The
National Board of Certification and Recertification for Nurse Anesthetists
(NBCRNA), an independent organization separate from the
American Association of Nurse Anesthesiology
(AANA), administers the National Certification Examination (NCE) and
oversees certification and continued competency programs for Certified
Registered Nurse Anesthetists (CRNAs).
Accreditation and Eligibility
The NBCRNA's certification programs are accredited by the Accreditation
Board for Specialty Nursing Certification (ABSNC) of the
American Board of Nursing Specialties
(ABNS).
Nurse anesthesia educational programs in the United States are accredited
by the
Council on Accreditation of Nurse Anesthesia Educational Programs
(COA), the accrediting agency recognized by the U.S. Department of
Education and the Council for Higher Education Accreditation for nurse
anesthesia education.
Graduation from a COA-accredited program is required for eligibility to
take the National Certification Examination.
National Certification Examination
The NCE is a variable-length computerized adaptive examination designed to
assess the knowledge, skills, and abilities required for entry-level nurse
anesthesia practice.
The examination consists of a minimum of 100 and a maximum of 170
questions, including 30 unscored pretest items. Candidates receive a
preliminary pass-or-fail result immediately after completing the
examination.
Additional information, including the content outline, examination
policies, and sample questions, is available in the
NCE Handbook.
Browse or search the content outline below.
I.
Basic Sciences (20%)
A.
Anatomy and physiology
3.
Central nervous system
B.
Pathophysiology
1.
Cardiovascular
a.
Ischemic heart disease
b.
Valvular heart disease
c.
Congenital heart defects
d.
Cardiac conduction and rhythm abnormalities
e.
Cardiovascular and peripheral vascular abnormalities
h.
Cardiomyopathy and heart failure
2.
Respiratory
d.
Pulmonary vascular abnormalities
e.
Altered airway anatomy
3.
Central nervous system
a.
Neurodegenerative diseases
c.
Cerebrovascular diseases
h.
Congenital abnormalities (e.g., cerebral palsy)
j.
Intracranial hypertension
4.
Musculoskeletal
a.
Myopathies/metabolic abnormalities (e.g., malignant hyperthermia)
b.
Neuromuscular diseases
d.
Musculoskeletal disorders (genetic and acquired)
5.
Endocrine
a.
Thyroid and parathyroid disorders
d.
Pancreatic disorders (endocrine disorders)
e.
Other endocrine disorders (thymus-, hypothalamus-, androgen-, and metabolic-related disorders)
6.
Hepatic
b.
Biliary tract and bilirubin disorders
d.
Hepatovascular abnormalities
7.
Renal
a.
Intrinsic kidney disorders
c.
Chronic kidney disease
8.
Hematologic
9.
Gastrointestinal
c.
Pancreatic disorders (exocrine disorders)
e.
Tumors/secreting lesions
f.
Malabsorption disorders
10.
Immune
a.
Infectious disorders (e.g., HIV, AIDS)
b.
Hypersensitivity disorders (Type I-IV)
11.
Other conditions
b.
Burns (inhalational, cutaneous)
d.
Substance use disorder (alcohol, nicotine, other)
C.
Pharmacology
1.
General principles
c.
Pharmacology-related mathematics
2.
Inhalation anesthetics
3.
Intravenous anesthetics and antagonists
b.
Sedative/hypnotics (e.g., propofol, etomidate, ketamine, dexmedetomidine)
c.
Benzodiazepines and benzodiazepine antagonists
d.
Opioid agonists, agonist-antagonists, and antagonists
4.
Depolarizing and nondepolarizing neuromuscular relaxants and antagonists
7.
Regional anesthesia adjuncts (neuraxial and peripheral)
8.
Anticholinergics/cholinergic agonists
10.
Cardiovascular medications
b.
Phosphodiesterase inhibitors
c.
Cardiac glycosides (e.g., digitalis)
d.
Alpha- and beta-receptor agonists and antagonists
e.
Centrally acting alpha2-adrenergic agonists
g.
Angiotensin II receptor inhibitors
k.
Calcium channel blockers
12.
Psychopharmacologic therapy
c.
Antiparkinsonian drugs
14.
Histamine receptor antagonists
15.
Antiemetics
a.
5-HT3 receptor antagonists
b.
Gastrointestinal prokinetic medications (metoclopramide)
19.
Anticoagulants and antagonists
a.
Heparin and low-molecular-weight heparins
b.
Heparin reversal—protamine
c.
Antiplatelet medications
e.
Oral anticoagulant reversal
20.
Procoagulants (e.g., antifibrinolytics, DDAVP)
21.
Antimicrobials and antivirals
23.
Lipid-lowering agents
24.
Herbal remedies and dietary supplements
25.
Minerals and electrolytes
27.
Steroids (e.g., dexamethasone, hydrocortisone)
D.
Applied chemistry, biochemistry, physics, and mathematics
1.
Chemistry and biochemistry
a.
Aqueous solutions and concentrations
b.
Acids, bases, and salts
c.
Chemical reactions: oxidation, reduction, hydrolysis, and conjugation
e.
Cellular mechanisms of action
f.
Drug receptor interaction
2.
Physics
c.
Solubility, diffusion, and osmosis
d.
Pressure and fluid flow
e.
Electricity and electrical safety
f.
Vaporization and humidification
g.
Measurement of oxygen, carbon dioxide, and hydrogen ions
3.
Nonpharmacology-related mathematics
II.
Equipment, Instrumentation and Technology (20%)
A.
Anesthetic delivery systems
1.
High/low pressure gas sources
3.
Flowmeters, valves, floats
6.
Pressure failure safety devices
9.
Carbon dioxide absorbents
10.
Anesthetic circuits
a.
Rebreathing, circle system
c.
Modified nonrebreathing
11.
Pneumatic and electronic alarm devices
B.
Airway equipment
2.
Laryngoscope
c.
Optically enhanced scopes
3.
Flexible fiberoptic bronchoscope
5.
Endobronchial tube
6.
Airways
8.
Supraglottic airways (e.g., LMA)
9.
Intubating supraglottic airways
12.
Cricothyrotomy (needle and surgical)
13.
Intubation aids (e.g., bougie, exchange catheter)
C.
Monitoring devices
1.
Central nervous system
2.
Cardiovascular
a.
Electrocardiogram (3-lead and 5-lead)
b.
Arterial pressure monitoring
c.
Noninvasive blood pressure monitoring
d.
Central venous pressure monitoring
e.
Pulmonary artery pressure monitoring/SvO2
f.
Hemodynamic monitoring
g.
Precordial/esophageal stethoscope
h.
Transesophageal echocardiogram
3.
Respiratory
4.
Others
a.
Peripheral nerve stimulator (qualitative and quantitative)
b.
Temperature monitoring
c.
Maternal/fetal monitoring
D.
Patient warming equipment
2.
Forced air warming devices
3.
Heat and moisture exchanger (HME)
E.
Infusion devices (e.g., rapid infusers)
F.
Imaging and imaging safety
III.
General Principles of Anesthesia (35%)
A.
Ethical considerations
1.
Autonomy, beneficence, nonmalfeasance
B.
Legal issues
1.
Advance healthcare directives
3.
Disclosure of errors/ injuries
C.
Safety and wellness
1.
Provider substance abuse disorder
2.
Issues surrounding patient safety
4.
Wellness initiatives and peer assistance
D.
Preoperative assessment and preparation of patient
E.
Fluid volume assessment and management
1.
Fluid/blood component therapy replacement (including plasma expanders)
2.
Bloodless medicine (including blood salvage devices and hemodilution techniques)
3.
Goal-directed fluid management (crossover with equipment)
4.
Massive transfusion protocol
F.
Positioning
2.
Physiologic alterations
G.
Utilization and interpretation of testing data
1.
Lab tests (blood gases, activated clotting time)
2.
Diagnostic exams (including basic 12-lead ECG interpretation)
H.
Airway management
2.
Techniques, procedures, and devices
4.
Difficult airway management (difficult airway algorithm)
I.
Local/regional anesthetics (technique, physiologic alterations, complications)
6.
Other blocks (airway, retrobulbar)
7.
Ultrasound and/or nerve stimulator guided concepts and techniques
8.
Management of complications (e.g., local anesthetic systemic toxicity)
J.
Light, moderate, and deep sedation (monitored anesthesia care)
K.
Total intravenous anesthesia
L.
Pain
1.
Pain theory (anatomy, physiology, pathology, and psychodynamics)
2.
Pain management
c.
Multimodal pain therapy
M.
Enhanced recovery after surgery (ERAS)
N.
Hypotensive technique and risks
O.
Postanesthesia care/respiratory therapy
P.
Infection control
1.
Provider (e.g., personal protective equipment, room air handling, ultraviolet sanitizers)
2.
Patient (e.g., aseptic technique, workstation cleanliness, needle safety)
Q.
Intraoperative fire safety
IV.
Anesthesia for Surgical Procedures and Special Populations (25%)
A.
Surgical and diagnostic anesthesia, including management of complications
1.
Intra-abdominal
b.
Gastrointestinal tract procedures
c.
Endocrine organ procedures
e.
Gynecologic procedures
f.
Peritoneal procedures (including hernia repair)
2.
Extrathoracic
b.
Plastics and/or reconstructive
3.
Head
v.
Plastics and/or reconstructive
i.
Decompression (burr holes, ventriculoperitoneal shunt)
ii.
Space-occupying lesion
iv.
Transsphenoidal hypophysectomy
v.
Stereotactic procedures
4.
Cardiac anesthesia
a.
Open procedures (e.g., coronary artery bypass grafting)
b.
Minimally invasive procedures (e.g., transcatheter aortic valve replacement/implantation [TAVR/TAVI], left atrial appendage closure implant, mitral clips)
c.
Interventional cardiology (e.g., pacemakers, automated internal cardiac defibrillator devices, electrophysiology cases)
d.
Management of patients with cardiac devices (e.g., ventricular assist device, extracorporeal membrane oxygenation, intraarterial balloon pump)
5.
Noncardiac intrathoracic (including open and thoracoscopic approach)
b.
Endoscopic procedures (bronchoscopy, mediastinoscopy)
6.
Neck
7.
Neuroskeletal
a.
Cervical spine (anterior and posterior approach)
b.
Laminectomy/discectomy fusions at all levels
c.
Pain management procedures
8.
Orthopedic
a.
Arthroscopic procedures
d.
Total joint replacements/arthroplasty
e.
Procedures of the hand and foot
9.
Perineal and pelvic procedures
10.
Vascular (open versus endovascular)
c.
Abdominal (including renal)
e.
Thromboembolic prevention
f.
Surgical management of portal hypertension
11.
Non-operating-room anesthesia (NORA)
a.
Diagnostic imaging and radiology
b.
Electroconvulsive therapy
c.
Interventional radiology
12.
Robotic/laparoscopic surgery
13.
Other surgical procedures
c.
Organ transplants (including management of posttransplant patient for nontransplant surgery)
B.
Anesthesia for special populations
1.
Pediatrics
a.
Anatomy, physiology, and pathophysiology
iii.
Congenital abnormalities
c.
Anesthesia techniques/procedures
d.
Management of complications
2.
Obstetrics
a.
Anatomy, physiology, and pathophysiology
c.
Anesthesia techniques/procedures
e.
Nonobstetric surgery in the parturient
f.
Management of complications (e.g., amniotic fluid embolism, HELLP syndrome)
3.
Geriatrics
a.
Anatomy, physiology, and pathophysiology
c.
Anesthesia techniques/procedures
d.
Management of complications (e.g., postoperative cognitive dysfunction)
4.
Obesity
a.
Anatomy, physiology, and pathophysiology
c.
Anesthesia techniques/procedures (including bariatric)
d.
Management of complications
5.
Substance use disorder population
a.
Medication-assisted therapy (MAT) (e.g., methadone, buprenorphine)
b.
Pharmacologic interactions (e.g., acute intoxication)
d.
Management of complications
6.
Immune compromised and oncology patients
b.
Anesthesia techniques/procedures
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