The CCRN exam from the AACN is one of the most respected certifications for critical care nurses. It tests your ability to make safe, rapid decisions in high-acuity settings — not just recall facts. These 10 sample questions mirror the style and difficulty of the real exam, covering hemodynamics, ventilator management, neuro assessment, pharmacology, and ethical/legal issues. Work through each one, read the reasoning, and note where you stumble. That gap is your study target.
Question 1: Hemodynamics — Cardiac Output
A 68-year-old patient with septic shock has a cardiac output of 3.2 L/min, SVR of 900 dynes·s·cm⁻⁵, and CVP of 4 mmHg. Which finding is most consistent with this presentation?
A. Warm, flushed skin B. Cold, mottled extremities C. Bounding pulses D. Narrow pulse pressure
Correct answer: B
Rationale: In septic shock, early hyperdynamic phase may show high CO and low SVR (warm shock). But this patient has a low CO (normal 4–8 L/min) and relatively normal SVR — this is more consistent with a hypodynamic state, often seen late in sepsis or with myocardial depression. Cold extremities, mottling, and narrow pulse pressure reflect reduced perfusion. Warm skin and bounding pulses are seen in high-CO states. Always correlate CO and SVR with clinical signs, not just numbers.
Question 2: Mechanical Ventilation — ARDS
A patient with ARDS is on volume-controlled ventilation with FiO₂ 0.8, PEEP 12 cm H₂O, and plateau pressure 28 cm H₂O. Arterial blood gas shows PaO₂ 58 mmHg, PaCO₂ 42 mmHg. Which intervention is most appropriate?
A. Increase PEEP to 15 cm H₂O B. Decrease FiO₂ to 0.6 C. Increase tidal volume to 8 mL/kg D. Switch to pressure-controlled ventilation
Correct answer: A
Rationale: This patient has refractory hypoxemia despite high FiO₂. The ARDSNet protocol recommends increasing PEEP to improve oxygenation while keeping plateau pressure ≤30 cm H₂O. Here plateau is 28, so increasing PEEP to 15 is safe and likely to recruit collapsed alveoli. Decreasing FiO₂ would worsen hypoxemia. Higher tidal volume is harmful in ARDS (lung-protective ventilation uses 4–6 mL/kg). Pressure control may help but is not first-line if plateau pressure is still acceptable. Always optimize PEEP before escalating other therapies.
Question 3: Neuro — ICP Management
A patient with traumatic brain injury has an ICP of 24 mmHg and CPP of 55 mmHg. Which nursing action should be performed first?
A. Administer mannitol 0.5 g/kg IV B. Elevate head of bed to 30 degrees C. Increase sedation D. Notify provider for ventriculostomy
Correct answer: B
Rationale: The first step in managing elevated ICP is to ensure proper head positioning — elevate the head of bed to 30 degrees and keep the neck midline to promote venous drainage. This is a non-invasive, immediate intervention that can lower ICP without medication. Mannitol and sedation are appropriate but not first-line. Ventriculostomy is for refractory elevation. Always start with positioning and check for noxious stimuli (e.g., tight ETT ties) before pharmacologic measures.
Question 4: Pharmacology — Vasopressors
Which vasopressor is preferred for a patient with septic shock and low cardiac output despite adequate fluid resuscitation?
A. Norepinephrine B. Epinephrine C. Vasopressin D. Phenylephrine
Correct answer: A
Rationale: Norepinephrine is the first-line vasopressor in septic shock per the Surviving Sepsis Campaign. It increases mean arterial pressure with minimal effect on heart rate and cardiac output. Epinephrine is second-line (adds inotropic effect but increases lactate). Vasopressin is added as a second agent, not first. Phenylephrine is a pure alpha-agonist — useful for neurogenic shock but not septic shock because it may reduce cardiac output. Always start with norepinephrine and titrate to a MAP ≥65 mmHg.
Question 5: ECG — Arrhythmia Recognition
A patient with an irregularly irregular rhythm has no discernible P waves and a ventricular rate of 110–130 bpm. Which is the most likely rhythm?
A. Atrial flutter with variable block B. Atrial fibrillation C. Multifocal atrial tachycardia D. Sinus tachycardia with PACs
Correct answer: B
Rationale: Atrial fibrillation is characterized by an irregularly irregular ventricular response and absent P waves, replaced by fibrillatory waves. Atrial flutter typically has a regular or regularly irregular rhythm with sawtooth flutter waves. Multifocal atrial tachycardia has at least three distinct P-wave morphologies and is usually irregular but P waves are present. Sinus tachycardia with PACs is basically regular with occasional premature beats. The description points directly to AFib.
Question 6: Endocrine — DKA Management
A patient with DKA has potassium 3.0 mEq/L. Which action is most appropriate before starting insulin infusion?
A. Start insulin and monitor potassium closely B. Give potassium replacement and delay insulin until K⁺ >3.3 mEq/L C. Give bicarbonate to correct acidosis first D. Administer calcium gluconate
Correct answer: B
Rationale: In DKA, total body potassium is depleted even if serum K⁺ is normal. Insulin drives potassium into cells, causing dangerous hypokalemia. If K⁺ is <3.3 mEq/L, you must replace potassium and hold insulin until K⁺ rises above 3.3 to prevent arrhythmias. Bicarbonate is rarely needed (only if pH <6.9). Calcium gluconate is for hyperkalemia, not hypokalemia. Always check potassium before starting insulin.
Question 7: Renal — Acute Kidney Injury
A patient in the ICU develops oliguria, BUN 40 mg/dL, creatinine 2.2 mg/dL, and urine sodium 20 mEq/L. Which type of AKI is most likely?
A. Prerenal B. Intrinsic renal C. Postrenal D. Chronic kidney disease
Correct answer: A
Rationale: Prerenal AKI (e.g., from hypovolemia, heart failure) shows low urine sodium (<20 mEq/L) because the kidneys are conserving sodium. The BUN:creatinine ratio is often >20:1. Intrinsic renal (e.g., ATN) typically has urine sodium >40 mEq/L and muddy brown casts. Postrenal is from obstruction and would show anuria or fluctuating output. This pattern is classic prerenal — the kidneys are intact but underperfused.
Question 8: Infection Control — Sepsis Screening
Which finding is the earliest indicator of sepsis in a critically ill patient?
A. Elevated lactate >2 mmol/L B. Hypotension (SBP <90 mmHg) C. Change in mental status D. Temperature >38.3°C
Correct answer: C
Rationale: Sepsis is a dysregulated host response to infection. Early signs are often subtle — confusion, agitation, or lethargy may appear before hemodynamic instability. Lactate elevation is a marker of tissue hypoperfusion but may not be elevated in early sepsis. Hypotension is a late sign (septic shock). Fever is common but not universal and not specific. A change in mental status is a red flag that prompts immediate screening and lactate measurement.
Question 9: Ethical/Legal — Withdrawal of Care
A patient with irreversible brain injury has a living will that states no artificial nutrition. The family requests feeding tube placement. What is the nurse's best action?
A. Honor the family's request to avoid conflict B. Place the feeding tube as ordered C. Inform the provider and ethics committee D. Refuse to participate in care
Correct answer: C
Rationale: The patient's living will is legally binding. The family's request conflicts with the patient's documented wishes. The nurse should advocate for the patient, notify the provider, and involve the ethics committee to mediate. Placing the tube would violate patient autonomy. Refusing care is not appropriate — you must continue to provide other care while the conflict is resolved. Always defer to the patient's advance directive.
Question 10: Multisystem — Fluid Resuscitation
A patient with severe pancreatitis has a heart rate of 128, BP 82/50, and urine output 0.3 mL/kg/hr. Which fluid should be administered first?
A. 0.9% normal saline bolus 30 mL/kg B. 5% dextrose in water C. 3% hypertonic saline D. Albumin 5% solution
Correct answer: A
Rationale: This patient is in hypovolemic shock (tachycardia, hypotension, low urine output) from third-spacing in pancreatitis. The first-line resuscitation fluid is isotonic crystalloid — 0.9% normal saline or lactated Ringer's — given as a bolus of 30 mL/kg. D5W is hypotonic and not for volume expansion. Hypertonic saline is for cerebral edema or hyponatremia, not initial resuscitation. Albumin is not preferred initially due to cost and no mortality benefit. Rapid bolus is key.
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How to Use These Questions for Study
- Don't just memorize the answer. Read the rationale and understand the underlying pathophysiology.
- Focus on your weak areas. If you missed hemodynamics, review Starling forces, vasopressors, and shock states.
- Practice with a timer. The real exam gives about 1.5 minutes per question. Time yourself.
- Use the AACN test plan. It breaks down content by percentage — know where the questions come from.
Common Mistakes to Avoid on the CCRN
- Overthinking simple questions. Many questions have one best answer, not a perfect one.
- Ignoring vital signs. Always correlate lab values with clinical presentation.
- Forgetting safety. Airway, breathing, circulation — always prioritize.
- Not reading the stem fully. Look for modifiers like "first" or "most appropriate."
What to Expect on the Real CCRN Exam
The CCRN exam is 150 questions (125 scored, 25 unscored) with a 3-hour time limit. It covers clinical judgment across cardiovascular, pulmonary, neuro, GI, renal, endocrine, hematology/immunology, and behavioral/ethical domains. The questions are scenario-based and require critical thinking. Passing score is determined by the AACN — verify the latest passing standard on the official portal.
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Where to Next?
- Take a free CCRN demo mock to assess your baseline.
- Explore CCRN question banks and full-length mocks with detailed analytics.
- Read our CCRN study guide for a step-by-step prep plan.
Good luck — you’ve got this. The only way to pass is to practice like you’re already there.