CCRN (Adult) Critical Care Nursing Exam — All Questions

A nurse notices that a patient's family and the medical team disagree about continuing dialysis, and the patient's own earlier wishes are not being heard. The nurse arranges a meeting and presents the patient's documented values. Which Synergy Model nurse characteristic does this best show?

• a.Facilitation of learning
• b.Clinical inquiry
• c.Advocacy/moral agency✓
• d.Systems thinking

The AACN Synergy Model defines advocacy/moral agency as working on another's behalf, representing the concerns of the patient and family, and helping resolve ethical and clinical concerns. Systems thinking is about managing environmental and system resources, clinical inquiry is questioning and evaluating practice, and facilitation of learning is teaching patients, families and staff.

During a surge, an ICU nurse repeatedly feels unable to give the care she believes is right because of staffing and equipment limits, and reports headaches, poor sleep and a sense of powerlessness. Which term does AACN use for this experience?

• a.Role ambiguity
• b.Burnout from overtime alone
• c.Compassion satisfaction
• d.Moral distress✓

AACN's position statement defines moral distress as the inability to do the right thing because of institutional constraints, and lists physical effects (sleep disturbance, headaches) and emotional effects (powerlessness, frustration) as its signs. Compassion satisfaction is a positive state. Role ambiguity is uncertainty about expectations, and the stem describes a conflict of conscience, not merely long hours.

According to AACN's position statement on moral distress, which action should a nurse take when experiencing it?

• a.Keep the concern private to avoid seeming unprofessional
• b.Wait for the situation to resolve before telling anyone
• c.Transfer to a different unit without discussing the concern
• d.Seek ethics consultation or peer and professional support✓

AACN says nurses must not hesitate to seek peer or professional ethical support, including the hospital ethics committee or moral distress consultation team, a trusted mentor and counseling resources. Staying silent, leaving without raising the concern, or waiting all leave the underlying ethical problem unaddressed.

An alert patient who has been assessed as having decision-making capacity refuses a recommended blood transfusion after the risks have been explained. What is the nurse's ethical obligation?

• a.Give the transfusion because it is medically indicated
• b.Respect the refusal; confirm it is informed and documented✓
• c.Ask the family to override the patient's decision today
• d.Sedate the patient so that the transfusion can proceed

The principle of autonomy gives a person with decision-making capacity the right to accept or refuse treatment; the nurse's role is to confirm the refusal is informed and to document it. Transfusing anyway, asking relatives to override a capable adult, or sedating the patient to proceed all violate autonomy. Autonomy does not extend to people who lack capacity, which is why capacity is confirmed first.

A patient who lacks decision-making capacity has named his sister as health care agent. The sister asks what her role is. Which explanation is accurate?

• a.She can act only after a court appoints her
• b.She manages his finances as well as his care
• c.She decides based on what she would want for herself
• d.She decides as he would, following his known wishes✓

MedlinePlus explains that a health care agent (proxy) acts only when the patient cannot, and that the agent's duty is to see that the patient's wishes are followed or, if unknown, to decide what the patient would want. The agent has no control over the patient's money unless separately given power of attorney, and a chosen agent does not need court appointment.

Which nursing action best reflects the Synergy Model characteristic of caring practices?

• a.Auditing hand hygiene compliance on the unit each month
• b.Adjusting care and surroundings to keep a dying patient comfortable✓
• c.Revising the unit's central line policy after reviewing new evidence
• d.Coordinating home oxygen and transport before a discharge

The Synergy Model defines caring practices as nursing activities that create a compassionate, supportive and therapeutic environment to promote comfort and healing and prevent unnecessary suffering, including vigilance and responsiveness. A compliance audit and a policy revision are clinical inquiry, and arranging discharge resources is systems thinking.

A family asks to stay while their father undergoes CPR. The unit supports family presence. Which approach best supports them?

• a.Let them stand at the bedside without any staff member present
• b.Assign a staff member to stay with them and explain events✓
• c.Ask them to wait outside until the resuscitation is finished
• d.Permit them to stay only if they agree not to ask any questions

Critical care nurses can serve as the family support person when families witness a resuscitation, staying with the family, explaining what is happening and responding to their needs. Leaving them alone at the bedside removes that support, excluding them contradicts the unit's family-presence practice, and conditioning presence on silence prevents the explanation the role provides.

A patient receiving comfort-focused care near the end of life is short of breath and frightened. Which nursing response best reflects caring practices?

• a.Offer a referral to a support group after discharge
• b.Treat the breathlessness, stay present, and reassure✓
• c.Explain that dyspnea is expected and nothing more can be done
• d.Reassess breathing at the next scheduled check

The National Institute on Aging describes palliative and hospice care as focused on relieving symptoms such as pain and shortness of breath and maintaining comfort, and caring practices in the Synergy Model emphasize vigilance, engagement and responsiveness to prevent suffering. Waiting for a scheduled check, telling the patient nothing can be done, or offering a later referral all fail to respond to present suffering.

A nurse sees colleagues routinely stripping chest tubes after lung resection 'to keep them open'. She searches the literature and finds that current guidance does not recommend it. What should she do next?

• a.Tell colleagues to stop at once on her own authority
• b.Keep stripping to match what the unit has always done
• c.Bring the evidence to the unit's practice council for review✓
• d.Stop stripping on her own patients and tell no one

Clinical inquiry in the Synergy Model is the ongoing questioning and evaluating of practice and creating change through evidence-based practice; bringing the evidence to the unit's practice structure is how that change is made. Guidance cited in a 2026 review states that chest tube milking and stripping are not recommended after lung resection. Continuing unchanged ignores the evidence, a silent individual change leaves other patients exposed, and a unilateral directive bypasses the team's process.

A unit still uses chlorhexidine oral rinse for all ventilated patients. A nurse checks the current infection prevention compendium and finds this practice is now 'generally not recommended'. Which Synergy characteristic is the nurse demonstrating?

• a.Response to diversity
• b.Caring practices
• c.Collaboration
• d.Clinical inquiry✓

Questioning a routine and checking it against current evidence is clinical inquiry. The 2022 SHEA/IDSA/APIC update moved oral care with chlorhexidine to 'generally not recommended' and added daily toothbrushing. Caring practices concern creating a therapeutic environment, response to diversity concerns incorporating differences, and collaboration concerns working with others toward shared goals.

When a unit decides which sedation practice to adopt for ventilated patients, which source should carry the most weight?

• a.A product brochure from a drug manufacturer
• b.The routine that the most senior nurse on the unit prefers
• c.A current practice guideline from a professional society✓
• d.The practice that was used at the nurse's previous hospital

Clinical inquiry means creating change through evidence-based practice, and the most reliable basis is a current guideline from the relevant professional society, such as the 2022 SHEA/IDSA/APIC recommendations to minimize sedation and avoid benzodiazepines. Seniority, marketing material and habits from another hospital are not evidence.

A nurse is calling a provider about a deteriorating patient using SBAR. Which statement belongs in the Assessment part?

• a."I think she is developing sepsis."✓
• b."She is 68 and was admitted with pneumonia."
• c."Please come and see her within 15 minutes."
• d."Her blood pressure is now 84/46 mm Hg."

In AHRQ's TeamSTEPPS SBAR, Assessment is what the person communicating thinks the problem is. The patient's age and admitting diagnosis belong to Background, the request to come within 15 minutes is the Recommendation or Request, and the current blood pressure describes the Situation.

During a rapid response, the provider says, "Give 1 mg of epinephrine IV now." What is the correct closed-loop reply from the nurse?

• a."Giving 1 mg epinephrine IV now."✓
• b."Got it, I'll go and get the drug now."
• c."The epinephrine is in the code cart."
• d."Okay, got it."

AHRQ describes the check-back as a closed-loop strategy in which the receiver repeats the information back so the sender can verify it, and the sender then confirms. Repeating the drug, dose, route and timing lets the provider catch an error. A bare acknowledgement or a partial reply does not repeat the order.

A nurse believes a patient is too unstable for transport to CT and the provider wants to proceed. Which statement follows AHRQ's CUS technique?

• a."I'm concerned, I'm uncomfortable, and this is a safety issue."✓
• b."Whatever you think is best, doctor."
• c."I'll go along with it, but I want it documented."
• d."I refuse to take this patient anywhere."

CUS stands for stating your Concern, stating that you are Uncomfortable, and, if the conflict is not resolved, stating that it is a Safety issue; if safety is still not acknowledged, a supervisor should be notified. Quietly complying, deferring completely or refusing without explanation do not use this structured escalation.

Which activity best reflects the Synergy Model characteristic of collaboration?

• a.Setting daily goals with family, pharmacist, therapist and physician✓
• b.Teaching a family how to suction the patient's tracheostomy
• c.Recognizing a family's spiritual practices at the bedside
• d.Reviewing published studies on early mobility in the ICU

Collaboration is working with others, including patients, families and healthcare providers, in a way that promotes each person's contributions toward optimal and realistic goals, including interdisciplinary work. Teaching suctioning is facilitation of learning, reviewing studies is clinical inquiry, and incorporating spiritual practices is response to diversity.

A nurse has a lot of discharge information to cover for a patient after an ICU stay. Which teaching approach does AHRQ recommend?

• a.Cover everything first, then ask for questions at the end
• b.Teach only the family, to spare the tired patient
• c.Teach in short segments and check understanding after each✓
• d.Give written material only, for review later at home

AHRQ recommends 'chunk and check': break information into small segments, have the patient teach each one back, then move on, rather than waiting until the end. Written material alone does not confirm understanding, and excluding the patient removes the person who must carry out the plan.

A patient going home on a new insulin pen correctly describes the dose and timing. What should the nurse do next?

• a.Give the manufacturer's leaflet to read at home tonight
• b.Document that the teaching has been completed
• c.Ask the patient to demonstrate a dose with the pen✓
• d.Ask whether the patient feels confident now

AHRQ's show-me method asks patients to demonstrate a new medicine or dose, because many who can correctly say how much to take still make mistakes when they actually do it. Documenting completion or handing over a leaflet skips that check, and asking about confidence does not verify skill.

A patient with limited English proficiency needs to consent to a procedure. His 15-year-old son is at the bedside and offers to translate. What should the nurse do?

• a.Use gestures and simple English
• b.Ask a bilingual visitor to help out
• c.Use a qualified medical interpreter✓
• d.Let the son interpret for his father

Federal rules under Section 1557 of the Affordable Care Act (45 CFR 92.201) require qualified interpreters and restrict relying on a minor child or an accompanying adult to interpret except in narrow emergency situations, and AHRQ's TeamSTEPPS materials present the need for a medical interpreter as a safety concern. Gestures and ad hoc interpreters risk an invalid consent.

The family of a dying patient asks to perform a religious ritual at the bedside that involves prayer and anointing. The patient is on a ventilator. Which response best reflects response to diversity?

• a.Explain that ICU rules do not allow religious rituals
• b.Allow it only after the patient has died
• c.Help them perform it safely around the equipment✓
• d.Ask them to hold it in the hospital chapel

The Synergy Model defines response to diversity as the sensitivity to recognize, appreciate and incorporate differences, including spiritual and cultural ones, into care. Working with the family to do the ritual safely incorporates their values, whereas refusing, delaying until after death or moving it away from the patient does not.

A nurse is caring for a patient from a cultural group the nurse has read about. Which approach best reflects response to diversity?

• a.Ask the patient and family about their own preferences✓
• b.Apply what the article said about that group
• c.Treat everyone the same regardless of background
• d.Let the interpreter decide what is culturally appropriate

Response to diversity includes individuality as well as culture, so the nurse learns each patient's and family's actual values and preferences rather than assuming them. Applying generalizations stereotypes the patient, treating everyone the same ignores meaningful differences, and an interpreter conveys language but does not decide care.

Before discharging a sepsis survivor who takes twelve medications, which step reflects systems thinking and the Surviving Sepsis Campaign 2026 transitions-of-care recommendations?

• a.Tell the patient to resume all home medications
• b.Arrange pharmacist-led medication reconciliation✓
• c.Leave medication review to the primary care visit
• d.Give the patient a printed medication list

The 2026 guideline recommends comprehensive medication reconciliation using a pharmacist-based approach at transitions of care, and systems thinking in the Synergy Model means using the resources that exist within and across healthcare systems for the patient. A printed list or a blanket instruction to resume home medications skips reconciliation, and deferring it leaves errors in place at the riskiest moment.

During a supply shortage, ventilators must be allocated among several critically ill patients. According to AACN's position on moral distress, what should the institution provide?

• a.Case-by-case decisions by whichever nurse is caring for the patient
• b.Consistent, equitable allocation policies and a triage committee✓
• c.Allocation according to the order in which patients were admitted
• d.Private decisions by administrators without explaining their reasons

AACN recommends that organizations establish evidence-based, consistent policies for equitably allocating scarce resources, consider an interdisciplinary triage committee, and keep communication transparent. Leaving the decision to the bedside nurse places the burden on one person, admission order is not an equitable criterion, and undisclosed decisions contradict the call for transparency.

A hospital wants to reduce sepsis deaths across all its units. Which action does the Surviving Sepsis Campaign 2026 guideline recommend at the hospital level?

• a.Relying on each unit's informal habits
• b.A poster campaign in the ICU only
• c.An annual lecture for new graduate nurses
• d.A sepsis performance improvement program✓

The 2026 guideline recommends that hospitals and health systems use a performance improvement program for sepsis, a system-level approach consistent with systems thinking. A poster in one unit, a once-a-year lecture or informal habits do not screen, measure and feed back performance across the organization.