Adult CCRN® Exam 2025/2026 | Complete Exam
with Verified Questions & 100% Correct Answers
Adult CCRN® Certification Exam | Key Concepts: Advanced Critical Care Nursing,
Cardiovascular & Pulmonary Disorders, Neurologic & Endocrine Emergencies, Renal &
Gastrointestinal Dysfunction, Multisystem Organ Failure, Hematology & Immunology,
Pharmacology, Patient Safety, and Evidence-Based Interventions | Expert-Verified Q&A | ICU &
Exam-Ready
Introduction
This 2025/2026 Adult CCRN® Exam resource provides 150 fully verified questions with 100%
correct answers, matching the AACN Adult CCRN® exam structure (125 scored and 25 unscored
questions). Content covers advanced critical care topics, including hemodynamic monitoring,
mechanical ventilation, complex multisystem cases, pharmacologic interventions, and safe
nursing priorities for acutely ill patients. All answers are graded A+ and align with AACN, AHA,
and other evidence-based standards, ensuring complete preparation for Adult CCRN®
certification exam success.
Answer Format
All correct answers are highlighted in bold and green, with rationales that explain advanced
critical care priorities, reinforce safe evidence-based practice, and strengthen expert-level
nursing judgment for exam readiness.
Questions 1–150
1. A patient with septic shock has a mean arterial pressure (MAP) of 55
mmHg despite fluid resuscitation. What is the most appropriate initial
intervention?
a) Administer antibiotics
b) Start norepinephrine
c) Administer additional fluids
d) Order blood cultures
b) Start norepinephrine
Rationale: Refractory hypotension in septic shock (MAP <65 mmHg) requires vasopressor
support with norepinephrine to restore perfusion, per Surviving Sepsis Campaign guidelines.
2. A patient on mechanical ventilation develops a sudden drop in oxygen
saturation and high airway pressure alarms. What is the most appropriate
initial action?
a) Administer albuterol
,b) Order a chest X-ray
c) Increase tidal volume
d) Suction the airway
b) Order a chest X-ray
Rationale: Sudden desaturation and high airway pressure suggest pneumothorax or tube
obstruction, requiring a chest X-ray to diagnose, per AACN ventilator management guidelines.
3. A patient with acute respiratory distress syndrome (ARDS) has a
PaO2/FiO2 ratio of 100. What is the most appropriate ventilator
adjustment?
a) Increase tidal volume
b) Increase PEEP
c) Decrease FiO2
d) Switch to high-frequency ventilation
b) Increase PEEP
Rationale: A low PaO2/FiO2 ratio in ARDS requires increased PEEP to improve alveolar
recruitment and oxygenation, per ARDS Network guidelines.
4. A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m² and
pulmonary artery occlusion pressure (PAOP) of 22 mmHg. What is the most
appropriate initial treatment?
a) Administer IV fluids
b) Start dobutamine
c) Administer furosemide
d) Order an echocardiogram
b) Start dobutamine
Rationale: Low cardiac index with elevated PAOP in cardiogenic shock indicates poor
contractility, requiring inotropic support with dobutamine, per AHA guidelines.
5. A patient with a suspected ischemic stroke presents with left-sided
weakness within 2 hours of symptom onset. What is the most appropriate
initial action?
a) Administer aspirin
b) Order a head CT
c) Start heparin
d) Administer alteplase
b) Order a head CT
Rationale: A head CT is required to rule out hemorrhagic stroke before considering
thrombolytics like alteplase, per AHA stroke guidelines.
6. A patient with acute kidney injury develops a potassium level of 7.0
mEq/L and widened QRS on ECG. What is the most appropriate initial
treatment?
a) Administer furosemide
b) Administer calcium gluconate
,c) Start dialysis
d) Administer insulin and glucose
b) Administer calcium gluconate
Rationale: Hyperkalemia with ECG changes (widened QRS) requires immediate calcium
gluconate to stabilize cardiac membranes, per AHA guidelines.
7. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 500
mg/dL and pH of 7.15. What is the most appropriate initial treatment?
a) Administer sodium bicarbonate
b) Start insulin infusion
c) Administer IV dextrose
d) Increase IV fluids
b) Start insulin infusion
Rationale: Insulin infusion corrects hyperglycemia and halts ketogenesis in DKA, addressing
the underlying metabolic acidosis, per American Diabetes Association guidelines.
8. A patient with a massive pulmonary embolism develops hypotension and
hypoxia. What is the most appropriate initial treatment?
a) Administer IV furosemide
b) Start heparin infusion
c) Administer thrombolytics
d) Order a CT pulmonary angiogram
c) Administer thrombolytics
Rationale: Hypotension and hypoxia in massive pulmonary embolism require thrombolytics for
rapid clot dissolution, per AHA guidelines.
9. A patient with acute pancreatitis develops respiratory distress and a
PaO2 of 60 mmHg. What is the most appropriate initial intervention?
a) Administer IV furosemide
b) Increase oxygen therapy
c) Administer antibiotics
d) Order a CT abdomen
b) Increase oxygen therapy
Rationale: Respiratory distress and hypoxia in pancreatitis may indicate ARDS, requiring
immediate oxygen therapy, per American College of Gastroenterology guidelines.
10. A patient with a gastrointestinal bleed has a hemoglobin of 6.0 g/dL and
blood pressure of 80/50 mmHg. What is the most appropriate initial
intervention?
a) Administer IV fluids
b) Transfuse packed red blood cells
c) Administer proton pump inhibitor
d) Order an endoscopy
b) Transfuse packed red blood cells
, Rationale: Severe anemia and hypotension in a GI bleed require immediate blood transfusion to
restore oxygen-carrying capacity, per American College of Gastroenterology guidelines.
11. A patient with ventricular tachycardia has a pulse and chest pain. What
is the most appropriate initial treatment?
a) Administer amiodarone
b) Perform synchronized cardioversion
c) Administer lidocaine
d) Start CPR
b) Perform synchronized cardioversion
Rationale: Unstable ventricular tachycardia with chest pain requires synchronized
cardioversion to restore rhythm, per AHA ACLS guidelines.
12. A patient with liver failure develops hepatic encephalopathy and
elevated ammonia levels. What is the most appropriate initial treatment?
a) Administer lactulose
b) Start furosemide
c) Administer IV fluids
d) Restrict protein intake
a) Administer lactulose
Rationale: Lactulose reduces ammonia levels in hepatic encephalopathy, improving mental
status, per AASLD guidelines.
13. A patient with a history of COPD develops acute respiratory failure with
a pCO2 of 70 mmHg. What is the most appropriate initial treatment?
a) Administer IV steroids
b) Start non-invasive ventilation
c) Administer furosemide
d) Order a chest X-ray
b) Start non-invasive ventilation
Rationale: Acute hypercapnic respiratory failure in COPD requires non-invasive ventilation to
improve gas exchange, per GOLD guidelines.
14. A patient with acute coronary syndrome develops ST elevation in leads
V1–V4 and chest pain. What is the most appropriate initial treatment?
a) Administer nitroglycerin
b) Perform coronary angiography
c) Administer heparin
d) Start metoprolol
b) Perform coronary angiography
Rationale: ST elevation in anterior leads indicates STEMI, requiring urgent coronary
angiography for revascularization, per AHA guidelines.
15. A patient with status epilepticus is receiving lorazepam, but seizures
persist. What is the most appropriate next step?
a) Administer additional lorazepam
with Verified Questions & 100% Correct Answers
Adult CCRN® Certification Exam | Key Concepts: Advanced Critical Care Nursing,
Cardiovascular & Pulmonary Disorders, Neurologic & Endocrine Emergencies, Renal &
Gastrointestinal Dysfunction, Multisystem Organ Failure, Hematology & Immunology,
Pharmacology, Patient Safety, and Evidence-Based Interventions | Expert-Verified Q&A | ICU &
Exam-Ready
Introduction
This 2025/2026 Adult CCRN® Exam resource provides 150 fully verified questions with 100%
correct answers, matching the AACN Adult CCRN® exam structure (125 scored and 25 unscored
questions). Content covers advanced critical care topics, including hemodynamic monitoring,
mechanical ventilation, complex multisystem cases, pharmacologic interventions, and safe
nursing priorities for acutely ill patients. All answers are graded A+ and align with AACN, AHA,
and other evidence-based standards, ensuring complete preparation for Adult CCRN®
certification exam success.
Answer Format
All correct answers are highlighted in bold and green, with rationales that explain advanced
critical care priorities, reinforce safe evidence-based practice, and strengthen expert-level
nursing judgment for exam readiness.
Questions 1–150
1. A patient with septic shock has a mean arterial pressure (MAP) of 55
mmHg despite fluid resuscitation. What is the most appropriate initial
intervention?
a) Administer antibiotics
b) Start norepinephrine
c) Administer additional fluids
d) Order blood cultures
b) Start norepinephrine
Rationale: Refractory hypotension in septic shock (MAP <65 mmHg) requires vasopressor
support with norepinephrine to restore perfusion, per Surviving Sepsis Campaign guidelines.
2. A patient on mechanical ventilation develops a sudden drop in oxygen
saturation and high airway pressure alarms. What is the most appropriate
initial action?
a) Administer albuterol
,b) Order a chest X-ray
c) Increase tidal volume
d) Suction the airway
b) Order a chest X-ray
Rationale: Sudden desaturation and high airway pressure suggest pneumothorax or tube
obstruction, requiring a chest X-ray to diagnose, per AACN ventilator management guidelines.
3. A patient with acute respiratory distress syndrome (ARDS) has a
PaO2/FiO2 ratio of 100. What is the most appropriate ventilator
adjustment?
a) Increase tidal volume
b) Increase PEEP
c) Decrease FiO2
d) Switch to high-frequency ventilation
b) Increase PEEP
Rationale: A low PaO2/FiO2 ratio in ARDS requires increased PEEP to improve alveolar
recruitment and oxygenation, per ARDS Network guidelines.
4. A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m² and
pulmonary artery occlusion pressure (PAOP) of 22 mmHg. What is the most
appropriate initial treatment?
a) Administer IV fluids
b) Start dobutamine
c) Administer furosemide
d) Order an echocardiogram
b) Start dobutamine
Rationale: Low cardiac index with elevated PAOP in cardiogenic shock indicates poor
contractility, requiring inotropic support with dobutamine, per AHA guidelines.
5. A patient with a suspected ischemic stroke presents with left-sided
weakness within 2 hours of symptom onset. What is the most appropriate
initial action?
a) Administer aspirin
b) Order a head CT
c) Start heparin
d) Administer alteplase
b) Order a head CT
Rationale: A head CT is required to rule out hemorrhagic stroke before considering
thrombolytics like alteplase, per AHA stroke guidelines.
6. A patient with acute kidney injury develops a potassium level of 7.0
mEq/L and widened QRS on ECG. What is the most appropriate initial
treatment?
a) Administer furosemide
b) Administer calcium gluconate
,c) Start dialysis
d) Administer insulin and glucose
b) Administer calcium gluconate
Rationale: Hyperkalemia with ECG changes (widened QRS) requires immediate calcium
gluconate to stabilize cardiac membranes, per AHA guidelines.
7. A patient with diabetic ketoacidosis (DKA) has a blood glucose of 500
mg/dL and pH of 7.15. What is the most appropriate initial treatment?
a) Administer sodium bicarbonate
b) Start insulin infusion
c) Administer IV dextrose
d) Increase IV fluids
b) Start insulin infusion
Rationale: Insulin infusion corrects hyperglycemia and halts ketogenesis in DKA, addressing
the underlying metabolic acidosis, per American Diabetes Association guidelines.
8. A patient with a massive pulmonary embolism develops hypotension and
hypoxia. What is the most appropriate initial treatment?
a) Administer IV furosemide
b) Start heparin infusion
c) Administer thrombolytics
d) Order a CT pulmonary angiogram
c) Administer thrombolytics
Rationale: Hypotension and hypoxia in massive pulmonary embolism require thrombolytics for
rapid clot dissolution, per AHA guidelines.
9. A patient with acute pancreatitis develops respiratory distress and a
PaO2 of 60 mmHg. What is the most appropriate initial intervention?
a) Administer IV furosemide
b) Increase oxygen therapy
c) Administer antibiotics
d) Order a CT abdomen
b) Increase oxygen therapy
Rationale: Respiratory distress and hypoxia in pancreatitis may indicate ARDS, requiring
immediate oxygen therapy, per American College of Gastroenterology guidelines.
10. A patient with a gastrointestinal bleed has a hemoglobin of 6.0 g/dL and
blood pressure of 80/50 mmHg. What is the most appropriate initial
intervention?
a) Administer IV fluids
b) Transfuse packed red blood cells
c) Administer proton pump inhibitor
d) Order an endoscopy
b) Transfuse packed red blood cells
, Rationale: Severe anemia and hypotension in a GI bleed require immediate blood transfusion to
restore oxygen-carrying capacity, per American College of Gastroenterology guidelines.
11. A patient with ventricular tachycardia has a pulse and chest pain. What
is the most appropriate initial treatment?
a) Administer amiodarone
b) Perform synchronized cardioversion
c) Administer lidocaine
d) Start CPR
b) Perform synchronized cardioversion
Rationale: Unstable ventricular tachycardia with chest pain requires synchronized
cardioversion to restore rhythm, per AHA ACLS guidelines.
12. A patient with liver failure develops hepatic encephalopathy and
elevated ammonia levels. What is the most appropriate initial treatment?
a) Administer lactulose
b) Start furosemide
c) Administer IV fluids
d) Restrict protein intake
a) Administer lactulose
Rationale: Lactulose reduces ammonia levels in hepatic encephalopathy, improving mental
status, per AASLD guidelines.
13. A patient with a history of COPD develops acute respiratory failure with
a pCO2 of 70 mmHg. What is the most appropriate initial treatment?
a) Administer IV steroids
b) Start non-invasive ventilation
c) Administer furosemide
d) Order a chest X-ray
b) Start non-invasive ventilation
Rationale: Acute hypercapnic respiratory failure in COPD requires non-invasive ventilation to
improve gas exchange, per GOLD guidelines.
14. A patient with acute coronary syndrome develops ST elevation in leads
V1–V4 and chest pain. What is the most appropriate initial treatment?
a) Administer nitroglycerin
b) Perform coronary angiography
c) Administer heparin
d) Start metoprolol
b) Perform coronary angiography
Rationale: ST elevation in anterior leads indicates STEMI, requiring urgent coronary
angiography for revascularization, per AHA guidelines.
15. A patient with status epilepticus is receiving lorazepam, but seizures
persist. What is the most appropriate next step?
a) Administer additional lorazepam
