CCRN Certification Exam Prep Document
2026/2027 | Critical Care Nursing, Clinical
Judgment & AACN Test Plan Review | 100+
Verified Questions with Detailed Rationales
This exam contains verified questions drawn from actual AACN CCRN certification exam content for the
2026/2027 cycle. It covers clinical judgment and nursing process application, cardiovascular, pulmonary,
neurological, endocrine, renal, gastrointestinal, and multisystem critical care, and the AACN Synergy
Model for Patient Care. The questions are complex, high-acuity clinical reasoning required for success
on the CCRN exam.
Section 1: Clinical Judgment & Cardiovascular Critical Care — Questions 1–40
Q1: A patient in the ICU has the following hemodynamic readings: MAP 55 mmHg, CVP 4 mmHg, PAOP 6
mmHg, and cardiac index 1.9 L/min/m². Which shock state is most consistent with these findings?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Septic shock
D. Anaphylactic shock
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the low CVP (4 mmHg), low PAOP (6
mmHg), and low cardiac index (1.9 L/min/m²) indicate inadequate preload and low cardiac output,
which are characteristic of hypovolemic shock. The MAP of 55 mmHg confirms hypotension. Cardiogenic
shock would show elevated PAOP with low cardiac output, while septic shock typically presents with low
PAOP and high or normal cardiac output initially.
Q2: A patient with an acute anterior wall myocardial infarction develops a new holosystolic murmur at
the apex, pulmonary edema, and hypotension. The nurse suspects:
,A. Papillary muscle rupture with acute mitral regurgitation [CORRECT]
B. Ventricular septal defect
C. Acute aortic regurgitation
D. Pericardial tamponade
Correct Answer: A
Rationale: The best answer is A. This choice is correct because a new holosystolic murmur at the apex
following an anterior MI strongly suggests papillary muscle rupture causing acute mitral regurgitation.
The resulting pulmonary edema and hypotension reflect acute left ventricular failure and backward
pressure into the pulmonary circulation. This is a mechanical complication requiring emergent surgical
intervention and hemodynamic support with vasodilators and possibly intra-aortic balloon pump.
Q3: A patient is receiving norepinephrine for septic shock. The nurse notes the patient's MAP has
increased from 58 to 72 mmHg, but the fingers and toes are becoming mottled and cool. Which action is
most appropriate?
A. Increase the norepinephrine dose to improve perfusion
B. Assess for excessive vasoconstriction and consider adding a vasodilator or inotrope; notify the
provider [CORRECT]
C. Discontinue the norepinephrine immediately
D. Apply warm blankets and continue current therapy
Correct Answer: B
Rationale: The best answer is B. This choice is correct because while the MAP has improved, the mottled
and cool extremities suggest excessive peripheral vasoconstriction from high-dose norepinephrine,
which can impair tissue perfusion despite adequate blood pressure. The provider may consider adding
dobutamine for inotropic support, using a vasodilator, or adjusting the vasopressor strategy to balance
perfusion pressure with tissue blood flow.
Q4: A patient has a pulmonary artery catheter in place. The nurse obtains the following readings: PA
systolic 28 mmHg, PA diastolic 12 mmHg, and PAOP 8 mmHg. The cardiac output is 5.2 L/min. How
should the nurse interpret the PAOP?
A. The PAOP is elevated, indicating left ventricular failure
B. The PAOP is within normal range, indicating adequate left ventricular preload [CORRECT]
C. The PAOP is critically low, indicating hypovolemia
D. The PAOP cannot be interpreted without the CVP
Correct Answer: B
,Rationale: The best answer is B. This choice is correct because a PAOP of 8 mmHg falls within the normal
range of 6 to 12 mmHg, indicating adequate left ventricular preload. The normal cardiac output of 5.2
L/min supports this interpretation. An elevated PAOP would suggest fluid overload or left heart failure,
while a low PAOP would indicate hypovolemia. The CVP provides additional information about right-
sided preload but is not required to interpret the PAOP.
Q5: A patient with cardiogenic shock has the following hemodynamic profile: MAP 62 mmHg, CVP 16
mmHg, PAOP 24 mmHg, and cardiac index 1.7 L/min/m². Which medication is most appropriate to
improve cardiac output?
A. Norepinephrine alone
B. Dobutamine or milrinone to increase contractility and reduce afterload [CORRECT]
C. Phenylephrine to increase afterload
D. Nitroprusside at a high dose
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the elevated CVP and PAOP with low
cardiac index indicate cardiogenic shock with biventricular failure and fluid overload. Dobutamine or
milrinone are inodilators that increase myocardial contractility while reducing afterload, improving
cardiac output without further increasing preload. Norepinephrine alone would increase afterload and
worsen cardiac workload, while high-dose nitroprusside could cause dangerous hypotension.
Q6: A patient has an intra-aortic balloon pump (IABP) set at 1:1 counterpulsation. The nurse observes
that the balloon inflates during diastole and deflates just before systole. Which hemodynamic benefit is
achieved?
A. Increased preload to the left ventricle
B. Augmented coronary perfusion and reduced afterload [CORRECT]
C. Decreased heart rate
D. Increased systemic vascular resistance
Correct Answer: B
Rationale: The best answer is B. This choice is correct because IABP counterpulsation inflates during
diastole, which increases aortic root pressure and augments coronary artery perfusion. Deflation just
before systole creates a vacuum effect that reduces afterload, decreasing myocardial oxygen demand
and improving forward cardiac output. This dual mechanism supports the failing left ventricle while
improving coronary blood flow.
, Q7: A patient with acute decompensated heart failure is receiving nitroprusside. The nurse knows the
primary therapeutic effect is:
A. Increased myocardial contractility
B. Afterload and preload reduction through direct arterial and venous dilation [CORRECT]
C. Positive chronotropy
D. Diuresis
Correct Answer: B
Rationale: The best answer is B. This choice is correct because nitroprusside is a potent direct
vasodilator that reduces both afterload (arterial dilation) and preload (venous dilation), decreasing
myocardial workload and improving cardiac output in heart failure. It does not increase contractility or
cause diuresis. The nurse must monitor blood pressure closely due to the risk of profound hypotension,
and cyanide toxicity must be considered with prolonged use.
Q8: A patient in the ICU has an arterial line. The nurse notices the waveform has become dampened
with a lower systolic pressure reading. Which action should the nurse take first?
A. Increase the flush bag pressure to 400 mmHg
B. Check for air bubbles, blood clots, or kinks in the tubing and perform a gentle flush per protocol
[CORRECT]
C. Remove the arterial line and insert a new one
D. Document the lower pressure as accurate
Correct Answer: B
Rationale: The best answer is B. This choice is correct because a dampened arterial waveform typically
indicates a problem with the pressure tubing system—air bubbles, blood clots, kinks, or loose
connections—rather than a true change in the patient's blood pressure. The nurse should systematically
check the entire system, ensure the flush bag is at 300 mmHg, and perform a gentle flush to restore
waveform fidelity. Removing the line is unnecessary if the problem is in the tubing.
Q9: A patient with acute coronary syndrome has ST-segment elevation in leads V1 through V4. Which
coronary artery is most likely occluded?
A. Right coronary artery
B. Left anterior descending artery [CORRECT]
C. Left circumflex artery
D. Posterior descending artery
Correct Answer: B
2026/2027 | Critical Care Nursing, Clinical
Judgment & AACN Test Plan Review | 100+
Verified Questions with Detailed Rationales
This exam contains verified questions drawn from actual AACN CCRN certification exam content for the
2026/2027 cycle. It covers clinical judgment and nursing process application, cardiovascular, pulmonary,
neurological, endocrine, renal, gastrointestinal, and multisystem critical care, and the AACN Synergy
Model for Patient Care. The questions are complex, high-acuity clinical reasoning required for success
on the CCRN exam.
Section 1: Clinical Judgment & Cardiovascular Critical Care — Questions 1–40
Q1: A patient in the ICU has the following hemodynamic readings: MAP 55 mmHg, CVP 4 mmHg, PAOP 6
mmHg, and cardiac index 1.9 L/min/m². Which shock state is most consistent with these findings?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Septic shock
D. Anaphylactic shock
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the low CVP (4 mmHg), low PAOP (6
mmHg), and low cardiac index (1.9 L/min/m²) indicate inadequate preload and low cardiac output,
which are characteristic of hypovolemic shock. The MAP of 55 mmHg confirms hypotension. Cardiogenic
shock would show elevated PAOP with low cardiac output, while septic shock typically presents with low
PAOP and high or normal cardiac output initially.
Q2: A patient with an acute anterior wall myocardial infarction develops a new holosystolic murmur at
the apex, pulmonary edema, and hypotension. The nurse suspects:
,A. Papillary muscle rupture with acute mitral regurgitation [CORRECT]
B. Ventricular septal defect
C. Acute aortic regurgitation
D. Pericardial tamponade
Correct Answer: A
Rationale: The best answer is A. This choice is correct because a new holosystolic murmur at the apex
following an anterior MI strongly suggests papillary muscle rupture causing acute mitral regurgitation.
The resulting pulmonary edema and hypotension reflect acute left ventricular failure and backward
pressure into the pulmonary circulation. This is a mechanical complication requiring emergent surgical
intervention and hemodynamic support with vasodilators and possibly intra-aortic balloon pump.
Q3: A patient is receiving norepinephrine for septic shock. The nurse notes the patient's MAP has
increased from 58 to 72 mmHg, but the fingers and toes are becoming mottled and cool. Which action is
most appropriate?
A. Increase the norepinephrine dose to improve perfusion
B. Assess for excessive vasoconstriction and consider adding a vasodilator or inotrope; notify the
provider [CORRECT]
C. Discontinue the norepinephrine immediately
D. Apply warm blankets and continue current therapy
Correct Answer: B
Rationale: The best answer is B. This choice is correct because while the MAP has improved, the mottled
and cool extremities suggest excessive peripheral vasoconstriction from high-dose norepinephrine,
which can impair tissue perfusion despite adequate blood pressure. The provider may consider adding
dobutamine for inotropic support, using a vasodilator, or adjusting the vasopressor strategy to balance
perfusion pressure with tissue blood flow.
Q4: A patient has a pulmonary artery catheter in place. The nurse obtains the following readings: PA
systolic 28 mmHg, PA diastolic 12 mmHg, and PAOP 8 mmHg. The cardiac output is 5.2 L/min. How
should the nurse interpret the PAOP?
A. The PAOP is elevated, indicating left ventricular failure
B. The PAOP is within normal range, indicating adequate left ventricular preload [CORRECT]
C. The PAOP is critically low, indicating hypovolemia
D. The PAOP cannot be interpreted without the CVP
Correct Answer: B
,Rationale: The best answer is B. This choice is correct because a PAOP of 8 mmHg falls within the normal
range of 6 to 12 mmHg, indicating adequate left ventricular preload. The normal cardiac output of 5.2
L/min supports this interpretation. An elevated PAOP would suggest fluid overload or left heart failure,
while a low PAOP would indicate hypovolemia. The CVP provides additional information about right-
sided preload but is not required to interpret the PAOP.
Q5: A patient with cardiogenic shock has the following hemodynamic profile: MAP 62 mmHg, CVP 16
mmHg, PAOP 24 mmHg, and cardiac index 1.7 L/min/m². Which medication is most appropriate to
improve cardiac output?
A. Norepinephrine alone
B. Dobutamine or milrinone to increase contractility and reduce afterload [CORRECT]
C. Phenylephrine to increase afterload
D. Nitroprusside at a high dose
Correct Answer: B
Rationale: The best answer is B. This choice is correct because the elevated CVP and PAOP with low
cardiac index indicate cardiogenic shock with biventricular failure and fluid overload. Dobutamine or
milrinone are inodilators that increase myocardial contractility while reducing afterload, improving
cardiac output without further increasing preload. Norepinephrine alone would increase afterload and
worsen cardiac workload, while high-dose nitroprusside could cause dangerous hypotension.
Q6: A patient has an intra-aortic balloon pump (IABP) set at 1:1 counterpulsation. The nurse observes
that the balloon inflates during diastole and deflates just before systole. Which hemodynamic benefit is
achieved?
A. Increased preload to the left ventricle
B. Augmented coronary perfusion and reduced afterload [CORRECT]
C. Decreased heart rate
D. Increased systemic vascular resistance
Correct Answer: B
Rationale: The best answer is B. This choice is correct because IABP counterpulsation inflates during
diastole, which increases aortic root pressure and augments coronary artery perfusion. Deflation just
before systole creates a vacuum effect that reduces afterload, decreasing myocardial oxygen demand
and improving forward cardiac output. This dual mechanism supports the failing left ventricle while
improving coronary blood flow.
, Q7: A patient with acute decompensated heart failure is receiving nitroprusside. The nurse knows the
primary therapeutic effect is:
A. Increased myocardial contractility
B. Afterload and preload reduction through direct arterial and venous dilation [CORRECT]
C. Positive chronotropy
D. Diuresis
Correct Answer: B
Rationale: The best answer is B. This choice is correct because nitroprusside is a potent direct
vasodilator that reduces both afterload (arterial dilation) and preload (venous dilation), decreasing
myocardial workload and improving cardiac output in heart failure. It does not increase contractility or
cause diuresis. The nurse must monitor blood pressure closely due to the risk of profound hypotension,
and cyanide toxicity must be considered with prolonged use.
Q8: A patient in the ICU has an arterial line. The nurse notices the waveform has become dampened
with a lower systolic pressure reading. Which action should the nurse take first?
A. Increase the flush bag pressure to 400 mmHg
B. Check for air bubbles, blood clots, or kinks in the tubing and perform a gentle flush per protocol
[CORRECT]
C. Remove the arterial line and insert a new one
D. Document the lower pressure as accurate
Correct Answer: B
Rationale: The best answer is B. This choice is correct because a dampened arterial waveform typically
indicates a problem with the pressure tubing system—air bubbles, blood clots, kinks, or loose
connections—rather than a true change in the patient's blood pressure. The nurse should systematically
check the entire system, ensure the flush bag is at 300 mmHg, and perform a gentle flush to restore
waveform fidelity. Removing the line is unnecessary if the problem is in the tubing.
Q9: A patient with acute coronary syndrome has ST-segment elevation in leads V1 through V4. Which
coronary artery is most likely occluded?
A. Right coronary artery
B. Left anterior descending artery [CORRECT]
C. Left circumflex artery
D. Posterior descending artery
Correct Answer: B
