Free Practice Questions for CRNA (NCE)

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Exam Review

Key Facts: CRNA (NCE) Exam

90.5%

First-Time Pass Rate

NBCRNA CY2025

100-170

Questions (CAT)

Variable length

450

Passing Standard Through CY2025

0-900 scale; raised July 1, 2026

$236,590

Median CRNA Salary

BLS May 2025

35%

General Principles

Largest domain

3 years

Program Duration

DNP/MSN programs

The NCE had a 90.5% first-time pass rate in calendar year 2025 (NBCRNA annual report). The exam uses computerized adaptive testing (CAT) with 100-170 questions over 3 hours. The largest domain is General Principles of Anesthesia at 35%. CRNAs earned a median salary of $236,590 in May 2025 (BLS), the highest of the APRN roles.

Sample CRNA (NCE) Practice Questions

Try these sample questions to review concepts for the CRNA (NCE) exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 235+ question experience with AI tutoring.

1Which of the following factors is the primary determinant of cardiac output?

A.Heart rate

B.Stroke volume

C.Systemic vascular resistance

D.Venous return

Explanation: Stroke volume is the primary determinant of cardiac output. While heart rate contributes, stroke volume has the greatest influence on overall cardiac output. The normal stroke volume is approximately 60-80 mL per beat in adults. Cardiac output is calculated as stroke volume multiplied by heart rate. Systemic vascular resistance affects afterload, which influences stroke volume, but is not the primary determinant of cardiac output itself.

2During general anesthesia, a leftward shift of the oxyhemoglobin dissociation curve would be caused by which condition?

A.Hyperthermia

B.Hypocarbia

C.Increased 2,3-DPG

D.Metabolic acidosis

Explanation: Hypocarbia (low PaCO2) causes a leftward shift of the oxyhemoglobin dissociation curve, increasing hemoglobin's affinity for oxygen and impairing oxygen release to tissues. This is one of the factors remembered by the mnemonic "CADET face right" for rightward shifts (CO2, Acid, 2,3-DPG, Exercise, Temperature). A leftward shift decreases oxygen availability to tissues and is also caused by hypothermia, alkalosis, and decreased 2,3-DPG.

3The pulmonary artery wedge pressure (PAWP) most closely reflects pressure in which cardiac chamber?

A.Right atrium

B.Right ventricle

C.Left atrium

D.Left ventricle during systole

Explanation: The pulmonary artery wedge pressure (PAWP), also called pulmonary capillary wedge pressure, most closely reflects left atrial pressure. When the pulmonary artery catheter balloon is inflated, it creates a continuous column of blood from the catheter tip through the pulmonary capillaries to the left atrium. This measurement provides an indirect assessment of left ventricular end-diastolic pressure (preload) when the mitral valve is normal.

4Which physiological change occurs in the elderly patient that most significantly impacts anesthetic management?

A.Increased total body water

B.Decreased sensitivity to sedatives

C.Reduced functional residual capacity

D.Increased cardiac compliance

Explanation: Aging causes a progressive reduction in functional residual capacity (FRC) due to decreased chest wall compliance, loss of elastic recoil, and alterations in chest wall geometry. This leads to faster desaturation during apnea and increased risk of airway closure. Elderly patients also have decreased total body water, increased sensitivity to sedatives and anesthetics (requiring lower doses), and decreased cardiac compliance due to ventricular stiffening.

5Coronary blood flow is primarily determined by which factor?

A.Heart rate

B.Aortic diastolic pressure minus left ventricular end-diastolic pressure

C.Systemic vascular resistance

D.Pulmonary artery pressure

Explanation: Coronary blood flow occurs primarily during diastole and is determined by the pressure gradient between the aortic root (coronary perfusion pressure) and the pressure within the cardiac chambers. For the left ventricle, this is approximated by aortic diastolic pressure minus left ventricular end-diastolic pressure. Tachycardia reduces coronary perfusion time, while increases in LVEDP (as in heart failure) reduce the perfusion gradient.

6The most important factor regulating cerebral blood flow is:

A.Arterial oxygen content

B.Cerebral perfusion pressure

C.Partial pressure of arterial carbon dioxide (PaCO2)

D.Blood viscosity

Explanation: PaCO2 is the most important physiologic regulator of cerebral blood flow. For each 1 mmHg change in PaCO2 between 20-80 mmHg, cerebral blood flow changes by approximately 1-2 mL/100g/min. Hypercapnia causes cerebral vasodilation and increased CBF, while hypocapnia causes vasoconstriction and decreased CBF. Cerebral autoregulation maintains constant flow across a range of mean arterial pressures (typically 50-150 mmHg in normotensive adults).

7Which neuromuscular blocking agent has the highest vagolytic (atropine-like) effect?

A.Rocuronium

B.Vecuronium

C.Pancuronium

D.Cisatracurium

Explanation: Pancuronium has the most significant vagolytic effects among neuromuscular blocking agents, frequently causing tachycardia and occasionally hypertension. This is due to its structural similarity to atropine (both are quaternary ammonium compounds). Rocuronium has minimal cardiovascular effects. Vecuronium and cisatracurium are essentially devoid of cardiovascular effects at clinical doses.

8The glomerular filtration rate (GFR) is most accurately estimated by which measurement?

A.Serum creatinine level

B.Blood urea nitrogen (BUN)

C.Creatinine clearance

D.Urine specific gravity

Explanation: Creatinine clearance is the most accurate clinical estimate of GFR because creatinine is freely filtered at the glomerulus and not reabsorbed. While serum creatinine reflects renal function, it is influenced by muscle mass, age, sex, and diet. The Cockcroft-Gault equation and MDRD formula estimate creatinine clearance or GFR from serum creatinine. BUN is affected by protein intake, hydration status, and catabolism, making it less specific.

9The primary site of erythropoietin production in adults is:

A.Spleen

B.Liver

C.Kidney

D.Bone marrow

Explanation: The kidney is the primary site of erythropoietin (EPO) production in adults, specifically from peritubular interstitial fibroblasts in the renal cortex. EPO stimulates erythropoiesis in the bone marrow. In chronic kidney disease, decreased EPO production contributes to anemia. The liver produces approximately 10-15% of circulating EPO in adults but is the primary source in fetuses.

10Which of the following best describes the Frank-Starling mechanism?

A.Increased heart rate increases contractility

B.Increased preload increases stroke volume

C.Increased afterload decreases heart rate

D.Increased contractility decreases oxygen demand

Explanation: The Frank-Starling mechanism states that the force of cardiac contraction is proportional to the initial length of the cardiac muscle fiber (preload). As venous return increases, ventricular filling increases, stretching the myocardial fibers and resulting in a more forceful contraction and increased stroke volume. This intrinsic property allows the heart to adjust output to match venous return without neural or hormonal input.

About the CRNA (NCE) Exam

The National Certification Examination (NCE) is required for CRNA certification. The computer-adaptive test covers 4 domains: Basic Sciences (20%), Equipment/Instrumentation/Technology (20%), General Principles of Anesthesia (35%), and Anesthesia for Surgical Procedures and Special Populations (25%).

Exam sponsor: NBCRNA. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

100 questions

Time Limit

3 hours maximum (variable length CAT)

Passing Score

Pass/fail against NBCRNA's passing standard on a 0-900 scale (450 through CY2025; raised for exams on or after July 1, 2026, new cut not published)

Exam / Certification Fees

$1,310 (includes the $160 MAC Check); $1,150 retake

Exam sponsor website

Reported exam pass rate: 90.5% first-time (CY2025). first-time pass rate (NBCRNA 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.

20%

Basic Sciences

Anatomy, physiology, pathophysiology, pharmacology, physics, and chemistry applied to anesthesia

20%

Equipment, Instrumentation & Technology

Anesthesia delivery systems, airway equipment, monitoring devices, and patient warming equipment

35%

General Principles of Anesthesia

Preoperative assessment, fluid management, airway management, regional anesthesia, sedation, pain management, and professional issues

25%

Anesthesia for Surgical Procedures and Special Populations

Pediatric, obstetric, geriatric, cardiac, neurosurgical, and trauma/emergency anesthesia

Preparing for the CRNA (NCE) Exam

What You Need to Know

Passing score: Pass/fail against NBCRNA's passing standard on a 0-900 scale (450 through CY2025; raised for exams on or after July 1, 2026, new cut not published)
Exam length: 100 questions
Time limit: 3 hours maximum (variable length CAT)
Exam / certification fees: $1,310 (includes the $160 MAC Check); $1,150 retake Official sources

Using Our Practice Resources

Work through all 235 available questions
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CRNA (NCE): Suggested Study Strategy

1Master the General Principles domain (35%) - this is the largest section and includes airway management, regional anesthesia, and pharmacology

2Practice anesthesia calculations: drug dosing, MAC values, fluid requirements, and hemodynamic calculations

3Understand equipment: know the anesthesia machine, vaporizers, monitors, and safety systems inside and out

4Focus on special populations: pediatric and obstetric anesthesia are heavily tested and differ significantly from adult practice

5Study pharmacology thoroughly: know MAC values, onset/duration, metabolism, drug interactions, and reversal agents

Frequently Asked Questions

What is the NCE pass rate?

The NCE first-time pass rate is approximately 89% for graduates of accredited nurse anesthesia programs (NBCRNA 2024). The exam uses computerized adaptive testing (CAT), adjusting difficulty based on your performance.

How many questions are on the NCE?

The NCE is a variable-length computerized adaptive test of 100 to 170 items (70 to 140 scored plus 30 pretest). In CY2025 about 70% of candidates finished at the 100-item minimum; the exam ends when the pass/fail decision is reached or the 3 hours expire.

How long should I study for the NCE?

Most SRNAs (Student Registered Nurse Anesthetists) study for 2-4 months before the NCE, completing 1,000-2,000 practice questions. Focus on understanding the 'why' behind anesthesia concepts, not just memorization. The General Principles domain (35%) deserves special attention.

What is the NCE passing score?

NBCRNA reports results on a 0-900 scale; the passing standard was 450 through CY2025 and was raised for exams on or after July 1, 2026 (the new cut score is not published). Candidates who pass receive no numeric score; those who fail receive a total score plus four domain scores.

How much do CRNAs earn?

According to BLS Occupational Employment and Wage Statistics for May 2025, nurse anesthetists earned a median of $236,590 per year, the highest of the advanced practice nursing roles. BLS projects nurse anesthetist employment to grow 10% from 2025 to 2035, with demand in outpatient surgery centers and rural healthcare.

What are the NCE content domains?

The NCE covers 4 domains: Basic Sciences (20%): anatomy, physiology, pathophysiology, pharmacology, physics; Equipment/Instrumentation/Technology (20%): anesthesia machines, airway equipment, monitors; General Principles (35%): preop assessment, airway management, regional anesthesia, fluid management; Special Populations (25%): pediatrics, OB, geriatrics, cardiac, neuro, trauma.