New 2025 Adult CCRN Certification Exam by AACN
Latest Version with All 150 Questions from Actual
Exams and 100% Correct Answers
1. A 68-year-old male patient in the ICU develops sudden chest pain, ST-segment elevation
in leads V1-V4, and hypotension (BP 88/56 mm Hg). ECG shows sinus tachycardia at
110 bpm. What is the priority nursing intervention?
A) Administer morphine sulfate IV as ordered.
B) Prepare for immediate percutaneous coronary intervention (PCI).
C) Apply oxygen via nasal cannula at 2 L/min.
D) Increase IV fluids to 500 mL bolus. Correct Answer: B) Prepare for immediate
percutaneous coronary intervention (PCI).
Rationale: This scenario indicates acute anterior STEMI (ST-elevation myocardial
infarction). Per AACN guidelines and AHA/ACC standards, the priority is reperfusion
therapy via PCI within 90 minutes of first medical contact to restore coronary blood flow
and limit myocardial damage.
2. A patient with cardiogenic shock post-MI has a pulmonary artery catheter showing
PAWP 25 mm Hg, CI 1.8 L/min/m², and SVR 1,800 dynes/sec/cm⁻⁵. What
pharmacologic intervention is most appropriate to improve cardiac output?
A) Dobutamine infusion.
B) Nitroglycerin drip.
C) Vasopressin bolus.
D) Esmolol IV push. Correct Answer: A) Dobutamine infusion.
Rationale: In cardiogenic shock (low CI, high PAWP), dobutamine (a beta-1 agonist)
enhances contractility and cardiac output without significantly increasing afterload. This
aligns with AACN hemodynamic monitoring protocols for shock states.
3. During continuous veno-venous hemofiltration (CVVH) for a patient with acute heart
failure and fluid overload, the nurse notes a sudden drop in BP to 82/50 mm Hg. What is
the most likely cause?
A) Hypovolemia from ultrafiltration.
B) Air embolism in the circuit.
C) Hyperkalemia from dialysate.
D) Allergic reaction to heparin. Correct Answer: A) Hypovolemia from ultrafiltration.
Rationale: Rapid fluid removal in CVVH can cause hypotension due to decreased
intravascular volume. AACN renal replacement therapy guidelines emphasize monitoring
fluid balance and adjusting rates to prevent hypovolemia.
4. A post-op CABG patient develops atrial fibrillation with rapid ventricular response (HR
140 bpm). The patient is hemodynamically stable. What is the initial pharmacologic
treatment?
A) Amiodarone IV bolus followed by infusion.
B) Synchronized cardioversion at 100 J.
C) Beta-blocker like metoprolol IV.
D) Digoxin loading dose. Correct Answer: C) Beta-blocker like metoprolol IV.
Rationale: For new-onset AF with RVR in stable patients, rate control with IV beta-
, blockers is first-line per AHA guidelines, as it slows AV conduction. AACN cardiac
dysrhythmia management supports this approach.
5. In assessing a patient with suspected pericardial tamponade, which clinical finding is
most indicative?
A) Bounding pulses and hypertension.
B) Muffled heart sounds and jugular vein distension.
C) Peripheral edema and crackles.
D) S3 gallop and tachycardia. Correct Answer: B) Muffled heart sounds and jugular vein
distension.
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) is classic for
tamponade. AACN cardiovascular assessment emphasizes recognizing these signs for
emergent pericardiocentesis.
6. A patient receiving nitroprusside for hypertensive crisis develops metabolic acidosis.
What is the most likely cause?
A) Cyanide toxicity from nitroprusside metabolites.
B) Hypokalemia from diuresis.
C) Hyperchloremia from fluids.
D) Lactic acidosis from hypoperfusion. Correct Answer: A) Cyanide toxicity from
nitroprusside metabolites.
Rationale: Prolonged nitroprusside use can lead to cyanide accumulation, causing lactic
acidosis. AACN pharmacology in critical care requires monitoring thiocyanate levels and
using antidotes like hydroxocobalamin if needed.
7. For a patient with aortic dissection (Stanford Type A), what is the priority preoperative
nursing action?
A) Administer beta-blockers to reduce shear stress.
B) Prepare for surgical repair.
C) Start anticoagulation therapy.
D) Perform frequent neuro checks only. Correct Answer: B) Prepare for immediate
surgical repair.
Rationale: Type A dissection involves the ascending aorta and requires emergent surgery.
AACN vascular emergency protocols prioritize surgical intervention, with beta-blockers
for BP/HR control pre-op.
8. A patient with ventricular assist device (VAD) alarms for low flow. What is the first
assessment?
A) Check for kinks or obstruction in the driveline.
B) Increase anticoagulation dose.
C) Administer vasopressors.
D) Perform CPR. Correct Answer: A) Check for kinks or obstruction in the driveline.
Rationale: Low flow alarms in VADs often result from pump thrombosis or
inflow/outflow obstruction. AACN mechanical circulatory support guidelines stress
troubleshooting the device first.
9. In managing a patient with pulmonary hypertension crisis, what ventilatory strategy is
recommended?
A) High PEEP to recruit alveoli.
B) Low tidal volume with prone positioning.
C) 100% FiO2 continuously.
, D) Avoid sedation to maintain drive. Correct Answer: B) Low tidal volume with prone
positioning.
Rationale: Protective ventilation (6 mL/kg TV, Pplat <30 cm H2O) prevents V/Q
mismatch in pulmonary HTN. AACN respiratory management integrates ARDSnet
protocols for right heart strain.
10. A post-cardiac arrest patient has therapeutic hypothermia initiated. What electrolyte
imbalance is most common?
A) Hyperkalemia due to cooling.
B) Hypokalemia from shifting.
C) Hyponatremia from fluids.
D) Hypocalcemia from citrate. Correct Answer: B) Hypokalemia from shifting.
Rationale: During induced hypothermia, potassium shifts intracellularly, causing
hypokalemia. AACN post-arrest care guidelines recommend monitoring and
supplementing K+ to 4-5 mEq/L.
11. For a patient with infective endocarditis, what diagnostic criterion is met by positive
blood cultures for typical organisms?
A) Major criterion.
B) Minor criterion.
C) Not applicable.
D) Only if vegetation seen on echo. Correct Answer: A) Major criterion.
Rationale: Per Duke criteria, persistent bacteremia with typical organisms (e.g., Staph
aureus) is a major diagnostic criterion for IE. AACN infectious disease protocols
emphasize early cultures.
12. A patient on ECMO for cardiogenic shock develops hemolysis. What is the likely cause?
A) Excessive anticoagulation.
B) Pump malfunction or high RPM.
C) Hypothermia.
D) Sepsis. Correct Answer: B) Pump malfunction or high RPM.
Rationale: Mechanical shear stress from pump issues causes RBC destruction. AACN
ECMO management requires monitoring LDH/plasma-free Hb for complications.
13. In assessing for cardiogenic pulmonary edema, which finding is most specific?
A) Crackles in bases.
B) S3 heart sound.
C) Orthopnea.
D) PND. Correct Answer: B) S3 heart sound.
Rationale: S3 indicates ventricular gallop from fluid overload in cardiogenic edema.
AACN cardiovascular assessment differentiates from non-cardiogenic causes.
14. A patient with ACS receives heparin. What lab value requires immediate intervention if
PT/INR is 1.5?
A) No intervention; therapeutic for UFH.
B) Hold heparin; target aPTT 1.5-2.5x normal.
C) Reverse with protamine.
D) Switch to LMWH. Correct Answer: B) Hold heparin; target aPTT 1.5-2.5x normal.
Rationale: Unfractionated heparin is monitored by aPTT, not PT/INR (for warfarin).
Elevated PT suggests over-anticoagulation or other factors; AACN pharmacology
guidelines prioritize aPTT.
Latest Version with All 150 Questions from Actual
Exams and 100% Correct Answers
1. A 68-year-old male patient in the ICU develops sudden chest pain, ST-segment elevation
in leads V1-V4, and hypotension (BP 88/56 mm Hg). ECG shows sinus tachycardia at
110 bpm. What is the priority nursing intervention?
A) Administer morphine sulfate IV as ordered.
B) Prepare for immediate percutaneous coronary intervention (PCI).
C) Apply oxygen via nasal cannula at 2 L/min.
D) Increase IV fluids to 500 mL bolus. Correct Answer: B) Prepare for immediate
percutaneous coronary intervention (PCI).
Rationale: This scenario indicates acute anterior STEMI (ST-elevation myocardial
infarction). Per AACN guidelines and AHA/ACC standards, the priority is reperfusion
therapy via PCI within 90 minutes of first medical contact to restore coronary blood flow
and limit myocardial damage.
2. A patient with cardiogenic shock post-MI has a pulmonary artery catheter showing
PAWP 25 mm Hg, CI 1.8 L/min/m², and SVR 1,800 dynes/sec/cm⁻⁵. What
pharmacologic intervention is most appropriate to improve cardiac output?
A) Dobutamine infusion.
B) Nitroglycerin drip.
C) Vasopressin bolus.
D) Esmolol IV push. Correct Answer: A) Dobutamine infusion.
Rationale: In cardiogenic shock (low CI, high PAWP), dobutamine (a beta-1 agonist)
enhances contractility and cardiac output without significantly increasing afterload. This
aligns with AACN hemodynamic monitoring protocols for shock states.
3. During continuous veno-venous hemofiltration (CVVH) for a patient with acute heart
failure and fluid overload, the nurse notes a sudden drop in BP to 82/50 mm Hg. What is
the most likely cause?
A) Hypovolemia from ultrafiltration.
B) Air embolism in the circuit.
C) Hyperkalemia from dialysate.
D) Allergic reaction to heparin. Correct Answer: A) Hypovolemia from ultrafiltration.
Rationale: Rapid fluid removal in CVVH can cause hypotension due to decreased
intravascular volume. AACN renal replacement therapy guidelines emphasize monitoring
fluid balance and adjusting rates to prevent hypovolemia.
4. A post-op CABG patient develops atrial fibrillation with rapid ventricular response (HR
140 bpm). The patient is hemodynamically stable. What is the initial pharmacologic
treatment?
A) Amiodarone IV bolus followed by infusion.
B) Synchronized cardioversion at 100 J.
C) Beta-blocker like metoprolol IV.
D) Digoxin loading dose. Correct Answer: C) Beta-blocker like metoprolol IV.
Rationale: For new-onset AF with RVR in stable patients, rate control with IV beta-
, blockers is first-line per AHA guidelines, as it slows AV conduction. AACN cardiac
dysrhythmia management supports this approach.
5. In assessing a patient with suspected pericardial tamponade, which clinical finding is
most indicative?
A) Bounding pulses and hypertension.
B) Muffled heart sounds and jugular vein distension.
C) Peripheral edema and crackles.
D) S3 gallop and tachycardia. Correct Answer: B) Muffled heart sounds and jugular vein
distension.
Rationale: Beck's triad (hypotension, muffled heart sounds, JVD) is classic for
tamponade. AACN cardiovascular assessment emphasizes recognizing these signs for
emergent pericardiocentesis.
6. A patient receiving nitroprusside for hypertensive crisis develops metabolic acidosis.
What is the most likely cause?
A) Cyanide toxicity from nitroprusside metabolites.
B) Hypokalemia from diuresis.
C) Hyperchloremia from fluids.
D) Lactic acidosis from hypoperfusion. Correct Answer: A) Cyanide toxicity from
nitroprusside metabolites.
Rationale: Prolonged nitroprusside use can lead to cyanide accumulation, causing lactic
acidosis. AACN pharmacology in critical care requires monitoring thiocyanate levels and
using antidotes like hydroxocobalamin if needed.
7. For a patient with aortic dissection (Stanford Type A), what is the priority preoperative
nursing action?
A) Administer beta-blockers to reduce shear stress.
B) Prepare for surgical repair.
C) Start anticoagulation therapy.
D) Perform frequent neuro checks only. Correct Answer: B) Prepare for immediate
surgical repair.
Rationale: Type A dissection involves the ascending aorta and requires emergent surgery.
AACN vascular emergency protocols prioritize surgical intervention, with beta-blockers
for BP/HR control pre-op.
8. A patient with ventricular assist device (VAD) alarms for low flow. What is the first
assessment?
A) Check for kinks or obstruction in the driveline.
B) Increase anticoagulation dose.
C) Administer vasopressors.
D) Perform CPR. Correct Answer: A) Check for kinks or obstruction in the driveline.
Rationale: Low flow alarms in VADs often result from pump thrombosis or
inflow/outflow obstruction. AACN mechanical circulatory support guidelines stress
troubleshooting the device first.
9. In managing a patient with pulmonary hypertension crisis, what ventilatory strategy is
recommended?
A) High PEEP to recruit alveoli.
B) Low tidal volume with prone positioning.
C) 100% FiO2 continuously.
, D) Avoid sedation to maintain drive. Correct Answer: B) Low tidal volume with prone
positioning.
Rationale: Protective ventilation (6 mL/kg TV, Pplat <30 cm H2O) prevents V/Q
mismatch in pulmonary HTN. AACN respiratory management integrates ARDSnet
protocols for right heart strain.
10. A post-cardiac arrest patient has therapeutic hypothermia initiated. What electrolyte
imbalance is most common?
A) Hyperkalemia due to cooling.
B) Hypokalemia from shifting.
C) Hyponatremia from fluids.
D) Hypocalcemia from citrate. Correct Answer: B) Hypokalemia from shifting.
Rationale: During induced hypothermia, potassium shifts intracellularly, causing
hypokalemia. AACN post-arrest care guidelines recommend monitoring and
supplementing K+ to 4-5 mEq/L.
11. For a patient with infective endocarditis, what diagnostic criterion is met by positive
blood cultures for typical organisms?
A) Major criterion.
B) Minor criterion.
C) Not applicable.
D) Only if vegetation seen on echo. Correct Answer: A) Major criterion.
Rationale: Per Duke criteria, persistent bacteremia with typical organisms (e.g., Staph
aureus) is a major diagnostic criterion for IE. AACN infectious disease protocols
emphasize early cultures.
12. A patient on ECMO for cardiogenic shock develops hemolysis. What is the likely cause?
A) Excessive anticoagulation.
B) Pump malfunction or high RPM.
C) Hypothermia.
D) Sepsis. Correct Answer: B) Pump malfunction or high RPM.
Rationale: Mechanical shear stress from pump issues causes RBC destruction. AACN
ECMO management requires monitoring LDH/plasma-free Hb for complications.
13. In assessing for cardiogenic pulmonary edema, which finding is most specific?
A) Crackles in bases.
B) S3 heart sound.
C) Orthopnea.
D) PND. Correct Answer: B) S3 heart sound.
Rationale: S3 indicates ventricular gallop from fluid overload in cardiogenic edema.
AACN cardiovascular assessment differentiates from non-cardiogenic causes.
14. A patient with ACS receives heparin. What lab value requires immediate intervention if
PT/INR is 1.5?
A) No intervention; therapeutic for UFH.
B) Hold heparin; target aPTT 1.5-2.5x normal.
C) Reverse with protamine.
D) Switch to LMWH. Correct Answer: B) Hold heparin; target aPTT 1.5-2.5x normal.
Rationale: Unfractionated heparin is monitored by aPTT, not PT/INR (for warfarin).
Elevated PT suggests over-anticoagulation or other factors; AACN pharmacology
guidelines prioritize aPTT.
