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CCRN (Adult)

CCRN practice questions, CCRN practice tests and CCRN exam prep for the AACN critical care certification

The CCRN got measurably harder to pass in the last three years. First-time pass rates fell from 81.20% in 2023 to 72.02% in 2025, and AACN reset the cut score in November 2025. Bedside experience alone stopped being enough somewhere in that window. What separates the nurses who pass is volume of exam-style questions worked and reviewed, not another read of a review book.

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  • Weighted the way the exam is: 80% clinical judgment, 20% professional caring
  • Every answer choice explained, including why the distractors look right
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The short answer

The CCRN (Adult) is AACN's critical care nursing certification exam. It has 150 items, of which 125 are scored and 25 are unscored pretest questions, with a three-hour time limit. You must answer 83 of the 125 scored items correctly to pass, a cut score that took effect on November 12, 2025. The exam is 80% Clinical Judgment and 20% Professional Caring and Ethical Practice. The fee is $260 for AACN members and $375 for nonmembers, and the 2025 first-time pass rate was 72.02% across 17,151 candidates. Aspirants.ai generates unlimited CCRN-style practice questions across the full test plan, explains every answer choice, and costs from $9 a month.

Last updated August 2026

Work the questions

Example CCRN questions with answers and explanations

Eight CCRN sample questions in the style AACN uses, weighted toward Clinical Judgment, which is 80% of the exam. Read every rationale, including why the wrong answers are wrong.

Question 1 · Cardiovascular

A patient two days after an anterior myocardial infarction has a cardiac index of 1.7 L/min/m2, a pulmonary artery occlusion pressure of 26 mmHg, and a systemic vascular resistance of 1,900 dynes/sec/cm-5. Skin is cool and mottled. These findings are most consistent with:

  1. A. Hypovolemic shock
  2. B. Cardiogenic shock
  3. C. Distributive shock
  4. D. Obstructive shock from cardiac tamponade
Show the answer and explanation

B. Cardiogenic shock

Read the three numbers as a pattern rather than individually. A cardiac index below 2.2 means the pump is failing to deliver. A pulmonary artery occlusion pressure of 26 means the left ventricle is not emptying and pressure is backing up, so the problem is not lack of volume. The elevated systemic vascular resistance is the compensatory vasoconstriction that produces the cool, mottled skin. Hypovolemic shock would show the same low index and high resistance but a low occlusion pressure, which is exactly how answer A is excluded. Distributive shock such as sepsis classically shows low resistance with a normal or high index, ruling out answer C. Tamponade can also raise filling pressures, but it equalizes them across all chambers and typically follows a different clinical story than a two-day-old anterior infarct.

Question 2 · Cardiovascular

A patient with an inferior wall myocardial infarction becomes hypotensive shortly after receiving sublingual nitroglycerin. A right-sided ECG shows ST elevation in V4R. The most appropriate next intervention is to:

  1. A. Administer an intravenous fluid bolus
  2. B. Give a second dose of nitroglycerin
  3. C. Start an intravenous beta blocker
  4. D. Begin a diuretic infusion
Show the answer and explanation

A. Administer an intravenous fluid bolus

ST elevation in V4R identifies right ventricular infarction, which complicates a large share of inferior infarcts and changes the management completely. The infarcted right ventricle cannot generate adequate output on its own, so it becomes entirely preload dependent: it needs high filling pressures to push blood through to the left side. Nitroglycerin drops preload, which is precisely why this patient crashed after receiving it, and that makes answer B actively dangerous. Volume is the treatment. Beta blockers reduce contractility and heart rate in a patient who needs both, so answer C is wrong, and diuretics remove the preload the right ventricle depends on, which rules out answer D. The reflex worth carrying into practice is that hypotension after nitrates in an inferior infarct means check the right ventricle.

Question 3 · Pulmonary

A patient with ARDS weighs 70 kg predicted body weight and is receiving volume control ventilation. Which ventilator settings best reflect current lung-protective practice?

  1. A. Tidal volume 700 mL, plateau pressure 35 cm H2O
  2. B. Tidal volume 420 mL, plateau pressure 28 cm H2O
  3. C. Tidal volume 560 mL, plateau pressure 32 cm H2O
  4. D. Tidal volume 840 mL, plateau pressure 26 cm H2O
Show the answer and explanation

B. Tidal volume 420 mL, plateau pressure 28 cm H2O

Lung-protective ventilation in ARDS targets roughly 6 mL/kg of predicted body weight with a plateau pressure at or below 30 cm H2O. For a 70 kg predicted body weight that is about 420 mL, which is answer B, and its plateau pressure of 28 sits under the ceiling. Two details make this question worth working through. First, the calculation uses predicted body weight derived from height and sex, not the patient's actual weight, because lung size does not increase with obesity. Second, both criteria have to be satisfied: answer D delivers 12 mL/kg, and although its plateau pressure looks acceptable, the volume itself causes the alveolar overdistension that drives ventilator-induced lung injury. Answers A and C exceed the plateau limit as well as the volume target.

Question 4 · Multisystem

A patient meets criteria for septic shock. According to current sepsis guidance, which set of interventions should be completed within the first hour?

  1. A. Blood cultures after antibiotics, and vasopressors only if fluids fail
  2. B. Measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics, begin 30 mL/kg crystalloid, and start vasopressors for persistent hypotension
  3. C. Obtain a CT scan to identify the source before starting antibiotics
  4. D. Begin 30 mL/kg of colloid solution and hold antibiotics pending culture results
Show the answer and explanation

B. Measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics, begin 30 mL/kg crystalloid, and start vasopressors for persistent hypotension

This is the sepsis bundle and the sequencing inside it is the point of the question. Cultures come before antibiotics because a single dose can sterilize a blood culture and cost you the organism, which is why answer A has the order reversed. Antibiotics are not delayed for imaging, so answer C fails: source identification matters, but it happens alongside treatment rather than ahead of it. Crystalloid is the resuscitation fluid of choice at 30 mL/kg, and colloids are not the first-line alternative, which along with the withheld antibiotics rules out answer D. Vasopressors are started for hypotension persisting through fluid resuscitation rather than held until fluids have entirely failed, with norepinephrine as the first-line agent.

Question 5 · Neurological

A patient with a traumatic brain injury has a mean arterial pressure of 70 mmHg and an intracranial pressure of 22 mmHg. The cerebral perfusion pressure is:

  1. A. 92 mmHg, which is adequate
  2. B. 48 mmHg, which is below the usual target range
  3. C. 22 mmHg, which is adequate
  4. D. 70 mmHg, which is at the usual target
Show the answer and explanation

B. 48 mmHg, which is below the usual target range

Cerebral perfusion pressure equals mean arterial pressure minus intracranial pressure, so 70 minus 22 gives 48 mmHg. The commonly used target after traumatic brain injury is roughly 60 to 70 mmHg, so this patient is underperfused and at risk of secondary ischemic injury. Answer A comes from adding the two values instead of subtracting, which is the error the question is built to catch. What makes the calculation clinically useful is that it shows you have two levers: raise the mean arterial pressure, usually with fluids and vasopressors, or lower the intracranial pressure through head-of-bed elevation, keeping the neck midline, sedation, osmotic therapy or cerebrospinal fluid drainage. Treating a low perfusion pressure by pushing blood pressure alone while ignoring a rising intracranial pressure addresses half the equation.

Question 6 · Endocrine

A patient in diabetic ketoacidosis has a glucose of 585 mg/dL, a pH of 7.12 and a serum potassium of 3.0 mEq/L. The nurse should anticipate that the insulin infusion will be:

  1. A. Started immediately at the standard rate
  2. B. Started at double the standard rate because of the acidosis
  3. C. Held until potassium replacement has raised the level above 3.3 mEq/L
  4. D. Replaced with subcutaneous insulin
Show the answer and explanation

C. Held until potassium replacement has raised the level above 3.3 mEq/L

A potassium of 3.0 in diabetic ketoacidosis is a genuine emergency, and it is more dangerous than it looks. Total body potassium is already severely depleted even when the serum level reads normal, because acidosis drives potassium out of cells into the serum and masks the deficit. Insulin reverses that shift and pushes potassium back intracellularly, so giving insulin to a patient who is already at 3.0 can precipitate life-threatening hypokalemia and arrhythmia. Standard practice is to hold insulin until potassium is above 3.3 mEq/L and replacement is running. Answer A ignores the potassium entirely, answer B compounds the risk, and answer D abandons the titratable intravenous route that severe ketoacidosis requires.

Question 7 · Pulmonary

Which intervention is a core component of preventing ventilator-associated pneumonia in a mechanically ventilated adult?

  1. A. Routine changes of the ventilator circuit every 24 hours
  2. B. Maintaining the head of the bed elevated 30 to 45 degrees unless contraindicated
  3. C. Instilling normal saline before every suctioning pass
  4. D. Continuous deep sedation to prevent patient-ventilator dyssynchrony
Show the answer and explanation

B. Maintaining the head of the bed elevated 30 to 45 degrees unless contraindicated

Semirecumbent positioning at 30 to 45 degrees reduces aspiration of gastric and oropharyngeal secretions past the cuff, which is the main route by which ventilator-associated pneumonia develops, and it sits in every prevention bundle alongside oral care with chlorhexidine where used, subglottic secretion drainage and daily assessment of readiness to extubate. The wrong answers are all practices that were once routine and have since been abandoned. Scheduled circuit changes do not reduce pneumonia and may increase it by breaking the circuit, so answer A is wrong. Saline instillation before suctioning is not supported and can push organisms distally, ruling out answer C. Answer D runs directly against current practice: daily sedation interruption and spontaneous breathing trials shorten ventilator days, and fewer ventilator days is the most effective prevention of all.

Question 8 · Professional Caring and Ethical Practice

A nurse is repeatedly asked to continue aggressive interventions for a patient the nurse believes is receiving nonbeneficial treatment, and feels unable to act on that judgment. This experience is best described as:

  1. A. Compassion fatigue
  2. B. Burnout
  3. C. Moral distress
  4. D. An ethical dilemma
Show the answer and explanation

C. Moral distress

Moral distress has a specific definition and the question supplies both of its parts: the nurse knows what they believe to be the ethically appropriate action, and institutional or interpersonal constraints prevent them from taking it. That gap between knowing and being able to act is what distinguishes it from the alternatives. An ethical dilemma, answer D, is a situation where the right course of action is genuinely unclear, which is not the case here. Compassion fatigue is the depletion that comes from sustained empathic engagement with suffering, and burnout is a broader syndrome of exhaustion, cynicism and reduced efficacy tied to the work environment rather than to a specific ethical constraint. The distinction matters because the remedies differ: unresolved moral distress accumulates into what AACN calls moral residue, and the response is structural, including ethics consultation and speaking up frameworks, rather than personal resilience training.

These eight are a sample. Inside Aspirants.ai you can generate unlimited CCRN practice questions across the full AACN test plan, with the same depth of explanation on every answer choice.

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What the CCRN exam looks like

The CCRN (Adult) is a computer-based exam administered for AACN Certification Corporation at PSI test centers and by live remote proctoring. You get 150 items in total: 125 that count toward your score and 25 unscored pretest items that AACN uses to trial future questions. The pretest items are scattered through the exam with no marking of any kind, so there is no way to spot them and no reason to try. The time limit is three hours, which works out to about 72 seconds per item, and most candidates finish with time left over. Passing takes 83 correct answers out of the 125 scored items, roughly 66.4%. That cut score is not folklore: AACN publishes it, and the current value took effect on November 12, 2025. The exam is offered year round rather than in windows, and you get your pass or fail result at the test center as soon as you finish.

  • 150 items total: 125 scored plus 25 unscored pretest items
  • Three hours, about 72 seconds per item
  • Pass with 83 of 125 correct, roughly 66.4%
  • Cut score effective November 12, 2025, published by AACN

What is on the CCRN exam: the AACN test plan

AACN splits the CCRN into two categories, and the split is lopsided on purpose. Clinical Judgment is 80% of the exam, about 100 of the 125 scored items, and it is organized by body system. Professional Caring and Ethical Practice is the other 20%, about 25 items, built on AACN's Synergy Model: advocacy and moral agency, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry and facilitation of learning. The Exam Handbook test plan breaks Clinical Judgment down by system, and the shape of it surprises people who assume the CCRN is a cardiac exam. Cardiovascular is the largest single system at roughly 18%, but the combined endocrine, hematology, gastrointestinal, renal and integumentary group is larger still at about 20%. Pulmonary runs about 17%, multisystem about 14%, and the musculoskeletal, neurological and psychosocial group about 13%.

  • Clinical Judgment: 80% of the exam, about 100 scored items
  • Professional Caring and Ethical Practice: 20%, about 25 items
  • Cardiovascular about 18%, but endocrine/heme/GI/renal/integumentary is about 20%
  • Pulmonary about 17%, multisystem about 14%, MSK/neuro/psychosocial about 13%

CCRN eligibility: the clinical hour requirements

You need an unencumbered RN or APRN license and a specific number of hours in the direct care of acutely or critically ill adult patients. AACN gives you two pathways and you only need to satisfy one. The two-year option asks for 1,750 hours in the previous two years, with 875 of those in the most recent year. The five-year option asks for 2,000 hours in the previous five years, with 144 of those in the most recent year. The five-year route exists for nurses whose bedside time is now intermittent, such as educators, rapid response staff and managers who still take assignments. Note what the hours have to be: direct care of acutely or critically ill adult patients. Charge shifts, orientation of new staff and time spent in non-critical areas do not count toward the total, and AACN audits a share of applications, so keep a record you could actually produce.

  • Two-year path: 1,750 hours in two years, 875 in the most recent year
  • Five-year path: 2,000 hours in five years, 144 in the most recent year
  • Hours must be direct care of acutely or critically ill adult patients
  • Applications are audited, so document your hours as you go

How hard is the CCRN exam and what is the pass rate?

AACN publishes its exam statistics, which puts the CCRN in a small group of credentials where you can check the difficulty against the regulator rather than a prep vendor. The 2025 first-time pass rate for CCRN (Adult) was 72.02% across 17,151 candidates. In 2024 it was 72.74% across 19,483 candidates. In 2023 it was 81.20%. That nine-point drop between 2023 and 2024 is the single most useful fact about this exam right now, and almost no study advice written before 2024 accounts for it. Roughly one in four experienced critical care nurses now fails on the first attempt. The comparison across AACN's other exams is worth knowing too: PCCN came in at 70.10% in 2025 and CSC at 52.20%, so the CCRN is not the hardest thing AACN administers, but it is no longer the near-formality some units still treat it as.

  • 2025 first-time pass rate: 72.02% on 17,151 candidates
  • 2024: 72.74%. 2023: 81.20%. The exam got harder to pass.
  • About one in four first-time candidates now fails
  • For comparison, PCCN was 70.10% and CSC 52.20% in 2025

CCRN cost, retakes and renewal

The exam fee is $260 for AACN members and $375 for nonmembers. AACN membership costs less than the $115 gap, so joining first and then registering is cheaper than registering as a nonmember, which is the one piece of arithmetic every candidate should do before paying. If you do not pass, you are eligible for a discounted retest fee, and that discount stays available until you pass. You may sit the CCRN up to four times in any 12-month period. Certification runs for three years, and you renew either by retaking the exam or through Renewal by Synergy CERPs, which requires a minimum of 100 continuing education recognition points across the three-year period. Many hospitals reimburse the exam fee on a pass and pay a certification differential on top, so check your own tuition and certification policy before you pay out of pocket.

  • Exam fee: $260 AACN members, $375 nonmembers
  • Discounted retest fee, available until you pass
  • Up to four attempts in any 12-month period
  • Certification lasts three years: retake, or renew with 100 CERPs

How to study for the CCRN when you already work in an ICU

The trap for experienced nurses is assuming the exam tests what the unit tests. It does not. Your unit gives you a population, a set of protocols and a physician group whose habits you know. The CCRN tests the whole adult critical care population against AACN's test plan, including systems you may go months without touching. A cardiac ICU nurse who can run a balloon pump in her sleep still loses points on endocrine emergencies and GI bleeds, and that group is 20% of the exam. So start by working questions across every system rather than reading a review book front to back. Question practice tells you where the gaps actually are, which is almost never where you expect. Then review with intent: for each miss, write down what the item was testing and why the answer you picked looked correct, because it did look correct at the time. Do not neglect the Professional Caring 20%. It is 25 items, it is the section most people skip, and Synergy Model questions are learnable in a way that pathophysiology is not.

  • Work questions across every system, not just your own unit's population
  • Endocrine, heme, GI, renal and integumentary is about 20% and gets neglected
  • Review every miss: what was it testing, why did your answer look right
  • The Professional Caring 20% is 25 free-ish items if you study the Synergy Model

Compare the options

CCRN and the other AACN certification exams

Cut scores and 2025 first-time pass rates, from AACN's published exam statistics.

CCRN (Adult) CCRN (Pediatric) CCRN (Neonatal) PCCN
Population Acutely/critically ill adults Critically ill children Critically ill neonates Progressive care adults
Scored items 125 (plus 25 unscored) 125 (plus 25 unscored) 125 (plus 25 unscored) 125 (plus 25 unscored)
Time limit 3 hours 3 hours 3 hours 3 hours
Correct answers to pass 83 of 125 83 of 125 84 of 125 82 of 125
2025 first-time pass rate 72.02% 68.72% 60.29% 70.10%
2025 candidates 17,151 1,474 305 3,321
Fee (member / nonmember) $260 / $375 $260 / $375 $260 / $375 $260 / $375

Cut scores and pass rates from AACN Certification Corporation exam statistics, July 2026. The CCRN Adult cut score of 83 took effect November 12, 2025. Small-cohort pass rates such as Neonatal move substantially year to year.

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Honest answers

CCRN practice questions, answered straight.

You must answer 83 of the 125 scored items correctly to pass the CCRN (Adult), which is about 66.4%. AACN publishes this cut score and the current value took effect on November 12, 2025. The 25 unscored pretest items do not count either way. There is no penalty for guessing, so answer every question.

The CCRN has 150 items in total: 125 scored questions plus 25 unscored pretest items that AACN uses to trial future content. The time limit is three hours, roughly 72 seconds per item. The pretest items are unmarked and mixed throughout, so treat every question as if it counts.

AACN reported a 72.02% first-time pass rate for CCRN (Adult) in 2025 across 17,151 candidates, and 72.74% in 2024. In 2023 it was 81.20%, so the exam has become noticeably harder to pass. About one in four first-time candidates now fails. These are AACN's own published statistics, not prep-provider estimates.

Hard enough that roughly a quarter of experienced critical care nurses fail on the first attempt. The difficulty is less about depth than breadth: the exam covers the entire adult critical care test plan, while your unit exposes you to one slice of it. Nurses fail on systems they rarely see, not on the ones they manage daily.

The CCRN exam fee is $260 for AACN members and $375 for nonmembers. Because AACN membership costs less than the $115 difference, joining before you register is usually cheaper than paying the nonmember rate. If you do not pass, a discounted retest fee is available until you do. Many employers reimburse the fee on a pass.

Either 1,750 hours in the direct care of acutely or critically ill adult patients over the previous two years, with 875 in the most recent year, or 2,000 hours over the previous five years with 144 in the most recent year. You need to meet only one pathway. Both require a current unencumbered RN or APRN license.

You may sit the CCRN up to four times in any 12-month period. Candidates who do not pass qualify for a discounted retest fee, and that discount remains available until the exam is passed. There is no lifetime cap, though your employer may have its own policy on funding repeat attempts.

CCRN certification is recognized for a three-year period. You renew either by retaking the exam or through the Renewal by Synergy CERPs program, which requires a minimum of 100 continuing education recognition points during the three-year cycle. Most nurses renew by CERPs rather than sitting the exam again.

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