The Adult CCRN exam is a challenging and comprehensive assessment for men and women who want to enter this exciting and rewarding field of health care. The exam requires three hours and consists of 150 multiple-choice questions. Each version of the test contains 25 pretest questions, which do not contribute to the final score.These questions, which are impossible to identify, help with development of future versions of the exam. An unofficial score report is provided immediately after the test has been completed.
The Adult CCRN exam is divided into two parts: the larger portion comprising 80 percent of the exam, clinical judgment; and the section on professional caring and ethical practice, making up 20 percent.
The area on clinical judgment covers nine domains:
- The cardiovascular section (20 percent of the exam) includes issues such as acute pulmonary edema, cardiogenic shock, heart failure, and hypovolemic shock.
- In the pulmonary section (18 percent), questions address conditions such as acute respiratory failure, asthma, chronic bronchitis, and thoracic surgery.
- Questions in the endocrine section (5 percent) are related to acute hypoglycemia, diabetes insipidus, diabetic ketoacidosis, inborn errors of metabolism, and the syndrome of inappropriate secretic antidiuretic hormone.
- The hematology and immunology section of the Adult CCRN exam (2 percent) includes questions on coagulopathies.
- Neurology (12 percent) reviews acute spinal cord injury, brain death, head trauma, neurosurgery, and other issues.
- The section on the gastrointestinal system (6 percent) covers issues such as acute abdominal trauma, GI surgeries, bowel infarction, and hepatic failure.
- The renal domain (6 percent) addresses acute renal failure, chronic renal failure, and life-threatening electrolyte imbalances.
- The CCRN section on multisystem (8 percent) covers issues such as asphyxia, near-drowning, toxic ingestions, sepsis, and shock.
- The behavioral and psychosocial (4 percent) domain includes questions regarding abuse, neglect, delirium, developmental delays, and other similar topics.
The professional caring and ethical practice portion of the Adult CCRN exam features seven domains: advocacy and moral agency (3 percent of the exam); caring practices (4 percent); collaboration (4 percent); systems thinking (2 percent); responses to diversity (2 percent); clinical inquiry (2 percent); and the facilitation of learning (3 percent).
1. A ventilator assisted patient is found to have a pneumothorax and it is determined that a chest tube is warranted. Where on the patient should this be placed?
a. Superiorly to a rib in the mid-axillary line.
b. Inferiorly to a rib in the mid-axillary line.
c. Inferiorly to a rib in the mid-clavicular line.
d. Inferiorly to a rib in the posterior chest area.
2. A patient needs a femoral venous IV. Arrange the following anatomic structures in the femoral canal in order from lateral to medial.
a. Femoral nerve, femoral vein, femoral artery
b. Femoral vein, femoral artery, femoral nerve
c. Femoral nerve, femoral artery, femoral vein
d. Femoral artery, femoral vein, femoral nerve
3. Which of the following conditions does NOT cause intrinsic positive end expiratory pressure conditions in the lung?
c. Status asthmaticus
4. A patient over anti-coagulated with Coumadin has an INR of 6.5. Which of the following would reverse the effects of the drug and lower the INR to a non-dangerous range?
a. Packed RBCs
c. Fresh frozen plasma
d. Vitamin C
5. In the initial treatment for chest pain and possible acute coronary syndrome, which of the following medications is NOT routinely immediately given?
1. A: As the neurovascular bundle runs inferiorly under each rib, a chest tube should be placed superior to the rib, and the mid-axillary line is the optimum placement site.
2. C: The anatomic structural sequence from lateral to medial is femoral nerve, femoral artery, and femoral vein. When inserting a femoral line, placement medial to the palpated artery will yield placement in the vein.
3. D: ARDS, status asthmaticus, and COPD are all conditions that can cause intrinsic end expiratory pressures, and reducing the usual PEEP on a ventilator should be considered.
4. C: FFP will provide the coagulating factors that were inhibited by the Coumadin and reverse the condition.
5. D: Coumadin would not immediately be indicated for an acute chest pain patient. The mnemonic MONA (morphine, oxygen, nitrates, aspirin) is useful.