CCRN AACN Practice Questions and Answers | 2025/2026
CCRN AACN Practice Questions and
Answers
Latest 2025/2026 Edition | Graded A+ | 100% Verified
Critical Care Registered Nurse — American Association of Critical-Care Nurses
Abstract
This document provides a comprehensive collection of practice questions and verified
answers designed for nurses preparing for the Critical Care Registered Nurse (CCRN)
certification examination administered by the American Association of Critical-Care
Nurses (AACN). The questions are aligned with the 2025/2026 CCRN examination
blueprint and encompass both Domain I: Clinical Judgment, which constitutes
approximately 80% of the examination, and Domain II: Professional Caring and Ethical
Practice, which accounts for the remaining 20%. Clinical topics include cardiovascular,
pulmonary, renal, neurological, endocrine, gastrointestinal, hematological, multisystem
disorders, and infectious diseases. Each question is accompanied by a detailed rationale
that integrates advanced pathophysiology, evidence-based clinical guidelines, and critical
reasoning principles essential for competent critical care nursing practice.
Keywords: CCRN, AACN, Critical Care Nursing, Practice Questions, Certification Exam,
Clinical Judgment
1. AACN CCRN Examination Blueprint Overview
The CCRN certification examination is designed to assess the clinical knowledge,
critical thinking skills, and professional competencies of nurses providing direct care to
acutely and critically ill patients. The examination consists of 150 multiple-choice
questions, of which 125 are scored and 25 are unscored pretest items distributed
throughout the examination. Candidates have three hours to complete the examination. The
content is distributed across two primary domains that reflect the complexity and scope of
contemporary critical care nursing practice.
Domain I: Clinical Judgment accounts for approximately 80% of the examination and
evaluates the nurse’s ability to apply knowledge of pathophysiology, pharmacology, and
evidence-based interventions to the care of critically ill patients across multiple organ
-1-
, CCRN AACN Practice Questions and Answers | 2025/2026
systems. Domain II: Professional Caring and Ethical Practice constitutes approximately
20% of the examination and assesses competencies in patient advocacy, ethical decision-
making, interprofessional collaboration, quality improvement, and end-of-life care. Both
domains are informed by the AACN Synergy Model, which emphasizes the dynamic
match between nurse competencies and patient characteristics and needs.
Table 1. CCRN Examination Blueprint Summary
Domain Weight Focus Areas
I: Clinical Judgment 80% Cardiovascular, Pulmonary,
Renal, Neurological, Endocrine,
GI, Hematology, Multisystem,
Infectious Diseases
II: Professional Caring 20% Ethics, Advocacy,
Collaboration, Quality
Improvement, EBP, Patient
Safety
Total Questions 150 125 scored + 25 unscored
pretest items
Time Allowed 3 hours Computer-based testing at
Prometric centers
2. Domain I: Clinical Judgment — Cardiovascular
1. A patient presents to the ICU with suspected cardiogenic shock following an acute
myocardial infarction. The nurse anticipates which hemodynamic profile?
A. Increased cardiac output, decreased SVR, elevated PCWP
B. Decreased cardiac output, elevated SVR, elevated PCWP
C. Decreased cardiac output, decreased SVR, low PCWP
D. Increased cardiac output, decreased SVR, low PCWP
Correct Answer: B. Decreased cardiac output, elevated SVR, elevated PCWP
Rationale: Cardiogenic shock is characterized by impaired cardiac output due to pump failure,
leading to compensatory sympathetic-mediated vasoconstriction (elevated systemic vascular
resistance) and pulmonary congestion from left-sided heart failure (elevated pulmonary capillary
wedge pressure). Decreased cardiac output is the hallmark finding. Option A describes distributive
-2-
, CCRN AACN Practice Questions and Answers | 2025/2026
shock; Option C describes hypovolemic shock; Option D is inconsistent with any shock
classification.
2. A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular
response (RVR) at 150 bpm. Blood pressure is 88/52 mmHg. Which intervention is the
priority?
A. Administer metoprolol IV 5 mg push
B. Initiate synchronized electrical cardioversion
C. Administer diltiazem IV infusion
D. Apply vagal maneuvers
Correct Answer: B. Initiate synchronized electrical cardioversion
Rationale: Synchronized electrical cardioversion is the treatment of choice for hemodynamically
unstable atrial fibrillation. This patient meets instability criteria with hypotension (systolic BP <
90 mmHg). Rate-controlling agents such as beta-blockers (metoprolol) or calcium channel
blockers (diltiazem) are contraindicated in unstable patients because they may further depress
blood pressure. Vagal maneuvers are appropriate for stable SVT but are not effective for atrial
fibrillation and are inappropriate in an unstable patient.
3. Following a coronary artery bypass graft (CABG) surgery, a patient has continuous
cardiac output monitoring. The nurse notes a sudden drop in cardiac index from 2.8 to 1.6
L/min/m². Which complication should be suspected first?
A. Cardiac tamponade B. Atelectasis
C. Urinary retention D. Paralytic ileus
Correct Answer: A. Cardiac tamponade
Rationale: A sudden decline in cardiac index following cardiac surgery is a classic sign of cardiac
tamponade, which occurs when fluid or blood accumulates in the pericardial space, compressing
the heart and restricting diastolic filling. Beck’s triad (hypotension, muffled heart sounds, jugular
venous distension) may also be present. This is a surgical emergency requiring immediate
pericardiocentesis or sternotomy. Atelectasis, urinary retention, and paralytic ileus do not cause
acute hemodynamic compromise of this nature.
-3-
CCRN AACN Practice Questions and
Answers
Latest 2025/2026 Edition | Graded A+ | 100% Verified
Critical Care Registered Nurse — American Association of Critical-Care Nurses
Abstract
This document provides a comprehensive collection of practice questions and verified
answers designed for nurses preparing for the Critical Care Registered Nurse (CCRN)
certification examination administered by the American Association of Critical-Care
Nurses (AACN). The questions are aligned with the 2025/2026 CCRN examination
blueprint and encompass both Domain I: Clinical Judgment, which constitutes
approximately 80% of the examination, and Domain II: Professional Caring and Ethical
Practice, which accounts for the remaining 20%. Clinical topics include cardiovascular,
pulmonary, renal, neurological, endocrine, gastrointestinal, hematological, multisystem
disorders, and infectious diseases. Each question is accompanied by a detailed rationale
that integrates advanced pathophysiology, evidence-based clinical guidelines, and critical
reasoning principles essential for competent critical care nursing practice.
Keywords: CCRN, AACN, Critical Care Nursing, Practice Questions, Certification Exam,
Clinical Judgment
1. AACN CCRN Examination Blueprint Overview
The CCRN certification examination is designed to assess the clinical knowledge,
critical thinking skills, and professional competencies of nurses providing direct care to
acutely and critically ill patients. The examination consists of 150 multiple-choice
questions, of which 125 are scored and 25 are unscored pretest items distributed
throughout the examination. Candidates have three hours to complete the examination. The
content is distributed across two primary domains that reflect the complexity and scope of
contemporary critical care nursing practice.
Domain I: Clinical Judgment accounts for approximately 80% of the examination and
evaluates the nurse’s ability to apply knowledge of pathophysiology, pharmacology, and
evidence-based interventions to the care of critically ill patients across multiple organ
-1-
, CCRN AACN Practice Questions and Answers | 2025/2026
systems. Domain II: Professional Caring and Ethical Practice constitutes approximately
20% of the examination and assesses competencies in patient advocacy, ethical decision-
making, interprofessional collaboration, quality improvement, and end-of-life care. Both
domains are informed by the AACN Synergy Model, which emphasizes the dynamic
match between nurse competencies and patient characteristics and needs.
Table 1. CCRN Examination Blueprint Summary
Domain Weight Focus Areas
I: Clinical Judgment 80% Cardiovascular, Pulmonary,
Renal, Neurological, Endocrine,
GI, Hematology, Multisystem,
Infectious Diseases
II: Professional Caring 20% Ethics, Advocacy,
Collaboration, Quality
Improvement, EBP, Patient
Safety
Total Questions 150 125 scored + 25 unscored
pretest items
Time Allowed 3 hours Computer-based testing at
Prometric centers
2. Domain I: Clinical Judgment — Cardiovascular
1. A patient presents to the ICU with suspected cardiogenic shock following an acute
myocardial infarction. The nurse anticipates which hemodynamic profile?
A. Increased cardiac output, decreased SVR, elevated PCWP
B. Decreased cardiac output, elevated SVR, elevated PCWP
C. Decreased cardiac output, decreased SVR, low PCWP
D. Increased cardiac output, decreased SVR, low PCWP
Correct Answer: B. Decreased cardiac output, elevated SVR, elevated PCWP
Rationale: Cardiogenic shock is characterized by impaired cardiac output due to pump failure,
leading to compensatory sympathetic-mediated vasoconstriction (elevated systemic vascular
resistance) and pulmonary congestion from left-sided heart failure (elevated pulmonary capillary
wedge pressure). Decreased cardiac output is the hallmark finding. Option A describes distributive
-2-
, CCRN AACN Practice Questions and Answers | 2025/2026
shock; Option C describes hypovolemic shock; Option D is inconsistent with any shock
classification.
2. A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular
response (RVR) at 150 bpm. Blood pressure is 88/52 mmHg. Which intervention is the
priority?
A. Administer metoprolol IV 5 mg push
B. Initiate synchronized electrical cardioversion
C. Administer diltiazem IV infusion
D. Apply vagal maneuvers
Correct Answer: B. Initiate synchronized electrical cardioversion
Rationale: Synchronized electrical cardioversion is the treatment of choice for hemodynamically
unstable atrial fibrillation. This patient meets instability criteria with hypotension (systolic BP <
90 mmHg). Rate-controlling agents such as beta-blockers (metoprolol) or calcium channel
blockers (diltiazem) are contraindicated in unstable patients because they may further depress
blood pressure. Vagal maneuvers are appropriate for stable SVT but are not effective for atrial
fibrillation and are inappropriate in an unstable patient.
3. Following a coronary artery bypass graft (CABG) surgery, a patient has continuous
cardiac output monitoring. The nurse notes a sudden drop in cardiac index from 2.8 to 1.6
L/min/m². Which complication should be suspected first?
A. Cardiac tamponade B. Atelectasis
C. Urinary retention D. Paralytic ileus
Correct Answer: A. Cardiac tamponade
Rationale: A sudden decline in cardiac index following cardiac surgery is a classic sign of cardiac
tamponade, which occurs when fluid or blood accumulates in the pericardial space, compressing
the heart and restricting diastolic filling. Beck’s triad (hypotension, muffled heart sounds, jugular
venous distension) may also be present. This is a surgical emergency requiring immediate
pericardiocentesis or sternotomy. Atelectasis, urinary retention, and paralytic ileus do not cause
acute hemodynamic compromise of this nature.
-3-
