Page 1 of 17
ADULT CCRN /PCCN CERTIFICATION
EXAM|REAL QUESTIONS AND ANSWERS
|ALREADY GRADED A+
Q1. A 68-year-old male is 2 days post-CABG. He suddenly
becomes hypotensive (BP 70/40), heart rate 130 bpm, CVP 2
mmHg, PAOP 4 mmHg. What is the priority intervention?
a) Administer IV furosemide
b) Start a norepinephrine drip
c) Give a 500 mL IV fluid bolus
d) Prepare for emergent pericardiocentesis
Correct Answer: c) Give a 500 mL IV fluid bolus
Rationale: Low CVP and PAOP indicate hypovolemia, not
cardiogenic shock. Fluid resuscitation is the initial step.
Norepinephrine is second-line after volume.
,Page 2 of 17
Q2. A patient with acute STEMI develops a new murmur and
hypotension. You suspect ventricular septal rupture. Which
hemodynamic profile is expected?
a) Step-up in oxygen saturation from RA to PA
b) Elevated PAOP with normal CVP
c) Low cardiac output and low SVR
d) Equalization of diastolic pressures
Correct Answer: a) Step-up in oxygen saturation from RA to
PA
Rationale: VSD causes left-to-right shunting, increasing oxygen
saturation in the right ventricle and pulmonary artery. This is
diagnostic.
Q3. A patient in the ICU has a right internal jugular CVP line. The
waveform shows large “v” waves equal to the R wave of the
ECG. What does this indicate?
a) Tricuspid stenosis
, Page 3 of 17
b) Pulmonary embolism
c) Tricuspid regurgitation
d) Cardiac tamponade
Correct Answer: c) Tricuspid regurgitation
Rationale: Large “v” waves on CVP occur when blood flows back
into the atrium during ventricular systole, pathognomonic for
tricuspid regurgitation.
*(Questions 4-45 continue in this pattern. Below are
representative examples from remaining sections.)*
SECTION 2: PULMONARY (35 Questions)
Q22. A 55-year-old with severe ARDS is on a ventilator (Vt 6
mL/kg, PEEP 14, FiO2 0.8). ABG: pH 7.28, PaCO2 55, PaO2
65, HCO3 24. What is the best next step?
a) Increase Vt to 8 mL/kg
b) Increase PEEP to 18
ADULT CCRN /PCCN CERTIFICATION
EXAM|REAL QUESTIONS AND ANSWERS
|ALREADY GRADED A+
Q1. A 68-year-old male is 2 days post-CABG. He suddenly
becomes hypotensive (BP 70/40), heart rate 130 bpm, CVP 2
mmHg, PAOP 4 mmHg. What is the priority intervention?
a) Administer IV furosemide
b) Start a norepinephrine drip
c) Give a 500 mL IV fluid bolus
d) Prepare for emergent pericardiocentesis
Correct Answer: c) Give a 500 mL IV fluid bolus
Rationale: Low CVP and PAOP indicate hypovolemia, not
cardiogenic shock. Fluid resuscitation is the initial step.
Norepinephrine is second-line after volume.
,Page 2 of 17
Q2. A patient with acute STEMI develops a new murmur and
hypotension. You suspect ventricular septal rupture. Which
hemodynamic profile is expected?
a) Step-up in oxygen saturation from RA to PA
b) Elevated PAOP with normal CVP
c) Low cardiac output and low SVR
d) Equalization of diastolic pressures
Correct Answer: a) Step-up in oxygen saturation from RA to
PA
Rationale: VSD causes left-to-right shunting, increasing oxygen
saturation in the right ventricle and pulmonary artery. This is
diagnostic.
Q3. A patient in the ICU has a right internal jugular CVP line. The
waveform shows large “v” waves equal to the R wave of the
ECG. What does this indicate?
a) Tricuspid stenosis
, Page 3 of 17
b) Pulmonary embolism
c) Tricuspid regurgitation
d) Cardiac tamponade
Correct Answer: c) Tricuspid regurgitation
Rationale: Large “v” waves on CVP occur when blood flows back
into the atrium during ventricular systole, pathognomonic for
tricuspid regurgitation.
*(Questions 4-45 continue in this pattern. Below are
representative examples from remaining sections.)*
SECTION 2: PULMONARY (35 Questions)
Q22. A 55-year-old with severe ARDS is on a ventilator (Vt 6
mL/kg, PEEP 14, FiO2 0.8). ABG: pH 7.28, PaCO2 55, PaO2
65, HCO3 24. What is the best next step?
a) Increase Vt to 8 mL/kg
b) Increase PEEP to 18
