How hard is the CRNA board exam (NCE)?

First-time pass rates have run high, about 89% in 2024, because candidates come straight out of a rigorous doctoral program. The difficulty is the breadth: it integrates basic sciences, pharmacology, equipment, and clinical anesthesia in application-level questions. A passing-standard increase took effect July 1, 2026, so candidates now testing should plan a larger margin.

What is the passing-standard change in July 2026?

NBCRNA announced that the NCE passing standard (the minimum ability estimate required to pass) was raised effective July 1, 2026, to reflect current professional competencies. The exact score is not published to candidates, but the practical effect is that the bar is higher than before, so prepare accordingly for any test date from that day on.

How much does the CRNA exam cost?

The NCE fee is $1,310, which includes the $160 MAC Check enrollment fee; a retake is $1,150. Confirm current pricing on the NBCRNA fee schedule, as fees change.

How long do I have to take the NCE after graduating?

You must have completed a COA-accredited nurse anesthesia program within the previous two calendar years to be eligible, so most graduates test promptly. You also need current, unrestricted RN or APRN licensure, with at least one license active on your exam date.

How do CRNAs stay certified?

Through the NBCRNA MAC program on a four-year cycle: MAC Ed (60 credits), MAC Dev (40 credits), and the MAC Check longitudinal assessment. It replaced the older CPC program. Confirm the current requirements with NBCRNA.

Field guide · Certifications

How to Pass the CRNA Boards

Certified Registered Nurse Anesthetist · NBCRNA · Last reviewed June 22, 2026

Built by Keegan, a travel RN · verified against official board sources

The NCE is the last gate between a nurse anesthesia program and practice as a CRNA, the highest-paid APRN role. It is an adaptive exam built on the basic sciences and clinical anesthesia, and a passing-standard increase took effect July 1, 2026. Here is the exam, a realistic plan, and what recertification looks like.

Exam quick facts

Exam	NBCRNA National Certification Examination (NCE)
Format	Variable-length computerized adaptive test, 100 to 170 questions (includes 30 unscored pretest items)
Time	Up to 3 hours
Passing standard	Set ability estimate via Item Response Theory (not released to candidates); the standard increased July 1, 2026
Recent pass rate	89.3% first-time (CY2024); ~84.7% five-year average
Initial exam fee	$1,310 (includes the $160 MAC Check enrollment fee); retake $1,150
Recertification	MAC program, 4-year cycle (MAC Ed 60 credits, MAC Dev 40 credits, MAC Check)

Exam specifications and fees change, so always confirm current details with NBCRNA before registering.

About the credential

The CRNA credential is earned by passing the National Certification Examination (NCE), administered by the National Board of Certification and Recertification of Nurse Anesthetists (NBCRNA), after completing a doctoral nurse anesthesia program. The NCE is a variable-length computerized adaptive test covering basic sciences, equipment and technology, basic principles of anesthesia, and advanced principles of anesthesia. Because the program is intensive and the exam is integrative, most candidates prepare throughout school and test soon after graduating. This guide covers the exam, an efficient final study plan, the fee, eligibility, and the MAC recertification program.

Who pursues it

Senior students finishing a COA-accredited doctoral nurse anesthesia program
New graduates preparing to sit the NCE within the two-year eligibility window
RNs researching the CRNA path who want to understand the boards before applying to programs

Does the CRNA actually raise your pay? (The honest answer)

CRNA is consistently the highest-compensated advanced-practice nursing role, but the certification is the gateway to practicing as a nurse anesthetist, not an optional differential. The income change comes from moving into the CRNA role after a doctoral program, not from the certificate in isolation. The actual number depends on setting (hospital, ambulatory, pain practice), region, call burden, and whether you practice independently or in a care-team model. Earning the credential without stepping into a CRNA position does not raise an RN's pay.

See how this ranks on nurse pay

Eligibility

Completion of a nurse anesthesia program accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) within the previous two calendar years
Current and unrestricted RN or APRN licensure in every state where you hold an active license, with at least one license current on your exam date
Application and fees submitted through the NBCRNA portal

A study plan that works

1Throughout the program: Treat every course as board prep. The NCE is integrative, so the most reliable preparation is mastering chemistry and physics of anesthesia, pharmacology, anatomy and physiology, and clinical principles as you take them. Keep a running summary of high-yield equations, drug profiles, and physiology curves you can review later.
2Weeks 1–2 of focused review: Benchmark with a full adaptive-style practice exam before you build a schedule. The NCE is adaptive, so a realistic diagnostic shows which of the four content areas (basic sciences, equipment and instrumentation, basic principles, advanced principles) are weakest and where your time should go.
3Weeks 1–6: Run a question bank daily. Adaptive board questions are application-level, so consistent reps surface gaps that reading hides. Review every item, right and wrong, and log the reasoning. The qbank is the spine of the plan.
4Weeks 2–4: Front-load pharmacology and physiology. Inhaled and IV anesthetics, neuromuscular blockers and reversal, opioids, vasoactive drugs, local anesthetics and toxicity, plus cardiac, pulmonary, renal, and neuro physiology under anesthesia. These carry the most questions and the most clinical consequence.
5Weeks 3–5: Drill equipment, physics, and monitoring. Gas laws and flow, the anesthesia machine and breathing circuits, vaporizers, scavenging, capnography and oximetry, electrical safety, and the math of dosing and dead space. This is the area candidates most often under-study.
6Weeks 4–6: Cover advanced and subspecialty principles. Anesthesia for cardiac, OB, pediatric, neuro, trauma, and ambulatory cases; regional techniques; airway management and difficult-airway algorithms; and crisis management (malignant hyperthermia, anaphylaxis, local-anesthetic systemic toxicity).
7Weeks 7–8: Switch to timed, mixed practice. Take full adaptive-style sets under exam conditions to build stamina and pacing. The higher post-July-2026 passing standard is now in effect, so plan a slightly larger margin.
8Final week: Consolidate, do not cram. Work your error log and high-yield sheets, taper new material, protect sleep, and confirm your Pearson VUE testing logistics.
9Throughout: Keep one error log. Every missed question goes in it with the reason. The final-week review of that log is the single highest-return activity because it targets your specific gaps.

Best CRNA review courses & question banks

Valley Anesthesia
Review course + materials
Long-established NCE review with comprehensive content modules. (Listed for completeness; no affiliate relationship.)
APEX Anesthesia
Subscription question bank + content
Popular SRNA platform with a large adaptive-style qbank and content review. (Listed for completeness; no affiliate relationship.)
Prodigy Anesthesia
Question bank
Question bank used as a second source for application-level reps. (Listed for completeness; no affiliate relationship.)
Mometrix CRNA Study Guide
Self-paced study guide & practice materials
Mometrix's self-paced Secrets study guide and practice materials to shore up weak areas before test day.
View Mometrix

Some links are affiliate links. If you buy through them, RenewRN may earn a commission at no extra cost to you. Courses listed without a link are included for completeness; we have no affiliate relationship with them.

Recommended CRNA books

Valley Anesthesia / Hall Anesthesia: A Comprehensive Review for the NCE
A widely-used NCE comprehensive review with practice questions.
View on Amazon
Nurse Anesthesia (Nagelhout)
The standard nurse-anesthesia text many programs build their boards review around.
View on Amazon

As an Amazon Associate, RenewRN earns from qualifying purchases, at no extra cost to you.

Which exam to take

There is one route to initial CRNA certification: the NBCRNA NCE. Do not confuse it with the SEE (Self-Evaluation Examination), a separate progress exam students take during the program. The NCE is the credentialing exam; the SEE is a low-stakes checkpoint.

Keeping it current

CRNAs recertify through the NBCRNA Maintaining Anesthesia Certification (MAC) program, a four-year cycle that replaced the older CPC structure. It requires MAC Ed (60 credits), MAC Dev (40 credits), and MAC Check, a self-paced longitudinal assessment completed across the cycle. All CRNAs are enrolled in MAC. Confirm the current credit requirements with NBCRNA, as the program is still phasing in.

How CE counts toward NBCRNA renewal

NBCRNA's MAC Program (4-year cycle, 100 credits: 60 Class A 'MAC Ed' plus 40 Class B 'MAC Dev') requires Class A credit to come from prior-approved, assessed CE with a post-test and be anesthesia-relevant; a plain contact-hour certificate without an assessment only fills the smaller 40-credit Class B tier. Core Modules are no longer required, and a MAC Check knowledge assessment is due across the cycle.

NBCRNA MAC Program↗ · Check whether a specific course counts

Certification renewal is one of up to four clocks an APRN keeps current, alongside the RN license, the state APRN license, and DEA registration. See the NP & APRN renewal hub for how they fit together by state.

Common CE questions

Recertifying with CE hours? These answers cover what counts toward renewal, how long to keep certificates, and more.

Check whether a specific course counts

Frequently asked questions

How hard is the CRNA board exam (NCE)?: First-time pass rates have run high, about 89% in 2024, because candidates come straight out of a rigorous doctoral program. The difficulty is the breadth: it integrates basic sciences, pharmacology, equipment, and clinical anesthesia in application-level questions. A passing-standard increase took effect July 1, 2026, so candidates now testing should plan a larger margin.
What is the passing-standard change in July 2026?: NBCRNA announced that the NCE passing standard (the minimum ability estimate required to pass) was raised effective July 1, 2026, to reflect current professional competencies. The exact score is not published to candidates, but the practical effect is that the bar is higher than before, so prepare accordingly for any test date from that day on.
How much does the CRNA exam cost?: The NCE fee is $1,310, which includes the $160 MAC Check enrollment fee; a retake is $1,150. Confirm current pricing on the NBCRNA fee schedule, as fees change.
How long do I have to take the NCE after graduating?: You must have completed a COA-accredited nurse anesthesia program within the previous two calendar years to be eligible, so most graduates test promptly. You also need current, unrestricted RN or APRN licensure, with at least one license active on your exam date.
How do CRNAs stay certified?: Through the NBCRNA MAC program on a four-year cycle: MAC Ed (60 credits), MAC Dev (40 credits), and the MAC Check longitudinal assessment. It replaced the older CPC program. Confirm the current requirements with NBCRNA.

New to this path? Read the step-by-step career roadmap.

How to become a CRNA

Keep exploring

Related certifications

Pass your boards: study tips to your inbox

Exam-prep guides, new certification breakdowns, and study plans. No spam.

No spam. We'll never sell your email. See our Privacy Policy.

Already certified? Track your recert deadlines, free

CRNA renews on a cycle with CE and practice-hour requirements. Log it all in one place so a recert deadline never sneaks up on you. Free, 60-second setup.

Start free All Certifications