CCRN (NeoNatal) examtest BaNk
(latest 2026/2027 Update) Complete
QUestioNs aNd GUide aNsweRs, 100%
VeRified GRaded a+
Based on the official AACN exam blueprint for the Neonatal CCRN, I have compiled 100 practice
questions to help you prepare for this challenging certification exam. The exam focuses heavily on the
unique pathophysiology of neonates, particularly prematurity complications, with Clinical Judgment
comprising 80% of the test .
The search results did not contain full practice questions. The following questions were developed based
on the official content outline and topical breakdowns found in the search results, including the exam
blueprint and the Certification and Core Review for Neonatal Intensive Care Nursing, 6th Ed. (2024),
which contains 789 questions with rationales and is developed in collaboration with AACN, AWHONN,
and NANN .
Exam Blueprint Overview
Content Area Percentage of Exam
Clinical Judgment 80%
Cardiovascular 5%
1
, Content Area Percentage of Exam
Respiratory 21%
Endocrine, Hematology, GI, Renal, Integumentary 27%
Musculoskeletal, Neurological, Psychosocial 13%
Multisystem 14%
Professional Caring and Ethical Practice 20%
Source:
Cardiovascular System (5% of Exam)
1. A 3-day-old term infant is diagnosed with a cyanotic congenital heart defect. The nurse
notes that the infant's oxygen saturation does not improve significantly with 100% oxygen
administration. This finding is consistent with:
• A. Transient tachypnea of the newborn (TTN)
• B. A right-to-left shunt
• C. Persistent pulmonary hypertension (PPHN)
• D. Respiratory distress syndrome (RDS)
Answer: B. A right-to-left shunt
Rationale: In cyanotic congenital heart defects with right-to-left shunting, deoxygenated blood
bypasses the lungs, so administering supplemental oxygen will not significantly improve
systemic oxygenation. This is a key differentiating feature from pulmonary causes of cyanosis .
2. A neonate with a suspected ductal-dependent congenital heart defect is receiving a
prostaglandin E1 (PGE1) infusion. Which assessment finding indicates the medication is
having the desired effect?
• A. Increased urine output
2
, • B. Improved systemic oxygenation
• C. Decreased heart rate
• D. Increased blood pressure
Answer: B. Improved systemic oxygenation
Rationale: PGE1 is used to maintain patency of the ductus arteriosus in ductal-dependent
lesions. Improvement in systemic oxygenation indicates that the ductus is open and blood flow
is being maintained .
3. The nurse is caring for an infant with a ventricular septal defect (VSD). Which finding is
most consistent with this diagnosis?
• A. Systolic murmur at the left lower sternal border
• B. Differential cyanosis
• C. Narrow pulse pressure
• D. Boot-shaped heart on chest x-ray
Answer: A. Systolic murmur at the left lower sternal border
Rationale: VSD typically presents with a holosystolic murmur at the left lower sternal border.
Differential cyanosis is associated with PDA with reversed shunt. A boot-shaped heart is
associated with Tetralogy of Fallot .
4. An infant with hypoplastic left heart syndrome is being managed with a PGE1 infusion. The
nurse should monitor for which common side effect of this medication?
• A. Hyperthermia
• B. Apnea
• C. Hypotension
• D. Seizures
Answer: B. Apnea
Rationale: Apnea is a well-known side effect of PGE1, particularly in premature and low-birth-
weight infants. The nurse should be prepared to provide respiratory support if apnea occurs .
5. A neonate has a blood pressure of 70/45 mmHg in the right arm and 45/25 mmHg in the
left leg. This finding is most consistent with:
3
, • A. Aortic stenosis
• B. Coarctation of the aorta
• C. Patent ductus arteriosus
• D. Pulmonary stenosis
Answer: B. Coarctation of the aorta
Rationale: Coarctation of the aorta causes narrowing of the aortic arch, leading to hypertension
in the upper extremities and hypotension in the lower extremities. This blood pressure
differential is a classic finding .
6. An infant is post-operative day 1 following a Norwood procedure for hypoplastic left heart
syndrome. The nurse notes a sudden drop in oxygen saturation. The priority action is:
• A. Increase the FiO2
• B. Administer a fluid bolus
• C. Check the arterial line for accuracy
• D. Notify the provider immediately
Answer: D. Notify the provider immediately
Rationale: The Norwood procedure is a complex palliative surgery. A sudden desaturation post-
operatively can indicate shunt occlusion, low cardiac output, or other life-threatening
complications requiring immediate evaluation .
7. The nurse is caring for a neonate with transposition of the great arteries (TGA). Which
intervention is most important to maintain ductal patency?
• A. Administering indomethacin
• B. Administering PGE1
• C. Administering epinephrine
• D. Administering nitric oxide
Answer: B. Administering PGE1
Rationale: In TGA, the pulmonary and systemic circulations are parallel. PGE1 maintains ductal
patency, allowing mixing of oxygenated and deoxygenated blood, which is life-saving until
surgical correction can be performed .
4
(latest 2026/2027 Update) Complete
QUestioNs aNd GUide aNsweRs, 100%
VeRified GRaded a+
Based on the official AACN exam blueprint for the Neonatal CCRN, I have compiled 100 practice
questions to help you prepare for this challenging certification exam. The exam focuses heavily on the
unique pathophysiology of neonates, particularly prematurity complications, with Clinical Judgment
comprising 80% of the test .
The search results did not contain full practice questions. The following questions were developed based
on the official content outline and topical breakdowns found in the search results, including the exam
blueprint and the Certification and Core Review for Neonatal Intensive Care Nursing, 6th Ed. (2024),
which contains 789 questions with rationales and is developed in collaboration with AACN, AWHONN,
and NANN .
Exam Blueprint Overview
Content Area Percentage of Exam
Clinical Judgment 80%
Cardiovascular 5%
1
, Content Area Percentage of Exam
Respiratory 21%
Endocrine, Hematology, GI, Renal, Integumentary 27%
Musculoskeletal, Neurological, Psychosocial 13%
Multisystem 14%
Professional Caring and Ethical Practice 20%
Source:
Cardiovascular System (5% of Exam)
1. A 3-day-old term infant is diagnosed with a cyanotic congenital heart defect. The nurse
notes that the infant's oxygen saturation does not improve significantly with 100% oxygen
administration. This finding is consistent with:
• A. Transient tachypnea of the newborn (TTN)
• B. A right-to-left shunt
• C. Persistent pulmonary hypertension (PPHN)
• D. Respiratory distress syndrome (RDS)
Answer: B. A right-to-left shunt
Rationale: In cyanotic congenital heart defects with right-to-left shunting, deoxygenated blood
bypasses the lungs, so administering supplemental oxygen will not significantly improve
systemic oxygenation. This is a key differentiating feature from pulmonary causes of cyanosis .
2. A neonate with a suspected ductal-dependent congenital heart defect is receiving a
prostaglandin E1 (PGE1) infusion. Which assessment finding indicates the medication is
having the desired effect?
• A. Increased urine output
2
, • B. Improved systemic oxygenation
• C. Decreased heart rate
• D. Increased blood pressure
Answer: B. Improved systemic oxygenation
Rationale: PGE1 is used to maintain patency of the ductus arteriosus in ductal-dependent
lesions. Improvement in systemic oxygenation indicates that the ductus is open and blood flow
is being maintained .
3. The nurse is caring for an infant with a ventricular septal defect (VSD). Which finding is
most consistent with this diagnosis?
• A. Systolic murmur at the left lower sternal border
• B. Differential cyanosis
• C. Narrow pulse pressure
• D. Boot-shaped heart on chest x-ray
Answer: A. Systolic murmur at the left lower sternal border
Rationale: VSD typically presents with a holosystolic murmur at the left lower sternal border.
Differential cyanosis is associated with PDA with reversed shunt. A boot-shaped heart is
associated with Tetralogy of Fallot .
4. An infant with hypoplastic left heart syndrome is being managed with a PGE1 infusion. The
nurse should monitor for which common side effect of this medication?
• A. Hyperthermia
• B. Apnea
• C. Hypotension
• D. Seizures
Answer: B. Apnea
Rationale: Apnea is a well-known side effect of PGE1, particularly in premature and low-birth-
weight infants. The nurse should be prepared to provide respiratory support if apnea occurs .
5. A neonate has a blood pressure of 70/45 mmHg in the right arm and 45/25 mmHg in the
left leg. This finding is most consistent with:
3
, • A. Aortic stenosis
• B. Coarctation of the aorta
• C. Patent ductus arteriosus
• D. Pulmonary stenosis
Answer: B. Coarctation of the aorta
Rationale: Coarctation of the aorta causes narrowing of the aortic arch, leading to hypertension
in the upper extremities and hypotension in the lower extremities. This blood pressure
differential is a classic finding .
6. An infant is post-operative day 1 following a Norwood procedure for hypoplastic left heart
syndrome. The nurse notes a sudden drop in oxygen saturation. The priority action is:
• A. Increase the FiO2
• B. Administer a fluid bolus
• C. Check the arterial line for accuracy
• D. Notify the provider immediately
Answer: D. Notify the provider immediately
Rationale: The Norwood procedure is a complex palliative surgery. A sudden desaturation post-
operatively can indicate shunt occlusion, low cardiac output, or other life-threatening
complications requiring immediate evaluation .
7. The nurse is caring for a neonate with transposition of the great arteries (TGA). Which
intervention is most important to maintain ductal patency?
• A. Administering indomethacin
• B. Administering PGE1
• C. Administering epinephrine
• D. Administering nitric oxide
Answer: B. Administering PGE1
Rationale: In TGA, the pulmonary and systemic circulations are parallel. PGE1 maintains ductal
patency, allowing mixing of oxygenated and deoxygenated blood, which is life-saving until
surgical correction can be performed .
4
