100+ Free CARN-AP Practice Questions
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Which DEA schedule does buprenorphine fall under for U.S. prescribing?
Key Facts: CARN-AP Exam
150
Total MCQ Items
ANCB/C-NET CARN-AP Examination
3 hr
Total Exam Time
Computer-based test at PSI
75%
Passing Score
~113/150 scored items (criterion-referenced)
$375
2026 Standard Fee
$325 with IntNSA USA/ASAN/NOVA membership
500 hr
Required Clinical Hours
Direct addictions/dual-dx contact within last 4 years
Dec 2022
X-Waiver Eliminated
MAT Act - any DEA Schedule III registrant can Rx buprenorphine
The CARN-AP exam is a 3-hour, 150-item, single-best-answer multiple-choice test administered year-round via C-NET and PSI Exams on behalf of the ANCB. Candidates must correctly answer 75% of items to pass. Eligibility: unrestricted RN license + MSN or higher + 500 supervised direct-contact addictions hours within 4 years + 1,500 APRN addictions hours within 3 years + 45 addictions-specific contact hours within 3 years. The 2026 fee is $375 (or $325 with IntNSA USA/ASAN/NOVA membership). The blueprint emphasizes advanced-practice pharmacotherapy (methadone, buprenorphine induction including Bernese micro-induction, XR-naltrexone, MAUD), differential diagnosis, complex co-occurring disorders, pain+OUD, pregnancy MOUD per ACOG/ASAM, and regulatory frameworks (MAT Act 2023, 42 CFR Part 2 2024 Final Rule).
Sample CARN-AP Practice Questions
Try these sample questions to test your CARN-AP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1Which DEA schedule does buprenorphine fall under for U.S. prescribing?
2What federal law eliminated the DATA 2000 X-waiver requirement for prescribing buprenorphine for opioid use disorder?
3Which naloxone formulation is an intramuscular autoinjector delivering 5 mg?
4Before initiating extended-release naltrexone (Vivitrol 380 mg IM) for opioid use disorder, what is the minimum required opioid-free interval?
5Which screening tool is validated for adolescents and asks about Car, Relax, Alone, Forget, Friends, Trouble?
6According to DSM-5-TR, substance use disorder is classified as MODERATE when a patient meets how many of the 11 criteria in a 12-month period?
7Thiamine should be given in what relationship to glucose in a patient with suspected heavy alcohol use presenting hypoglycemic?
8Which FDA-approved medication for alcohol use disorder causes aversive reactions (flushing, tachycardia, nausea) when ethanol is consumed?
9Acamprosate should be avoided or dose-reduced in patients with what condition?
10What is the approximate time window during which delirium tremens (DTs) typically develops after the last drink?
About the CARN-AP Exam
The Certified Addictions Registered Nurse - Advanced Practice (CARN-AP) credential, administered by the Addictions Nursing Certification Board (ANCB) and delivered by C-NET via PSI Exams, validates expert, APRN-level competency in addictions nursing. The advanced-practice scope extends beyond CARN (generalist RN) to include full MAT prescribing (methadone in OTPs, buprenorphine/Sublocade/Brixadi, extended-release naltrexone, disulfiram, acamprosate), differential diagnosis of substance-induced vs primary psychiatric disorders, complex co-occurring disorder treatment planning, pain management with OUD using the CDC 2022 Clinical Practice Guideline, pregnancy (MOTHER trial, NAS, breastfeeding on MOUD), pharmacotherapy for stimulant/cannabis/sedative use disorders, 42 CFR Part 2 (2024 Final Rule), and regulatory changes from the MAT Act 2023 (DATA 2000 X-waiver elimination; 8-hour training requirement for DEA registrants). Candidates must hold a current unrestricted RN license, a master's (MSN) or higher nursing degree, 500 supervised clinical hours in addictions/dual diagnosis within the last 4 years, 1,500 additional APRN addictions-nursing hours within the last 3 years, and 45 contact hours (at least 51% addictions-specific) within 3 years.
Questions
150 scored questions
Time Limit
3 hours
Passing Score
75% (approximately 113 of 150 scored items)
Exam Fee
$375 (standard) / $325 for IntNSA USA, ASAN, or NOVA members (Addictions Nursing Certification Board (ANCB) / C-NET / PSI Exams)
CARN-AP Exam Content Outline
Advanced Pharmacotherapy for SUDs
Methadone pharmacokinetics (full mu-agonist; QTc >450 ms; CYP3A4/2B6/2D6 interactions with rifampin, efavirenz, phenytoin, fluoxetine); buprenorphine/naloxone SL (partial mu; ceiling effect; precipitated withdrawal when started too soon); Sublocade monthly SC depot, Brixadi weekly/monthly; home induction vs office induction; Bernese low-dose micro-induction; XR-naltrexone Vivitrol (7-10 day opioid-free window, LFT monitoring); acamprosate 666 mg TID (renal dosing CrCl <30); disulfiram 250-500 mg/d (DER - flushing, tachycardia); naloxone (Narcan 4 mg IN, Kloxxado 8 mg IN, Zimhi 5 mg IM, Opvee nalmefene 2.7 mg IN); varenicline, bupropion (contraindicated seizures/eating disorders), topiramate/gabapentin/baclofen AUD.
MAT Induction & Long-Acting Protocols
Buprenorphine home vs office induction (COWS ≥8-12 for standard); precipitated withdrawal recognition and rescue (high-dose bup, symptomatic); Bernese method/micro-induction for patients on full agonist; long-acting Sublocade (300 mg x2 then 100 mg monthly); post-MAT Act 2023 (Dec 29, 2022) DATA 2000 X-waiver eliminated; SUPPORT Act/Consolidated Appropriations Act 8-hour training requirement for all new/renewing DEA registrants; ASAM 2020 National Practice Guideline for OUD.
Differential Diagnosis & Complex Assessment
Substance-induced vs primary mood/anxiety/psychotic disorders (30-day abstinence rule of thumb, family history, pre-morbid onset); medical mimics (hyperthyroidism, hypoglycemia, pheochromocytoma, adrenal insufficiency, Cushing, delirium, Wernicke encephalopathy); withdrawal delirium (DTs, BZD withdrawal); DSM-5-TR 11 SUD criteria and severity; decisional capacity assessment; polysubstance considerations.
Co-Occurring Disorders & Complex Treatment Planning
Integrated (not sequential or parallel) treatment of SMI+SUD; bipolar disorder + stimulant use (mood stabilization, avoid antidepressant monotherapy); PTSD + opioid use (trauma-focused CBT, Seeking Safety, avoid BZDs); borderline personality disorder + SUD (DBT adaptations — SUD-specific skills, dialectical abstinence); schizophrenia + cannabis/nicotine; ADHD + SUD (long-acting stimulants, atomoxetine); complex case conceptualization and stepped care.
Pain Management with OUD & CDC 2022 Guideline
CDC 2022 Clinical Practice Guideline - NOT hard caps; individualized; avoid initial doses >50 MME/day; taper ~10%/month shared decision; exclusions for cancer/palliative/end-of-life/sickle cell; multimodal (NSAIDs, acetaminophen, gabapentinoids, duloxetine, topical agents, PT, CBT, mindfulness); buprenorphine for chronic pain (Belbuca, Butrans); avoid opioid+BZD co-prescription; PDMP mandatory checks; urine drug testing with LC-MS/MS confirmatory; naloxone co-Rx at ≥50 MME/day or concurrent BZD.
Pregnancy, NAS & Breastfeeding
ACOG/ASAM recommend MOUD over withdrawal in pregnancy; MOTHER trial comparison of methadone vs buprenorphine (similar maternal outcomes; buprenorphine shorter/milder NAS); Finnegan Neonatal Abstinence Scoring vs Eat-Sleep-Console (ESC) functional assessment; first-line NAS pharmacotherapy morphine/methadone; breastfeeding encouraged on methadone/buprenorphine if HIV-negative and not using illicit substances; naltrexone data limited in pregnancy.
Regulatory, Legal & Scope of Practice
MAT Act 2023 (elimination of DATA 2000 X-waiver; 8-hour training requirement); 42 CFR Part 2 2024 Final Rule harmonizing with HIPAA (consent for TPO, breach notification, restrictions on use in legal proceedings); CSA Schedule II (methadone, oxycodone, morphine) vs III (buprenorphine) vs IV (BZDs, tramadol) vs V (pregabalin, codeine cough prep); DEA registration; state PDMP mandates; APRN scope of practice and state variation (full vs reduced vs restricted); collaborative practice agreements; prescriptive authority.
Infectious Disease in PWID
HCV universal screening all adults ≥18 (USPSTF 2020); direct-acting antivirals (glecaprevir/pibrentasvir pangenotypic 8-week, sofosbuvir/velpatasvir 12-week); HIV testing; PrEP (F/TDF Truvada, F/TAF Descovy, cabotegravir LA Apretude) for PWID; PEP within 72 hours; STI screening (syphilis, gonorrhea, chlamydia, HBV); endocarditis risk (tricuspid); xylazine wound care.
Stimulant, Cannabis & Benzodiazepine Disorders
Stimulant use disorder - NO FDA-approved pharmacotherapy; ADAPT-2 bupropion + naltrexone (Trivedi et al); topiramate; mirtazapine; contingency management strongest evidence. Cannabis use disorder - N-acetylcysteine (adolescents), gabapentin; CBT/MET/contingency management. BZD tapering - clonazepam/diazepam equivalents; ~10% weekly or ~25% q2wk; flumazenil NOT routine (precipitates seizures in chronic users).
Screening, SBIRT & Research Literacy
USPSTF 2018 alcohol/2020 drug screening in adults; SBIRT framework (screen, brief intervention, referral to treatment); NIDA Quick Screen; validated tools (AUDIT-C, DAST-10, TAPS-1/TAPS-2, CAGE, CRAFFT); key studies: Project MATCH (AUD psychosocial matching), MOTHER (methadone vs buprenorphine pregnancy), ADAPT-2 (stimulants), NIDA CTN trials; evidence appraisal (effect size, NNT, intention-to-treat).
Trauma-Informed & Recovery-Oriented Care
ACEs (Adverse Childhood Experiences); polyvagal theory (ventral vagal social engagement, sympathetic mobilization, dorsal vagal shutdown); SAMHSA's six TIC principles (safety, trustworthiness, peer support, collaboration, empowerment, cultural humility); recovery capital; mutual-help (AA, NA, SMART Recovery, LifeRing, Recovery Dharma); peer recovery specialists; Oxford Houses.
How to Pass the CARN-AP Exam
What You Need to Know
- Passing score: 75% (approximately 113 of 150 scored items)
- Exam length: 150 questions
- Time limit: 3 hours
- Exam fee: $375 (standard) / $325 for IntNSA USA, ASAN, or NOVA members
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
CARN-AP Study Tips from Top Performers
Frequently Asked Questions
What is the CARN-AP certification and who administers it?
The Certified Addictions Registered Nurse - Advanced Practice (CARN-AP) credential is an advanced-practice specialty certification for APRNs (NPs and CNSs) working in addictions nursing. It is administered by the Addictions Nursing Certification Board (ANCB), the credentialing body of the International Nurses Society on Addictions (IntNSA). The exam is developed and delivered by the Center for Nursing Education and Testing (C-NET) and proctored by PSI Exams at test centers nationwide. The certification is accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC) and is valid for four years.
Who is eligible to take the CARN-AP exam in 2026?
Eligibility requires: (1) current unrestricted RN license (via NCLEX-RN or CGFNS/WES/ERES equivalency for internationally educated nurses); (2) master's degree (MSN) or higher in nursing; (3) minimum of 500 supervised direct-contact clinical hours with individuals and families affected by addictions or dual diagnosis within the last 4 years; (4) minimum of 1,500 additional nursing hours as an advanced practice nurse in addictions within the last 3 years; and (5) minimum of 45 contact hours in addictions nursing (at least 51% addictions-specific) within the last 3 years. CARN generalist certification is NOT a prerequisite, but many candidates hold it.
What is the format of the CARN-AP exam?
The CARN-AP exam is a 3-hour computer-based test (CBT) consisting of 150 single-best-answer multiple-choice items. Questions are mapped to the ANCB/C-NET test blueprint and emphasize APRN-level clinical judgment: MAT prescribing and induction (methadone, buprenorphine, XR-naltrexone), differential diagnosis, complex co-occurring disorder treatment planning, pain management with OUD, pregnancy MOUD, and regulatory/ethical frameworks. PSI Exams proctors the exam year-round; candidates schedule after ANCB application approval.
What is the 2026 CARN-AP exam fee?
The 2026 standard CARN-AP exam fee is $375. IntNSA USA, American Society for Pain Management Nursing (ASAN), and NOVA members qualify for a $50 discount ($325 total). Renewal every four years also carries a comparable fee. Retakes within the candidacy window require re-application and full fee. Cancellation/reschedule policies follow the C-NET/PSI schedule.
What is the CARN-AP passing score?
Candidates must correctly answer 75% of the 150 items (approximately 113 items) to pass the CARN-AP exam. The standard is criterion-referenced, meaning pass/fail is determined against a fixed content-expert standard rather than ranking candidates against each other. Score reports include domain-level performance feedback to guide remediation for unsuccessful candidates.
How does CARN-AP differ from CARN?
CARN (Certified Addictions Registered Nurse) is the generalist RN-level credential - it focuses on addictions nursing assessment, withdrawal monitoring, education, harm reduction, and referral. CARN-AP is the advanced-practice credential for APRNs (NPs/CNSs) with a master's degree or higher and expanded competencies including MAT prescribing (buprenorphine, methadone referral to OTP, extended-release naltrexone, acamprosate, disulfiram), differential diagnosis, complex treatment planning for co-occurring disorders, and APRN scope-of-practice issues. CARN-AP questions assume the candidate has prescriptive authority within their state scope of practice.
What are the highest-yield topics for the 2026 CARN-AP exam?
Highest-yield: buprenorphine induction (standard and Bernese micro-induction), precipitated withdrawal recognition and management, methadone QTc monitoring and CYP450 drug-drug interactions, XR-naltrexone 7-10 day opioid-free window and LFT monitoring, MAT Act 2023 X-waiver elimination and 8-hour training requirement, 42 CFR Part 2 2024 Final Rule, pregnancy MOUD (MOTHER trial, ACOG/ASAM), NAS scoring (Finnegan vs Eat-Sleep-Console), substance-induced vs primary psychiatric differential diagnosis, CDC 2022 Opioid Prescribing Guideline (not hard caps; exclusions for cancer/palliative/sickle cell), stimulant use disorder pharmacotherapy (ADAPT-2, topiramate), naloxone formulations (Narcan 4 mg, Kloxxado 8 mg, Zimhi 5 mg IM, Opvee nalmefene 2.7 mg), benzodiazepine tapering, and HCV/HIV screening and treatment in PWID.
How should I prepare for the CARN-AP exam?
A structured 3-6 month plan is typical. Start with the ANCB/C-NET candidate handbook and exam blueprint. Anchor content to guidelines: ASAM 2020 National Practice Guideline for OUD, CDC 2022 Clinical Practice Guideline for Prescribing Opioids, SAMHSA TIPs (TIP 63 MOUD, TIP 42 co-occurring), USPSTF, ACOG, DSM-5-TR. Core textbook: 'The CARN/CARN-AP Review Manual' from IntNSA and 'The ASAM Principles of Addiction Medicine.' Complete high-volume timed MCQs (aim 1,000+). Use IntNSA review courses (e.g., Boston Medical Center/Grayken Center CARN/CARN-AP Review Course). Practice differential diagnosis vignettes and pharmacotherapy calculations (CIWA, COWS, MME conversions, OUD induction dosing).