CCRN (Adult) Practice Exam – Direct Care
Pathway
Questions (with Answers & Rationales)
1. A patient with acute myocardial infarction (MI) has a blood pressure of
85/50 mmHg and heart rate of 120 bpm. What is the priority nursing action?
A. Administer IV fluids cautiously and notify the provider
B. Encourage ambulation
C. Apply warm blankets
D. Document only
✅ Answer: A
Rationale: Hypotension and tachycardia indicate possible cardiogenic shock. Immediate
intervention and provider notification are required.
2. Which lab value is most indicative of renal perfusion in a critically ill
patient?
A. Serum creatinine
B. Hemoglobin
C. Sodium
D. Albumin
✅ Answer: A
Rationale: Creatinine reflects kidney function and perfusion, important for detecting acute
kidney injury.
3. A patient on a mechanical ventilator has a sudden drop in oxygen
saturation. What is the first action?
A. Assess airway and ventilator settings
B. Increase sedation
C. Start chest physiotherapy
D. Change IV fluids
,✅ Answer: A
Rationale: Rapid assessment identifies potential causes of hypoxia such as disconnection,
obstruction, or ventilator malfunction.
4. Which finding indicates increased intracranial pressure (ICP)?
A. Decreased level of consciousness and bradycardia
B. Clear lung sounds
C. Warm extremities
D. Hypotension only
✅ Answer: A
Rationale: Classic Cushing’s triad (bradycardia, hypertension, irregular respirations) signals
elevated ICP.
5. Which is the preferred site for central venous pressure (CVP)
monitoring?
A. Internal jugular or subclavian vein
B. Radial artery
C. Peripheral IV
D. Femoral artery
✅ Answer: A
Rationale: CVP reflects right atrial pressure and guides fluid management in critically ill
patients.
6. Which electrolyte imbalance increases the risk of ventricular
arrhythmias?
A. Hypokalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypermagnesemia
✅ Answer: A
Rationale: Low potassium can cause ectopy, ventricular tachycardia, or fibrillation.
, 7. Which intervention is most appropriate for a patient with acute
respiratory distress syndrome (ARDS)?
A. Low tidal volume mechanical ventilation
B. High tidal volume ventilation
C. Encourage spontaneous deep breaths only
D. Discontinue oxygen therapy
✅ Answer: A
Rationale: Low tidal volume ventilation prevents ventilator-induced lung injury in ARDS.
8. Which lab result indicates tissue hypoxia?
A. Elevated lactate
B. Elevated sodium
C. Low WBC
D. High albumin
✅ Answer: A
Rationale: Lactate accumulation reflects anaerobic metabolism due to inadequate tissue
oxygenation.
9. Which nursing intervention is priority for a patient with sepsis and
hypotension?
A. Rapid fluid resuscitation and monitor perfusion
B. Apply warm blankets only
C. Encourage oral intake
D. Start physical therapy
✅ Answer: A
Rationale: Early fluid resuscitation maintains perfusion and prevents organ failure in septic
shock.
10. Which finding is most concerning in a patient with acute heart failure?
A. Pulmonary edema and dyspnea
B. Clear lung sounds
Pathway
Questions (with Answers & Rationales)
1. A patient with acute myocardial infarction (MI) has a blood pressure of
85/50 mmHg and heart rate of 120 bpm. What is the priority nursing action?
A. Administer IV fluids cautiously and notify the provider
B. Encourage ambulation
C. Apply warm blankets
D. Document only
✅ Answer: A
Rationale: Hypotension and tachycardia indicate possible cardiogenic shock. Immediate
intervention and provider notification are required.
2. Which lab value is most indicative of renal perfusion in a critically ill
patient?
A. Serum creatinine
B. Hemoglobin
C. Sodium
D. Albumin
✅ Answer: A
Rationale: Creatinine reflects kidney function and perfusion, important for detecting acute
kidney injury.
3. A patient on a mechanical ventilator has a sudden drop in oxygen
saturation. What is the first action?
A. Assess airway and ventilator settings
B. Increase sedation
C. Start chest physiotherapy
D. Change IV fluids
,✅ Answer: A
Rationale: Rapid assessment identifies potential causes of hypoxia such as disconnection,
obstruction, or ventilator malfunction.
4. Which finding indicates increased intracranial pressure (ICP)?
A. Decreased level of consciousness and bradycardia
B. Clear lung sounds
C. Warm extremities
D. Hypotension only
✅ Answer: A
Rationale: Classic Cushing’s triad (bradycardia, hypertension, irregular respirations) signals
elevated ICP.
5. Which is the preferred site for central venous pressure (CVP)
monitoring?
A. Internal jugular or subclavian vein
B. Radial artery
C. Peripheral IV
D. Femoral artery
✅ Answer: A
Rationale: CVP reflects right atrial pressure and guides fluid management in critically ill
patients.
6. Which electrolyte imbalance increases the risk of ventricular
arrhythmias?
A. Hypokalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypermagnesemia
✅ Answer: A
Rationale: Low potassium can cause ectopy, ventricular tachycardia, or fibrillation.
, 7. Which intervention is most appropriate for a patient with acute
respiratory distress syndrome (ARDS)?
A. Low tidal volume mechanical ventilation
B. High tidal volume ventilation
C. Encourage spontaneous deep breaths only
D. Discontinue oxygen therapy
✅ Answer: A
Rationale: Low tidal volume ventilation prevents ventilator-induced lung injury in ARDS.
8. Which lab result indicates tissue hypoxia?
A. Elevated lactate
B. Elevated sodium
C. Low WBC
D. High albumin
✅ Answer: A
Rationale: Lactate accumulation reflects anaerobic metabolism due to inadequate tissue
oxygenation.
9. Which nursing intervention is priority for a patient with sepsis and
hypotension?
A. Rapid fluid resuscitation and monitor perfusion
B. Apply warm blankets only
C. Encourage oral intake
D. Start physical therapy
✅ Answer: A
Rationale: Early fluid resuscitation maintains perfusion and prevents organ failure in septic
shock.
10. Which finding is most concerning in a patient with acute heart failure?
A. Pulmonary edema and dyspnea
B. Clear lung sounds
