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CCRN (Adult) Cheat Sheet

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Cardiovascular

  • 13% of exam
  • Hemodynamic Normals Shock Profiles Dysrhythmias & ECG Vasoactive Drips IABP + ACS

Respiratory

  • 12% of exam
  • ABG Interpretation Ventilation Modes Respiratory Emergencies ARDS + P/F PEEP + oxygenation

Endo, Heme, GI, Renal

  • 21% of exam
  • Endocrine Crises Heme, GI & Renal DKA vs HHS AKI + CRRT DIC + HIT

Neuro, MSK, Behavioral

  • 18% of exam
  • Neuro & Behavioral ICP + CPP Herniation Delirium + CAM-ICU Brain death

Multisystem

  • 16% of exam
  • Sepsis & Multiorgan Sepsis-3 criteria Hour-1 bundle Lactate clearance MODS

Professional Caring & Ethics

  • 20% of exam
  • Synergy Model Ethics & End-of-Life Advocacy Collaboration Systems Thinking

Quick Facts

  • Credential CCRN (Adult)
  • Items 150 (125 scored)
  • Time 3 hours
  • Pass 83 of 125
  • Format Multiple choice
  • Fee $260 or $375
  • Framework Judgment 80%, Caring 20%
  • Body AACN Certification
  • Valid 3 years

Shockable Rhythms CA

  • Shock VF and pulseless VT
  • VF: defibrillate Pulseless VT: defibrillate Asystole/PEA: no shock

Cardiogenic vs Hypovolemic CA

Cardiogenic

  • High PAWP
  • Low cardiac index
  • Needs inotropes

Hypovolemic

  • Low PAWP
  • Low CVP
  • Needs fluids
  • Pump vs volume

Shock Type Picker CA

  • Low CVP, high SVR → Hypovolemic ( Give fluids )
  • High PAWP, low output → Cardiogenic ( Inotropes )
  • Low SVR, warm skin → Distributive ( Pressors + source )
  • Equal diastolic pressures → Tamponade ( Drain pericardium )
  • Fluid-refractory, high lactate → Septic shock ( Norepinephrine )

Hemodynamic Normals CA

  • CVP 2-6 mmHg, preload
  • PAWP 8-12 mmHg, left preload
  • CO 4-8 L/min
  • CI 2.5-4; shock under 2.2
  • SVR 800-1200; afterload
  • MAP 70-100; target over 65
  • SvO2 60-80% oxygen delivery
  • PA pressure Systolic 15-25 mmHg

MAP Formula CA

  • MAP = (SBP + 2 DBP) / 3
  • Two-thirds diastole Target over 65

Mobitz I vs Mobitz II CA

Mobitz I

  • PR progressively lengthens
  • Then dropped beat
  • Usually benign

Mobitz II

  • PR stays constant
  • Sudden dropped beat
  • May need pacing
  • Gradual vs sudden

Vasopressor Picker CA

  • Septic shock → Norepinephrine ( First-line )
  • Refractory septic shock → Add vasopressin ( Fixed dose )
  • Cardiogenic, low output → Dobutamine ( Inotrope )
  • Anaphylaxis → Epinephrine ( IM first )
  • Symptomatic bradycardia → Atropine ( Then pace )
  • Reduce afterload → Nitroprusside ( Arterial dilator )

Shock Profiles CA

  • Hypovolemic Low preload, high SVR
  • Cardiogenic High PAWP, low output
  • Distributive Low SVR, warm skin
  • Obstructive Tamponade, PE, tension pneumo
  • Septic Distributive; give norepinephrine
  • Anaphylactic Distributive; epinephrine first
  • Neurogenic Low SVR with bradycardia

Norepinephrine vs Dobutamine CA

Norepinephrine

  • Vasopressor
  • Raises SVR/MAP
  • Septic shock

Dobutamine

  • Inotrope
  • Raises cardiac output
  • Low-output states
  • Squeeze vs pump

Dysrhythmia Response CA

  • Pulseless VF or VT → Defibrillate ( Unsynchronized shock )
  • Asystole or PEA → CPR and epinephrine ( No shock )
  • Unstable tachycardia → Synchronized cardioversion
  • Torsades de pointes → Magnesium
  • Symptomatic bradycardia → Atropine, then pace

Dysrhythmias & ECG CA

  • Atrial fib Irregular, no P waves
  • Atrial flutter Sawtooth flutter waves
  • SVT Narrow, fast, regular
  • V-tach Wide QRS over 100
  • V-fib Chaotic; defibrillate immediately
  • Torsades Polymorphic VT; give magnesium
  • Asystole / PEA Non-shockable; CPR and epinephrine
  • 1st-degree block PR over 0.20 seconds
  • Mobitz I PR lengthens, drops beat
  • Mobitz II Constant PR, sudden drop
  • 3rd-degree block AV dissociation; may pace

Vasoactive Drips CA

  • Norepinephrine Alpha vasopressor; septic first-line
  • Epinephrine Alpha and beta; arrest
  • Vasopressin Non-adrenergic; septic add-on
  • Phenylephrine Pure alpha vasoconstrictor
  • Dopamine Dose-dependent adrenergic effects
  • Dobutamine Beta inotrope; raises output
  • Milrinone PDE-3 inodilator
  • Nitroglycerin Venodilator; lowers preload
  • Nitroprusside Arterial dilator; lowers afterload

ROME for ABGs RE

  • Respiratory Opposite, Metabolic Equal
  • Resp: pH and CO2 opposite Metab: pH and HCO3 same

Oxygenation vs Ventilation RE

Oxygenation

  • Low PaO2
  • Raise FiO2 and PEEP
  • Shunt or V/Q

Ventilation

  • High PaCO2
  • Raise minute ventilation
  • Hypoventilation
  • PaO2 vs PaCO2

ABG Disorder Picker RE

  • pH down, CO2 up → Respiratory acidosis
  • pH up, CO2 down → Respiratory alkalosis
  • pH down, HCO3 down → Metabolic acidosis
  • pH up, HCO3 up → Metabolic alkalosis
  • High anion gap → DKA, lactate, toxins

ABG Interpretation RE

  • pH 7.35-7.45 normal range
  • PaCO2 35-45 mmHg; respiratory
  • HCO3 22-26 mEq/L; metabolic
  • PaO2 80-100 mmHg oxygenation
  • Resp acidosis pH down, CO2 up
  • Resp alkalosis pH up, CO2 down
  • Metabolic acidosis pH down, HCO3 down
  • Metabolic alkalosis pH up, HCO3 up
  • Anion gap High: DKA, lactate, toxins

Ventilation Modes RE

  • Assist-Control Full support every breath
  • SIMV Mandatory plus spontaneous breaths
  • PSV Pressure support; spontaneous only
  • CPAP Constant pressure; spontaneous
  • PEEP End-expiratory alveolar pressure
  • Tidal volume 6 mL/kg in ARDS
  • Plateau pressure Keep below 30 cmH2O
  • Auto-PEEP Air trapping; drops preload

Respiratory Emergencies RE

  • ARDS Bilateral infiltrates; normal wedge
  • P/F ratio Under 300 signals ARDS
  • Berlin severe P/F under 100
  • Oxygenation failure Low PaO2; raise PEEP
  • Ventilation failure High PaCO2; raise rate
  • Prone positioning Improves severe ARDS oxygenation
  • Tension pneumo Tracheal shift; needle decompress
  • Pulmonary embolism Obstructive shock; anticoagulate

DKA vs HHS MU

DKA

  • Ketoacidosis
  • pH under 7.3
  • Younger, type 1

HHS

  • No ketoacidosis
  • Glucose over 600
  • Older, type 2
  • Acidosis vs hyperosmolar

Endocrine Crises MU

  • DKA Acidosis, ketones; watch K+
  • HHS Very high glucose, hyperosmolar
  • Thyroid storm Fever, tachycardia, agitation
  • Myxedema coma Hypothermia; IV levothyroxine
  • Adrenal crisis Refractory hypotension; hydrocortisone
  • Diabetes insipidus Dilute urine; give desmopressin
  • SIADH Concentrated urine; hyponatremia

CRRT vs Hemodialysis MU

CRRT

  • Slow, continuous
  • Hemodynamically unstable
  • Gentle fluid shifts

Hemodialysis

  • Fast clearance
  • Stable patients
  • Rapid fluid removal
  • Slow vs fast

Heme, GI & Renal MU

  • DIC Clots and bleeds together
  • HIT Platelets drop; stop heparin
  • Neutropenic fever ANC under 500; antibiotics
  • Pre-renal AKI Perfusion loss; fluid responsive
  • Intrinsic AKI ATN; muddy brown casts
  • Post-renal AKI Obstruction; relieve it
  • CRRT Slow; for unstable patients
  • Hepatorenal Cirrhosis; albumin and vasoconstrictor
  • SBP Ascites PMN over 250
  • Variceal bleed Octreotide, banding, antibiotics

Cushing Triad NE

  • Rising ICP: up BP, down pulse
  • Widening pulse pressure Bradycardia Irregular breathing

Brain Death vs Vegetative NE

Brain death

  • No brainstem reflexes
  • Apnea test positive
  • Legally dead

Vegetative

  • Brainstem reflexes intact
  • Breathes spontaneously
  • Alive, unconscious
  • Dead vs unconscious

Neuro & Behavioral NE

  • CPP MAP minus ICP; 60-70
  • ICP Treat over 22 mmHg
  • Cushing triad Hypertension, bradycardia, irregular breathing
  • Uncal herniation Blown pupil; neurosurgical emergency
  • Brain death No brainstem reflexes; apnea
  • Alteplase Ischemic stroke within 4.5h
  • Meningitis Antibiotics within one hour
  • Delirium CAM-ICU; fluctuating attention
  • Restraints Last resort; time-limited
  • Status epilepticus Benzodiazepine is first-line

Sepsis vs Septic Shock MU

Sepsis

  • Infection plus SOFA rise
  • Organ dysfunction
  • No pressors yet

Septic shock

  • Needs vasopressors
  • Lactate over 2
  • Higher mortality
  • Dysfunction vs collapse

Sepsis & Multiorgan MU

  • Sepsis-3 Infection plus organ dysfunction
  • qSOFA Altered, low BP, tachypnea
  • Septic shock Pressors plus lactate over 2
  • Hour-1 bundle Cultures, lactate, antibiotics, fluids
  • Initial fluids 30 mL/kg crystalloid
  • First pressor Norepinephrine, then vasopressin
  • MODS Two or more organs fail
  • Lactate Trend to guide resuscitation

8 Nurse Competencies PR

  • Judgment, Advocacy, Caring, Collaboration, Systems, Inquiry, Learning, Diversity
  • 8 nurse competencies 8 patient characteristics Match = synergy

Synergy Model PR

  • Core premise Match competence to patient need
  • Resiliency Ability to bounce back
  • Vulnerability Susceptibility to stressors
  • Stability Ability to stay steady
  • Complexity Entangled patient systems
  • Predictability Expected illness trajectory
  • Clinical judgment Reasoning and critical thinking
  • Advocacy Moral agency for patient
  • Systems thinking Navigate care resources
  • Clinical inquiry Question and improve practice

Ethics & End-of-Life PR

  • Autonomy Patient right to choose
  • Beneficence Act for patient good
  • Non-maleficence Avoid causing harm
  • Justice Fair resource distribution
  • Informed consent Capacity, disclosure, voluntariness
  • Moral distress Blocked from right action
  • Palliative care Symptom relief, any stage
  • Goals of care Align treatment with values
  • Surrogate Substituted judgment for patient

Common Traps

DKA potassium

  • Hold insulin if low K+ ≠ Replace potassium first

HIT platelets

  • Stop all heparin ≠ Never transfuse platelets

First pressor

  • Norepinephrine first-line ≠ Not dopamine

qSOFA role

  • Bedside screen only ≠ Not diagnostic criteria

IABP contraindication

  • Avoid in aortic insufficiency ≠ Inflates during diastole

Brain vs vegetative

  • Brain death is dead ≠ Vegetative is alive

ARDS wedge pressure

  • ARDS wedge is normal ≠ High wedge is cardiogenic

Last Minute

  • 1. Pass = 83 of 125
  • 2. MAP target 65 or higher
  • 3. Norepinephrine first in septic shock
  • 4. Shock VF and pulseless VT
  • 5. ARDS tidal volume 6 mL/kg
  • 6. ROME reads the ABG
  • 7. DKA: replace potassium first
  • 8. HIT: stop all heparin
  • 9. CPP equals MAP minus ICP
  • 10. Sepsis bundle within one hour
  • 11. Synergy matches nurse to patient
  • 12. qSOFA screens, not diagnoses

CCRN Adult Critical Care Nurse

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