The CCRN is the specialty certification for nurses who care for critically ill patients, awarded by the AACN Certification Corporation, the certifying arm of the American Association of Critical-Care Nurses. There are three versions, Adult, Pediatric and Neonatal, and this guide covers the Adult exam, which most candidates take. It explains the format, how passing works, what is on the test plan, who is eligible, what it costs, how renewal works and how to plan your study time.

This site offers independent practice and is not official AACN material. Check aacn.org for the current handbook before you apply, because fees and policies change.

The CCRN (Adult) exam at a glance

Item	Details
Questions	150 multiple-choice questions: 125 scored and 25 unscored pretest questions you cannot tell apart
Question type	Four choices, one best answer
Time	3 hours
Breaks	Up to two breaks of no more than 5 minutes each; the clock keeps running
Passing score	83 of the 125 scored questions correct, about 66%
Where	A PSI test center or live remote proctoring
Results	Pass or fail on screen when you finish; a score report by content area follows by email
Fee	\(260 for AACN members, \)375 for nonmembers
2025 first-time pass rate	72.02% of 17,151 candidates

You can move back and forth between questions, change answers and flag questions to come back to. There is no penalty for guessing, so answer every question. AACN says most questions are written at the application and analysis levels, so expect bedside scenarios rather than definitions, and expect generic drug names.

The test plan

The current Adult test plan applies to exams taken on or after November 12, 2025. It replaced the 2020 plan, so check that any review material you use reflects these weights.

Area	Share	About how many of 125 scored	Practice
Cardiovascular	13%	16	Cardiovascular questions
Respiratory	12%	15	Respiratory questions
Endocrine, hematology and immunology, GI, renal and GU, integumentary	21%	26	Endocrine, heme, GI and renal questions
Musculoskeletal, neurological, behavioral and psychosocial	18%	22 to 23	Neuro, musculoskeletal and behavioral questions
Multisystem	16%	20	Multisystem questions
Professional Caring and Ethical Practice	20%	25	Professional caring and ethics questions

The first five areas make up Clinical Judgment, 80% of the exam. Professional Caring and Ethical Practice is the other 20% and is based on the AACN Synergy Model: advocacy and moral agency, caring practices, response to diversity, facilitation of learning, collaboration, systems thinking and clinical inquiry.

Compared with the 2020 plan, cardiovascular fell from 17% to 13% and respiratory from 15% to 12%, while neuro, musculoskeletal and behavioral rose from 14% to 18% and multisystem from 14% to 16%. Hemodynamics runs through several areas; see hemodynamics for the CCRN.

How passing works

The passing score is a raw count, not a percentage or a scaled score: you need 83 of the 125 scored questions right. AACN sets it with a modified Angoff study, in which expert nurses judge how a minimally competent candidate would do on each question. Only your total counts; there is no minimum for each area. For more detail, see CCRN passing score and how scoring works.

Eligibility

For the Direct Care pathway you need:

• A current, unencumbered US RN or APRN license, meaning no formal discipline or conditions that limit your practice.
• Practice hours caring directly for acutely or critically ill adult patients, using one of two options:
  • 1,750 hours in the previous 2 years, with 875 of them in the most recent year before you apply, or
  • 2,000 hours over the previous 5 years, with at least 144 in the most recent year.

Most of your hours, including those in the most recent year, must be with critically ill patients. Hours must be in a US- or Canada-based facility or a comparable one. Orientation hours count only when you were the assigned nurse, not while shadowing. Nurse managers, educators, APRNs and preceptors can count time spent at the bedside. You give the name of a supervisor or colleague who can verify your hours, and they are contacted only if your application is audited.

AACN also offers Knowledge Professional and Tele-critical Care pathways with different hour requirements. Everyone on the same population takes the same exam.

Fees

Fee	AACN member	Nonmember
First attempt	$260	$375
Retest	$185	$290
Renewal by exam	$185	$290
Renewal by CERPs	$150	$230

These are the fees in AACN’s July 2026 handbook. They went up in 2026 from \(255 and \)370, so older pages may show lower numbers. Buying a one-year AACN membership with the exam can cost less than the nonmember fee. Extending your testing window or cancelling costs $100.

Scheduling

After your application is approved you get a window to take the exam: AACN says it is normally 90 days but currently 180 days. Schedule at least 24 hours ahead, and reschedule or cancel at least 48 hours ahead. If you miss your appointment you lose the fee.

Retakes

If you don’t pass, you can take the same exam up to 4 times in a rolling 12-month period. There is no required wait between attempts. You reapply each time and pay the retest fee. Your score report shows how many questions you got right in each area, which tells you where to focus.

Renewal

CCRN certification lasts 3 years. Both renewal options require 432 hours of direct care of acutely or critically ill adult patients during the 3 years, with 144 of them in the 12 months before renewal. Then you either:

• Renew with Synergy CERPs: 100 continuing education points, with at least 60 in Category A, 10 in Category B and 10 in Category C, plus 20 more in any category; or
• Renew by exam: apply at least 30 days before your renewal date and pass before it.

How hard is the CCRN?

The CCRN is a hard exam. In 2025, 72.02% of first-time Adult candidates passed, down from 81.20% in 2023. The difficulty comes from the question style more than the facts: several choices are often reasonable, and the right one is the MOST appropriate or the FIRST thing to do for that patient. Answer the way the standard critical care references would, not the way your own unit happens to do it.

The Professional Caring and Ethical Practice area catches people out too. It is a fifth of the exam, and the questions are scenarios about families, interpreters, ethics and teamwork, not definitions.

If you also work step-down or telemetry, see CCRN vs PCCN to decide which exam fits your practice.

A 4-week study plan

Four weeks suits a nurse with solid ICU experience who mainly needs to review and practice.

Week	Focus
1	Take a full practice exam to find weak areas. Review cardiovascular and hemodynamics, and answer 30 to 40 questions a day with full review of each rationale.
2	Respiratory, ventilation and ABGs; then endocrine, hematology, GI and renal. Keep answering questions daily.
3	Neuro, musculoskeletal and behavioral; multisystem, including shock, sepsis, toxicology and end of life. Do a block of Professional Caring and Ethics questions every other day.
4	Two more full timed practice exams. Review every missed question, then go back to your weakest area. Rest the day before the exam.

An 8-week study plan

Eight weeks suits a nurse who is newer to the ICU, works mostly in one specialty unit, or has a busy schedule.

Weeks	Focus
1	Baseline practice exam. Read the official test plan and list the topics you rarely see at work.
2 to 3	Cardiovascular and hemodynamics, then respiratory and ventilation. About 20 to 30 questions a day.
4	Endocrine, hematology and immunology, GI, renal and skin.
5	Neuro, musculoskeletal and behavioral.
6	Multisystem: shock, sepsis, burns, toxicology, acid-base, end of life.
7	Professional Caring and Ethics, plus mixed review of every area you scored lowest in.
8	Two or three full timed practice exams, review of missed questions, and a light final day.

In either plan, reading why the wrong choices are wrong is as important as getting the right answer. Aim to be comfortably above 83 of 125 on full practice exams before test day.

Start practicing

Our full practice exams have 125 scored questions mixed like the real exam, with 83 to pass. Start from the home page, or begin with one area from the table above.