2024 Edition

CCRN Certification Test

A Free CCRN Certification Practice Test will give you an idea of the types of questions and sections on your actual CCRN exam.

It was written by Sue Montgomery, registered nurse with over 28 years of nursing experience. She has worked in critical care nursing at some of the top hospitals in the country, including The Ohio State University Hospitals. Sue is the author of the CCRN Practice Exam Kit with 300 questions and explained answers.

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Cardiovascular

1.	What is the most common cause of dilated cardiomyopathy?
		a. Restrictive cardiomyopathy
		b. Ischemic cardiomyopathy
		c. Idiopathic cardiomyopathy
		d. Hypertrophic cardiomyopathy
Ischemic cardiomyopathy is the most common cause of dilated cardiomyopathy, accounting for over 60% of symptomatic cases. The World Health Organization (WHO) has classified cardiomyopathy into five distinct categories: dilated, hypertrophic, restrictive, arrhythmogenic right ventricular, and unclassified. The diagnosis of cardiomyopathy is typically based on an ejection fraction (EF) of <50%. The ejection fraction is the percentage of blood that is ejected from the heart with each beat. Incorrect answer. Please choose another answer.

2.	What type of heart block is characterized by AV dissociation?
		a. Second degree
		b. Wenckebach
		c. Mobitz II
		d. Third degree
Third degree heart block lacks conduction through the AV node, and is characterized by QRS complexes being conducted at their own rate, with no relation to the p waves. Bradycardia and its effects are the significant symptoms to monitor in patients with this type of conduction system defect. Often, this defect is associated with a causative agent, which must be discovered and removed. Temporary pacemaker use is often necessary, and the patient usually requires permanent pacemaker placement. Incorrect answer. Please choose another answer.

Pulmonary

Molly is a 22-year-old college student who was struck by a car while jogging. She sustained a massive right lower leg injury and was airlifted to the hospital. She was stabilized in the emergency room, and left leg x-ray revealed a compound, comminuted fracture to her right tibia and fibula. All other radiographic evaluations were normal. She underwent surgery and was admitted to the trauma ICU postoperatively. Twenty-four hours after admission, Molly developed dyspnea and a non-productive cough. Vitals were as follows: T-102.8F, P-150, RR-32, BP 164/88, O2 sats 80% on room air, and 95% with 40% facemask. Bibasilar inspiratory crackles were present.

3.	What equipment should be checked prior to intubation?
		a. Endotracheal tube
		b. Ventilator settings
		c. Laryngoscope blade
		d. Both a and c
Both the endotracheal tube (ETT) and the laryngoscope blade should be checked prior to intubation. The cuff on the ETT should be inflated and deflated according to appropriate balloon volume to verify the absence of leaks. The laryngoscope blade light should be checked for functionality. Incorrect answer. Please choose another answer.

Frank is a 40-year-old male who presented to the emergency room two days ago with a 2-day history of increasing respiratory distress. In addition, he has a history of prostate cancer with known metastasis to the lungs. His condition deteriorated quickly and he was diagnosed with acute respiratory distress syndrome (ARDS) and placed on the ventilator. His morning chest x-ray indicated a left pleural effusion, requiring chest tube placement.

4.	A few hours after his chest tube is placed, Frank becomes agitated and pulls it out. What is one of the first interventions that should take place?
		a. Open the thoracotomy tray and prepare for reinsertion
		b. Apply a Vaseline gauze dressing over the site
		c. Hold manual pressure over the site
		d. Place the patient in Trendelenburg to increase intrathoracic pressure
One of the first interventions that should take place when a chest tube is dislodged is to place a Vaseline gauze dressing over the site. This will help to prevent an influx of air into the intrathoracic space, which could create a pneumothorax, tension pneumothorax, and/or a variety of related sequelae. Incorrect answer. Please choose another answer.

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Endocrine

Barbara is a 72-year-old female with a history of Grave’s disease, who is being admitted to the ICU after a sub-total thyroidectomy for a diagnosis of thyroid cancer. Upon her admission assessment, you note that she is tachycardic, agitated, and has an elevated temperature. She reports nausea, and suddenly vomits.

5.	Of the following, which would NOT be included in Barbara's treatment priorities?
		a. Oxygen, ventilatory support, dextrose IV fluids
		b. Propylthiouracil (PTU) or methimazol administration
		c. Propanolol administration, ice packs
		d. Norepinephrine
Norephinephrine would not be included in Barbara's treatment plan, since it carries adrenergic effects, which need to be countered in this situation. Treatment priorities focus on initial stabilization and management of systemic decompensation which may include the need for oxygen, ventilatory support, dextrose IV fluids, treatment of cardiac arrhythmia, aggressive control of hyperthermia, administration of antiadrenergic drugs to minimize sympathomimetic symptoms, and correction of the hyperthyroid state. Propylthiouracil (PTU) carries a high risk for liver damage, and must be used with caution. Incorrect answer. Please choose another answer.

Robert is a 21-year-old who presented to the emergency room with a 2-day history of respiratory infection, nausea, vomiting, increased thirst, increased urination and dizziness. Upon assessment, he is hypotensive, tachycardic, tachypneic, flushed, and somewhat confused. Admission serum blood glucose level is 550 mg/dL. A radial arterial blood gas is drawn, which reveals pH- 7.22 and HCO₃– 13 mEq/L.

6.	What is the initial priority for Robert's care?
		a. Normalization of blood glucose levels
		b. Fluid replacement
		c. Potassium replacement
		d. Insulin administration
Patients who are in diabetic ketoacidosis (DKA) typically experience free water loss of approximately 6 liters or nearly 100ml/kg of body weight, so fluid resuscitation is one of the first measures in treatment, to begin to return the patient to a euvolemic state. Insulin should be started about an hour after IV fluid replacement is started to permit assessment of potassium levels and because insulin use may be more dangerous and less effective until some fluid replacement is achieved. It's important to note that these patients may have a significantly lower potassium level than what may be reflected on initial laboratory results due to extracellular shift of potassium in acidotic conditions. Since serum potassium levels can drop drastically once insulin therapy is started, so levels should be monitored closely. Incorrect answer. Please choose another answer.

Hematology / Immunology

7.	Which of the following best describes disseminated intravascular coagulation (DIC)?
		a. Thrombocytopenia between days 5 and 14 of beginning heparin treatment
		b. Thrombocytopenia in absence of toxic exposure
		c. Characterized by intravascular coagulation and hemorrhage
		d. Presence of autoantibodies against ADAMTS13 protease
Disseminated intravascular coagulation (DIC) is characterized by both intravascular coagulation and hemorrhage. It is a complex systemic disorder which involves the generation of intravascular fibrin and consumption of coagulating agents and platelets. It is not a primary disease, but is always secondary to an underlying pathology and associated with many clinical conditions. Most commonly, it's observed in patients with sepsis and septic shock. Treatment should focus on correcting the underlying disorder, but additional interventional care may be needed depending on the patient's status. Incorrect answer. Please choose another answer.

8.	Of the following neutrophil counts over /µL, which result is not a concern?
		a. 1800
		b. 1100
		c. 500
		d. 1000
The normal lower limit of the neutrophil count is 1500/uL in Caucasians and about 1200/uL in African Americans. Neutrophils (granulocytes) are the main defense that the body has against infections, both bacterial and fungal. The presence of neutropenia makes the body's inflammatory response to those infections ineffective. Relative risk of infection relates to the severity of neutropenia: mild (1000 to 1500/µL), moderate (500 to 1000/µL) and severe (<500/µL). Incorrect answer. Please choose another answer.

Neurology

9.	There are many approaches to treating an arteriovenous malformation (AVM), including various forms of surgery. What grading scale has traditionally been used to estimate surgical risk for AVM?
		a. Hunt and Hess
		b. Spetzler-Martin
		c. West Haven
		d. ASIA
The Spetzler-Martin grading scale has traditionally been used to estimate surgical risk for AVM, and includes grades I-V. AVMs smaller than 3 cm in largest diameter = 1 point, AVMs between 3-6 cm in largest diameter = 2 points, and AVMs larger than 6 cm = 3 points. An additional point is added if the location of the AVM is in a functionally critical area of the brain, and another if the AVM has deep venous drainage. Surgical options may include any of the following as a single approach, or in combination: surgical resection, endovascular embolization, and radiosurgery. Incorrect answer. Please choose another answer.

10.	Depending on the GCS and patient status, intracranial pressure (ICP) monitoring may be indicated as part of the plan of care for patients with head injuries. Which of the following readings might be an indication for intervention?
		a. ICP = 14 mm Hg
		b. ICP = 26 mm Hg
		c. ICP = 7 mm Hg
		d. ICP = 5 mm Hg
An ICP of 26 mm Hg would typically be an indication for intervention. The normal range for the ICP is less than 20 mm Hg, though some settings recommend a range under 15 mm Hg. Depending upon the patient's situation, the cerebral perfusion pressure (CPP) may be a more specific indicator for intervention, since patients who have an increased ICP with an increased MAP may still maintain an adequate CPP. Incorrect answer. Please choose another answer.

Gastrointestinal

Mike is a 79-year-old who has been admitted with abdominal distention, abdominal pain, and nausea and vomiting for the last 2 days. He states that he last remembers having a bowel movement about a week prior to admission, and further states that he is recovering from a myocardial infarction two weeks ago. Initial work-up revealed what appeared to be an acute large bowel obstruction, but there was no evidence of obstruction of the distal colon.

11.	What does this patient most likely have?
		a. Hirschsprung's disease
		b. Crohn's disease
		c. Ogilvie syndrome
		d. Ulcerative colitis
This patient most likely has Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO). In this disorder, the patient presents with symptoms and radiographic results consistent with acute large bowel obstruction, but there is no apparent obstruction present in the distal colon. Although the pathology of this syndrome is not clearly understood, it is believed to be related to an imbalance in the autonomic innervations of the bowel. This syndrome usually occurs after recent serious medical illness or surgery, most commonly trauma, infection and cardiac disease. If not treated promptly and appropriately, bowel perforation and serious sequelae can occur. Incorrect answer. Please choose another answer.

Renal

12.	Renal failure is broadly divided into specific categories. Which type is the type II diabetic patient most likely to experience secondary to the diabetes?
		a. Acute renal failure (ARF)
		b. Intermittent renal failure (IRF)
		c. Chronic renal failure (CRF)
		d. Reversable renal failure (RRF)
Chronic renal failure (CRF) and acute renal failure (ARF) are the two broad categories of renal failure. Diabetic nephropathy is common in the diabetic population, and an increasing cause of chronic renal failure (CRF) in the United States. Other common causes of CRF include chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, connective tissue disorders and amyloidosis. Chronic renal failure (CRF) differs from acute renal failure partly in the time frame of disease onset and reversibility of the disorder. If treated in a timely and appropriate manner, ARF has a much better prognosis and is usually reversible. Chronic renal failure is not reversible. Depending on severity, patients may be placed on renal replacement therapy (RRT) and may be candidates for kidney transplant. Incorrect answer. Please choose another answer.

Dawn has just undergone kidney transplant surgery.

13.	Which of the following is one of the reasons to monitor her fluid status closely in the post-operative period?
		a. To monitor for infection
		b. To monitor for adverse effects of anesthesia
		c. To monitor for adequate perfusion of the transplanted kidney
		d. To monitor for suture line stability
Fluid status should be monitored closely in the post-operative period of kidney transplant because diuresis may occur immediately after the transplanted kidney is functioning. This can cause hypovolemia, low cardiac output, and decreased perfusion of the implanted kidney. Incorrect answer. Please choose another answer.

Multisystem

14.	Patients who have suffered multiple trauma and require large amounts of blood products are at increased risk for TRALI. What does this acronym stand for?
		a. Transfusion response after lung injury
		b. Transfusion rebound and long-term injury
		c. Transfusion related acute lung injury
		d. Transfusion related acute liver injury
Patients who have sustained multiple trauma and receive large amounts of blood products are at increased risk for transfusion related acute lung injury (TRALI). This population is also at increased risk for other complications of massive transfusion including alloimmunization, major and minor histocompatibility reaction, and hemolysis. TRALI does not respond to steroids or antibiotics and requires supportive care. Incorrect answer. Please choose another answer.

15.	What should be the target score on the Ramsay Sedation Scale (RSS) for the patient who is having an endoscopy?
		a. Score = 4-5
		b. Score = 1-2
		c. Score = 5-6
		d. Score = 2-3
Moderate sedation and analgesia are used for procedural sedation, and the target score on the Ramsay Sedation Scale (RSS) is 2-3. The RSS scoring consists of: (1) patient is anxious, restless, agitated, or all three (2) patient is cooperative, oriented and tranquil (3) patient is easily arousable and responds appropriately to stimuli (4) patient is asleep but has brisk response to light glabellar tap or loud auditory stimulus (5) patient is asleep and has sluggish response to glabellar tap or auditory stimulus; responds to painful stimuli. Incorrect answer. Please choose another answer.

Behavior / Psychological

16.	Which of the following is an appropriate tension-reduction intervention for the patient who may be escalating toward aggressive behavior?
		a. Asking to speak to someone
		b. Asking to be alone
		c. Listening to music
		d. All of the above
All of the above interventions are excellent tension reduction techniques for the patient in the ICU. Others include walking the hallway, watching the television for distraction, writing in a journal, and asking for a prn medication. When the plan of care is being developed, patient input should be obtained regarding what triggers create an episode of aggression, and what tension reduction techniques have been most effective in the past. Patients who are in the midst of escalation are often unable to recognize the need for a tension reducing intervention. Therefore, it is very helpful for staff to be able to both recognize potential triggers, and offer appropriate tension reduction techniques that have been individualized to the patient's needs. Incorrect answer. Please choose another answer.

17.	Causes which contribute to delirium are often remembered as an acronym of the same name. What cause does the E in DELIRIUM represent?
		a. EEG
		b. EKG
		c. Electrolytes
		d. Echocardiogram
The E in the acronym DELIRIUM represents electrolytes, since an electrolyte imbalance can contribute to this state. The other letters represent the following: D = Dementia; L = Lung, liver, heart, kidney, brain; I = Infection; R = Rx Drugs; I = Injury, Pain, Stress; U = Unfamiliar environment; M = Metabolic. Delirium is often misdiagnosed as dementia, which may be a coexisting diagnosis. Dementia should not be given as a differential diagnosis until delirium is ruled out, as many factors which contribute to delirium can be treated and may resolve the condition. Incorrect answer. Please choose another answer.

Professional Caring and Ethical Practice

18.	Upon entering an elderly patient's room, you find a research assistant with a clipboard, obtaining consent to participate in a new study. After signing the form, the patient begins to ask questions about the study. The assistant smiles and says, "Don't worry about all that, we'll take good care of you. Now enjoy the chocolate I brought." What should your first response be?
		a. Ignore the patient's questions
		b. Stop the assistant and question the consent
		c. Notify the nurse manager
		d. Notify the research department
The patient has not given informed consent if she still has questions that are not answered prior to participating in the study. The assistant should be stopped, the consent questioned, and the patient's questions answered to ensure she understands all aspects of participation in the study. Additionally, notifications may need to take place as appropriate to prevent this individual from obtaining future consents in an unethical manner. Incorrect answer. Please choose another answer.

19.	What ethical principle has led to the need for informed consent?
		a. Autonomy
		b. Justice
		c. Fidelity
		d. Beneficence
Autonomy is the ethical principle that states that patients have the right to make their own decisions for themselves, if they are mentally competent to do so. Informed consent has been one of the outcomes of this principle, since patients should be thoroughly educated and informed prior to providing consent. Autonomy is a often a difficult concept for healthcare professionals, since patients often make decisions for themselves which healthcare professionals do not always agree with. Incorrect answer. Please choose another answer.

Quality starts with who wrote the material.

Our practice exam writer

Sarah Morris

, RN, MSN, CCRN, is an adjunct instructor in the nursing program at The College of the Canyons. She also works in the neuro/trauma ICU at the UCLA Medical Center. Sarah has been in nursing for over ten years and a CCRN for over seven years.

Brynn Knibbe

, RN, BSN, CCRN, has lectured at the University of Arizona BSN-MSN program on advanced CCRN level topics and precepted and mentored many nurse graduates in the ICU setting. She works in an intensive care unit at the Cleveland Clinic.

Shamin Hampton

, RN, MSN, CCRN, worked as a critical care clinical unit leader in a hospital in Charlotte, North Carolina. She has worked in critical care for over ten years and is now an NP.

Sue Montgomery

is a medical writer who worked as a CCRN for six years. As a CCRN, she served as a staff nurse, clinical leader, preceptor and assistant nurse manager. She has been an RN for over 28 years.

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