CCRN Adult Exam- Direct Care Eligibility Pathway
2026
The exam is a 3-hour, computer-based test consisting of 150 multiple-choice items (125 scored,
25 unscored for statistical purposes).
Content distribution: 80% Clinical Judgment (covering systems like cardiovascular, respiratory,
endocrine, etc.) and 20% Professional Caring and Ethical Practice
,Question 1
A patient with open-angle glaucoma has been using latanoprost ophthalmic solution 0.005%
once daily in the affected eye for 8 months. The patient reports to the nurse, “My treated eye
looks darker brown now, and my eyelashes seem longer and thicker.” What is the most
appropriate response by the nurse?
a. Instruct the patient to discontinue the drops immediately and contact the ophthalmologist.
b. Reassure the patient that increased iris pigmentation and eyelash changes are known,
usually permanent, but harmless cosmetic side effects of latanoprost.
c. Explain that the changes indicate an allergic reaction and recommend switching to
timolol drops.
d. Advise the patient that the eye color change will reverse within weeks after stopping the
medication.
ANSWER: B
Rationale: Latanoprost, a prostaglandin analog, commonly causes increased brown pigmentation
of the iris (especially in hazel or mixed-color eyes) and hypertrichosis (longer, thicker, darker
eyelashes). These are well-documented side effects, typically permanent for iris color but
cosmetic and not vision-threatening or requiring discontinuation unless bothersome.
Question 2
A mechanically ventilated patient in the ICU develops acute respiratory distress syndrome
(ARDS) with PaO₂/FiO₂ ratio of 140. The provider orders prone positioning for at least 16 hours
per day. During the first prone session, the nurse notes increased peak inspiratory pressures.
What is the priority nursing action?
a. Immediately return the patient to supine position.
b. Assess endotracheal tube placement and obtain a chest X-ray.
c. Increase the FiO₂ to 100% and notify the provider.
d. Document the finding and continue monitoring as pressures often rise initially in prone
position.
ANSWER: D
Rationale: Transient increases in peak pressures are common during prone positioning due to
chest wall mechanics. If oxygenation and hemodynamics are stable, therapy should continue
with close monitoring.
Question 3
,A patient with diabetic ketoacidosis (DKA) is receiving IV regular insulin at 0.1 units/kg/hour.
After 4 hours, serum glucose decreases from 620 mg/dL to 280 mg/dL, but the anion gap
remains 22. What is the most appropriate next step?
a. Discontinue the insulin infusion and transition to subcutaneous insulin.
b. Continue the insulin infusion and add dextrose to IV fluids to prevent hypoglycemia
while closing the anion gap.
c. Increase the insulin infusion rate to 0.2 units/kg/hour.
d. Administer sodium bicarbonate to correct the acidosis.
ANSWER: B
Rationale: Insulin must continue until the anion gap closes. Dextrose is added once glucose
normalizes to prevent hypoglycemia.
Question 4
A patient post–cardiac arrest is undergoing targeted temperature management (TTM) at 33°C
and develops shivering. Which pharmacologic intervention is first-line?
a. Meperidine 25–50 mg IV.
b. Propofol continuous infusion.
c. Lorazepam intermittent IV doses.
d. Dexmedetomidine infusion.
ANSWER: A
Rationale: Meperidine has specific anti-shivering properties and is commonly first-line in TTM
protocols.
Question 5
A patient with septic shock is receiving norepinephrine 0.5 mcg/kg/min with MAP 68 mmHg.
Vasopressin 0.03 units/min is added primarily to:
a. Directly increase cardiac output.
b. Reduce norepinephrine requirements and catecholamine-related adverse effects.
c. Improve renal perfusion.
d. Cause pulmonary vasodilation.
, ANSWER: B
Rationale: Low-dose vasopressin is catecholamine-sparing and helps maintain MAP.
Question 6
A patient post–myocardial infarction develops sudden dyspnea, hypotension (BP 82/50 mmHg),
and jugular venous distention. A new holosystolic murmur is heard at the apex. What is the most
likely complication?
a. Ventricular septal rupture.
b. Papillary muscle rupture.
c. Free wall rupture.
d. Right ventricular infarction.
ANSWER: B
Rationale: Papillary muscle rupture causes acute mitral regurgitation leading to pulmonary
edema, hypotension, and a new holosystolic murmur at the apex.
Question 7
A patient in cardiogenic shock is on dobutamine infusion. The nurse notes increasing ventricular
ectopy and tachycardia. What is the priority action?
a. Increase the dobutamine dose.
b. Administer amiodarone.
c. Discontinue dobutamine and prepare for intra-aortic balloon pump insertion.
d. Switch to milrinone infusion.
ANSWER: C
Rationale: Dobutamine can worsen arrhythmias. Mechanical circulatory support is indicated
when inotropes are proarrhythmic.
Question 8
In a patient with Type A aortic dissection, which hemodynamic parameter is most critical to
control initially?
2026
The exam is a 3-hour, computer-based test consisting of 150 multiple-choice items (125 scored,
25 unscored for statistical purposes).
Content distribution: 80% Clinical Judgment (covering systems like cardiovascular, respiratory,
endocrine, etc.) and 20% Professional Caring and Ethical Practice
,Question 1
A patient with open-angle glaucoma has been using latanoprost ophthalmic solution 0.005%
once daily in the affected eye for 8 months. The patient reports to the nurse, “My treated eye
looks darker brown now, and my eyelashes seem longer and thicker.” What is the most
appropriate response by the nurse?
a. Instruct the patient to discontinue the drops immediately and contact the ophthalmologist.
b. Reassure the patient that increased iris pigmentation and eyelash changes are known,
usually permanent, but harmless cosmetic side effects of latanoprost.
c. Explain that the changes indicate an allergic reaction and recommend switching to
timolol drops.
d. Advise the patient that the eye color change will reverse within weeks after stopping the
medication.
ANSWER: B
Rationale: Latanoprost, a prostaglandin analog, commonly causes increased brown pigmentation
of the iris (especially in hazel or mixed-color eyes) and hypertrichosis (longer, thicker, darker
eyelashes). These are well-documented side effects, typically permanent for iris color but
cosmetic and not vision-threatening or requiring discontinuation unless bothersome.
Question 2
A mechanically ventilated patient in the ICU develops acute respiratory distress syndrome
(ARDS) with PaO₂/FiO₂ ratio of 140. The provider orders prone positioning for at least 16 hours
per day. During the first prone session, the nurse notes increased peak inspiratory pressures.
What is the priority nursing action?
a. Immediately return the patient to supine position.
b. Assess endotracheal tube placement and obtain a chest X-ray.
c. Increase the FiO₂ to 100% and notify the provider.
d. Document the finding and continue monitoring as pressures often rise initially in prone
position.
ANSWER: D
Rationale: Transient increases in peak pressures are common during prone positioning due to
chest wall mechanics. If oxygenation and hemodynamics are stable, therapy should continue
with close monitoring.
Question 3
,A patient with diabetic ketoacidosis (DKA) is receiving IV regular insulin at 0.1 units/kg/hour.
After 4 hours, serum glucose decreases from 620 mg/dL to 280 mg/dL, but the anion gap
remains 22. What is the most appropriate next step?
a. Discontinue the insulin infusion and transition to subcutaneous insulin.
b. Continue the insulin infusion and add dextrose to IV fluids to prevent hypoglycemia
while closing the anion gap.
c. Increase the insulin infusion rate to 0.2 units/kg/hour.
d. Administer sodium bicarbonate to correct the acidosis.
ANSWER: B
Rationale: Insulin must continue until the anion gap closes. Dextrose is added once glucose
normalizes to prevent hypoglycemia.
Question 4
A patient post–cardiac arrest is undergoing targeted temperature management (TTM) at 33°C
and develops shivering. Which pharmacologic intervention is first-line?
a. Meperidine 25–50 mg IV.
b. Propofol continuous infusion.
c. Lorazepam intermittent IV doses.
d. Dexmedetomidine infusion.
ANSWER: A
Rationale: Meperidine has specific anti-shivering properties and is commonly first-line in TTM
protocols.
Question 5
A patient with septic shock is receiving norepinephrine 0.5 mcg/kg/min with MAP 68 mmHg.
Vasopressin 0.03 units/min is added primarily to:
a. Directly increase cardiac output.
b. Reduce norepinephrine requirements and catecholamine-related adverse effects.
c. Improve renal perfusion.
d. Cause pulmonary vasodilation.
, ANSWER: B
Rationale: Low-dose vasopressin is catecholamine-sparing and helps maintain MAP.
Question 6
A patient post–myocardial infarction develops sudden dyspnea, hypotension (BP 82/50 mmHg),
and jugular venous distention. A new holosystolic murmur is heard at the apex. What is the most
likely complication?
a. Ventricular septal rupture.
b. Papillary muscle rupture.
c. Free wall rupture.
d. Right ventricular infarction.
ANSWER: B
Rationale: Papillary muscle rupture causes acute mitral regurgitation leading to pulmonary
edema, hypotension, and a new holosystolic murmur at the apex.
Question 7
A patient in cardiogenic shock is on dobutamine infusion. The nurse notes increasing ventricular
ectopy and tachycardia. What is the priority action?
a. Increase the dobutamine dose.
b. Administer amiodarone.
c. Discontinue dobutamine and prepare for intra-aortic balloon pump insertion.
d. Switch to milrinone infusion.
ANSWER: C
Rationale: Dobutamine can worsen arrhythmias. Mechanical circulatory support is indicated
when inotropes are proarrhythmic.
Question 8
In a patient with Type A aortic dissection, which hemodynamic parameter is most critical to
control initially?
