Critical Care Nursing | CCRN Certification Comprehensive Test Bank
(175 NCLEX-Style Questions with Detailed Rationales – Critical Care
Nursing Prep 2025)
Critical Care Nursing | CCRN Certification Comprehensive Test Bank
(175 NCLEX-Style Questions with Detailed Rationales – Critical Care
Nursing Prep 2025)
This CCRN Certification Test Bank (2025 Edition) covers key adult critical care topics,
including cardiovascular, respiratory, neurological, renal, endocrine, and multisystem disorders.
,Each question follows the AACN CCRN exam blueprint with clear rationales and clinical
reasoning. Ideal for RNs preparing for the Adult CCRN exam or ICU competency checks.
Designed for quick review, concept mastery, and test readiness.
CCRN, Critical Care Nursing, ICU Nurse Exam, AACN, CCRN 2025, Nursing Certification,
Adult CCRN Practice Questions, Critical Care Review, ICU Exam Prep, Nursing Test Bank,
Nursing Study Guide, NCLEX-style, CCRN Rationales, Intensive Care Nursing, Test Bank PDF
Questions (1–175)
1. A patient with cardiogenic shock is receiving a dopamine infusion at 10 mcg/kg/min. Which
finding indicates the drug is achieving its desired effect?
A. Decreased urine output
B. Widened QRS complex
C. Increased cardiac output and urine output
D. Decreased heart rate
Rationale: Dopamine at moderate doses (5–10 mcg/kg/min) stimulates beta-1 receptors,
improving myocardial contractility, heart rate, and renal perfusion. This results in improved
cardiac output and urine output, showing adequate perfusion. Higher doses, however, can
cause excessive vasoconstriction.
2. Which hemodynamic parameter most directly reflects left ventricular preload?
A. Cardiac output
B. Systemic vascular resistance
C. Pulmonary capillary wedge pressure (PCWP)
D. Central venous pressure
Rationale: The PCWP estimates left atrial pressure and is the best reflection of left ventricular
end-diastolic pressure, indicating preload. CVP reflects right-sided preload, not left.
3. A patient with ARDS on mechanical ventilation shows rising peak pressures and decreasing
oxygenation. What should the nurse assess first?
A. Arterial line placement
B. Lung compliance and possible pneumothorax
C. IV fluid status
D. Sedation depth
Rationale: Rising peak pressures with poor oxygenation suggest decreasing lung compliance—
,common in worsening ARDS or barotrauma like pneumothorax. Immediate assessment of breath
sounds and chest expansion is essential before other interventions.
4. The nurse notes ST elevation in leads II, III, and aVF. Which coronary artery is most likely
affected?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery (RCA)
D. Left main coronary artery
Rationale: Inferior wall MI involves leads II, III, and aVF, which correspond to the right
coronary artery supplying the inferior left ventricle and AV node.
5. A patient with septic shock is hypotensive despite fluids. Norepinephrine is started. What is
the expected physiologic effect?
A. Beta-2 stimulation causing bronchodilation
B. Dopaminergic stimulation increasing renal perfusion
C. Alpha stimulation increasing vascular tone and BP
D. Beta-1 blockade decreasing heart rate
Rationale: Norepinephrine acts primarily on alpha receptors, causing peripheral
vasoconstriction, which increases systemic vascular resistance and raises BP. It also mildly
stimulates beta-1 receptors to support cardiac output.
6. Which acid-base imbalance is most commonly seen in cardiogenic shock?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Rationale: Poor tissue perfusion leads to anaerobic metabolism and lactic acid accumulation,
resulting in metabolic acidosis. ABGs often show low pH and low bicarbonate.
7. During continuous renal replacement therapy (CRRT), the nurse should monitor closely for
which complication?
A. Pulmonary embolism
B. Filter clotting and hypotension
C. Fluid overload
D. Hyperkalemia
Rationale: CRRT can cause filter clotting from blood stasis and hypotension from fluid shifts.
, Frequent monitoring of pressures and filter integrity prevents therapy interruption and
hemodynamic instability.
8. Which finding in a patient with increased intracranial pressure (ICP) requires immediate
intervention?
A. Restlessness
B. Nausea and vomiting
C. Bradycardia with widening pulse pressure
D. Headache
Rationale: Cushing’s triad (bradycardia, widening pulse pressure, irregular respirations)
signals imminent brain herniation and requires urgent action to reduce ICP.
9. In acute pancreatitis, which electrolyte imbalance is expected?
A. Hypernatremia
B. Hyperkalemia
C. Hypercalcemia
D. Hypocalcemia
Rationale: Hypocalcemia occurs because fatty acids released during pancreatic autodigestion
bind calcium salts (“fat necrosis”). Chvostek’s and Trousseau’s signs may be observed.
10. A post-cardiac surgery patient develops atrial fibrillation with rapid ventricular response.
Which initial medication is indicated?
A. Epinephrine
B. Atropine
C. Amiodarone
D. Dopamine
Rationale: Amiodarone is used to control rate and rhythm in new-onset AFib after cardiac
surgery. It suppresses abnormal automaticity and prolongs repolarization, reducing ventricular
rate safely.
11. A patient in the ICU with severe sepsis is being treated with broad-spectrum antibiotics.
Despite fluids and pressors, lactate remains high. What intervention should the nurse anticipate
next?
A. Stop all antibiotics
B. Increase IV fluids
C. Assess for source control such as abscess or necrotic tissue
D. Add corticosteroids
Rationale: Persistent lactic acidosis despite therapy suggests inadequate source control.
Surgical drainage or removal of infected tissue is often necessary. Continuing fluids and pressors
without source management will not resolve the underlying infection.
(175 NCLEX-Style Questions with Detailed Rationales – Critical Care
Nursing Prep 2025)
Critical Care Nursing | CCRN Certification Comprehensive Test Bank
(175 NCLEX-Style Questions with Detailed Rationales – Critical Care
Nursing Prep 2025)
This CCRN Certification Test Bank (2025 Edition) covers key adult critical care topics,
including cardiovascular, respiratory, neurological, renal, endocrine, and multisystem disorders.
,Each question follows the AACN CCRN exam blueprint with clear rationales and clinical
reasoning. Ideal for RNs preparing for the Adult CCRN exam or ICU competency checks.
Designed for quick review, concept mastery, and test readiness.
CCRN, Critical Care Nursing, ICU Nurse Exam, AACN, CCRN 2025, Nursing Certification,
Adult CCRN Practice Questions, Critical Care Review, ICU Exam Prep, Nursing Test Bank,
Nursing Study Guide, NCLEX-style, CCRN Rationales, Intensive Care Nursing, Test Bank PDF
Questions (1–175)
1. A patient with cardiogenic shock is receiving a dopamine infusion at 10 mcg/kg/min. Which
finding indicates the drug is achieving its desired effect?
A. Decreased urine output
B. Widened QRS complex
C. Increased cardiac output and urine output
D. Decreased heart rate
Rationale: Dopamine at moderate doses (5–10 mcg/kg/min) stimulates beta-1 receptors,
improving myocardial contractility, heart rate, and renal perfusion. This results in improved
cardiac output and urine output, showing adequate perfusion. Higher doses, however, can
cause excessive vasoconstriction.
2. Which hemodynamic parameter most directly reflects left ventricular preload?
A. Cardiac output
B. Systemic vascular resistance
C. Pulmonary capillary wedge pressure (PCWP)
D. Central venous pressure
Rationale: The PCWP estimates left atrial pressure and is the best reflection of left ventricular
end-diastolic pressure, indicating preload. CVP reflects right-sided preload, not left.
3. A patient with ARDS on mechanical ventilation shows rising peak pressures and decreasing
oxygenation. What should the nurse assess first?
A. Arterial line placement
B. Lung compliance and possible pneumothorax
C. IV fluid status
D. Sedation depth
Rationale: Rising peak pressures with poor oxygenation suggest decreasing lung compliance—
,common in worsening ARDS or barotrauma like pneumothorax. Immediate assessment of breath
sounds and chest expansion is essential before other interventions.
4. The nurse notes ST elevation in leads II, III, and aVF. Which coronary artery is most likely
affected?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery (RCA)
D. Left main coronary artery
Rationale: Inferior wall MI involves leads II, III, and aVF, which correspond to the right
coronary artery supplying the inferior left ventricle and AV node.
5. A patient with septic shock is hypotensive despite fluids. Norepinephrine is started. What is
the expected physiologic effect?
A. Beta-2 stimulation causing bronchodilation
B. Dopaminergic stimulation increasing renal perfusion
C. Alpha stimulation increasing vascular tone and BP
D. Beta-1 blockade decreasing heart rate
Rationale: Norepinephrine acts primarily on alpha receptors, causing peripheral
vasoconstriction, which increases systemic vascular resistance and raises BP. It also mildly
stimulates beta-1 receptors to support cardiac output.
6. Which acid-base imbalance is most commonly seen in cardiogenic shock?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Rationale: Poor tissue perfusion leads to anaerobic metabolism and lactic acid accumulation,
resulting in metabolic acidosis. ABGs often show low pH and low bicarbonate.
7. During continuous renal replacement therapy (CRRT), the nurse should monitor closely for
which complication?
A. Pulmonary embolism
B. Filter clotting and hypotension
C. Fluid overload
D. Hyperkalemia
Rationale: CRRT can cause filter clotting from blood stasis and hypotension from fluid shifts.
, Frequent monitoring of pressures and filter integrity prevents therapy interruption and
hemodynamic instability.
8. Which finding in a patient with increased intracranial pressure (ICP) requires immediate
intervention?
A. Restlessness
B. Nausea and vomiting
C. Bradycardia with widening pulse pressure
D. Headache
Rationale: Cushing’s triad (bradycardia, widening pulse pressure, irregular respirations)
signals imminent brain herniation and requires urgent action to reduce ICP.
9. In acute pancreatitis, which electrolyte imbalance is expected?
A. Hypernatremia
B. Hyperkalemia
C. Hypercalcemia
D. Hypocalcemia
Rationale: Hypocalcemia occurs because fatty acids released during pancreatic autodigestion
bind calcium salts (“fat necrosis”). Chvostek’s and Trousseau’s signs may be observed.
10. A post-cardiac surgery patient develops atrial fibrillation with rapid ventricular response.
Which initial medication is indicated?
A. Epinephrine
B. Atropine
C. Amiodarone
D. Dopamine
Rationale: Amiodarone is used to control rate and rhythm in new-onset AFib after cardiac
surgery. It suppresses abnormal automaticity and prolongs repolarization, reducing ventricular
rate safely.
11. A patient in the ICU with severe sepsis is being treated with broad-spectrum antibiotics.
Despite fluids and pressors, lactate remains high. What intervention should the nurse anticipate
next?
A. Stop all antibiotics
B. Increase IV fluids
C. Assess for source control such as abscess or necrotic tissue
D. Add corticosteroids
Rationale: Persistent lactic acidosis despite therapy suggests inadequate source control.
Surgical drainage or removal of infected tissue is often necessary. Continuing fluids and pressors
without source management will not resolve the underlying infection.
