Critical Care Registered Nurse {CCRN} CERTIFICATION EXAM
STUDY GUIDE | 2025–2026 COMPLETE REVIEW | 170
VERIFIED QUESTIONS & HIGH-YIELD CRITICAL CARE
ANSWERS
This all-in-one CCRN prep guide is built to help nurses pass the Adult CCRN
Exam with confidence. It focuses on high-yield topics and frequently tested
clinical concepts, such as interpreting hemodynamic monitoring, managing
ventilated patients, handling complex arrhythmias, titrating vasoactive drips,
and identifying signs of multi-organ dysfunction. Each question is carefully
aligned with the AACN blueprint, making it ideal for focused review and
reinforcing clinical judgment. Whether you’re testing soon or building your
knowledge throughout the year, this resource supports success on the first
attempt.
A patient in hyperosolar hyperglycemic state (HHS) is being admitted with dehydration and a serum
glucose level of 836 mg/dL. Which of the following additional laboratory findings should the nurse
anticipate?
A. decreased BUN, decreased creatinine, and elevated serum osmolality
B. decreased BUN, decreased creatinine and decreased serum osmolality
C. decreased BUN, elevated creatinine and decreased serum osmolality
D. elevated BUN, elevated creatinine and elevated serum osmolality - CORRECT ANSWER-D.
elevated BUN, elevated creatinine and elevated serum osmolality
Serum osmolality > 320 mOsm/kg distinguishes HHS from DKA
On the fifth day post-admission, a patient with Q waves in V1, V2, and V3 develops hypotension,
tachycardia, and a pan-systolic murmur that is loudest at the lower left sternal border. This patient
most likely developed
A. idiopathic hypertrophic cardiomyopathy
B. inferior wall infarction
C. cardiac tamponade
D. a ruptured inter-ventricular septum - CORRECT ANSWER-D. a ruptured inter-ventricular septum
(septal wall MI)
,A patient with a history of chronic pain, asthma, diabetes, and heavy alcohol intake is now
experiencing cognitive impairment from medications. Assessment: awake but confused, BP 155/82,
HR 84, RR 16 and SpO2 95% on RA. This patient is at high risk for
A. Intubation
B. needing long-term psychiatric care
C. attempting suicide
D. over-sedation by staff - CORRECT ANSWER-C. attempting suicide (chronic medical illness, heavy
alcohol intake, and chronic pain)
Which of the following 12-lead ECG changes should be expected in a patient with acute coronary
syndrome involving the inferior wall?
A. ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL
B. ST segment elevation in leads II, III, and all precordial leads
C. ST segment elevation and deeply inverted T waves in leads II, III, aVF
D. ST segment depression and T wave elevation in leads II, III, aVL - CORRECT ANSWER-C. ST
segment elevation and deeply inverted T waves in leads II, III, aVF
The major effect of acute lung injury (ALI) on the lung tissue is
A. decreased capillary permeability
B. increased function residual capacity (FRC)
C. decreased compliance
D. decreased alveolar surface tension - CORRECT ANSWER-C. decreased compliance (related to the
alteration of lung endothelium and vascular tissue. Results in stiffness and fluid filled non-aerated
airways)
A patient with mitral regurgitation suddenly develops atrial fibrillation with a rate of 156. BP is
118/74. The nurse should anticipate medication orders for
A. beta-blockers and vasopressors
B. warfarin (Coumadin) and alpha-agonists
C. beta-agonists and calcium-channel blockers
D. cardiac glycosides and calcium channel blockers - CORRECT ANSWER-D. cardiac glycosides
(digoxin) and calcium channel blockers
,Which of the following pulmonary artery catheter findings would be anticipated in a patient with
chronic emphysema?
A. increased CVP
B. decreased CI
C. increased SV
D. decreased PAOP - CORRECT ANSWER-A. increased CVP (emphysema can cause cor pulmonale
secondary to increased pressure)
A patient is admitted complaining of chest pain and nausea. The ECG monitor reveals secondary AV
block, Type II. These findings are probably a result of occlusion of which of the following coronary
arteries?
A. left anterior descending
B. left circumflex
C. posterior descending
D. right - CORRECT ANSWER-A. left anterior descending (LAD supplies blood to the septum)
A patient has heart failure secondary to ischemic cardiomyopathy and end-stage coronary artery
disease. Which of the following agents would be most beneficial
A. digoxin and diltiazem
B. carvedilol and lisinopril
C. veramapril and spironolactone
D. flecainide and hydralazine - CORRECT ANSWER-B. carvedilol and lisinopril (decreases after-load
and minimizes remodeling that is associated with HF)
When providing care to a patient with status epilepticus, the nurse should recognize that usually
A. it is a state of continuous seizures lasting more than two minutes
B. the patient comes out of the post ictal state between seizures
C. it results from abrupt discontinuation of anti-seizure meds
D. the cause of death is due to cerebral hemorrhage - CORRECT ANSWER-C. it results from abrupt
discontinuation of anti-seizure meds
A patient with a history of angina is admitted to the units after surgical repair of an AAA. The patient
is receiving a sodium nitroprusside (Nipride) gtt for severe postop hypertension. Twelve hours later,
the pattient complains of back pain.
, BP 80/60
HR 120
UO 20 mL/hr
+1 left and right dorsalis pedis pulse
A. Admin of NS 200 ml/hr and prepare for doppler studies
B. spiral chest CT and emergent pericardiocentesis
C. procedural sedation and IABP insertion
D. discontinuation of Nipride and prepare for surgery - CORRECT ANSWER-D. discontinuation of
Nipride and prepare for surgery (because the patient is hypotensive-DUH! w/ s/s of postop bleeding
and hypovolemic shock)
A patient with head trauma is experiencing increased ICP. The ideal level at which to maintain
arterial pCO2
A. below 20
B. between 35 and 45
C. between 25 and 30
D. above 45 - CORRECT ANSWER-B. between 35 and 45 (normocapnia is essential for maintaining
stable intracranial pressure, because CO2 directly affects the degree of vasodilation in cerebral blood
vessels)
Which of the following is an endpoint of volume resuscitation?
A. CVP 3 mm Hg
B. CI 2.4 L/min/m2
C. oxygen consumption 250 ml/min
D. BE 4 mmol/L - CORRECT ANSWER-C. oxygen consumption 250 ml/min (the amount of oxygen
used by the body)
Which of the following life-threatening dysrhythmias is most frequently associated with HF?
A. bigeminy PACs
B. ventricular tachycardia
C. second-degree AV Block Type II (anterior wall MI)
D. junctional tachycardia (digoxin toxicity) - CORRECT ANSWER-B. ventricular tachycardia (Low Ef
leads to stretch and excitability of ventricles. Can lead to electrolyte shifts from diuretic therapy
which can exacerbate VTACH)
STUDY GUIDE | 2025–2026 COMPLETE REVIEW | 170
VERIFIED QUESTIONS & HIGH-YIELD CRITICAL CARE
ANSWERS
This all-in-one CCRN prep guide is built to help nurses pass the Adult CCRN
Exam with confidence. It focuses on high-yield topics and frequently tested
clinical concepts, such as interpreting hemodynamic monitoring, managing
ventilated patients, handling complex arrhythmias, titrating vasoactive drips,
and identifying signs of multi-organ dysfunction. Each question is carefully
aligned with the AACN blueprint, making it ideal for focused review and
reinforcing clinical judgment. Whether you’re testing soon or building your
knowledge throughout the year, this resource supports success on the first
attempt.
A patient in hyperosolar hyperglycemic state (HHS) is being admitted with dehydration and a serum
glucose level of 836 mg/dL. Which of the following additional laboratory findings should the nurse
anticipate?
A. decreased BUN, decreased creatinine, and elevated serum osmolality
B. decreased BUN, decreased creatinine and decreased serum osmolality
C. decreased BUN, elevated creatinine and decreased serum osmolality
D. elevated BUN, elevated creatinine and elevated serum osmolality - CORRECT ANSWER-D.
elevated BUN, elevated creatinine and elevated serum osmolality
Serum osmolality > 320 mOsm/kg distinguishes HHS from DKA
On the fifth day post-admission, a patient with Q waves in V1, V2, and V3 develops hypotension,
tachycardia, and a pan-systolic murmur that is loudest at the lower left sternal border. This patient
most likely developed
A. idiopathic hypertrophic cardiomyopathy
B. inferior wall infarction
C. cardiac tamponade
D. a ruptured inter-ventricular septum - CORRECT ANSWER-D. a ruptured inter-ventricular septum
(septal wall MI)
,A patient with a history of chronic pain, asthma, diabetes, and heavy alcohol intake is now
experiencing cognitive impairment from medications. Assessment: awake but confused, BP 155/82,
HR 84, RR 16 and SpO2 95% on RA. This patient is at high risk for
A. Intubation
B. needing long-term psychiatric care
C. attempting suicide
D. over-sedation by staff - CORRECT ANSWER-C. attempting suicide (chronic medical illness, heavy
alcohol intake, and chronic pain)
Which of the following 12-lead ECG changes should be expected in a patient with acute coronary
syndrome involving the inferior wall?
A. ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL
B. ST segment elevation in leads II, III, and all precordial leads
C. ST segment elevation and deeply inverted T waves in leads II, III, aVF
D. ST segment depression and T wave elevation in leads II, III, aVL - CORRECT ANSWER-C. ST
segment elevation and deeply inverted T waves in leads II, III, aVF
The major effect of acute lung injury (ALI) on the lung tissue is
A. decreased capillary permeability
B. increased function residual capacity (FRC)
C. decreased compliance
D. decreased alveolar surface tension - CORRECT ANSWER-C. decreased compliance (related to the
alteration of lung endothelium and vascular tissue. Results in stiffness and fluid filled non-aerated
airways)
A patient with mitral regurgitation suddenly develops atrial fibrillation with a rate of 156. BP is
118/74. The nurse should anticipate medication orders for
A. beta-blockers and vasopressors
B. warfarin (Coumadin) and alpha-agonists
C. beta-agonists and calcium-channel blockers
D. cardiac glycosides and calcium channel blockers - CORRECT ANSWER-D. cardiac glycosides
(digoxin) and calcium channel blockers
,Which of the following pulmonary artery catheter findings would be anticipated in a patient with
chronic emphysema?
A. increased CVP
B. decreased CI
C. increased SV
D. decreased PAOP - CORRECT ANSWER-A. increased CVP (emphysema can cause cor pulmonale
secondary to increased pressure)
A patient is admitted complaining of chest pain and nausea. The ECG monitor reveals secondary AV
block, Type II. These findings are probably a result of occlusion of which of the following coronary
arteries?
A. left anterior descending
B. left circumflex
C. posterior descending
D. right - CORRECT ANSWER-A. left anterior descending (LAD supplies blood to the septum)
A patient has heart failure secondary to ischemic cardiomyopathy and end-stage coronary artery
disease. Which of the following agents would be most beneficial
A. digoxin and diltiazem
B. carvedilol and lisinopril
C. veramapril and spironolactone
D. flecainide and hydralazine - CORRECT ANSWER-B. carvedilol and lisinopril (decreases after-load
and minimizes remodeling that is associated with HF)
When providing care to a patient with status epilepticus, the nurse should recognize that usually
A. it is a state of continuous seizures lasting more than two minutes
B. the patient comes out of the post ictal state between seizures
C. it results from abrupt discontinuation of anti-seizure meds
D. the cause of death is due to cerebral hemorrhage - CORRECT ANSWER-C. it results from abrupt
discontinuation of anti-seizure meds
A patient with a history of angina is admitted to the units after surgical repair of an AAA. The patient
is receiving a sodium nitroprusside (Nipride) gtt for severe postop hypertension. Twelve hours later,
the pattient complains of back pain.
, BP 80/60
HR 120
UO 20 mL/hr
+1 left and right dorsalis pedis pulse
A. Admin of NS 200 ml/hr and prepare for doppler studies
B. spiral chest CT and emergent pericardiocentesis
C. procedural sedation and IABP insertion
D. discontinuation of Nipride and prepare for surgery - CORRECT ANSWER-D. discontinuation of
Nipride and prepare for surgery (because the patient is hypotensive-DUH! w/ s/s of postop bleeding
and hypovolemic shock)
A patient with head trauma is experiencing increased ICP. The ideal level at which to maintain
arterial pCO2
A. below 20
B. between 35 and 45
C. between 25 and 30
D. above 45 - CORRECT ANSWER-B. between 35 and 45 (normocapnia is essential for maintaining
stable intracranial pressure, because CO2 directly affects the degree of vasodilation in cerebral blood
vessels)
Which of the following is an endpoint of volume resuscitation?
A. CVP 3 mm Hg
B. CI 2.4 L/min/m2
C. oxygen consumption 250 ml/min
D. BE 4 mmol/L - CORRECT ANSWER-C. oxygen consumption 250 ml/min (the amount of oxygen
used by the body)
Which of the following life-threatening dysrhythmias is most frequently associated with HF?
A. bigeminy PACs
B. ventricular tachycardia
C. second-degree AV Block Type II (anterior wall MI)
D. junctional tachycardia (digoxin toxicity) - CORRECT ANSWER-B. ventricular tachycardia (Low Ef
leads to stretch and excitability of ventricles. Can lead to electrolyte shifts from diuretic therapy
which can exacerbate VTACH)
