- 150 scored questions, 3 hours, and 99 correct answers required to pass.
- Patient Conditions and Principles of Management carries 43.3% of the exam - the biggest single domain.
- Fees are $285 for ASTNA members and $380 for nonmembers through BCEN/PSI.
- The current outline took effect March 30, 2026 after a 2025 role delineation study.
Quick Facts Snapshot
If you only have five minutes before your exam appointment, this is the page to reread. The Certified Transport Registered Nurse (CTRN) credential is administered by the Board of Certification for Emergency Nursing (BCEN) and delivered through PSI testing centers or live remote proctoring. Every fact below reflects BCEN's current outline, effective March 30, 2026.
- Scored questions: 150
- Time allotted: 3 hours
- Passing threshold: 99 correct out of 150 scored items
- Domains: 4 (General Principles of Ground Transport Nursing Practice, Resuscitation Principles, Patient Conditions and Principles of Management, Special Populations)
- Initial fee: $285 ASTNA members / $380 nonmembers
- Validity: 4 years, renewable by exam or 100 CE contact hours
For a deeper dive into any single line item, the full CTRN Study Guide 2026: How to Pass on Your First Attempt walks through preparation strategy in more detail than a cheat sheet can.
Exam Format at a Glance
The CTRN exam is a fixed-form, 150-scored-question test taken over a 3-hour window at a PSI test center or via remote proctoring. Because BCEN publishes exact question counts per domain rather than vague weightings, you can calculate almost precisely how many items you'll see on each topic - which is far more useful for prioritizing review than a generic percentage range.
The Four CTRN Domains, Ranked by Weight
Ground transport nursing practice spans everything from scene management to critical care transport physiology, and BCEN's outline reflects that breadth across four unevenly weighted domains. Understanding the weighting is the single fastest way to triage your study time.
| Domain | Scored Questions | Approx. Weight |
|---|---|---|
| Patient Conditions and Principles of Management | 65 | 43.3% |
| Resuscitation Principles | 40 | 26.7% |
| Special Populations | 23 | 15.3% |
| General Principles of Ground Transport Nursing Practice | 22 | 14.7% |
Notice that Patient Conditions alone carries nearly as much weight as the other three domains combined. A candidate who under-prepares this domain is taking on outsized risk relative to time saved elsewhere. For a domain-by-domain breakdown of specific subtopics, see the CTRN Exam Domains 2026: Complete Guide to All 4 Content Areas.
Key Takeaway
Allocate roughly 40-45% of your total study hours to Patient Conditions and Principles of Management - it's the domain that decides most borderline scores.
What Each Domain Actually Tests
Domain names alone don't tell you what to memorize. Here's what each one is actually probing during the ground transport context.
Domain 1: General Principles of Ground Transport Nursing Practice
Covers the operational and legal backbone of ground transport work - scene safety, communication with dispatch and receiving facilities, transport team roles, and the regulatory framework unique to ground-based critical care transport.
- Interfacility and scene response protocols
- Legal, ethical, and documentation standards for transport
- Team dynamics and crew resource management during transport
Domain 2: Resuscitation Principles
Focuses on stabilizing and resuscitating critically unstable patients in a moving vehicle with limited resources - a scenario very different from a fixed hospital bay.
- Advanced airway management in transit
- Shock recognition and hemodynamic support en route
- Cardiac arrest management under transport constraints
Domain 3: Patient Conditions and Principles of Management
The heaviest-weighted domain at 43.3%, testing recognition and ongoing management of specific clinical conditions across body systems during ground transport.
- Cardiovascular, respiratory, neurological, and trauma presentations
- Toxicological, metabolic, and infectious conditions
- Ongoing monitoring and intervention adjustments mid-transport
Domain 4: Special Populations
Addresses patients whose transport needs differ from the standard adult critical care patient.
- Pediatric and neonatal transport considerations
- Obstetric and geriatric physiology in transit
- Bariatric and behavioral health transport nuances
If you're still deciding whether the exam's clinical depth matches your current experience level, the How Hard Is the CTRN Exam? Complete Difficulty Guide 2026 article breaks down what makes this content genuinely challenging versus what's manageable with focused review.
Registration, Fees & Eligibility Cheat Sheet
Registration mechanics trip up more candidates than the clinical content does. Keep these numbers close.
- Certifying body: Board of Certification for Emergency Nursing (BCEN)
- Testing vendor: PSI, at test centers or via live remote proctoring
- Initial exam fee: $285 for Air & Surface Transport Nurses Association (ASTNA) members, $380 for nonmembers
- License requirement: Current unrestricted RN license from the U.S., a U.S. territory, Canada, Australia, or an accepted international equivalent
- Experience: Two years of ground transport nursing experience is recommended, not required
For the complete cost picture including retake and renewal expenses, review CTRN Certification Cost 2026: Complete Pricing Breakdown. And if you're unsure whether you meet the license or experience prerequisites, the CTRN Requirements 2026: Eligibility, Prerequisites & How to Qualify guide covers every eligibility path in detail.
Passing Score Math
BCEN sets a fixed passing standard rather than a curve: you need 99 correct answers out of 150 scored questions. That works out to roughly two-thirds of the scored items - a number worth memorizing so you can track your progress on practice tests using the same math.
Key Takeaway
Score your own practice sessions against the 99-of-150 benchmark, not against an arbitrary 80% target - it changes how you triage difficult questions on test day.
A full explanation of how this threshold was set and what it means for your study buffer is available in CTRN Passing Score 2026: Exactly What You Need to Pass.
Validity & Renewal
Once earned, CTRN certification is valid for four years. Renewal happens through one of two paths:
- Retake the exam under the current outline in effect at your renewal date.
- Complete 100 continuing education contact hours relevant to transport nursing practice within the four-year cycle.
Because the outline itself changes over time - the 2026 version followed a 2025 ground transport nursing role delineation study - candidates renewing by exam should always confirm they're studying the current domain structure, not an outdated version.
Who Hires CTRNs
CTRN-credentialed nurses typically work in ground critical care transport programs, interfacility ambulance services, mobile ICU units, and hospital-based transport teams that move critically ill patients between facilities. The certification signals validated competency across resuscitation, complex patient management, and special population transport - exactly the domains tested on the exam itself. If you're weighing whether the credential translates into career or compensation movement, Is the CTRN Certification Worth It? Complete ROI Analysis 2026 and CTRN Salary Guide 2026: Complete Earnings Analysis both address that question directly.
Final-Week Crunch Plan
With four domains of uneven weight and only three hours on exam day, the final stretch of prep should mirror the exam's own priorities rather than a generic countdown.
Patient Conditions and Principles of Management
- Drill condition-specific management scenarios across body systems - this domain alone is 43.3% of your score
Resuscitation Principles
- Rehearse airway, shock, and arrest management specifically in a moving-transport context
Special Populations & General Principles
- Combine these two smaller domains since together they're still under 30% of the exam
Full-length timed practice
- Simulate the 3-hour, 150-question format under real time pressure using full-length CTRN practice tests
Run at least one complete timed simulation before test day through CTRN Exam Prep's practice platform so the 3-hour pacing feels familiar rather than new. If your testing window is still flexible, confirm current scheduling options in CTRN Exam Dates 2026: Testing Windows, Deadlines & Scheduling before locking in your crunch timeline.
Frequently Asked Questions
The CTRN exam has 150 scored questions, administered over a 3-hour testing window at PSI centers or through live remote proctoring.
You need 99 correct answers out of the 150 scored questions to pass, per BCEN's current passing standard.
Start with Patient Conditions and Principles of Management - it accounts for 43.3% of the exam, more than any other domain.
The initial fee is $285 for ASTNA members and $380 for nonmembers, paid through BCEN's PSI-administered registration process.
CTRN certification is valid for four years and can be renewed either by retaking the exam or completing 100 continuing education contact hours.