CCRN EXAM – QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE
*Core Domains*
*- Cardiovascular System*
*- Pulmonary System*
*- Neurological System*
*- Renal and Endocrine Systems*
*- Gastrointestinal System*
*- Multisystem and Professional Caring*
*Introduction*
*The purpose of this examination is to evaluate the advanced kno
Section One: Questions 1–100
Question 1
A critically ill patient with septic shock is receiving norepinephrine
infusion via a peripheral IV line in the forearm. The nurse notes cool,
pale skin and swelling surrounding the insertion site, with a sluggish
capillary refill distal to the site. What is the immediate priority action?
A. Slow the infusion rate by half and reassess the site in fifteen
minutes.
B. Stop the infusion immediately and notify the provider for
phentolamine orders.
C. Apply warm compresses to the site while continuing the infusion at a
lower rate.
D. Flush the peripheral line with normal saline to clear the remaining
medication.
🟢 B. Stop the infusion immediately and notify the provider for
phentolamine orders.
🔴 Explanation: Extravasation of vasoconstrictive agents like
norepinephrine causes severe local tissue ischemia and necrosis. The
,infusion must be stopped immediately, and phentolamine (an alpha-
adrenergic blocker) should be infiltrated into the affected area to
reverse vasoconstriction.
Question 2
A patient admitted with acute respiratory distress syndrome (ARDS) is
placed on mechanical ventilation with low tidal volume ventilation and
high positive end-expiratory pressure (PEEP). Which arterial blood gas
value indicates that the current ventilator settings are achieving
adequate oxygenation?
A. PaO2 of 40 mmHg
B. PaO2 of 88 mmHg on an FiO2 of 0.40
C. PaCO2 of 55 mmHg
D. pH of 7.28
🟢 B. PaO2 of 88 mmHg on an FiO2 of 0.40
🔴 Explanation: A PaO2 between 80 and 100 mmHg on a relatively
low fraction of inspired oxygen indicates good arterial oxygenation and
adequate alveolar recruitment without excessive oxygen toxicity risk.
Question 3
A postoperative cardiac surgery patient suddenly develops a right-
sided hemiparesis and expressive aphasia. The telemetry monitor
shows normal sinus rhythm, but continuous heart rhythm monitoring is
ordered. What is the most likely underlying mechanism for this
neurological deficit?
A. Hypoglycemic encephalopathy
B. Cerebral salt wasting syndrome
C. Thromboembolic stroke originating from the heart
D. Acute hypertensive emergency with vasogenic edema
🟢 C. Thromboembolic stroke originating from the heart
🔴 Explanation: Post-cardiac surgery patients are at high risk for
cardioembolic events, often due to atrial fibrillation or manipulation of
the aorta during surgery, leading to acute cerebral vessel occlusion.
Question 4
A patient in the intensive care unit with severe acute pancreatitis
exhibits severe abdominal pain, a serum calcium level of 6.8 mg/dL,
and positive Trousseau sign. What is the underlying pathophysiology
,for this electrolyte abnormality?
A. Excessive renal excretion caused by aggressive fluid resuscitation
B. Saponification of calcium by free fatty acids in the retroperitoneum
C. Primary hyperparathyroidism secondary to pancreatic inflammation
D. Intracellular shifting of calcium caused by massive insulin release
🟢 B. Saponification of calcium by free fatty acids in the
retroperitoneum
🔴 Explanation: In acute pancreatitis, pancreatic enzymes autodigest
adipose tissue, releasing free fatty acids that bind with ionized calcium
to form soap-like compounds, leading to hypocalcemia.
Question 5
An intracranial pressure (ICP) monitor is placed in a patient with severe
traumatic brain injury. The mean arterial pressure (MAP) is 85 mmHg
and the ICP is 20 mmHg. What is the calculated cerebral perfusion
pressure (CPP), and is it within the target range?
A. CPP is 65 mmHg, which is within the normal therapeutic range.
B. CPP is 105 mmHg, which is dangerously high.
C. CPP is 60 mmHg, which is lower than the recommended target.
D. CPP is 85 mmHg, which reflects normal intracranial compliance.
🟢 A. CPP is 65 mmHg, which is within the normal therapeutic range.
🔴 Explanation: Cerebral perfusion pressure is calculated as MAP
minus ICP (85 - 20 = 65 mmHg). The target CPP for patients with
traumatic brain injury is generally between 60 and 70 mmHg.
Question 6
A patient with chronic kidney disease presents with profound muscle
weakness, peaked T waves on the electrocardiogram, and a widened
QRS complex. Which intravenous medication should the nurse prepare
to administer first to protect the myocardium?
A. Regular insulin and dextrose
B. Sodium polystyrene sulfonate
C. Calcium gluconate
D. Sodium bicarbonate
🟢 C. Calcium gluconate
🔴 Explanation: Calcium gluconate stabilizes the cardiac cell
membrane against the arrhythmogenic effects of severe hyperkalemia,
, providing immediate myocardial protection before measures to shift or
eliminate potassium take effect.
Question 7
A patient with a pulmonary artery catheter in place shows a pulmonary
artery wedge pressure (PAWP) of 22 mmHg, cardiac output of 3.2
L/min, and bilateral crackles in the lung fields. Which clinical condition
is most consistent with these hemodynamic values?
A. Hypovolemic shock
B. Left ventricular heart failure
C. Cardiac tamponade
D. Septic shock
🟢 B. Left ventricular heart failure
🔴 Explanation: An elevated PAWP (above 12 mmHg) combined with
a low cardiac output and pulmonary congestion indicates elevated left
ventricular filling pressures, characteristic of left ventricular failure or
fluid overload.
Question 8
A trauma patient arrives in the emergency department following a
motor vehicle collision. The patient is restless, tachycardic, and has
absent breath sounds over the right hemithorax with tracheal deviation
to the left. What is the immediate life-saving intervention?
A. Insertion of a chest tube in the fifth intercostal space
B. Needle decompression in the second intercostal space
C. Immediate endotracheal intubation and mechanical ventilation
D. Administration of an intravenous fluid bolus
🟢 B. Needle decompression in the second intercostal space
🔴 Explanation: The patient is exhibiting classic signs of a tension
pneumothorax. Immediate needle decompression relieves intrapleural
pressure before definitive chest tube insertion.
Question 9
A patient is receiving continuous enteral nutrition via a nasogastric
tube. The nurse checks residual gastric volume and obtains 350 mL of
formula. What is the appropriate nursing action based on this finding?
A. Discontinue the feeding permanently and notify the physician.
B. Hold the feeding temporarily, reassess per protocol, and monitor for
WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE
*Core Domains*
*- Cardiovascular System*
*- Pulmonary System*
*- Neurological System*
*- Renal and Endocrine Systems*
*- Gastrointestinal System*
*- Multisystem and Professional Caring*
*Introduction*
*The purpose of this examination is to evaluate the advanced kno
Section One: Questions 1–100
Question 1
A critically ill patient with septic shock is receiving norepinephrine
infusion via a peripheral IV line in the forearm. The nurse notes cool,
pale skin and swelling surrounding the insertion site, with a sluggish
capillary refill distal to the site. What is the immediate priority action?
A. Slow the infusion rate by half and reassess the site in fifteen
minutes.
B. Stop the infusion immediately and notify the provider for
phentolamine orders.
C. Apply warm compresses to the site while continuing the infusion at a
lower rate.
D. Flush the peripheral line with normal saline to clear the remaining
medication.
🟢 B. Stop the infusion immediately and notify the provider for
phentolamine orders.
🔴 Explanation: Extravasation of vasoconstrictive agents like
norepinephrine causes severe local tissue ischemia and necrosis. The
,infusion must be stopped immediately, and phentolamine (an alpha-
adrenergic blocker) should be infiltrated into the affected area to
reverse vasoconstriction.
Question 2
A patient admitted with acute respiratory distress syndrome (ARDS) is
placed on mechanical ventilation with low tidal volume ventilation and
high positive end-expiratory pressure (PEEP). Which arterial blood gas
value indicates that the current ventilator settings are achieving
adequate oxygenation?
A. PaO2 of 40 mmHg
B. PaO2 of 88 mmHg on an FiO2 of 0.40
C. PaCO2 of 55 mmHg
D. pH of 7.28
🟢 B. PaO2 of 88 mmHg on an FiO2 of 0.40
🔴 Explanation: A PaO2 between 80 and 100 mmHg on a relatively
low fraction of inspired oxygen indicates good arterial oxygenation and
adequate alveolar recruitment without excessive oxygen toxicity risk.
Question 3
A postoperative cardiac surgery patient suddenly develops a right-
sided hemiparesis and expressive aphasia. The telemetry monitor
shows normal sinus rhythm, but continuous heart rhythm monitoring is
ordered. What is the most likely underlying mechanism for this
neurological deficit?
A. Hypoglycemic encephalopathy
B. Cerebral salt wasting syndrome
C. Thromboembolic stroke originating from the heart
D. Acute hypertensive emergency with vasogenic edema
🟢 C. Thromboembolic stroke originating from the heart
🔴 Explanation: Post-cardiac surgery patients are at high risk for
cardioembolic events, often due to atrial fibrillation or manipulation of
the aorta during surgery, leading to acute cerebral vessel occlusion.
Question 4
A patient in the intensive care unit with severe acute pancreatitis
exhibits severe abdominal pain, a serum calcium level of 6.8 mg/dL,
and positive Trousseau sign. What is the underlying pathophysiology
,for this electrolyte abnormality?
A. Excessive renal excretion caused by aggressive fluid resuscitation
B. Saponification of calcium by free fatty acids in the retroperitoneum
C. Primary hyperparathyroidism secondary to pancreatic inflammation
D. Intracellular shifting of calcium caused by massive insulin release
🟢 B. Saponification of calcium by free fatty acids in the
retroperitoneum
🔴 Explanation: In acute pancreatitis, pancreatic enzymes autodigest
adipose tissue, releasing free fatty acids that bind with ionized calcium
to form soap-like compounds, leading to hypocalcemia.
Question 5
An intracranial pressure (ICP) monitor is placed in a patient with severe
traumatic brain injury. The mean arterial pressure (MAP) is 85 mmHg
and the ICP is 20 mmHg. What is the calculated cerebral perfusion
pressure (CPP), and is it within the target range?
A. CPP is 65 mmHg, which is within the normal therapeutic range.
B. CPP is 105 mmHg, which is dangerously high.
C. CPP is 60 mmHg, which is lower than the recommended target.
D. CPP is 85 mmHg, which reflects normal intracranial compliance.
🟢 A. CPP is 65 mmHg, which is within the normal therapeutic range.
🔴 Explanation: Cerebral perfusion pressure is calculated as MAP
minus ICP (85 - 20 = 65 mmHg). The target CPP for patients with
traumatic brain injury is generally between 60 and 70 mmHg.
Question 6
A patient with chronic kidney disease presents with profound muscle
weakness, peaked T waves on the electrocardiogram, and a widened
QRS complex. Which intravenous medication should the nurse prepare
to administer first to protect the myocardium?
A. Regular insulin and dextrose
B. Sodium polystyrene sulfonate
C. Calcium gluconate
D. Sodium bicarbonate
🟢 C. Calcium gluconate
🔴 Explanation: Calcium gluconate stabilizes the cardiac cell
membrane against the arrhythmogenic effects of severe hyperkalemia,
, providing immediate myocardial protection before measures to shift or
eliminate potassium take effect.
Question 7
A patient with a pulmonary artery catheter in place shows a pulmonary
artery wedge pressure (PAWP) of 22 mmHg, cardiac output of 3.2
L/min, and bilateral crackles in the lung fields. Which clinical condition
is most consistent with these hemodynamic values?
A. Hypovolemic shock
B. Left ventricular heart failure
C. Cardiac tamponade
D. Septic shock
🟢 B. Left ventricular heart failure
🔴 Explanation: An elevated PAWP (above 12 mmHg) combined with
a low cardiac output and pulmonary congestion indicates elevated left
ventricular filling pressures, characteristic of left ventricular failure or
fluid overload.
Question 8
A trauma patient arrives in the emergency department following a
motor vehicle collision. The patient is restless, tachycardic, and has
absent breath sounds over the right hemithorax with tracheal deviation
to the left. What is the immediate life-saving intervention?
A. Insertion of a chest tube in the fifth intercostal space
B. Needle decompression in the second intercostal space
C. Immediate endotracheal intubation and mechanical ventilation
D. Administration of an intravenous fluid bolus
🟢 B. Needle decompression in the second intercostal space
🔴 Explanation: The patient is exhibiting classic signs of a tension
pneumothorax. Immediate needle decompression relieves intrapleural
pressure before definitive chest tube insertion.
Question 9
A patient is receiving continuous enteral nutrition via a nasogastric
tube. The nurse checks residual gastric volume and obtains 350 mL of
formula. What is the appropriate nursing action based on this finding?
A. Discontinue the feeding permanently and notify the physician.
B. Hold the feeding temporarily, reassess per protocol, and monitor for
