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CCRN (Adult) Critical Care Nursing Exam Cheat Sheet (2026)
A free, printable CCRN (Adult) Critical Care Nursing exam cheat sheet: the 101 highest-yield points to know, grouped into 6 sections that follow the exam's content areas, each section with its published weight.
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- 101 of the 101 points carry a citation to the rule they come from.
- The real CCRN (Adult) Critical Care Nursing exam: 150 questions · 180 minutes.
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- 118 free CCRN (Adult) Critical Care Nursing practice questions on the same material, every one explained.
- Last updated: September 2026.
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Cardiovascular
13% of the exam- Atypical presentations
- Little or no chest pain is common in older adults, people with diabetes and women; treat new dyspnea or fatigue as possible ischemia and get an ECG.· MedlinePlus (NLM), Heart attack
- Primary angioplasty timing
- Angioplasty should ideally be done within 90 minutes of hospital arrival.· MedlinePlus (NLM), Heart attack
- Thrombolytic timing
- When used, clot-dissolving drugs are ideally given within 30 minutes of arrival and usually no later than 12 hours after symptom onset.· MedlinePlus (NLM), Heart attack
- Tamponade findings
- Hypotension with distended neck veins, faint heart sounds, tachycardia and a blood pressure that falls on inspiration.· MedlinePlus (NLM), Cardiac tamponade
- Tamponade treatment
- Drain the fluid (pericardiocentesis or surgical window); fluids and pressors only support preload and pressure until drainage.· MedlinePlus (NLM), Cardiac tamponade
- Pericarditis therapy
- NSAIDs given with colchicine are the usual treatment; aspirin with colchicine is used after MI.· MedlinePlus (NLM), Pericarditis; Pericarditis - after heart attack
- Dressler syndrome
- Late pericarditis weeks after MI or heart surgery, often with fever and effusion; tamponade is a key complication.· MedlinePlus (NLM), Pericarditis - after heart attack
- First drug in dissection
- Beta-blockers are the first-choice IV agents to reduce heart rate and blood pressure.· MedlinePlus (NLM), Aortic dissection
- Where the tear is decides the plan
- Ascending dissections are treated with surgery; descending ones may be managed medically or surgically.· MedlinePlus (NLM), Aortic dissection
- Malperfusion
- New abdominal pain, falling urine output or limb changes can mean the dissection is compromising branch arteries.· MedlinePlus (NLM), Aortic dissection
- Hypertensive emergency
- Optic nerve swelling, retinal bleeding, confusion, chest pain or reduced urine output with very high pressure mean IV therapy in hospital.· MedlinePlus (NLM), Malignant hypertension
- Verapamil and accessory pathways
- IV verapamil is contraindicated in atrial fibrillation or flutter with an accessory pathway such as Wolff-Parkinson-White because it can trigger ventricular fibrillation.· DailyMed, verapamil injection label
- Nitroprusside and cyanide
- Beyond brief or low-rate use, nitroprusside releases cyanide; worsening acidosis or confusion is a reason to stop and report.· DailyMed, sodium nitroprusside label
- Normal PA catheter values
- Cardiac index 2.8–4.2 L/min/m²; wedge pressure 4–12 mm Hg; right atrial pressure 0–7 mm Hg.· MedlinePlus (NLM), Swan-Ganz catheterization
- Cardioversion and clots
- Anticoagulation may be needed before elective cardioversion of atrial fibrillation to prevent stroke from atrial clot.· MedlinePlus (NLM), Cardioversion; Atrial fibrillation
Respiratory
12% of the exam- Global definition oxygenation
- PaO2/FiO2 ≤300 or SpO2/FiO2 ≤315 (SpO2 ≤97%), including patients on high-flow nasal oxygen at ≥30 L/min.· Matthay et al., Am J Respir Crit Care Med 2024
- Timing and imaging
- Onset within 1 week of a known insult; bilateral opacities on X-ray, CT or ultrasound not fully explained by other causes.· Matthay et al., Am J Respir Crit Care Med 2024
- Low tidal volume
- About 6 mL/kg of predicted body weight, with an upper plateau pressure goal of 30 cm H2O.· Surviving Sepsis Campaign 2021
- Prone positioning
- More than 12 hours daily in moderate to severe ARDS.· Surviving Sepsis Campaign 2021
- COPD oxygen target
- Titrate to an SpO2 of 88–92%; high inspired oxygen can cause hypercapnia and acidosis.· STOP-COPD protocol, Trials 2024 (guideline background)
- High-flow first in sepsis
- High-flow nasal cannula is favored over conventional oxygen and noninvasive ventilation for sepsis with acute hypoxemic respiratory failure.· Surviving Sepsis Campaign 2026
- Respiratory acidosis
- Low pH with high PaCO2; a normal bicarbonate means the process is acute and uncompensated.· MedlinePlus (NLM), Respiratory acidosis
- Asthma danger signs
- Drowsiness, confusion, difficulty speaking or cyanosis during an attack mean failing ventilation.· MedlinePlus (NLM), Asthma
- Essential practices
- Avoid intubation where safe, minimize sedation and avoid benzodiazepines, keep patients mobile, elevate the head of the bed 30–45°, and feed enterally.· SHEA/IDSA/APIC 2022 Update
- Oral care
- Toothbrushing without chlorhexidine; chlorhexidine oral care is generally not recommended.· SHEA/IDSA/APIC 2022 Update
- Circuits
- Change the ventilator circuit only when visibly soiled or malfunctioning.· SHEA/IDSA/APIC 2022 Update
- Liberation
- Assess readiness to extubate daily with spontaneous breathing trials.· SHEA/IDSA/APIC 2022 Update
- Blocked drain for pneumothorax
- Do not clamp it; check for kinks or clots and get an urgent chest X-ray to avoid tension pneumothorax.· Cureus 2024, blocked chest drain review
- Stripping chest tubes
- Milking or stripping is not recommended after lung resection and is considered ineffective and potentially harmful after cardiac surgery.· J Thorac Dis 2026 chest tube review
- High-risk embolism
- Thrombolysis or thrombectomy is reserved for severe, life-threatening PE with hemodynamic instability.· MedlinePlus (NLM), Pulmonary embolus; ESC 2019 PE guideline
- Cor pulmonale
- Right heart failure from lung disease: neck vein distention, ankle swelling, liver enlargement; oxygen is central to treatment.· MedlinePlus (NLM), Cor pulmonale
Endocrine, Hematology/Immunology, GI, Renal/GU and Integumentary
21% of the exam- Potassium before insulin
- If potassium is below 3.5 mmol/L, replace it and delay insulin until it rises above 3.5.· ADA/EASD Hyperglycemic Crises Consensus, Diabetes Care 2024
- Add dextrose at 250
- When glucose falls below 250 mg/dL in DKA, add 5–10% dextrose and continue insulin until ketoacidosis resolves.· ADA/EASD Consensus 2024
- Euglycemic DKA
- Ketoacidosis with glucose below 200 mg/dL, notably with SGLT2 inhibitors.· ADA/EASD Consensus 2024
- SIADH vs DI
- SIADH: hyponatremia with concentrated urine, restrict fluids first. Central DI: large dilute urine and rising sodium, give desmopressin.· MedlinePlus (NLM), SIADH; Diabetes insipidus
- Adrenal crisis
- Give IV or IM hydrocortisone right away; abrupt withdrawal of long-term steroids is a classic trigger.· MedlinePlus (NLM), Acute adrenal crisis
- HIT management
- With intermediate or high probability, stop all heparin and start a non-heparin anticoagulant; do not start warfarin until platelets recover.· ASH 2018 HIT guideline
- Platelets in HIT
- Routine platelet transfusion is not suggested unless bleeding or at high bleeding risk.· ASH 2018 HIT guideline
- Hemolytic transfusion reaction
- Fever, chills, flank pain or dark urine during a transfusion: stop the transfusion immediately.· MedlinePlus (NLM), Hemolytic transfusion reaction
- DIC
- Treat the cause; plasma replaces factors when bleeding dominates and heparin may be used when clotting dominates.· MedlinePlus (NLM), DIC
- Protamine
- Give slowly, no more than 50 mg in 10 minutes, about 1 mg per 100 units of heparin, with resuscitation available.· DailyMed, heparin label
- Varices
- Protect the airway in massive bleeding; vasoconstrictors such as octreotide and endoscopic banding control bleeding.· MedlinePlus (NLM), Bleeding esophageal varices
- Pancreatitis fluids
- Moderately aggressive resuscitation, lactated Ringer's preferred over saline, with caution in heart or kidney disease.· ACG Acute Pancreatitis Guideline 2024
- Early feeding
- In mild pancreatitis, start oral feeding within 24–48 hours as tolerated.· ACG Acute Pancreatitis Guideline 2024
- Lactulose goal
- Titrate to about 2–3 soft stools daily (2–4 in acute episodes), adding rifaximin as indicated.· ACG Hepatic Encephalopathy Guideline
- Lipase
- Lipase is more specific for pancreatitis than amylase.· MedlinePlus (NLM), Acute pancreatitis
- Hyperkalemia with ECG changes
- IV calcium first to protect the heart, then measures that shift or remove potassium.· MedlinePlus (NLM), High potassium level
- Nephrotoxins
- NSAIDs, IV contrast and certain antibiotics and blood pressure medicines can cause AKI.· MedlinePlus (NLM), Acute kidney failure
- Dialysis triggers
- Dangerous potassium, fluid overload, pericarditis, mental status change or rising nitrogen wastes.· MedlinePlus (NLM), Acute kidney failure
- Pressure injury prevention
- Reposition every 1–2 hours, float heels, avoid pillows under knees, keep the head of the bed at 30° or less when allowed.· MedlinePlus (NLM), Preventing pressure injuries
Musculoskeletal, Neurological and Behavioral/Psychosocial
18% of the exam- Compartment syndrome
- Pain out of proportion, unrelieved by medication or elevation, with numbness or weakness; fasciotomy is needed right away.· MedlinePlus (NLM), Compartment syndrome
- Sedated patients
- Diagnosis is often delayed when patients cannot report pain.· MedlinePlus (NLM), Compartment syndrome
- Physical conditioning
- Maintaining and improving conditioning is an essential practice for ventilated adults.· SHEA/IDSA/APIC 2022 Update
- Tranexamic acid
- Survival benefit in bleeding trauma was seen only when started within 3 hours of injury.· CRASH-2 analysis, Crit Care 2014
- Thresholds
- Treat ICP above 22 mm Hg; keep cerebral perfusion pressure (MAP − ICP) at 60 mm Hg or more.· SIBICC 2019 / Brain Trauma Foundation
- Hyperventilation
- Only mild hyperventilation (PaCO2 32–35 mm Hg) as a tier-two option; routine PaCO2 below 30 is not recommended.· SIBICC 2019
- Fever
- Avoid core temperature above 38 °C as part of basic care.· SIBICC 2019
- Epidural hematoma
- Brief loss of consciousness, a lucid interval, then rapid decline with an ipsilateral dilated pupil and contralateral weakness.· MedlinePlus (NLM), Epidural hematoma
- Cushing response
- Bradycardia, rising blood pressure and irregular breathing with rising ICP.· Cureus 2026 case review
- Before thrombolysis
- A CT or MRI must exclude bleeding; clot-dissolving therapy is given within 4½ hours of onset.· MedlinePlus (NLM), Stroke
- Status epilepticus
- Treat seizures lasting over 5 minutes with a benzodiazepine; IM midazolam works well without IV access.· American Epilepsy Society guideline 2016
- Autonomic dysreflexia
- Sit the patient up, loosen clothing and look for the trigger, most often a blocked catheter or constipation.· MedlinePlus (NLM), Autonomic dysreflexia
- Neurogenic shock
- Hypotension and bradycardia from loss of sympathetic tone after injury at T6 or above.· Colomb Med 2021 neurogenic shock review
- Delirium
- Sudden onset and fluctuating attention; reorient, restore glasses and hearing aids, protect sleep and minimize sedatives.· MedlinePlus (NLM), Delirium
- Withdrawal timeline
- Seizures usually 12–48 hours and delirium tremens 48–96 hours after the last drink.· MedlinePlus (NLM), Delirium tremens
- Wernicke encephalopathy
- Confusion, ataxia and eye movement changes in thiamine deficiency; give thiamine promptly.· MedlinePlus (NLM), Wernicke-Korsakoff syndrome
- Naloxone
- Its effect may wear off before the opioid, so observation continues for hours.· MedlinePlus (NLM), Opioid intoxication
- Suicide risk
- Screen, assess and protect patients at risk.· The Joint Commission NPSG.15.01.01
Multisystem
16% of the exam- Screening
- Use NEWS, NEWS2, MEWS or SIRS rather than qSOFA alone to screen acutely ill inpatients.· Surviving Sepsis Campaign 2026
- Cultures and antimicrobials
- Draw blood cultures as soon as possible, ideally before antimicrobials; in septic shock give antimicrobials immediately, ideally within 1 hour.· Surviving Sepsis Campaign 2021 and 2026
- Fluids
- Balanced crystalloids are suggested over 0.9% saline; dynamic measures guide further fluid.· Surviving Sepsis Campaign 2026
- Pressure target and first vasopressor
- Initial MAP of 65 mm Hg (60–65 in patients 65 and older); norepinephrine first-line.· Surviving Sepsis Campaign 2026
- Anaphylaxis
- IM epinephrine 0.01 mg/kg (maximum 0.5 mg in adults) into the anterolateral thigh, repeated every 5–15 minutes as needed.· World Allergy Organization Anaphylaxis Guidance 2020
- Burn fluids
- Lactated Ringer's 2–4 mL/kg per %TBSA over 24 hours in adults; in the Parkland convention half is given in the first 8 hours.· Nurs Open 2026 burn fluid review (ABLS range)
- Burn depth
- Partial-thickness burns are painful and blistered; full-thickness burns look white or charred and may be numb.· MedlinePlus (NLM), Burns
- Lethal triad
- Hypothermia, acidosis and coagulopathy reinforce one another in bleeding trauma patients.· World J Emerg Surg 2025
- Balanced transfusion
- A 1:1:1 plasma:platelet:red cell ratio achieved hemostasis more often and reduced early deaths from exsanguination.· PROPPR, JAMA 2015
- Salicylates
- Mixed respiratory alkalosis and metabolic acidosis; avoid sedation or intubation that reduces ventilation, and alkalinize.· Cureus 2025 salicylate review
- Calcium channel blockers
- First-line therapy includes IV calcium, high-dose insulin and vasopressors.· CCB Poisoning Expert Consensus, Crit Care Med 2017
- Acetaminophen
- Symptoms may not appear for 12 hours or more; N-acetylcysteine is the antidote and works best early.· MedlinePlus (NLM), Acetaminophen overdose
- Opioids
- Small pupils and slow breathing respond to naloxone, which may wear off first.· MedlinePlus (NLM), Opioid intoxication
- Metabolic alkalosis
- High pH and bicarbonate, often from vomiting or gastric suction (chloride loss) or diuretics (potassium loss).· MedlinePlus (NLM), Alkalosis
- Rhabdomyolysis
- Tea-colored urine, heme-positive dipstick with few red cells, and CK above five times normal.· Crit Care 2016 rhabdomyolysis review
- Refeeding syndrome
- A fall in phosphorus, potassium or magnesium within 5 days of starting nutrition.· ASPEN 2020 consensus (via Nutrients 2026)
- Palliative care
- Can start at diagnosis and run alongside disease-directed treatment; hospice applies when that treatment stops.· National Institute on Aging
Professional Caring and Ethical Practice
20% of the exam- Patient characteristics
- Resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision-making, predictability.· CCRN Exam Handbook (July 2026), Synergy Model
- Tested nurse characteristics
- Advocacy/moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity, systems thinking.· Adult CCRN Test Plan, Part II
- Clinical judgment
- The eighth characteristic, clinical judgment, is the organizing idea behind the clinical part of the exam.· CCRN Exam Handbook (July 2026)
- Autonomy
- A patient with decision-making capacity may accept or refuse treatment; confirm the refusal is informed and document it.· Varkey, Principles of Clinical Ethics, 2021
- Health care agent
- Acts only when the patient cannot and follows the patient's known wishes, not personal preferences.· MedlinePlus (NLM), Health care agents
- DNR scope
- A DNR order applies to CPR; other treatments such as antibiotics and pain relief continue unless separately declined.· MedlinePlus (NLM), Do-not-resuscitate order
- Moral distress
- The inability to do the right thing because of institutional constraints; seek ethics and peer support.· AACN Position Statement on Moral Distress (2025)
- SBAR
- Situation, Background, Assessment (what you think is wrong), Recommendation or Request.· AHRQ TeamSTEPPS, SBAR
- Check-back
- The receiver repeats the order back and the sender confirms, closing the loop.· AHRQ TeamSTEPPS, Check-Back
- CUS
- Concerned, Uncomfortable, Safety issue; escalate to a supervisor if safety is not acknowledged.· AHRQ TeamSTEPPS, CUS
- Teach-back and show-me
- Ask patients to explain in their own words and to demonstrate new skills; teach in chunks and check each one.· AHRQ Health Literacy Toolkit, Tool 5
- Language access
- Use qualified interpreters; do not rely on minor children or accompanying adults except in narrow emergency situations.· 45 CFR 92.201 (Section 1557)
- Family presence
- A staff member can act as family support person during a witnessed resuscitation.· J Clin Nurs 2023 family support person study
- Clinical inquiry
- Question routine practice and bring current evidence to the unit's decision process.· CCRN Exam Handbook, Synergy Model
- Systems thinking in transitions
- Pharmacist-led medication reconciliation and structured post-discharge support for sepsis survivors.· Surviving Sepsis Campaign 2026
- Scarce resources
- Institutions should use consistent, equitable allocation policies and interdisciplinary triage committees.· AACN Position Statement on Moral Distress (2025)
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