BCEN · flight and ground transport nursing · checked Nov 11, 2026
CFRN stands for Certified Flight Registered Nurse, the board credential for nurses on helicopter and airplane medical crews. BCEN, the board that awards it, also runs CTRN for critical care ground transport: the same fee, clock and testing rules on a different outline.
The transport team anticipates a difficult airway in a patient with a BMI of 58 and a short, thick neck who will need intubation before transport. Which primary equipment plan is MOST appropriate?
Answer and why, all 4 options
Low-flow nasal cannula gives too little oxygen to build a reserve; obese patients desaturate within seconds of apnea and need high-flow or positive-pressure preoxygenation.
Direct laryngoscopy alone in a predicted difficult airway leaves no tested backup, the classic setup for repeated failed attempts and desaturation.
A video laryngoscope improves the glottic view in a short, thick neck, and a bougie helps pass the tube when only part of the glottis is seen.
A smaller mask worsens the seal on a large face; obese patients need a well-fitted mask with two-handed technique and adjuncts.
Item 1882783
Flight and ground credentials, sourced line by line
01
Awarded by
Board of Certification for Emergency Nursing (BCEN)
175 on the CFRN; the mark uses 150, while 25 pretest items go unscoredThe CTRN outline in force totals 150 scored questions. BCEN's CTRN FAQ gives 155 items with 130 scored, which matches neither the outline nor its own "99 of the 150"; the same line was already there in 2025, beside the old mark of 92 of 150.
PSI testing site, or online from home while a live proctor watchesA PSI appointment can be moved without a fee until 24 hours before it, inside the 90-day window.
CFRN: 102 of 150 scored questions from August 31, 2026. CTRN: 99 of 150 from March 30, 2026Each mark changed with its new outline: CFRN came down from 108, CTRN went up from 92. BCEN uses the Angoff method and equates forms; neither exam is curved.
An unrestricted, current RN license from the US, Canada, Australia or a US territory (a foreign equivalent goes through BCEN’s CGFNS review); no flight or transport hours are requiredBCEN recommends two years as a flight nurse before the CFRN and two years as a ground transport nurse before the CTRN.
In 2025, 930 CFRN exams were passed and 680 failed (1,696 delivered); 98 CTRN exams were passed and 75 failed (186 delivered)BCEN publishes exam counts, repeat attempts included, rather than a pass rate. Passes as a share of all exams passed or failed, 2025: CFRN 57.8%, CTRN 56.6%; in 2024: 62.1% and 56.4%.share calculated from BCEN counts (read Nov 11, 2026)
CAMTS accreditation standards (13th edition, September 29, 2026), 03.05.01 item 3g: nurses employed more than 2 years need a current CFRN or CTRN pertinent to the program's scope of care and patient population, or a population-specific certification such as C-NPT
A CFRN is a registered nurse who has passed the board's flight nursing exam. It is a board certification earned once by testing and then renewed, which sets it apart from course completion cards (airway, trauma, pediatric and neonatal resuscitation courses) that employers list separately.
The exam does not check where you fly or for how long. To apply you need an RN license, nothing more; the board's suggestion of crew experience (2 years recommended) is not checked. Employers are stricter than the board: hiring rules, crew experience and the order of courses are covered on how to become a flight nurse.
Flight crew or ground crew: which credential
Both credentials come from one board at one price, and both test airway, ventilation and shock in a moving vehicle. The split is the vehicle and the weighting:
CFRN is written for flight crews. Its general domain carries the physiology of altitude, landing zones, radio work and survival, and trauma and medical emergencies are separate domains of 30 items and 35 items.
CTRN is written for critical care ground transport. Its general domain is smaller, 22 scored questions against 30, and adds emergency vehicle operations and legal concepts; trauma and medical conditions share one domain of 65 scored questions.
Flight exams far outnumber ground exams: the board delivered 1,696 flight exams and 186 ground exams in 2025. An employer rule can settle the choice. Under the 13th edition of the CAMTS accreditation standards (03.05.01, item 3g), a transport credential is required after 2 years at CAMTS programs, and it has to be the one pertinent to the program's scope of care and patients, so it should match the vehicle and patients the program serves. The ground exam's outline, its higher 2026 mark and a separate question set are on CTRN certification.
In the order the board lists them; bars on one scale[7][8]
4 transport scenarios to start with
Medical Emergencies · 35 items
Before lifting off with a patient supported by a continuous-flow ventricular assist device, which preflight check is the HIGHEST priority to prevent device shutdown in flight?
Answer and why, all 4 options
Cabin pressure matters for trapped gas, not for a continuous-flow pump, whose main in-flight failure point is its power supply.
A continuous-flow VAD stops when power fails, so charged spare batteries and a backup controller are the check that prevents an in-flight shutdown.
Prophylactic drugs for ventricular arrhythmia are not standard before a VAD flight; many VAD patients tolerate VT, while a dead battery stops flow at once.
Inotropes treat right heart failure once it appears, but they do nothing to keep the pump running if power is lost in the air.
Item 1883111
Perfusion and shock
Before an interfacility transfer of a patient in cardiogenic shock, the crew holds a preflight briefing. Which element is the MOST important clinical part of this crew resource management briefing?
Answer and why, all 4 options
Fuel planning is the pilot's operational responsibility; it is a safety item, but not the clinical part of the briefing.
Maintenance history is reviewed by the pilot and mechanics before the shift, not discussed as clinical preparation for this patient.
Billing codes have no role in a safety briefing and distract from patient risk.
Briefing how the patient is likely to deteriorate and who will do what gives the team a shared mental model before the event, which is the clinical core of CRM.
Item 1882698
Scene operations, communications, safety and preparation
Late afternoon sun is shining through the turning main rotor. A patient in the helicopter becomes nauseated and dizzy, then has a brief episode of staring and twitching. What is the MOST appropriate action?
Answer and why, all 4 options
Light strobing through rotor blades at a few to 20 flashes per second causes flicker vertigo and can trigger seizures in susceptible people; blocking the light removes the cause.
Oxygen treats hypoxia, but the symptoms began with sunlight strobing through the blades, pointing to flicker vertigo, not desaturation.
An antiemetic masks the nausea while the flicker that provokes the symptoms and the seizure-like activity continues.
Altitude change does not stop light from flickering through the rotor; it treats hypoxia, which is not the trigger described here.
Item 566221
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Money, marks and renewal
Exam fee:$380, or $285 for ASTNA members, as of November 2026. Retest pricing, Test Assurance and renewal are totaled on what the CFRN costs.
Pass mark:102 of 150 for the flight exam, down from 108 before the new outline; both exams and four years of BCEN counts: pass marks and pass counts.
Applying and test day: PSI scheduling, results and retakes, in order, on exam facts.
Renewal: every 4 years, by exam or by continuing education (recertification).
Preparation: a plan sized to the outline counts is in the study guide. Stroke care is taught on the SCRN pages, coronary and rhythm problems on the CMC pages.
CFRN practice testA CFRN set across the five 2026 domains, every option explained
CFRN exam factsEligibility, PSI testing, both formats, results, retakes and renewal
CTRNGround transport credential: 150 scored items, the mark of 99, four domains
CFRN costExam fee, ASTNA and military prices, Test Assurance math, renewal, both credentials
CFRN passing scoreCFRN 108 to 102, CTRN 92 to 99, and four years of BCEN pass counts
CFRN study guideWeek-by-week CFRN plan sized to the 2026 outline, plus a CTRN variant
CFRN in short
What does CFRN after a nurse's name mean?
Certified Flight Registered Nurse: the nurse passed BCEN's flight nursing board exam; the credential is renewed every 4 years.
How long is the CFRN, in questions and time?
175 in all, 150 scored plus 25 pretest, answered in 3 h. Only the scored questions count toward the mark.
Do flight hours count toward eligibility?
None are checked. BCEN asks only for an active RN license with no restrictions; time on a crew is recommended, not verified.
Is one exam easier than the other?
By 2025 counts they look alike: passes were 57.8% of flight-exam results and 56.6% of ground-exam results (our arithmetic, repeat attempts included). Both marks changed in 2026, the ground mark upward and the flight mark downward.
Does passing one exam award both credentials?
No. They are separate credentials, each with its own application, fee and exam.