CCRN CRITICAL CARE REGISTERED NURSE
PRACTICE EXAMINATION 2026–2027 — STUDY GUIDE
| LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A client with septic shock has a blood pressure of 78/45 mm Hg,
central venous pressure of 2 mm Hg, and a cardiac index of 1.8
L/min/m². Which initial intervention is most appropriate?
A) Start a norepinephrine infusion
B) Administer a 30 mL/kg crystalloid bolus
C) Give furosemide IV
D) Start a dobutamine infusion
Correct Answer: B
The low CVP indicates hypovolemia; in septic shock, initial management
includes fluid resuscitation with 30 mL/kg crystalloid before or with
vasopressors. Norepinephrine may be added if MAP remains <65 after
fluid. Furosemide would worsen hypovolemia. Dobutamine is not first-
line without fluid resuscitation.
2. A client on mechanical ventilation has the following arterial blood
gas: pH 7.28, PaCO₂ 55 mm Hg, HCO₃⁻ 24 mEq/L, PaO₂ 75 mm Hg
on FiO₂ 0.60. What is the primary acid-base disturbance?
A) Uncompensated metabolic acidosis
B) Uncompensated respiratory acidosis
, C) Partially compensated respiratory acidosis
D) Combined metabolic and respiratory acidosis
Correct Answer: B
Low pH with elevated PaCO₂ and normal HCO₃⁻ indicates
uncompensated respiratory acidosis. If HCO₃⁻ were elevated, it would be
partially compensated. Metabolic acidosis would show low HCO₃⁻.
Combined would show both low HCO₃⁻ and high PaCO₂.
3. A nurse is caring for a client with an acute anterior myocardial
infarction. Which hemodynamic finding indicates cardiogenic
shock?
A) Cardiac index 3.0 L/min/m² and PAWP 10 mm Hg
B) Cardiac index 1.7 L/min/m² and PAWP 24 mm Hg
C) Cardiac index 4.0 L/min/m² and SVR 600 dynes/sec/cm⁻⁵
D) CVP 2 mm Hg and PAWP 6 mm Hg
Correct Answer: B
Cardiogenic shock is characterized by low cardiac index (<2.2) and
elevated PAWP (>18) due to left ventricular failure. Option A is normal. C
is hyperdynamic sepsis. D suggests hypovolemia.
4. A client with acute respiratory distress syndrome is being
ventilated with low tidal volumes. The PaCO₂ is 60 mm Hg and pH
7.25. What is the most appropriate interpretation?
A) The ventilator settings are inadequate and must be increased
B) Permissive hypercapnia is expected with lung-protective
ventilation
C) The client is hyperventilating
D) The client needs sodium bicarbonate immediately
,Correct Answer: B
Permissive hypercapnia is an expected consequence of low tidal volume
ventilation in ARDS and is tolerated as long as pH remains above 7.20–
7.25. Increasing tidal volumes may cause ventilator-induced lung injury.
Hyperventilation would lower PaCO₂. Bicarbonate is not routinely
indicated for permissive hypercapnia.
5. A client has sustained a traumatic brain injury and develops a
blood pressure of 170/50 mm Hg, heart rate 52 bpm, and irregular
respirations. What does this triad indicate?
A) Neurogenic shock
B) Cushing's triad with increased intracranial pressure
C) Autonomic dysreflexia
D) A normal response to pain
Correct Answer: B
Cushing's triad (hypertension with widened pulse pressure, bradycardia,
irregular respirations) indicates increased intracranial pressure and
brainstem compression. Neurogenic shock causes hypotension and
bradycardia. Autonomic dysreflexia causes hypertension with
bradycardia but is associated with spinal cord injury, not TBI. Pain would
cause tachycardia.
6. A client with sepsis is receiving norepinephrine at 0.3 mcg/kg/min
and has a MAP of 55 mm Hg. What is the next appropriate
intervention?
A) Decrease norepinephrine
B) Add vasopressin or increase norepinephrine
C) Give furosemide
D) Stop all fluids
, Correct Answer: B
If MAP remains below 65 with moderate-dose norepinephrine, adding
vasopressin is recommended per Surviving Sepsis Campaign. Decreasing
norepinephrine or stopping fluids would worsen hypotension.
Furosemide is not indicated.
7. A nurse is monitoring a client with a pulmonary artery catheter.
The PAWP is 25 mm Hg. Which condition is most likely?
A) Hypovolemia
B) Left ventricular failure or fluid overload
C) Pulmonary hypertension without left heart involvement
D) Cardiac tamponade with equalization
Correct Answer: B
Elevated PAWP (>18) indicates increased left ventricular end-diastolic
pressure, usually from left ventricular failure or fluid overload.
Hypovolemia lowers PAWP. Isolated pulmonary hypertension elevates PA
pressure but not PAWP unless left heart failure. Tamponade shows
equalization of diastolic pressures.
8. A client with a severe asthma exacerbation is intubated and
mechanically ventilated. Which ventilator strategy is most
appropriate?
A) High tidal volumes and low respiratory rate
B) Low tidal volumes, low respiratory rate, and permissive
hypercapnia
C) High PEEP always
D) No PEEP
Correct Answer: B
Asthma requires low tidal volumes and low respiratory rates to prevent
PRACTICE EXAMINATION 2026–2027 — STUDY GUIDE
| LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A client with septic shock has a blood pressure of 78/45 mm Hg,
central venous pressure of 2 mm Hg, and a cardiac index of 1.8
L/min/m². Which initial intervention is most appropriate?
A) Start a norepinephrine infusion
B) Administer a 30 mL/kg crystalloid bolus
C) Give furosemide IV
D) Start a dobutamine infusion
Correct Answer: B
The low CVP indicates hypovolemia; in septic shock, initial management
includes fluid resuscitation with 30 mL/kg crystalloid before or with
vasopressors. Norepinephrine may be added if MAP remains <65 after
fluid. Furosemide would worsen hypovolemia. Dobutamine is not first-
line without fluid resuscitation.
2. A client on mechanical ventilation has the following arterial blood
gas: pH 7.28, PaCO₂ 55 mm Hg, HCO₃⁻ 24 mEq/L, PaO₂ 75 mm Hg
on FiO₂ 0.60. What is the primary acid-base disturbance?
A) Uncompensated metabolic acidosis
B) Uncompensated respiratory acidosis
, C) Partially compensated respiratory acidosis
D) Combined metabolic and respiratory acidosis
Correct Answer: B
Low pH with elevated PaCO₂ and normal HCO₃⁻ indicates
uncompensated respiratory acidosis. If HCO₃⁻ were elevated, it would be
partially compensated. Metabolic acidosis would show low HCO₃⁻.
Combined would show both low HCO₃⁻ and high PaCO₂.
3. A nurse is caring for a client with an acute anterior myocardial
infarction. Which hemodynamic finding indicates cardiogenic
shock?
A) Cardiac index 3.0 L/min/m² and PAWP 10 mm Hg
B) Cardiac index 1.7 L/min/m² and PAWP 24 mm Hg
C) Cardiac index 4.0 L/min/m² and SVR 600 dynes/sec/cm⁻⁵
D) CVP 2 mm Hg and PAWP 6 mm Hg
Correct Answer: B
Cardiogenic shock is characterized by low cardiac index (<2.2) and
elevated PAWP (>18) due to left ventricular failure. Option A is normal. C
is hyperdynamic sepsis. D suggests hypovolemia.
4. A client with acute respiratory distress syndrome is being
ventilated with low tidal volumes. The PaCO₂ is 60 mm Hg and pH
7.25. What is the most appropriate interpretation?
A) The ventilator settings are inadequate and must be increased
B) Permissive hypercapnia is expected with lung-protective
ventilation
C) The client is hyperventilating
D) The client needs sodium bicarbonate immediately
,Correct Answer: B
Permissive hypercapnia is an expected consequence of low tidal volume
ventilation in ARDS and is tolerated as long as pH remains above 7.20–
7.25. Increasing tidal volumes may cause ventilator-induced lung injury.
Hyperventilation would lower PaCO₂. Bicarbonate is not routinely
indicated for permissive hypercapnia.
5. A client has sustained a traumatic brain injury and develops a
blood pressure of 170/50 mm Hg, heart rate 52 bpm, and irregular
respirations. What does this triad indicate?
A) Neurogenic shock
B) Cushing's triad with increased intracranial pressure
C) Autonomic dysreflexia
D) A normal response to pain
Correct Answer: B
Cushing's triad (hypertension with widened pulse pressure, bradycardia,
irregular respirations) indicates increased intracranial pressure and
brainstem compression. Neurogenic shock causes hypotension and
bradycardia. Autonomic dysreflexia causes hypertension with
bradycardia but is associated with spinal cord injury, not TBI. Pain would
cause tachycardia.
6. A client with sepsis is receiving norepinephrine at 0.3 mcg/kg/min
and has a MAP of 55 mm Hg. What is the next appropriate
intervention?
A) Decrease norepinephrine
B) Add vasopressin or increase norepinephrine
C) Give furosemide
D) Stop all fluids
, Correct Answer: B
If MAP remains below 65 with moderate-dose norepinephrine, adding
vasopressin is recommended per Surviving Sepsis Campaign. Decreasing
norepinephrine or stopping fluids would worsen hypotension.
Furosemide is not indicated.
7. A nurse is monitoring a client with a pulmonary artery catheter.
The PAWP is 25 mm Hg. Which condition is most likely?
A) Hypovolemia
B) Left ventricular failure or fluid overload
C) Pulmonary hypertension without left heart involvement
D) Cardiac tamponade with equalization
Correct Answer: B
Elevated PAWP (>18) indicates increased left ventricular end-diastolic
pressure, usually from left ventricular failure or fluid overload.
Hypovolemia lowers PAWP. Isolated pulmonary hypertension elevates PA
pressure but not PAWP unless left heart failure. Tamponade shows
equalization of diastolic pressures.
8. A client with a severe asthma exacerbation is intubated and
mechanically ventilated. Which ventilator strategy is most
appropriate?
A) High tidal volumes and low respiratory rate
B) Low tidal volumes, low respiratory rate, and permissive
hypercapnia
C) High PEEP always
D) No PEEP
Correct Answer: B
Asthma requires low tidal volumes and low respiratory rates to prevent
