Free CCRN Practice Test: 125 Adult Questions With Full Rationales

Correct answer: A. Synchronized cardioversion

The rhythm is causing hypotension and a change in mental status, so this patient is unstable. AHA's 2025 adult guidelines recommend synchronized cardioversion for hemodynamically unstable narrow-complex tachycardia. Synchronizing times the shock to the QRS complex, which is possible because this rhythm is organized.

Why the other choices don't fit

• B. IV diltiazem — Diltiazem belongs to the stable pathway. It also commonly causes hypotension, which this patient cannot afford.
• C. Unsynchronized defibrillation — Unsynchronized shocks are for pulseless VF/VT and sustained polymorphic VT. This organized narrow-complex tachycardia with a pulse should be cardioverted with synchronization.
• D. Vagal maneuvers, then reassess before any electrical therapy — Vagal maneuvers are a first step for stable patients. Here they would delay the treatment the instability calls for.

Takeaway: Unstable narrow-complex tachycardia causing hypotension or altered mental status calls for synchronized cardioversion.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-01
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §17 Regular Narrow-Complex Tachycardia, recommendation 3 and synopsis

Correct answer: A. Replace potassium and hold insulin until potassium is above 3.5 mEq/L

The 2024 hyperglycemic crises consensus report says that when potassium is below 3.5 mmol/L (1 mmol/L = 1 mEq/L for potassium), replacement should start at about 10 mmol/h and insulin should be delayed until potassium rises above 3.5. Insulin drives potassium into cells, and starting it now risks life-threatening arrhythmias and respiratory muscle weakness.

Why the other choices don't fit

• B. Give sodium bicarbonate to correct the acidosis first — In DKA, bicarbonate is considered for severe acidosis with pH below 7.0. It is not routine, and it can worsen hypokalemia.
• C. Give an IV insulin bolus, then replace potassium — Insulin shifts potassium into cells. A bolus before correcting this low potassium does not fix the sequencing problem.
• D. Start insulin at 0.1 units/kg/h and add potassium to the fluids — Starting insulin before potassium is above 3.5 is the danger the consensus warns against.

Takeaway: In DKA, a potassium below 3.5 means potassium first and insulin second.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Diabetic ketoacidosis (DKA) · Question ID: CCRN-A-EHGRI-01
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 4, Potassium; Bicarbonate

Correct answer: B. Tell the team about his stated wish right away, so it can be confirmed with him and documented

AACN's Synergy Model defines advocacy and moral agency as representing the patient's concerns and helping identify and resolve ethical and clinical concerns. A capacitated patient's stated wish must reach the people making the plan before the moment of crisis.

Why the other choices don't fit

• A. Follow the rounds plan and intubate if he worsens — Acting on a plan that may conflict with his own stated wish, without raising it, fails to represent him.
• C. Keep it between the two of them unless he brings it up again — Staying silent doesn't serve the patient when the plan may override him.
• D. Ask his family to decide — He has capacity. His voice comes first.

Takeaway: Advocacy means carrying the patient's own words to the people making the plan.

Content area: Professional Caring & Ethical Practice · Topic: Advocacy/Moral Agency · Question ID: CCRN-A-PCEP-01
Source: AACN CCRN Exam Handbook — Direct Care Eligibility Pathway, Synergy Model nurse characteristics, p. 9: Advocacy/Moral Agency

Correct answer: C. Vasopressors and mechanical ventilation aren't barriers to rehabilitation if the patient is otherwise stable, so mobility can proceed per protocol

The 2018 PADIS guideline states that vasoactive infusions or mechanical ventilation are not barriers to starting rehabilitation or mobilization, assuming the patient is otherwise stable on those therapies.

Why the other choices don't fit

• A. Keep the patient on bed rest until ICU discharge — Prolonged immobility adds to deconditioning.
• B. Delay all mobility until every vasoactive drip is off — This treats a stable infusion as an automatic barrier, which PADIS says it isn't.
• D. Delay mobility until the patient is extubated — Mechanical ventilation alone isn't a barrier to mobilization.

Takeaway: A stable patient on a ventilator or a pressor can still mobilize.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Muscular deconditioning (TNA: early mobility) · Question ID: CCRN-A-MNBP-01
Source: SCCM, 2018 PADIS recommendations, Rehabilitation/mobilization statement

Correct answer: A. Norepinephrine

SSC recommends norepinephrine as the first-line vasopressor in septic shock, over dopamine, epinephrine, or selepressin, and suggests it over vasopressin or angiotensin II.

Why the other choices don't fit

• B. Angiotensin II — SSC suggests norepinephrine over angiotensin II as the first-line agent.
• C. Vasopressin as the first agent — Vasopressin is suggested as an add-on when norepinephrine requirements escalate, not as first-line.
• D. Dopamine — SSC recommends norepinephrine over dopamine, with high certainty of evidence.

Takeaway: Norepinephrine is the first vasopressor in septic shock.

Content area: Multisystem · Topic: Shock states (septic shock) · Question ID: CCRN-A-MULTI-01
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Vasopressor recommendations

Correct answer: D. 330 mL

Low tidal volume ventilation is dosed by predicted body weight, not actual weight: 6 mL/kg × 55 kg = 330 mL. The Surviving Sepsis Campaign strongly recommends 6 mL/kg over high tidal volumes for sepsis-associated ARDS.

Why the other choices don't fit

• A. 440 mL — This is 8 mL/kg of predicted body weight.
• B. 552 mL — This uses actual weight (6 × 92). Dosing by actual weight overdistends the lungs.
• C. 385 mL — This is 7 mL/kg of predicted body weight, not the ordered 6 mL/kg.

Takeaway: Dose tidal volume by predicted body weight, never actual weight.

Content area: Respiratory · Topic: Acute respiratory distress syndrome (ARDS) · Question ID: CCRN-A-RESP-01
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mechanical ventilation: low tidal volume in sepsis-associated ARDS

Correct answer: A. Add 5–10% dextrose to the fluids, lower insulin to 0.05 units/kg/h, and continue until DKA resolves

Glucose usually falls below 250 mg/dL before ketoacidosis clears. The consensus says to add 5–10% dextrose at that point and reduce the insulin rate to 0.05 units/kg/h. Insulin then continues, with glucose kept near 200 mg/dL, until DKA resolves.

Why the other choices don't fit

• B. Stop the insulin infusion because glucose is under 250 — Stopping insulin lets ketone production resume while the patient is still acidotic.
• C. Switch to subcutaneous insulin now — The patient doesn't meet resolution criteria yet.
• D. Leave both fluids and insulin unchanged — Without dextrose, continuing full-rate insulin risks hypoglycemia, a common complication of DKA treatment.

Takeaway: In DKA, glucose falls first and ketones clear last. Add dextrose and keep the insulin going.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Diabetic ketoacidosis (DKA) · Question ID: CCRN-A-EHGRI-02
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 4, Fluid therapy and Insulin; Table 3 hypoglycaemia mitigation

Correct answer: A. Connect her with the hospital's process or resources so she can complete one before discharge

SSC includes a good-practice statement that health systems should ensure patients discharged after sepsis or septic shock have the opportunity to execute advance directives. The nurse's role is to make that opportunity real.

Why the other choices don't fit

• B. Explain that advance directives are only for terminal illness — Advance directives aren't limited to terminal illness.
• C. Complete the form without confirming that it reflects her choices — Assistance may help, but the directive must reflect the patient's own choices and follow the proper process.
• D. Tell her to handle it with her primary care provider someday — That passes up the opportunity the good-practice statement asks systems to provide.

Takeaway: Discharge after sepsis is a moment to make an advance directive possible.

Content area: Professional Caring & Ethical Practice · Topic: Advocacy/Moral Agency · Question ID: CCRN-A-PCEP-02
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Advanced directives good-practice statement

Correct answer: C. Offer physical rehabilitation services after discharge

SSC suggests offering physical rehabilitation after discharge to sepsis survivors who received invasive mechanical ventilation for more than 48 hours. Format and intensity depend on local resources and the patient's needs.

Why the other choices don't fit

• A. Wait 6 months to see whether weakness persists — Nothing in the guidance supports a planned delay.
• B. Skip rehabilitation if the patient can walk to the bathroom — Walking short distances doesn't rule out the physical impairments that often follow sepsis.
• D. Offer rehabilitation only if the patient asks — The suggestion is to offer it, not to wait for a request.

Takeaway: Survivors ventilated for more than 48 hours should be offered rehabilitation after discharge.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Muscular deconditioning · Question ID: CCRN-A-MNBP-02
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Physical rehabilitation recommendation

Correct answer: A. Vasopressin

For septic shock on escalating norepinephrine doses, SSC suggests adding vasopressin (moderate certainty). Epinephrine is suggested if MAP stays inadequate despite both.

Why the other choices don't fit

• B. Switching to dopamine — Dopamine isn't the recommended vasopressor in septic shock.
• C. IV methylene blue — SSC found insufficient evidence to recommend methylene blue for refractory septic shock.
• D. Terlipressin — SSC suggests against terlipressin.

Takeaway: When norepinephrine keeps climbing, add vasopressin.

Content area: Multisystem · Topic: Shock states (septic shock) · Question ID: CCRN-A-MULTI-02
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Vasopressor, methylene blue, and terlipressin recommendations

Correct answer: D. A vagal maneuver, such as a modified Valsalva

The patient is stable. AHA recommends vagal maneuvers for acute treatment of regular narrow-complex tachycardia, and modified techniques improve the termination rate. Adenosine is the usual next step if vagal maneuvers fail.

Why the other choices don't fit

• A. IV amiodarone — Amiodarone is used for wide-complex tachycardia. It isn't the first step for a stable, regular narrow-complex rhythm.
• B. IV procainamide — Procainamide is also a wide-complex tachycardia option. It isn't a first-line therapy here.
• C. Synchronized cardioversion — Cardioversion is for unstable patients, or for stable patients after vagal maneuvers and drugs fail or can't be used.

Takeaway: For stable regular narrow-complex tachycardia, start with vagal maneuvers, then adenosine.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-02
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §17 Regular Narrow-Complex Tachycardia, recommendations 1–2 and supportive text

Correct answer: C. Euglycemic DKA: treat with insulin and dextrose-containing fluids, and stop the SGLT2 inhibitor

The 2024 criteria allow a DKA diagnosis in someone with known diabetes regardless of the glucose value when ketonemia and metabolic acidosis are present. SGLT2 inhibitors are a leading cause of euglycemic DKA. The consensus advises adding 5–10% dextrose alongside the saline from the start, and stopping the SGLT2 inhibitor on admission.

Why the other choices don't fit

• A. Resume the SGLT2 inhibitor as soon as the patient eats — After DKA, restarting an SGLT2 inhibitor is not routinely recommended in type 2 diabetes.
• B. This isn't DKA, because glucose is below 250 mg/dL — The glucose criterion was revised. Known diabetes plus ketonemia and acidosis meets the definition.
• D. Give IV fluids only, because insulin would cause hypoglycemia — Insulin is still required to stop ketogenesis. Dextrose is what prevents hypoglycemia.

Takeaway: Ketones plus acidosis in known diabetes is DKA, even with a normal-ish glucose.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Diabetic ketoacidosis (DKA) · Question ID: CCRN-A-EHGRI-03
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 3 diagnostic criteria; Table 4, SGLT2 inhibitor row

Correct answer: A. The plateau pressure is the value compared with the 30 cm H2O limit, and 27 is within it

SSC recommends keeping plateau pressure at or below 30 cm H2O in sepsis-associated ARDS. Plateau pressure, measured during an inspiratory hold when flow has stopped, reflects alveolar pressure. Peak pressure also includes the pressure needed to push gas through the airways during flow.

Why the other choices don't fit

• B. Both values must be under 25 cm H2O — The recommended upper limit for plateau pressure is 30 cm H2O. There isn't a 25 cm H2O rule for both pressures.
• C. The difference means the patient's lungs are overdistended — The difference between peak and plateau pressure does not establish overdistension. The measured plateau pressure is within the guideline target.
• D. Peak pressure exceeds 30, so tidal volume must be reduced to 4 mL/kg — The limit applies to plateau pressure, which here is within goal.

Takeaway: Judge lung protection by plateau pressure, not peak pressure.

Content area: Respiratory · Topic: Acute respiratory distress syndrome (ARDS) · Question ID: CCRN-A-RESP-02
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mechanical ventilation: plateau pressure upper limit

Correct answer: A. Involve social services to address insulin access before discharge

The 2024 consensus says that for people with poor access to insulin, the social service department should be consulted to address these barriers. It also identifies cost-related rationing as linked to DKA risk.

Why the other choices don't fit

• B. Re-teach insulin injection technique — Technique isn't the barrier she described.
• C. Document 'nonadherence' and discharge on the same regimen — Labeling the problem does not solve the insulin-access barrier.
• D. Tell her to make her insulin last by skipping doses when glucose looks normal — That is rationing, which is the behavior driving DKA.

Takeaway: When cost causes DKA, involve social services.

Content area: Professional Caring & Ethical Practice · Topic: Advocacy/Moral Agency · Question ID: CCRN-A-PCEP-03
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 7, Prevention; Section 8, insulin rationing

Correct answer: A. Question the order, because prolonged prophylactic hyperventilation to PaCO2 of 25 mm Hg or less isn't recommended

The Brain Trauma Foundation's 4th edition does not recommend prolonged prophylactic hyperventilation to a PaCO2 of 25 mm Hg or less. Hyperventilation lowers ICP by constricting cerebral vessels, which also cuts cerebral blood flow.

Why the other choices don't fit

• B. Hyperventilate only during the first 24 hours — BTF specifically says to avoid hyperventilation in the first 24 hours after injury, when cerebral blood flow is often critically reduced.
• C. Carry out the order but check PaCO2 only once a day — Monitoring doesn't make an unsupported strategy appropriate.
• D. Carry out the order, because it prevents secondary injury — The recommendation is against exactly this preventive use.

Takeaway: Don't use hyperventilation as prophylaxis in TBI.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Traumatic brain injury · Question ID: CCRN-A-MNBP-03
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, §5 Ventilation Therapies: Level IIB prolonged-prophylactic-hyperventilation recommendation; temporizing ICP advice is explicitly restated from the prior edition, not a newly graded fourth-edition recommendation

Correct answer: D. 60–65 mm Hg

SSC recommends an initial MAP target of 65 mm Hg for adults with septic shock, practically managed as a range within about 5 mm Hg. For patients 65 or older, it suggests an initial MAP range of 60–65 mm Hg over higher ranges.

Why the other choices don't fit

• A. 65–75 mm Hg — For patients 65 or older, SSC suggests 60–65 mm Hg over higher ranges.
• B. 75–85 mm Hg — Higher targets aren't recommended over 65 mm Hg, and for older adults the suggested range is lower still.
• C. 85 mm Hg or higher — Higher MAP targets carry more vasopressor exposure without an established benefit.

Takeaway: In septic shock, target a MAP of 65, or 60–65 for patients 65 and older.

Content area: Multisystem · Topic: Sepsis · Question ID: CCRN-A-MULTI-03
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mean arterial pressure recommendations

Correct answer: D. Beta-hydroxybutyrate 0.4 mmol/L, venous pH 7.34, bicarbonate 19 mEq/L

Resolution is defined as plasma ketones below 0.6 mmol/L plus a venous pH of 7.3 or higher or a bicarbonate of 18 or higher. Only this set meets both parts.

Why the other choices don't fit

• A. Anion gap 10, with beta-hydroxybutyrate 1.8 mmol/L — The anion gap isn't a resolution criterion, and ketones are still too high.
• B. Glucose 140 mg/dL, with bicarbonate 14 mEq/L — Normal glucose doesn't mean resolution. The bicarbonate is still below 18.
• C. Urine ketones negative, with pH 7.24 — The consensus says not to use urine ketones for resolution, and the pH is still below 7.3.

Takeaway: DKA resolves when blood ketones are below 0.6 and pH is 7.3 or higher (or bicarbonate 18 or higher). Glucose and anion gap don't decide it.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Diabetic ketoacidosis (DKA) · Question ID: CCRN-A-EHGRI-04
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 4, Criteria for resolution of DKA and HHS

Correct answer: D. Ask the team to hold a goals-of-care and prognosis discussion early, within the first 72 hours

SSC includes a good-practice statement that clinicians should discuss goals of care and prognosis with patients or families, and suggests addressing goals of care early (within 72 hours) rather than later.

Why the other choices don't fit

• A. Avoid prognosis discussions until the patient can speak for himself — Families often need to be involved when the patient can't participate.
• B. Wait the week, as planned — Waiting goes against the early goals-of-care suggestion.
• C. Tell the family the prognosis yourself before the team meets — Advocacy means making the conversation happen with the team, not replacing it.

Takeaway: Goals-of-care conversations in septic shock belong in the first 72 hours.

Content area: Professional Caring & Ethical Practice · Topic: Advocacy/Moral Agency · Question ID: CCRN-A-PCEP-04
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Goals of care good-practice statement and recommendation

Correct answer: B. Brief hyperventilation may be used as a temporizing measure, with brain oxygenation monitoring (SjO2 or PbtO2) if available

BTF restates that hyperventilation is recommended as a temporizing measure to reduce elevated ICP, should be avoided in the first 24 hours, and, if used, should be monitored with jugular venous (SjO2) or brain tissue (PbtO2) oxygen measurements.

Why the other choices don't fit

• A. Hyperventilation works best in the first 6 hours after injury — BTF advises avoiding it during the first 24 hours.
• C. Keep PaCO2 at 22 mm Hg for 48 hours — That is the prolonged, deep hyperventilation that risks ischemia.
• D. Hyperventilation is prohibited at all times after TBI — BTF allows it as a short-term bridge. What it rejects is prolonged prophylactic use.

Takeaway: Hyperventilation in TBI is a bridge, not a plan, and it's monitored when used.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Traumatic brain injury · Question ID: CCRN-A-MNBP-04
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, §5 Ventilation Therapies: Level IIB prolonged-prophylactic-hyperventilation recommendation; temporizing ICP advice is explicitly restated from the prior edition, not a newly graded fourth-edition recommendation

Correct answer: C. Adenosine 6 mg rapid IV push

Adenosine can cause severe bronchospasm in patients with asthma. AHA's 2025 guidance calls it contraindicated in that situation, and this patient's asthma history is severe.

Why the other choices don't fit

• A. A 12-lead ECG — A 12-lead ECG documents the rhythm and helps identify it. There's nothing to question.
• B. IV diltiazem infused slowly — For a stable, regular narrow-complex tachycardia without systolic heart failure, IV diltiazem is a reasonable option if given slowly.
• D. A repeat modified Valsalva with passive leg raise — A repeat modified vagal maneuver is a reasonable, low-risk step.

Takeaway: Always check for asthma before adenosine.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-03
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §17, supportive text for recommendation 2 (adenosine) and recommendation 5 (diltiazem/verapamil)

Correct answer: D. Prone ventilation for more than 12 hours a day

SSC suggests prone ventilation for longer than 12 hours daily in sepsis with moderate-to-severe ARDS. Short sessions don't match the regimen the evidence supports.

Why the other choices don't fit

• A. A continuous neuromuscular blocker infusion for all patients with this ratio — SSC suggests intermittent neuromuscular blocker boluses over a continuous infusion.
• B. A stepwise, incremental PEEP titration (recruitment) strategy — SSC recommends against an incremental PEEP titration strategy in moderate-to-severe ARDS.
• C. Prone positioning for 2 hours, twice a day — That falls well short of the more-than-12-hours-daily duration that is supported.

Takeaway: In moderate-to-severe ARDS, proning means long sessions of more than 12 hours a day.

Content area: Respiratory · Topic: Acute respiratory distress syndrome (ARDS) · Question ID: CCRN-A-RESP-03
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mechanical ventilation: prone ventilation, PEEP titration, NMBA

Correct answer: B. Give subcutaneous basal insulin, then continue the IV infusion for 1–2 more hours before stopping it

The consensus calls for 1–2 hours of overlap between subcutaneous insulin and discontinuing the IV infusion, with basal insulin given at least 1–2 hours before the drip stops. IV insulin has a very short half-life, so stopping it first leaves a gap with no insulin.

Why the other choices don't fit

• A. Give only rapid-acting insulin with the next meal after stopping the drip — Without basal coverage, there's nothing to suppress ketogenesis between meals.
• C. Stop the IV infusion, then give basal insulin 2 hours later — That leaves a gap with no insulin, which invites a rebound.
• D. Stop the infusion as soon as glucose is under 200, regardless of ketones — Glucose alone doesn't define resolution, and there's still no overlap.

Takeaway: Overlap is the rule: subcutaneous basal insulin goes in 1–2 hours before the drip comes off.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Diabetes mellitus · Question ID: CCRN-A-EHGRI-05
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 4, Transition to maintenance insulin therapy; Fig. 5 legend

Correct answer: C. Give the antimicrobials now and obtain cultures as soon as possible

SSC strongly recommends giving antimicrobials immediately, ideally within 1 hour of recognizing septic shock. It also recommends drawing blood cultures as soon as possible and ideally before antimicrobials. In this case, waiting another 90 minutes for cultures would prevent prompt treatment of the shock.

Why the other choices don't fit

• A. Hold antimicrobials until cultures are drawn, even if that takes 90 minutes — Waiting 90 minutes blows well past the within-1-hour recommendation in septic shock.
• B. Give antimicrobials only after lactate returns — Lactate supports assessment. It isn't a gate for antimicrobials.
• D. Wait for a procalcitonin level to confirm infection — SSC suggests clinical evaluation alone over procalcitonin plus clinical evaluation for deciding to start antimicrobials.

Takeaway: In septic shock, cultures matter, but they don't get to delay the antibiotics.

Content area: Multisystem · Topic: Sepsis · Question ID: CCRN-A-MULTI-04
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Blood culture, antibiotic initiation, and procalcitonin recommendations

Correct answer: C. Include her observations in the pain assessment alongside a validated behavioral tool

PADIS states that when a patient can't self-report, family can be involved in their loved one's pain assessment. It remains paired with validated behavioral tools such as the CPOT or BPS.

Why the other choices don't fit

• A. Use her report instead of any structured assessment — Family input adds to a validated tool. It doesn't replace one.
• B. Thank her but rely only on vital signs — Vital signs aren't valid pain indicators on their own.
• D. Ask her to leave during assessments to avoid bias — Excluding family discards useful information and support.

Takeaway: Family knowledge adds to behavioral pain assessment.

Content area: Professional Caring & Ethical Practice · Topic: Caring Practices · Question ID: CCRN-A-PCEP-05
Source: SCCM, 2018 PADIS recommendations, Pain assessment: family involvement when a patient cannot self-report

Correct answer: B. High-dose methylprednisolone to reduce cerebral edema

BTF does not recommend steroids for improving outcome or lowering ICP in severe TBI. High-dose methylprednisolone was associated with increased mortality and is contraindicated.

Why the other choices don't fit

• A. Phenytoin to reduce early posttraumatic seizures — BTF supports phenytoin to decrease early seizures (within 7 days) when the benefit outweighs the risks.
• C. Treating ICP that stays above 22 mm Hg, per protocol — BTF recommends treating ICP above 22 mm Hg.
• D. A cerebral perfusion pressure goal of 60–70 mm Hg — BTF recommends a cerebral perfusion pressure target of 60–70 mm Hg, individualized to the patient.

Takeaway: Do not use high-dose methylprednisolone to lower ICP or improve outcomes after severe TBI; it can raise mortality.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Traumatic brain injury · Question ID: CCRN-A-MNBP-05
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, Steroids; seizure prophylaxis; ICP thresholds

Correct answer: D. Continue 0.9% saline. The sodium rise is expected as glucose falls.

As glucose falls, water shifts into cells and serum sodium rises (about 1.6 mmol/L per 100 mg/dL drop in glucose). The consensus says this rise alone is not an indication for hypotonic fluid. It recommends 0.45% saline only if osmolality isn't declining despite adequate fluids and insulin. Here, osmolality is falling within the 3–8 mOsm/kg/h range, and glucose is falling about 90 mg/dL per hour.

Why the other choices don't fit

• A. Switch to 0.45% saline now because sodium rose — The consensus specifically says the early sodium rise isn't a reason to give hypotonic fluid.
• B. Give a D5W bolus to lower sodium quickly — A rapid fall in osmolality raises the risk of cerebral edema. This patient’s osmolality is already falling within the recommended range.
• C. Stop IV fluids until sodium normalizes — The patient is still hyperosmolar and volume depleted.

Takeaway: In HHS, watch the osmolality trend, not the sodium alone.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Hyperosmolar hyperglycemic state (HHS) · Question ID: CCRN-A-EHGRI-06
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 4, Fluid therapy (HHS paragraph); Table 3, cerebral oedema and osmotic demyelination

Correct answer: C. IV magnesium, plus correcting the potassium

Recurrent polymorphic VT with a long QT interval is torsades de pointes. AHA says magnesium may be considered to suppress recurrences, and correcting hypokalemia is also advised. The drug that prolongs the QT should be reviewed as well.

Why the other choices don't fit

• A. An IV amiodarone infusion — Antiarrhythmics can prolong the QT further and promote torsades.
• B. IV metoprolol — Given acutely, beta-blockers can cause or worsen bradycardia, and bradycardia can set off torsades.
• D. Synchronized cardioversion now — She's in sinus rhythm with a pulse, so there's nothing to cardiovert. A sustained polymorphic run would need an unsynchronized shock anyway.

Takeaway: Torsades recurrences call for magnesium and electrolyte repair, not more QT-prolonging drugs.

Content area: Cardiovascular · Topic: Myocardial conduction system defects (prolonged QT) · Question ID: CCRN-A-CV-04
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §16 Polymorphic Ventricular Tachycardia, recommendation 2 and supportive text

Correct answer: C. Written and verbal education about sepsis, its treatment, and possible after-effects (post-ICU/post-sepsis syndrome), before discharge and at follow-up

SSC suggests offering written and verbal sepsis education, covering diagnosis, treatment, and post-ICU or post-sepsis syndrome, before discharge and in follow-up. Survivors and families should also get information about the hospital stay and common impairments in the discharge summary.

Why the other choices don't fit

• A. No discussion of possible impairments, to avoid worrying them — Information about common impairments after sepsis is specifically part of it.
• B. A pamphlet only if they ask for one — The suggestion is to offer education proactively, in writing and verbally.
• D. Medication instructions only — The education covers much more than medications.

Takeaway: Sepsis survivors and families should leave knowing what happened and what may come next.

Content area: Professional Caring & Ethical Practice · Topic: Caring Practices · Question ID: CCRN-A-PCEP-06
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Patient/family education recommendations and good-practice statements

Correct answer: A. Investigate rapidly, and give antimicrobials within 3 hours if concern for infection persists

For possible sepsis without shock, SSC suggests a time-limited course of rapid investigation, with antimicrobials within 3 hours of first suspicion if concern persists. If infection is unlikely, it suggests deferring antimicrobials while monitoring closely.

Why the other choices don't fit

• B. Give broad-spectrum antimicrobials within 1 hour regardless of likelihood — The 1-hour standard applies to septic shock and probable or definite sepsis. This patient has neither.
• C. Withhold evaluation until the fever persists for 24 hours — The guideline calls for rapid, not delayed, investigation.
• D. Start empiric antifungal therapy — Empiric antifungals are suggested against in most sepsis patients.

Takeaway: How likely sepsis is, and whether shock is present, set the antibiotic clock.

Content area: Multisystem · Topic: Sepsis · Question ID: CCRN-A-MULTI-05
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Antibiotic initiation recommendations for possible sepsis without shock

Correct answer: B. Intermittent NMBA boluses rather than a continuous infusion

SSC suggests intermittent NMBA boluses over a continuous infusion for sepsis with moderate-to-severe ARDS. Because paralysis removes the ability to show distress, adequate sedation and analgesia must continue.

Why the other choices don't fit

• A. NMBA without sedation, since the patient can't move — Paralysis without adequate sedation can leave the patient aware and suffering.
• C. Avoiding NMBA in ARDS under all circumstances — The guideline addresses how to give NMBA in moderate-to-severe ARDS. It doesn't ban it.
• D. A routine continuous NMBA infusion — Continuous infusion is the approach SSC suggests using less often than intermittent boluses.

Takeaway: When an NMBA is used for sepsis-associated moderate-to-severe ARDS, intermittent boluses are suggested over a continuous infusion; continue adequate sedation and analgesia.

Content area: Respiratory · Topic: Mechanical ventilation · Question ID: CCRN-A-RESP-04
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mechanical ventilation: NMBA recommendation

Correct answer: B. It's used to lower the chance of early seizures in the first 7 days. It isn't recommended for preventing late seizures.

BTF recommends phenytoin to decrease early posttraumatic seizures (within 7 days of injury) when the overall benefit outweighs the complications. Prophylactic phenytoin or valproate is not recommended for preventing late posttraumatic seizures.

Why the other choices don't fit

• A. It's used because early seizures clearly worsen long-term outcome — BTF notes that early posttraumatic seizures haven't been associated with worse outcomes.
• C. It's given mainly to lower intracranial pressure — Seizure prophylaxis doesn't target ICP.
• D. Yes, it prevents epilepsy if it's taken for a full year — Prophylaxis doesn't prevent late seizures, and a year of therapy isn't recommended for that purpose.

Takeaway: TBI seizure prophylaxis covers the first 7 days, not a lifetime.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Traumatic brain injury (TNA: seizure precautions) · Question ID: CCRN-A-MNBP-06
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, Seizure prophylaxis recommendations

Correct answer: A. 180 mg/dL or higher

SSC recommends starting insulin at a glucose of 180 mg/dL (10 mmol/L) or higher, with moderate certainty. Lower thresholds increase hypoglycemia risk without an established benefit.

Why the other choices don't fit

• B. 140 mg/dL or higher — This is lower than the recommended trigger.
• C. 250 mg/dL or higher — Waiting for 250 mg/dL is higher than recommended.
• D. 110 mg/dL or higher — This is a tight-control threshold, not the recommended trigger.

Takeaway: In sepsis, start insulin at a glucose of 180 mg/dL or higher.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Hyperglycemia · Question ID: CCRN-A-EHGRI-07
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Insulin therapy recommendation

Correct answer: B. Give her and her family the chance to take part in shared decision-making about the discharge plan

SSC includes a good-practice statement that clinical teams should give patients and families the opportunity to participate in shared decision-making in post-ICU and hospital discharge planning, so plans are acceptable and feasible.

Why the other choices don't fit

• A. Finalize the plan and inform her at discharge — That skips the shared decision-making the statement calls for.
• C. Postpone planning until the day of discharge — Late planning undermines whether the plan is feasible.
• D. Let the family decide without her — She should be part of the decision.

Takeaway: Discharge plans should be made with patients, not handed to them.

Content area: Professional Caring & Ethical Practice · Topic: Caring Practices · Question ID: CCRN-A-PCEP-07
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Hospital discharge good-practice statements

Correct answer: C. Adjusted or ideal body weight may be used to calculate the volume

SSC suggests at least 30 mL/kg in the first 3 hours for sepsis-induced hypoperfusion or septic shock. It notes that weight-based volume is calculated from actual body weight, or from adjusted or ideal body weight in patients with a BMI above 30, with frequent reassessment.

Why the other choices don't fit

• A. Weight-based dosing doesn't apply to obese patients, so give 1 liter only — The recommendation still applies. Only the weight used changes.
• B. Actual body weight is required: 3,900 mL with no exceptions — The remark specifically allows adjusted or ideal weight for a BMI above 30.
• D. Double the calculated volume to account for obesity — Nothing supports doubling, and it risks over-resuscitation.

Takeaway: For fluid dosing with a BMI above 30, adjusted or ideal body weight may be used.

Content area: Multisystem · Topic: Obesity-related complications / sepsis · Question ID: CCRN-A-MULTI-06
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Fluid resuscitation recommendation and remarks

Correct answer: D. An immediate unsynchronized shock at the maximum manufacturer setting

AHA treats every form of polymorphic VT as unstable. Because the QRS changes from beat to beat, the defibrillator can't reliably synchronize, so an immediate high-energy unsynchronized shock is recommended.

Why the other choices don't fit

• A. Synchronized cardioversion at 100 J — Synchronization depends on a consistent QRS. Polymorphic VT doesn't have one, so the shock may be delayed or never delivered.
• B. IV magnesium before any shock — Magnesium may help prevent torsades from coming back. It doesn't replace an immediate shock for sustained polymorphic VT.
• C. IV adenosine to clarify the rhythm — AHA says adenosine should not be given for polymorphic or unstable wide-complex tachycardia.

Takeaway: Polymorphic VT means an unsynchronized shock, right away, even with a pulse.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-05
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §16 recommendation 1; §15 recommendation 6

Correct answer: D. The ICP is above the level BTF recommends treating, so the provider should be notified and ICP-lowering measures started per protocol

BTF's 4th edition recommends treating ICP above 22 mm Hg, because values above that level are associated with higher mortality. A sustained 25 mm Hg at rest is not a transient spike from stimulation.

Why the other choices don't fit

• A. ICP up to 30 mm Hg is acceptable after TBI — This exceeds the treatment threshold.
• B. Recheck in 2 hours, because readings above 20 are common — A sustained elevation above the threshold calls for action, not watchful waiting.
• C. Treat only if the pupils change — Waiting for pupillary changes means waiting for herniation signs.

Takeaway: In severe TBI, a sustained ICP above 22 mm Hg is a number to treat.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Traumatic brain injury (TNA: ICP monitoring) · Question ID: CCRN-A-MNBP-07
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, Intracranial pressure thresholds recommendation

Correct answer: B. Stop all heparin and start a non-heparin anticoagulant at therapeutic intensity

In suspected HIT with a high-probability 4Ts score, ASH recommends stopping heparin and treating with a non-heparin anticoagulant, such as argatroban or bivalirudin, at therapeutic intensity. HIT is prothrombotic, and this patient already has a clot.

Why the other choices don't fit

• A. Stop heparin and give no anticoagulant until the antibody test returns — With high probability and a new thrombosis, waiting leaves a prothrombotic process untreated.
• C. Switch to low-molecular-weight heparin — LMWH is still a heparin and can cross-react. It isn't a non-heparin anticoagulant.
• D. Start warfarin now — ASH recommends against starting a vitamin K antagonist before the platelet count recovers.

Takeaway: High-probability HIT means stopping every source of heparin and switching to a non-heparin anticoagulant now.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Coagulopathies (HIT) · Question ID: CCRN-A-EHGRI-08
Source: American Society of Hematology, Diagnosis and Management of HIT pocket guide, PDF p. 2: high-probability 4Ts pathway—stop heparin and start therapeutic-intensity non-heparin anticoagulation

Correct answer: C. Low-dose sedation to help the patient tolerate proning

SSC suggests a trial of awake proning in this situation. It specifically says sedation should not be used to promote tolerance of proning in patients who aren't intubated. The patient's tolerance sets how long and how often sessions last.

Why the other choices don't fit

• A. Close SpO2 and work-of-breathing monitoring during the trial — Close monitoring is appropriate so failure is recognized early.
• B. Letting tolerance decide the duration and frequency of proning — This is exactly how the guideline frames duration and frequency.
• D. Continuing high-flow nasal cannula during proning — High-flow oxygen stays in place. Proning is added to it.

Takeaway: Awake proning happens awake, without sedation to make it tolerable.

Content area: Respiratory · Topic: Acute respiratory failure · Question ID: CCRN-A-RESP-05
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Awake proning recommendation and remark

Correct answer: A. Integrate palliative-care principles into the plan to address the patient's symptoms and the family's suffering

SSC includes a good-practice statement that palliative-care principles, which may include palliative consultation based on clinician judgment, should be integrated into the treatment plan when appropriate, to address patient and family symptoms and suffering.

Why the other choices don't fit

• B. Continue escalating vasopressors despite the change in goals — That contradicts the comfort-focused plan.
• C. Wait for a formal palliative consult before treating symptoms — The principles apply at the bedside, whether or not a consult has happened.
• D. Focus only on the patient, since family distress is outside nursing's role — The statement explicitly includes family suffering.

Takeaway: Palliative principles are part of everyday ICU care, for patients and their families.

Content area: Professional Caring & Ethical Practice · Topic: Caring Practices / palliative care · Question ID: CCRN-A-PCEP-08
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Palliative care good-practice statement

Correct answer: B. A dynamic measure, such as the stroke volume response to a passive leg raise

SSC suggests dynamic measures over physical exam or static measures alone to guide fluid resuscitation. Examples include the response to a passive leg raise or fluid bolus, measured by stroke volume, stroke volume variation, pulse pressure, or pulse pressure variation.

Why the other choices don't fit

• A. Skin turgor — Physical exam alone is less reliable than dynamic assessment.
• C. A single central venous pressure reading — CVP is a static measure and shouldn't be used alone.
• D. A fixed schedule of 1-liter boluses until lactate normalizes — Fluids should be individualized, not continued until lactate is normal.

Takeaway: Use dynamic measures to decide on more fluid. Static numbers alone aren't enough.

Content area: Multisystem · Topic: Shock states · Question ID: CCRN-A-MULTI-07
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Dynamic measures and serial lactate recommendations

Correct answer: B. Prophylactic barbiturate burst suppression isn't recommended. High-dose barbiturates are reserved for refractory ICP in hemodynamically stable patients.

BTF does not recommend barbiturates to induce EEG burst suppression as prophylaxis against intracranial hypertension. High-dose barbiturates are recommended for elevated ICP refractory to maximal standard treatment, with hemodynamic stability required before and during therapy.

Why the other choices don't fit

• A. Barbiturates are first-line for any ICP above 15 mm Hg — They are a last-tier therapy for refractory ICP, not a first-line treatment.
• C. Barbiturates are never used in TBI — They have a defined role in refractory intracranial hypertension.
• D. Start barbiturates now, because early is better — This is the prophylactic use BTF recommends against.

Takeaway: Barbiturate coma is for refractory ICP, not for prevention.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Traumatic brain injury · Question ID: CCRN-A-MNBP-08
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, Anesthetics, analgesics, and sedatives recommendations

Correct answer: D. Clarify the order. Warfarin should wait until platelets recover (usually 150,000/mm3 or higher).

ASH strongly recommends against starting a vitamin K antagonist in acute HIT before the platelet count recovers, usually to 150 × 10^9/L or more. The non-heparin anticoagulant continues in the meantime.

Why the other choices don't fit

• A. Bridge with low-molecular-weight heparin — Any heparin product is inappropriate in acute HIT.
• B. Start warfarin and stop argatroban today — This creates the early-warfarin, unprotected period ASH warns against.
• C. Give a platelet transfusion so warfarin can start — ASH suggests against routine platelet transfusion in HIT for patients at average bleeding risk.

Takeaway: In HIT, warfarin waits until platelets reach about 150,000.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Coagulopathies (HIT) · Question ID: CCRN-A-EHGRI-09
Source: American Society of Hematology, Diagnosis and Management of HIT pocket guide, PDF p. 3: do not initiate a vitamin K antagonist before platelet-count recovery, usually at least 150 × 10^9/L

Correct answer: A. Bring the guideline evidence to the unit's practice council and propose reviewing the order set

AACN's Synergy Model defines clinical inquiry as the ongoing process of questioning and evaluating practice and creating change through evidence-based practice. SSC suggests balanced crystalloids over saline for initial resuscitation, except with TBI, so the order set deserves review.

Why the other choices don't fit

• B. Change the fluids for her own patients without an order — Inquiry works through the proper channels. Nurses don't change orders unilaterally.
• C. Assume the order set is correct because it's been used for years — Accepting tradition without evaluating it is the opposite of inquiry.
• D. Stop using the order set entirely — Abandoning the tool creates its own safety risks. The fix is to review and update it.

Takeaway: Clinical inquiry means bringing the evidence through the right channel.

Content area: Professional Caring & Ethical Practice · Topic: Clinical Inquiry · Question ID: CCRN-A-PCEP-09
Source: AACN CCRN Exam Handbook — Direct Care Eligibility Pathway, Synergy Model, p. 9: Clinical Inquiry
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Fluid type recommendation

Correct answer: D. IV verapamil

AHA gives verapamil and diltiazem a 'harm' recommendation in wide-complex tachycardia. If the rhythm is ventricular, verapamil won't stop it and can cause profound hypotension, shock, or arrest.

Why the other choices don't fit

• A. IV adenosine to help clarify the rhythm — For a stable, regular, monomorphic wide-complex tachycardia of uncertain cause, adenosine may be considered for treatment or diagnosis.
• B. A 12-lead ECG — A stable patient gives the team time to get a 12-lead ECG, and they should.
• C. IV procainamide, infused no faster than 50 mg/min — Procainamide may be considered for wide-complex tachycardia. The infusion-rate limit is part of giving it safely.

Takeaway: A wide-complex rhythm of unknown origin is not a calcium channel blocker rhythm.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-06
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §15 Wide-Complex Tachycardia, recommendations 3–5

Correct answer: C. Current sepsis guidance recommends a restrictive transfusion strategy over a liberal one

SSC recommends a restrictive rather than liberal transfusion strategy for adults with sepsis or septic shock (moderate certainty). A stable patient without bleeding or ischemia doesn't need transfusion simply to raise the number.

Why the other choices don't fit

• A. Transfusion is avoided in all sepsis patients — Restrictive doesn't mean never. Transfusion is still used when indicated.
• B. Blood is given only when hemoglobin is below 4 g/dL — This invents a threshold the guideline doesn't set.
• D. Transfusion is delayed until lactate normalizes — Lactate isn't the transfusion trigger in this guidance.

Takeaway: In sepsis, transfuse by a restrictive strategy and the clinical picture, not by habit.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Anemia · Question ID: CCRN-A-EHGRI-10
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Blood transfusion recommendation

Correct answer: C. Switch to high-flow nasal cannula (HFNC)

PaO2/FiO2 = 68 ÷ 0.40 = 170. SSC suggests HFNC over conventional oxygen when the P/F ratio is below 200, and HFNC as the initial therapy over noninvasive positive pressure ventilation for sepsis-related hypoxemic respiratory failure.

Why the other choices don't fit

• A. Intubate now based on the P/F ratio alone — Nothing in the stem calls for immediate intubation. Escalating noninvasively with close monitoring is appropriate.
• B. Stay on the Venturi mask, because P/F is above 150 — A P/F of 170 is below 200, which is the range where HFNC is suggested over conventional oxygen.
• D. Start BiPAP as first-line therapy — For this situation, SSC suggests HFNC as the initial therapy over noninvasive ventilation.

Takeaway: In sepsis-related hypoxemic respiratory failure without an immediate need for intubation, a P/F ratio below 200 supports considering HFNC over conventional oxygen.

Content area: Respiratory · Topic: Acute respiratory failure · Question ID: CCRN-A-RESP-06
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Respiratory support recommendations and remark (P/F < 200)

Correct answer: D. 0.9% saline, and avoid supplemental albumin

SSC generally suggests balanced crystalloids over 0.9% saline, but for patients with sepsis and a TBI it suggests 0.9% saline. It also states that supplemental albumin should be avoided in patients with a TBI.

Why the other choices don't fit

• A. A balanced crystalloid, as for every sepsis patient — The balanced-crystalloid suggestion carries a specific exception for TBI.
• B. Hydroxyethyl starch — SSC recommends against starches in sepsis.
• C. Albumin to limit total fluid volume — SSC says albumin should be avoided in TBI.

Takeaway: Sepsis with TBI is the exception: use saline and skip the albumin.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Traumatic brain injury · Question ID: CCRN-A-MNBP-09
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Fluid type recommendations and remarks

Correct answer: B. Clarify the order. Fluids should be individualized by response rather than continued until lactate normalizes.

SSC suggests serial lactate measurements to guide resuscitation. Its remark says fluid should be individualized after the initial bolus and lactate decline, rather than continued until lactate normalizes. Capillary refill is suggested as an adjunct perfusion marker.

Why the other choices don't fit

• A. Start sodium bicarbonate to clear lactate faster — SSC suggests against bicarbonate for hypoperfusion-related lactic acidemia to improve hemodynamics.
• C. Continue the boluses until lactate is below 2 — This is the 'give fluid until lactate is normal' approach the remark cautions against.
• D. Stop measuring lactate, because it's improving — Serial lactate is suggested to guide resuscitation.

Takeaway: A falling lactate guides resuscitation, but normalizing it isn't the goal of fluids.

Content area: Multisystem · Topic: Sepsis · Question ID: CCRN-A-MULTI-08
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Serial lactate, capillary refill, and sodium bicarbonate recommendations

Correct answer: A. Review the protocol against the 2024 consensus, which uses ketones plus pH or bicarbonate, not the anion gap, to define resolution

The 2024 consensus defines DKA resolution as ketones below 0.6 mmol/L plus either pH of at least 7.3 or bicarbonate of at least 18 mmol/L. It says the anion gap should not be used because hyperchloremic acidosis from large saline volumes can mislead. These patients meet the ketone-and-pH criteria; the protocol needs an evidence-based review.

Why the other choices don't fit

• B. Switch to urine ketones as the resolution marker — The consensus says urine ketones should be avoided as a resolution criterion.
• C. Add more saline until the bicarbonate normalizes — Large saline volumes can contribute to hyperchloremic acidosis. More saline does not repair a misleading resolution rule.
• D. Keep the protocol, because both a normal gap and normal bicarbonate are always required — The current consensus does not require both of those findings. It uses ketones plus either the pH or bicarbonate criterion.

Takeaway: When outcomes look off, check the protocol against the current evidence.

Content area: Professional Caring & Ethical Practice · Topic: Clinical Inquiry · Question ID: CCRN-A-PCEP-10
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 4, Criteria for resolution; Section 3 on hyperchloraemic acidosis
Source: AACN CCRN Exam Handbook — Direct Care Eligibility Pathway, Synergy Model, p. 9: Clinical Inquiry

Correct answer: D. Low-molecular-weight heparin alone

SSC recommends pharmacologic prophylaxis unless contraindicated, recommends LMWH over unfractionated heparin, and suggests pharmacologic prophylaxis alone over adding mechanical devices.

Why the other choices don't fit

• A. No prophylaxis until the patient is walking — Pharmacologic prophylaxis is recommended now, unless contraindicated.
• B. Unfractionated heparin plus sequential compression devices — SSC prefers LMWH over UFH and doesn't suggest routinely adding mechanical prophylaxis.
• C. Sequential compression devices alone — Mechanical-only prophylaxis isn't the recommendation when there's no contraindication to anticoagulation.

Takeaway: For VTE prevention in sepsis, use LMWH alone unless something prevents it.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Coagulopathies (VTE prevention) · Question ID: CCRN-A-EHGRI-11
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, VTE prophylaxis recommendations

Correct answer: D. IV diltiazem

Diltiazem and verapamil are negative inotropes and vasodilators. AHA advises avoiding them when systolic heart failure is suspected, and an EF of 20% goes beyond suspicion.

Why the other choices don't fit

• A. Applying defibrillator pads before further treatment — Having pads on is a sensible precaution while escalating treatment.
• B. Synchronized cardioversion with procedural sedation — Cardioversion is recommended when a stable narrow-complex tachycardia doesn't respond to vagal maneuvers and drugs. Sedation is appropriate if the patient is alert.
• C. Continuous cardiac monitoring — Monitoring is needed throughout. There's nothing to clarify.

Takeaway: Weak ventricle plus narrow-complex tachycardia: skip diltiazem and verapamil.

Content area: Cardiovascular · Topic: Heart failure · Question ID: CCRN-A-CV-07
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §17 supportive text for recommendation 5; recommendation 4

Correct answer: B. Lower systolic pressure below 185 and diastolic pressure below 110 mm Hg

The 2026 AHA/ASA guideline recommends lowering systolic pressure below 185 and diastolic pressure below 110 mm Hg before IV thrombolysis. This patient exceeds both limits. The pressure needs treatment before thrombolysis proceeds.

Why the other choices don't fit

• A. Give the thrombolytic now and lower the pressure afterward — The threshold must be met before the bolus is given.
• C. Allow blood pressure up to 220/120 mm Hg for this candidate — This patient is receiving IV thrombolysis, so the pretreatment limits apply. Blood-pressure decisions in patients not receiving reperfusion depend on their separate clinical circumstances.
• D. Lower the systolic pressure quickly to below 120 mm Hg — Aggressive lowering before reperfusion risks cerebral hypoperfusion. The goal is to get below the threshold.

Takeaway: Before a thrombolytic, blood pressure must be below 185/110.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Stroke · Question ID: CCRN-A-MNBP-10
Source: AHA/ASA 2026 Acute Ischemic Stroke guideline pocket guide, Printed p. 20, §4.3, recommendation 5 (before IV thrombolysis)

Correct answer: C. AHA doesn't recommend head-up CPR outside clinical trials, so the unit should keep standard CPR

AHA's 2025 ALS guideline states that head-up CPR is not recommended except within clinical trials, given very low-certainty evidence and specialized equipment requirements. One study doesn't outweigh a guideline built on systematic evidence review.

Why the other choices don't fit

• A. Let each nurse decide during the code — Individual improvisation during a code isn't how practice change works.
• B. Adopt it only for in-hospital arrests — The recommendation isn't limited by setting.
• D. Adopt it now, because newer is better — Newness isn't evidence.

Takeaway: Evaluate a single study against the guideline, and don't let a single study override it.

Content area: Professional Caring & Ethical Practice · Topic: Clinical Inquiry · Question ID: CCRN-A-PCEP-11
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §12 recommendation 8 and supportive text

Correct answer: D. A balanced crystalloid, such as lactated Ringer's

SSC recommends crystalloids as first-line fluid and suggests balanced crystalloids over 0.9% saline for initial resuscitation (moderate certainty). The exception is traumatic brain injury.

Why the other choices don't fit

• A. Hydroxyethyl starch — SSC recommends against starches, with high certainty.
• B. 0.9% saline for everyone — Normal saline is not restricted to patients with TBI, but SSC favors a balanced crystalloid for this sepsis case without brain injury.
• C. Albumin as the first-line fluid — SSC suggests crystalloids alone over adding albumin for most patients.

Takeaway: Sepsis without brain injury: start with a balanced crystalloid.

Content area: Multisystem · Topic: Fluid and electrolyte imbalances · Question ID: CCRN-A-MULTI-09
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Fluid type recommendations

Correct answer: C. Obtain an arterial blood gas to confirm oxygenation

SSC notes that pulse-oximetry estimates are less accurate in shock, in patients with darker skin tones, and at saturations below 90% or above 97%. An arterial blood gas can confirm arterial oxygenation and also measures pH and PaCO2.

Why the other choices don't fit

• A. Keep titrating FiO2 to the pulse oximeter reading alone — This patient has two conditions that reduce oximeter accuracy.
• B. Move the probe to another finger and accept the higher value — A different finger doesn't fix the reduced accuracy that comes with shock and skin pigmentation.
• D. Treat SpO2/FiO2 as an exact substitute for PaO2/FiO2 — SSC says SpO2/FiO2 can substitute but is less accurate in exactly this situation.

Takeaway: When the clinical picture and pulse-oximetry reliability raise concern, confirm arterial oxygenation rather than relying on the displayed saturation alone.

Content area: Respiratory · Topic: Acute respiratory failure (TNA: respiratory monitoring) · Question ID: CCRN-A-RESP-07
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Hypoxemia monitoring recommendation and remark

Correct answer: A. Enteral feeding by nasogastric tube

The ACG highlights recommend tube feeding in moderately severe or severe pancreatitis and prefer the nasogastric route over the nasojejunal route. Parenteral nutrition should be avoided when enteral feeding is feasible.

Why the other choices don't fit

• B. Total parenteral nutrition — Parenteral nutrition is a fallback when the enteral route fails, not a first choice.
• C. Enteral feeding only through a nasojejunal tube — Nasogastric feeding is an acceptable route, so a nasojejunal tube isn't required.
• D. NPO until lipase normalizes — Prolonged fasting isn't supported, and lipase isn't the feeding trigger.

Takeaway: In severe pancreatitis, feed the gut, and a nasogastric tube is fine.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Pancreatitis · Question ID: CCRN-A-EHGRI-12
Source: American College of Gastroenterology, Acute Pancreatitis guideline highlights, Single-page Management panel: Feeding—nasogastric feeding in moderately severe/severe disease; avoid parenteral nutrition when possible

Correct answer: B. Treat the blood pressure to keep it below 180/105 mm Hg

After IV thrombolysis, the 2026 AHA/ASA guideline recommends maintaining systolic pressure below 180 and diastolic pressure below 105 mm Hg for at least the first 24 hours. A systolic pressure of 186 exceeds that limit.

Why the other choices don't fit

• A. Recheck in 4 hours — A pressure above the limit during the first 24 hours needs prompt treatment.
• C. Target a systolic of 110 mm Hg — The guidance sets an upper limit, not an aggressive low target.
• D. Accept it, because permissive hypertension up to 220/120 applies — A different blood-pressure approach may apply when reperfusion is not given, but that does not override this patient’s post-thrombolysis limits.

Takeaway: For at least the first 24 hours after IV thrombolysis, keep systolic pressure below 180 and diastolic pressure below 105 mm Hg.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Stroke · Question ID: CCRN-A-MNBP-11
Source: AHA/ASA 2026 Acute Ischemic Stroke guideline pocket guide, Printed p. 20, §4.3, recommendation 7 (after IV thrombolysis, at least 24 hours)

Correct answer: D. Use NEWS, NEWS2, MEWS, or SIRS rather than qSOFA as a single screening tool

SSC recommends NEWS, NEWS2, MEWS, or SIRS over qSOFA as a single screening tool for acutely ill hospitalized patients (moderate certainty). It also says sepsis shouldn't be ruled in or out by any single biomarker or test.

Why the other choices don't fit

• A. Replace screening with a single procalcitonin cutoff — SSC says sepsis shouldn't be ruled in or out by a single biomarker.
• B. Keep qSOFA, because it's the most specific — The recommendation favors the other tools over qSOFA alone for screening.
• C. Stop screening and rely on clinical judgment — SSC strongly recommends screening within performance improvement programs.

Takeaway: For inpatient sepsis screening, don't rely on qSOFA alone.

Content area: Professional Caring & Ethical Practice · Topic: Clinical Inquiry / systems · Question ID: CCRN-A-PCEP-12
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Screening and biomarker recommendations; performance improvement

Correct answer: D. Immediate synchronized cardioversion

AHA recommends immediate electrical cardioversion when atrial fibrillation or flutter with a rapid rate is causing hemodynamic instability. Rate-control drugs can worsen hypotension.

Why the other choices don't fit

• A. An IV amiodarone infusion over 24 hours — An infusion acts too slowly for shock that the rhythm itself is causing.
• B. IV diltiazem for rate control — Negative inotropes can deepen hypotension. This patient needs the rhythm fixed, not slowed with a drug.
• C. Transesophageal echocardiography before any cardioversion — Instability caused by the rhythm calls for cardioversion now. Do not delay this emergency intervention for the workup used before an elective cardioversion.

Takeaway: Unstable because of the AF itself? Cardiovert now.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-08
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §18.1 Electrical Therapies, recommendation 1 and supportive text

Correct answer: D. It recommends against starches for resuscitation

SSC recommends against using starches for resuscitation in sepsis or septic shock. This is a strong recommendation with high certainty of evidence. It also suggests against gelatin.

Why the other choices don't fit

• A. Starches are acceptable if limited to 1 liter — No volume limit makes them recommended.
• B. Starches are preferred when volume overload is a concern — The recommendation is against starches, full stop.
• C. Starches are suggested for patients with AKI — Nothing in the guideline suggests starches for AKI.

Takeaway: Starches are out for sepsis resuscitation.

Content area: Multisystem · Topic: Fluid and electrolyte imbalances · Question ID: CCRN-A-MULTI-10
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Fluid type recommendations

Correct answer: B. Prophylactic IV meropenem

ACG does not recommend routine prophylactic antibiotics in severe pancreatitis or sterile necrosis. Antibiotics are indicated for suspected infection, not solely to prevent infection in sterile necrosis.

Why the other choices don't fit

• A. Serial monitoring for new fever or organ dysfunction — Watching for infection is how a change to infected necrosis would be caught.
• C. Enteral nutrition — Enteral feeding is recommended in severe pancreatitis.
• D. Multimodal analgesia with reassessment — Pain control is standard supportive care.

Takeaway: Sterile necrosis doesn't get prophylactic antibiotics.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Pancreatitis · Question ID: CCRN-A-EHGRI-13
Source: American College of Gastroenterology, Acute Pancreatitis guideline highlights, Single-page Management panel: Antibiotics—when infection is a concern, not for sterile necrosis prophylaxis

Correct answer: A. 6–8 mL/kg ideal body weight

Without ARDS, SSC suggests 6–8 mL/kg ideal body weight over a lower 4 to under 6 mL/kg. It also advises regular screening for ARDS, because the diagnosis is often missed.

Why the other choices don't fit

• B. 10–12 mL/kg actual body weight — This is both too high and uses the wrong weight.
• C. 4–5 mL/kg ideal body weight — SSC suggests against going this low when ARDS isn't present.
• D. 10–12 mL/kg ideal body weight — High tidal volumes aren't recommended in sepsis-related respiratory failure.

Takeaway: Without ARDS, use 6–8 mL/kg ideal body weight and keep screening for ARDS.

Content area: Respiratory · Topic: Mechanical ventilation · Question ID: CCRN-A-RESP-08
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mechanical ventilation: sepsis-associated respiratory failure without ARDS

Correct answer: B. It helps prevent delayed cerebral ischemia and improve functional outcome

The 2023 AHA/ASA aSAH guideline states that early enteral nimodipine is beneficial in preventing delayed cerebral ischemia (DCI) and improving functional outcomes.

Why the other choices don't fit

• A. It's mainly used to treat high blood pressure — Any blood-pressure effect is incidental. The purpose is preventing DCI and improving outcome.
• C. It prevents the aneurysm from rebleeding — Nimodipine isn't a rebleeding therapy.
• D. It's started only after vasospasm appears — The guideline supports early initiation to prevent DCI, not a delayed start.

Takeaway: Nimodipine in aSAH is started early to prevent delayed cerebral ischemia.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Neurovascular abnormalities (aneurysmal SAH) · Question ID: CCRN-A-MNBP-12
Source: AHA/ASA 2023 Aneurysmal Subarachnoid Hemorrhage: Top Things to Know, Top Things to Know: delayed cerebral ischemia

Correct answer: B. A bedside multidisciplinary huddle to speed diagnosis and treatment after the positive screen

SSC suggests using a 'code sepsis' or 'sepsis huddle' protocol, which it describes as a multidisciplinary team huddle at the bedside after a positive screen to expedite sepsis diagnosis and treatment.

Why the other choices don't fit

• A. A page to the physician only, with the nurse continuing routine care — The protocol is multidisciplinary, not a single page.
• C. An overhead announcement to clear the unit — A sepsis huddle isn't a cardiac arrest response.
• D. An automatic ICU transfer without assessment — The huddle is about coordinated assessment and treatment, not automatic transfer.

Takeaway: Code sepsis brings the team to the bedside.

Content area: Professional Caring & Ethical Practice · Topic: Collaboration · Question ID: CCRN-A-PCEP-13
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Implementation recommendation: code sepsis/sepsis huddle

Correct answer: B. Begin oral feeding with a low-fat solid diet as tolerated

In mild pancreatitis, ACG suggests early oral feeding within 24–48 hours as tolerated, starting with a low-fat solid diet rather than a stepwise liquid-to-solid progression.

Why the other choices don't fit

• A. NPO until lipase normalizes — The traditional NPO approach is what early feeding replaced.
• C. Start parenteral nutrition — Parenteral nutrition has no role when a patient can eat.
• D. Clear liquids for 48 hours, then advance stepwise — ACG suggests starting with low-fat solids rather than stepwise advancement.

Takeaway: In mild pancreatitis, feed early with low-fat solids.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Pancreatitis · Question ID: CCRN-A-EHGRI-14
Source: American College of Gastroenterology, Acute Pancreatitis guideline highlights, Single-page Management panel: Feeding—low-fat solid diet within 24–48 hours for mild disease as tolerated

Correct answer: D. Start the vasopressor peripherally now rather than waiting for central access

SSC suggests starting vasopressors peripherally to restore MAP rather than delaying until central access is secured. Data are insufficient to recommend a particular duration, dose, or catheter size or site, so local protocol and close site monitoring apply.

Why the other choices don't fit

• A. Give additional fluid indefinitely until the central line is placed — Continued fluids without reassessment risk overload and don't restore vascular tone.
• B. Wait for the central line before starting any vasopressor — This is the delay SSC suggests avoiding.
• C. Give the vasopressor as intermittent IV pushes until central access is placed — The suggestion is peripheral infusion, not improvised pushes.

Takeaway: Don't let the central line hold up the pressor.

Content area: Multisystem · Topic: Shock states (TNA: vascular access) · Question ID: CCRN-A-MULTI-11
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Vasopressor administration recommendation

Correct answer: C. Treat the likely sepsis with fluids and prompt antimicrobials instead of targeting the rate

AHA reserves electrical therapy for a narrow-complex tachycardia that is causing the instability, not one that results from another illness such as sepsis. Sinus tachycardia here is a compensation for hypoperfusion. The Surviving Sepsis Campaign calls for immediate resuscitation and antimicrobials.

Why the other choices don't fit

• A. Synchronized cardioversion — Sinus tachycardia can't be cardioverted away, and the underlying shock would persist.
• B. IV adenosine — Adenosine won't end sinus tachycardia. The rate is a response to the illness, not the problem itself.
• D. IV diltiazem for rate control — Slowing a compensatory tachycardia in a hypotensive patient can make perfusion worse.

Takeaway: Ask whether the tachycardia is the cause of the instability or a response to something else. In sepsis it's usually a response.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-09
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §17 synopsis on causative vs secondary tachycardia
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, antimicrobial timing and fluid resuscitation recommendations

Correct answer: A. A structured handoff of critically important information

SSC suggests using a handoff process for critically important information at transitions of care, and a critical care transition program when patients move to the floor.

Why the other choices don't fit

• B. Sending a transfer order only — An order doesn't carry the clinical picture.
• C. A brief verbal update in the hallway — An unstructured exchange isn't a handoff process.
• D. Having the receiving nurse read the chart later — Leaving the transfer of critical information to chance undermines safety.

Takeaway: Transitions after sepsis need a real handoff.

Content area: Professional Caring & Ethical Practice · Topic: Collaboration · Question ID: CCRN-A-PCEP-14
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Transitions of care recommendations

Correct answer: C. Question the order. Euvolemia is the goal, and prophylactic hypervolemia or hemodynamic augmentation isn't recommended.

The 2023 AHA/ASA aSAH guideline says prophylactic hemodynamic augmentation and hypervolemia should not be performed, to avoid iatrogenic harm. Maintaining euvolemia, with goal-directed volume management, is recommended.

Why the other choices don't fit

• A. Give the boluses as ordered — This is the prophylactic hypervolemia the guideline advises against.
• B. Give the boluses and also start IV magnesium — Routine IV magnesium is also not recommended.
• D. Restrict fluids to below maintenance to prevent cerebral edema — Hypovolemia isn't the goal either. Euvolemia is.

Takeaway: In aSAH, aim for euvolemia and avoid prophylactic 'triple-H' therapy.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Neurovascular abnormalities (aneurysmal SAH) · Question ID: CCRN-A-MNBP-13
Source: AHA/ASA 2023 Aneurysmal Subarachnoid Hemorrhage: Top Things to Know, Top Things to Know: DCI; medical complications

Correct answer: A. Antibiotics that penetrate pancreatic necrosis, with intervention deferred toward 4–6 weeks from pancreatitis onset while the patient remains stable

The ACG highlights recommend antibiotics that penetrate pancreatic necrosis when infection is a concern. In stable patients with necrosis, they favor delaying intervention for 4–6 weeks from disease onset. That is not an additional 4–6 weeks starting today; deterioration would change the plan.

Why the other choices don't fit

• B. Withhold antibiotics because pancreatic necrosis never needs them — The restriction is against prophylactic antibiotics for sterile disease. Findings of infected necrosis call for antibiotics, not withholding them.
• C. Wait until 4–6 weeks from onset before starting any antibiotics — The delay concerns intervention in a stable patient, not withholding treatment for suspected infected necrosis.
• D. Immediate open surgical necrosectomy — In a stable patient, the ACG highlights favor delaying intervention for 4–6 weeks from pancreatitis onset. Immediate open surgery is not the preferred default here.

Takeaway: For infected necrosis in a stable patient, give antibiotics now and intervene later.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Pancreatitis · Question ID: CCRN-A-EHGRI-15
Source: American College of Gastroenterology, Acute Pancreatitis guideline highlights, Single-page Management panel: antibiotics that penetrate necrosis; delay intervention in stable necrosis for 4–6 weeks from onset

Correct answer: B. Continuous waveform capnography

AHA recommends continuous waveform capnography, together with clinical assessment, as the most reliable method to confirm and monitor endotracheal tube placement in cardiac arrest. Its sensitivity falls in prolonged arrest, so clinical assessment still matters.

Why the other choices don't fit

• A. A rise in SpO2 — Oxygen saturation can lag or mislead during low-flow states.
• C. A chest x-ray — A film shows depth but can't confirm tracheal placement in real time or keep monitoring it.
• D. Auscultation alone — Breath sounds help but are not the most reliable confirmation on their own.

Takeaway: Waveform capnography confirms the tube and keeps watching it.

Content area: Respiratory · Topic: Airway management (TNA: capnography) · Question ID: CCRN-A-RESP-09
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §14 Advanced Airway Placement, recommendation 3

Correct answer: A. IV corticosteroids

SSC suggests IV corticosteroids for adults with septic shock. It suggests against IV vitamin C, IV immunoglobulins, and polymyxin B hemoperfusion.

Why the other choices don't fit

• B. IV vitamin C — SSC suggests against IV vitamin C.
• C. Polymyxin B hemoperfusion — SSC suggests against polymyxin B hemoperfusion.
• D. IV immunoglobulins — SSC suggests against IV immunoglobulins in sepsis.

Takeaway: In septic shock, add steroids and skip the add-on 'cocktails.'

Content area: Multisystem · Topic: Shock states (septic shock) · Question ID: CCRN-A-MULTI-12
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, IV corticosteroids and adjunctive therapy recommendations

Correct answer: D. Comprehensive medication reconciliation with a pharmacist at the transition

SSC includes a good-practice statement to perform comprehensive medication reconciliation at care transitions, including ICU and hospital discharge, and suggests a pharmacist-based approach.

Why the other choices don't fit

• A. Let the receiving unit sort it out — Reconciliation belongs at the transition.
• B. Resume all home medications automatically — Some were held for reasons that may still apply.
• C. Discharge on the ICU medication list unchanged — ICU-only drugs and held home drugs both need deliberate review.

Takeaway: Transitions call for a team-based medication reconciliation.

Content area: Professional Caring & Ethical Practice · Topic: Collaboration · Question ID: CCRN-A-PCEP-15
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Medication reconciliation statements

Correct answer: B. Antiseizure medication for 7 days

The guideline recommends 7 days of antiseizure medication for new-onset seizures after aSAH. It advises against routine prophylactic antiseizure medication, though prophylaxis may be considered in specific high-risk patients.

Why the other choices don't fit

• A. Routine antiseizure prophylaxis for every aSAH patient from admission — Routine prophylaxis isn't recommended. It's considered only in selected high-risk patients.
• C. No treatment, because seizures after aSAH are expected — A seizure that has occurred should be treated.
• D. Lifelong antiseizure medication — The recommended course for new-onset seizures after aSAH is 7 days.

Takeaway: After aSAH, a new seizure means 7 days of treatment, and routine prophylaxis isn't used.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Seizure disorders (aneurysmal SAH) · Question ID: CCRN-A-MNBP-14
Source: AHA/ASA 2023 Aneurysmal Subarachnoid Hemorrhage: Top Things to Know, Top Things to Know: seizures

Correct answer: B. Deliver one shock, then resume CPR immediately

Early defibrillation is critical in VF. AHA prefers a single shock followed immediately by CPR over stacked shocks. For shockable rhythms, epinephrine comes after the initial defibrillation attempts fail.

Why the other choices don't fit

• A. Give amiodarone 300 mg IV before shocking — Amiodarone may be considered for VF that doesn't respond to defibrillation. It never replaces the first shock.
• C. Give epinephrine 1 mg IV before the first shock — For shockable rhythms, AHA places epinephrine after initial defibrillation attempts, not before.
• D. Place an endotracheal tube before shocking — AHA advises deferring an advanced airway that would interrupt compressions until the patient fails to respond to initial CPR and defibrillation.

Takeaway: In VF, the shock comes first and CPR resumes right after it.

Content area: Cardiovascular · Topic: Dysrhythmias · Question ID: CCRN-A-CV-10
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §5 Defibrillation rec 3; §10 rec 4; §11 rec 1; §14 rec 2

Correct answer: A. Give a proton-pump inhibitor for stress ulcer prophylaxis

SSC suggests stress ulcer prophylaxis with proton-pump inhibitors for adults with sepsis who have risk factors for GI bleeding. The recommendation is tied to those risk factors, not given to everyone.

Why the other choices don't fit

• B. No prophylaxis, since sepsis alone isn't an indication — This patient has bleeding risk factors, so the suggestion applies.
• C. Probiotics instead of acid suppression — SSC suggests against probiotics in sepsis.
• D. Proton-pump inhibitors for every ICU patient regardless of risk — The recommendation is targeted to patients with GI-bleeding risk factors.

Takeaway: Stress ulcer prophylaxis in sepsis follows bleeding risk factors.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Acute GI hemorrhage (prevention) · Question ID: CCRN-A-EHGRI-16
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Stress ulcer prophylaxis; probiotics

Correct answer: B. Use a critical care transition program when the patient moves to the floor

SSC suggests using a critical care transition program, compared with usual care, when adults with sepsis move from the ICU to the floor. Collaboration across units supports continuity after the ICU.

Why the other choices don't fit

• A. Ask the family to watch for deterioration instead — Families can help, but they don't replace a structured clinical program.
• C. Keep the patient in the ICU until discharge home — The guidance supports a structured transition, not indefinite ICU stays.
• D. Transfer with no special follow-up — That is the usual care the suggestion aims to improve on.

Takeaway: Leaving the ICU should come with a structured transition.

Content area: Professional Caring & Ethical Practice · Topic: Collaboration · Question ID: CCRN-A-PCEP-16
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Transitions of care: critical care transition program

Correct answer: C. Clarify the order. SSC suggests against antipyretic therapy to improve outcomes in sepsis.

SSC suggests against pharmacologic or surface-cooling antipyretic therapy for the purpose of improving outcomes in sepsis. The remark says this doesn't apply to antipyretics for pain or symptom control, or to neurocritical care or post-arrest patients.

Why the other choices don't fit

• A. Apply the blanket, because fever control improves sepsis survival — The evidence doesn't support cooling to improve outcomes in sepsis.
• B. Give acetaminophen every 4 hours to normalize temperature for survival benefit — The same reasoning applies to drug antipyretics given for outcome.
• D. Refuse any antipyretic even if the patient becomes uncomfortable — The remark allows antipyretics for symptom control.

Takeaway: In sepsis, treat fever for comfort, not in the hope of better survival.

Content area: Multisystem · Topic: Thermoregulation · Question ID: CCRN-A-MULTI-13
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Antipyretic recommendation and remark

Correct answer: B. The Critical-Care Pain Observation Tool (CPOT) or the Behavioral Pain Scale (BPS)

PADIS identifies the BPS (for intubated patients), the BPS-NI (for nonintubated patients), and the CPOT as the most valid and reliable tools for monitoring pain in critically ill adults who can't self-report but whose behaviors can be observed.

Why the other choices don't fit

• A. A 0–10 numeric rating scale — Self-report scales need a patient who can report.
• C. Heart rate and blood pressure trends — PADIS says vital signs aren't valid pain indicators on their own.
• D. The Richmond Agitation-Sedation Scale (RASS) — RASS measures sedation and agitation, not pain.

Takeaway: If the patient can't self-report pain, use CPOT or BPS.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Pain (TNA: pain assessment) · Question ID: CCRN-A-MNBP-15
Source: SCCM, 2018 PADIS recommendations, Pain assessment: BPS and CPOT when self-report is not possible and behaviors are observable

Correct answer: B. One breath every 6 seconds (10/min) with continuous chest compressions

Once an advanced airway is placed, AHA says it may be reasonable to give 1 breath every 6 seconds while compressions continue without pauses.

Why the other choices don't fit

• A. One breath every 2–3 seconds — That rate risks hyperventilation.
• C. 30 compressions, then a pause for 2 breaths — The 30:2 pause pattern is for ventilating without an advanced airway.
• D. 20 breaths per minute to clear CO2 — Faster ventilation isn't recommended and can impair circulation during CPR.

Takeaway: With an advanced airway, give 10 breaths a minute without pausing compressions for breaths.

Content area: Respiratory · Topic: Airway management · Question ID: CCRN-A-RESP-10
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §14 recommendation 9

Correct answer: D. Start enteral nutrition early, within 72 hours

SSC suggests early enteral nutrition, within 72 hours, for adults with sepsis or septic shock who can be fed enterally. This stem establishes that suitability.

Why the other choices don't fit

• A. Start parenteral nutrition on day 1 instead — The suggestion is for early enteral feeding.
• B. Hold all nutrition until day 7 — Waiting a week goes against the early-feeding suggestion.
• C. Wait until vasopressors have been off for 72 hours — This builds in a delay the guideline doesn't ask for.

Takeaway: In sepsis, start enteral feeding early, within 72 hours, when the patient can be fed enterally.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Malnutrition (TNA: enteral nutrition) · Question ID: CCRN-A-EHGRI-17
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Enteral nutrition recommendation

Correct answer: A. Epinephrine 1 mg IV as soon as feasible

For nonshockable rhythms, AHA says it is reasonable to give epinephrine as soon as feasible, then every 3–5 minutes. Earlier epinephrine in nonshockable arrest is associated with more ROSC.

Why the other choices don't fit

• B. Routine IV calcium chloride — AHA does not recommend routine calcium in cardiac arrest. It is reserved for special circumstances such as hyperkalemia.
• C. Routine IV sodium bicarbonate — Routine bicarbonate in arrest is not recommended outside special circumstances.
• D. Hold epinephrine until after two full CPR cycles — Delaying epinephrine in a nonshockable rhythm goes against the timing recommendation.

Takeaway: Nonshockable rhythm? Give epinephrine early, and skip routine calcium and bicarbonate.

Content area: Cardiovascular · Topic: Dysrhythmias (cardiac arrest) · Question ID: CCRN-A-CV-11
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §10 recs 2–3; §11 recs 4–5

Correct answer: C. "So I know I explained it clearly, can you tell me in your own words how you'll take this at home?"

AHRQ describes teach-back as asking the patient to explain what they need to know or do in their own words. Patients often answer yes to 'Do you understand?' even when they don't.

Why the other choices don't fit

• A. "Any questions?" — This invites questions, but it does not show how the patient understands or will carry out the instructions.
• B. "You'll remember all of that, right?" — A leading yes-or-no question doesn't verify understanding.
• D. "Do you understand everything?" — AHRQ notes that patients often say yes when they don't understand.

Takeaway: Teach-back means the patient explains it in their own words.

Content area: Professional Caring & Ethical Practice · Topic: Facilitation of Learning · Question ID: CCRN-A-PCEP-17
Source: AHRQ TeamSTEPPS, Tool: Teach-Back, Tool: Teach-Back

Correct answer: D. Prepare for early source control, ideally within 6 hours, while resuscitation continues

SSC says adults with sepsis should be rapidly evaluated for sources that need emergent control. It suggests early source control, ideally within 6 hours of diagnosis.

Why the other choices don't fit

• A. Antibiotics alone for 48 hours, then reassess — A perforation needs anatomical control that antibiotics can't provide.
• B. Delay surgery until lactate normalizes — Resuscitation and source control happen together. Waiting for lactate to normalize delays the fix.
• C. Wait for blood culture results before surgery — Culture results don't decide whether a perforation needs repair.

Takeaway: If there's a hole, plan to close it early, ideally within 6 hours.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Bowel perforation · Question ID: CCRN-A-EHGRI-18
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Source control good-practice statement and recommendation

Correct answer: D. Treat it as a cue to do a validated pain assessment, not as proof of pain

PADIS states that vital signs are not valid indicators of pain in critically ill adults. They should be used only as cues to start a further assessment with a valid method, such as a behavioral pain tool.

Why the other choices don't fit

• A. It rules out pain, because the values return to baseline — Vital signs can't rule pain in or out.
• B. It confirms pain, so give an opioid bolus without further assessment — Vital sign changes alone don't validate pain.
• C. It indicates undersedation, so increase the sedative infusion — Deeper sedation isn't a substitute for assessing and treating pain.

Takeaway: Changes in vital signs prompt a pain assessment. They don't answer it.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Pain · Question ID: CCRN-A-MNBP-16
Source: SCCM, 2018 PADIS recommendations, Pain assessment: vital signs are cues, not valid pain measures by themselves

Correct answer: A. Continue temperature control for at least 36 hours

The 2025 AHA post-cardiac arrest guideline says it is reasonable to maintain temperature control for at least 36 hours in adults who remain unresponsive to verbal commands after ROSC. Fever after an initial period of temperature control is associated with poor outcomes.

Why the other choices don't fit

• B. Stop, because temperature control only matters if cooling began before hospital arrival — Prehospital cooling isn't the determining factor.
• C. Stop at 24 hours, because the patient is past the highest-risk window — The recommended minimum is 36 hours.
• D. Stop, and treat fever only if it exceeds 39°C — Post-arrest care focuses on preventing fever, not tolerating it.

Takeaway: For a comatose patient after cardiac arrest, temperature control lasts at least 36 hours.

Content area: Multisystem · Topic: Anoxic injury · Question ID: CCRN-A-MULTI-14
Source: American Heart Association, 2025 Guidelines Part 11: Post–Cardiac Arrest Care, Temperature control: at least 36 hours total temperature control is reasonable for adults unresponsive to verbal commands after ROSC

Correct answer: A. Improve compression quality, including depth and full recoil, and reassess ETCO2

ETCO2 during CPR reflects cardiac output. AHA suggests targeting compressions to reach at least 10 mm Hg and ideally 20 mm Hg or more. A low value early in the resuscitation is a prompt to improve CPR, not to stop.

Why the other choices don't fit

• B. Ignore ETCO2 because it isn't valid during CPR — AHA supports using ETCO2 to monitor and optimize CPR quality.
• C. Stop resuscitation because ETCO2 is below 10 — An early ETCO2 value is not a reason to stop resuscitation. AHA warns against using ETCO2 alone to decide when to terminate efforts.
• D. Increase the ventilation rate to raise ETCO2 — Over-ventilating doesn't improve blood flow and can impair it.

Takeaway: Low ETCO2 during CPR prompts reassessment of compression quality, ventilation, and reversible causes—not automatically deeper compressions or stopping resuscitation.

Content area: Respiratory · Topic: Airway management (TNA: capnography) · Question ID: CCRN-A-RESP-11
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §12 recommendation 6; §13 recommendation 4

Correct answer: D. Re-explain it in a different, simpler way, then ask him to teach it back again

Teach-back tests how well the information was explained, not the patient. AHRQ frames it as a way to confirm that information was explained clearly. When the explanation doesn't land, the nurse clarifies and checks again.

Why the other choices don't fit

• A. Give him the handout and move on — Written material reinforces teaching but doesn't confirm understanding.
• B. Document that he failed the teaching — Teach-back isn't a pass-or-fail test of the patient.
• C. Repeat the same explanation word for word, louder — If it didn't work the first time, it needs a different approach.

Takeaway: If the teach-back is wrong, the explanation needs work. Re-teach and re-check.

Content area: Professional Caring & Ethical Practice · Topic: Facilitation of Learning · Question ID: CCRN-A-PCEP-18
Source: AHRQ TeamSTEPPS, Tool: Teach-Back, Tool: Teach-Back

Correct answer: A. Include anaerobic coverage, because an intra-abdominal source is a risk factor

SSC suggests an empiric regimen with anaerobic coverage when there are specific risk factors, and it lists intra-abdominal infection among them. Without such risk factors, it suggests leaving anaerobic coverage out.

Why the other choices don't fit

• B. Add empiric antifungal therapy routinely — SSC suggests against routine empiric antifungals, considering them case by case.
• C. Anaerobic coverage isn't needed until cultures confirm anaerobes — Coverage is chosen empirically from risk factors, before cultures result.
• D. Leave out anaerobic coverage for all sepsis — That applies only to patients without anaerobic risk factors.

Takeaway: Intra-abdominal source means anaerobic coverage.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Peritonitis / intra-abdominal infection · Question ID: CCRN-A-EHGRI-19
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Anaerobic coverage and antifungal recommendations

Correct answer: D. Target light sedation, with regular assessment and adjustment to the patient’s needs

PADIS suggests light rather than deep sedation for mechanically ventilated adults. The goal should be assessed and individualized; this case supplies no competing reason for deep sedation.

Why the other choices don't fit

• A. Choose the infusion rate once and stop reassessing the sedation level — A sedation goal requires repeated assessment. An unchanging infusion rate does not establish that the goal is being met.
• B. A goal of no response to voice for every ventilated patient — A fixed deep target ignores this patient’s condition and the light-sedation recommendation.
• C. Deep sedation throughout ventilation, even when no clinical indication remains — PADIS favors light over deep sedation for most mechanically ventilated adults. Ventilation alone does not require continued deep sedation.

Takeaway: Use a light-sedation goal when no clinical indication for deeper sedation is present, and reassess it.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Agitation (TNA: sedation) · Question ID: CCRN-A-MNBP-17
Source: SCCM, 2018 PADIS recommendations, Agitation/sedation: light rather than deep sedation in mechanically ventilated adults

Correct answer: C. Continue high-quality CPR and epinephrine. Pacing isn't recommended for established asystolic arrest.

AHA gives routine pacing during an established arrest a 'no benefit' recommendation. Pacing hasn't improved ROSC or survival, and checking for capture interrupts compressions.

Why the other choices don't fit

• A. Start pacing at maximum output and check for capture — This contradicts the no-benefit recommendation and interrupts CPR.
• B. Make pacing the priority over epinephrine — Epinephrine is recommended in cardiac arrest. Routine pacing is not.
• D. Pause compressions for 30 seconds to confirm capture — Long pauses in compressions can reduce survival.

Takeaway: Pacing is for bradycardia with a pulse, not for established asystole.

Content area: Cardiovascular · Topic: Dysrhythmias (cardiac arrest) · Question ID: CCRN-A-CV-12
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §8 Nondefibrillation Electrical Therapies; §10 rec 1

Correct answer: C. MAP of at least 65 mm Hg

AHA's 2025 post-arrest guideline supports a MAP target of at least 65 mm Hg. Higher targets haven't shown benefit in trials comparing MAP goals after arrest.

Why the other choices don't fit

• A. MAP of at least 90 mm Hg — Routinely higher targets aren't supported.
• B. Systolic of at least 160 mm Hg — There's no systolic target like this in post-arrest care.
• D. MAP of 55–60 mm Hg — This is below the supported minimum.

Takeaway: After ROSC, keep MAP at 65 mm Hg or higher.

Content area: Multisystem · Topic: Anoxic injury · Question ID: CCRN-A-MULTI-15
Source: American Heart Association, 2025 Guidelines Part 11: Post–Cardiac Arrest Care, §5 Blood Pressure in Adults After Cardiac Arrest: maintain MAP at least 65 mm Hg

Correct answer: B. Injection technique, glucose monitoring, blood or urine ketone testing, and when to call for help

The consensus says education should review injection technique, glucose monitoring, and ketone testing, along with when to call for assistance and sick-day advice. Structured education with problem-solving reduces DKA admissions.

Why the other choices don't fit

• A. Teaching deferred to the outpatient clinic — Education should happen before discharge.
• C. A handout to read at home, without discussion — Structured education with problem-solving is what reduces readmissions.
• D. Diet teaching only — The core content is broader and centers on insulin and monitoring.

Takeaway: DKA discharge teaching covers insulin, glucose, ketones, and when to call.

Content area: Professional Caring & Ethical Practice · Topic: Facilitation of Learning · Question ID: CCRN-A-PCEP-19
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 7, Prevention

Correct answer: B. Stage 2

2.1 ÷ 0.9 = 2.33 times baseline. KDIGO stages a creatinine of 2.0–2.9 times baseline as stage 2. Stage 1 includes 1.5–1.9 times baseline or an increase of at least 0.3 mg/dL within 48 hours. Stage 3 includes 3.0 times baseline or more, creatinine of at least 4.0 mg/dL, or initiation of renal replacement therapy. This question asks about the creatinine criteria, not an unstated urine-output history.

Why the other choices don't fit

• A. Stage 3 — It hasn't reached 3 times baseline or 4.0 mg/dL, and RRT hasn't started.
• C. Stage 1 — The rise is more than 2 times baseline, which puts it past stage 1.
• D. Not AKI by KDIGO criteria — A rise of 1.5 times baseline or more within 7 days meets the definition.

Takeaway: Divide by baseline: 1.5–1.9 is stage 1, 2.0–2.9 is stage 2, and 3.0 or more is stage 3.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Acute kidney injury (AKI) · Question ID: CCRN-A-EHGRI-20
Source: KDIGO Clinical Practice Guideline for Acute Kidney Injury, §2.1.1 and Table 2, printed p. 8/PDF p. 11: AKI definition and staging

Correct answer: A. Clarify the treatment goal and review reversible causes and nonpharmacologic care rather than automatically starting haloperidol to shorten delirium

The 2025 PADIS focused update was unable to recommend for or against antipsychotics for treating ICU delirium. A positive screen alone does not establish a benefit from scheduled haloperidol. Review the stated goal, reversible contributors, and the nonpharmacologic measures supported by PADIS.

Why the other choices don't fit

• B. Give it as ordered, because antipsychotics shorten ICU delirium — The 2025 focused update could not recommend for or against antipsychotics for ICU delirium. It does not establish that scheduled haloperidol will shorten delirium in this calm patient.
• C. Stop CAM-ICU screening now that delirium is identified — PADIS calls for regular delirium assessment with a valid tool.
• D. Change to a scheduled benzodiazepine instead — Routine benzodiazepines are not the answer to this calm patient’s hypoactive delirium. No separate indication for a benzodiazepine is supplied in the case.

Takeaway: A positive CAM-ICU doesn't automatically mean haloperidol.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Delirium · Question ID: CCRN-A-MNBP-18
Source: SCCM, 2018 PADIS recommendations, Delirium treatment recommendation
Source: SCCM, 2025 focused PADIS update, Delirium: unable to recommend for or against antipsychotics for ICU delirium

Correct answer: D. Possible return of spontaneous circulation (ROSC)

AHA notes that an abrupt rise in ETCO2 may be used to detect ROSC during compressions. A sudden rise of more than 10 mm Hg can signal ROSC.

Why the other choices don't fit

• A. Epinephrine is due — Drug timing doesn't explain a sudden, large rise in ETCO2.
• B. The endotracheal tube has dislodged — A dislodged tube causes a drop or loss of the ETCO2 waveform, not a jump.
• C. The patient is being hyperventilated — Hyperventilation lowers ETCO2. It doesn't raise it.

Takeaway: A sudden ETCO2 jump during CPR should prompt a check for ROSC.

Content area: Respiratory · Topic: Airway management (TNA: capnography) · Question ID: CCRN-A-RESP-12
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §12 recommendation 1 and supportive text

Correct answer: A. This sedated examination cannot determine the outcome. Prognosis uses several assessments after confounders are addressed, with the consolidated assessment generally at least 72 hours after normothermia and sedatives have been discontinued.

AHA recommends multimodal neuroprognostication, not a conclusion from one early finding. It is reasonable to consolidate the assessment at least 72 hours after normothermia and discontinuation of sedatives, while addressing other confounders. A motor examination 24 hours after ROSC during sedation cannot establish a definitive neurologic prognosis.

Why the other choices don't fit

• B. A normal head CT today guarantees recovery — No single test establishes prognosis, favorable or unfavorable.
• C. Recovery depends mostly on how long CPR lasted — Resuscitation duration alone isn't how prognosis is decided.
• D. Yes. No motor response at 24 hours confirms a poor outcome. — A single early exam confounded by sedation isn't reliable.

Takeaway: Neuroprognosis after arrest takes time and several tests.

Content area: Multisystem · Topic: Anoxic injury / end-of-life · Question ID: CCRN-A-MULTI-16
Source: American Heart Association, 2025 Guidelines Part 11: Post–Cardiac Arrest Care, §14.2 General Considerations for Neuroprognostication, particularly recommendation 4 and supportive text

Correct answer: B. Use the qualified interpreter

National CLAS Standard 7 calls for ensuring the competence of individuals providing language assistance, and states that using untrained individuals and/or minors as interpreters should be avoided.

Why the other choices don't fit

• A. Delay the discussion until an in-person interpreter can come tomorrow — A qualified video interpreter is available now. Delaying isn't necessary.
• C. Let the son interpret, since the family prefers it — A qualified interpreter is available. CLAS advises avoiding untrained individuals and minors as interpreters; the son’s offer does not replace competent language assistance.
• D. Proceed in English slowly with gestures — That doesn't provide meaningful language access.

Takeaway: Use the available qualified interpreter; avoid relying on untrained family members or minors for interpretation.

Content area: Professional Caring & Ethical Practice · Topic: Response to Diversity · Question ID: CCRN-A-PCEP-20
Source: HHS Office of Minority Health, National CLAS Standards, National CLAS Standards 5 and 7: language assistance and interpreter competence

Correct answer: B. Intraosseous (IO) access

AHA recommends trying IV access first and calls IO access reasonable when IV attempts fail or are not feasible. Central access may be considered when IV and IO access are unsuccessful or not feasible.

Why the other choices don't fit

• A. Place a central line before trying IO — Central access is a later option, considered only when both IV and IO access fail or aren't feasible.
• C. Give epinephrine down the endotracheal tube — AHA removed endotracheal drug delivery from the guidelines because blood levels are low and unpredictable.
• D. Hold medications until a central line is placed — That delays a recommended drug with no benefit.

Takeaway: Try IV access first; use IO when IV attempts fail or are not feasible. Central access is a later option when IV and IO are unsuccessful or not feasible.

Content area: Cardiovascular · Topic: Cardiac arrest (vascular access) · Question ID: CCRN-A-CV-13
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §9 Vascular Access, recs 1–3 and synopsis

Correct answer: C. 0.25 mL/kg/h, which meets stage 1

160 mL ÷ 80 kg ÷ 8 h = 0.25 mL/kg/h. Urine output below 0.5 mL/kg/h for 6–12 hours is stage 1. Stage 2 needs below 0.5 mL/kg/h for 12 hours or more, and stage 3 needs below 0.3 mL/kg/h for 24 hours or more, or anuria for 12 hours.

Why the other choices don't fit

• A. 0.25 mL/kg/h, which is stage 3 because it's below 0.3 — Stage 3 by urine output needs 24 hours or more below 0.3 mL/kg/h. Eight hours doesn't qualify.
• B. 2.0 mL/kg/h, so no AKI — This divides by weight but not by the 8-hour duration: 160 ÷ 80 = 2 mL/kg over 8 hours, not 2 mL/kg each hour.
• D. 0.5 mL/kg/h, so no AKI — The math is off: the hourly rate is 20 mL, which is 0.25 mL/kg/h.

Takeaway: Urine-output staging needs both the rate and the duration.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Acute kidney injury (AKI) · Question ID: CCRN-A-EHGRI-21
Source: KDIGO Clinical Practice Guideline for Acute Kidney Injury, §2.1.1 and Table 2, printed p. 8/PDF p. 11: urine-output rate and duration

Correct answer: B. A multicomponent nonpharmacologic program targeting sleep, mobility, cognition, hearing, and vision

PADIS suggests a multicomponent, nonpharmacologic intervention focused on reducing modifiable risk factors, improving cognition, and optimizing sleep, mobility, hearing, and vision. Single-component bright light therapy isn't suggested.

Why the other choices don't fit

• A. Routine statin therapy — Statins aren't recommended for delirium.
• C. Bright light therapy on its own — PADIS suggests not using bright light therapy alone to reduce delirium.
• D. Scheduled nighttime benzodiazepines for sleep — Benzodiazepines are associated with delirium risk. They aren't a sleep strategy for this purpose.

Takeaway: Delirium responds to bundles, not single fixes.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Delirium / sleep disruption · Question ID: CCRN-A-MNBP-19
Source: SCCM, 2018 PADIS recommendations, Delirium prevention recommendations

Correct answer: B. Clearly, in the patient's preferred language, both verbally and in writing

CLAS Standard 6 calls for informing all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. Standard 5 adds that the assistance is offered at no cost.

Why the other choices don't fit

• A. In English on the admission paperwork — That fails to reach patients who don't read English.
• C. Verbally only, to save time — The standard specifies both verbal and written notice.
• D. Only if the patient asks — The standard calls for proactively informing everyone.

Takeaway: Tell patients about language services in their language, out loud and in writing.

Content area: Professional Caring & Ethical Practice · Topic: Response to Diversity · Question ID: CCRN-A-PCEP-21
Source: HHS Office of Minority Health, National CLAS Standards, National CLAS Standards 6 and 8: oral/written information and understandable materials

Correct answer: A. Start contact precautions with gown and gloves while the test is pending

CDC recommends isolating patients and starting contact precautions for suspected or confirmed C. difficile infection. Use gown and gloves, dedicated equipment, and the facility’s hand-hygiene process. Current CDC guidance calls for sporicidal environmental cleaning; STRIVE training favors soap and water during outbreaks or high endemic rates.

Why the other choices don't fit

• B. Use alcohol hand rub alone, without gloves — Hand hygiene does not replace gown and gloves for contact precautions. Follow the facility’s hand-hygiene policy as well as the required protective equipment.
• C. Place the patient on droplet precautions — C. difficile spreads by contact, not droplets.
• D. Wait for a positive result before isolating — Precautions start when the infection is suspected, not after confirmation.

Takeaway: Suspected C. difficile: start contact precautions while testing proceeds, with gown, gloves, and appropriate hand hygiene.

Content area: Multisystem · Topic: Healthcare-associated infections · Question ID: CCRN-A-MULTI-17
Source: CDC STRIVE, C. difficile Infection: Preventing Transmission, Contact precautions, hand hygiene, and environmental cleaning sections
Source: CDC, Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, Isolate and initiate contact precautions for suspected/confirmed cases; environmental cleaning with a sporicidal agent

Correct answer: C. Regional citrate anticoagulation

KDIGO suggests regional citrate anticoagulation rather than heparin for CRRT in patients without contraindications to citrate. Heparin is suggested when citrate is contraindicated.

Why the other choices don't fit

• A. Low-molecular-weight heparin as the first choice — KDIGO favors regional citrate for this case. Unfractionated or low-molecular-weight heparin is an alternative when citrate is contraindicated and the other anticoagulation conditions are met.
• B. Systemic unfractionated heparin — For this CRRT patient who is suitable for citrate, KDIGO suggests regional citrate rather than heparin. Other systemic-anticoagulation indications would need their own assessment.
• D. No anticoagulation in any patient — The guideline gives a preferred anticoagulant for CRRT when it isn't contraindicated.

Takeaway: For a suitable CRRT patient who needs circuit anticoagulation, KDIGO suggests regional citrate over heparin.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: AKI (TNA: CRRT) · Question ID: CCRN-A-EHGRI-22
Source: KDIGO Clinical Practice Guideline for Acute Kidney Injury, §5.3.2.2, printed p. 10/PDF p. 13; CRRT anticoagulation decision path

Correct answer: C. Venovenous ECMO

SSC suggests venovenous ECMO for severe sepsis-related ARDS when conventional mechanical ventilation fails, in centers with the experience and infrastructure to support it.

Why the other choices don't fit

• A. Routine IV vitamin C instead of evaluating ECMO — SSC suggests against IV vitamin C for sepsis or septic shock. It is not the recommended rescue pathway for this severe ARDS case.
• B. Increasing tidal volume to 10 mL/kg to improve oxygenation — SSC strongly recommends 6 mL/kg over high tidal volumes because of ventilator-induced lung injury.
• D. Accepting a plateau pressure of 35 cm H2O to recruit more lung — SSC recommends an upper limit of 30 cm H2O for plateau pressure.

Takeaway: When lung-protective care fails in severe ARDS, consider VV ECMO, not higher pressures.

Content area: Respiratory · Topic: Acute respiratory distress syndrome (ARDS) (TNA: ECMO) · Question ID: CCRN-A-RESP-13
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mechanical ventilation: VV ECMO when conventional ventilation fails; plateau/tidal-volume limits; IV vitamin C recommendation

Correct answer: A. Emergency coronary angiography

AHA's 2025 post-arrest guideline supports emergency coronary angiography after ROSC when the ECG shows ST elevation and a cardiac cause is suspected. Being comatose doesn't change that indication.

Why the other choices don't fit

• B. Elective angiography before discharge — Before-discharge angiography applies to survivors without an emergency indication. Persistent ST elevation is an emergency indication.
• C. A head CT only, with no cardiac workup — Imaging to look for other causes can be useful, but it doesn't replace angiography for STEMI.
• D. Delay angiography until a definitive neurologic prognosis is available — Prognostication timing doesn't override the time-sensitive treatment of an ST-elevation infarction.

Takeaway: ST elevation after ROSC points to the cath lab, even in a comatose patient.

Content area: Cardiovascular · Topic: Acute coronary syndrome · Question ID: CCRN-A-CV-14
Source: American Heart Association, 2025 Guidelines Part 11: Post–Cardiac Arrest Care, Coronary angiography: emergency angiography for persistent ST elevation with suspected cardiac cause, regardless of coma

Correct answer: D. Dexmedetomidine

PADIS suggests dexmedetomidine for delirium in mechanically ventilated adults when agitation is keeping them from weaning or extubation.

Why the other choices don't fit

• A. Deepening propofol sedation to RASS −4 — Deeper sedation works against weaning and extubation.
• B. Lorazepam boluses as needed — Lorazepam is not the agent named in the PADIS suggestion for agitation preventing extubation. No separate indication for lorazepam is supplied here.
• C. Scheduled haloperidol — The 2025 update could not recommend for or against antipsychotics for ICU delirium. The more specific PADIS suggestion for agitation preventing ventilator liberation is dexmedetomidine.

Takeaway: When delirium-related agitation blocks extubation, PADIS suggests dexmedetomidine.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Agitation / delirium · Question ID: CCRN-A-MNBP-20
Source: SCCM, 2018 PADIS recommendations, Dexmedetomidine for delirium recommendation
Source: SCCM, 2025 focused PADIS update, Delirium: unable to recommend for or against antipsychotics for ICU delirium

Correct answer: D. Make room for the ritual and coordinate timing with the procedure team

AACN's Synergy Model defines response to diversity as recognizing, appreciating, and incorporating differences into care, including spiritual beliefs and values. When a practice is safe, incorporating it is part of the nurse's role.

Why the other choices don't fit

• A. Decline, because the ICU must be a neutral space — That refuses a safe practice the Synergy Model asks nurses to incorporate.
• B. Refer the request to chaplaincy without responding — Chaplaincy may help, but the nurse can respond directly and coordinate.
• C. Allow it only after the procedure — Delaying the ritual may defeat its purpose, and it poses no safety conflict.

Takeaway: Safe spiritual practices belong in the plan of care.

Content area: Professional Caring & Ethical Practice · Topic: Response to Diversity · Question ID: CCRN-A-PCEP-22
Source: AACN CCRN Exam Handbook — Direct Care Eligibility Pathway, Synergy Model, p. 9: Response to Diversity

Correct answer: C. Don't start renal replacement therapy without a definitive indication, and keep monitoring

SSC suggests against renal replacement therapy for sepsis-associated AKI when there's no definitive indication. When RRT is warranted, either continuous or intermittent therapy is acceptable.

Why the other choices don't fit

• A. Start CRRT now to protect the kidneys — Starting RRT without a definitive indication is what SSC suggests against.
• B. Give sodium bicarbonate to prevent the need for dialysis — Bicarbonate is suggested only for specific severe acidemia with AKI, not as routine kidney protection.
• D. Start intermittent hemodialysis instead — Changing the modality doesn't fix the lack of an indication.

Takeaway: In septic AKI, start RRT for an indication, not a number or a hope.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Acute kidney injury (AKI) · Question ID: CCRN-A-EHGRI-23
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Renal replacement therapy recommendations

Correct answer: D. Admit to the ICU within 6 hours

SSC suggests admitting adults with sepsis or septic shock who require ICU care to the ICU within 6 hours. That gives the team a concrete target to escalate against.

Why the other choices don't fit

• A. ICU admission timing doesn't matter if care is ongoing — SSC gives a specific suggested time frame.
• B. Keep the patient in the ED until vasopressors are weaned — Needing vasopressors is a reason for ICU care, not a reason to delay it.
• C. Admit within 24 hours — That is well beyond the suggested window.

Takeaway: Septic shock patients who need the ICU should get there within 6 hours.

Content area: Multisystem · Topic: Sepsis · Question ID: CCRN-A-MULTI-18
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, ICU admission recommendation

Correct answer: B. Dexmedetomidine

The 2025 focused update suggests dexmedetomidine over propofol for sedation in mechanically ventilated adults when light sedation and/or delirium reduction are priorities. It's a conditional suggestion, so individual patient factors still matter.

Why the other choices don't fit

• A. Lorazepam — Like midazolam, it's a benzodiazepine, and benzodiazepines aren't the suggested choice for these goals.
• C. Midazolam — Benzodiazepines aren't the suggested agent for light sedation and delirium reduction.
• D. Propofol — Propofol is the comparator. When these priorities apply, the update favors dexmedetomidine over it.

Takeaway: Light sedation plus delirium reduction as goals: dexmedetomidine is suggested over propofol.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Agitation (TNA: sedation) · Question ID: CCRN-A-MNBP-21
Source: SCCM, 2025 focused PADIS update, Sedation recommendation

Correct answer: C. Higher PEEP rather than lower PEEP

SSC suggests higher PEEP over lower PEEP in sepsis-associated moderate-to-severe ARDS. This is a conditional recommendation, not a fixed PEEP value for every patient; response and tolerance still require assessment.

Why the other choices don't fit

• A. Zero PEEP during proning — Nothing in the guidance supports removing PEEP during proning.
• B. Use the same PEEP for every ARDS patient regardless of severity or response — The guideline distinguishes ARDS severity rather than prescribing one PEEP value for every patient. A fixed setting that ignores response is not this recommendation.
• D. Lower PEEP, to limit hemodynamic effects — This is the opposite of the suggestion for moderate-to-severe ARDS.

Takeaway: In sepsis-associated moderate-to-severe ARDS, higher rather than lower PEEP is suggested; individual response and tolerance still matter.

Content area: Respiratory · Topic: Acute respiratory distress syndrome (ARDS) · Question ID: CCRN-A-RESP-14
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mechanical ventilation: higher versus lower PEEP in moderate-to-severe ARDS

Correct answer: A. Screen for economic and social support needs and refer to available resources

SSC includes a good-practice statement that hospitals and health systems should screen sepsis survivors for economic and social support needs, including housing, nutrition, financial, and spiritual support, and make referrals where available.

Why the other choices don't fit

• B. Note it and proceed, since social issues are outside the medical plan — Unmet social needs threaten recovery, and the statement asks systems to act.
• C. Extend her hospital stay until she finds housing on her own — Keeping her in the hospital isn't a social-needs strategy.
• D. Refer only if she requests it in writing — Screening and referral are proactive.

Takeaway: Screening for social needs is part of sepsis discharge planning.

Content area: Professional Caring & Ethical Practice · Topic: Systems Thinking · Question ID: CCRN-A-PCEP-23
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Patient support good-practice statement

Correct answer: B. Unstageable pressure injury

NPIAP defines an unstageable pressure injury as full-thickness skin and tissue loss in which slough or eschar hides the extent of damage. Once that tissue is removed, the wound will turn out to be stage 3 or stage 4.

Why the other choices don't fit

• A. Stage 2 pressure injury — Stage 2 is partial thickness with a viable pink or red bed, and no slough or eschar.
• C. Stage 4 pressure injury — Stage 4 requires exposed or palpable fascia, muscle, tendon, cartilage, or bone, and that can't be confirmed here.
• D. Deep tissue pressure injury — DTPI describes persistent deep red, maroon, or purple discoloration. It isn't used for an open wound covered with slough.

Takeaway: When slough or eschar obscures the extent of a full-thickness pressure injury, it is unstageable.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Pressure injury · Question ID: CCRN-A-EHGRI-24
Source: National Pressure Injury Advisory Panel, Pressure Injury Stages, Stage definitions: Stage 2, Stage 4, Unstageable, DTPI

Correct answer: D. Adding dobutamine to the norepinephrine

For septic shock with cardiac dysfunction and persistent hypoperfusion despite adequate fluids and blood pressure, the 2026 Surviving Sepsis Campaign suggests adding dobutamine to norepinephrine, or using epinephrine alone. Adding dobutamine while retaining norepinephrine is the option offered here.

Why the other choices don't fit

• A. Replacing norepinephrine with dobutamine — Dobutamine alone does not replace the vasopressor support this patient still needs. SSC offers adding dobutamine to norepinephrine or using epinephrine alone, which supplies both vasopressor and inotropic effects.
• B. Starting levosimendan — SSC suggests against levosimendan in this situation.
• C. Titrating norepinephrine to a MAP of 85 mm Hg — SSC recommends an initial MAP target of 65 mm Hg over higher targets. The problem here is forward flow, not pressure.

Takeaway: Adequate pressure with persistent hypoperfusion and a weak heart points to adding an inotrope.

Content area: Cardiovascular · Topic: Cardiogenic shock / cardiac dysfunction · Question ID: CCRN-A-CV-15
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Inotropes and MAP target recommendations

Correct answer: C. Active fluid removal with diuretics, and ultrafiltration if diuretics aren't enough

SSC suggests active fluid removal after the acute resuscitation phase. It defines this as diuretics and, if they are insufficient, ultrafiltration or extracorporeal removal, guided by cardiorespiratory status, vasopressor dose, edema, weight, and fluid balance.

Why the other choices don't fit

• A. Wait for fluid to mobilize on its own after discharge — Active removal is suggested, not passive waiting.
• B. Continue maintenance fluids at the same rate — This ignores the fluid overload the guideline addresses.
• D. Give another bolus to protect the kidneys — More fluid in an overloaded patient past resuscitation isn't supported.

Takeaway: Once resuscitation is over, de-resuscitate.

Content area: Multisystem · Topic: Fluid and electrolyte imbalances · Question ID: CCRN-A-MULTI-19
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Active fluid removal recommendation and remark

Correct answer: D. Screen for depression with a validated tool such as the PHQ-9, assess diabetes distress, and involve the care team

The 2024 consensus calls for screening people with a hyperglycemic crisis for mental health concerns. It identifies the PHQ-9 as a validated depression screen in diabetes. Screening should be accompanied by discussion of diabetes distress and practical barriers, not an assumption that recurrent DKA is only a technique problem.

Why the other choices don't fit

• A. Attribute it to hyperglycemia and reassess after discharge — Symptoms can overlap, but the consensus calls for screening, not assumption.
• B. Refer to psychiatry only if she states a suicide plan — Screening shouldn't wait for an explicit plan in a high-risk group.
• C. Focus discharge teaching only on insulin technique — Recurrent DKA is strongly linked to mental health and social factors, not just technique.

Takeaway: Recurrent DKA is a cue to screen for depression and distress.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Mood disorders, depression, anxiety · Question ID: CCRN-A-MNBP-22
Source: Umpierrez et al., Hyperglycaemic crises in adults with diabetes: a consensus report, Section 1, Risk factors (mental health, PHQ-9); Section 7

Correct answer: C. Help patients access assessment and follow-up for physical, cognitive, and emotional problems after discharge

SSC states that health systems should facilitate assessment and follow-up for physical, cognitive, and emotional problems after sepsis, and suggests offering post-critical-illness follow-up services.

Why the other choices don't fit

• A. A single phone call to confirm medications — That falls short of facilitated assessment and follow-up.
• B. No follow-up unless readmitted — The guidance calls for proactive follow-up.
• D. Follow-up for physical problems only — Cognitive and emotional problems are explicitly included.

Takeaway: Sepsis recovery follow-up covers body, mind, and mood.

Content area: Professional Caring & Ethical Practice · Topic: Systems Thinking · Question ID: CCRN-A-PCEP-24
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Post-hospital evaluation statements and recommendation

Correct answer: A. Leave the eschar intact, offload the heel, and monitor for signs of instability

NPIAP states that stable eschar on the heel or on an ischemic limb (dry, adherent, intact, without erythema or fluctuance) should not be softened or removed.

Why the other choices don't fit

• B. Cover it with a moist occlusive dressing to lift the eschar — That's another way of softening the eschar.
• C. Sharp-debride the eschar at the bedside so the wound can be staged — Removing stable heel eschar on an ischemic limb isn't recommended just to allow staging.
• D. Apply an enzymatic agent to soften the eschar — Softening stable heel eschar is what NPIAP advises against.

Takeaway: Stable heel eschar on an ischemic limb stays in place. Offload and watch.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Pressure injury / wounds · Question ID: CCRN-A-EHGRI-25
Source: National Pressure Injury Advisory Panel, Pressure Injury Stages, Unstageable pressure injury definition, stable eschar statement
Source: International Pressure Injury Guideline, Preventing Heel Pressure Injuries, H3: elevate heels completely from the support surface; implementation considerations

Correct answer: C. Choose either a conservative or a more liberal SpO2 target based on patient factors and resources

SSC suggests titrating FiO2 to either higher (more liberal) or lower (conservative) oxygen targets depending on patient factors and resource limits. Most trials used a lower target of about 90–93% and a higher target of 96% or more.

Why the other choices don't fit

• A. Maintain SpO2 at 100% at all times — A universal target of 100% is not the individualized approach SSC describes. The saturation alone also does not quantify how much oxygen is being delivered.
• B. Fix FiO2 at 1.0 until the patient improves — Fixed maximal oxygen ignores titration entirely.
• D. Accept an SpO2 of 80% to conserve oxygen — That is far below the ranges studied.

Takeaway: Oxygen targets in sepsis are titrated and individualized, not maximal and not permissive to the extreme.

Content area: Respiratory · Topic: Acute respiratory failure · Question ID: CCRN-A-RESP-15
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Oxygen targets recommendation and remark

Correct answer: A. Continue epinephrine 1 mg every 3–5 minutes. Vasopressin offers no advantage as a substitute.

AHA recommends epinephrine in cardiac arrest and says 1 mg every 3–5 minutes is reasonable. Vasopressin alone, or combined with epinephrine, offers no advantage as a substitute for epinephrine. High-dose epinephrine isn't recommended for routine use either.

Why the other choices don't fit

• B. Replace epinephrine with vasopressin for the rest of the code — Trials and meta-analyses found no survival advantage for vasopressin as a substitute.
• C. Switch to high-dose epinephrine because standard doses have failed — High-dose epinephrine isn't recommended for routine use.
• D. Stop vasopressors, because they don't improve neurological outcome — Epinephrine improves ROSC and short-term survival, which are prerequisites for any recovery, and it remains standard therapy.

Takeaway: In cardiac arrest, standard-dose epinephrine every 3–5 minutes remains the vasopressor.

Content area: Cardiovascular · Topic: Dysrhythmias (cardiac arrest) · Question ID: CCRN-A-CV-16
Source: American Heart Association, 2025 Guidelines Part 9: Adult Advanced Life Support, §10 Vasopressor Medications, recs 1, 2, 5, 6 and supportive text

Correct answer: C. Don't give sodium bicarbonate to improve hemodynamics or reduce vasopressor needs. Continue treating the shock.

SSC suggests against sodium bicarbonate for hypoperfusion-induced lactic acidemia to improve hemodynamics or reduce vasopressor requirements. Separately, it suggests bicarbonate for severe metabolic acidemia (pH 7.2 or below) with AKIN stage 2 or 3 acute kidney injury, and this patient meets neither condition.

Why the other choices don't fit

• A. Give bicarbonate whenever lactate is above 4 mmol/L — Lactate level isn't the criterion for bicarbonate.
• B. Give bicarbonate to reduce the norepinephrine dose — This is the use SSC suggests against.
• D. Give bicarbonate because any pH below 7.35 needs correction — The suggested use is limited to pH 7.2 or below with AKIN stage 2 or 3 acute kidney injury.

Takeaway: In septic shock, bicarbonate treats a specific subgroup, not the blood pressure.

Content area: Multisystem · Topic: Acid-base imbalance · Question ID: CCRN-A-MULTI-20
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Sodium bicarbonate recommendations

Correct answer: B. Refer for evaluation, and offer services that support mental health after discharge

SSC states that survivors with clinical symptoms of mental health disorders should be referred to appropriate professionals for evaluation and management. It suggests offering mental health support services after discharge.

Why the other choices don't fit

• A. Document the symptoms and defer them to the primary care visit in 6 months — That delays evaluation of current symptoms.
• C. Reassure the patient that these symptoms always fade on their own — Symptoms of a mental health disorder call for referral, not a promise of recovery.
• D. Start a benzodiazepine at discharge for the nightmares — Nothing here supports starting a sedative instead of evaluating the patient.

Takeaway: Psychological symptoms after sepsis deserve a referral, not reassurance.

Content area: Musculoskeletal, Neurological, Behavioral/Psychosocial · Topic: Post-intensive care syndrome (PICS) / PTSD · Question ID: CCRN-A-MNBP-23
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Mental health services recommendations

Correct answer: C. Coordinate with case management to arrange transportation and dialysis placement before discharge

AACN's Synergy Model defines systems thinking as using knowledge and tools to manage the environmental and system resources available to the patient and family, within or across healthcare and non-healthcare systems.

Why the other choices don't fit

• A. Keep him hospitalized for dialysis indefinitely — That misuses resources instead of mobilizing the right ones.
• B. Note the problem for the outpatient nephrologist — Documenting it doesn't close the gap before discharge.
• D. Discharge and tell him to find a ride — That leaves a resource gap for him to solve alone.

Takeaway: Systems thinking means lining up the resources before the patient needs them.

Content area: Professional Caring & Ethical Practice · Topic: Systems Thinking · Question ID: CCRN-A-PCEP-25
Source: AACN CCRN Exam Handbook — Direct Care Eligibility Pathway, Synergy Model, p. 9: Systems Thinking

Correct answer: C. Empiric antibiotics with anaerobic coverage, plus urgent surgical source control

SSC lists necrotizing soft-tissue infection among the risk factors that call for empiric anaerobic coverage, and it suggests early source control, ideally within 6 hours, for an anatomical source that needs it.

Why the other choices don't fit

• A. Antibiotics alone, with surgery only if they fail — Necrotic tissue needs anatomical source control. Antibiotics can't replace it.
• B. Routine empiric antifungal therapy — Antifungals aren't routine in sepsis. SSC considers them case by case.
• D. Antibiotics without anaerobic coverage, then reassess in 24 hours — This source is a named anaerobic risk factor, and delaying source control lets necrosis spread.

Takeaway: For necrotizing soft-tissue infection, cover anaerobes and get to the OR early.

Content area: Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary · Topic: Necrotizing fasciitis · Question ID: CCRN-A-EHGRI-26
Source: SCCM/ESICM, Surviving Sepsis Campaign adult recommendations, Anaerobic coverage remark; source control recommendation