CCRN Critical Care Nursing Exam 2026 | Advanced ICU
Practice Questions
1. Cardiovascular – Acute MI (NSTEMI)
A 62-year-old patient presents with chest pain, ST depression, and elevated troponin. Which
intervention is the priority?
A. Administer IV furosemide
B. Start antiplatelet therapy (aspirin)
C. Prepare for immediate thrombolysis
D. Encourage ambulation
Answer: B
Rationale: NSTEMI management prioritizes antiplatelet therapy + anticoagulation to prevent
clot extension. Thrombolysis is not first-line for NSTEMI.
2. Shock – Hemodynamic interpretation
A patient has:
BP: 78/40 mmHg
HR: 128 bpm
CVP: low
Skin: cool, clammy
What type of shock?
A. Cardiogenic
B. Septic (warm phase)
C. Hypovolemic
D. Neurogenic
Answer: C
Rationale: Low CVP + tachycardia + hypotension + cold skin = hypovolemic shock (low
volume state).
3. Respiratory – ABG interpretation
ABG:
,pH: 7.25
PaCO₂: 60 mmHg
HCO₃⁻: 26
Interpretation?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B
Rationale: High CO₂ with low pH = respiratory acidosis (hypoventilation).
4. Mechanical ventilation – Priority action
A ventilated patient suddenly alarms with high peak pressure. What should the nurse do
first?
A. Increase tidal volume
B. Check for tube obstruction or secretions
C. Sedate the patient
D. Increase FiO₂
Answer: B
Rationale: High pressure alarm = obstruction, biting tube, mucus plug, or pneumothorax risk.
Always assess first.
5. Neurology – Increased ICP
Which finding suggests rising intracranial pressure?
A. Bradycardia + widened pulse pressure
B. Tachycardia + hypotension
C. Fever + sweating
D. Hypoglycemia
Answer: A
Rationale: Cushing’s triad (bradycardia, hypertension with widened pulse pressure, irregular
respirations) = late ICP sign.
, 6. Sepsis management
A patient has fever, hypotension, elevated lactate, and confusion. First intervention?
A. Start broad-spectrum antibiotics
B. Give insulin infusion
C. Restrict fluids
D. Give diuretics
Answer: A
Rationale: In sepsis, early antibiotics are lifesaving and time-critical.
7. Renal – Acute kidney injury (AKI)
Which lab indicates worsening AKI?
A. Decreased creatinine
B. Increased BUN and creatinine
C. Decreased potassium
D. Increased sodium
Answer: B
Rationale: Rising BUN/creatinine = declining renal function.
8. ECG – Life-threatening rhythm
Which rhythm requires immediate defibrillation?
A. Atrial fibrillation
B. Pulseless ventricular tachycardia
C. Sinus bradycardia
D. First-degree AV block
Answer: B
Rationale: Pulseless VT/VF = shock immediately.
9. Endocrine – DKA
Which finding is expected in diabetic ketoacidosis?
A. Metabolic alkalosis
B. Hypokalemia only
Practice Questions
1. Cardiovascular – Acute MI (NSTEMI)
A 62-year-old patient presents with chest pain, ST depression, and elevated troponin. Which
intervention is the priority?
A. Administer IV furosemide
B. Start antiplatelet therapy (aspirin)
C. Prepare for immediate thrombolysis
D. Encourage ambulation
Answer: B
Rationale: NSTEMI management prioritizes antiplatelet therapy + anticoagulation to prevent
clot extension. Thrombolysis is not first-line for NSTEMI.
2. Shock – Hemodynamic interpretation
A patient has:
BP: 78/40 mmHg
HR: 128 bpm
CVP: low
Skin: cool, clammy
What type of shock?
A. Cardiogenic
B. Septic (warm phase)
C. Hypovolemic
D. Neurogenic
Answer: C
Rationale: Low CVP + tachycardia + hypotension + cold skin = hypovolemic shock (low
volume state).
3. Respiratory – ABG interpretation
ABG:
,pH: 7.25
PaCO₂: 60 mmHg
HCO₃⁻: 26
Interpretation?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B
Rationale: High CO₂ with low pH = respiratory acidosis (hypoventilation).
4. Mechanical ventilation – Priority action
A ventilated patient suddenly alarms with high peak pressure. What should the nurse do
first?
A. Increase tidal volume
B. Check for tube obstruction or secretions
C. Sedate the patient
D. Increase FiO₂
Answer: B
Rationale: High pressure alarm = obstruction, biting tube, mucus plug, or pneumothorax risk.
Always assess first.
5. Neurology – Increased ICP
Which finding suggests rising intracranial pressure?
A. Bradycardia + widened pulse pressure
B. Tachycardia + hypotension
C. Fever + sweating
D. Hypoglycemia
Answer: A
Rationale: Cushing’s triad (bradycardia, hypertension with widened pulse pressure, irregular
respirations) = late ICP sign.
, 6. Sepsis management
A patient has fever, hypotension, elevated lactate, and confusion. First intervention?
A. Start broad-spectrum antibiotics
B. Give insulin infusion
C. Restrict fluids
D. Give diuretics
Answer: A
Rationale: In sepsis, early antibiotics are lifesaving and time-critical.
7. Renal – Acute kidney injury (AKI)
Which lab indicates worsening AKI?
A. Decreased creatinine
B. Increased BUN and creatinine
C. Decreased potassium
D. Increased sodium
Answer: B
Rationale: Rising BUN/creatinine = declining renal function.
8. ECG – Life-threatening rhythm
Which rhythm requires immediate defibrillation?
A. Atrial fibrillation
B. Pulseless ventricular tachycardia
C. Sinus bradycardia
D. First-degree AV block
Answer: B
Rationale: Pulseless VT/VF = shock immediately.
9. Endocrine – DKA
Which finding is expected in diabetic ketoacidosis?
A. Metabolic alkalosis
B. Hypokalemia only
