic illness. which observation indicates to the nurse that the person has dispelled the myth that older people cannot learn new things?
Answer: B. Researching medications on the internet
Researching medications on the internet demonstrates initiative in learning new technology and seeking health information, directly countering the myth that older adults cannot learn new things. Planning lunch, scheduling appointments, and writing shopping lists are routine tasks that do not require acquiring new knowledge or skills.
A resident receiving end-of-life care tells the GNA, "I'm so scared of dying." What is the MOST therapeutic response from the GNA?
Answer: B. "Would you like to talk about what is making you feel scared?"
The most therapeutic response is one that acknowledges the resident's feelings and provides an open-ended invitation for them to express themselves further. [3, 19] This demonstrates active listening and empathy. Providing false reassurance (A), dismissing their feelings (C), or immediately deferring to the nurse (D) closes off communication and fails to provide immediate emotional support. [19, 20]
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