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100+ Free CNCC(C) Practice Questions

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2026 Statistics

Key Facts: CNCC(C) Exam

165

Questions

CNA

4 hours

Time Limit

CNA

1,950

Hours Required

CNA

$570

Member Fee

CNA

$756

Non-Member Fee

CNA

The CNCC(C) exam is the gold standard for Canadian critical care nurses. It consists of 165 multiple-choice questions over 4 hours, and requires a current RN license and either 1,950 hours of specialty practice or 1,000 hours plus specialty education.

Sample CNCC(C) Practice Questions

Try these sample questions to test your CNCC(C) exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A patient with acute coronary syndrome (ACS) is receiving an intravenous nitroglycerin infusion. Which of the following is the primary therapeutic goal of this medication?
A.To increase myocardial oxygen demand by dilating coronary arteries.
B.To reduce myocardial oxygen demand by decreasing ventricular preload.
C.To increase systemic vascular resistance to maintain blood pressure.
D.To increase ventricular afterload by dilating peripheral veins.
Explanation: Nitroglycerin is a potent venous vasodilator that decreases venous return to the heart, thereby reducing ventricular preload and lowering myocardial oxygen demand. It also dilates coronary arteries to improve collateral blood flow to ischemic areas, helping to relieve ischemic chest pain. By reducing preload, it helps lower the workload of the failing heart.
2A patient in the intensive care unit is exhibiting signs of cardiogenic shock. Which set of hemodynamic parameters is most consistent with this diagnosis?
A.Decreased Central Venous Pressure (CVP), decreased Pulmonary Artery Wedge Pressure (PAWP), increased Cardiac Index (CI).
B.Increased CVP, increased PAWP, decreased CI, increased Systemic Vascular Resistance (SVR).
C.Decreased CVP, increased PAWP, increased CI, decreased SVR.
D.Increased CVP, decreased PAWP, decreased CI, decreased SVR.
Explanation: Cardiogenic shock is characterized by primary myocardial pump failure, which leads to a low cardiac index (CI) and inadequate tissue perfusion. Because the heart cannot pump blood forward effectively, pressures back up into the venous system and lungs, resulting in elevated CVP and PAWP. The body compensates for the low cardiac output by vasoconstricting, which increases the systemic vascular resistance (SVR).
3An arterial line trace for a patient shows a blood pressure of 90/60 mmHg. What is the calculated Mean Arterial Pressure (MAP), and what is the minimum MAP typically required to maintain adequate organ perfusion?
A.MAP is 75 mmHg; the minimum required is 60 mmHg.
B.MAP is 70 mmHg; the minimum required is 65 mmHg.
C.MAP is 70 mmHg; the minimum required is 60 mmHg.
D.MAP is 80 mmHg; the minimum required is 70 mmHg.
Explanation: Mean Arterial Pressure (MAP) is calculated using the formula: MAP = [Systolic Blood Pressure + 2(Diastolic Blood Pressure)] / 3. For a BP of 90/60 mmHg, MAP = [90 + 2(60)] / 3 = 70 mmHg. In critical care settings, a minimum MAP of 65 mmHg is standardly targeted to ensure adequate perfusion to vital organs, such as the brain and kidneys.
4A 12-lead ECG reveals ST-segment elevation in leads V1 to V4. Which coronary artery is most likely occluded, and which area of the myocardium is affected?
A.Right coronary artery (RCA); inferior wall.
B.Left anterior descending (LAD) coronary artery; anterior wall.
C.Left circumflex (LCx) coronary artery; lateral wall.
D.Posterior descending artery (PDA); posterior wall.
Explanation: ST-segment elevation in leads V1 through V4 indicates an acute anterior wall myocardial infarction. The left anterior descending (LAD) coronary artery provides blood flow to the anterior wall of the left ventricle and the interventricular septum, making it the culprit vessel in this presentation. Blockage of this artery is often associated with high risk of cardiogenic shock and heart block.
5A patient is supported by an intra-aortic balloon pump (IABP) for cardiogenic shock. During your assessment, you note that the timing waveform shows 'late inflation' of the balloon. What is the primary physiological consequence of late inflation?
A.Premature closure of the aortic valve and increased left ventricular afterload.
B.Decreased coronary artery perfusion and suboptimal diastolic augmentation.
C.Increased risk of aortic dissection due to high pressure during systole.
D.Retrograde blood flow into the left ventricle causing pulmonary edema.
Explanation: Late inflation of an IABP balloon occurs after diastolic pressure has already started to fall, resulting in suboptimal diastolic augmentation. Because inflation is delayed, the pressure wave that pushes blood back into the coronary arteries is weaker, thereby reducing coronary artery perfusion. This timing error reduces the therapeutic efficacy of the pump but is less hemodynamically harmful than early inflation.
6A patient in the coronary care unit suddenly develops a third-degree (complete) AV block. The patient is hypotensive, diaphoretic, and has a heart rate of 28 bpm. What is the immediate nursing priority?
A.Administer an intravenous bolus of 1 mg atropine and repeat every 3-5 minutes.
B.Initiate immediate transcutaneous pacing and prepare for transvenous pacemaker insertion.
C.Perform immediate synchronized cardioversion at 100 Joules.
D.Initiate a continuous infusion of epinephrine at 20 mcg/min.
Explanation: Third-degree AV block is characterized by complete dissociation between atria and ventricles, resulting in severe bradycardia and hemodynamic instability. Transcutaneous pacing is the immediate, definitive therapy to restore a perfusing heart rate and blood pressure while preparing for a temporary transvenous pacemaker. Atropine is generally ineffective in third-degree AV blocks because the block is nodal or sub-nodal, where vagolytic actions do not reach.
7A patient with severe heart failure is started on a dobutamine infusion. How should the nurse explain the primary mechanism of action and physiological effects of this drug?
A.It acts as a potent alpha-1 agonist, increasing systemic vascular resistance and blood pressure.
B.It acts primarily as a beta-1 agonist, increasing myocardial contractility and cardiac output.
C.It is a selective phosphodiesterase inhibitor, causing vasodilation and decreasing heart rate.
D.It acts as a beta-2 agonist, causing profound bronchodilation and reducing venous return.
Explanation: Dobutamine is a synthetic catecholamine that acts primarily as a beta-1 adrenergic agonist. It has positive inotropic effects, meaning it increases myocardial contractility, which in turn increases stroke volume and cardiac output. It has mild beta-2 and alpha-1 effects, which typically balance out to produce mild systemic vasodilation (afterload reduction) while improving perfusion.
8While monitoring a patient's ECG, you observe a sudden transition to a chaotic, rapid wave rhythm with no identifiable P waves, QRS complexes, or T waves. The patient is unresponsive and pulseless. What is the immediate treatment of choice?
A.Administration of amiodarone 300 mg IV push.
B.Immediate unsynchronized defibrillation.
C.Delivery of a synchronized cardioversion shock at 200 Joules.
D.Initiation of high-quality CPR for 2 minutes before any shocks are delivered.
Explanation: The rhythm described is ventricular fibrillation (VF), which is a shockable cardiac arrest rhythm. The definitive and immediate treatment for VF is unsynchronized defibrillation, which depolarizes the entire myocardium and allows the natural pacemaker to resume a normal rhythm. CPR should be performed while the defibrillator is charging, but the shock should be delivered without delay.
9A patient with hypertensive emergency has been receiving a sodium nitroprusside infusion for 48 hours. The patient develops unexplained metabolic acidosis, confusion, and hyperreflexia. What is the most likely cause of these symptoms?
A.Severe hypokalemia due to drug-induced renal excretion.
B.Thiocyanate or cyanide toxicity.
C.Acute ischemic stroke from rapid blood pressure reduction.
D.Adrenal insufficiency triggered by the medication.
Explanation: Sodium nitroprusside is metabolized into thiocyanate and cyanide. Prolonged infusions (especially over 48 hours), high doses, or renal impairment increase the risk of toxicity. Unexplained metabolic acidosis (due to cellular hypoxia), mental status changes, and hyperreflexia are classic signs of cyanide poisoning, and treatment involves stopping the drug and administering an antidote like sodium thiosulfate.
10During monitoring of a patient with a pulmonary artery (PA) catheter, you observe that the distal PA waveform suddenly dampens and shows an elevated, flat diastolic pressure similar to a wedge tracing. The balloon is deflated. What is the immediate nursing action?
A.Flush the distal lumen aggressively with heparinized saline to clear a suspected blood clot.
B.Immediately verify that the balloon is completely deflated, ensure the locking mechanism is open, and notify the physician.
C.Inflate the balloon with 1.5 mL of air to confirm the wedge position.
D.Advance the catheter 5 to 10 cm further to secure its position in the pulmonary artery.
Explanation: A dampened PA waveform with elevated pressure when the balloon is deflated indicates that the catheter has migrated forward into a smaller branch of the pulmonary artery, causing permanent mechanical wedging. This is a medical emergency because it blocks pulmonary blood flow and can lead to pulmonary artery rupture or infarction. The nurse must verify balloon deflation, keep the line open, and contact the physician to pull the catheter back; flushing should be avoided as it can rupture the vessel.

About the CNCC(C) Exam

The CNCC(C) (Certified Nurse in Critical Care (Canada)) is a national specialty certification for registered nurses who specialize in adult critical care nursing. It is administered by the Canadian Nurses Association (CNA) and recognizes nurses who have met rigorous national standards of knowledge, skills, and experience in critical care.

Questions

165 scored questions

Time Limit

4 hours

Passing Score

Standard-set

Exam Fee

$588 CAD (CNA member) / $780 CAD (non-member) application fee, plus $85 online (ProctorU) or $110 in-person writing appointment fee; rewrite $378 (member) / $500 (non-member). Applicable taxes extra. (Canadian Nurses Association)

CNCC(C) Exam Content Outline

20-25%

Cardiovascular System

Assessment, troubleshooting, and management of hemodynamic monitoring, ECGs, cardiac arrest, myocardial infarction, and shock.

20-25%

Respiratory System

Caring for patients undergoing invasive or non-invasive mechanical ventilation, ARDS management, chest tube troubleshooting, and airway emergencies.

15-20%

Neurologic System

Monitoring and care of patients with increased intracranial pressure, traumatic brain injuries, stroke, spinal cord injuries, and status epilepticus.

10-20%

Systemic and Multi-System Conditions

Sepsis guidelines, endocrine crises, acute kidney injury, severe burns, rhabdomyolysis, compartment syndrome, and hematological issues.

5-10%

Gastrointestinal and Nutritional Care

Management of upper and lower GI bleeding, pancreatitis, liver failure, and nutritional support (enteral/parenteral).

5-10%

Psychosocial and Professional Practice

Ethical frameworks, family meetings, patient advocacy, ICU delirium prevention, handover protocols, and end-of-life care.

How to Pass the CNCC(C) Exam

What You Need to Know

  • Passing score: Standard-set
  • Exam length: 165 questions
  • Time limit: 4 hours
  • Exam fee: $588 CAD (CNA member) / $780 CAD (non-member) application fee, plus $85 online (ProctorU) or $110 in-person writing appointment fee; rewrite $378 (member) / $500 (non-member). Applicable taxes extra.

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

CNCC(C) Study Tips from Top Performers

1Review the official CNA exam blueprint and competencies for Critical Care Adult Nursing.
2Utilize the Canadian Association of Critical Care Nurses (CACCN) study materials and review resources.
3Practice calculating hemodynamic values and interpreting arterial line and PA catheter waveforms.
4Study the Surviving Sepsis Campaign guidelines and the ARDS Network mechanical ventilation protocols.
5Familiarize yourself with Canadian clinical standards, including the use of SI units (e.g., mmol/L for laboratory values).

Frequently Asked Questions

What is the CNCC(C) certification?

The CNCC(C) is a Canadian nursing specialty certification for Registered Nurses who provide care to critically ill adult patients. It is administered by the Canadian Nurses Association (CNA).

How many questions are on the CNCC(C) exam?

The official exam consists of approximately 165 multiple-choice questions, which include both independent questions and case-based scenarios.

What is the fee for the CNCC(C) exam?

The initial exam fee is $570 CAD for CNA members and $756 CAD for non-members, plus proctoring/writing fees of $85 CAD (remote) or $110 CAD (in-person).

How is the passing score determined?

The passing score is determined through standard-setting (criterion-referenced), established by a national committee of critical care nursing experts.