CCRN Certification Exam Critical Care
Nursing Clinical Judgment AACN Test Plan
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
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SECTION 1: CARDIOVASCULAR Q1 – Q10
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Question 1 of 50
A 67-year-old male is post-op day 2 after CABG x3. His arterial line waveform shows a narrow
pulse pressure with a pulsus paradoxus of 18 mmHg. HR is 112, BP 88/62, CVP 18 mmHg. He
reports increasing chest tightness and dyspnea. Which intervention should the nurse
anticipate as the priority?
A. Administer a fluid bolus of 500 mL normal saline
B. Prepare the patient for emergent pericardiocentesis
C. Initiate dobutamine at 5 mcg/kg/min
D. Increase the PEEP on the ventilator to 12 cmH2O
B ✓ CORRECT
Correct Answer: B
Rationale: The combination of elevated CVP, pulsus paradoxus greater than 10 mmHg, and
hypotension in a post-CABG patient is classic for cardiac tamponade, where fluid
accumulation in the pericardium compresses the heart and impairs diastolic filling. Emergent
pericardiocentesis is the definitive treatment to relieve pericardial pressure and restore
cardiac output. A fluid bolus is inappropriate because tamponade is a problem of external
compression, not hypovolemia, and additional volume would further distend the right heart
without improving left-sided filling. On the CCRN, always suspect tamponade in post-cardiac
surgery patients with rising CVP, falling BP, and pulsus paradoxus.
Question 2 of 50
,A 54-year-old female with a history of dilated cardiomyopathy presents with acute
decompensated heart failure. Her BP is 82/48, HR 118, SpO2 89% on 4 L NC. She has crackles
bilaterally, JVD at 8 cm, and cool clammy extremities. Which vasopressor should the nurse
prepare to administer first?
A. Norepinephrine at 0.05 mcg/kg/min
B. Phenylephrine at 50 mcg/min
C. Vasopressin at 0.03 units/min
D. Epinephrine at 2 mcg/min
A ✓ CORRECT
Correct Answer: A
Rationale: In cardiogenic shock with hypotension, norepinephrine is the first-line vasopressor
because it provides both alpha-1 mediated vasoconstriction to restore MAP and modest
beta-1 activity to support contractility without significantly increasing myocardial oxygen
demand. Phenylephrine is a pure alpha-agonist that increases afterload without any inotropic
support, which can worsen cardiac output in a failing ventricle and is therefore
contraindicated in cardiogenic shock. On the CCRN, remember that norepinephrine is the
vasopressor of choice for most shock states except anaphylaxis, where epinephrine is
preferred.
Question 3 of 50
A 72-year-old male with an inferior STEMI is being monitored on the cardiac unit. He suddenly
develops bradycardia at 38 bpm, BP 58/40, and complains of severe dizziness. The 12-lead
ECG shows a new third-degree AV block with junctional escape rhythm. Which medication
should the nurse administer immediately?
A. Atropine 0.5 mg IV push
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV over 10 minutes
D. Metoprolol 5 mg IV push
A ✓ CORRECT
Correct Answer: A
Rationale: In symptomatic bradycardia with hypotension and altered perfusion, atropine 0.5
mg IV is the first-line medication per ACLS guidelines because it blocks parasympathetic
vagal tone and increases SA node firing and AV nodal conduction. Adenosine would further
slow the heart rate and is absolutely contraindicated in any bradycardic or heart block
rhythm. On the CCRN, inferior STEMIs frequently involve the right coronary artery, which
supplies the SA and AV nodes, making high-grade blocks common and atropine the priority
intervention before transcutaneous pacing.
, Question 4 of 50
A 58-year-old male is 4 hours s/p open abdominal aortic aneurysm repair. His arterial line
shows a systolic pressure variation of 18 mmHg with positive pressure ventilation. HR is 105,
MAP 62, CVP 6 mmHg, urine output 15 mL/hr for the past 2 hours. Which hemodynamic
parameter best supports the nurse's clinical decision to administer a fluid bolus?
A. Elevated systemic vascular resistance
B. Low cardiac index with low stroke volume variation
C. Low stroke volume variation with elevated CVP
D. Elevated stroke volume variation with low CVP
D ✓ CORRECT
Correct Answer: D
Rationale: Elevated stroke volume variation (greater than 13%) combined with low CVP
indicates preload responsiveness and hypovolemia in a mechanically ventilated patient,
making a fluid bolus the appropriate intervention to improve cardiac output and organ
perfusion. Low stroke volume variation would suggest the patient is not fluid responsive, and
giving fluids in that scenario risks volume overload without hemodynamic benefit. On the
CCRN, dynamic indicators like stroke volume variation and pulse pressure variation are more
reliable predictors of fluid responsiveness than static measures like CVP alone.
Question 5 of 50
A 49-year-old female with hypertrophic cardiomyopathy develops sudden dyspnea, chest pain,
and syncope. Her BP is 76/48, HR 132 irregularly irregular, and she has a harsh systolic
murmur at the left sternal border that increases with Valsalva. Which intervention is most
appropriate for the nurse to implement first?
A. Administer IV fluids at 125 mL/hr and place the patient supine
B. Initiate beta-blockade with esmolol 50 mcg/kg/min
C. Prepare for synchronized cardioversion at 150 joules
D. Administer digoxin 0.25 mg IV push for rate control
B ✓ CORRECT
Correct Answer: B
Rationale: In hypertrophic cardiomyopathy with dynamic left ventricular outflow tract
obstruction, beta-blockade with esmolol reduces heart rate and contractility, thereby
decreasing the obstruction and improving cardiac output and coronary perfusion. IV fluids
and supine positioning can increase preload and worsen the obstruction by bringing the
hypertrophied septum closer to the mitral valve apparatus. On the CCRN, always remember
Nursing Clinical Judgment AACN Test Plan
Review Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 67-year-old male is post-op day 2 after CABG x3. His arterial line waveform shows a narrow
pulse pressure with a pulsus paradoxus of 18 mmHg. HR is 112, BP 88/62, CVP 18 mmHg. He
reports increasing chest tightness and dyspnea. Which intervention should the nurse
anticipate as the priority?
A. Administer a fluid bolus of 500 mL normal saline
B. Prepare the patient for emergent pericardiocentesis
C. Initiate dobutamine at 5 mcg/kg/min
D. Increase the PEEP on the ventilator to 12 cmH2O
B ✓ CORRECT
Correct Answer: B
Rationale: The combination of elevated CVP, pulsus paradoxus greater than 10 mmHg, and
hypotension in a post-CABG patient is classic for cardiac tamponade, where fluid
accumulation in the pericardium compresses the heart and impairs diastolic filling. Emergent
pericardiocentesis is the definitive treatment to relieve pericardial pressure and restore
cardiac output. A fluid bolus is inappropriate because tamponade is a problem of external
compression, not hypovolemia, and additional volume would further distend the right heart
without improving left-sided filling. On the CCRN, always suspect tamponade in post-cardiac
surgery patients with rising CVP, falling BP, and pulsus paradoxus.
Question 2 of 50
,A 54-year-old female with a history of dilated cardiomyopathy presents with acute
decompensated heart failure. Her BP is 82/48, HR 118, SpO2 89% on 4 L NC. She has crackles
bilaterally, JVD at 8 cm, and cool clammy extremities. Which vasopressor should the nurse
prepare to administer first?
A. Norepinephrine at 0.05 mcg/kg/min
B. Phenylephrine at 50 mcg/min
C. Vasopressin at 0.03 units/min
D. Epinephrine at 2 mcg/min
A ✓ CORRECT
Correct Answer: A
Rationale: In cardiogenic shock with hypotension, norepinephrine is the first-line vasopressor
because it provides both alpha-1 mediated vasoconstriction to restore MAP and modest
beta-1 activity to support contractility without significantly increasing myocardial oxygen
demand. Phenylephrine is a pure alpha-agonist that increases afterload without any inotropic
support, which can worsen cardiac output in a failing ventricle and is therefore
contraindicated in cardiogenic shock. On the CCRN, remember that norepinephrine is the
vasopressor of choice for most shock states except anaphylaxis, where epinephrine is
preferred.
Question 3 of 50
A 72-year-old male with an inferior STEMI is being monitored on the cardiac unit. He suddenly
develops bradycardia at 38 bpm, BP 58/40, and complains of severe dizziness. The 12-lead
ECG shows a new third-degree AV block with junctional escape rhythm. Which medication
should the nurse administer immediately?
A. Atropine 0.5 mg IV push
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV over 10 minutes
D. Metoprolol 5 mg IV push
A ✓ CORRECT
Correct Answer: A
Rationale: In symptomatic bradycardia with hypotension and altered perfusion, atropine 0.5
mg IV is the first-line medication per ACLS guidelines because it blocks parasympathetic
vagal tone and increases SA node firing and AV nodal conduction. Adenosine would further
slow the heart rate and is absolutely contraindicated in any bradycardic or heart block
rhythm. On the CCRN, inferior STEMIs frequently involve the right coronary artery, which
supplies the SA and AV nodes, making high-grade blocks common and atropine the priority
intervention before transcutaneous pacing.
, Question 4 of 50
A 58-year-old male is 4 hours s/p open abdominal aortic aneurysm repair. His arterial line
shows a systolic pressure variation of 18 mmHg with positive pressure ventilation. HR is 105,
MAP 62, CVP 6 mmHg, urine output 15 mL/hr for the past 2 hours. Which hemodynamic
parameter best supports the nurse's clinical decision to administer a fluid bolus?
A. Elevated systemic vascular resistance
B. Low cardiac index with low stroke volume variation
C. Low stroke volume variation with elevated CVP
D. Elevated stroke volume variation with low CVP
D ✓ CORRECT
Correct Answer: D
Rationale: Elevated stroke volume variation (greater than 13%) combined with low CVP
indicates preload responsiveness and hypovolemia in a mechanically ventilated patient,
making a fluid bolus the appropriate intervention to improve cardiac output and organ
perfusion. Low stroke volume variation would suggest the patient is not fluid responsive, and
giving fluids in that scenario risks volume overload without hemodynamic benefit. On the
CCRN, dynamic indicators like stroke volume variation and pulse pressure variation are more
reliable predictors of fluid responsiveness than static measures like CVP alone.
Question 5 of 50
A 49-year-old female with hypertrophic cardiomyopathy develops sudden dyspnea, chest pain,
and syncope. Her BP is 76/48, HR 132 irregularly irregular, and she has a harsh systolic
murmur at the left sternal border that increases with Valsalva. Which intervention is most
appropriate for the nurse to implement first?
A. Administer IV fluids at 125 mL/hr and place the patient supine
B. Initiate beta-blockade with esmolol 50 mcg/kg/min
C. Prepare for synchronized cardioversion at 150 joules
D. Administer digoxin 0.25 mg IV push for rate control
B ✓ CORRECT
Correct Answer: B
Rationale: In hypertrophic cardiomyopathy with dynamic left ventricular outflow tract
obstruction, beta-blockade with esmolol reduces heart rate and contractility, thereby
decreasing the obstruction and improving cardiac output and coronary perfusion. IV fluids
and supine positioning can increase preload and worsen the obstruction by bringing the
hypertrophied septum closer to the mitral valve apparatus. On the CCRN, always remember
