CCRN Test Plans

Prior to the application of the AACN Synergy Model for Patient Care framework to the CCRN certification program, the examination was solely based on the Clinical Judgment facet of critical care nursing practice. In recognition of the additional components that comprise critical care nursing, as of July 1, 1999, twenty percent (20%) of the CCRN examination is based on Advocacy/Moral Agency, Caring Practices, Collaboration, Systems Thinking, Response to Diversity, Clinical Inquiry, and Facilitation of Learning. These nursing characteristics are referred to collectively as Professional Caring and Ethical Practice; for further information, please refer to the AACN Synergy Model for Patient Care.

Adult CCRN Test Plan

I. Clinical Judgment (80%)
  • Cardiovascular (32%)
    1. Acute coronary syndromes/unstable angina
    2. Acute heart failure/pulmonary edema
    3. Acute inflammatory disease (e.g., myocarditis, endocarditis, pericarditis)
    4. Acute myocardial infarction/papillary muscle rupture
    5. Acute peripheral vascular insufficiency (e.g., acute arterial occlusion, carotid artery stenosis, endartarectomy, peripheral stents)
    6. Cardiac surgery (e.g., valve replacement, CABG)
    7. Cardiac tamponade
    8. Cardiac trauma (blunt and penetrating)
    9. Cardiogenic shock
    10. Cardiomyopathies (e.g., hypertrophic, dilated, restrictive, idiopathic)
    11. Cardiovascular pharmacology
    12. Conduction defects, blocks and pacemakers
    13. Dysrhythmias/AICDs
    14. Heart failure
    15. Hemodynamic monitoring
    16. Hypertensive crisis
    17. Hypovolemic shock and volume deficit
    18. Pulmonary hypertension(e.g., valvular defects, aortic stenosis, mitral stenosis)
    19. Ruptured or dissecting aneurysm (e.g., thoracic, abdominal)
  • Pulmonary (17%)
    1. Acute pulmonary embolus, fat embolus
    2. Acute respiratory distress syndrome (ARDS)
    3. Acute respiratory failure, hypoxemia
    4. Acute respiratory infections
    5. Air-leak syndromes (e.g., spontaneous pneumothorax, pneumopericardium, pneumomediastinum, PIE)
    6. Aspirations (e.g., aspiration pneumonia, hospital acquired pneumonia, foreign-body aspiration)
    7. Chronic lung disease
    8. Pulmonary pharmacology
    9. Pulmonary trauma (e.g., pulmonary hemorrhage, tracheal perforation)
    10. Respiratory distress (e.g., emphysema, bronchitis)
    11. Status asthmaticus, exacerbation of COPD, emphysema
    12. Thoracic surgery (e.g., lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage, lung reduction, pneumonectomy, lobectomy, tracheal surgery)
    13. Thoracic trauma (e.g., lung contusions, fractured ribs, hemothorax, pneumothorax from trauma, pulmonary hemorrhage)
    14. Ventilator management and ABG interpretation, mixed venous gases, CPAP, volutrauma and barotraumas
  • Endocrine (4%)
    1. Acute hypoglycemia
    2. Diabetes insipidus
    3. Diabetic ketoacidosis
    4. Hormones and endocrine anatomy and physiology
    5. Hyperglycemic hyperosmolar nonketotic coma (HHNK)
  • Hematology/Immunology (3%)
    1. Hematology, anatomy and physiology, blood products and plasma
    2. Immunosuppression-acquired (e.g., HIV, AIDS, neoplasms)
    3. Life-threatening coagulopathies (e.g., ITP, DIC, hemophilia, HITTS, ReoPro-induced) and non life-threatening coagulopathies
    4. Organ transplantation (e.g., liver, bone marrow, kidney, heart, pancreas, lung)
    5. Sickle cell crisis
  • Neurology (5%)
    1. Aneurysm, AV malformation
    2. Encephalopathy (e.g., hypoxic-ischemic, metabolic, edema, infectious)
    3. Head trauma (blunt, penetrating), skull fractures
    4. Intracranial hemorrhage/intraventricular hemorrhage (e.g., subarachnoid, epidural, subdural)
    5. Neurologic infectious diseases (e.g., meningitis, GBS, West Nile)
    6. ICP monitoring
    7. Neurosurgery (e.g., evacuation of hematoma, tumor resection)
    8. Seizure disorders
    9. Stroke (e.g., embolic events, hemorrhagic)
  • Gastrointestinal (6%)
    1. Acute abdominal trauma
    2. Acute GI hemorrhage (e.g., esophageal, upper and lower)
    3. Bowel infarction, bowel obstruction, bowel perforation
    4. GI surgeries (e.g., Whipple, esophago-gastrectomy, gastric bypass)
    5. Hepatic failure/coma (e.g., portal hypertension, cirrhosis, esophageal varicies, fulminant hepatitis)
    6. Pancreatitis
    7. Gastro-esophageal reflux
  • Renal (5%)
    1. Acute renal failure (e.g., acute tubular necrosis, hypoxia, dialysis)
    2. Chronic renal failure and dialysis
    3. Life-threatening electrolyte imbalances (e.g., potassium, sodium, phosphorus, magnesium, calcium)
    4. Fluid balance concepts and renal anatomy & physiology
    5. Renal trauma
  • Multisystem (8%)
    1. Multisystem trauma
    2. Septic shock/infectious diseases (e.g., viral, bacterial, line sepsis, nosocomial infections, immunosuppression)
    3. Systemic inflammatory response syndrome (SIRS)/sepsis/MODS
    4. Toxic exposure (e.g., chemicals, radiation, anaphylaxis)
    5. Toxic ingestions and inhalations (e.g., drug/alcohol overdose, poisoning)
II. Professional Caring and Ethical Practice (20%)
  • Advocacy/Moral Agency (2%)
  • Caring Practices (4%)
  • Collaboration (4%)
  • Systems Thinking (2%)
  • Response to Diversity (2%)
  • Clinical Inquiry (2%)
  • Facilitation of Learning (4%)

Neonatal CCRN Test Plan

I. Clinical Judgment (80%)
  • Cardiovascular (10%)
    1. Acute heart failure/pulmonary edema
    2. Acute inflammatory disease (e.g., myocarditis, endocarditis, pericarditis)
    3. Cardiac surgery
    4. Cardiovascular pharmacology
    5. Congenital heart defect/disease
    6. Hemodynamic concepts
    7. Pulmonary hypertension
    8. 8. Shock states (e.g., cardiogenic, hypovolemic)/volume deficit
  • Pulmonary (36%)
    1. Acute respiratory failure, hypoxemia
    2. Acute respiratory infections
    3. Air-leak syndromes (e.g., spontaneous pneumothorax, bronch-fistula, emphysema, [PIE], pneumopericardium, pneumomediastinum)
    4. Apnea of prematurity
    5. Aspirations (e.g., aspiration pneumonia, meconium aspiration)
    6. Chronic lung disease (e.g., bronchopulmonary dysplasia)
    7. Congenital anomalies
    8. Pulmonary hypertension in newborn
    9. Respiratory distress syndrome
    10. Respiratory pharmacology
    11. Thoracic surgery (e.g., lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage, lung reduction, pneumonectomy, lobectomy, tracheal surgery)
    12. Transient tachypnea of the newborn
    13. Ventilator management and ABG interpretation, mixed venous gases, CPAP, volutrauma and barotrauma
  • Endocrine (4%)
    1. Acute hypoglycemia
    2. Hormones and anatomy & physiology
    3. Inborn errors of metabolism
    4. Infant of diabetic mother
  • Hematology/Immunology (4%)
    1. Anemia of prematurity
    2. Hematology, blood products and plasma
    3. Hyperbilirubinemia
    4. Immunosuppression (e.g., Rh incompatibilities, ABO incompatibilities, hydrops fetalis)
    5. Life-threatening coagulopathies (e.g., ITP, DIC) and non life-threatening coagulopathies
  • Neurology (6%)
    1. Congenital neurological abnormalities (e.g., spina bifida, myelomeningocele, anencephaly, encephalocele)
    2. Encephalopathy (e.g., hypoxic-ischemic, metabolic, edema, infectious)
    3. Hydrocephalus
    4. ICP monitoring
    5. Intracranial hemorrhage/intraventricular hemorrhage
    6. Neurologic infectious diseases (e.g., meningitis, congenital infections, viral infections, TORCH)
    7. Seizure disorders
  • Gastrointestinal (7%)
    1. Bowel infarction /obstruction/ perforation (e.g., necrotizing enterocolitis, adhesions, shortgut)
    2. Gastro-esophageal reflux
    3. GI abnormalities at birth
    4. Hepatic failure/coma
  • Renal (2%)
    1. Acute renal failure (e.g., acute tubular necrosis, hypoxia)
    2. Congenital renal-genitourinary abnormalities (e.g., polycystic kidneys, exstrophy of bladder, hydronephrosis)
    3. Fluid balance concepts and renal anatomy & physiology
    4. Life-threatening electrolyte imbalances (e.g., potassium, sodium, phosphorus, magnesium, calcium)
  • Multisystem (11%)
    1. Asphyxia (e.g., neonatal-perinatal)
    2. Life-threatening maternal-fetal complications (e.g., birth trauma and birth-related injuries, genetic disorders, maternal-fetal transfusion, abruption placenta, placenta previa)
    3. Low birth weight/prematurity
    4. Septic shock/infectious diseases (e.g., congenital viral, bacterial, line sepsis, nosocomial infections)
    5. Toxic exposure (e.g., fetal exposure to drug/alcohol, drug withdrawal, anaphylaxis)
II. Professional Caring and Ethical Practice (20%)
  • Advocacy/Moral Agency (2%)
  • Caring Practices (4%)
  • Collaboration (4%)
  • Systems Thinking (2%)
  • Response to Diversity (2%)
  • Clinical Inquiry (2%)
  • Facilitation of Learning (4%)

Pediatric CCRN Test Plan

I. Clinical Judgment (80%)
  • Cardiovascular (19%)
    1. Acute heart failure/pulmonary edema
    2. Acute inflammatory disease (e.g., myocarditis, endocarditis, pericarditis)
    3. Cardiac surgery
    4. Cardiac trauma (blunt and penetrating)
    5. Cardiogenic shock
    6. Cardiomyopathies (e.g., hypertrophic, dilated, restrictive, idiopathic)
    7. Cardiovascular pharmacology
    8. Conduction defects, blocks and pacemakers
    9. Congenital heart defect/disease
    10. Dysrhythmias
    11. Hemodynamic monitoring
    12. Hypertensive crisis
    13. Hypovolemic shock and volume deficit
    14. Pulmonary hypertension (e.g., aortic and mitral stenosis and regurgitation)
  • Pulmonary (22%)
    1. Acute respiratory distress syndrome (ARDS)
    2. Acute respiratory failure, hypoxemia
    3. Acute respiratory infections (e.g., pneumonia, croup, strep pneumonia, RSV, bronchiolitis
    4. Air-leak syndromes (e.g., spontaneous pneumothorax, bronch-fistula, emphysema, [PIE], pneumopericardium, pneumomediastinum)
    5. Apnea of prematurity
    6. Aspirations (e.g., aspiration pneumonia, hospital acquired pneumonia, foreign-body aspiration)
    7. Chronic lung disease (e.g., bronchopulmonary dysplasia)
    8. Congenital anomalies
    9. Persistent pulmonary hypertension
    10. Pulmonary trauma (e.g., pulmonary hemorrhage, tracheal perforation)
    11. Pulmonary pharmacology
    12. Respiratory distress (e.g., epiglottitis, bronchitis)
    13. Status asthmaticus
    14. Thoracic surgery (e.g., lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage, lung reduction, pneumonectomy, lobectomy, tracheal surgery)
    15. Thoracic trauma (e.g., lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage)
    16. Ventilator management and ABG interpretation, mixed venous gases, CPAP, volutrauma and barotraumas
  • Endocrine (5%)
    1. Acute hypoglycemia
    2. Diabetes insipidus
    3. Diabetic ketoacidosis
    4. Hormones and anatomy & physiology
    5. Inborn errors of metabolism
    6. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
  • Hematology/Immunology (6%)
    1. Hematology, anatomy & physiology, blood products and plasma
    2. Hyperbilirubinemia
    3. Immunosuppression (e.g., congenital [SCIDS], acquired [HIV, AIDS, neoplasms])
    4. Life-threatening coagulopathies (e.g., DIC, ITP, hemophilia)
    5. Organ transplantation (e.g., liver, bone marrow, kidney, heart, pancreas, lung)
    6. Sickle cell crisis
  • Neurology (10%)
    1. Acute spinal cord injury
    2. Congenital neurological abnormalities (e.g., spina bifida, myelomeningocele, anencephaly, encephalocele)
    3. Encephalopathy (e.g., hypoxic-ischemic, metabolic, edema, infectious)
    4. Head trauma (blunt, penetrating) including shaken baby
    5. Hydrocephalus
    6. ICP monitoring
    7. Intracranial hemorrhage/intraventricular hemorrhage (e.g., subarachnoid, epidural, subdural) including stroke
    8. Neurologic infectious diseases (e.g., meningitis, congenital infections, viral infections, West Nile)
    9. Neuromuscular disorders (e.g., muscular dystrophy, Werdnig-Hoffman)
    10. Neurosurgery (e.g., evacuation of hematoma, tumor resection
    11. Seizure disorders
    12. Space-occupying lesions (e.g., brain tumors)
    13. Spinal fusion
  • Gastrointestinal (5%)
    1. Acute abdominal trauma
    2. Acute GI hemorrhage
    3. Bowel infarction /obstruction/ perforation (e.g., necrotizing enterocolitis)
    4. Gastro-esophageal reflux
    5. GI abnormalities at birth(e.g., Hirschprung's)
    6. GI surgeries
    7. Hepatic failure/coma (e.g., portal hypertension, fulminant hepatitis, biliary atresia, hyperbilirubinemia)
  • Renal (4%)
    1. Acute renal failure (e.g., acute tubular necrosis)
    2. Chronic renal failure and dialysis
    3. Congenital renal-genitourinary abnormalities (e.g., polycystic kidneys, exstrophy of bladder, hydronephrosis)
    4. Fluid balance concepts and renal anatomy & physiology
    5. Life-threatening electrolyte imbalances (e.g., potassium, sodium, phosphorus, magnesium, calcium)
    6. Renal trauma
  • Multisystem (9%)
    1. Asphyxia (e.g., near-drowning, traumatic)
    2. Burns
    3. Hemolytic uremic syndrome
    4. Multisystem trauma
    5. Septic shock/infectious diseases (e.g., congenital viral, bacterial, line sepsis, nosocomial infections)
    6. Systemic inflammatory response syndrome (SIRS)/sepsis/MODS
    7. Toxic exposure (e.g., fetal exposure to drug/alcohol, drug withdrawal, anaphylaxis)
    8. Toxic ingestions and inhalations (e.g., drug/alcohol overdose, poisoning)
II. Professional Caring and Ethical Practice (20%)
  • Advocacy/Moral Agency (2%)
  • Caring Practices (4%)
  • Collaboration (4%)
  • Systems Thinking (2%)
  • Response to Diversity (2%)
  • Clinical Inquiry (2%)
  • Facilitation of Learning (4%)