[CCRN Adult Certification Exam] – EXAM-STYLE QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A 68-year-old patient is admitted to the ICU with a diagnosis of severe sepsis
secondary to a urinary tract infection. The patient's serum lactate is 4.2
mmol/L, and mean arterial pressure (MAP) is 55 mmHg despite a 30 mL/kg
fluid bolus. Which intervention should the nurse anticipate as the immediate
next step in managing this patient's septic shock?
A. Administration of intravenous antibiotics
B. Initiation of continuous renal replacement therapy
C. Placement of a central venous catheter for vasopressor administration
D. Titration of supplemental oxygen to maintain SpO2 above 94%
Correct Answer: C. Placement of a central venous catheter for vasopressor
administration
Rationale: The patient remains hypotensive with a MAP < 65 mmHg and has
elevated lactate despite adequate fluid resuscitation, indicating fluid-refractory
septic shock. The Surviving Sepsis Campaign guidelines recommend the prompt
initiation of vasopressors, preferably norepinephrine, which requires central venous
access. While antibiotic administration (A) is critical and should have been initiated
early, it is not the immediate next step after fluid resuscitation in a patient with
persistent hypotension. Renal replacement therapy (B) is not indicated based on the
information provided. Oxygen supplementation (D) is a supportive measure but
does not address the underlying hemodynamic instability.
,2. A patient with a history of heart failure with reduced ejection fraction is
receiving a continuous infusion of milrinone. The nurse notes the patient's
heart rate has increased from 82 to 112 beats per minute and the patient
reports palpitations. Which action is most appropriate?
A. Discontinue the milrinone infusion immediately
B. Obtain a 12-lead electrocardiogram
C. Administer a beta-blocker as prescribed
D. Reduce the infusion rate by half
Correct Answer: B. Obtain a 12-lead electrocardiogram
Rationale: Tachycardia is a known adverse effect of milrinone, a phosphodiesterase
inhibitor. While this side effect is expected, new-onset palpitations with a significant
heart rate increase warrant a thorough evaluation. Obtaining a 12-lead ECG is the
appropriate initial action to assess for potentially dangerous dysrhythmias such as
atrial fibrillation or ventricular tachycardia before any further interventions.
Discontinuing the infusion (A) may be too drastic without a clear indication of a
life-threatening arrhythmia and could precipitate acute decompensation.
Administering a beta-blocker (C) is not the first step without an ECG to rule out
other causes, and reducing the rate (D) is not appropriate without a comprehensive
assessment.
3. A patient is being mechanically ventilated in the pressure control mode with
a set inspiratory pressure of 16 cm H2O and a rate of 14 breaths per minute.
The nurse observes that the patient's exhaled tidal volumes are consistently
decreasing from 520 mL to 430 mL. The peak inspiratory pressure remains
stable. What is the most likely cause of this change?
,A. A decrease in lung compliance
B. An increase in airway resistance
C. A developing pneumothorax
D. A leak in the ventilator circuit
Correct Answer: D. A leak in the ventilator circuit
Rationale: In pressure control ventilation, the ventilator delivers a set pressure, and
the resulting tidal volume is determined by the patient's lung compliance and
airway resistance. If there is a circuit leak, the set pressure may still be achieved, but
the volume delivered to the patient will decrease. A decrease in compliance (A)
would typically cause a decrease in tidal volume, but it would also likely cause an
increase in peak inspiratory pressure, which is not the case here. An increase in
airway resistance (B) would also typically cause a decrease in volume delivered, but
the peak pressure would be likely to increase. A developing pneumothorax (C)
would also cause a decrease in tidal volume and would likely cause a pressure
change or hemodynamic instability, making a circuit leak a more plausible and
common cause given stable pressures.
4. Which finding in a patient who has sustained a moderate traumatic brain
injury is the earliest and most sensitive indicator of increasing intracranial
pressure?
A. A change in level of consciousness
B. A widening pulse pressure
C. A unilateral, fixed and dilated pupil
D. A Cushing's triad (hypertension, bradycardia, irregular respirations)
Correct Answer: A. A change in level of consciousness
, Rationale: A change in level of consciousness (LOC) is the earliest and most
sensitive clinical indicator of increasing intracranial pressure (ICP). As ICP rises,
cerebral perfusion decreases, affecting the reticular activating system and higher
cortical functions first. While a widened pulse pressure (B) and Cushing's triad (D)
are classic late signs of cerebral herniation and severe intracranial hypertension. A
unilateral, fixed and dilated pupil (C) indicates uncal herniation and compression of
the oculomotor nerve, which is also a late and ominous sign.
5. The nurse is caring for a patient receiving a balanced crystalloid solution.
The patient's serum sodium is 128 mEq/L, and the urine osmolality is 650
mOsm/kg. Which type of fluid imbalance does the nurse suspect?
A. Hypervolemic hyponatremia
B. Hypovolemic hyponatremia
C. Euvolemic hyponatremia
D. Hypertonic hyponatremia
Correct Answer: B. Hypovolemic hyponatremia
Rationale: The patient's serum sodium is low (hyponatremia). Urine osmolality of >
100 mOsm/kg indicates the kidneys are attempting to conserve water, which is an
appropriate response to hypovolemia. This is a hallmark of hypovolemic
hyponatremia where total body water is decreased, but sodium loss is
proportionally greater. In hypervolemic hyponatremia (A), the urine would typically
be dilute (osmolality < 100) due to conditions like SIADH. Euvolemic hyponatremia
(C) would also present with a dilute urine. Hypertonic hyponatremia (D) is not a
fluid imbalance type but rather refers to the serum tonicity.
6. A 74-year-old patient is three hours post-hemorrhagic stroke and is now
somnolent with a Glasgow Coma Scale score of 10. Blood pressure is 185/95
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A 68-year-old patient is admitted to the ICU with a diagnosis of severe sepsis
secondary to a urinary tract infection. The patient's serum lactate is 4.2
mmol/L, and mean arterial pressure (MAP) is 55 mmHg despite a 30 mL/kg
fluid bolus. Which intervention should the nurse anticipate as the immediate
next step in managing this patient's septic shock?
A. Administration of intravenous antibiotics
B. Initiation of continuous renal replacement therapy
C. Placement of a central venous catheter for vasopressor administration
D. Titration of supplemental oxygen to maintain SpO2 above 94%
Correct Answer: C. Placement of a central venous catheter for vasopressor
administration
Rationale: The patient remains hypotensive with a MAP < 65 mmHg and has
elevated lactate despite adequate fluid resuscitation, indicating fluid-refractory
septic shock. The Surviving Sepsis Campaign guidelines recommend the prompt
initiation of vasopressors, preferably norepinephrine, which requires central venous
access. While antibiotic administration (A) is critical and should have been initiated
early, it is not the immediate next step after fluid resuscitation in a patient with
persistent hypotension. Renal replacement therapy (B) is not indicated based on the
information provided. Oxygen supplementation (D) is a supportive measure but
does not address the underlying hemodynamic instability.
,2. A patient with a history of heart failure with reduced ejection fraction is
receiving a continuous infusion of milrinone. The nurse notes the patient's
heart rate has increased from 82 to 112 beats per minute and the patient
reports palpitations. Which action is most appropriate?
A. Discontinue the milrinone infusion immediately
B. Obtain a 12-lead electrocardiogram
C. Administer a beta-blocker as prescribed
D. Reduce the infusion rate by half
Correct Answer: B. Obtain a 12-lead electrocardiogram
Rationale: Tachycardia is a known adverse effect of milrinone, a phosphodiesterase
inhibitor. While this side effect is expected, new-onset palpitations with a significant
heart rate increase warrant a thorough evaluation. Obtaining a 12-lead ECG is the
appropriate initial action to assess for potentially dangerous dysrhythmias such as
atrial fibrillation or ventricular tachycardia before any further interventions.
Discontinuing the infusion (A) may be too drastic without a clear indication of a
life-threatening arrhythmia and could precipitate acute decompensation.
Administering a beta-blocker (C) is not the first step without an ECG to rule out
other causes, and reducing the rate (D) is not appropriate without a comprehensive
assessment.
3. A patient is being mechanically ventilated in the pressure control mode with
a set inspiratory pressure of 16 cm H2O and a rate of 14 breaths per minute.
The nurse observes that the patient's exhaled tidal volumes are consistently
decreasing from 520 mL to 430 mL. The peak inspiratory pressure remains
stable. What is the most likely cause of this change?
,A. A decrease in lung compliance
B. An increase in airway resistance
C. A developing pneumothorax
D. A leak in the ventilator circuit
Correct Answer: D. A leak in the ventilator circuit
Rationale: In pressure control ventilation, the ventilator delivers a set pressure, and
the resulting tidal volume is determined by the patient's lung compliance and
airway resistance. If there is a circuit leak, the set pressure may still be achieved, but
the volume delivered to the patient will decrease. A decrease in compliance (A)
would typically cause a decrease in tidal volume, but it would also likely cause an
increase in peak inspiratory pressure, which is not the case here. An increase in
airway resistance (B) would also typically cause a decrease in volume delivered, but
the peak pressure would be likely to increase. A developing pneumothorax (C)
would also cause a decrease in tidal volume and would likely cause a pressure
change or hemodynamic instability, making a circuit leak a more plausible and
common cause given stable pressures.
4. Which finding in a patient who has sustained a moderate traumatic brain
injury is the earliest and most sensitive indicator of increasing intracranial
pressure?
A. A change in level of consciousness
B. A widening pulse pressure
C. A unilateral, fixed and dilated pupil
D. A Cushing's triad (hypertension, bradycardia, irregular respirations)
Correct Answer: A. A change in level of consciousness
, Rationale: A change in level of consciousness (LOC) is the earliest and most
sensitive clinical indicator of increasing intracranial pressure (ICP). As ICP rises,
cerebral perfusion decreases, affecting the reticular activating system and higher
cortical functions first. While a widened pulse pressure (B) and Cushing's triad (D)
are classic late signs of cerebral herniation and severe intracranial hypertension. A
unilateral, fixed and dilated pupil (C) indicates uncal herniation and compression of
the oculomotor nerve, which is also a late and ominous sign.
5. The nurse is caring for a patient receiving a balanced crystalloid solution.
The patient's serum sodium is 128 mEq/L, and the urine osmolality is 650
mOsm/kg. Which type of fluid imbalance does the nurse suspect?
A. Hypervolemic hyponatremia
B. Hypovolemic hyponatremia
C. Euvolemic hyponatremia
D. Hypertonic hyponatremia
Correct Answer: B. Hypovolemic hyponatremia
Rationale: The patient's serum sodium is low (hyponatremia). Urine osmolality of >
100 mOsm/kg indicates the kidneys are attempting to conserve water, which is an
appropriate response to hypovolemia. This is a hallmark of hypovolemic
hyponatremia where total body water is decreased, but sodium loss is
proportionally greater. In hypervolemic hyponatremia (A), the urine would typically
be dilute (osmolality < 100) due to conditions like SIADH. Euvolemic hyponatremia
(C) would also present with a dilute urine. Hypertonic hyponatremia (D) is not a
fluid imbalance type but rather refers to the serum tonicity.
6. A 74-year-old patient is three hours post-hemorrhagic stroke and is now
somnolent with a Glasgow Coma Scale score of 10. Blood pressure is 185/95
