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ArticleCARN Exam Guide 2026: Eligibility, Fees, Topics, and Practice15 min read

Exam Review

Key Facts: CARN Exam

150

Exam Questions

ANCB / C-NET

75%

Passing Score

ANCB

3 hours

Exam Time

C-NET

$300

Standard Exam Fee

ANCB 2026

2,000 hrs

Required Practice Hours

In the last 3 years

4 years

Certification Validity

ANCB recertification cycle

The CARN exam is 150 multiple-choice questions in 3 hours, with a 75% passing standard. Eligibility requires an active, unrestricted RN license, 2000+ hours of addictions nursing practice in the last 3 years, and 30 hours of continuing education (at least 51% specific to addictions nursing). The fee is $300 ($250 for IntNSA USA members), and certification is valid for 4 years. Our 100 free practice questions cover the ANA/IntNSA Scope and Standards of Addictions Nursing Practice, DSM-5-TR SUD criteria, CIWA-Ar and COWS scales, MAT (methadone, buprenorphine, extended-release naltrexone), harm reduction, trauma-informed care, motivational interviewing, 42 CFR Part 2, and neonatal abstinence/opioid withdrawal syndrome.

Sample CARN Practice Questions

Try these sample questions to review concepts for the CARN exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 115+ question experience with AI tutoring.

1Which brain pathway is most directly implicated in the reinforcing effects of virtually all drugs of abuse?

A.Nigrostriatal pathway

B.Mesolimbic dopamine pathway

C.Tuberoinfundibular pathway

D.Raphe serotonergic pathway

Explanation: The mesolimbic dopamine pathway connects the ventral tegmental area (VTA) to the nucleus accumbens and is the primary reward circuit in the brain. Addictive substances acutely increase dopamine release in the nucleus accumbens, producing euphoria and reinforcing drug-seeking behavior.

2According to DSM-5-TR, how many criteria must a person meet within a 12-month period for a moderate substance use disorder?

A.1 criterion

B.2-3 criteria

C.4-5 criteria

D.6 or more criteria

Explanation: DSM-5-TR grades substance use disorder severity by the number of the 11 criteria met within 12 months: mild (2-3), moderate (4-5), and severe (6 or more). A single criterion does not meet the threshold for diagnosis.

3A patient in alcohol withdrawal has a CIWA-Ar score of 18. This score indicates:

A.Minimal withdrawal — no pharmacotherapy needed

B.Mild withdrawal — reassess every 4 hours

C.Moderate to severe withdrawal — benzodiazepine pharmacotherapy indicated

D.The patient is intoxicated, not withdrawing

Explanation: CIWA-Ar scores of 10-18 indicate moderate withdrawal and scores above 18 are severe; both warrant symptom-triggered benzodiazepine therapy and close monitoring. Scores under 10 typically do not require pharmacotherapy. A score of 18 is a clear threshold for active intervention to prevent seizures and delirium tremens.

4Which vitamin must be administered BEFORE glucose in a malnourished patient with alcohol use disorder to prevent Wernicke encephalopathy?

A.Vitamin B12 (cyanocobalamin)

B.Thiamine (vitamin B1)

C.Folate

D.Vitamin D

Explanation: Thiamine (B1) deficiency is common in chronic alcohol use and causes Wernicke encephalopathy (classic triad: confusion, ataxia, ophthalmoplegia). Giving glucose before thiamine can precipitate acute Wernicke encephalopathy because glucose metabolism consumes thiamine. Parenteral thiamine 100 mg or more is standard before glucose loading.

5The AUDIT-C is a 3-question screening tool primarily used to detect:

A.Opioid use disorder

B.Hazardous or harmful alcohol use

C.Cannabis use disorder

D.Tobacco dependence

Explanation: AUDIT-C (Alcohol Use Disorders Identification Test — Consumption) is a brief 3-item version of the 10-item AUDIT, asking about frequency, quantity, and heavy drinking episodes. A score of 4+ in men or 3+ in women suggests hazardous drinking and triggers full assessment.

6Which screening tool was developed specifically for adolescents aged 12-21?

A.CAGE

B.AUDIT

C.CRAFFT

D.MAST

Explanation: CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) is a validated screening tool designed for adolescents aged 12-21 and identifies both alcohol and other drug use risk. Two or more yes responses indicate the need for further assessment.

7A nurse uses motivational interviewing with a patient ambivalent about drinking. Which statement BEST reflects the MI spirit?

A.You need to stop drinking or you will die.

B.On one hand you enjoy relaxing with drinks; on the other, you're worried about your liver. Tell me more.

C.Let me explain what will happen if you keep drinking.

D.Your wife is right — you should stop.

Explanation: Motivational interviewing relies on the spirit of partnership, acceptance, compassion, and evocation. Reflective listening and rolling with ambivalence (as in option B) elicits change talk from the patient rather than confronting or persuading. Direct confrontation often increases resistance.

8Which stage of change in the transtheoretical model describes a person who intends to change within the next 6 months but not yet?

A.Precontemplation

B.Contemplation

C.Preparation

D.Action

Explanation: Prochaska and DiClemente's transtheoretical model defines Contemplation as the stage where the person recognizes a problem and intends to change within 6 months but is not yet committed to action. Preparation is within 30 days; Action is active change.

9Which medication is a partial opioid agonist commonly used for medications for opioid use disorder (MOUD)?

A.Methadone

B.Buprenorphine

C.Naltrexone

D.Naloxone

Explanation: Buprenorphine is a partial mu-opioid agonist with a ceiling effect on respiratory depression, making it safer than full agonists and a first-line MOUD. Methadone is a full agonist, naltrexone is an antagonist, and naloxone is a short-acting antagonist used for overdose reversal.

10Before initiating buprenorphine, the nurse should confirm the patient is in:

A.Full opioid intoxication

B.Mild-to-moderate opioid withdrawal (COWS score ≥ ~8-12)

C.No opioid use for 2 weeks

D.Heavy methadone maintenance

Explanation: Buprenorphine has high mu-receptor affinity but only partial activity. Starting it while full agonists still occupy the receptors can precipitate withdrawal. Patients should be in mild-to-moderate withdrawal (typically COWS 8-12+) before the first dose. Long-acting opioids (methadone) require longer abstinence or microdose induction.

About the CARN Exam

The Certified Addictions Registered Nurse (CARN) is the national credential for RNs who specialize in the care of patients and families affected by substance use disorders. ANCB, the certifying arm of the International Nurses Society on Addictions (IntNSA), partners with the Center for Nursing Education and Testing (C-NET) to administer a 150-question computer-based exam covering the full scope of addictions nursing practice.

Exam sponsor: Addictions Nursing Certification Board (ANCB) via C-NET. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

150 multiple-choice questions (about 25 unscored pilot items) delivered by computer at PSI test centers; C-NET handles applications and registers candidates with PSI

Time Limit

3 hours

Passing Score

75%

Exam / Certification Fees

$300 standard / $250 IntNSA USA member

Exam sponsor website

Reported exam pass rate: 70% (2025) per ANCB. ANCB publishes annual exam statistics: 150 of 213 CARN candidates passed in 2025 (70%) and 69% passed in 2024. This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

15%

Perform a Biopsychosocial SUD Assessment

Screening and comprehensive assessment of substance use, withdrawal risk, co-occurring disorders, and psychosocial factors

20%

Assess Acute Care Needs of SUD Patients

Intoxication, overdose, and withdrawal recognition and management across opioids, alcohol, stimulants, cannabinoids, and sedatives

15%

Develop and Implement an Individualized Plan of Care

Level-of-care placement (ASAM Criteria), pharmacotherapy selection, harm reduction, and care coordination

15%

Educate and Promote Behavioral Change

Motivational interviewing, stages of change, patient and family education, and relapse prevention

35%

Care Management, Treatment, and Evaluation Throughout Recovery (including special populations)

Ongoing medication and recovery management, monitoring and evaluation, pregnancy, adolescent and older-adult populations, and legal and ethical standards. Patient-problem weights across the exam: opioid 27%, alcohol 25%, stimulant 15%, co-occurring 12%, medication misuse 10%, cannabinoids 6%, tobacco 5% (ANCB CARN Test Specifications, implemented 2026)

Preparing for the CARN Exam

What You Need to Know

Passing score: 75%
Assessment: 150 multiple-choice questions (about 25 unscored pilot items) delivered by computer at PSI test centers; C-NET handles applications and registers candidates with PSI
Time limit: 3 hours
Exam / certification fees: $300 standard / $250 IntNSA USA member Official sources

Using Our Practice Resources

Work through all 115 available questions
Review every answer and explanation
Track weak areas and revisit them
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CARN: Suggested Study Strategy

1Memorize CIWA-Ar (alcohol) and COWS (opioid) withdrawal scales — know the score cut-offs for starting, titrating, and discontinuing pharmacotherapy

2Master MAT/MOUD medications: methadone (OTP/SAMHSA rules), buprenorphine (X-waiver eliminated by 2023 MAT Act), and extended-release naltrexone — indications, contraindications, and patient counseling

3Know 42 CFR Part 2 inside out — how SUD treatment records differ from HIPAA, who can re-disclose, and the 2024 alignment updates

4Practice motivational interviewing (OARS, stages of change, change talk) — scenario questions test MI spirit, not just terminology

5Review neonatal abstinence/opioid withdrawal syndrome, Finnegan scale, and Eat-Sleep-Console — obstetric/neonatal items appear every exam

6Use person-first language on every question (person with SUD, not addict) — stigma-reducing terminology reflects current IntNSA position statements

Frequently Asked Questions

What is the CARN certification?

The Certified Addictions Registered Nurse (CARN) is a national certification for registered nurses who specialize in the care of individuals with substance use disorders. It is administered by the Addictions Nursing Certification Board (ANCB), the certifying body of the International Nurses Society on Addictions (IntNSA), in partnership with C-NET. CARN recognizes both basic and specialty-level competence in addictions nursing.

What are the CARN eligibility requirements?

Candidates need (1) a current, full, and unrestricted registered nurse (RN) license (NCLEX-RN or verified equivalent via CGFNS/WES/ERES), (2) a minimum of 2,000 hours (one year) of clinical experience in addictions or co-occurring disorders nursing within the last 3 years, and (3) 30 hours of continuing education within the last 3 years, with at least 51% specific to addictions nursing.

How many questions are on the CARN exam and how long is it?

The CARN exam has 150 multiple-choice items, about 25 of which are unscored pilot items, delivered by computer at PSI test centers (C-NET processes applications and registers candidates with PSI). Candidates have 3 hours. The passing standard is 75% correct on the scored items, set by an Angoff study; ANCB does not publish a raw cut count.

How much does the CARN exam cost in 2026?

The standard CARN exam fee is $300. ASAN, IntNSA USA, or NOVA members qualify for a reduced fee of $250 (proof of membership must be attached to the online application). Retake and recertification fees apply separately. All applications are now submitted online.

How long is CARN certification valid?

CARN certification is valid for 4 years from the date you pass the exam. Renewal can be accomplished by continuing-education-based recertification (typically 60 contact hours, with the majority addictions-specific) or by re-examination.

What topics does the CARN exam cover?

The exam covers the full nursing process applied to addictions: assessment and screening (AUDIT, DAST, CRAFFT, CIWA-Ar, COWS), DSM-5-TR SUD criteria, ASAM level-of-care criteria, pharmacotherapy (MAT for opioid use disorder, alcohol withdrawal, nicotine cessation), harm reduction, motivational interviewing, trauma-informed care, 12-step and recovery support, neonatal abstinence syndrome, adolescents and older adults, co-occurring disorders, and legal/ethical issues including 42 CFR Part 2.

How should I prepare for the CARN exam?

Start with the ANA/IntNSA Scope and Standards of Addictions Nursing Practice and the IntNSA Addiction Nursing Competencies. Use the ANCB study guide and the Grayken Center for Addiction TTA CARN/CARN-AP exam review course. Complete at least 300-500 practice questions, aim for 80%+ on practice exams consistently, and review weak content domains — particularly withdrawal management, pharmacotherapy, and legal/ethical topics.