AACN CRITICAL-CARE
NURSING CERTIFICATION
CCRN ADULT EXAM REVIEW
High-Acuity Clinical Judgment, Evidence-Based Interventions &
Professional Practice
125 Questions with Correct Answers and Rationales
2026/2027 Certification Year
American Association of Critical-Care Nurses | Professional Certification Review
, TABLE OF CONTENTS
Section 1: Cardiovascular Systems Management (Q1–Q25) — 25 questions
Section 2: Respiratory & Ventilator Management (Q26–Q43) — 18 questions
Section 3: Sepsis, Shock & Multisystem Failure (Q44–Q61) — 18 questions
Section 4: GI, Renal, Electrolyte & Metabolic Emergencies (Q62–Q75) — 14 questions
Section 5: Neurological & Neurocritical Care (Q76–Q88) — 13 questions
Section 6: Endocrine, Hematology & Immunology (Q89–Q100) — 12 questions
Section 7: Professional Caring, Ethics & Family Support (Q101–Q125) — 25 questions
(Sections 5–7 are included in Part 2 of this review series)
,Section 1: Cardiovascular Systems Management (Q1–
Q25)
This section covers hemodynamic monitoring principles, acute coronary syndrome management,
heart failure pharmacology and mechanical support devices, cardiac arrhythmia recognition and
treatment according to ACLS algorithms, anticoagulation therapies and reversal agents, and key
hemodynamic calculations essential for critical care nursing practice. All content aligns with
AACN procedural guidelines and AHA/ACC clinical practice standards.
Q1. A patient with an arterial line has a systolic blood pressure of 120 mmHg and a diastolic
blood pressure of 80 mmHg. What is the calculated mean arterial pressure (MAP)?
A) 80 mmHg
B) 93 mmHg
C) 100 mmHg
D) 200 mmHg
Rationale: MAP is calculated using the formula: MAP = DBP + (SBP - DBP)/3, or MAP = (2 ×
DBP + SBP)/3. Using the second formula: MAP = (2 × 80 + 120)/3 = 280/3 = 93.3 mmHg. The
AACN recognizes MAP as a key indicator of organ perfusion, with a target of at least 65 mmHg
in most adult patients.
Q2. The critical care nurse is interpreting a pulmonary artery catheter waveform. Which pressure
reading is obtained during balloon inflation in the pulmonary artery (PA) catheter?
A) Central venous pressure (CVP)
B) Pulmonary artery systolic pressure
C) Pulmonary capillary wedge pressure (PCWP)
D) Systemic vascular resistance (SVR)
Rationale: PCWP is measured by inflating the balloon at the tip of the PA catheter, which
temporarily occludes a branch of the pulmonary artery and transmits left atrial pressures
retrograde. Per AACN hemodynamic monitoring standards, PCWP reflects left ventricular preload
and is a surrogate for left ventricular end-diastolic pressure (LVEDP). Normal PCWP ranges from
6 to 12 mmHg.
, Q3. A patient's cardiac output (CO) is 5 L/min and body surface area (BSA) is 1.8 m². What is
the calculated cardiac index (CI)?
A) 2.2 L/min/m²
B) 2.8 L/min/m²
C) 3.5 L/min/m²
D) 9.0 L/min/m²
Rationale: Cardiac index is calculated by dividing cardiac output by body surface area: CI =
CO/BSA = 5/1.8 = 2.78 L/min/m². The normal CI range is 2.5 to 4.0 L/min/m². AACN
hemodynamic monitoring guidelines emphasize that CI normalizes CO for differences in body
size and is a more accurate reflection of cardiac performance than CO alone.
Q4. A patient has a MAP of 70 mmHg, a CVP of 8 mmHg, and a CO of 4 L/min. What is the
calculated systemic vascular resistance (SVR)?
A) 800 dynes/sec/cm⁻⁵
B) 1,240 dynes/sec/cm⁻⁵
C) 1,560 dynes/sec/cm⁻⁵
D) 2,240 dynes/sec/cm⁻⁵
Rationale: SVR is calculated using the formula: SVR = [(MAP - CVP) × 80] / CO. Substituting:
SVR = [(70 - 8) × 80] / 4 = (62 × 80)/4 = 4,960/4 = 1,240 dynes/sec/cm⁻⁵. Normal SVR is 800 to
1,200 dynes/sec/cm⁻⁵. Elevated SVR indicates increased afterload, commonly seen in cardiogenic
shock and hypovolemic states per AACN guidelines.
Q5. A patient with a mean pulmonary artery pressure (mPAP) of 25 mmHg, PCWP of 10 mmHg,
and CO of 5 L/min has which calculated pulmonary vascular resistance (PVR)?
A) 120 dynes/sec/cm⁻⁵
B) 240 dynes/sec/cm⁻⁵
C) 320 dynes/sec/cm⁻⁵
D) 400 dynes/sec/cm⁻⁵
Rationale: PVR is calculated as: PVR = [(mPAP - PCWP) × 80] / CO = [(25 - 10) × 80] / 5 = (15
× 80)/5 = 1,200/5 = 240 dynes/sec/cm⁻⁵. Normal PVR is 100 to 250 dynes/sec/cm⁻⁵. AACN
hemodynamic monitoring standards reference this calculation as essential for evaluating right
ventricular afterload in patients with pulmonary hypertension or acute respiratory distress
syndrome.
NURSING CERTIFICATION
CCRN ADULT EXAM REVIEW
High-Acuity Clinical Judgment, Evidence-Based Interventions &
Professional Practice
125 Questions with Correct Answers and Rationales
2026/2027 Certification Year
American Association of Critical-Care Nurses | Professional Certification Review
, TABLE OF CONTENTS
Section 1: Cardiovascular Systems Management (Q1–Q25) — 25 questions
Section 2: Respiratory & Ventilator Management (Q26–Q43) — 18 questions
Section 3: Sepsis, Shock & Multisystem Failure (Q44–Q61) — 18 questions
Section 4: GI, Renal, Electrolyte & Metabolic Emergencies (Q62–Q75) — 14 questions
Section 5: Neurological & Neurocritical Care (Q76–Q88) — 13 questions
Section 6: Endocrine, Hematology & Immunology (Q89–Q100) — 12 questions
Section 7: Professional Caring, Ethics & Family Support (Q101–Q125) — 25 questions
(Sections 5–7 are included in Part 2 of this review series)
,Section 1: Cardiovascular Systems Management (Q1–
Q25)
This section covers hemodynamic monitoring principles, acute coronary syndrome management,
heart failure pharmacology and mechanical support devices, cardiac arrhythmia recognition and
treatment according to ACLS algorithms, anticoagulation therapies and reversal agents, and key
hemodynamic calculations essential for critical care nursing practice. All content aligns with
AACN procedural guidelines and AHA/ACC clinical practice standards.
Q1. A patient with an arterial line has a systolic blood pressure of 120 mmHg and a diastolic
blood pressure of 80 mmHg. What is the calculated mean arterial pressure (MAP)?
A) 80 mmHg
B) 93 mmHg
C) 100 mmHg
D) 200 mmHg
Rationale: MAP is calculated using the formula: MAP = DBP + (SBP - DBP)/3, or MAP = (2 ×
DBP + SBP)/3. Using the second formula: MAP = (2 × 80 + 120)/3 = 280/3 = 93.3 mmHg. The
AACN recognizes MAP as a key indicator of organ perfusion, with a target of at least 65 mmHg
in most adult patients.
Q2. The critical care nurse is interpreting a pulmonary artery catheter waveform. Which pressure
reading is obtained during balloon inflation in the pulmonary artery (PA) catheter?
A) Central venous pressure (CVP)
B) Pulmonary artery systolic pressure
C) Pulmonary capillary wedge pressure (PCWP)
D) Systemic vascular resistance (SVR)
Rationale: PCWP is measured by inflating the balloon at the tip of the PA catheter, which
temporarily occludes a branch of the pulmonary artery and transmits left atrial pressures
retrograde. Per AACN hemodynamic monitoring standards, PCWP reflects left ventricular preload
and is a surrogate for left ventricular end-diastolic pressure (LVEDP). Normal PCWP ranges from
6 to 12 mmHg.
, Q3. A patient's cardiac output (CO) is 5 L/min and body surface area (BSA) is 1.8 m². What is
the calculated cardiac index (CI)?
A) 2.2 L/min/m²
B) 2.8 L/min/m²
C) 3.5 L/min/m²
D) 9.0 L/min/m²
Rationale: Cardiac index is calculated by dividing cardiac output by body surface area: CI =
CO/BSA = 5/1.8 = 2.78 L/min/m². The normal CI range is 2.5 to 4.0 L/min/m². AACN
hemodynamic monitoring guidelines emphasize that CI normalizes CO for differences in body
size and is a more accurate reflection of cardiac performance than CO alone.
Q4. A patient has a MAP of 70 mmHg, a CVP of 8 mmHg, and a CO of 4 L/min. What is the
calculated systemic vascular resistance (SVR)?
A) 800 dynes/sec/cm⁻⁵
B) 1,240 dynes/sec/cm⁻⁵
C) 1,560 dynes/sec/cm⁻⁵
D) 2,240 dynes/sec/cm⁻⁵
Rationale: SVR is calculated using the formula: SVR = [(MAP - CVP) × 80] / CO. Substituting:
SVR = [(70 - 8) × 80] / 4 = (62 × 80)/4 = 4,960/4 = 1,240 dynes/sec/cm⁻⁵. Normal SVR is 800 to
1,200 dynes/sec/cm⁻⁵. Elevated SVR indicates increased afterload, commonly seen in cardiogenic
shock and hypovolemic states per AACN guidelines.
Q5. A patient with a mean pulmonary artery pressure (mPAP) of 25 mmHg, PCWP of 10 mmHg,
and CO of 5 L/min has which calculated pulmonary vascular resistance (PVR)?
A) 120 dynes/sec/cm⁻⁵
B) 240 dynes/sec/cm⁻⁵
C) 320 dynes/sec/cm⁻⁵
D) 400 dynes/sec/cm⁻⁵
Rationale: PVR is calculated as: PVR = [(mPAP - PCWP) × 80] / CO = [(25 - 10) × 80] / 5 = (15
× 80)/5 = 1,200/5 = 240 dynes/sec/cm⁻⁵. Normal PVR is 100 to 250 dynes/sec/cm⁻⁵. AACN
hemodynamic monitoring standards reference this calculation as essential for evaluating right
ventricular afterload in patients with pulmonary hypertension or acute respiratory distress
syndrome.
