1|Page
(CCRN) CRITICAL CARE REGISTERED NURSE EXAM
NEWEST 2025 ACTUAL EXAM TEST BANK| COMPLETE 450
REAL EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS WITH RATIONALES)
GRADED A+| CCRN EXAM PREP|| BRAND NEW!!
A patient experiencing alcohol withdrawal syndrome describes the
swirls in the wallpaper as being worms. This is an example of which of
the following?
A. Delusion
B. Hallucination
C. Illusion
D. Visual impairment - Correct Answer - C. Illusion
An illusion is a misperception or misinterpretation of an actual external
stimulus. Illusions and hallucinations (a perception that has no actual
external stimulus) are common during alcohol withdrawal syndrome.
A patient arrives in the emergency department with multiple gunshot
wounds. He requires massive transfusion for blood loss from chest and
abdominal wounds. The electrocardiogram should be observed closely
for changes indicative of which of the following?
A. Atrioventricular block
B. Hyperkalemia
C. Hypercalcemia
D. Hypomagnesemia - Correct Answer - Hyperkalemia
Banked blood is high in potassium because of hemolysis. Look for tall,
peaked T waves and widening of the QRS complex. Other
pg. 1
,2|Page
considerations with massive transfusion of banked blood are
hypocalcemia, hypothermia, and decreased tissue oxygen delivery
caused by decreased levels of 2,3-diphosphoglycerate.
A 65-year-old woman reports severe dyspnea 2 days after abdominal
surgery. She is transferred to the critical care unit. On 5 L of oxygen by
nasal cannula, her arterial blood gases are as follows:
pH 7.39
PaCO2 35 mm Hg
HCO3 19 mEq/L
PaO2 40 mm Hg
Arterial oxygen saturation 75%
Why does this patient have hypoxemia without hypercapnia?
A. Because carbon dioxide is more diffusible than oxygen
B. Because carbon dioxide has more driving pressure
C. Because carbon dioxide is less diffusible than oxygen
D. Because carbon dioxide excretion by the kidney is increased -
Correct Answer - Because carbon dioxide is more diffusible than oxygen
Carbon dioxide is 20 times more diffusible than oxygen. In conditions
that affect diffusion but do not affect ventilation, expect the PaO2 to be
decreased and the PaCO2 to be normal (or decreased in hyperventilation,
as in this patient). If ventilation were affected, such as if this patient
were fatiguing, the PaCO2 then would increase. Driving pressure is the
fraction of the gas in inspired air multiplied by the barometric pressure.
Because carbon dioxide is ~0.5% of inspired air, the driving pressure
pg. 2
,3|Page
would be very low. The kidney eliminates bicarbonate and hydrogen
ions, but the lungs eliminate carbon dioxide.
A 55-year-old patient has headache, nuchal rigidity, photophobia, and
positive Kernig's and Brudzinski's signs. These are consistent with
which of the following?
A. Intracranial hemorrhage
B. Subarachnoid hemorrhage
C. Epidural hemorrhage
D. Subdural hemorrhage - Correct Answer - Subarachnoid hemorrhage
When there is bleeding from an aneurysm, that blood irritates the
meninges. The clinical presentation is very similar to meningitis. This
clinical presentation is not consistent with intracranial, epidural, or
subdural bleeding because the blood is not in contact with the meninges
in those situations.
A 58-year-old man is admitted to the critical care unit with upper
gastrointestinal bleeding. He has a history of chronic renal failure. When
one is administering antacids, it is important to remember to avoid:
A. magnesium-containing antacids.
B. phosphate-binding antacids.
C. calcium-containing antacids.
D. histamine2 receptor antagonists. - Correct Answer - magnesium-
containing antacids.
Magnesium-containing antacids can lead to magnesium intoxication in
the patient with renal failure.
pg. 3
, 4|Page
A patient is complaining of dull, diffuse abdominal pain. Of the
following possible causes, which is most likely to be the cause?
A. Appendicitis
B. Cholecystitis
C. Ulcerative colitis
D. Large intestinal obstruction - Correct Answer - Large intestinal
obstruction
The rest are sharp pain
Vt for extubation - Correct Answer - 5ml/kg
A 30-year-old man is in the surgical intensive care unit after exploratory
laparotomy performed after he sustained a gunshot wound to the
abdomen. He now has developed a pancreatic fistula. Which acid-base
imbalance is this patient at risk for developing?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis - Correct Answer - Metabolic acidosis
The stomach is acidic, but the gastrointestinal tract below the stomach is
alkaline. Pancreatic secretions are rich in bicarbonate, and these losses
would cause metabolic acidosis.
A 65-year-old man was admitted 2 hours ago after coronary artery
bypass grafting. He has had the following vital sign changes:
Admission 2 Hours Later
pg. 4
(CCRN) CRITICAL CARE REGISTERED NURSE EXAM
NEWEST 2025 ACTUAL EXAM TEST BANK| COMPLETE 450
REAL EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS WITH RATIONALES)
GRADED A+| CCRN EXAM PREP|| BRAND NEW!!
A patient experiencing alcohol withdrawal syndrome describes the
swirls in the wallpaper as being worms. This is an example of which of
the following?
A. Delusion
B. Hallucination
C. Illusion
D. Visual impairment - Correct Answer - C. Illusion
An illusion is a misperception or misinterpretation of an actual external
stimulus. Illusions and hallucinations (a perception that has no actual
external stimulus) are common during alcohol withdrawal syndrome.
A patient arrives in the emergency department with multiple gunshot
wounds. He requires massive transfusion for blood loss from chest and
abdominal wounds. The electrocardiogram should be observed closely
for changes indicative of which of the following?
A. Atrioventricular block
B. Hyperkalemia
C. Hypercalcemia
D. Hypomagnesemia - Correct Answer - Hyperkalemia
Banked blood is high in potassium because of hemolysis. Look for tall,
peaked T waves and widening of the QRS complex. Other
pg. 1
,2|Page
considerations with massive transfusion of banked blood are
hypocalcemia, hypothermia, and decreased tissue oxygen delivery
caused by decreased levels of 2,3-diphosphoglycerate.
A 65-year-old woman reports severe dyspnea 2 days after abdominal
surgery. She is transferred to the critical care unit. On 5 L of oxygen by
nasal cannula, her arterial blood gases are as follows:
pH 7.39
PaCO2 35 mm Hg
HCO3 19 mEq/L
PaO2 40 mm Hg
Arterial oxygen saturation 75%
Why does this patient have hypoxemia without hypercapnia?
A. Because carbon dioxide is more diffusible than oxygen
B. Because carbon dioxide has more driving pressure
C. Because carbon dioxide is less diffusible than oxygen
D. Because carbon dioxide excretion by the kidney is increased -
Correct Answer - Because carbon dioxide is more diffusible than oxygen
Carbon dioxide is 20 times more diffusible than oxygen. In conditions
that affect diffusion but do not affect ventilation, expect the PaO2 to be
decreased and the PaCO2 to be normal (or decreased in hyperventilation,
as in this patient). If ventilation were affected, such as if this patient
were fatiguing, the PaCO2 then would increase. Driving pressure is the
fraction of the gas in inspired air multiplied by the barometric pressure.
Because carbon dioxide is ~0.5% of inspired air, the driving pressure
pg. 2
,3|Page
would be very low. The kidney eliminates bicarbonate and hydrogen
ions, but the lungs eliminate carbon dioxide.
A 55-year-old patient has headache, nuchal rigidity, photophobia, and
positive Kernig's and Brudzinski's signs. These are consistent with
which of the following?
A. Intracranial hemorrhage
B. Subarachnoid hemorrhage
C. Epidural hemorrhage
D. Subdural hemorrhage - Correct Answer - Subarachnoid hemorrhage
When there is bleeding from an aneurysm, that blood irritates the
meninges. The clinical presentation is very similar to meningitis. This
clinical presentation is not consistent with intracranial, epidural, or
subdural bleeding because the blood is not in contact with the meninges
in those situations.
A 58-year-old man is admitted to the critical care unit with upper
gastrointestinal bleeding. He has a history of chronic renal failure. When
one is administering antacids, it is important to remember to avoid:
A. magnesium-containing antacids.
B. phosphate-binding antacids.
C. calcium-containing antacids.
D. histamine2 receptor antagonists. - Correct Answer - magnesium-
containing antacids.
Magnesium-containing antacids can lead to magnesium intoxication in
the patient with renal failure.
pg. 3
, 4|Page
A patient is complaining of dull, diffuse abdominal pain. Of the
following possible causes, which is most likely to be the cause?
A. Appendicitis
B. Cholecystitis
C. Ulcerative colitis
D. Large intestinal obstruction - Correct Answer - Large intestinal
obstruction
The rest are sharp pain
Vt for extubation - Correct Answer - 5ml/kg
A 30-year-old man is in the surgical intensive care unit after exploratory
laparotomy performed after he sustained a gunshot wound to the
abdomen. He now has developed a pancreatic fistula. Which acid-base
imbalance is this patient at risk for developing?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis - Correct Answer - Metabolic acidosis
The stomach is acidic, but the gastrointestinal tract below the stomach is
alkaline. Pancreatic secretions are rich in bicarbonate, and these losses
would cause metabolic acidosis.
A 65-year-old man was admitted 2 hours ago after coronary artery
bypass grafting. He has had the following vital sign changes:
Admission 2 Hours Later
pg. 4
