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| Credentialing body | AACN Certification Corporation |
|---|---|
| Length | 150 multiple-choice items: 125 scored + 25 unscored |
| Time | 3 hours |
| Test plan | Revised Adult CCRN test plan for exams taken on or after November 12, 2025. Framework: AACN Synergy Model for Patient Care |
| Eligibility | Current, unencumbered U.S. RN/APRN license plus clinical practice hours in direct care of acutely/critically ill adults (two- and five-year hour options; see the CCRN Exam Handbook) |
| Fees (verify) | As of this writing, AACN lists $260 for members and $375 for nonmembers. Check aacn.org. |
| Area | Weight |
|---|---|
| Cardiovascular | 13% |
| Respiratory | 12% |
| Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary | 21% |
| Musculoskeletal, Neurological, Behavioral/Psychosocial | 18% |
| Multisystem | 16% |
| Professional Caring and Ethical Practice | 20% |
Source: AACN – CCRN (Adult) certification. Always check the official site for updates.
A patient 4 hours after CABG has a sudden decrease in chest tube output, BP 82/60 mm Hg, HR 128/min, rising CVP, and equalization of filling pressures. What is the most likely cause?
Answer: D
Abrupt cessation of chest tube drainage (clot) with hypotension, tachycardia, rising CVP, and equalizing pressures suggests tamponade. Notify the surgeon emergently; reexploration may be needed.
A patient with ARDS is on volume-control ventilation. Which tidal volume strategy is evidence based?
Answer: A
Lung-protective ventilation (low tidal volume based on predicted body weight, plateau ≤30 cm H2O) reduces mortality in ARDS. Permissive hypercapnia may be accepted.
A patient with small cell lung cancer has a serum sodium of 118 mEq/L, serum osmolality of 250 mOsm/kg, and concentrated urine. Which condition is suspected?
Answer: C
SIADH causes euvolemic hypotonic hyponatremia with inappropriately concentrated urine. Small cell lung cancer is a classic cause. Treat with fluid restriction and, if symptomatic, hypertonic saline.
A patient receiving heparin for 7 days has a platelet count drop from 240,000 to 95,000/mm3 and a new DVT. What should the nurse anticipate?
Answer: B
Heparin-induced thrombocytopenia (HIT) causes a >50% platelet drop 5–10 days after exposure with thrombosis. All heparin, including LMWH, is stopped; a direct thrombin inhibitor is used.
A patient with a subarachnoid hemorrhage is on day 6 after aneurysm coiling and develops new confusion and hemiparesis. What is the most likely cause?
Answer: D
Vasospasm peaks around days 4–14 after SAH. Nimodipine is given to improve outcomes; euvolemia is maintained; imaging/transcranial Doppler and endovascular therapy may be used.
Which tool is used to screen for delirium in mechanically ventilated ICU patients?
Answer: A
CAM-ICU assesses acute change/fluctuation, inattention, altered level of consciousness, and disorganized thinking and can be used in nonverbal intubated patients.
A patient in septic shock has received 30 mL/kg of crystalloid and remains with a MAP of 58 mm Hg. Which is the first-line vasopressor?
Answer: B
Norepinephrine is first-line for septic shock to target MAP ≥65 mm Hg. Vasopressin may be added; dobutamine is for myocardial dysfunction.
A patient's ABG shows pH 7.22, PaCO2 28 mm Hg, HCO3- 11 mEq/L. Sodium is 138, chloride 102. What is the interpretation?
Answer: C
Anion gap = 138 − (102 + 11) = 25 (elevated). Expected PaCO2 by Winter's formula = 1.5(11) + 8 ± 2 = 22.5–26.5; actual 28 is close, suggesting near-appropriate compensation (consider a mild respiratory component).
The family of a dying ICU patient asks to be present during resuscitation. Which response reflects evidence-based practice?
Answer: B
Family presence during resuscitation is supported by AACN and other organizations when a designated staff member supports the family.
A nurse notices an increase in central line–associated bloodstream infections on the unit. Which action best reflects clinical inquiry and systems thinking?
Answer: C
Clinical inquiry involves questioning practice and applying evidence; systems thinking uses resources and processes to improve outcomes.