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A patient is being transported via ground ambulance from a rural hospital to a tertiary care center. The vehicle is traveling at high speed on a winding road. Which physiologic effect is MOST likely to occur due to the transport environment?

Decreased heart rate from vagal stimulation

Increased intraocular pressure from vertical vibration

Improved venous return from gravitational forces

Decreased metabolic rate from reduced activity

to track

2026 Statistics

Key Facts: CTRN Exam

155

Total Items

BCEN CTRN exam page

130 + 25

Scored + Unscored

BCEN CTRN exam page

91/130

Passing Standard

BCEN CTRN exam page

Exam Time

BCEN CTRN exam page

$230/$310

Member / Nonmember Fee

BCEN CTRN exam page

Feb 2026

Current Content Outline

BCEN CTRN 2026 Content Outline

4 years

Recertification Cycle

BCEN CTRN FAQ

BCEN lists the CTRN exam at 155 total items (130 scored + 25 unscored pretest), 3-hour test time, and a passing standard of 91 scored items. The updated CTRN Content Outline (effective February 2026) includes 7 domains: General Principles of Transport (19%), Resuscitation Principles (25%), Mechanical Ventilation (8%), Clinical Practice: Trauma (17%), Clinical Practice: Medical (16%), Special Populations (9%), and Professional Issues (6%). BCEN requires active unrestricted RN licensure and 2+ years of transport nursing experience is recommended.

Sample CTRN Practice Questions

Try these sample questions to test your CTRN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A patient is being transported via ground ambulance from a rural hospital to a tertiary care center. The vehicle is traveling at high speed on a winding road. Which physiologic effect is MOST likely to occur due to the transport environment?

A.Decreased heart rate from vagal stimulation

B.Increased intraocular pressure from vertical vibration

C.Improved venous return from gravitational forces

D.Decreased metabolic rate from reduced activity

Explanation: Ground transport exposes patients to various physiologic stressors including vibration, noise, temperature changes, and motion. Vertical vibration can increase intraocular pressure, which is particularly concerning for patients with eye injuries or recent ocular surgery. The transport environment typically increases metabolic demands and heart rate due to stress, not decreases them.

2During interfacility transport, the nurse notices the patient's oxygen saturation has decreased from 98% to 91%. The patient is on 4L nasal cannula. What is the FIRST action the nurse should take?

A.Increase oxygen flow rate to 6L

B.Assess the patient's airway and breathing

C.Call the receiving hospital for orders

D.Prepare for intubation

Explanation: The first step in any clinical change during transport is to assess the patient systematically. Following the ABC approach (Airway, Breathing, Circulation), the nurse should assess airway patency and breathing effort before making interventions. This assessment will guide whether simple interventions like increasing oxygen or more aggressive interventions are needed.

3Which piece of equipment is ESSENTIAL for every ground transport regardless of patient condition?

A.Portable ventilator

B.Cardiac monitor with defibrillation capability

C.Infusion pump for every IV line

D.Portable ultrasound

Explanation: A cardiac monitor with defibrillation capability is essential equipment for all ground transports. Even stable patients can deteriorate during transport, and the ability to monitor cardiac rhythm and deliver defibrillation if needed is critical. Other equipment like ventilators, infusion pumps, and ultrasound are situation-dependent based on patient needs.

4The transport team is preparing to move a patient with suspected cervical spine injury from the hospital bed to the ambulance stretcher. What is the MOST appropriate technique?

A.Log roll the patient using four team members

B.Have the patient self-transfer to minimize movement

C.Slide the patient directly onto the stretcher

D.Lift the patient using a draw sheet

Explanation: For patients with suspected cervical spine injury, a log roll with adequate personnel (typically 4-5 team members) is the appropriate technique to maintain spinal alignment during transfer. One person maintains manual in-line stabilization of the cervical spine while others roll the patient as a unit. Self-transfer and sliding can cause spinal movement and potential further injury.

5During transport, the ambulance experiences a sudden stop due to traffic. The patient, who was unsecured, slides partially off the stretcher. What does this incident BEST demonstrate?

A.The need for improved driver training

B.The importance of proper patient restraint

C.A violation of the Emergency Medical Treatment and Labor Act

D.The need for more staff in the ambulance

Explanation: This incident demonstrates the critical importance of proper patient restraint during transport. All patients should be secured with appropriate straps and the stretcher secured to the ambulance floor. This is a fundamental safety principle in ground transport to prevent patient injury during sudden stops, turns, or collisions.

6A transport team is preparing for a 3-hour ground transport of a ventilated patient. Which consideration is MOST important for this extended transport?

A.Bringing backup communication devices

B.Calculating oxygen supply needs for the entire trip

C.Arranging for meal breaks during transport

D.Coordinating with air traffic control

Explanation: For extended transports, calculating oxygen supply needs is critical to ensure adequate oxygen for the ventilator throughout the entire journey. The calculation must include the liter flow, transport time, plus a safety margin. Running out of oxygen during transport would be a life-threatening emergency.

7Which communication method provides the MOST reliable direct communication between the transport team and the receiving hospital during ground transport?

A.Cellular telephone

B.Radio communication system

C.Satellite phone

D.Hospital-issued pagers

Explanation: Radio communication systems specifically designed for emergency medical services provide the most reliable direct communication during ground transport. These systems are designed to work in various geographic areas and allow direct communication with receiving hospitals. Cell phones may have coverage gaps, and satellite phones can have delays.

8During transport, the driver of the ambulance radios that they need to divert due to a road closure. What is the transport nurse's PRIMARY responsibility in this situation?

A.Contact the medical control physician immediately

B.Continue patient care while the driver determines the best route

C.Request air medical transport as backup

D.Direct the driver to use emergency lights and sirens

Explanation: The transport nurse's primary responsibility is to continue providing patient care while the driver, who is responsible for navigation and vehicle operation, determines the best alternate route. The nurse should remain focused on the patient unless the diversion creates a medical emergency that requires immediate consultation.

9A patient being transported for a non-emergent procedure begins to experience severe chest pain. What is the FIRST action the transport nurse should take?

A.Turn on emergency lights and sirens

B.Pull over to the side of the road

C.Assess the patient and notify medical control

D.Call the receiving hospital to cancel the transport

Explanation: When a patient's condition changes during transport, the first action is to assess the patient systematically and notify medical control for guidance. This allows for appropriate clinical decision-making. Turning on lights and sirens or pulling over may be appropriate later based on assessment findings and medical direction.

10Which factor MOST increases the risk of motion sickness during ground transport?

A.High ambient temperature in the ambulance

B.Visual focus on a stable object inside the vehicle

C.Reading or focusing on close objects during motion

D.Listening to music through headphones

Explanation: Reading or focusing on close objects during motion significantly increases the risk of motion sickness. This occurs because the vestibular system senses motion while the visual system perceives a stationary environment, creating sensory conflict. Patients should be advised to look at distant, stable objects or close their eyes during transport.

About the CTRN Exam

CTRN is BCEN's specialty certification for registered nurses providing care to acutely ill or injured patients during ground interfacility transport. The exam tests clinical judgment in transport physiology and safety, resuscitation principles, mechanical ventilation, clinical trauma and medical emergencies, special populations considerations, and professional issues in transport medicine. The 2026 BCEN content outline separates ground transport (CTRN) from air transport (CFRN) certifications.

Questions

155 scored questions

Time Limit

3 hours

Passing Score

91 out of 130 scored items (70%)

Exam Fee

$230 ENA/BCEN members / $310 non-members (BCEN (Board of Certification for Emergency Nursing))

CTRN Exam Content Outline

19%

General Principles of Transport

Transport physiology including effects of acceleration, deceleration, and altitude; vehicle safety and operations; patient packaging; environmental considerations; and interfacility transfer coordination

25%

Resuscitation Principles

Airway management during transport, rapid sequence intubation, shock recognition and management, cardiac arrest protocols, fluid resuscitation, and hemodynamic monitoring in mobile environments

Mechanical Ventilation

Ventilator modes and settings, transport ventilator management, weaning considerations, troubleshooting alarms, and managing ventilator-dependent patients during transfer

17%

Clinical Practice: Trauma

Traumatic brain injury, spinal cord injury, thoracic trauma, abdominal trauma, pelvic trauma, burns, and musculoskeletal injuries during interfacility transport

16%

Clinical Practice: Medical

Cardiac emergencies, respiratory failure, neurologic emergencies, GI emergencies, environmental emergencies, and toxicology in transport settings

Special Populations

Pediatric transport considerations, geriatric trauma, pregnant patient transport, bariatric patients, and patients with special medical devices

Professional Issues

Legal and ethical issues in transport medicine, documentation requirements, quality improvement, safety management, and scope of practice during transport

How to Pass the CTRN Exam

What You Need to Know

Passing score: 91 out of 130 scored items (70%)
Exam length: 155 questions
Time limit: 3 hours
Exam fee: $230 ENA/BCEN members / $310 non-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

CTRN Study Tips from Top Performers

1Study by the 2026 BCEN domain weighting - prioritize Resuscitation Principles (25%) and General Principles of Transport (19%) as the largest sections

2Master transport-specific physiology - understand how acceleration, deceleration, and confined space affect patient care

3Practice airway management in mobile environments - RSI, difficult airways, and limited access challenges are heavily tested

4Review mechanical ventilation principles specific to transport ventilators and limited oxygen supply

5Study special populations considerations - pediatric dosing, pregnancy modifications, and geriatric considerations in transport

6Add a weekly professional issues review block (legal, documentation, safety) to protect points in the non-clinical domain

Frequently Asked Questions

What is the difference between CTRN and CFRN?

Effective February 2026, BCEN separated ground and air transport certifications. CTRN (Certified Transport Registered Nurse) covers ground interfacility transport only. CFRN (Certified Flight Registered Nurse) covers rotor-wing and fixed-wing air transport and includes flight-specific physiology. Both certifications are separate and require different exam preparation.

How many questions are on the CTRN exam?

BCEN lists 155 total items: 130 scored items and 25 unscored pretest items. You have 3 hours to complete the exam.

What score do I need to pass CTRN?

BCEN lists the CTRN passing standard as 91 correct out of 130 scored items, which is approximately 70%.

How long is the CTRN exam?

BCEN lists a 3-hour testing appointment for CTRN.

What changed for CTRN in 2026?

BCEN released an updated CTRN Exam Content Outline effective February 2026 that separates ground transport (CTRN) from air transport (CFRN). The new CTRN outline focuses specifically on ground interfacility transport with 7 domains including General Principles (19%), Resuscitation (25%), Mechanical Ventilation (8%), Clinical Trauma (17%), Clinical Medical (16%), Special Populations (9%), and Professional Issues (6%).

How much does CTRN cost?

BCEN's current CTRN fees are $230 for ENA/BCEN members and $310 for non-members.

Who can take the CTRN exam?

BCEN requires active unrestricted RN licensure. Two years of transport nursing experience is recommended before testing. CTRN is ideal for nurses working in critical care transport, mobile ICU, and interfacility transfer services using ground ambulance or mobile intensive care units.

How often do I renew CTRN?

BCEN certifications follow a 4-year recertification cycle. You can recertify by continuing education hours or by retaking the exam.