AACN CRITICAL CARE CERTIFICATION EXAM MASTERY GUIDE: 100 PRACTICE QUESTIONS WITH
DETAILED RATIONALES FOR CCRN & ACUTE CARE NURSING SUCCESS (2026 UPDATED EDITION)
Question 1
A nurse is caring for a patient with septic shock who remains hypotensive after adequate fluid
resuscitation. Which medication should the nurse anticipate administering first?
A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Furosemide
Correct Answer: B. Norepinephrine
Rationale:
Norepinephrine is the first-line vasopressor recommended for septic shock after fluid
resuscitation fails to restore adequate blood pressure. It primarily stimulates alpha-adrenergic
receptors, causing vasoconstriction and improving systemic vascular resistance and blood
pressure.
• Dopamine is associated with more arrhythmias and is not preferred as first-line
therapy.
• Dobutamine is an inotrope used mainly for cardiac dysfunction with low cardiac
output.
• Furosemide is a diuretic and would worsen hypotension in shock.
Question 2
A patient with acute respiratory distress syndrome (ARDS) is mechanically ventilated. Which
intervention is most appropriate to prevent ventilator-induced lung injury?
A. High tidal volume ventilation
B. Low tidal volume ventilation
C. Routine hyperventilation
D. Frequent disconnection from the ventilator
Correct Answer: B. Low tidal volume ventilation
,Rationale:
Low tidal volume ventilation (approximately 4–6 mL/kg of ideal body weight) helps prevent
overdistention of alveoli and reduces ventilator-induced lung injury in patients with ARDS.
• High tidal volumes increase the risk of barotrauma and volutrauma.
• Hyperventilation can lead to respiratory alkalosis.
• Frequent ventilator disconnections increase infection risk and loss of PEEP.
Question 3
A nurse notes peaked T waves on a cardiac monitor. Which electrolyte imbalance should the
nurse suspect?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hyponatremia
Correct Answer: C. Hyperkalemia
Rationale:
Peaked T waves are a classic ECG finding associated with hyperkalemia. As potassium levels
rise, cardiac conduction abnormalities develop and can progress to fatal arrhythmias.
• Hypokalemia commonly causes flattened T waves and U waves.
• Hypercalcemia shortens the QT interval.
• Hyponatremia does not typically cause peaked T waves.
Question 4
Which assessment finding indicates decreased cardiac output?
A. Warm extremities
B. Bounding pulses
C. Decreased urine output
D. Increased alertness
Correct Answer: C. Decreased urine output
,Rationale:
Decreased cardiac output leads to reduced renal perfusion, causing oliguria or decreased
urine output.
Other signs include:
• Cool extremities
• Hypotension
• Altered mental status
• Weak peripheral pulses
Warm extremities and bounding pulses are more consistent with hyperdynamic circulation.
Question 5
A patient develops sudden chest pain and shortness of breath after surgery. Which
complication should the nurse suspect first?
A. Pneumonia
B. Pulmonary embolism
C. Pleural effusion
D. Atelectasis
Correct Answer: B. Pulmonary embolism
Rationale:
Sudden chest pain, dyspnea, tachycardia, and hypoxemia after surgery strongly suggest
pulmonary embolism (PE), especially in immobilized patients.
• Pneumonia develops more gradually with fever and productive cough.
• Atelectasis commonly causes mild hypoxia but not sudden severe chest pain.
• Pleural effusion usually develops progressively.
Question 6
Which laboratory value requires immediate nursing intervention?
, A. Sodium 138 mEq/L
B. Potassium 6.2 mEq/L
C. Calcium 9.1 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: B. Potassium 6.2 mEq/L
Rationale:
A potassium level of 6.2 mEq/L indicates significant hyperkalemia and can cause life-
threatening cardiac dysrhythmias.
Normal ranges:
• Sodium: 135–145 mEq/L
• Potassium: 3.5–5.0 mEq/L
• Calcium: 8.5–10.5 mg/dL
• Magnesium: 1.5–2.5 mg/dL
Immediate cardiac monitoring and treatment are necessary.
Question 7
A patient with increased intracranial pressure (ICP) should be positioned:
A. Flat in bed
B. Trendelenburg position
C. Head elevated 30 degrees
D. On the abdomen
Correct Answer: C. Head elevated 30 degrees
Rationale:
Elevating the head of the bed to approximately 30 degrees promotes venous drainage from
the brain and helps reduce intracranial pressure.
• Flat or Trendelenburg positioning may worsen ICP.
• Prone positioning is generally avoided unless specifically ordered.
DETAILED RATIONALES FOR CCRN & ACUTE CARE NURSING SUCCESS (2026 UPDATED EDITION)
Question 1
A nurse is caring for a patient with septic shock who remains hypotensive after adequate fluid
resuscitation. Which medication should the nurse anticipate administering first?
A. Dopamine
B. Norepinephrine
C. Dobutamine
D. Furosemide
Correct Answer: B. Norepinephrine
Rationale:
Norepinephrine is the first-line vasopressor recommended for septic shock after fluid
resuscitation fails to restore adequate blood pressure. It primarily stimulates alpha-adrenergic
receptors, causing vasoconstriction and improving systemic vascular resistance and blood
pressure.
• Dopamine is associated with more arrhythmias and is not preferred as first-line
therapy.
• Dobutamine is an inotrope used mainly for cardiac dysfunction with low cardiac
output.
• Furosemide is a diuretic and would worsen hypotension in shock.
Question 2
A patient with acute respiratory distress syndrome (ARDS) is mechanically ventilated. Which
intervention is most appropriate to prevent ventilator-induced lung injury?
A. High tidal volume ventilation
B. Low tidal volume ventilation
C. Routine hyperventilation
D. Frequent disconnection from the ventilator
Correct Answer: B. Low tidal volume ventilation
,Rationale:
Low tidal volume ventilation (approximately 4–6 mL/kg of ideal body weight) helps prevent
overdistention of alveoli and reduces ventilator-induced lung injury in patients with ARDS.
• High tidal volumes increase the risk of barotrauma and volutrauma.
• Hyperventilation can lead to respiratory alkalosis.
• Frequent ventilator disconnections increase infection risk and loss of PEEP.
Question 3
A nurse notes peaked T waves on a cardiac monitor. Which electrolyte imbalance should the
nurse suspect?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hyponatremia
Correct Answer: C. Hyperkalemia
Rationale:
Peaked T waves are a classic ECG finding associated with hyperkalemia. As potassium levels
rise, cardiac conduction abnormalities develop and can progress to fatal arrhythmias.
• Hypokalemia commonly causes flattened T waves and U waves.
• Hypercalcemia shortens the QT interval.
• Hyponatremia does not typically cause peaked T waves.
Question 4
Which assessment finding indicates decreased cardiac output?
A. Warm extremities
B. Bounding pulses
C. Decreased urine output
D. Increased alertness
Correct Answer: C. Decreased urine output
,Rationale:
Decreased cardiac output leads to reduced renal perfusion, causing oliguria or decreased
urine output.
Other signs include:
• Cool extremities
• Hypotension
• Altered mental status
• Weak peripheral pulses
Warm extremities and bounding pulses are more consistent with hyperdynamic circulation.
Question 5
A patient develops sudden chest pain and shortness of breath after surgery. Which
complication should the nurse suspect first?
A. Pneumonia
B. Pulmonary embolism
C. Pleural effusion
D. Atelectasis
Correct Answer: B. Pulmonary embolism
Rationale:
Sudden chest pain, dyspnea, tachycardia, and hypoxemia after surgery strongly suggest
pulmonary embolism (PE), especially in immobilized patients.
• Pneumonia develops more gradually with fever and productive cough.
• Atelectasis commonly causes mild hypoxia but not sudden severe chest pain.
• Pleural effusion usually develops progressively.
Question 6
Which laboratory value requires immediate nursing intervention?
, A. Sodium 138 mEq/L
B. Potassium 6.2 mEq/L
C. Calcium 9.1 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: B. Potassium 6.2 mEq/L
Rationale:
A potassium level of 6.2 mEq/L indicates significant hyperkalemia and can cause life-
threatening cardiac dysrhythmias.
Normal ranges:
• Sodium: 135–145 mEq/L
• Potassium: 3.5–5.0 mEq/L
• Calcium: 8.5–10.5 mg/dL
• Magnesium: 1.5–2.5 mg/dL
Immediate cardiac monitoring and treatment are necessary.
Question 7
A patient with increased intracranial pressure (ICP) should be positioned:
A. Flat in bed
B. Trendelenburg position
C. Head elevated 30 degrees
D. On the abdomen
Correct Answer: C. Head elevated 30 degrees
Rationale:
Elevating the head of the bed to approximately 30 degrees promotes venous drainage from
the brain and helps reduce intracranial pressure.
• Flat or Trendelenburg positioning may worsen ICP.
• Prone positioning is generally avoided unless specifically ordered.
