If you’re still deciding whether to sit the exam, start with our guide to CCRN certification requirements, which covers eligibility, cost and renewal.
What Does the CCRN Adult Exam Cover?
According to the CCRN Exam Handbook (July 2026 edition), the exam is a 3-hour test of 150 multiple-choice items. 125 are scored and 25 are unscored items used to gather data for future exams. Eighty percent covers Clinical Judgment and 20 percent covers Professional Caring and Ethical Practice. This adult test plan applies to exams taken on and after November 12, 2025.
| Adult CCRN Test Plan Area | Share of Exam |
| Cardiovascular | 13% |
| Respiratory | 12% |
| Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary | 21% |
| Musculoskeletal, Neurological, Behavioral/Psychosocial | 18% |
| Multisystem (including sepsis, shock, rhabdomyolysis, end-of-life care) | 16% |
| Professional Caring and Ethical Practice | 20% |
AACN is moving to generic drug names only. To apply for the adult exam you need a current, unencumbered U.S. RN or APRN license plus 1,750 hours of direct care of acutely or critically ill adults in the past two years (875 in the most recent year), or 2,000 hours over five years (144 in the most recent year), per the AACN CCRN (Adult) page.
Can You Answer These Cardiovascular and Respiratory Questions?
Question 1
Three hours after coronary artery bypass surgery, brisk mediastinal chest tube drainage has nearly stopped. BP has fallen from 118/70 to 84/62, HR is 128, CVP is rising and heart sounds are muffled. Breath sounds are equal. What is the most likely cause?
A. Hypovolemia from ongoing bleeding B. Cardiac tamponade C. Tension pneumothorax D. Acute left ventricular failure
Correct answer: B. A clotted chest tube lets blood collect around the heart. Falling BP and rising CVP right after drainage stops is the classic pattern. Notify the surgeon now and prepare for re-exploration.
- A is not correct. Hypovolemia lowers CVP, and drainage would usually continue.
- C is not correct. Equal breath sounds argue against it.
- D is not correct. It doesn’t explain the sudden stop in drainage.
Question 2
A patient with ARDS is on volume control with a tidal volume of 8 mL/kg predicted body weight. Plateau pressure is 34 cm H2O and SpO2 is 91% on FiO2 0.6. Which change do you anticipate?
A. Increase tidal volume to improve oxygenation B. Reduce tidal volume, accepting some rise in PaCO2 C. Remove PEEP to lower the plateau pressure D. Leave the settings and increase FiO2 to 1.0
Correct answer: B. Lung-protective ventilation uses tidal volumes of 4 to 8 mL/kg predicted body weight and keeps plateau pressure under 30 cm H2O.
- A is not correct. Bigger breaths raise plateau pressure further.
- C is not correct. PEEP keeps alveoli open; removing it worsens hypoxemia.
- D is not correct. It ignores the injurious pressure.
For more practice in this format, try our cardiac NCLEX question walkthroughs and our 12-lead ECG placement guide.
Can You Answer These Endocrine, Hematology and Multisystem Questions?
Question 3
After pituitary surgery, urine output has been 350 mL/hr for three hours. Urine is pale with low specific gravity, serum sodium has risen from 140 to 151 mEq/L, and the patient is very thirsty. What do you anticipate?
A. Fluid restriction and hypertonic saline B. Desmopressin and replacement of free water C. IV furosemide D. An insulin infusion
Correct answer: B. This is central diabetes insipidus: too little ADH, so the kidneys lose free water. Replace the hormone and the water, and trend sodium.
- A is not correct. Fluid restriction would worsen this patient’s free-water deficit, and hypertonic saline would push the sodium even higher.
- C is not correct. A diuretic deepens the water loss.
- D is not correct. Nothing here points to hyperglycemia.
Question 4
On day 7 of unfractionated heparin after a fem-pop bypass, platelets have dropped from 260,000 to 95,000/mm3 and ultrasound confirms a new DVT. What do you anticipate?
A. Switch to enoxaparin B. Stop all heparin, including flushes, and start a non-heparin anticoagulant such as argatroban C. Transfuse platelets D. Hold all anticoagulation until platelets recover
Correct answer: B. A large platelet fall about a week into heparin, plus a new clot, points to heparin-induced thrombocytopenia (HIT), a clotting disorder that still needs anticoagulation, just not heparin.
- A is not correct. Low-molecular-weight heparin can cross-react.
- C is not correct. Platelets are generally avoided in HIT unless the patient is bleeding.
- D is not correct. It leaves an active clot untreated.
Question 5
A 52-year-old patient with pneumonia has a MAP of 59 after an initial crystalloid bolus. HR is 122, temperature 39.1°C and lactate is high. Antibiotics are running. What comes next?
A. Start norepinephrine, titrated to a MAP of at least 65 B. Start dopamine as the first vasopressor C. Keep giving fluid boluses until BP normalizes D. Hold further antibiotics until cultures result
Correct answer: A. This presentation raises concern for septic shock. The Surviving Sepsis Campaign 2026 guidelines recommend norepinephrine first-line and, for adults under 65, an initial MAP target of 65 mm Hg.
- B is not correct. Norepinephrine is preferred; dopamine causes more dysrhythmias.
- C is not correct. After initial resuscitation (the guidelines suggest at least 30 mL/kg of crystalloid within 3 hours), more fluid should follow reassessment.
- D is not correct. Antimicrobials for possible septic shock go in immediately, ideally within an hour.
Question 6
A 54-year-old lay on the floor for about 18 hours after a fall. Urine is tea-colored, the dipstick is strongly positive for blood with few red cells, CK is markedly high and potassium is 5.9 mEq/L. What is the priority?
A. Aggressive potassium-free IV isotonic fluids, plus serial potassium and cardiac rhythm monitoring B. Fluid restriction C. Oral potassium supplements D. IV furosemide before any fluids
Correct answer: A. Rhabdomyolysis releases myoglobin and potassium from muscle. Early volume repletion protects the kidneys.
- B is not correct. Restriction raises the risk of acute kidney injury.
- C is not correct. Potassium is already high.
- D is not correct. A diuretic before volume repletion worsens kidney injury.
Can You Answer These Neuro, Behavioral and Ethics Questions?
Question 7
A patient with a traumatic brain injury develops a larger, sluggish right pupil over 20 minutes. BP is 186/72, HR 48 and respirations irregular. What do you do?
A. Give atropine for the bradycardia B. Lower the head of the bed flat C. Notify the provider immediately and prepare for emergency ICP-lowering therapy and imaging D. Recheck vital signs in one hour
Correct answer: C. Widening pulse pressure, bradycardia and irregular breathing (Cushing’s triad) plus a pupil change signal possible herniation.
- A is not correct. The slow rate is a brainstem reflex; treating the number misses the cause.
- B is not correct. Lying flat impairs venous drainage. Keep the head of the bed up and the head midline.
- D is not correct. Herniation can’t wait an hour.
Question 8
On ICU day 4, a calm, drowsy 76-year-old follows commands inconsistently and screens positive on the CAM-ICU. What is the best action?
A. Document that the patient is resting comfortably B. Request a benzodiazepine at night for sleep C. Report the screen, look for causes and start non-drug delirium measures D. Apply soft restraints to protect the lines
Correct answer: C. This is hypoactive delirium, the type most often missed. Look for causes (infection, hypoxemia, metabolic changes, sedating drugs) and use reorientation, glasses and hearing aids, a day-night routine and early mobility.
- A is not correct. The screen is positive.
- B is not correct. Benzodiazepines are a known delirium risk factor.
- D is not correct. The patient is calm, and restraints tend to worsen agitation.
Question 9
An 82-year-old with metastatic cancer lacks capacity. Her advance directive declines CPR and names her son as health care agent, who supports it. Her daughter insists “everything be done.” What is the best action?
A. Follow the daughter’s wishes to avoid conflict B. Tell the daughter the directive is final and leave C. Arrange a family meeting to review the directive and the agent’s role, and involve palliative care or ethics if conflict continues D. Leave the decision to the physician alone
Correct answer: C. This is advocacy and moral agency: protect her stated wishes while caring for the family. Surrogate laws vary by state, so follow your hospital’s policy.
- A is not correct. It overrides her documented wishes.
- B is not correct. It abandons the family.
- D is not correct. Advocacy and collaboration are part of your role.
Question 10
Your patient speaks Vietnamese and little English, and needs to consent to a procedure. Her grandson offers to interpret. What do you do?
A. Let the grandson interpret B. Use a qualified medical interpreter in person, by video or by phone, and document it C. Use a translation app D. Speak slowly in English and use gestures
Correct answer: B. Qualified interpreters carry accurate meaning and protect privacy; most hospital policies require them for consent.
- A is not correct. Family may filter bad news or mistranslate.
- C is not correct. Apps aren’t reliable for consent conversations.
- D is not correct. It doesn’t ensure understanding.
How Should You Use CCRN Practice Questions?
Start untimed and read every rationale, even for questions you got right. Log each miss by blueprint area and spend your next session on the weakest one. Later, we recommend timed blocks of 50 to 75 questions and at least one full 3-hour session.
For questions that ask what to do first, practice spotting the most immediate threat to the patient, the same priority logic as our NGN case study walkthrough. If shock, ventilation or ABGs keep tripping you up, the Lecturio Critical Care Nursing course covers them with video lessons and a built-in Qbank.
Common Pitfalls
Skipping the ethics questions. Professional Caring and Ethical Practice is a fifth of the exam.
Treating the number, not the patient. Fixing one vital sign while missing the cause is a classic wrong answer.
Practicing with brand names. AACN is moving to generic names, so learn them now.
Studying outdated practice. Old habits, like dopamine first in septic shock, are now wrong answers.
FAQ
How many questions are on the CCRN exam? 150 multiple-choice questions in 3 hours. 125 are scored and 25 are unscored.
What score do you need to pass the CCRN? AACN sets the passing point with a criterion-referenced method (the modified Angoff), so you’re measured against a fixed standard, not other candidates.
How many CCRN practice questions should I do? There’s no official number. Finish your question bank with time left to redo your misses.
Can you retake the CCRN if you fail? Yes. AACN allows up to four attempts in a rolling 12-month period, with a retest fee of $185 for members and $290 for nonmembers.
