Adult CCRN® Exam 2026/2027 150 Verified Questions • AACN Blueprint Aligned
ADULT CCRN® EXAM 2026/2027
Complete Exam with Verified Questions and 100% Correct Answers
Aligned with AACN CCRN (Adult) Examination Blueprint • 150 Questions • 9 Sections •
AACN Synergy Model • Evidence-Based Practice
Cognitive: 20% Recall •
Style: 80% Scenario-Based
Total Questions: 150 50% Application • 30%
• 20% Direct Knowledge
Analysis
Section 1: Clinical Judgment – Cardiovascular — 25
Questions
Q1. A 62-year-old male presents to the ED with crushing substernal chest pain
radiating to the left arm, diaphoresis, and dyspnea that began 45 minutes ago. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF with reciprocal
depression in I and aVL. Vital signs: BP 96/60, HR 48, RR 22, SpO2 94% on RA. Which
intervention is the PRIORITY at this moment?
A. Administer metoprolol 5 mg IV push to reduce myocardial oxygen demand
B. Give nitroglycerin 0.4 mg sublingual to relieve chest pain
C. Initiate dual antiplatelet therapy and activate the cath lab for primary PCI
*[CORRECT]*
D. Administer atropine 1 mg IV push to increase heart rate
Correct Answer: C
Rationale: The patient has an acute inferior STEMI with cardiogenic shock features (hypotension,
bradycardia). Right coronary artery occlusion is likely; beta-blockers and nitroglycerin are
contraindicated in the hypotensive inferior STEMI patient because RV involvement makes them
preload-dependent. The AACN/AHA/ACC STEMI guideline mandates immediate dual antiplatelet
therapy (aspirin + P2Y12 inhibitor) and activation of the cath lab for primary PCI within 90 minutes
(door-to-balloon). Atropine may be considered only if bradycardia causes hemodynamic instability
unresponsive to reperfusion.
Q2. A patient with an acute anterior wall MI develops new bibasilar crackles, an S3
gallop, BP 88/52, HR 124, and a PA wedge pressure of 28 mmHg with a cardiac index
of 1.8 L/min/m2. The mixed venous saturation (SvO2) is 55%. Which pharmacologic
regimen best addresses the underlying pathophysiology of cardiogenic shock?
A. Lisinopril 10 mg PO daily to reduce afterload
B. Norepinephrine to raise MAP > 65 mmHg followed by dobutamine to augment
CI *[CORRECT]*
C. Furosemide 80 mg IV push to reduce preload
D. Diltiazem 20 mg IV push for rate control and afterload reduction
Correct Answer: B
Rationale: Cardiogenic shock complicating acute MI requires restoring MAP to preserve coronary
perfusion (norepinephrine is preferred over dopamine per SPRINT-CSI and current guidelines due to
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 1
,Adult CCRN® Exam 2026/2027 150 Verified Questions • AACN Blueprint Aligned
lower arrhythmia burden) plus an inotrope (dobutamine or milrinone) to raise cardiac index toward >
2.2 L/min/m2 and SvO2 > 65%. ACE inhibitors and CCBs are contraindicated in acute decompensated
shock. Diuretics alone will worsen the already low preload-dependence and may precipitate collapse.
(AACN Procedure Manual; AHA Scientific Statement on Cardiogenic Shock.)
Q3. A 58-year-old female with chronic NYHA Class IV heart failure is on furosemide
80 mg BID, lisinopril 20 mg, and spironolactone 25 mg daily. Today she presents
with confusion, peaked T waves, wide QRS, and a serum K+ of 7.1 mEq/L. BP 84/50.
ECG shows a sine-wave pattern. Which sequence is MOST appropriate?
A. Administer IV insulin + 50% dextrose, IV calcium gluconate, then arrange
emergent hemodialysis *[CORRECT]*
B. Administer oral sodium polystyrene sulfonate and recheck K+ in 4 hours
C. Administer IV sodium bicarbonate 150 mEq bolus and reassess
D. Administer IV furosemide 80 mg push and isotonic saline bolus
Correct Answer: A
Rationale: The patient has life-threatening hyperkalemia with ECG changes (sine-wave = severe). The
ACLS/AACN-recommended sequence is: (1) calcium gluconate 10 mL of 10% IV to stabilize the
myocardium, (2) insulin + dextrose to shift K+ intracellularly, (3) albuterol nebulized, (4) sodium
bicarbonate if acidotic. Definitive removal via emergent hemodialysis is required because she has
refractory hyperkalemia in the setting of CKD/heart failure and hemodynamic instability. Sodium
polystyrene is too slow (onset 2+ hours) and contraindicated in unstable patients.
Q4. A 71-year-old male is admitted with decompensated heart failure. Pulmonary
artery catheter reveals: RA 14 mmHg, PA 52/24 mmHg, PCWP 26 mmHg, CO 4.2
L/min, CI 2.1 L/min/m2, SVR 1900 dynes/sec/cm5. Which hemodynamic profile best
describes this patient, and what is the optimal initial therapy?
A. Cold and dry - give IV fluids
B. Cold and wet - give IV diuretics plus vasodilator if BP permits *[CORRECT]*
C. Warm and wet - give IV diuretics plus inotrope
D. Warm and dry - observe and optimize oral therapy
Correct Answer: B
Rationale: Elevated filling pressures (PCWP 26, RA 14) define the 'wet' profile; low CI with elevated
SVR defines the 'cold' profile. The patient is therefore 'cold & wet,' consistent with low-output
decompensated HF. Therapy is IV loop diuretics to relieve congestion plus a vasodilator if blood
pressure allows; inotropes are reserved for those with refractory hypoperfusion. (Stevenson
hemodynamic profiles, AHA/HFSA 2022 HF Guideline.)
Q5. A patient post-cardiac arrest (ROSC after 12 minutes) is being managed with
targeted temperature management (TTM) at 36 degrees C. The patient is shivering
vigorously despite buspirone and surface warming. Which pharmacologic adjunct is
most appropriate as a first-line agent to suppress shivering without significant
sedation?
A. Cisatracurium 0.15 mg/kg IV bolus
B. Morphine 4 mg IV push
C. Dexmedetomidine 0.7 mcg/kg/hr infusion (no bolus) *[CORRECT]*
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 2
,Adult CCRN® Exam 2026/2027 150 Verified Questions • AACN Blueprint Aligned
D. Propofol 50 mcg/kg/min infusion
Correct Answer: C
Rationale: Dexmedetomidine is recommended by the AACN TTM Practice Alert as a first-line
counter-shivering agent because it provides sedation and analgesia without significant respiratory
depression and reduces shivering via alpha-2 agonism. Neuromuscular blockers mask shivering and
should be reserved for refractory cases due to loss of neurologic exam. Morphine and propofol may help
but dexmedetomidine is preferred when neurologic assessment must be preserved.
Q6. A 69-year-old with a mechanical mitral valve replacement on warfarin presents
with acute onset severe dyspnea, HR 142 and irregularly irregular, BP 92/58, and an
INR of 1.4. The patient was non-adherent with warfarin for past 3 weeks.
Auscultation reveals a mute mechanical click. What is the MOST likely diagnosis and
immediate management?
A. Acute ST-segment elevation MI - activate cath lab
B. Acute valve thrombosis - emergent echocardiography and IV heparin; consider
fibrinolysis or surgery *[CORRECT]*
C. Acute pericarditis - administer NSAIDs and colchicine
D. Pulmonary embolism - administer IV tPA
Correct Answer: B
Rationale: A subtherapeutic INR, loss of the mechanical click, new AF with hypotension, and acute
dyspnea in a patient with a mechanical mitral valve strongly suggest acute valve thrombosis. The
AHA/ACC valvular guidelines recommend emergent TEE to confirm, immediate initiation of IV
unfractionated heparin, and either fibrinolytic therapy or emergent surgery depending on thrombus size
and patient stability. Thrombolytics for PE here would be inappropriate without confirmation.
Q7. A patient in the cardiac ICU develops sudden onset wide-complex tachycardia at
220 bpm, no P waves visible, and a QRS of 0.16 sec with a right bundle branch block
pattern and northwest axis. The patient is pulseless. Which is the appropriate
action?
A. Administer adenosine 6 mg rapid IV push
B. Synchronized cardioversion at 100 J
C. Initiate CPR and defibrillate at 200 J biphasic *[CORRECT]*
D. Administer amiodarone 150 mg IV over 10 minutes
Correct Answer: C
Rationale: A pulseless patient in a wide-complex tachycardia is in cardiac arrest (VF/pulseless VT). The
ACLS algorithm requires immediate high-quality CPR and defibrillation. Adenosine is contraindicated in
pulseless rhythms; synchronized cardioversion is contraindicated when no pulse is present (the sync
marker would not work and could deteriorate to VF). Amiodarone is given after ROSC or for stable
wide-complex tachycardia, not as the first action in pulseless VT.
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 3
, Adult CCRN® Exam 2026/2027 150 Verified Questions • AACN Blueprint Aligned
Q8. A 75-year-old presents with chest pain that improves when sitting forward and
worsens when supine. There is a three-component friction rub at the left sternal
border. ECG shows diffuse PR depression and ST elevation in most leads except aVR
and V1. The patient reports a recent viral URI. Two hours later, BP drops to 84/52,
JVD is markedly elevated, and HR rises to 130. Which finding on bedside echo would
confirm the suspected complication?
A. Large aneurysm of the LV apex
B. Right ventricular diastolic collapse with right atrial inversion during diastole
*[CORRECT]*
C. Severe mitral regurgitation with a flail leaflet
D. Reduced LV ejection fraction < 25%
Correct Answer: B
Rationale: Acute pericarditis has progressed to cardiac tamponade. The hallmark echo findings of
tamponade are RV diastolic collapse, RA inversion (late diastole), plethoric IVC, and respiratory
variation in inflow velocities. Prompt pericardiocentesis is required. The other findings suggest MI
complications unrelated to the clinical picture.
Q9. A 68-year-old male with a known abdominal aortic aneurysm (5.8 cm) suddenly
complains of severe, tearing back pain and presents with syncope. BP is 76/40 in the
right arm and 92/58 in the left. HR 128. Which action is MOST appropriate?
A. Administer labetalol IV then obtain a STAT CT angiogram of the abdomen and
pelvis *[CORRECT]*
B. Administer IV nitroprusside for BP control before imaging
C. Transfer to the floor for serial abdominal exams
D. Administer IV morphine 4 mg and observe for pain relief
Correct Answer: A
Rationale: The patient has classic presentation of a ruptured AAA with shock and BP differential. Initial
management includes IV beta-blockade (esmolol or labetalol) to reduce shear stress on the aorta (target
HR < 80, SBP 100-120), large-bore IV access, type and cross for massive transfusion, and emergent
surgical or endovascular repair. CTA confirms diagnosis in stable patients, but if unstable, the patient
may go directly to OR. Nitroprusside alone without beta-blockade causes reflex tachycardia that
worsens dissection extension.
Q10. A 55-year-old with hypertensive emergency has BP 240/130, confusion,
papilledema on funduscopic exam, and crackles at both lung bases. Which
medication and route are MOST appropriate as the initial treatment?
A. Sublingual captopril 25 mg
B. IV nicardipine infusion titrated to lower MAP by 10-20% in the first hour
*[CORRECT]*
C. IV hydralazine 20 mg push
D. Oral amlodipine 10 mg
Correct Answer: B
Rationale: Hypertensive emergency with end-organ damage (encephalopathy, pulmonary edema)
requires a titratable IV agent that lowers BP in a controlled fashion (10-20% in the first hour, then
gradually toward 160/100 over 2-6 hours). Nicardipine, labetalol, or clevidipine are preferred.
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 4
ADULT CCRN® EXAM 2026/2027
Complete Exam with Verified Questions and 100% Correct Answers
Aligned with AACN CCRN (Adult) Examination Blueprint • 150 Questions • 9 Sections •
AACN Synergy Model • Evidence-Based Practice
Cognitive: 20% Recall •
Style: 80% Scenario-Based
Total Questions: 150 50% Application • 30%
• 20% Direct Knowledge
Analysis
Section 1: Clinical Judgment – Cardiovascular — 25
Questions
Q1. A 62-year-old male presents to the ED with crushing substernal chest pain
radiating to the left arm, diaphoresis, and dyspnea that began 45 minutes ago. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF with reciprocal
depression in I and aVL. Vital signs: BP 96/60, HR 48, RR 22, SpO2 94% on RA. Which
intervention is the PRIORITY at this moment?
A. Administer metoprolol 5 mg IV push to reduce myocardial oxygen demand
B. Give nitroglycerin 0.4 mg sublingual to relieve chest pain
C. Initiate dual antiplatelet therapy and activate the cath lab for primary PCI
*[CORRECT]*
D. Administer atropine 1 mg IV push to increase heart rate
Correct Answer: C
Rationale: The patient has an acute inferior STEMI with cardiogenic shock features (hypotension,
bradycardia). Right coronary artery occlusion is likely; beta-blockers and nitroglycerin are
contraindicated in the hypotensive inferior STEMI patient because RV involvement makes them
preload-dependent. The AACN/AHA/ACC STEMI guideline mandates immediate dual antiplatelet
therapy (aspirin + P2Y12 inhibitor) and activation of the cath lab for primary PCI within 90 minutes
(door-to-balloon). Atropine may be considered only if bradycardia causes hemodynamic instability
unresponsive to reperfusion.
Q2. A patient with an acute anterior wall MI develops new bibasilar crackles, an S3
gallop, BP 88/52, HR 124, and a PA wedge pressure of 28 mmHg with a cardiac index
of 1.8 L/min/m2. The mixed venous saturation (SvO2) is 55%. Which pharmacologic
regimen best addresses the underlying pathophysiology of cardiogenic shock?
A. Lisinopril 10 mg PO daily to reduce afterload
B. Norepinephrine to raise MAP > 65 mmHg followed by dobutamine to augment
CI *[CORRECT]*
C. Furosemide 80 mg IV push to reduce preload
D. Diltiazem 20 mg IV push for rate control and afterload reduction
Correct Answer: B
Rationale: Cardiogenic shock complicating acute MI requires restoring MAP to preserve coronary
perfusion (norepinephrine is preferred over dopamine per SPRINT-CSI and current guidelines due to
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 1
,Adult CCRN® Exam 2026/2027 150 Verified Questions • AACN Blueprint Aligned
lower arrhythmia burden) plus an inotrope (dobutamine or milrinone) to raise cardiac index toward >
2.2 L/min/m2 and SvO2 > 65%. ACE inhibitors and CCBs are contraindicated in acute decompensated
shock. Diuretics alone will worsen the already low preload-dependence and may precipitate collapse.
(AACN Procedure Manual; AHA Scientific Statement on Cardiogenic Shock.)
Q3. A 58-year-old female with chronic NYHA Class IV heart failure is on furosemide
80 mg BID, lisinopril 20 mg, and spironolactone 25 mg daily. Today she presents
with confusion, peaked T waves, wide QRS, and a serum K+ of 7.1 mEq/L. BP 84/50.
ECG shows a sine-wave pattern. Which sequence is MOST appropriate?
A. Administer IV insulin + 50% dextrose, IV calcium gluconate, then arrange
emergent hemodialysis *[CORRECT]*
B. Administer oral sodium polystyrene sulfonate and recheck K+ in 4 hours
C. Administer IV sodium bicarbonate 150 mEq bolus and reassess
D. Administer IV furosemide 80 mg push and isotonic saline bolus
Correct Answer: A
Rationale: The patient has life-threatening hyperkalemia with ECG changes (sine-wave = severe). The
ACLS/AACN-recommended sequence is: (1) calcium gluconate 10 mL of 10% IV to stabilize the
myocardium, (2) insulin + dextrose to shift K+ intracellularly, (3) albuterol nebulized, (4) sodium
bicarbonate if acidotic. Definitive removal via emergent hemodialysis is required because she has
refractory hyperkalemia in the setting of CKD/heart failure and hemodynamic instability. Sodium
polystyrene is too slow (onset 2+ hours) and contraindicated in unstable patients.
Q4. A 71-year-old male is admitted with decompensated heart failure. Pulmonary
artery catheter reveals: RA 14 mmHg, PA 52/24 mmHg, PCWP 26 mmHg, CO 4.2
L/min, CI 2.1 L/min/m2, SVR 1900 dynes/sec/cm5. Which hemodynamic profile best
describes this patient, and what is the optimal initial therapy?
A. Cold and dry - give IV fluids
B. Cold and wet - give IV diuretics plus vasodilator if BP permits *[CORRECT]*
C. Warm and wet - give IV diuretics plus inotrope
D. Warm and dry - observe and optimize oral therapy
Correct Answer: B
Rationale: Elevated filling pressures (PCWP 26, RA 14) define the 'wet' profile; low CI with elevated
SVR defines the 'cold' profile. The patient is therefore 'cold & wet,' consistent with low-output
decompensated HF. Therapy is IV loop diuretics to relieve congestion plus a vasodilator if blood
pressure allows; inotropes are reserved for those with refractory hypoperfusion. (Stevenson
hemodynamic profiles, AHA/HFSA 2022 HF Guideline.)
Q5. A patient post-cardiac arrest (ROSC after 12 minutes) is being managed with
targeted temperature management (TTM) at 36 degrees C. The patient is shivering
vigorously despite buspirone and surface warming. Which pharmacologic adjunct is
most appropriate as a first-line agent to suppress shivering without significant
sedation?
A. Cisatracurium 0.15 mg/kg IV bolus
B. Morphine 4 mg IV push
C. Dexmedetomidine 0.7 mcg/kg/hr infusion (no bolus) *[CORRECT]*
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 2
,Adult CCRN® Exam 2026/2027 150 Verified Questions • AACN Blueprint Aligned
D. Propofol 50 mcg/kg/min infusion
Correct Answer: C
Rationale: Dexmedetomidine is recommended by the AACN TTM Practice Alert as a first-line
counter-shivering agent because it provides sedation and analgesia without significant respiratory
depression and reduces shivering via alpha-2 agonism. Neuromuscular blockers mask shivering and
should be reserved for refractory cases due to loss of neurologic exam. Morphine and propofol may help
but dexmedetomidine is preferred when neurologic assessment must be preserved.
Q6. A 69-year-old with a mechanical mitral valve replacement on warfarin presents
with acute onset severe dyspnea, HR 142 and irregularly irregular, BP 92/58, and an
INR of 1.4. The patient was non-adherent with warfarin for past 3 weeks.
Auscultation reveals a mute mechanical click. What is the MOST likely diagnosis and
immediate management?
A. Acute ST-segment elevation MI - activate cath lab
B. Acute valve thrombosis - emergent echocardiography and IV heparin; consider
fibrinolysis or surgery *[CORRECT]*
C. Acute pericarditis - administer NSAIDs and colchicine
D. Pulmonary embolism - administer IV tPA
Correct Answer: B
Rationale: A subtherapeutic INR, loss of the mechanical click, new AF with hypotension, and acute
dyspnea in a patient with a mechanical mitral valve strongly suggest acute valve thrombosis. The
AHA/ACC valvular guidelines recommend emergent TEE to confirm, immediate initiation of IV
unfractionated heparin, and either fibrinolytic therapy or emergent surgery depending on thrombus size
and patient stability. Thrombolytics for PE here would be inappropriate without confirmation.
Q7. A patient in the cardiac ICU develops sudden onset wide-complex tachycardia at
220 bpm, no P waves visible, and a QRS of 0.16 sec with a right bundle branch block
pattern and northwest axis. The patient is pulseless. Which is the appropriate
action?
A. Administer adenosine 6 mg rapid IV push
B. Synchronized cardioversion at 100 J
C. Initiate CPR and defibrillate at 200 J biphasic *[CORRECT]*
D. Administer amiodarone 150 mg IV over 10 minutes
Correct Answer: C
Rationale: A pulseless patient in a wide-complex tachycardia is in cardiac arrest (VF/pulseless VT). The
ACLS algorithm requires immediate high-quality CPR and defibrillation. Adenosine is contraindicated in
pulseless rhythms; synchronized cardioversion is contraindicated when no pulse is present (the sync
marker would not work and could deteriorate to VF). Amiodarone is given after ROSC or for stable
wide-complex tachycardia, not as the first action in pulseless VT.
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 3
, Adult CCRN® Exam 2026/2027 150 Verified Questions • AACN Blueprint Aligned
Q8. A 75-year-old presents with chest pain that improves when sitting forward and
worsens when supine. There is a three-component friction rub at the left sternal
border. ECG shows diffuse PR depression and ST elevation in most leads except aVR
and V1. The patient reports a recent viral URI. Two hours later, BP drops to 84/52,
JVD is markedly elevated, and HR rises to 130. Which finding on bedside echo would
confirm the suspected complication?
A. Large aneurysm of the LV apex
B. Right ventricular diastolic collapse with right atrial inversion during diastole
*[CORRECT]*
C. Severe mitral regurgitation with a flail leaflet
D. Reduced LV ejection fraction < 25%
Correct Answer: B
Rationale: Acute pericarditis has progressed to cardiac tamponade. The hallmark echo findings of
tamponade are RV diastolic collapse, RA inversion (late diastole), plethoric IVC, and respiratory
variation in inflow velocities. Prompt pericardiocentesis is required. The other findings suggest MI
complications unrelated to the clinical picture.
Q9. A 68-year-old male with a known abdominal aortic aneurysm (5.8 cm) suddenly
complains of severe, tearing back pain and presents with syncope. BP is 76/40 in the
right arm and 92/58 in the left. HR 128. Which action is MOST appropriate?
A. Administer labetalol IV then obtain a STAT CT angiogram of the abdomen and
pelvis *[CORRECT]*
B. Administer IV nitroprusside for BP control before imaging
C. Transfer to the floor for serial abdominal exams
D. Administer IV morphine 4 mg and observe for pain relief
Correct Answer: A
Rationale: The patient has classic presentation of a ruptured AAA with shock and BP differential. Initial
management includes IV beta-blockade (esmolol or labetalol) to reduce shear stress on the aorta (target
HR < 80, SBP 100-120), large-bore IV access, type and cross for massive transfusion, and emergent
surgical or endovascular repair. CTA confirms diagnosis in stable patients, but if unstable, the patient
may go directly to OR. Nitroprusside alone without beta-blockade causes reflex tachycardia that
worsens dissection extension.
Q10. A 55-year-old with hypertensive emergency has BP 240/130, confusion,
papilledema on funduscopic exam, and crackles at both lung bases. Which
medication and route are MOST appropriate as the initial treatment?
A. Sublingual captopril 25 mg
B. IV nicardipine infusion titrated to lower MAP by 10-20% in the first hour
*[CORRECT]*
C. IV hydralazine 20 mg push
D. Oral amlodipine 10 mg
Correct Answer: B
Rationale: Hypertensive emergency with end-organ damage (encephalopathy, pulmonary edema)
requires a titratable IV agent that lowers BP in a controlled fashion (10-20% in the first hour, then
gradually toward 160/100 over 2-6 hours). Nicardipine, labetalol, or clevidipine are preferred.
Copyright © 2026-2027 — CCRN Exam Preparation Series • For Educational Use Only Page 4
