BCEN · critical care ground transport · checked Nov 11, 2026
The Certified Transport Registered Nurse credential is BCEN's exam for nurses who move critically ill patients by road. It shares the fee, the clock and the testing rules with CFRN, but has its own outline and, since March 30, 2026, a higher pass mark.
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.
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.
CFRN: General Principles 30, Resuscitation 40, Trauma 30, Medical Emergencies 35, Special Populations 15. CTRN: General Principles 22, Resuscitation 40, Patient Conditions and Principles of Management 65, Special Populations 23 (scored questions)
BCEN's CTRN outline adds up to 150 scored questions, with the pass mark counted out of that total. Unscored pretest questions come on top; how many is uncertain, because the only BCEN page that counts them disagrees with the outline.
The CTRN FAQ gives 155 / 130 (total and scored, the rest pretest), yet sets its mark at 99 of 150; the same line stood in its 2025 version next to the old mark of 92. We follow the outline PDF and print no total, and some prep pages copy the FAQ's scored figure. We read the outline, the FAQ and its 2025 archive copy on November 11, 2026.
Four domains, all of them ground-keyed
The CTRN outline in force since Mar 30, 2026, with scored questions per domain:
General Principles of Ground Transport Nursing Practice, 22: stressors of transport on crew and patient, scene safety, emergency vehicle operations, vehicle emergencies, dispatch and handoff, crew resource management, EMTALA and consent. Pages: safety and operations, transport physiology.
Resuscitation Principles, 40: assessment and packaging, airway and rapid sequence induction, ventilation and oxygenation, the four shock states. Pages: airway and ventilation, shock and perfusion.
Patient Conditions and Principles of Management, 65: injuries and medical conditions in a single domain, with pulmonary hypertension, thyroid and adrenal disorders and lab abnormalities named. Pages: trauma in transport, medical emergencies in transport.
Special Populations, 23: obstetric, neonatal and pediatric, geriatric and bariatric patients, with positioning for each and securement devices for children. Page: special populations in transport.
The mark went up on March 30
The new outline came with a new standard: 99 of 150 correct, up from 92. That is 66% of the scored questions, against about 61% before (our arithmetic). The CFRN mark moved the other way the same year. Both changes, with four years of BCEN counts for each exam, sit on the pass-mark page.
25 questions set in a ground unit
0 of 25 attempted · 0 correct · 0 missed
Scene operations, communications, safety and preparation · 14.7% of CTRN, with flight physiology
After a crash in a remote area with rescue expected to take more than 6 hours, the crew should address survival needs in which order of priority?
Answer and why, all 4 options
Rescue signaling matters, but exposure kills before thirst or hunger, so protection comes first.
Food comes last; people survive weeks without food but hours without protection from the elements.
Protection from the elements comes first, then signaling your location, then water, then food, reflecting how quickly each threat kills.
Water matters within days, but exposure can kill within hours.
Item 1882808
Airway and mechanical ventilation · 26.7% of CTRN, with perfusion and shock
A male trauma patient with an isolated head injury is 74 inches tall and weighs 150 kg. The transport nurse is starting volume-control ventilation. Which initial tidal volume is MOST appropriate?
Answer and why, all 4 options
Predicted body weight for a 74-inch man is 50 + 2.3 × 14 ≈ 82 kg, and 7 mL/kg gives about 575 mL, within the 6–8 mL/kg range.
411 mL is 5 mL/kg of predicted body weight, lower than needed for a patient without lung injury.
1,050 mL uses actual weight (7 mL/kg × 150 kg), the error that overdistends the lungs in large patients.
750 mL is about 9 mL/kg of predicted weight, above the protective range.
Item 1882955
Airway and mechanical ventilation · 26.7% of CTRN, with perfusion and shock
During transport, a patient on volume-control ventilation is making strong inspiratory efforts, and the inspiratory pressure waveform has a 'scooped-out' (concave) shape. Which ventilator adjustment is MOST appropriate?
Answer and why, all 4 options
A fluid bolus does not address flow starvation; the waveform reflects the patient pulling against the ventilator.
A less sensitive trigger makes it harder to start a breath and worsens the patient's work.
PEEP does not meet the patient's inspiratory demand; the scooped pressure curve reflects too little flow.
A scooped-out pressure waveform during strong effort shows flow starvation; raising the inspiratory flow meets the demand.
Item 1882976
Airway and mechanical ventilation · 26.7% of CTRN, with perfusion and shock
A patient with ARDS is ventilated for transport: VT 400 mL (6 mL/kg PBW), RR 20 breaths/min, PEEP 12 cmH2O Plateau pressure 28 cmH2O ABG: pH 7.27, PaCO2 58 mmHg, PaO2 70 mmHg Which adjustment is MOST appropriate?
Answer and why, all 4 options
Bicarbonate adds CO2 that the lungs must clear and does not fix the ventilatory cause of the acidosis.
A larger tidal volume pushes the plateau above 30 cmH2O and causes ventilator-induced lung injury.
Raising PEEP improves oxygenation but does not clear CO2 and pushes the plateau above 30 cmH2O.
With the plateau at 28 cmH2O, a faster rate raises minute ventilation and clears CO2 while keeping the protective tidal volume, watching for auto-PEEP.
Item 1882971
Trauma · 43.3% of CTRN, with medical emergencies
A trauma patient with a right chest tube is being prepared for a 45-minute ground transfer. Which action is MOST important just before loading?
Answer and why, all 4 options
Clamping blocks air escape and can cause a tension pneumothorax during the trip.
Secure connections and tube, with the drainage unit upright and below the chest, prevent disconnection, air entry and backflow during movement.
Stripping creates high negative pressure that can injure the lung; gentle milking is used only for visible clots.
Suction is set by order, usually about −20 cmH2O; maximum suction can injure lung tissue and does not secure the system.
Item 1943927
Medical Emergencies · 43.3% of CTRN, with trauma
A patient on a valid involuntary psychiatric hold is being transported by ground to a psychiatric facility. The patient is calm but demands to be released. What should the transport nurse do?
Answer and why, all 4 options
A valid involuntary hold provides legal authority to transport the patient despite the patient's objection.
Family consent does not override a legal hold; the hold is the authority for transport.
Written consent is not required for a patient on a legal hold.
Releasing the patient violates the hold and can endanger the patient or others.
Item 1882620
Medical Emergencies · 43.3% of CTRN, with trauma
The transport nurse is caring for a patient with alcohol use disorder who has vomited for 3 days after a binge. Glucose 104 mg/dL, pH 7.19, HCO3 11 mEq/L, anion gap 24, serum beta-hydroxybutyrate markedly elevated. Which therapy is MOST appropriate?
Answer and why, all 4 options
Fluid without dextrose restores volume but does not stop ketone production.
Alcoholic ketoacidosis with a normal glucose is treated with dextrose-containing saline and thiamine given before or with the dextrose.
Bicarbonate is not routine; the acidosis corrects with dextrose and fluids.
Insulin is not needed when glucose is normal; dextrose stops ketone production in alcoholic ketoacidosis.
Item 566067
Medical Emergencies · 43.3% of CTRN, with trauma
A patient with progressive rattlesnake envenomation started an antivenom infusion 15 minutes ago. A 2-hour ground transfer is planned. Which preparation is MOST critical before departure?
Answer and why, all 4 options
Antivenom can cause acute hypersensitivity reactions, so reliable access, epinephrine at hand and a secured infusion pump let the nurse treat a reaction and keep the dose going.
Oral drugs act too slowly for a reaction in transport, and a routine bolus is not needed.
Premedication is not routine and does not prevent anaphylaxis; delaying departure for it adds time without benefit.
A single line leaves no backup if it fails during a reaction, and no epinephrine is ready.
Item 1943572
Medical Emergencies · 43.3% of CTRN, with trauma
After transporting a patient with suspected organophosphate contamination who vomited en route, which action is MOST appropriate before the ambulance returns to service?
Answer and why, all 4 options
Organophosphate in vomit can off-gas and contaminate surfaces, so the unit is isolated until it is decontaminated and cleared.
Changing linens leaves contamination on surfaces and equipment.
Wiping visible spills misses residue that is not visible.
Routine disinfectant does not neutralize organophosphate, and airing out does not remove residue.
Item 1943579
Special Populations · 15.3% of CTRN
Which pre-departure equipment check is MOST important for a neonatal ground transport?
Answer and why, all 4 options
Neonatal suction is limited to about −80 to −100 mmHg; higher pressure injures the mucosa.
Silenced alarms hide desaturation and bradycardia in a patient who cannot signal distress.
An isolette set higher than the NICU setting risks hyperthermia; the goal is a normal temperature.
Isolette heat and oxygen depend on battery and cylinder supply; running out mid-transport causes hypothermia and hypoxia in a newborn.
Item 1943756
Special Populations · 15.3% of CTRN
A 76-year-old with acute delirium (CAM-positive) needs a non-emergency transfer to another facility. The patient cannot explain the reason for the transfer or its risks. There is no advance directive, and the daughter, the next of kin, can be reached by phone. Which action is MOST appropriate before departure?
Answer and why, all 4 options
Agreement from a delirious patient is not informed consent because the patient lacks capacity.
Implied consent applies to emergencies; this is a non-emergency transfer with a reachable surrogate.
A delirious patient lacks capacity, so consent for a non-emergency transfer comes from the surrogate, which a phone consent can give, with the capacity assessment documented.
A surrogate's phone consent, witnessed and documented, is valid; waiting delays the transfer for no reason.
Item 1943652
Special Populations · 15.3% of CTRN
An 85-year-old with a creatinine clearance of 30 mL/min becomes severely agitated during transport and pulls at lines despite nonpharmacologic measures. Which medication is MOST appropriate?
Answer and why, all 4 options
A low dose of haloperidol controls dangerous agitation in older adults while limiting oversedation; the ECG is watched for QT prolongation.
Diphenhydramine is strongly anticholinergic and worsens delirium in older adults.
A standard adult dose is too high to start with in an 85-year-old and raises the risk of oversedation and extrapyramidal effects.
Benzodiazepines worsen delirium and cause respiratory depression in older adults.
Item 1943659
Special Populations · 15.3% of CTRN
A patient had a chest tube removed 18 hours ago and has had no chest x-ray since. An elective ground transfer is planned over a 7,000-ft mountain pass. Which action is MOST appropriate before departure?
Answer and why, all 4 options
Planning to decompress en route accepts a preventable emergency in a moving vehicle.
A prophylactic drain is an invasive procedure without a confirmed pneumothorax.
A residual pneumothorax after tube removal expands as altitude rises over the pass; for an elective transfer, imaging first is the safe step.
Oxygen and monitoring detect a pneumothorax only after it expands; they do not rule it out beforehand.
Item 1943541
Airway and mechanical ventilation · 26.7% of CTRN, with perfusion and shock
A ventilated patient with severe COPD needs a longer expiratory time to prevent breath stacking. The rate is 12 breaths/min and the target I:E ratio is 1:4. Which inspiratory time should be set?
Answer and why, all 4 options
2.5 seconds is a 1:1 ratio, which worsens breath stacking.
At 12 breaths/min each cycle lasts 5 seconds; a 1:4 ratio splits that into 1 second of inspiration and 4 of expiration.
1.25 seconds divides the 5-second cycle by 4 instead of 5 (1 + 4 parts).
1.67 seconds corresponds to a 1:2 ratio, which gives less time to exhale.
Item 1882972
Airway and mechanical ventilation · 26.7% of CTRN, with perfusion and shock
A referring ICU requests transport of a patient with severe ARDS on mechanical ventilation. Before accepting the mission, which information is MOST important to clarify?
Answer and why, all 4 options
The time of the last x-ray matters less than current oxygenation and ventilator needs.
PEEP and FiO2 requirements show whether the transport ventilator can maintain oxygenation and whether the patient can tolerate the trip.
The history of modes tried is less useful than what the patient needs now.
The brand of the ICU ventilator does not decide whether the transport ventilator can support the patient.
Item 1882703
Medical Emergencies · 43.3% of CTRN, with trauma
During a lights-and-sirens ground transport, the IV pump alarms out of reach at the head of the stretcher. The transport nurse is belted in the side seat. What is the SAFEST action?
Answer and why, all 4 options
A loosened belt does not protect the nurse in a sudden stop or crash.
Asking the driver to stop safely before the nurse stands avoids unrestrained movement in a moving ambulance, where crew injuries are common.
An unbelted nurse kneeling beside the stretcher becomes a projectile in a sudden stop.
Standing in a moving ambulance, even holding a rail, exposes the nurse to falls and crash injury.
Item 1882712
Scene operations, communications, safety and preparation · 14.7% of CTRN, with flight physiology
At night, a critical care ground ambulance carrying a ventilated patient breaks down on the shoulder of a busy highway. The warning lights still work. The MOST appropriate action is to
Answer and why, all 4 options
Moving a ventilated patient outside at night beside a busy highway is dangerous.
Keeping the patient in the ambulance, with power and equipment, while another unit is sent is safest.
A passing motorist's vehicle cannot carry a ventilated patient and crew safely.
Repairs on a busy highway shoulder at night put the crew at risk and delay care.
Item 565914
Trauma · 43.3% of CTRN, with medical emergencies
A patient with a cervical spine fracture and normal neurologic findings is immobilized and secured to the stretcher for a 50-minute ground transfer. Vital signs are stable. Which instruction to the driver is MOST appropriate?
Answer and why, all 4 options
For a stable patient, lights and siren save only minutes, raise crash risk and add hard braking and turns that jolt an unstable spine; smooth, steady driving is safer.
Rapid acceleration and braking move the patient on the stretcher and stress the unstable spine.
Lights and siren are for time-critical patients; here they add crash risk and abrupt motion without changing outcome.
A rough road transmits more vibration and jolting to the spine; a smoother route is worth a few extra minutes.
Item 9730001
Special Populations · 15.3% of CTRN
A 220-kg (485-lb) patient needs a 90-minute ground transfer, and the sending hospital has limited bariatric equipment. Which plan BEST reduces the risk of pressure injury en route?
Answer and why, all 4 options
Padding the occiput, sacrum, heels and other bony points and rechecking the skin during the trip limits pressure and catches early damage on a long transfer.
Checking only at the ends of a 90-minute transfer misses damage that develops on the way.
Full turns of a bariatric patient in a moving ambulance are unsafe for the crew and patient; padding and small weight shifts are used instead.
Lying flat loads the sacrum and occiput and worsens breathing in a large patient; there is no spinal reason to keep this patient flat.
Item 1943473
Perfusion and shock · 26.7% of CTRN, with airway and ventilation
The transport nurse receives a patient with septic shock. Lactate 8 mmol/L, BP 78/40 mmHg after 1 L of lactated Ringer's, weight 70 kg, blood cultures drawn, antibiotics given. Which intervention is MOST appropriate next?
Answer and why, all 4 options
Bicarbonate does not improve outcomes in lactic acidosis with a pH above 7.15; the lactate falls when perfusion is restored.
Dopamine causes more arrhythmias than norepinephrine and is no longer the first-line vasopressor in septic shock.
After 1 L the patient is still hypotensive with a lactate of 8, so fluids continue toward about 30 mL/kg while norepinephrine, the first-line vasopressor, is started.
Dobutamine is an inotrope for low cardiac output; stopping fluids and using it as the first agent leaves the vasodilated patient underfilled.
Item 565938
Special Populations · 15.3% of CTRN
A 3-year-old with pneumonia on 2 L/min of oxygen is moving by ground ambulance to a children's hospital, and a parent rides along. How should the child be secured for the trip?
Answer and why, all 4 options
Adult cot straps do not fit a 3-year-old, who can slide out under them or be ejected in a crash.
A child held on a lap is torn from the parent's arms in a crash or hard stop; a lap is never a restraint.
A size-appropriate child restraint attached to the cot keeps a small child from being thrown in a sudden stop while still allowing care.
An adult lap belt on a small child concentrates crash forces on the abdomen and spine.
Item 9730003
Scene operations, communications, safety and preparation · 14.7% of CTRN, with flight physiology
At a busy receiving ED, a staff member asks the transport team to leave their ventilated patient in a hallway bay because the assigned nurse is with another patient. What should the transport nurse do?
Answer and why, all 4 options
A clerk cannot accept clinical care of a ventilated patient.
A technician cannot accept care of a ventilated patient; handoff must go to a clinician of equal or higher level.
A monitor is not a clinician; no one has accepted responsibility for the patient.
Leaving a patient before care is accepted by a clinician of equal or higher level is abandonment, so the team stays until a receiving RN takes report.
Item 9730017
Medical Emergencies · 43.3% of CTRN, with trauma
A critical care ground unit keeps succinylcholine in the ambulance at room temperature because the vehicle has no refrigerator. How long can the vials be kept before they must be replaced?
Answer and why, all 4 options
The printed date applies only to refrigerated storage.
Sixty days is the room-temperature limit for rocuronium, not succinylcholine.
Succinylcholine is labeled stable for up to 14 days at room temperature, so the vials are dated when moved out of the refrigerator.
Six months far exceeds the labeled room-temperature stability of succinylcholine.
Item 9730018
Medical Emergencies · 43.3% of CTRN, with trauma
During a 2-hour ground transfer, the nurse and the stable patient both develop headache and nausea, and the patient compartment smells of exhaust. Which action is MOST appropriate FIRST?
Answer and why, all 4 options
The heater recirculates air and does not remove exhaust from the compartment.
Treating nausea while continuing leaves everyone breathing exhaust.
Pulse oximetry reads carboxyhemoglobin as oxyhemoglobin, so a normal SpO2 does not rule out carbon monoxide.
Exhaust entering the compartment points to carbon monoxide; stopping and ventilating ends the exposure for both patient and crew before anything else.
Item 9730019
Scene operations, communications, safety and preparation · 14.7% of CTRN, with flight physiology
A patient with suspected active pulmonary tuberculosis is being moved by ground ambulance. The patient wears a surgical mask and the crew wear N95 respirators. Which vehicle setting is MOST appropriate?
Answer and why, all 4 options
Turning the fan off lets droplet nuclei build up; airflow out of the compartment lowers the concentration.
An open partition lets compartment air reach the driver, who is often not wearing a respirator.
Recirculated air keeps infectious particles in the compartment and spreads them through the vehicle.
Bringing in outside air without recirculation and running the rear exhaust fan dilutes and removes infectious droplet nuclei from the compartment.
Item 9730024
Your score: – fills in as you answer; nothing is saved.Doubt a key? Note the item number — how corrections work →
No scenario in this set needs an aircraft: they play out in ground units, at the bedside before or after a transfer, or after a vehicle emergency. The flight-weighted set is the CFRN practice test; the two sets share no questions.
Where CTRN study time goes
Resuscitation is 40 questions on both outlines, and injuries plus medical conditions carry 65 on both: the CTRN pools them in one domain and adds pulmonary hypertension, thyroid and adrenal disorders and lab abnormalities. The difference is at the edges, 22 general-principles questions against 30 and 23 on special populations against 15. Landing zones, navigation and aircraft survival are not on the ground outline; vehicle operations, consent and legal concepts are.
The outline closes with an Advanced Intervention Awareness list (BCEN outline PDF, p. 5): devices and procedures a ground crew should be familiar with in transit, from arterial lines and pacing to IABP, Impella, ECMO, isolettes and inhaled nitric oxide. The study guide plans by the CFRN counts; for CTRN, move time from flight physiology and landing zones to special populations (23 questions against 15).
How long CTRN lasts and how it renews
CTRN runs 4 years and renews by exam or continuing education on the same terms as CFRN. Hours, fees and the accreditation rule for 2027 are on recertification.
CFRN and CTRNWhat CFRN means, the 2026 outline, the pass mark, and when CTRN fits better
CFRN practice testA CFRN set across the five 2026 domains, every option explained
CFRN exam factsEligibility, PSI testing, both formats, results, retakes and renewal
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
CTRN questions, answered
What is a CTRN nurse?
A registered nurse who holds BCEN's Certified Transport Registered Nurse credential, earned by exam, for critical care ground transport. CFRN is the separate credential aimed at flight crews.
What is the CTRN question count?
150 scored, by the outline in force. The FAQ's 155 / 130 figures contradict the outline and the FAQ's own mark of 99 of 150.
Can a flight nurse take the CTRN instead of the CFRN?
Yes. Eligibility does not depend on the vehicle you work in. Choose the outline that matches your practice; CAMTS names CFRN or CTRN, the one pertinent to the program's scope of care.
Does the CTRN ask about stroke?
Yes. Ischemic and hemorrhagic stroke are named under Patient Conditions. This site teaches stroke on the SCRN pages, so the set above has no stroke items.