CRNA Exam

The NCE is a computer-based exam delivered year-round at Pearson VUE test centers. You may sit for it after you complete a nurse anesthesia program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and NBCRNA confirms your eligibility. Active-duty military candidates stationed overseas may be able to test at Pearson centers on select U.S. bases.

To be eligible, you must meet all of the following requirements:

• Complete a COA-accredited nurse anesthesia educational program within the previous two calendar years. Your program administrator submits your academic and clinical record after graduation.
• Hold a current, unrestricted registered nurse license in every state where you hold an active license.
• Hold current ACLS and PALS certification.
• Submit a complete online application through the NBCRNA portal, including a recent color digital photo, the required eligibility certifications, and signed waiver and confidentiality statements.

After graduation, your program sends your record to NBCRNA and you apply and pay online. NBCRNA then emails an eligibility notification. The notice is valid for 90 days or until you test, whichever comes first, so schedule promptly with Pearson VUE; appointments usually need at least two weeks of lead time, and popular test centers fill quickly. There is no refund if you cancel less than 24 hours before your appointment, arrive more than 15 minutes late or miss the appointment.

The NCE follows four official content areas. NBCRNA describes the percentages as the share of questions you can expect from each area.

This content area covers anatomy and physiology of every major body system, pathophysiology and coexisting disease, a long list of pharmacology topics (inhaled and intravenous anesthetics, opioids, neuromuscular blockers and their reversal, local anesthetics, cardiovascular drugs, anticoagulants and reversal agents, antiemetics, endocrine drugs, dantrolene, uterotonics and more), and the applied chemistry, physics and mathematics behind anesthesia practice.

This content area covers the anesthesia delivery system from gas supply to scavenging, vaporizers, breathing circuits, carbon dioxide absorbents and ventilators; airway equipment from face masks to double-lumen tubes and cricothyrotomy kits; monitoring of the central nervous, cardiovascular and respiratory systems and neuromuscular function; patient warming; infusion devices; and imaging and imaging safety.

The largest content area covers ethics and legal issues, safety and wellness (including provider substance use disorder), preoperative assessment, fluid and blood management, positioning, testing data, airway management, local and regional anesthesia, sedation, total intravenous anesthesia, pain management, enhanced recovery after surgery, deliberate hypotension, postanesthesia care, infection control and intraoperative fire safety.

This content area covers anesthesia for every type of surgical and diagnostic procedure, from intra-abdominal, head and neck, cardiac, thoracic, spine, orthopedic and vascular surgery to non-operating-room anesthesia, robotic surgery, trauma, burns and transplantation. It also covers pediatric, obstetric, geriatric, obese, substance-using, immunocompromised and oncology patients.

The NCE uses computerized adaptive testing. The computer starts with a question of moderate difficulty. After each answer it updates its estimate of your ability and chooses the next question to match. If you answer correctly, the next question tends to be harder; if you answer incorrectly, it tends to be easier. The exam keeps a balance of content areas as it adapts.

The test stops when the computer is confident that your ability is clearly above or clearly below the passing standard. That can happen after the minimum of 100 questions (70 scored plus 30 pretest) or anywhere up to the maximum of 170. Finishing early does not mean you failed, and running to the maximum does not mean you passed. If time expires before you reach the minimum number of questions, the result is a fail, so pacing matters.

Because the test adapts, you will answer many questions that feel hard. That is the design, not a sign that you are doing badly. Each question can be answered only once; you cannot skip a question, flag it or return to it later.

This guide's practice tests use the four-option, single-best-answer format so that every question has a clear answer and explanation. Calculation, ordering and select-all ideas are included as four-option questions, so work them out yourself before you look at the choices.

The NCE is pass or fail. Your result depends on whether your final ability estimate is above or below the passing standard, a criterion-referenced standard set by expert panels of practicing CRNAs and educators; you are not graded on a curve against other candidates. NBCRNA reviews the standard every few years and recently raised it. The content outline, format, and number and type of questions did not change, and NBCRNA does not publish the new cut score.

You receive a preliminary pass or fail result when you check out at the test center. Official results can take up to four weeks. Passing candidates do not receive a score. Failing candidates receive a total scaled score and a diagnostic score for each of the four content areas, which show where to focus before retesting.

If you do not pass, you can apply to retest; allow up to five business days for the retake application to be processed. You may take the NCE up to four times in each of the two years after you complete your program, and you must pay the full application fee each time. There is no required waiting period between attempts. You must pass within two years of completing your program; after that, you would need to complete another accredited program to become eligible again.

NBCRNA notifies you electronically and you can print your certification documents. You may use the CRNA credential, and NBCRNA sends verification to state boards of nursing within a couple of business days after results are processed. You then complete your state's APRN or CRNA licensure steps.

CRNAs maintain certification through NBCRNA's Maintaining Anesthesia Certification (MAC) Program, which runs on a four-year cycle. Requirements include 60 assessed continuing education credits (MAC Ed, Class A), 40 professional development credits (MAC Dev, Class B), and participation in the MAC Check, a longitudinal online knowledge assessment answered in short quarterly sets. The habits you build studying for the NCE carry straight into MAC Check.