ADULT CCRN EXAM 2026/2027, HIGH YIELD PRACTICE QUESTIONS
AND A NEW UPDATED STUDY GUIDE COMPLETE ACCURATE
QUESTIONS AND CORRECT SOLUTIONS WITH DETAILED RATIONALES
(100% CORRECT VERIFIED ANSWERS) NEWEST UPDATED VERSION
2026 EDITION |GUARANTEED PASS A+ (BRAND NEW!) FULL REVISED
ADULT CCRN APPROVED EXAM
1. A 68-year-old male with a history of hypertension and type 2 diabetes is
admitted to the ICU with acute respiratory distress syndrome (ARDS) secondary to
pneumonia. He is intubated and on lung-protective ventilation. Which arterial
blood gas (ABG) finding is most consistent with the early (exudative) phase of
ARDS?
A) pH 7.48, PaCO2 32 mm Hg, PaO2 55 mm Hg (FiO2 0.8), HCO3 24 me/L
B) pH 7.32, PaCO2 48 mm Hg, PaO2 70 mm Hg (FiO2 0.5), HCO3 26 me/L
C) pH 7.52, PaCO2 28 mm Hg, PaO2 90 mm Hg (FiO2 0.4), HCO3 22 me/L
D) pH 7.38, PaCO2 42 mm Hg, PaO2 85 mm Hg (FiO2 0.3), HCO3 23 me/L
Correct Answer: A
Rationale: In early ARDS, hypoxemia is often severe relative to FiO2 (PaO2/FiO2
ratio ≤200). Respiratory alkalosis from tachypnea is common (low PaCO2,
elevated pH). Option A shows PaO2 55 on FiO2 0.8 (ratio 68.75) indicating severe
ARDS with acute respiratory alkalosis. Options B, C, and D do not demonstrate
severe refractory hypoxemia.
2. A patient post-cardiac arrest has return of spontaneous circulation (ROSC) but
remains comatose. Targeted temperature management (TTM) is initiated. Which
core temperature range and duration are recommended by current guidelines?
A) 32–34°C for 12 hours
B) 33–36°C for 24 hours
,C) 36–37.5°C for 48 hours
D) 34–35°C for 6 hours
Correct Answer: B
Rationale: Current guidelines (2020 AHA) recommend TTM with a target
temperature between 32°C and 36°C, with 33–36°C common, maintained for at
least 24 hours after ROSC. Option B is correct. Options A and D have incorrect
durations; C is normothermia, not TTM.
3. A patient with septic shock is on norepinephrine 0.3 mcg/kg/min and
vasopressin 0.04 units/min. Mean arterial pressure (MAP) is 58 mm Hg. Which
intervention is most appropriate next?
A) Increase norepinephrine to 0.5 mcg/kg/min
B) Add dobutamine 5 mcg/kg/min
C) Administer a 500 mL fluid bolus of normal saline
D) Start hydrocortisone 50 mg IV q6h
Correct Answer: A
Rationale: In septic shock, norepinephrine is first-line. If MAP remains <65 mm
Hg despite moderate doses, increase norepinephrine before adding second agents.
Vasopressin is already on board. Fluid resuscitation should be completed prior to
escalating vasopressors. Hydrocortisone is considered if vasopressor-refractory.
4. A 45-year-old female with acute pancreatitis develops fever, hypotension, and
oxygen desaturation. Which hemodynamic profile is most consistent with early
distributive shock?
A) High CVP, low cardiac output, high SVR
B) Low CVP, low cardiac output, high SVR
C) Low CVP, high cardiac output, low SVR
,D) High CVP, high cardiac output, low SVR
Correct Answer: C
Rationale: Distributive shock (e.g., sepsis, pancreatitis) shows decreased SVR
(vasodilation), increased cardiac output (compensatory), and often low or normal
CVP (relative hypovolemia). Option C matches this profile. Options A and B
suggest cardiogenic or hypovolemic shock.
5. Which ventilator setting adjustment is most appropriate for a patient with status
asthmatics on volume-controlled ventilation who develops auto-PEEP of 12 cm
H2O and hypotension?
A) Increase the tidal volume to 8 mL/kg PBW
B) Increase the respiratory rate to 22 breaths/min
C) Decrease inspiratory time and prolong expiratory time
D) Switch to pressure support ventilation at 20 cm H2O
Correct Answer: C
Rationale: Auto-PEEP in asthma is due to insufficient expiratory time. Decreasing
inspiratory time and prolonging expiratory time (e.g., lower I: E ratio, lower rate)
reduces air trapping and auto-PEEP, improving hemodynamics. Option C is
correct; increasing rate or tidal volume worsens auto-PEEP.
6. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of
22 mm Hg and cerebral perfusion pressure (CPP) of 55 mm Hg. Which
intervention is priority?
A) Administer mannitol 1 g/kg IV
B) Elevate head of bed to 30 degrees
C) Start norepinephrine to raise MAP
D) Hyperventilate to PaCO2 28 mm Hg
, Correct Answer: C
Rationale: CPP = MAP – ICP. CPP should be ≥60 mm Hg. With ICP 22, to
achieve CPP 60, need MAP ≥82. Norepinephrine raises MAP and CPP. Head
elevation is standard but does not immediately fix low CPP. Hyperventilation is
temporizing only for herniation.
7. Which electrocardiographic (ECG) finding is most specific for acute
pericarditis?
A) Diffuse ST-segment elevation with PR depression
B) ST-segment elevation in leads V1–V4 with Q waves
C) Deep Q waves in inferior leads
D) Peaked T waves in precordial leads
Correct Answer: A
Rationale: Acute pericarditis classically shows diffuse ST elevation (concave up)
and PR segment depression. Option A is correct. Option B suggests anterior MI; Q
waves imply infarction, not pericarditis.
8. A patient with acute kidney injury (AKI) from sepsis has a serum potassium of
6.8 me/L, peaked T waves, and widened QRS. Which therapy should be
administered first?
A) Calcium gluconate 1 g IV
B) Sodium polystyrene sulfonate 30 g rectally
C) Insulin 10 units with D50 IV
D) Furosemide 40 mg IV
Correct Answer: A
AND A NEW UPDATED STUDY GUIDE COMPLETE ACCURATE
QUESTIONS AND CORRECT SOLUTIONS WITH DETAILED RATIONALES
(100% CORRECT VERIFIED ANSWERS) NEWEST UPDATED VERSION
2026 EDITION |GUARANTEED PASS A+ (BRAND NEW!) FULL REVISED
ADULT CCRN APPROVED EXAM
1. A 68-year-old male with a history of hypertension and type 2 diabetes is
admitted to the ICU with acute respiratory distress syndrome (ARDS) secondary to
pneumonia. He is intubated and on lung-protective ventilation. Which arterial
blood gas (ABG) finding is most consistent with the early (exudative) phase of
ARDS?
A) pH 7.48, PaCO2 32 mm Hg, PaO2 55 mm Hg (FiO2 0.8), HCO3 24 me/L
B) pH 7.32, PaCO2 48 mm Hg, PaO2 70 mm Hg (FiO2 0.5), HCO3 26 me/L
C) pH 7.52, PaCO2 28 mm Hg, PaO2 90 mm Hg (FiO2 0.4), HCO3 22 me/L
D) pH 7.38, PaCO2 42 mm Hg, PaO2 85 mm Hg (FiO2 0.3), HCO3 23 me/L
Correct Answer: A
Rationale: In early ARDS, hypoxemia is often severe relative to FiO2 (PaO2/FiO2
ratio ≤200). Respiratory alkalosis from tachypnea is common (low PaCO2,
elevated pH). Option A shows PaO2 55 on FiO2 0.8 (ratio 68.75) indicating severe
ARDS with acute respiratory alkalosis. Options B, C, and D do not demonstrate
severe refractory hypoxemia.
2. A patient post-cardiac arrest has return of spontaneous circulation (ROSC) but
remains comatose. Targeted temperature management (TTM) is initiated. Which
core temperature range and duration are recommended by current guidelines?
A) 32–34°C for 12 hours
B) 33–36°C for 24 hours
,C) 36–37.5°C for 48 hours
D) 34–35°C for 6 hours
Correct Answer: B
Rationale: Current guidelines (2020 AHA) recommend TTM with a target
temperature between 32°C and 36°C, with 33–36°C common, maintained for at
least 24 hours after ROSC. Option B is correct. Options A and D have incorrect
durations; C is normothermia, not TTM.
3. A patient with septic shock is on norepinephrine 0.3 mcg/kg/min and
vasopressin 0.04 units/min. Mean arterial pressure (MAP) is 58 mm Hg. Which
intervention is most appropriate next?
A) Increase norepinephrine to 0.5 mcg/kg/min
B) Add dobutamine 5 mcg/kg/min
C) Administer a 500 mL fluid bolus of normal saline
D) Start hydrocortisone 50 mg IV q6h
Correct Answer: A
Rationale: In septic shock, norepinephrine is first-line. If MAP remains <65 mm
Hg despite moderate doses, increase norepinephrine before adding second agents.
Vasopressin is already on board. Fluid resuscitation should be completed prior to
escalating vasopressors. Hydrocortisone is considered if vasopressor-refractory.
4. A 45-year-old female with acute pancreatitis develops fever, hypotension, and
oxygen desaturation. Which hemodynamic profile is most consistent with early
distributive shock?
A) High CVP, low cardiac output, high SVR
B) Low CVP, low cardiac output, high SVR
C) Low CVP, high cardiac output, low SVR
,D) High CVP, high cardiac output, low SVR
Correct Answer: C
Rationale: Distributive shock (e.g., sepsis, pancreatitis) shows decreased SVR
(vasodilation), increased cardiac output (compensatory), and often low or normal
CVP (relative hypovolemia). Option C matches this profile. Options A and B
suggest cardiogenic or hypovolemic shock.
5. Which ventilator setting adjustment is most appropriate for a patient with status
asthmatics on volume-controlled ventilation who develops auto-PEEP of 12 cm
H2O and hypotension?
A) Increase the tidal volume to 8 mL/kg PBW
B) Increase the respiratory rate to 22 breaths/min
C) Decrease inspiratory time and prolong expiratory time
D) Switch to pressure support ventilation at 20 cm H2O
Correct Answer: C
Rationale: Auto-PEEP in asthma is due to insufficient expiratory time. Decreasing
inspiratory time and prolonging expiratory time (e.g., lower I: E ratio, lower rate)
reduces air trapping and auto-PEEP, improving hemodynamics. Option C is
correct; increasing rate or tidal volume worsens auto-PEEP.
6. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of
22 mm Hg and cerebral perfusion pressure (CPP) of 55 mm Hg. Which
intervention is priority?
A) Administer mannitol 1 g/kg IV
B) Elevate head of bed to 30 degrees
C) Start norepinephrine to raise MAP
D) Hyperventilate to PaCO2 28 mm Hg
, Correct Answer: C
Rationale: CPP = MAP – ICP. CPP should be ≥60 mm Hg. With ICP 22, to
achieve CPP 60, need MAP ≥82. Norepinephrine raises MAP and CPP. Head
elevation is standard but does not immediately fix low CPP. Hyperventilation is
temporizing only for herniation.
7. Which electrocardiographic (ECG) finding is most specific for acute
pericarditis?
A) Diffuse ST-segment elevation with PR depression
B) ST-segment elevation in leads V1–V4 with Q waves
C) Deep Q waves in inferior leads
D) Peaked T waves in precordial leads
Correct Answer: A
Rationale: Acute pericarditis classically shows diffuse ST elevation (concave up)
and PR segment depression. Option A is correct. Option B suggests anterior MI; Q
waves imply infarction, not pericarditis.
8. A patient with acute kidney injury (AKI) from sepsis has a serum potassium of
6.8 me/L, peaked T waves, and widened QRS. Which therapy should be
administered first?
A) Calcium gluconate 1 g IV
B) Sodium polystyrene sulfonate 30 g rectally
C) Insulin 10 units with D50 IV
D) Furosemide 40 mg IV
Correct Answer: A
