A 58-year-old patient with ST-segment elevation in leads II, III, and aVF receives one sublingual nitroglycerin tablet. Blood pressure falls from 118/72 to 76/44 mmHg. Jugular veins are distended and breath sounds are clear bilaterally. Which intervention should the nurse anticipate?

Infuse a 0.9% sodium chloride bolus and obtain a right-sided ECG

Start a nitroglycerin infusion titrated to chest pain

Give morphine IV and repeat the sublingual nitroglycerin

Fifteen minutes into a spontaneous breathing trial, a patient has a respiratory rate of 38/min, a tidal volume of 220 mL, accessory muscle use, and diaphoresis. What should the nurse do?

Return the patient to the previous ventilator settings and look for the cause of failure

Continue the trial for the full 120 minutes

Extubate, because the trial has lasted longer than 5 minutes

Administer a sedative and continue the trial

On hospital day 3, a patient with severe acute pancreatitis is hemodynamically stable with controlled pain and active bowel sounds. Which nutrition plan should the nurse advocate?

Begin enteral nutrition as tolerated

Keep the patient NPO until the lipase is normal

Offer only clear liquids until the patient has been pain free for 48 hours

Start parenteral nutrition through a central line

A ventilated patient receiving a lorazepam infusion is withdrawn, does not follow commands consistently, and is positive on the CAM-ICU. Which change should the nurse recommend?

Stop the benzodiazepine infusion and target light sedation with a non-benzodiazepine agent

Apply wrist restraints to prevent self-extubation

Add scheduled haloperidol to shorten the delirium

Increase the lorazepam infusion to promote rest

A charge nurse is making assignments. One patient is hemodynamically unstable on three vasoactive infusions and continuous renal replacement therapy, with a family in conflict about the plan of care. Which assignment best reflects the AACN Synergy Model?

Assign the nurse whose competencies match the patient's low stability and high complexity

Assign the newest nurse to build experience

Assign by rotation so that workload is equal

Assign the nurse who cared for the patient yesterday, regardless of the other assignments

A patient arrives at a hospital without a catheterization laboratory 70 minutes after the onset of chest pain. The ECG shows ST-segment elevation in leads V1 to V4. Transfer for primary percutaneous coronary intervention will take at least 150 minutes, and the patient has no bleeding risks. Which plan is indicated?

Give fibrinolytic therapy within 30 minutes of arrival

Wait for a troponin result before choosing a strategy

Transfer without reperfusion therapy

Start a heparin infusion and repeat the ECG in 6 hours

A patient rescued from a house fire has a headache, confusion, and an SpO₂ of 99% on room air. The carboxyhemoglobin level is 28%. What should the nurse do?

Give 100% oxygen by non-rebreather mask regardless of the pulse oximetry reading

Give oxygen by nasal cannula at 2 L/min

Give sodium bicarbonate to treat the acidosis

Withhold oxygen, because the saturation is normal

A patient with acute pancreatitis is receiving goal-directed fluid therapy with lactated Ringer's solution. Which finding indicates that resuscitation is adequate?

Urine output of 0.7 mL/kg/hr with a falling BUN and hematocrit

Hematocrit rising from 44% to 49%

A patient is admitted to the ICU after an intentional overdose and is now medically stable and awake. Which nursing intervention has priority?

Continuous one-to-one observation and removal of potentially harmful items from the room

Soft wrist restraints until a psychiatric evaluation

A verbal agreement that the patient will not self-harm

Checks every 30 minutes with the door closed

CCRN (Adult)

Free CCRN Practice Questions

10 sample questions for the CCRN (Adult), with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Clinical Judgment, Professional Caring and Ethical Practice.

Question 1 · Clinical Judgment
A 58-year-old patient with ST-segment elevation in leads II, III, and aVF receives one sublingual nitroglycerin tablet. Blood pressure falls from 118/72 to 76/44 mmHg. Jugular veins are distended and breath sounds are clear bilaterally. Which intervention should the nurse anticipate?
- A.Administer furosemide 40 mg IV
- B.Start a nitroglycerin infusion titrated to chest pain
- C.Infuse a 0.9% sodium chloride bolus and obtain a right-sided ECG
- D.Give morphine IV and repeat the sublingual nitroglycerin
Show answer and explanation
Answer: C. Infuse a 0.9% sodium chloride bolus and obtain a right-sided ECG
Hypotension after a nitrate, jugular venous distention, and clear lungs with an inferior infarction point to right ventricular involvement. The right ventricle is preload dependent, so volume is given and nitrates, diuretics, and morphine are avoided. ST elevation in lead V4R on a right-sided ECG confirms the diagnosis.
Question 2 · Clinical Judgment
Fifteen minutes into a spontaneous breathing trial, a patient has a respiratory rate of 38/min, a tidal volume of 220 mL, accessory muscle use, and diaphoresis. What should the nurse do?
- A.Continue the trial for the full 120 minutes
- B.Extubate, because the trial has lasted longer than 5 minutes
- C.Administer a sedative and continue the trial
- D.Return the patient to the previous ventilator settings and look for the cause of failure
Show answer and explanation
Answer: D. Return the patient to the previous ventilator settings and look for the cause of failure
The rapid shallow breathing index is 38 divided by 0.22 L, or about 173, which is well above the threshold of 105, and the patient shows distress. The trial has failed. The patient is rested on full support while reversible causes are addressed, and another trial is attempted the next day.
Question 3 · Clinical Judgment
On hospital day 3, a patient with severe acute pancreatitis is hemodynamically stable with controlled pain and active bowel sounds. Which nutrition plan should the nurse advocate?
- A.Keep the patient NPO until the lipase is normal
- B.Offer only clear liquids until the patient has been pain free for 48 hours
- C.Start parenteral nutrition through a central line
- D.Begin enteral nutrition as tolerated
Show answer and explanation
Answer: D. Begin enteral nutrition as tolerated
Early enteral feeding maintains the gut barrier and lowers infection, organ failure, and mortality compared with parenteral nutrition. Gastric or jejunal routes are both acceptable. Feeding does not wait for enzyme levels to normalize.
Question 4 · Clinical Judgment
A ventilated patient receiving a lorazepam infusion is withdrawn, does not follow commands consistently, and is positive on the CAM-ICU. Which change should the nurse recommend?
- A.Apply wrist restraints to prevent self-extubation
- B.Add scheduled haloperidol to shorten the delirium
- C.Stop the benzodiazepine infusion and target light sedation with a non-benzodiazepine agent
- D.Increase the lorazepam infusion to promote rest
Show answer and explanation
Answer: C. Stop the benzodiazepine infusion and target light sedation with a non-benzodiazepine agent
The patient has hypoactive delirium, and benzodiazepines are a major modifiable risk factor. Guidelines favor propofol or dexmedetomidine with light sedation targets, daily awakening, and early mobility. Antipsychotics do not shorten delirium, and restraints increase agitation.
Question 5 · Professional Caring and Ethical Practice
A charge nurse is making assignments. One patient is hemodynamically unstable on three vasoactive infusions and continuous renal replacement therapy, with a family in conflict about the plan of care. Which assignment best reflects the AACN Synergy Model?
- A.Assign the newest nurse to build experience
- B.Assign by rotation so that workload is equal
- C.Assign the nurse who cared for the patient yesterday, regardless of the other assignments
- D.Assign the nurse whose competencies match the patient's low stability and high complexity
Show answer and explanation
Answer: D. Assign the nurse whose competencies match the patient's low stability and high complexity
The Synergy Model holds that outcomes are best when nurse competencies match patient characteristics. An unstable, complex, vulnerable patient needs a nurse with advanced clinical judgment and collaboration skills.
Question 6 · Clinical Judgment
A patient arrives at a hospital without a catheterization laboratory 70 minutes after the onset of chest pain. The ECG shows ST-segment elevation in leads V1 to V4. Transfer for primary percutaneous coronary intervention will take at least 150 minutes, and the patient has no bleeding risks. Which plan is indicated?
- A.Wait for a troponin result before choosing a strategy
- B.Transfer without reperfusion therapy
- C.Give fibrinolytic therapy within 30 minutes of arrival
- D.Start a heparin infusion and repeat the ECG in 6 hours
Show answer and explanation
Answer: C. Give fibrinolytic therapy within 30 minutes of arrival
When primary percutaneous coronary intervention cannot be delivered within 120 minutes of first medical contact, fibrinolysis is given, with a door-to-needle goal of 30 minutes. The patient is then transferred for angiography. Treatment is based on the ECG and does not wait for biomarkers.
Question 7 · Clinical Judgment
A patient rescued from a house fire has a headache, confusion, and an SpO₂ of 99% on room air. The carboxyhemoglobin level is 28%. What should the nurse do?
- A.Give 100% oxygen by non-rebreather mask regardless of the pulse oximetry reading
- B.Give oxygen by nasal cannula at 2 L/min
- C.Give sodium bicarbonate to treat the acidosis
- D.Withhold oxygen, because the saturation is normal
Show answer and explanation
Answer: A. Give 100% oxygen by non-rebreather mask regardless of the pulse oximetry reading
A standard pulse oximeter reads carboxyhemoglobin as oxyhemoglobin, so the displayed saturation is falsely normal. High-concentration oxygen shortens the half-life of carboxyhemoglobin from several hours to about 1 hour. Hyperbaric oxygen is considered for severe poisoning.
Question 8 · Clinical Judgment
A patient with acute pancreatitis is receiving goal-directed fluid therapy with lactated Ringer's solution. Which finding indicates that resuscitation is adequate?
- A.Hematocrit rising from 44% to 49%
- B.Serum lipase reduced by half
- C.Heart rate of 124/min
- D.Urine output of 0.7 mL/kg/hr with a falling BUN and hematocrit
Show answer and explanation
Answer: D. Urine output of 0.7 mL/kg/hr with a falling BUN and hematocrit
Adequate resuscitation is judged by perfusion: urine output above 0.5 mL/kg/hr, a falling BUN, and a falling hematocrit as hemoconcentration resolves. Lipase does not track severity or volume status. Excess fluid causes respiratory failure and abdominal compartment syndrome.
Question 9 · Clinical Judgment
A patient is admitted to the ICU after an intentional overdose and is now medically stable and awake. Which nursing intervention has priority?
- A.Soft wrist restraints until a psychiatric evaluation
- B.A verbal agreement that the patient will not self-harm
- C.Checks every 30 minutes with the door closed
- D.Continuous one-to-one observation and removal of potentially harmful items from the room
Show answer and explanation
Answer: D. Continuous one-to-one observation and removal of potentially harmful items from the room
A patient at risk of suicide needs constant observation and an environment free of ligature and sharp hazards until a psychiatric evaluation is complete. Verbal agreements do not prevent self-harm, and restraints are not a substitute for observation.
Question 10 · Professional Caring and Ethical Practice
A nurse questions the unit practice of instilling saline before suctioning, reviews the literature, and presents a proposal to the practice council. Which nurse competency of the Synergy Model does this show?
- A.Response to diversity
- B.Advocacy and moral agency
- C.Caring practices
- D.Clinical inquiry
Show answer and explanation
Answer: D. Clinical inquiry
Clinical inquiry is the ongoing process of questioning and evaluating practice and bringing change through evidence. Caring practices create a compassionate environment, response to diversity recognizes individual differences, and advocacy means acting on behalf of the patient.

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