CCRN (Adult Critical Care Nursing) – AACN Certification 260
Multiple-Choice Questions with Rationales Multiple Correct
Answers & Detailed Explanations for High-Yield Practice
Exam 2026 Updated
TABLE OF CONTENTS
1. Cardiovascular System (Questions 1–50)
2. Pulmonary System (Questions 51–90)
3. Neurologic System (Questions 91–120)
4. Renal & Endocrine Systems (Questions 121–150)
5. Gastrointestinal & Multisystem (Questions 151–180)
6. Hematology & Immunology (Questions 181–210)
7. Professional Caring & Ethical Practice (Questions 211–260)
CARDIOVASCULAR SYSTEM (Questions 1–50)
Question 1 A patient with acute myocardial infarction develops hypotension and jugular venous
distension. The nurse notes clear lung sounds. Which complication should the nurse suspect?
A. Cardiogenic shock B. Cardiac tamponade C. Right ventricular infarction D. Pulmonary embolism
Correct Answer: C Rationale: Right ventricular infarction presents with hypotension, JVD, clear
lungs (no pulmonary congestion), and may require volume resuscitation. Cardiogenic shock (A)
typically has pulmonary congestion. Tamponade (B) has muffled heart sounds. PE (D) has hypoxia
and signs of right heart strain.
Question 2 (Select all that apply) Which of the following are expected ECG changes in acute
pericarditis? (Select all that apply)
A. Diffuse ST-segment elevation B. PR-segment depression C. Reciprocal ST-segment depression D.
Q waves E. T-wave inversion (late)
,Correct Answers: A, B, E Rationale: Pericarditis shows diffuse ST elevation (A), PR depression
(B), and late T-wave inversion (E). Reciprocal ST depression (C) is seen in MI. Q waves (D) indicate
infarction.
Question 3 A patient with ST-elevation MI is receiving thrombolytic therapy. Which finding indicates
successful reperfusion?
A. Resolution of ST-segment elevation by ≥50% B. Development of new Q waves C. Persistent chest
pain D. Decreased heart rate
Correct Answer: A Rationale: Resolution of ST elevation by ≥50% is a marker of reperfusion.
Other signs include reperfusion arrhythmias (accelerated idioventricular rhythm) and relief of chest
pain. New Q waves (B) indicate infarction, not reperfusion.
Question 4 Which hemodynamic parameter is most indicative of left ventricular preload?
A. Central venous pressure (CVP) B. Pulmonary artery wedge pressure (PAWP) C. Cardiac index
(CI) D. Systemic vascular resistance (SVR)
Correct Answer: B Rationale: PAWP (pulmonary artery wedge pressure) reflects left ventricular
end-diastolic pressure (preload). CVP (A) reflects right ventricular preload. CI (C) measures cardiac
output. SVR (D) measures afterload.
Question 5 (Select all that apply) Which of the following are indications for placement of an intra-
aortic balloon pump (IABP)? (Select all that apply)
A. Cardiogenic shock B. Acute mitral regurgitation C. Ventricular septal defect D. Severe aortic
regurgitation E. Unstable angina refractory to medical therapy
Correct Answers: A, B, C, E Rationale: IABP is contraindicated in severe aortic regurgitation (D)
because balloon inflation during diastole would worsen regurgitation. It is used for cardiogenic shock
(A), acute MR (B), VSD (C), and refractory unstable angina (E).
Question 6 A patient with acute heart failure has the following hemodynamic values: PAWP 28 mm
Hg, CI 1.8 L/min/m2, SVR 1,800 dynes/sec/cm5. Which medication should the nurse anticipate?
A. Dobutamine B. Nitroprusside C. Norepinephrine D. Dopamine (low dose)
Correct Answer: B Rationale: High PAWP (pulmonary congestion) + low CI (low cardiac output) +
high SVR (vasoconstriction) = cardiogenic shock with high afterload. Nitroprusside is a vasodilator
that reduces afterload and improves cardiac output. Dobutamine (A) is an inotrope but does not
reduce afterload as effectively.
,Question 7 A patient with heart failure is on milrinone. Which adverse effect should the nurse
monitor most closely?
A. Hypertension B. Arrhythmias (ventricular tachycardia) C. Bradycardia D. Hyperkalemia
Correct Answer: B Rationale: Milrinone is a phosphodiesterase inhibitor with inotropic and
vasodilatory effects. It can cause arrhythmias (ventricular tachycardia), hypotension (not hypertension
– A), and thrombocytopenia. It is not associated with hyperkalemia (D).
Question 8 (Select all that apply) Which of the following are contraindications to thrombolytic
therapy in acute MI? (Select all that apply)
A. Active internal bleeding B. Recent major surgery (<3 weeks) C. Ischemic stroke within 3
months D. Uncontrolled hypertension (BP >180/110) E. Age >75 (not an absolute contraindication)
Correct Answers: A, B, C, D Rationale: Active bleeding (A), recent surgery (B), prior stroke (C),
and severe hypertension (D) are contraindications. Age >75 (E) is not an absolute contraindication.
Question 9 A patient with atrial fibrillation is on amiodarone. Which lab value should be monitored?
A. Liver function tests B. Serum potassium C. Serum magnesium D. Serum creatinine
Correct Answers: A, B, C, D Rationale: Amiodarone affects the liver (A), thyroid, lungs, and eyes.
It can prolong QT, so potassium (B) and magnesium (C) should be normal. Creatinine (D) is
monitored for renal function.
Question 10 Which ECG finding is characteristic of hypokalemia?
A. Peaked T waves B. U waves C. Prolonged PR interval D. Widened QRS
Correct Answer: B Rationale: Hypokalemia causes U waves, flat T waves, and ST depression.
Peaked T waves (A) is hyperkalemia. Prolonged PR (C) and widened QRS (D) are hyperkalemia.
Question 11 (Select all that apply) Which of the following are signs of cardiac tamponade? (Select all
that apply)
A. Muffled heart sounds B. Hypotension C. JVD (jugular venous distension) D. Pulsus paradoxus E.
Widened pulse pressure
Correct Answers: A, B, C, D Rationale: Beck's triad: muffled heart sounds (A), hypotension (B),
JVD (C). Pulsus paradoxus (D) is also present. Widened pulse pressure (E) is not seen in tamponade
(it's seen in aortic regurgitation).
, Question 12 A patient with cardiac tamponade is scheduled for a pericardiocentesis. What is the
nurse's priority action?
A. Position the patient supine B. Position the patient at 45-60 degrees (semi-Fowler's) C. Administer
IV fluids before the procedure D. Administer diuretics
Correct Answer: B Rationale: Semi-Fowler's position improves breathing and reduces the risk of
complications. Supine (A) may worsen symptoms. IV fluids (C) may be given but are not the priority.
Diuretics (D) are contraindicated (decrease preload).
Question 13 A patient with acute aortic dissection presents with a blood pressure of 220/110. Which
medication is the first-line treatment?
A. Nitroprusside B. Esmolol (beta-blocker) C. Labetalol D. Nicardipine
Correct Answer: B Rationale: Esmolol (or another beta-blocker) is first-line to reduce heart rate and
BP, decreasing shear stress on the aortic wall. Nitroprusside (A) can be used but should be after beta-
blockade to prevent reflex tachycardia.
Question 14 (Select all that apply) Which of the following are signs of left-sided heart failure?
(Select all that apply)
A. Crackles (rales) in lung bases B. Jugular venous distension C. S3 gallop D. Peripheral edema E.
Orthopnea
Correct Answers: A, C, E Rationale: Left-sided heart failure causes pulmonary congestion (crackles
– A), S3 gallop (C), and orthopnea (E). JVD (B) and peripheral edema (D) are signs of right-sided
heart failure.
Question 15 A patient is receiving dobutamine for cardiogenic shock. What is the primary effect of
dobutamine?
A. Increased contractility (inotropy) with minimal vasoconstriction B. Vasoconstriction C.
Vasodilation D. Chronotropy (increased heart rate)
Correct Answer: A Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility
(inotropy) with relatively mild chronotropic effects and mild vasodilation (due to beta-2 effects). It is
useful in cardiogenic shock with low cardiac output.
Question 16 A patient with acute MI develops a new systolic murmur at the apex. Which
complication should the nurse suspect?
A. Papillary muscle rupture B. Ventricular septal defect C. Left ventricular aneurysm D. Pericarditis
Multiple-Choice Questions with Rationales Multiple Correct
Answers & Detailed Explanations for High-Yield Practice
Exam 2026 Updated
TABLE OF CONTENTS
1. Cardiovascular System (Questions 1–50)
2. Pulmonary System (Questions 51–90)
3. Neurologic System (Questions 91–120)
4. Renal & Endocrine Systems (Questions 121–150)
5. Gastrointestinal & Multisystem (Questions 151–180)
6. Hematology & Immunology (Questions 181–210)
7. Professional Caring & Ethical Practice (Questions 211–260)
CARDIOVASCULAR SYSTEM (Questions 1–50)
Question 1 A patient with acute myocardial infarction develops hypotension and jugular venous
distension. The nurse notes clear lung sounds. Which complication should the nurse suspect?
A. Cardiogenic shock B. Cardiac tamponade C. Right ventricular infarction D. Pulmonary embolism
Correct Answer: C Rationale: Right ventricular infarction presents with hypotension, JVD, clear
lungs (no pulmonary congestion), and may require volume resuscitation. Cardiogenic shock (A)
typically has pulmonary congestion. Tamponade (B) has muffled heart sounds. PE (D) has hypoxia
and signs of right heart strain.
Question 2 (Select all that apply) Which of the following are expected ECG changes in acute
pericarditis? (Select all that apply)
A. Diffuse ST-segment elevation B. PR-segment depression C. Reciprocal ST-segment depression D.
Q waves E. T-wave inversion (late)
,Correct Answers: A, B, E Rationale: Pericarditis shows diffuse ST elevation (A), PR depression
(B), and late T-wave inversion (E). Reciprocal ST depression (C) is seen in MI. Q waves (D) indicate
infarction.
Question 3 A patient with ST-elevation MI is receiving thrombolytic therapy. Which finding indicates
successful reperfusion?
A. Resolution of ST-segment elevation by ≥50% B. Development of new Q waves C. Persistent chest
pain D. Decreased heart rate
Correct Answer: A Rationale: Resolution of ST elevation by ≥50% is a marker of reperfusion.
Other signs include reperfusion arrhythmias (accelerated idioventricular rhythm) and relief of chest
pain. New Q waves (B) indicate infarction, not reperfusion.
Question 4 Which hemodynamic parameter is most indicative of left ventricular preload?
A. Central venous pressure (CVP) B. Pulmonary artery wedge pressure (PAWP) C. Cardiac index
(CI) D. Systemic vascular resistance (SVR)
Correct Answer: B Rationale: PAWP (pulmonary artery wedge pressure) reflects left ventricular
end-diastolic pressure (preload). CVP (A) reflects right ventricular preload. CI (C) measures cardiac
output. SVR (D) measures afterload.
Question 5 (Select all that apply) Which of the following are indications for placement of an intra-
aortic balloon pump (IABP)? (Select all that apply)
A. Cardiogenic shock B. Acute mitral regurgitation C. Ventricular septal defect D. Severe aortic
regurgitation E. Unstable angina refractory to medical therapy
Correct Answers: A, B, C, E Rationale: IABP is contraindicated in severe aortic regurgitation (D)
because balloon inflation during diastole would worsen regurgitation. It is used for cardiogenic shock
(A), acute MR (B), VSD (C), and refractory unstable angina (E).
Question 6 A patient with acute heart failure has the following hemodynamic values: PAWP 28 mm
Hg, CI 1.8 L/min/m2, SVR 1,800 dynes/sec/cm5. Which medication should the nurse anticipate?
A. Dobutamine B. Nitroprusside C. Norepinephrine D. Dopamine (low dose)
Correct Answer: B Rationale: High PAWP (pulmonary congestion) + low CI (low cardiac output) +
high SVR (vasoconstriction) = cardiogenic shock with high afterload. Nitroprusside is a vasodilator
that reduces afterload and improves cardiac output. Dobutamine (A) is an inotrope but does not
reduce afterload as effectively.
,Question 7 A patient with heart failure is on milrinone. Which adverse effect should the nurse
monitor most closely?
A. Hypertension B. Arrhythmias (ventricular tachycardia) C. Bradycardia D. Hyperkalemia
Correct Answer: B Rationale: Milrinone is a phosphodiesterase inhibitor with inotropic and
vasodilatory effects. It can cause arrhythmias (ventricular tachycardia), hypotension (not hypertension
– A), and thrombocytopenia. It is not associated with hyperkalemia (D).
Question 8 (Select all that apply) Which of the following are contraindications to thrombolytic
therapy in acute MI? (Select all that apply)
A. Active internal bleeding B. Recent major surgery (<3 weeks) C. Ischemic stroke within 3
months D. Uncontrolled hypertension (BP >180/110) E. Age >75 (not an absolute contraindication)
Correct Answers: A, B, C, D Rationale: Active bleeding (A), recent surgery (B), prior stroke (C),
and severe hypertension (D) are contraindications. Age >75 (E) is not an absolute contraindication.
Question 9 A patient with atrial fibrillation is on amiodarone. Which lab value should be monitored?
A. Liver function tests B. Serum potassium C. Serum magnesium D. Serum creatinine
Correct Answers: A, B, C, D Rationale: Amiodarone affects the liver (A), thyroid, lungs, and eyes.
It can prolong QT, so potassium (B) and magnesium (C) should be normal. Creatinine (D) is
monitored for renal function.
Question 10 Which ECG finding is characteristic of hypokalemia?
A. Peaked T waves B. U waves C. Prolonged PR interval D. Widened QRS
Correct Answer: B Rationale: Hypokalemia causes U waves, flat T waves, and ST depression.
Peaked T waves (A) is hyperkalemia. Prolonged PR (C) and widened QRS (D) are hyperkalemia.
Question 11 (Select all that apply) Which of the following are signs of cardiac tamponade? (Select all
that apply)
A. Muffled heart sounds B. Hypotension C. JVD (jugular venous distension) D. Pulsus paradoxus E.
Widened pulse pressure
Correct Answers: A, B, C, D Rationale: Beck's triad: muffled heart sounds (A), hypotension (B),
JVD (C). Pulsus paradoxus (D) is also present. Widened pulse pressure (E) is not seen in tamponade
(it's seen in aortic regurgitation).
, Question 12 A patient with cardiac tamponade is scheduled for a pericardiocentesis. What is the
nurse's priority action?
A. Position the patient supine B. Position the patient at 45-60 degrees (semi-Fowler's) C. Administer
IV fluids before the procedure D. Administer diuretics
Correct Answer: B Rationale: Semi-Fowler's position improves breathing and reduces the risk of
complications. Supine (A) may worsen symptoms. IV fluids (C) may be given but are not the priority.
Diuretics (D) are contraindicated (decrease preload).
Question 13 A patient with acute aortic dissection presents with a blood pressure of 220/110. Which
medication is the first-line treatment?
A. Nitroprusside B. Esmolol (beta-blocker) C. Labetalol D. Nicardipine
Correct Answer: B Rationale: Esmolol (or another beta-blocker) is first-line to reduce heart rate and
BP, decreasing shear stress on the aortic wall. Nitroprusside (A) can be used but should be after beta-
blockade to prevent reflex tachycardia.
Question 14 (Select all that apply) Which of the following are signs of left-sided heart failure?
(Select all that apply)
A. Crackles (rales) in lung bases B. Jugular venous distension C. S3 gallop D. Peripheral edema E.
Orthopnea
Correct Answers: A, C, E Rationale: Left-sided heart failure causes pulmonary congestion (crackles
– A), S3 gallop (C), and orthopnea (E). JVD (B) and peripheral edema (D) are signs of right-sided
heart failure.
Question 15 A patient is receiving dobutamine for cardiogenic shock. What is the primary effect of
dobutamine?
A. Increased contractility (inotropy) with minimal vasoconstriction B. Vasoconstriction C.
Vasodilation D. Chronotropy (increased heart rate)
Correct Answer: A Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility
(inotropy) with relatively mild chronotropic effects and mild vasodilation (due to beta-2 effects). It is
useful in cardiogenic shock with low cardiac output.
Question 16 A patient with acute MI develops a new systolic murmur at the apex. Which
complication should the nurse suspect?
A. Papillary muscle rupture B. Ventricular septal defect C. Left ventricular aneurysm D. Pericarditis
