CCRN Exam Prep: Critical Care Registered Nurse — Adult (AACN) Study Guide + 590+ Practice Questions

A patient with severe sepsis and acute kidney injury is receiving continuous venovenous hemofiltration. Over the past two hours, the transmembrane pressure has increased from 110 mmHg to 240 mmHg, and the filter pressure drop has widened significantly. The ultrafiltration rate remains at the prescribed target. Which intervention is most appropriate for this patient?

A patient successfully resuscitated from initial septic shock remains in the intensive care unit for two weeks. The patient now develops a secondary opportunistic fungal infection and exhibits a significantly diminished lymphocyte count on the daily laboratory panel.

A patient treated for severe bacteremia over the past three days develops a sudden decrease in cardiac ejection fraction to thirty percent. The systemic vascular resistance remains normal, and the patient has no history of cardiovascular disease.

A patient with a urinary tract infection presents with a mean arterial pressure of 52 mm Hg and warm, flushed skin. Hemodynamic monitoring indicates a significantly elevated cardiac output and a profoundly decreased systemic vascular resistance.

A patient recovering from a severe intra-abdominal infection develops new-onset oozing from intravenous catheter sites and a sudden drop in platelet count. Laboratory results reveal elevated fibrin degradation products and prolonged clotting times.

A patient with a ruptured appendix and peritonitis has a central venous oxygen saturation of 82% and a cardiac index of 4.5 L/min/m2. Despite these parameters, the patient’s serum lactate continues to rise rapidly.

A patient admitted with severe pneumonia develops profound non-cardiogenic pulmonary edema and generalized anasarca despite a negative fluid balance over the past 24 hours. Hemodynamics reveal a low central venous pressure and low systemic vascular resistance.

A patient on continuous venovenous hemofiltration triggers a sudden air detector alarm, and the blood pump stops automatically. The nurse visualizes a small amount of air in the venous return line just above the air sensing chamber. The patient’s vital signs remain stable. What is the most appropriate initial intervention?

A patient receiving continuous venovenous hemodialysis suddenly triggers a high return pressure alarm. The nurse notes the access pressure and transmembrane pressure are within normal limits. The patient was recently repositioned in bed, and the catheter insertion site appears clean and intact. Which action should the nurse take to resolve this?

A patient with severe rhabdomyolysis and acute kidney injury requires renal replacement therapy. The nephrology team wants to maximize the clearance of myoglobin, which is a large molecular weight solute, while maintaining hemodynamic stability. Which continuous renal replacement therapy modality is most appropriate for achieving this specific clearance goal?

A patient with ischemic hepatitis and acute kidney injury is undergoing continuous venovenous hemodiafiltration with regional citrate anticoagulation. Laboratory results reveal a total calcium to ionized calcium ratio of 3.1 and a worsening metabolic acidosis. The patient’s systemic ionized calcium level is critically low. What is the most appropriate clinical response?

A patient with acute respiratory distress syndrome is receiving continuous venovenous hemodialysis. The machine repeatedly alarms for highly negative access pressure. The patient recently had a large volume of gastric aspirate, and the central venous pressure has trended downward over the shift. Which action best addresses the underlying cause of this alarm?

A patient with severe ARDS is receiving volume-assist control ventilation. Current settings include a tidal volume of 550 mL, respiratory rate of 18/min, PEEP of 10 cm H2O, and FiO2 of 0.70. The plateau pressure is 35 cm H2O, and the arterial pH is 7.32. Which ventilator adjustment is most appropriate?

A patient with a subarachnoid hemorrhage has an external ventricular drain. After returning from a diagnostic scan, the intracranial pressure reads twenty-eight millimeters of mercury. The patient is resting quietly with unchanged neurological status. What is the most appropriate action?

A patient with a severe traumatic brain injury exhibits a sustained, regular, and rapid respiratory pattern. The arterial blood gas shows profound hypocapnia. This specific respiratory pattern is most indicative of which condition?

A patient admitted with a right-sided epidural hematoma suddenly develops a fixed, dilated right pupil measuring six millimeters and new left-sided hemiparesis. These assessment findings are most consistent with which neurological emergency?

A patient with a severe traumatic brain injury has a blood pressure of 90/50 mm Hg and an intracranial pressure of 22 mm Hg. To optimize this patient’s cerebral hemodynamics, which intervention is most appropriate?

A patient with a subarachnoid hemorrhage has an external ventricular drain open at 10 cm H2O. The nurse notes a dampened waveform, zero drainage over two hours, and new-onset restlessness. Which intervention should the nurse perform first?

A patient with a traumatic brain injury has a mean arterial pressure of 85 mm Hg and an intracranial pressure of 18 mm Hg. The nurse observes that the P2 amplitude on the intracranial pressure waveform is consistently higher than the P1 amplitude. Based on these findings, which action is most appropriate?

A patient with ARDS is on assist-control ventilation with a tidal volume of 6 mL/kg, respiratory rate of 24/min, PEEP of 10 cm H2O, and FiO2 of 1.0. The arterial blood gas shows a PaO2 of 52 mm Hg and a plateau pressure of 24 cm H2O. Which adjustment is most appropriate?

An ARDS patient is receiving lung-protective ventilation with a respiratory rate of 32 breaths/min to manage hypercapnia. The nurse notes the expiratory flow waveform does not return to baseline before the next breath begins, and the patient’s mean arterial pressure has decreased from 75 to 55 mm Hg. Which action is most appropriate?

A patient recovering from ARDS is mechanically ventilated in volume control mode. The ventilator displays a peak inspiratory pressure of 40 cm H2O, a plateau pressure of 28 cm H2O, and a PEEP of 12 cm H2O. The tidal volume is set at 400 mL. What is the most accurate interpretation of these mechanical parameters?

A patient with severe ARDS remains hypoxemic despite optimized ventilator settings. Current parameters include a PEEP of 16 cm H2O, FiO2 of 0.80, and a PaO2 of 55 mm Hg. The plateau pressure is 28 cm H2O, and the patient is hemodynamically stable. Which intervention is most appropriate to improve oxygenation?

A patient with ARDS is ventilated with a tidal volume of 5 mL/kg of predicted body weight. The arterial blood gas reveals a pH of 7.26, PaCO2 of 58 mm Hg, and PaO2 of 68 mm Hg on an FiO2 of 0.50. The plateau pressure is 26 cm H2O. How should the nurse manage these findings?