CFRN Practice Test

CFRN Exam at a Glance

What changed for CFRN in 2026

• Oct 25, 2026: Delivery changed to Computer-based at PSI Testing Centers or Live Remote Proctoring (previously Computer-based at PSI centers or Live Remote Proctoring).^[1]
• Oct 25, 2026: Exam fee changed to $380 ($285 ASTNA members) (previously $380 ($285 ASTNA members, $195 military)).^[2]
• Oct 25, 2026: Number of questions changed to 175 items (150 scored + 25 unscored) (previously 175 items (150 scored + 25 unscored pretest)).^[1]
• Oct 25, 2026: Retake policy changed to 90-day wait after a failed attempt (previously Unlimited retakes after a 90-day wait).^[1]

What the CFRN is and how it works

According to Board of Certification for Emergency Nursing, “The CFRN exam consists of 175 items (150 scored and 25 unscored pretest items).”^[1]

The CFRN credential from BCEN is for registered nurses who care for patients during flight transport. To be eligible, you must hold a current, unrestricted Registered Nurse license from the United States, a US territory, Canada or Australia, or an equivalent RN license.

You take the exam on a computer, either at a PSI Testing Center or at home through Live Remote Proctoring. It has 175 items. 150 of them are scored and 25 are unscored pretest items. Total seat time is 180 minutes. Your score appears on screen as soon as you finish.

Once you are approved, you must schedule and sit the exam within a 90-day test window. If you do not pass, you have to wait 90 days before you can test again. The fee is $380, or $285 for members of the Air & Surface Transport Nurses Association (ASTNA).

The certification is valid for 4 years. To renew, you either re-take the exam or use CE attestation. BCEN sets the passing standard, the CE requirements for renewal and all current policies, and these can change. Check the details at bcen.org before you apply, schedule or renew.

CFRN content outline and where to practise each area

The content areas below are copied from the official CFRN content outline published by Board of Certification for Emergency Nursing. The right-hand column shows which of our practice sets covers it.

Worked examples: how to reason through CFRN questions

These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.

Example 1

Question: What is the significance of 'density altitude' for helicopter flight nurses?

1. It determines the pressurization requirements of the aircraft cabin
2. It affects aircraft performance by reducing lift capacity in hot, high, or humid conditions
3. It calculates the maximum safe dose of medications at altitude
4. It indicates the altitude at which supplemental oxygen is mandatory

Answer: B. It affects aircraft performance by reducing lift capacity in hot, high, or humid conditions

Explanation:

B is correct. Density altitude is the altitude the aircraft performs as if it were at, once temperature, elevation and humidity are taken into account. Hot, high or humid air is thinner, so the rotor makes less lift and the engine makes less power. That reduces how much weight the aircraft can carry and how well it hovers and climbs. This is why a pilot may limit crew, equipment or patient weight on some flights.

A is wrong because medical helicopters are usually unpressurized, and pressurization has nothing to do with air density for lift. C is wrong because density altitude does not affect drug dosing. D is wrong because oxygen decisions follow cabin altitude and the patient's condition, not aircraft performance.

Rule to remember: density altitude is about how the aircraft performs. Gas laws and hypoxia are about the patient's physiology.

Example 2

Question: Rocuronium is selected instead of succinylcholine for RSI. What reversal agent is available for rocuronium?

1. Neostigmine
2. Sugammadex
3. Flumazenil
4. Physostigmine

Answer: B. Sugammadex

Explanation:

B is correct. Sugammadex is a modified cyclodextrin. It binds rocuronium (and vecuronium) directly in the plasma and pulls it away from the neuromuscular junction. It can reverse even deep blockade quickly, which matters in a cannot-intubate, cannot-ventilate situation.

A is wrong. Neostigmine is a cholinesterase inhibitor. It can help reverse non-depolarizing blockade, but only after some recovery has started. It also works more slowly and needs an anticholinergic given with it. C is wrong because flumazenil reverses benzodiazepines. D is wrong because physostigmine treats anticholinergic toxicity.

Rule to remember: sugammadex works only on the aminosteroid blockers, rocuronium and vecuronium. Succinylcholine has no reversal agent. Have your airway plan and backup ready before you push either drug.

Example 3

Question: What is the correct IV loading dose of amiodarone for a hemodynamically stable patient with ventricular tachycardia?

1. 75 mg over 10 minutes
2. 150 mg over 10 minutes
3. 300 mg IV push
4. 600 mg over 30 minutes

Answer: B. 150 mg over 10 minutes

Explanation:

B is correct. For a stable patient in ventricular tachycardia with a pulse, the amiodarone load is 150 mg IV over 10 minutes, followed by a maintenance infusion. The bolus can be repeated if VT comes back. Giving it slowly lowers the risk of hypotension and bradycardia.

A is wrong because 75 mg is below the standard adult loading dose. C is wrong because 300 mg IV push is the first dose for pulseless VT or ventricular fibrillation during cardiac arrest, not for a patient with a pulse. D is wrong because 600 mg over 30 minutes is not a standard loading regimen and makes hypotension more likely.

Rule to remember: if there is a pulse and the patient is stable, give 150 mg slowly. If there is no pulse, give 300 mg push. Confirm the pulse and blood pressure before you choose the dose, and follow your program's protocols.

How to use these practice tests

Start with the official content outline and candidate information on bcen.org so you know what the exam covers and the rules for test day. Then do the CFRN General set without notes to find your weak areas.

Next, work through the topic sets that match those gaps. For transport practice, use Physiology and Gas Laws and Aviation Safety and Survival. For resuscitation, use Advanced Airway Management and Shock and Hemodynamic Monitoring. For special populations, use Obstetrical Patient Management. After each set, read every explanation, including the ones for questions you got right, and write down the rule behind each miss.

Closer to test day, do the CFRN MCQ set under a timer. The real exam gives you 180 minutes for 175 items, so practise keeping a steady pace and flagging hard questions instead of getting stuck. Book your exam early in your 90-day window so you have room to reschedule. Decide whether you will test at a PSI center or by Live Remote Proctoring, then prepare your route or your room.

Sources & last verified

1. Board of Certification for Emergency Nursing — number of questions, time limit, retake policy, delivery (official source). “The CFRN exam consists of 175 items (150 scored and 25 unscored pretest items).” Verified Oct 25, 2026 · source checked Oct 21, 2026.
2. Board of Certification for Emergency Nursing — exam fee, validity (official source). “Yes, the fee is $285 for Air & Surface Transport Nurses Association (ASTNA) members and $380 for non-members.” Verified Oct 25, 2026 · source checked Oct 21, 2026.
3. Board of Certification for Emergency Nursing — renewal (official source). “At BCEN, we make it easy to maintain your certification, either by re-taking your certification exam or by CE attestation.” Verified Oct 25, 2026 · source checked Oct 21, 2026.
4. Board of Certification for Emergency Nursing — eligibility, score release (official source). “you must hold a current, unrestricted Registered Nurse license in either the United States, a US Territory, Canada, Australia or equivalent RN license.” Verified Oct 25, 2026 · source checked Oct 21, 2026.
5. Board of Certification for Emergency Nursing — other (official source). “general principles of flight transport nursing practice” Verified Oct 28, 2026.

How we verify: editorial & fact-checking policy. Report an error: contact us.