Adult CCRN Certification Review Examination
Exam 2026–2027|||questions and answers
with rationales/graded A+/2026 update/100%
correct /instant download
1. A patient is admitted with acute decompensated heart failure. A pulmonary
artery catheter is inserted. The nurse notes a pulmonary artery wedge pressure
(PAWP) of 22 mmHg. This reading is most indicative of:
a) Left ventricular overhydration
b) Pulmonary hypertension
c) Decreased systemic vascular resistance
d) Right ventricular failure
Answer: a) Left ventricular overhydration
Rationale: PAWP reflects left ventricular end-diastolic pressure (LVEDP) and is a
measure of left heart preload. A normal PAWP is 8-12 mmHg. A reading of 22
mmHg indicates increased pressure in the left ventricle, most commonly due to
fluid volume overload or left ventricular pump failure.
2. A patient with a history of chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 3 L/min via nasal cannula. The patient becomes somnolent
and difficult to arouse. What is the priority nursing intervention?
a) Increase oxygen flow to 6 L/min.
b) Obtain an arterial blood gas.
,c) Initiate a non-rebreather mask.
d) Decrease the oxygen flow rate.
Answer: d) Decrease the oxygen flow rate.
Rationale: This patient's decreasing level of consciousness is likely due to CO2
narcosis from the loss of hypoxic drive. In chronic CO2 retainers, high levels of
supplemental oxygen can suppress the respiratory drive. The immediate priority is
to titrate oxygen to the lowest level needed to maintain a target SpO2 of 88-92%,
then obtain an ABG.
3. A patient is admitted after a motor vehicle crash with a closed head injury. The
nurse notes a sudden increase in blood pressure, widening pulse pressure, and
bradycardia. These findings are consistent with:
a) Neurogenic shock
b) Cushing's triad
c) Increasing intracranial pressure (ICP)
d) Both B and C
Answer: d) Both B and C
Rationale: Cushing's triad (hypertension, bradycardia, and irregular or decreased
respirations) is a late and ominous sign of significantly increased intracranial
pressure (ICP). The widened pulse pressure (systolic hypertension with a normal
or decreasing diastolic) is the hallmark cardiovascular change as the brain
attempts to maintain cerebral perfusion pressure (CPP).
4. Continuous cardiac monitoring of a patient post-inferior wall MI shows a new
third-degree heart block. The patient's blood pressure is 74/40 mmHg and they
are complaining of dizziness. What is the priority intervention?
,a) Administer a 1 L normal saline fluid bolus.
b) Administer atropine 0.5 mg IV push.
c) Initiate transcutaneous pacing.
d) Prepare for immediate defibrillation.
Answer: c) Initiate transcutaneous pacing.
Rationale: A third-degree (complete) heart block post-inferior MI is often
transient but, when symptomatic with hypotension, requires immediate pacing.
Atropine is unlikely to work on a complete infranodal block. Transcutaneous
pacing is the fastest, most appropriate bridge until a transvenous pacemaker can
be placed.
5. A patient with diabetic ketoacidosis (DKA) is on an insulin drip and receiving IV
fluids. Which serum electrolyte level must be carefully monitored and replaced to
prevent cardiac arrhythmias?
a) Sodium
b) Calcium
c) Magnesium
d) Potassium
Answer: d) Potassium
Rationale: Although serum potassium may be high upon admission due to acidosis
shifting potassium out of cells, total body potassium is profoundly depleted.
Insulin and IV fluids drive potassium back into cells, causing a precipitous drop in
serum levels. Hypokalemia is a life-threatening risk, making frequent monitoring
and replacement essential.
, 6. A patient on mechanical ventilation develops sudden onset of severe dyspnea,
diminished breath sounds on the right, and tracheal deviation to the left. What is
the priority intervention?
a) Increase the FiO2 to 100%.
b) Obtain a STAT portable chest x-ray.
c) Insert a large-bore needle into the 2nd intercostal space, midclavicular line.
d) Suction the endotracheal tube immediately.
Answer: c) Insert a large-bore needle into the 2nd intercostal space, midclavicular
line.
Rationale: The clinical presentation is a classic tension pneumothorax. Tracheal
deviation and hypotension (implied by "severe dyspnea" and likely shock) indicate
a medical emergency. Immediate needle decompression is required before
obtaining a chest x-ray.
7. A patient post-renal transplant develops a sudden drop in urine output, BUN
and creatinine elevation, and tenderness over the graft site. The patient is
afebrile. The nurse suspects:
a) Acute tubular necrosis
b) Urinary tract infection
c) Renal artery stenosis
d) Acute graft rejection
Answer: d) Acute graft rejection
Rationale: The classic signs of acute rejection include oliguria, elevated
BUN/creatinine, graft tenderness, and hypertension. Fever is more common with
hyperacute rejection or infection. This presentation warrants immediate
investigation and intervention to salvage the graft.
Exam 2026–2027|||questions and answers
with rationales/graded A+/2026 update/100%
correct /instant download
1. A patient is admitted with acute decompensated heart failure. A pulmonary
artery catheter is inserted. The nurse notes a pulmonary artery wedge pressure
(PAWP) of 22 mmHg. This reading is most indicative of:
a) Left ventricular overhydration
b) Pulmonary hypertension
c) Decreased systemic vascular resistance
d) Right ventricular failure
Answer: a) Left ventricular overhydration
Rationale: PAWP reflects left ventricular end-diastolic pressure (LVEDP) and is a
measure of left heart preload. A normal PAWP is 8-12 mmHg. A reading of 22
mmHg indicates increased pressure in the left ventricle, most commonly due to
fluid volume overload or left ventricular pump failure.
2. A patient with a history of chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 3 L/min via nasal cannula. The patient becomes somnolent
and difficult to arouse. What is the priority nursing intervention?
a) Increase oxygen flow to 6 L/min.
b) Obtain an arterial blood gas.
,c) Initiate a non-rebreather mask.
d) Decrease the oxygen flow rate.
Answer: d) Decrease the oxygen flow rate.
Rationale: This patient's decreasing level of consciousness is likely due to CO2
narcosis from the loss of hypoxic drive. In chronic CO2 retainers, high levels of
supplemental oxygen can suppress the respiratory drive. The immediate priority is
to titrate oxygen to the lowest level needed to maintain a target SpO2 of 88-92%,
then obtain an ABG.
3. A patient is admitted after a motor vehicle crash with a closed head injury. The
nurse notes a sudden increase in blood pressure, widening pulse pressure, and
bradycardia. These findings are consistent with:
a) Neurogenic shock
b) Cushing's triad
c) Increasing intracranial pressure (ICP)
d) Both B and C
Answer: d) Both B and C
Rationale: Cushing's triad (hypertension, bradycardia, and irregular or decreased
respirations) is a late and ominous sign of significantly increased intracranial
pressure (ICP). The widened pulse pressure (systolic hypertension with a normal
or decreasing diastolic) is the hallmark cardiovascular change as the brain
attempts to maintain cerebral perfusion pressure (CPP).
4. Continuous cardiac monitoring of a patient post-inferior wall MI shows a new
third-degree heart block. The patient's blood pressure is 74/40 mmHg and they
are complaining of dizziness. What is the priority intervention?
,a) Administer a 1 L normal saline fluid bolus.
b) Administer atropine 0.5 mg IV push.
c) Initiate transcutaneous pacing.
d) Prepare for immediate defibrillation.
Answer: c) Initiate transcutaneous pacing.
Rationale: A third-degree (complete) heart block post-inferior MI is often
transient but, when symptomatic with hypotension, requires immediate pacing.
Atropine is unlikely to work on a complete infranodal block. Transcutaneous
pacing is the fastest, most appropriate bridge until a transvenous pacemaker can
be placed.
5. A patient with diabetic ketoacidosis (DKA) is on an insulin drip and receiving IV
fluids. Which serum electrolyte level must be carefully monitored and replaced to
prevent cardiac arrhythmias?
a) Sodium
b) Calcium
c) Magnesium
d) Potassium
Answer: d) Potassium
Rationale: Although serum potassium may be high upon admission due to acidosis
shifting potassium out of cells, total body potassium is profoundly depleted.
Insulin and IV fluids drive potassium back into cells, causing a precipitous drop in
serum levels. Hypokalemia is a life-threatening risk, making frequent monitoring
and replacement essential.
, 6. A patient on mechanical ventilation develops sudden onset of severe dyspnea,
diminished breath sounds on the right, and tracheal deviation to the left. What is
the priority intervention?
a) Increase the FiO2 to 100%.
b) Obtain a STAT portable chest x-ray.
c) Insert a large-bore needle into the 2nd intercostal space, midclavicular line.
d) Suction the endotracheal tube immediately.
Answer: c) Insert a large-bore needle into the 2nd intercostal space, midclavicular
line.
Rationale: The clinical presentation is a classic tension pneumothorax. Tracheal
deviation and hypotension (implied by "severe dyspnea" and likely shock) indicate
a medical emergency. Immediate needle decompression is required before
obtaining a chest x-ray.
7. A patient post-renal transplant develops a sudden drop in urine output, BUN
and creatinine elevation, and tenderness over the graft site. The patient is
afebrile. The nurse suspects:
a) Acute tubular necrosis
b) Urinary tract infection
c) Renal artery stenosis
d) Acute graft rejection
Answer: d) Acute graft rejection
Rationale: The classic signs of acute rejection include oliguria, elevated
BUN/creatinine, graft tenderness, and hypertension. Fever is more common with
hyperacute rejection or infection. This presentation warrants immediate
investigation and intervention to salvage the graft.
