CCRN Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

diltiazem: An AV nodal blocker; blocking the node sends more impulses down the accessory pathway and can trigger VF.

procainamide: Correct. An irregular, very fast wide-complex rhythm with varying QRS width in WPW is pre-excited atrial fibrillation. In a stable patient, a drug that slows accessory-pathway conduction (such as procainamide) is used. AV nodal blockers are avoided, and synchronized cardioversion is used if the patient becomes unstable.

digoxin: Slows the AV node and may shorten the accessory pathway refractory period; contraindicated in pre-excited AF.

adenosine: Also blocks the AV node and can speed conduction over the accessory pathway; it is not used for an irregular wide-complex rhythm.

WPW with AF: avoid AV nodal blockers (adenosine, beta-blockers, diltiazem, verapamil, digoxin). Use procainamide or ibutilide if stable, and cardioversion if unstable.

Answer: A

cardiac tamponade: Correct. Chest tube drainage that suddenly stops after heavy bleeding suggests clotted tubes. Add hypotension with a narrow pulse pressure, tachycardia, a low CI, and CVP, PA diastolic and PAOP that have equalized near 19–20 mm Hg. Blood is collecting around the heart and compressing all chambers. Notify the surgeon at once and prepare for reexploration.

left ventricular failure: This raises the PAOP but does not raise the CVP to the same level. It also does not explain chest tube drainage that suddenly stopped.

acute right ventricular infarction: This raises the CVP while the PAOP stays normal or low. It does not equalize the pressures.

hypovolemia from surgical bleeding: Bleeding would lower the CVP and PAOP. Here the filling pressures are high.

After cardiac surgery, chest tube output that suddenly drops, with rising and equalizing CVP, PAD and PAOP and falling CO, is tamponade until proven otherwise.

Answer: D

worsening pulmonary edema reducing compliance: Reduced compliance raises both peak and plateau pressures; plateau here is unchanged.

an endotracheal tube cuff leak: A cuff leak causes low-pressure and low exhaled-volume alarms, not high pressure.

a right-sided pneumothorax: A pneumothorax lowers compliance, raising the plateau pressure with the peak.

secretions increasing airway resistance: Correct. Peak pressure rose 17 cm H2O while plateau pressure is unchanged, so the problem is airway resistance (secretions, biting, kinking, bronchospasm), not the lungs. With coughing and a falling SpO2, suctioning is the next step.

High peak with a normal plateau pressure is a resistance problem; when both rise, compliance has fallen (edema, ARDS, pneumothorax, right mainstem).

Answer: C

1. P/F ratio = PaO2 ÷ FiO2 (as a decimal).
2. 60 ÷ 0.60 = 100.
3. P/F ≤100 on PEEP ≥5 cm H2O = severe ARDS (Berlin definition).
4. Severe ARDS with P/F <150 on FiO2 ≥0.6 → anticipate early prone positioning.

Increase the respiratory rate to normalize the PaCO2 of 52.: Treats the ABG number, not the hypoxemia; a pH of 7.31 is acceptable permissive hypercapnia, and a higher rate risks auto-PEEP.

Reduce PEEP to 8 cm H2O to limit barotrauma.: Lowering PEEP derecruits alveoli and worsens shunt in severe hypoxemia; plateau pressure is acceptable.

Place the patient prone for at least 16 hours per day.: Correct. A P/F ratio of 60 ÷ 0.60 = 100 on PEEP 14 is severe ARDS. Early prolonged prone positioning (P/F <150 on FiO2 ≥0.6) improves V/Q matching and lowers mortality, and the plateau pressure is already at the 30 cm H2O ceiling.

Begin inhaled nitric oxide to improve oxygenation.: Inhaled nitric oxide may transiently raise PaO2 but does not lower mortality; it is a rescue measure, not the next step before proning.

Calculate the P/F ratio: under 150 on high FiO2 and PEEP in ARDS calls for early prone positioning of at least 16 hours daily, while continuing low tidal volumes.

Answer: B

1. Abdominal perfusion pressure (APP) = MAP − IAP.
2. APP = 72 − 27 = 45 mm Hg.
3. An APP below about 60 mm Hg with IAP above 20 mm Hg and new organ dysfunction (oliguria, high airway pressures) defines abdominal compartment syndrome.
4. Sustained IAP above 25 mm Hg with organ failure calls for surgical decompression.

Give a 1-liter crystalloid bolus to improve urine output.: More fluid increases bowel and abdominal wall edema and raises IAP further.

Prepare the patient for decompressive laparotomy.: Correct. IAP 27 mm Hg gives an APP of 45 mm Hg, and the patient has new oliguria and rising airway pressures: abdominal compartment syndrome. Pressure of this degree with organ dysfunction requires surgical decompression.

Increase PEEP to offset the rising airway pressures.: Treats the ventilator numbers; added PEEP raises intrathoracic pressure and does not relieve the abdomen.

Insert a nasogastric tube to suction and recheck IAP in 4 hours.: Gastric decompression helps lower grades of intra-abdominal hypertension, but grade IV pressure with organ failure needs surgery now.

APP = MAP − IAP (goal at least 60 mm Hg). IAP above 20 mm Hg with new organ failure is abdominal compartment syndrome; severe cases need decompressive laparotomy.

Answer: A

transfusion-related acute lung injury: Correct. Hypoxemia with bilateral infiltrates within 6 hours of a plasma-rich product, with fever, hypotension, low CVP and a normal BNP, points to noncardiogenic pulmonary edema: TRALI.

transfusion-associated circulatory overload: TACO produces hypertension, high filling pressures, JVD and an elevated BNP; this patient has low CVP and hypotension.

acute hemolytic transfusion reaction: Fever and hypotension fit, but the decisive picture is acute lung injury rather than hemolysis (flank pain, hemoglobinuria, DIC), and plasma carries few red cells.

anaphylactic transfusion reaction: Anaphylaxis causes bronchospasm, urticaria and angioedema, usually without fever or bilateral infiltrates.

TRALI and TACO both cause pulmonary edema after transfusion. TRALI: hypotension, fever, normal filling pressures and BNP. TACO: hypertension, volume overload and a high BNP.

Answer: B

Start the insulin infusion and recheck potassium in 4 hours.: Insulin at this potassium level will push K lower still; a 4-hour recheck is too late to catch it.

Hold the insulin and begin IV potassium replacement.: Correct. Insulin drives potassium into the cells. Starting it with K 3.1 mEq/L can cause life-threatening hypokalemia and dysrhythmias. The ADA hyperglycemic-crisis guidance is to delay insulin and replace potassium until K is at least 3.5 mEq/L, while fluids continue.

Give sodium bicarbonate to correct the acidosis.: Bicarbonate is not indicated at pH 7.14 and shifts potassium into cells, worsening hypokalemia.

Change the fluid to dextrose 5% in 0.45% sodium chloride.: Dextrose is added when glucose falls to about 250 mg/dL, not at 612 mg/dL.

In DKA, total-body potassium is depleted even when the serum level looks normal. If K is below 3.5 mEq/L, replace it before starting insulin.

Answer: C

sepsis from ventilator-associated pneumonia: Fits the fever and tachycardia, but the episodes are brief and triggered, and cultures are negative.

nonconvulsive status epilepticus: Continuous EEG shows no seizure activity.

paroxysmal sympathetic hyperactivity: Correct. Repeated, stimulus-triggered episodes of tachycardia, hypertension, hyperthermia, sweating and posturing after a severe diffuse brain injury, with infection and seizures ruled out, are paroxysmal sympathetic hyperactivity (neurological storming). Management includes reducing triggers and drugs such as opioids, propranolol or gabapentin.

neuroleptic malignant syndrome: Needs exposure to a dopamine antagonist and causes sustained rigidity and fever, not brief triggered episodes.

Episodic, trigger-related sympathetic surges with posturing after severe TBI, once infection and seizures are excluded, are neurological storming (PSH).

Answer: A

delayed cerebral ischemia from vasospasm: Correct. Vasospasm peaks about days 4–14 after aneurysmal SAH. A new focal deficit with reduced alertness, plus a sharp rise in left MCA velocity on Doppler, points to vasospasm causing delayed cerebral ischemia. The provider will likely order CT angiography and consider induced hypertension or endovascular treatment.

hyponatremia from SIADH: A sodium of 133 is only mildly low and would not explain a focal right-sided deficit.

acute obstructive hydrocephalus: Causes a global decline in consciousness, not a new lateralized deficit with high MCA velocities.

rebleeding of the coiled aneurysm: Rebleeding is most likely in the first 24 hours of an unsecured aneurysm and presents with a sudden severe headache; this aneurysm is coiled.

A new focal deficit or drop in consciousness on days 4–14 after SAH is vasospasm with delayed cerebral ischemia until proven otherwise.

Answer: A

Give IV labetalol and recheck the BP before the thrombolytic.: Correct. Before IV thrombolysis the BP must be below 185/110 mm Hg; a BP of 196/106 is a correctable barrier. Lowering it with IV labetalol or nicardipine, then confirming it, allows treatment. After the drug, keep BP below 180/105 mm Hg for 24 hours.

Withhold antihypertensives to preserve perfusion of the penumbra.: Permissive hypertension (up to 220/120) applies only to patients not receiving reperfusion therapy.

Start the thrombolytic now, because BP will fall with reperfusion.: Treating above 185/110 raises the risk of symptomatic intracranial hemorrhage.

Cancel thrombolysis, because the BP exceeds the eligibility limit.: Elevated BP is not an exclusion if it can be lowered safely; cancelling denies time-sensitive treatment.

For thrombolysis, lower BP below 185/110 before the drug and keep it below 180/105 for 24 hours afterward; permissive hypertension is only for patients not treated.

Answer: B

acetaminophen: Treats the fever, not the hypermetabolic muscle crisis; antipyretics do not work on this heat source.

dantrolene: Correct — rigidity, a rapidly rising ETCO2, tachycardia and hyperthermia soon after succinylcholine indicate malignant hyperthermia. Dantrolene stops the uncontrolled calcium release from the sarcoplasmic reticulum and is the specific treatment.

bromocriptine: Used for neuroleptic malignant syndrome, which develops over days after antipsychotics, not minutes after succinylcholine.

cyproheptadine: Used for serotonin syndrome, which follows serotonergic drugs and causes clonus rather than this anesthetic reaction.

A sudden rise in ETCO2 with rigidity and hyperthermia after succinylcholine or a volatile anesthetic is malignant hyperthermia; give dantrolene.

Answer: A

Administer broad-spectrum antibiotics and begin a 30 mL/kg crystalloid bolus.: Correct — hypotension, a lactate of 4.6 mmol/L and a suspected urinary source define septic shock. With cultures drawn, antibiotics should not be delayed, and hypotension or lactate ≥4 mmol/L calls for 30 mL/kg of crystalloid.

Insert a central venous catheter and measure CVP before giving fluids.: Delays resuscitation; initial crystalloid is given through peripheral access and does not wait for a CVP.

Obtain a urine culture and wait for sensitivities before choosing an antibiotic regimen.: A urine culture is appropriate, but waiting for sensitivities delays antibiotics, which increases mortality in septic shock.

Give acetaminophen for the fever and apply a cooling blanket to lower the temperature.: Treats the fever, not the infection or the hypoperfusion.

In suspected septic shock, draw cultures without delaying antibiotics and give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Answer: C

1. Winter's formula: expected PaCO2 = (1.5 × HCO3) + 8 ± 2.
2. 1.5 × 12 = 18; 18 + 8 = 26, so the expected range is 24–28 mm Hg.
3. Measured PaCO2 = 40, which is higher than expected → concurrent respiratory acidosis.

metabolic acidosis with appropriate respiratory compensation: A "normal" PaCO2 of 40 is not compensation; compensation would lower it to about 26.

primary respiratory acidosis with metabolic compensation: Compensation for respiratory acidosis raises HCO3; here HCO3 is very low.

metabolic acidosis with concurrent respiratory acidosis: Correct. Expected PaCO2 = 1.5 × 12 + 8 = 26 ± 2 (24–28 mm Hg). A measured PaCO2 of 40 is far above that, so ventilation is inadequate (opioid-related hypoventilation). The result is a superimposed respiratory acidosis and a dangerously low pH.

metabolic acidosis with concurrent respiratory alkalosis: The direction is wrong: respiratory alkalosis would push PaCO2 below 24.

In metabolic acidosis, apply Winter's formula: a PaCO2 above the expected range is a second, respiratory acidosis needing ventilatory support.

Answer: C

Ask the adult child to help persuade the patient to accept blood.: Uses family pressure against a capable patient's informed, faith-based decision.

Plan to transfuse if the patient loses consciousness later.: An informed refusal stays valid if the patient later loses capacity. Transfusing would violate it.

Clarify which products the patient accepts and inform the team.: Correct. A capable adult may refuse transfusion. Individual Witnesses differ in what they accept, for example certain blood fractions or cell salvage. The nurse clarifies this patient's own choices, makes sure the refusal is informed and documented, and shares them with the team so it can plan blood-conservation care.

Ask the hospital attorney to seek a court order for transfusion.: Not appropriate for the informed refusal of a capable adult.

Respond to diversity by learning the individual patient's beliefs and choices, not assumptions about the group, and plan care within them. A capable adult's informed refusal is honored.

Answer: A

Raise the discrepancy with the attending and request a joint meeting.: Correct. The family is making decisions on information that conflicts with the documented neurological findings. Moral agency means acting on that concern: the nurse raises it directly with the attending and asks for a meeting with the attending and neurologist together, so the family hears one consistent, honest message.

Reassure the spouse that the attending knows the case best.: Dismisses the family's question and ignores a discrepancy that affects their decisions. This is a failure of moral agency.

Tell the spouse that the neurologist expects a poor outcome.: Delivering a prognosis the team has not reconciled goes beyond the nurse's role and leaves the family with two conflicting messages.

Suggest that the family ask for a transfer to obtain a second opinion.: Signals distrust of the team and burdens the family with a transfer instead of resolving the inconsistency at its source.

When the information a family receives conflicts with the clinical record, the nurse raises the concern with the provider and arranges a unified team discussion. The nurse neither stays silent nor delivers the prognosis alone.

Answer: C

Proceed with the tracheostomy until the whole family reaches agreement.: Treats the sister's wish as decisive and imposes treatment the patient reportedly would not want.

Tell the sister she has no role in decisions and limit her visits.: Dismissive; family members who are not decision-makers still deserve support and inclusion.

Support the spouse's decision and arrange a team family meeting.: Correct — the designated agent speaks for the patient using substituted judgment, based on the patient's known values. A family meeting with the team shares prognosis, explains the agent's role and helps the sister be heard.

Delay all decisions about treatment until the patient regains capacity.: Recovery of capacity is unlikely with this prognosis, and delay prolongs treatment the patient may not want.

When a patient lacks capacity, the designated surrogate decides using the patient's known wishes; the nurse supports that process and the whole family.