AACN CCRN-Adult CCRN (Adult) – Direct Care Eligibility Pathway Exam Practice Test

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Total 150 questions
Question 1

A patient lying on the left side in Trendelenburg position is in the correct position for postural drainage of which of the following lobes of the lungs?



Answer : C

For postural drainage of the right lower lobe, the patient should be positioned on their left side in the Trendelenburg position. This positioning utilizes gravity to facilitate the drainage of secretions from the right lower lobe of the lungs. In the Trendelenburg position, the body is laid flat on the back with the feet higher than the head, which helps drain the lower lobes effectively. Reference: = CCRN Exam Handbook, page 22


Question 2

A patient is admitted following a motor vehicle crash. A fluid challenge is initiated immediately after assessing a BP of 80/palpable. Fifteen minutes later,

vital signs are as follows:

BP 86/50

HR 150

RR 36

The most appropriate action should be to



Answer : B


Question 3

An older adult patient is admitted with acute exacerbation of congestive heart failure. An echocardiogram indicates that EF is unchanged at 50%. The patient is most likely experiencing



Answer : B

Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure that occurs when the heart muscle is stiff and does not relax well, causing high pressure in the heart and lungs. HFpEF is diagnosed when the patient has symptoms and signs of heart failure and a normal or high ejection fraction (EF), which is the percentage of blood pumped out of the left ventricle with each heartbeat. HFpEF is usually caused by conditions that affect the heart or blood vessels, such as aging, high blood pressure, diabetes, obesity, or kidney disease12


What Is Heart Failure with Preserved Ejection Fraction? - Healthline

Heart failure with preserved ejection fraction - BMJ Best Practice

Question 4

A patient is admitted with a traumatic brain injury. During assessment, a nurse notes increased urinary output from the catheter. Which of the following should the nurse suspect?



Answer : B

brain injury (TBI) is most suggestive of central diabetes insipidus (DI). This condition is caused by damage to the hypothalamus or pituitary gland, leading to insufficient secretion of antidiuretic hormone (ADH). The result is an inability to concentrate urine, leading to polyuria (excessive urine output) and potentially significant dehydration and electrolyte imbalances if not managed appropriately. Reference: =

CCRN (Adult) Certification Review Course Online: Neurological Disorders and Endocrine Emergencies.

American Association of Critical-Care Nurses (AACN). (2024). CCRN Exam Handbook. Retrieved from AACN CCRN Exam Handbook

Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online. AACN


Question 5

In septic shock, a mixed venous O2 saturation (SO2) of 84% indicates that



Answer : D

A high mixed venous O2 saturation (SO2) indicates that the tissue cells are not extracting enough oxygen from the blood, which can be due to impaired cellular metabolism or increased oxygen delivery. In septic shock, there is often a mismatch between oxygen delivery and consumption, resulting in a high SO2 despite tissue hypoxia. Therefore, SO2 alone is not a reliable indicator of tissue perfusion in septic shock.


Mixed venous oxygen saturation (SvO2) monitoring * LITFL * CCC

SvO2 to monitor resuscitation of septic patients: let's just understand the basic physiology | Critical Care | Full Text

Reference Guide for CCRN (Adult), page 14.

Question 6

A patient who is confused and dyspneic is admitted with ABG values that reveal hypoxemi

a. Results from insertion of a pulmonary artery catheter are:

PAP 38/18 mm Hg

PAOP 10 mm Hg

CI 3.5 L/min/m2

These values are most indicative of



Answer : C

The patient's ABG values show hypoxemia, which is a low level of oxygen in the blood. This can be caused by various pulmonary disorders that impair gas exchange, such as pneumonia, pulmonary edema, pulmonary embolism, or acute respiratory distress syndrome (ARDS). The patient's PAP (pulmonary artery pressure) is elevated, indicating increased resistance in the pulmonary circulation. This can also result from pulmonary dysfunction, as the lungs become stiff and inflamed, or from pulmonary hypertension, which is a chronic condition that affects the small arteries in the lungs. The patient's PAOP (pulmonary artery occlusion pressure) is normal, suggesting that the left ventricle is not failing and that the patient is not hypovolemic or hypervolemic. The patient's CI (cardiac index) is also normal, indicating adequate cardiac output. Therefore, the most likely cause of the patient's hypoxemia and dyspnea is pulmonary dysfunction.


AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.

AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.

Question 7

Which of the following is a sign of brain death?



Answer : B

A negative apnea test means that the patient does not breathe spontaneously when disconnected from the ventilator and exposed to a high level of carbon dioxide, which normally stimulates breathing. A negative apnea test is one of the criteria for brain death, as it indicates the loss of brainstem function. A positive vestibulo-ocular reflex, also known as the oculocephalic or doll's eye reflex, means that the eyes move in the opposite direction of the head when the head is turned. A positive cough reflex means that the patient coughs when the trachea is stimulated. A negative cold caloric test means that the eyes do not move when cold water is injected into the ear canal. All these tests assess the integrity of the brainstem, and a positive result would exclude brain death. Therefore, the correct answer is B.


Diagnosis of brain death - UpToDate, under ''Apnea testing''.

Brain Death | Critical Care Medicine | JAMA | JAMA Network, under ''How Is Brain Death Diagnosed?''.

The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by ..., under ''Apnea Testing''.

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Total 150 questions