Changed : New exam content outline; passing score · BCEN
TCRN certification, the trauma board exam
BCEN · trauma across the continuum · outline of Nov 29, 2025
The Trauma Certified Registered Nurse credential is a proctored board exam about the injured patient, from the scene and the resuscitation bay through the ICU, the floor and rehabilitation. Below: the figures that shape your preparation, the six-domain outline and four sample items.
A patient who had Roux-en-Y gastric bypass is admitted after a crash with an order for extended-release oxycodone. The nurse should:
Answer and why, all 4 options
Giving it unchanged overlooks the altered anatomy after bypass, which makes the release profile unreliable and pain control unpredictable.
Roux-en-Y bypass shortens the absorptive path and bypasses most of the stomach, so extended-release products may dissolve incompletely and absorb unpredictably. The nurse clarifies with the prescriber, who usually switches to an immediate-release form titrated to effect.
Doubling on assumption risks overdose if absorption is adequate; dose changes follow the prescriber's assessment and the patient's response.
Crushing an extended-release opioid dumps the whole dose at once and can cause respiratory depression; it is never a fix for absorption problems.
Item 536071
TCRN figures, each with its BCEN page
Values from the board's FAQ, cost, delivery, eligibility and statistics pages and the candidate handbook, read November 11, 2026.
01
Awarded by
Board of Certification for Emergency Nursing (BCEN)
An unrestricted, current RN license from the US, Canada, Australia or a US territory (a foreign equivalent goes through BCEN’s CGFNS review); no hours, course or TNCC are requiredBCEN recommends two years of trauma nursing at about 1,000 hours a year, plus 20–30 hours of trauma coursework.
At a PSI testing center, or from home with a live remote proctorA PSI appointment can be moved without a fee until 24 hours before it, inside the 90-day window.
96 of 150 scored questions (64%), in effect since November 29, 2025The previous outline required 104 of 150. BCEN sets the mark with the Angoff method and equates forms; it is not graded on a curve.
Pass or fail right away: a score report handed over at the testing center, or on screen after remote testing, plus an emailCandidates who do not pass get their raw score in each content area.
1,260 passed and 884 failed in 2025, out of 2,333 exams deliveredBCEN publishes exam counts, repeat attempts included, rather than a pass rate. Passes as a share of all exams passed or failed: 58.8% in 2025, 59.2% in 2024, 62.1% in 2023, 57.8% in 2022.share calculated from BCEN counts (read Nov 11, 2026)
The outline is organized around the injured patient rather than a unit. It covers the patient from prehospital care and injury prevention, through resuscitation, shock and the tertiary exam, to rehabilitation, discharge planning and end-of-life care. It also tests the work of a trauma program: quality review, disaster triage and the rules on transfer (content outline, pp. 1–3).
That makes it a fit for an ED nurse at a trauma center, a trauma ICU or step-down nurse, and trauma program staff alike. A few neighboring subjects belong to other exams on this site:
TNCC and ATCN are provider courses with their own end-of-course test. This exam is a separate certification, and the board does not require either course before you apply. The full comparison is on trauma nurse certifications.
Six domains, counted in scored items
The board publishes item counts rather than percentages. Trunk and pelvis (38 items) and the continuum of care (36) are the two largest and make up almost half of the 150 scored items. This site splits trunk and pelvis into a chest page and an abdomen and pelvis page.
Geriatric, pediatric, pregnant and bariatric patients; burn patients (chemical burns of any body part including the eye, electrical and thermal burns, inhalation injuries); victims of violence (intimate partner violence, child and elder abuse, human trafficking, evidence collection and preservation, chain of custody, intentional self-inflicted injuries); comorbidities and pre-existing conditions; substance use disorder.
Resuscitation (primary and secondary survey, blood administration and massive transfusion, coagulant therapy, damage control, the trauma diamond of death, pre-intubation optimization); shock; acute care, including reassessment, consequences of resuscitation such as TRALI and TACO, and the tertiary exam; complications and hospital events; psychosocial issues; rehabilitation and multidisciplinary care; end of life, including organ and tissue donation and brain death; injury prevention; prehospital care; intrafacility and interfacility transfer; discharge planning.
Disaster management (triage, decontamination); trauma quality improvement (over- and under-triage, missed injuries, mortality and morbidity reviews, trauma registry, outcomes feedback, evidence-based practice, debriefing); patient safety (handoff, event reporting); regulations and standards (HIPAA, EMTALA, workplace violence, trauma center designation and verification, injury prevention, community outreach).
10 items6.7%
In the order the board lists them; bars on one scale[9]
4 sample items from the outline
Continuum of Care for Trauma · 36 items
During active hemorrhage, the nurse finds that the name on a unit of red cells does not match the patient's identification band. The nurse should:
Answer and why, all 4 options
Bleeding makes speed important, but an incompatible unit can cause fatal hemolysis; emergency-release blood exists so identity checks never have to be skipped.
Relabeling hides the discrepancy and could send a unit meant for another patient; only the blood bank resolves labeling errors.
A unit labeled for another patient may be ABO-incompatible, and urgency does not change that. The nurse sets it aside, notifies the blood bank, and requests uncrossmatched emergency-release units, which arrive within minutes.
Verbal approval does not make the unit compatible; no one can authorize transfusing blood labeled for someone else.
Item 2100406
Clinical Practice: Head and Neck · 31 items
The nurse uses the Galveston Orientation and Amnesia Test (GOAT) daily for a patient with a moderate traumatic brain injury. Which result indicates that posttraumatic amnesia has resolved?
Answer and why, all 4 options
A GOAT score of 75 or higher on two consecutive days marks the end of posttraumatic amnesia. Two scores of 80 meet that standard, which matters for prognosis and readiness for rehabilitation.
A single passing score followed by a drop shows amnesia has not resolved; the threshold must be met on consecutive days.
A score under 75 shows the patient is still in posttraumatic amnesia.
Consistency alone is not enough; both scores are below the 75 threshold.
Item 536014
Special Populations · 22 items
A patient reports being strangled by a partner last night and now has a normal voice and SpO₂ 99%. Which reported symptom indicates the MOST severe strangulation?
Answer and why, all 4 options
Fear is expected and important to document, but it does not indicate the severity of the physical injury.
Painful swallowing can occur after any strangulation; on its own it signals less severe injury than loss of consciousness.
Many victims have few or no visible marks; absent or faint marks do not rule out serious injury, but they are not a severity sign.
Loss of consciousness and incontinence during strangulation mean the brain was deprived of blood or oxygen, the most dangerous end of the spectrum. These patients need imaging of the neck vessels for injury and close observation even when they look well, and their risk of later homicide is markedly higher.
Item 2100399
Your score: – fills in as you answer; nothing is saved.Doubt a key? Note the item number — how corrections work →
Fees, scoring and renewal in brief
Fee:$380 as of November 2026, or $285 for members of the Society of Trauma Nurses; retest pricing and Test Assurance are worked out on the cost page.
Passing:96 of 150 scored items, a raw count rather than a curve (how the mark was set).
Pass data: the board posts counts, not rates. In 2025 that was 1,260 passes and 884 fails, or 58.8% of exams with a result by our arithmetic, repeat attempts included (four years of counts).
Who can apply:RN license only; no hours are verified (requirements).
Keeping it: valid for 4 years, then renewed by exam or contact hours (renewal).
TCRN practice testMixed trauma items in outline proportions, a reason for each choice
TCRN exam factsFormat, booking, results on the day, retest wait and renewal
TCRN costExam, STN and military prices, retest against Test Assurance, renewal
TCRN requirementsWho can sit the exam, the pass mark, four years of pass counts
TCRN study guideA plan by item counts, the 2026 resource list, guideline editions
Questions trauma nurses ask before applying
What does TCRN stand for, and who awards it?
Trauma Certified Registered Nurse, a credential from BCEN; ABSNC accredits the program.
Can the TCRN be taken from home?
Yes: either a live remote proctor, from a private and secure room, or a seat at a PSI center (exam delivery).
Is there a separate pediatric trauma nurse certification?
BCEN has no pediatric trauma credential. Injured children are part of the TCRN's special populations domain; the pediatric emergency credential, CPEN, covers the pediatric ED as a whole.