CCRN Practice Questions
This is a free 15-question sampler for the CCRN (Adult) exam, written by the StudyPDF team. It works through hemodynamic calculations, shock patterns, blood gases, ARDS, endocrine and renal physiology, intracranial pressure, electrolytes and one question on the Synergy Model, mixing multiple choice, select all that apply and fill in the blank. Answer all 15, then check your score and read the explanation for every question.
Cardiac output is the product of which two values?
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All 15 questions at a glance
Prefer to read before you play? Every question in the sampler is listed below. Answers and explanations stay collapsed until you open them.
1. Cardiac output is the product of which two values?
- A. Mean arterial pressure and systemic vascular resistance
- B. Stroke volume and ejection fraction
- C. Heart rate and stroke volume
- D. Heart rate and preload
Show answer and explanation
Answer: C. Heart rate and stroke volume
Cardiac output is heart rate times stroke volume, usually about 4 to 8 liters per minute in an adult at rest. Stroke volume in turn depends on preload, afterload and contractility, which is why those three come up in almost every hemodynamics question. Cardiac index divides the output by body surface area so that patients of different sizes can be compared.
2. A patient's hemodynamic readings show a low cardiac output, a high systemic vascular resistance and a high pulmonary artery occlusion pressure. Which shock state fits this pattern best?
- A. Cardiogenic shock
- B. Hypovolemic shock
- C. Early septic shock
- D. Neurogenic shock
Show answer and explanation
Answer: A. Cardiogenic shock
In cardiogenic shock the pump fails, so blood backs up behind the left ventricle and the occlusion or wedge pressure rises, while the vessels clamp down to hold the blood pressure up. Hypovolemic shock also has a low output and a high resistance, but its filling pressures are low because there is not enough volume. Septic and neurogenic shock are distributive, so their resistance is low, and neurogenic shock often comes with a slow heart rate.
3. Complete the sentence.
With a blood pressure of 120/60 mm Hg, the mean arterial pressure is about _____ mm Hg.
Options for blank 1: 70, 80, 90, 100
Show answer and explanation
Answer: 80
Mean arterial pressure is the diastolic pressure counted twice plus the systolic pressure, divided by three: (60 + 60 + 120) / 3 = 80. Diastole is weighted more because the heart spends about two thirds of each beat in it. The MAP is the pressure that actually pushes blood into the organs, which is why monitors and test questions lean on it more than on the systolic number alone.
4. An arterial blood gas shows a pH of 7.30, a PaCO2 of 55 mm Hg and a bicarbonate of 25 mEq/L. How is this best interpreted?
- A. Metabolic acidosis with respiratory compensation
- B. Uncompensated respiratory acidosis
- C. Respiratory alkalosis
- D. Compensated metabolic alkalosis
Show answer and explanation
Answer: B. Uncompensated respiratory acidosis
A pH under 7.35 is acidosis. The PaCO2 is above its normal range of about 35 to 45, which matches an acid, so the cause is respiratory. The bicarbonate is still inside its normal range of about 22 to 26, so the kidneys have not started to compensate yet, which usually means the problem is recent.
5. Which change shifts the oxyhemoglobin dissociation curve to the right, so that hemoglobin releases oxygen to the tissues more easily?
- A. Alkalosis
- B. Hypothermia
- C. A low level of 2,3-DPG
- D. Fever
Show answer and explanation
Answer: D. Fever
Heat, acid, a high carbon dioxide level and more 2,3-DPG all shift the curve to the right, and they are exactly the conditions of hard-working tissue, so oxygen is unloaded where it is needed. Alkalosis, hypothermia and low 2,3-DPG shift it to the left, and hemoglobin then holds on to its oxygen. That is why a normal saturation does not guarantee good tissue oxygen delivery in a cold, alkalotic patient.
6. Which statements describe acute respiratory distress syndrome (ARDS)?
Select all that apply.
- A. Hypoxemia that improves poorly with supplemental oxygen alone
- B. Pulmonary edema caused mainly by a high pulmonary artery occlusion pressure
- C. Bilateral opacities on chest imaging
- D. Consolidation limited to a single lobe on one side
- E. Fluid leaking into the alveoli because the capillaries have become more permeable
Show answer and explanation
Answer: A. Hypoxemia that improves poorly with supplemental oxygen alone, C. Bilateral opacities on chest imaging, E. Fluid leaking into the alveoli because the capillaries have become more permeable
In ARDS an injury such as sepsis, pneumonia or trauma makes the lung capillaries leaky, so protein-rich fluid floods the alveoli on both sides. Blood then passes through lung units that cannot take up oxygen, a shunt, which is why extra oxygen helps so little. The edema is noncardiogenic: if a high wedge pressure from a failing heart explains it, the picture is heart failure, not ARDS, and severity is usually graded by the ratio of arterial oxygen to inspired oxygen.
7. Complete the sentence.
In the syndrome of inappropriate antidiuretic hormone (SIADH), the kidneys keep holding on to water, so the urine is inappropriately _____ and the serum sodium _____.
Options for blank 1: concentrated, dilute, alkaline
Options for blank 2: rises, falls, does not change
Show answer and explanation
Answer: concentrated, falls
Too much antidiuretic hormone makes the kidneys reabsorb free water even when the body does not need it, so the urine stays concentrated and the extra water dilutes the blood sodium. Diabetes insipidus is the mirror image: too little hormone, or kidneys that ignore it, produce large amounts of dilute urine and the serum sodium climbs. Both turn up after head injury and neurosurgery, which is why they are tested side by side.
8. In diabetic ketoacidosis, which breathing pattern reflects the body's attempt to compensate for the acidosis?
- A. Kussmaul respirations
- B. Cheyne-Stokes respirations
- C. Biot respirations
- D. Apneustic breathing
Show answer and explanation
Answer: A. Kussmaul respirations
Kussmaul breathing is deep and rapid, and it blows off carbon dioxide to push the pH back up, a respiratory compensation for a metabolic acidosis. The ketones that cause the acidosis also give the breath its fruity smell. Hyperosmolar hyperglycemic state is the contrast case: a very high glucose and serum osmolality with little or no ketoacidosis, so Kussmaul breathing is not expected.
9. Which signs make up Cushing's triad, a late sign of rising intracranial pressure?
Select all that apply.
- A. Tachycardia
- B. A rising systolic pressure with a widening pulse pressure
- C. Bradycardia
- D. Irregular or abnormal respirations
- E. A narrowing pulse pressure
Show answer and explanation
Answer: B. A rising systolic pressure with a widening pulse pressure, C. Bradycardia, D. Irregular or abnormal respirations
As the pressure inside the skull rises, the body pushes the systolic pressure up to keep blood reaching the brain, which widens the pulse pressure. The heart slows in response, and pressure on the brainstem disturbs the breathing pattern. Because the triad appears late, a falling level of consciousness is usually the earlier warning, and the triad means the brainstem is already under threat.
10. Complete the sentence.
With a mean arterial pressure of 80 mm Hg and an intracranial pressure of 20 mm Hg, the cerebral perfusion pressure is _____ mm Hg.
Options for blank 1: 40, 50, 60, 100
Show answer and explanation
Answer: 60
Cerebral perfusion pressure is the mean arterial pressure minus the intracranial pressure, so 80 - 20 = 60. Normal intracranial pressure in adults is usually given as about 5 to 15 mm Hg. The formula shows why a rising ICP or a falling MAP threatens the brain the same way: either one shrinks the pressure difference that drives blood into it.
11. Which finding is typical of prerenal acute kidney injury, as opposed to acute tubular necrosis?
- A. Muddy brown granular casts and a high urine sodium
- B. Red blood cell casts in the urine
- C. A BUN to creatinine ratio above 20 to 1 and a low urine sodium
- D. A urine specific gravity fixed at about 1.010
Show answer and explanation
Answer: C. A BUN to creatinine ratio above 20 to 1 and a low urine sodium
In prerenal injury the kidney itself still works but is underperfused, so it holds on to sodium and water as hard as it can, the urine sodium drops and urea is reabsorbed out of proportion to creatinine. Once the tubules are damaged, as in acute tubular necrosis, they can no longer conserve sodium or concentrate urine, which gives a high urine sodium, a fixed specific gravity near 1.010 and muddy brown casts. Red cell casts point to the glomeruli instead.
12. Why does a patient with disseminated intravascular coagulation (DIC) bleed?
- A. Antibodies against heparin destroy the platelets
- B. Widespread clotting uses up platelets and clotting factors
- C. The liver stops producing albumin
- D. Vitamin C deficiency weakens the vessel walls
Show answer and explanation
Answer: B. Widespread clotting uses up platelets and clotting factors
DIC starts with clotting, not bleeding: a trigger such as sepsis, trauma or an obstetric emergency switches on coagulation throughout the small vessels. That consumes platelets and clotting factors faster than the body can replace them, and the breakdown of all those clots adds to the problem. The typical labs are a low platelet count, a low fibrinogen, a prolonged PT and aPTT and a high D-dimer, while heparin-induced thrombocytopenia, the first option, causes clots rather than bleeding.
13. Which findings are signs of hypocalcemia?
Select all that apply.
- A. A positive Chvostek sign
- B. A positive Trousseau sign
- C. A shortened QT interval
- D. Numbness and tingling around the mouth
- E. Decreased deep tendon reflexes
Show answer and explanation
Answer: A. A positive Chvostek sign, B. A positive Trousseau sign, D. Numbness and tingling around the mouth
Low calcium makes nerves and muscles too excitable: tapping the facial nerve twitches the face (Chvostek), a blood pressure cuff on the arm brings on a hand spasm (Trousseau), and the lips and fingertips tingle. It also lengthens the QT interval. A short QT and weak reflexes belong to high calcium, and low calcium is watched for after thyroid or parathyroid surgery and after large transfusions, because the citrate in stored blood binds calcium.
14. In the AACN Synergy Model, which nurse characteristic means speaking up for the patient and family and helping to resolve the ethical problems that come up in their care?
- A. Systems thinking
- B. Clinical inquiry
- C. Facilitation of learning
- D. Advocacy and moral agency
Show answer and explanation
Answer: D. Advocacy and moral agency
The Synergy Model, the framework behind every AACN certification exam, matches patient characteristics such as stability, complexity and resiliency with eight nurse characteristics. Clinical judgment is one of them and drives the clinical 80 percent of the exam. The other seven, advocacy and moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity and systems thinking, make up the Professional Caring and Ethical Practice domain.
15. A patient after cardiac surgery becomes hypotensive with distended neck veins, muffled heart sounds and a systolic pressure that drops more than 10 mm Hg on inspiration. Which complication do these findings point to?
- A. Cardiac tamponade
- B. Tension pneumothorax
- C. Acute aortic dissection
- D. Hypovolemia from chest tube losses
Show answer and explanation
Answer: A. Cardiac tamponade
Hypotension, distended neck veins and muffled heart sounds are Beck's triad, and the inspiratory drop in systolic pressure is pulsus paradoxus: fluid around the heart keeps the chambers from filling. On a pulmonary artery catheter the right atrial, pulmonary artery diastolic and occlusion pressures tend to equalize. A tension pneumothorax also raises the neck veins and drops the pressure, but it comes with absent breath sounds on one side, and hypovolemia flattens the neck veins.
What the CCRN (Adult) exam covers
The CCRN is the specialty certification for nurses who care for acutely and critically ill patients, awarded by AACN Certification Corporation. There are separate exams for adult, pediatric and neonatal patients, and the handbook points out that CCRN is not an acronym for critical care registered nurse. Before you can sit it you need an active, unencumbered RN or APRN license and a set number of verified clinical hours with critically ill patients. The handbook lists the exact hour options, so read them there rather than from a prep site.
According to the AACN CCRN Exam Handbook, the exam is a 3-hour test of 150 multiple-choice questions. Only 125 of them count toward your score. The other 25 are unscored items AACN is trying out for future exams, and you cannot tell which ones they are. The pass mark is set by a panel of experts against a fixed standard, so you are not competing with the other people testing that day.
Eighty percent of the exam is Clinical Judgment and twenty percent is Professional Caring and Ethical Practice. For exams taken on and after November 12, 2025, the Adult test plan splits Clinical Judgment into cardiovascular at 13 percent, respiratory at 12 percent, endocrine, hematology and immunology, gastrointestinal, renal and genitourinary, and integumentary together at 21 percent, musculoskeletal, neurological and behavioral or psychosocial at 18 percent, and multisystem problems such as sepsis, shock and acid-base imbalance at 16 percent. The caring and ethics domain covers advocacy and moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity and systems thinking.
That test plan is newer than many prep books and question banks. If a resource shows different percentages, it was probably written for the earlier plan, so check the date on the handbook you download from aacn.org before you decide where to spend your study time.
How to use this sampler
The real exam asks a lot of questions about what the nurse should do next. This sampler deliberately does not. Interventions, drug choices and doses depend on your unit's protocols, the provider's orders and current references, so they do not belong on a free practice page. Every question here tests the reasoning underneath those decisions instead: what a hemodynamic profile means, how to read a blood gas, why a lab pattern points to one cause and not another. This is exam practice, not medical guidance.
That reasoning is worth drilling on its own, because it is what lets you eliminate wrong answers on the real test. If you know why cardiogenic shock raises the wedge pressure and hypovolemic shock lowers it, a question about either one becomes a matter of reading the numbers. The same goes for acid-base: work out the pH first, then which value explains it, then whether the other value has started to compensate.
Take the 15 questions in one sitting without notes, then read every explanation, including the ones you got right. Treat each miss as a topic. Two misses on the hemodynamic questions point at one gap, not two, so go back to cardiac output, preload, afterload and the shock profiles together. Because the real exam spreads across the whole body, a weak multisystem or neuro score matters as much as a weak cardiac one.
Every question on this page was written by the StudyPDF team from the published test plan. None of them comes from AACN, from its practice exams or from any commercial question bank.
How to build more practice tests from your own materials
Fifteen questions can show you which body system needs work. They cannot get you ready for a certification exam on their own, and a generic question bank does not know what your review course stressed or which areas you keep getting wrong.
StudyPDF works from your material instead. Upload your critical care review book, the slides from your CCRN course, your unit's education packets or your own notes. Then press New material, pick a practice exam or a quiz, choose those files as the sources and set the length and the difficulty. Every question is written from those exact pages and every explanation cites where the answer comes from, so you can open the source the moment something looks off. You can narrow a test to one area such as hemodynamics or neuro, and your answers build a per-concept picture of what keeps costing you points.
Bo is the tutor for the rest. Ask him why an answer is right and he explains it from your own pages, with a hint first if you want one.
You do not have to upload anything to start. Name a topic instead, for example shock states, acid-base interpretation or intracranial pressure, and Bo sets it up with its key concepts so you can build a practice test on it. Starting is free.
Written by the StudyPDF team. Last updated 2026-08-19.