CCRN Exam 2026-2027 Questions And Correct Detailed
Answers
Comprehensive Assessment
Year: 2026–2027 | Total Questions: 150 | 100% VERIFIED
Introduction
The Certified Critical-Care Registered Nurse (CCRN) examination, administered by the
American Association of Critical-Care Nurses (AACN), is the gold-standard certification for
nurses providing direct care to acutely and critically ill patients. This comprehensive
question bank covers all key domains of the official AACN CCRN blueprint: (1)
Cardiovascular, encompassing acute coronary syndromes, hemodynamic monitoring,
cardiac arrhythmias, heart failure management, mechanical circulatory support, and post-
cardiac surgery care; (2) Pulmonary, addressing ARDS, mechanical ventilation, pulmonary
embolism, chest tube management, and airway emergencies; (3) Endocrine, covering DKA,
HHS, thyroid storm, adrenal crisis, diabetes insipidus, and SIADH; (4) Hematology, including
DIC, transfusion reactions, HIT, tumor lysis syndrome, and coagulation management; (5)
Gastrointestinal, addressing acute pancreatitis, GI hemorrhage, hepatic failure, and
abdominal compartment syndrome; (6) Renal, encompassing AKI classification, CRRT,
electrolyte management, and rhabdomyolysis; (7) Integumentary, covering burn
assessment, fluid resuscitation, wound management, and inhalation injury; (8)
Musculoskeletal, addressing compartment syndrome, fat embolism, spinal cord injury, and
DVT prophylaxis; (9) Neurological, including stroke management, ICP monitoring, SAH,
brain death determination, and neuromuscular emergencies; (10) Psychosocial, covering
ICU delirium, PICS, sedation management, and cultural competence; and (11) Professional
Caring and Ethical Operations, encompassing the AACN Synergy Model, evidence-based
methodology, ethical principles, sepsis bundles, targeted temperature management, quality
improvement, and infection prevention. Each of the 150 questions is mapped to a distinct
sub-topic within the AACN CCRN domain blueprint, ensuring thorough, non-overlapping
coverage. Mastery of these domains demonstrates professional readiness for competent,
ethical, and evidence-based critical care nursing execution.
Question 1: A patient with an acute ST-elevation myocardial infarction (STEMI) presents
with ST elevation in leads II, III, and aVF. The nurse recognizes this as an infarction of which
coronary territory?
A. Left main coronary artery (global ischemia)
B. Left circumflex artery (lateral wall)
, C. Left anterior descending artery (anterior wall)
D. Right coronary artery (inferior wall)
Correct Answer: D. Right coronary artery (inferior wall)
Rationale: Leads II, III, and aVF reflect the inferior wall, supplied by the right coronary
artery. LAD (A) produces anterior changes in V1-V4. Circumflex (C) affects lateral leads I,
aVL, V5-V6. Left main (D) shows diffuse ST changes.
Question 2: The critical care nurse interprets an arterial blood gas showing pH 7.28, PaCO₂
32 mmHg, HCO₃⁻ 14 mEq/L, and lactate 6.2 mmol/L in a patient with cardiogenic shock.
This pattern indicates:
A. Respiratory alkalosis without metabolic involvement
B. Metabolic acidosis with respiratory compensation, consistent with lactic
acidosis from inadequate tissue perfusion
C. Metabolic alkalosis with respiratory compensation
D. Respiratory acidosis without metabolic component
Correct Answer: B. Metabolic acidosis with respiratory compensation, consistent with
lactic acidosis from inadequate tissue perfusion
Rationale: Low pH with low HCO₃⁻ and compensatory low PaCO₂ indicates compensated
metabolic acidosis. Elevated lactate confirms tissue hypoperfusion. Options A, C, and D do
not match the ABG pattern.
Question 3: A patient develops a new-onset atrial fibrillation with rapid ventricular
response (HR 168 bpm) and hemodynamic instability (BP 78/50 mmHg). The PRIORITY
intervention is:
A. Withholding all treatment and monitoring the rhythm overnight
B. Oral diltiazem administration and reassessment in 30 minutes
C. Synchronized cardioversion at the recommended energy level per ACLS
protocol
D. Vagal maneuvers including carotid sinus massage
Correct Answer: C. Synchronized cardioversion at the recommended energy level per
ACLS protocol
,Rationale: Unstable tachyarrhythmias with hemodynamic compromise require immediate
synchronized cardioversion per ACLS guidelines. Oral medications (A) are too slow. Vagal
maneuvers (C) are for stable SVT. Withholding treatment (D) risks cardiovascular collapse.
Question 4: The nurse is monitoring a patient with a pulmonary artery catheter. A
pulmonary artery occlusion pressure (PAOP/wedge pressure) of 24 mmHg MOST likely
indicates:
A. Hypovolemia requiring aggressive fluid resuscitation
B. Normal cardiac filling pressures requiring no intervention
C. Left ventricular failure with elevated left atrial pressure and pulmonary
congestion
D. Right ventricular failure without left-sided involvement
Correct Answer: C. Left ventricular failure with elevated left atrial pressure and
pulmonary congestion
Rationale: Normal PAOP is 6-12 mmHg. A value of 24 mmHg indicates elevated left heart
pressures with pulmonary congestion. Hypovolemia (A) shows low PAOP. Isolated RV
failure (C) elevates CVP, not PAOP. Normal (D) is 6-12 mmHg.
Question 5: A patient with a temporary transvenous pacemaker exhibits failure to capture
on the monitor. The nurse should FIRST:
A. Decrease the sensitivity setting to zero
B. Increase the milliampere (mA) output, check lead connections, reposition the
patient, and assess for lead displacement
C. Administer atropine 3 mg IV push immediately
D. Remove the pacemaker immediately without assessment
Correct Answer: B. Increase the milliampere (mA) output, check lead connections,
reposition the patient, and assess for lead displacement
Rationale: Failure to capture requires increasing output and checking connections.
Removing the pacemaker (A) eliminates the therapy. Decreasing sensitivity (C) does not
address capture failure. Atropine (D) may be adjunctive but does not fix the pacemaker
issue.
, Question 6: A patient presents with Beck's triad: hypotension, muffled heart sounds, and
jugular venous distension. This clinical presentation is MOST consistent with:
A. Cardiac tamponade requiring emergent pericardiocentesis
B. Tension pneumothorax
C. Simple pleural effusion
D. Acute pulmonary embolism
Correct Answer: A. Cardiac tamponade requiring emergent pericardiocentesis
Rationale: Beck's triad is pathognomonic for cardiac tamponade. Tension pneumothorax
(A) shows tracheal deviation and absent breath sounds. PE (C) presents with dyspnea and
tachycardia. Pleural effusion (D) does not produce Beck's triad.
Question 7: Intra-aortic balloon pump (IABP) therapy improves cardiac function through
which mechanism?
A. Delivering electrical impulses to the myocardium
B. Increasing afterload during systole
C. Continuously compressing the aorta to increase blood pressure
D. Inflating during diastole to augment coronary perfusion and deflating during
systole to reduce afterload (counterpulsation)
Correct Answer: D. Inflating during diastole to augment coronary perfusion and
deflating during systole to reduce afterload (counterpulsation)
Rationale: IABP counterpulsation augments diastolic coronary filling and reduces systolic
afterload. Increasing afterload (A) is detrimental. Continuous compression (C) is not the
mechanism. Electrical impulses (D) describe pacemakers.
Question 8: The nurse caring for a patient after coronary artery bypass graft (CABG)
surgery monitors chest tube output. An output exceeding which volume in the first hour
post-operatively requires IMMEDIATE notification of the surgeon?
A. 200 mL or greater in the first hour, suggesting active surgical bleeding
B. 10 mL in the first hour
C. 1 mL per hour
D. 50 mL in the first hour
Answers
Comprehensive Assessment
Year: 2026–2027 | Total Questions: 150 | 100% VERIFIED
Introduction
The Certified Critical-Care Registered Nurse (CCRN) examination, administered by the
American Association of Critical-Care Nurses (AACN), is the gold-standard certification for
nurses providing direct care to acutely and critically ill patients. This comprehensive
question bank covers all key domains of the official AACN CCRN blueprint: (1)
Cardiovascular, encompassing acute coronary syndromes, hemodynamic monitoring,
cardiac arrhythmias, heart failure management, mechanical circulatory support, and post-
cardiac surgery care; (2) Pulmonary, addressing ARDS, mechanical ventilation, pulmonary
embolism, chest tube management, and airway emergencies; (3) Endocrine, covering DKA,
HHS, thyroid storm, adrenal crisis, diabetes insipidus, and SIADH; (4) Hematology, including
DIC, transfusion reactions, HIT, tumor lysis syndrome, and coagulation management; (5)
Gastrointestinal, addressing acute pancreatitis, GI hemorrhage, hepatic failure, and
abdominal compartment syndrome; (6) Renal, encompassing AKI classification, CRRT,
electrolyte management, and rhabdomyolysis; (7) Integumentary, covering burn
assessment, fluid resuscitation, wound management, and inhalation injury; (8)
Musculoskeletal, addressing compartment syndrome, fat embolism, spinal cord injury, and
DVT prophylaxis; (9) Neurological, including stroke management, ICP monitoring, SAH,
brain death determination, and neuromuscular emergencies; (10) Psychosocial, covering
ICU delirium, PICS, sedation management, and cultural competence; and (11) Professional
Caring and Ethical Operations, encompassing the AACN Synergy Model, evidence-based
methodology, ethical principles, sepsis bundles, targeted temperature management, quality
improvement, and infection prevention. Each of the 150 questions is mapped to a distinct
sub-topic within the AACN CCRN domain blueprint, ensuring thorough, non-overlapping
coverage. Mastery of these domains demonstrates professional readiness for competent,
ethical, and evidence-based critical care nursing execution.
Question 1: A patient with an acute ST-elevation myocardial infarction (STEMI) presents
with ST elevation in leads II, III, and aVF. The nurse recognizes this as an infarction of which
coronary territory?
A. Left main coronary artery (global ischemia)
B. Left circumflex artery (lateral wall)
, C. Left anterior descending artery (anterior wall)
D. Right coronary artery (inferior wall)
Correct Answer: D. Right coronary artery (inferior wall)
Rationale: Leads II, III, and aVF reflect the inferior wall, supplied by the right coronary
artery. LAD (A) produces anterior changes in V1-V4. Circumflex (C) affects lateral leads I,
aVL, V5-V6. Left main (D) shows diffuse ST changes.
Question 2: The critical care nurse interprets an arterial blood gas showing pH 7.28, PaCO₂
32 mmHg, HCO₃⁻ 14 mEq/L, and lactate 6.2 mmol/L in a patient with cardiogenic shock.
This pattern indicates:
A. Respiratory alkalosis without metabolic involvement
B. Metabolic acidosis with respiratory compensation, consistent with lactic
acidosis from inadequate tissue perfusion
C. Metabolic alkalosis with respiratory compensation
D. Respiratory acidosis without metabolic component
Correct Answer: B. Metabolic acidosis with respiratory compensation, consistent with
lactic acidosis from inadequate tissue perfusion
Rationale: Low pH with low HCO₃⁻ and compensatory low PaCO₂ indicates compensated
metabolic acidosis. Elevated lactate confirms tissue hypoperfusion. Options A, C, and D do
not match the ABG pattern.
Question 3: A patient develops a new-onset atrial fibrillation with rapid ventricular
response (HR 168 bpm) and hemodynamic instability (BP 78/50 mmHg). The PRIORITY
intervention is:
A. Withholding all treatment and monitoring the rhythm overnight
B. Oral diltiazem administration and reassessment in 30 minutes
C. Synchronized cardioversion at the recommended energy level per ACLS
protocol
D. Vagal maneuvers including carotid sinus massage
Correct Answer: C. Synchronized cardioversion at the recommended energy level per
ACLS protocol
,Rationale: Unstable tachyarrhythmias with hemodynamic compromise require immediate
synchronized cardioversion per ACLS guidelines. Oral medications (A) are too slow. Vagal
maneuvers (C) are for stable SVT. Withholding treatment (D) risks cardiovascular collapse.
Question 4: The nurse is monitoring a patient with a pulmonary artery catheter. A
pulmonary artery occlusion pressure (PAOP/wedge pressure) of 24 mmHg MOST likely
indicates:
A. Hypovolemia requiring aggressive fluid resuscitation
B. Normal cardiac filling pressures requiring no intervention
C. Left ventricular failure with elevated left atrial pressure and pulmonary
congestion
D. Right ventricular failure without left-sided involvement
Correct Answer: C. Left ventricular failure with elevated left atrial pressure and
pulmonary congestion
Rationale: Normal PAOP is 6-12 mmHg. A value of 24 mmHg indicates elevated left heart
pressures with pulmonary congestion. Hypovolemia (A) shows low PAOP. Isolated RV
failure (C) elevates CVP, not PAOP. Normal (D) is 6-12 mmHg.
Question 5: A patient with a temporary transvenous pacemaker exhibits failure to capture
on the monitor. The nurse should FIRST:
A. Decrease the sensitivity setting to zero
B. Increase the milliampere (mA) output, check lead connections, reposition the
patient, and assess for lead displacement
C. Administer atropine 3 mg IV push immediately
D. Remove the pacemaker immediately without assessment
Correct Answer: B. Increase the milliampere (mA) output, check lead connections,
reposition the patient, and assess for lead displacement
Rationale: Failure to capture requires increasing output and checking connections.
Removing the pacemaker (A) eliminates the therapy. Decreasing sensitivity (C) does not
address capture failure. Atropine (D) may be adjunctive but does not fix the pacemaker
issue.
, Question 6: A patient presents with Beck's triad: hypotension, muffled heart sounds, and
jugular venous distension. This clinical presentation is MOST consistent with:
A. Cardiac tamponade requiring emergent pericardiocentesis
B. Tension pneumothorax
C. Simple pleural effusion
D. Acute pulmonary embolism
Correct Answer: A. Cardiac tamponade requiring emergent pericardiocentesis
Rationale: Beck's triad is pathognomonic for cardiac tamponade. Tension pneumothorax
(A) shows tracheal deviation and absent breath sounds. PE (C) presents with dyspnea and
tachycardia. Pleural effusion (D) does not produce Beck's triad.
Question 7: Intra-aortic balloon pump (IABP) therapy improves cardiac function through
which mechanism?
A. Delivering electrical impulses to the myocardium
B. Increasing afterload during systole
C. Continuously compressing the aorta to increase blood pressure
D. Inflating during diastole to augment coronary perfusion and deflating during
systole to reduce afterload (counterpulsation)
Correct Answer: D. Inflating during diastole to augment coronary perfusion and
deflating during systole to reduce afterload (counterpulsation)
Rationale: IABP counterpulsation augments diastolic coronary filling and reduces systolic
afterload. Increasing afterload (A) is detrimental. Continuous compression (C) is not the
mechanism. Electrical impulses (D) describe pacemakers.
Question 8: The nurse caring for a patient after coronary artery bypass graft (CABG)
surgery monitors chest tube output. An output exceeding which volume in the first hour
post-operatively requires IMMEDIATE notification of the surgeon?
A. 200 mL or greater in the first hour, suggesting active surgical bleeding
B. 10 mL in the first hour
C. 1 mL per hour
D. 50 mL in the first hour
