CCRN Certification Exam Prep Document
2026/2027 | Critical Care Nursing, Clinical
Judgment & AACN Test Plan Review | 150 Verified
Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR
1. A patient with an acute inferior wall myocardial infarction develops
hypotension, bradycardia, and jugular venous distention. The nurse should
suspect which complication?
• A) Left ventricular failure
• B) Right ventricular infarction
• C) Cardiac tamponade
• D) Papillary muscle rupture
Correct Answer: B) Right ventricular infarction
Rationale: Inferior wall MI commonly involves the right coronary artery, which
supplies the right ventricle. Right ventricular infarction presents with hypotension
(preload-dependent), bradycardia (AV node ischemia), and elevated JVD without
pulmonary congestion. Treatment is volume resuscitation; nitroglycerin and
diuretics are contraindicated as they reduce preload and worsen hypotension.
2. A patient on a dobutamine infusion for cardiogenic shock has a cardiac index
of 2.8 L/min/m² and a systemic vascular resistance (SVR) of 400 dynes/sec/cm⁻⁵.
The patient is tachycardic and hypotensive. Which intervention is most
appropriate?
• A) Increase the dobutamine rate
• B) Start a norepinephrine infusion
, • C) Add a vasodilator like nitroprusside
• D) Administer an IV fluid bolus of 500 mL
Correct Answer: B) Start a norepinephrine infusion
Rationale: This patient has low SVR (normal 800-1200) with inadequate MAP
despite a reasonable cardiac index. Norepinephrine is a potent vasoconstrictor
that will increase SVR and MAP. Dobutamine is primarily an inotrope and
vasodilator; increasing it would further drop SVR. Adding nitroprusside would
worsen hypotension.
3. A patient's arterial line waveform shows a dampened tracing with a systolic
pressure of 90 mmHg, but the non-invasive cuff reads 120/80 mmHg. The
nurse's priority action is:
• A) Level the transducer to the phlebostatic axis
• B) Zero the transducer to atmospheric pressure
• C) Assess the arterial catheter for clot or kink
• D) Document the discrepancy and continue monitoring
Correct Answer: C) Assess the arterial catheter for clot or kink
Rationale: A dampened waveform indicates mechanical obstruction (clot, kink, air
bubble) or catheter malposition. The priority is to assess the catheter and
waveform quality. Levelling and zeroing address pressure drift, not dampening.
The cuff reading should be verified, and the arterial line should be assessed, but
the priority is correcting the mechanical issue.
4. A patient with aortic stenosis scheduled for valve replacement suddenly
develops chest pain, hypotension, and a new systolic murmur. The nurse should
prepare for:
• A) Thrombolytic therapy
• B) Emergent pericardiocentesis
• C) Transesophageal echocardiogram
, • D) Synchronized cardioversion
Correct Answer: C) Transesophageal echocardiogram
Rationale: The classic triad of chest pain, hypotension, and a new systolic murmur
in a patient with aortic stenosis suggests acute aortic regurgitation from infective
endocarditis or aortic dissection. A TEE is the definitive diagnostic study to
evaluate valve function and aortic root integrity. Thrombolytics would be
contraindicated. Pericardiocentesis is for tamponade.
5. Which hemodynamic parameter is most indicative of left ventricular preload?
• A) Central venous pressure (CVP)
• B) Pulmonary artery wedge pressure (PAWP)
• C) Cardiac output (CO)
• D) Systemic vascular resistance (SVR)
Correct Answer: B) Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end-diastolic pressure, which is the best
estimate of left ventricular preload. CVP reflects right ventricular preload. CO
measures cardiac performance, not preload. SVR measures afterload.
SECTION 2: RESPIRATORY
6. A patient on pressure-controlled ventilation has a tidal volume that has
dropped from 450 mL to 280 mL. The peak inspiratory pressure (PIP) remains
stable. Which is the most likely cause?
• A) Mainstem intubation
• B) Pneumothorax
• C) Decreased lung compliance
• D) Increased airway resistance
Correct Answer: C) Decreased lung compliance
2026/2027 | Critical Care Nursing, Clinical
Judgment & AACN Test Plan Review | 150 Verified
Questions with Detailed Rationales
SECTION 1: CARDIOVASCULAR
1. A patient with an acute inferior wall myocardial infarction develops
hypotension, bradycardia, and jugular venous distention. The nurse should
suspect which complication?
• A) Left ventricular failure
• B) Right ventricular infarction
• C) Cardiac tamponade
• D) Papillary muscle rupture
Correct Answer: B) Right ventricular infarction
Rationale: Inferior wall MI commonly involves the right coronary artery, which
supplies the right ventricle. Right ventricular infarction presents with hypotension
(preload-dependent), bradycardia (AV node ischemia), and elevated JVD without
pulmonary congestion. Treatment is volume resuscitation; nitroglycerin and
diuretics are contraindicated as they reduce preload and worsen hypotension.
2. A patient on a dobutamine infusion for cardiogenic shock has a cardiac index
of 2.8 L/min/m² and a systemic vascular resistance (SVR) of 400 dynes/sec/cm⁻⁵.
The patient is tachycardic and hypotensive. Which intervention is most
appropriate?
• A) Increase the dobutamine rate
• B) Start a norepinephrine infusion
, • C) Add a vasodilator like nitroprusside
• D) Administer an IV fluid bolus of 500 mL
Correct Answer: B) Start a norepinephrine infusion
Rationale: This patient has low SVR (normal 800-1200) with inadequate MAP
despite a reasonable cardiac index. Norepinephrine is a potent vasoconstrictor
that will increase SVR and MAP. Dobutamine is primarily an inotrope and
vasodilator; increasing it would further drop SVR. Adding nitroprusside would
worsen hypotension.
3. A patient's arterial line waveform shows a dampened tracing with a systolic
pressure of 90 mmHg, but the non-invasive cuff reads 120/80 mmHg. The
nurse's priority action is:
• A) Level the transducer to the phlebostatic axis
• B) Zero the transducer to atmospheric pressure
• C) Assess the arterial catheter for clot or kink
• D) Document the discrepancy and continue monitoring
Correct Answer: C) Assess the arterial catheter for clot or kink
Rationale: A dampened waveform indicates mechanical obstruction (clot, kink, air
bubble) or catheter malposition. The priority is to assess the catheter and
waveform quality. Levelling and zeroing address pressure drift, not dampening.
The cuff reading should be verified, and the arterial line should be assessed, but
the priority is correcting the mechanical issue.
4. A patient with aortic stenosis scheduled for valve replacement suddenly
develops chest pain, hypotension, and a new systolic murmur. The nurse should
prepare for:
• A) Thrombolytic therapy
• B) Emergent pericardiocentesis
• C) Transesophageal echocardiogram
, • D) Synchronized cardioversion
Correct Answer: C) Transesophageal echocardiogram
Rationale: The classic triad of chest pain, hypotension, and a new systolic murmur
in a patient with aortic stenosis suggests acute aortic regurgitation from infective
endocarditis or aortic dissection. A TEE is the definitive diagnostic study to
evaluate valve function and aortic root integrity. Thrombolytics would be
contraindicated. Pericardiocentesis is for tamponade.
5. Which hemodynamic parameter is most indicative of left ventricular preload?
• A) Central venous pressure (CVP)
• B) Pulmonary artery wedge pressure (PAWP)
• C) Cardiac output (CO)
• D) Systemic vascular resistance (SVR)
Correct Answer: B) Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end-diastolic pressure, which is the best
estimate of left ventricular preload. CVP reflects right ventricular preload. CO
measures cardiac performance, not preload. SVR measures afterload.
SECTION 2: RESPIRATORY
6. A patient on pressure-controlled ventilation has a tidal volume that has
dropped from 450 mL to 280 mL. The peak inspiratory pressure (PIP) remains
stable. Which is the most likely cause?
• A) Mainstem intubation
• B) Pneumothorax
• C) Decreased lung compliance
• D) Increased airway resistance
Correct Answer: C) Decreased lung compliance
