200+ Free CCRN Neonatal Practice Questions

Pass your AACN CCRN Neonatal Critical Care Certification exam on the first try — instant access, no signup required.

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Question 1

Score: 0/0

A 2-day-old infant with a patent ductus arteriosus (PDA) is receiving IV indomethacin. Which assessment finding would indicate a potential adverse effect requiring immediate intervention?

Decreased urine output from 2.5 mL/kg/hr to 1 mL/kg/hr

Increased heart rate from 140 to 160 beats per minute

Decreased respiratory rate from 45 to 35 breaths per minute

Increased blood pressure from 65/40 to 72/45 mmHg

to track

2026 Statistics

Key Facts: CCRN Neonatal Exam

65.57%

First-Time Pass Rate

AACN 2024 (305 candidates)

150

Total Items

AACN CCRN Neonatal handbook

125 + 25

Scored + Unscored

AACN CCRN Neonatal handbook

Exam Time

AACN CCRN Neonatal handbook

84/125

Passing Cut Score

AACN standard-setting (67.2%)

80/20

Clinical Judgment / Professional Caring

AACN CCRN Neonatal test plan

$255/$370

Member/Nonmember Fee

AACN CCRN Neonatal handbook

CCRN Neonatal has a 65.57% first-time pass rate (2024 data, 305 candidates tested). The exam uses 150 questions (125 scored) over 3 hours with a passing score of 84/125 (67.2%). Clinical Judgment accounts for 80% of content. Eligibility requires 1,750 hours of direct neonatal critical care bedside nursing within 2 years. Certification is valid for 3 years with renewal via CERPs or exam.

Sample CCRN Neonatal Practice Questions

Try these sample questions to test your CCRN Neonatal exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 2-day-old infant with a patent ductus arteriosus (PDA) is receiving IV indomethacin. Which assessment finding would indicate a potential adverse effect requiring immediate intervention?

A.Decreased urine output from 2.5 mL/kg/hr to 1 mL/kg/hr

B.Increased heart rate from 140 to 160 beats per minute

C.Decreased respiratory rate from 45 to 35 breaths per minute

D.Increased blood pressure from 65/40 to 72/45 mmHg

Explanation: Indomethacin, a prostaglandin inhibitor used to close a PDA, can cause reduced renal blood flow leading to decreased urine output. A drop from 2.5 mL/kg/hr to 1 mL/kg/hr indicates significant renal impairment and requires immediate intervention. The other options represent normal physiologic variations or expected improvements (decreased respiratory rate may indicate improved pulmonary status as the PDA closes).

2An infant with hypoplastic left heart syndrome (HLHS) becomes irritable, diaphoretic, and tachypneic shortly after feeding. The nurse notes that the preductal SpO2 was 85% but is now 72%. What is the priority nursing intervention?

A.Increase the oxygen flow rate to maintain SpO2 above 90%

B.Administer a bolus of IV fluids and notify the provider immediately

C.Position the infant supine and stimulate gently

D.Provide oral sucrose for comfort and continue monitoring

Explanation: Infants with HLHS depend on maintaining a balance between systemic and pulmonary blood flow. Signs of poor perfusion with decreased SpO2 may indicate inadequate systemic output or pulmonary overcirculation. A fluid bolus can help improve preload and systemic perfusion, but the provider must be notified immediately as this represents a pre-arrest condition. High oxygen concentrations are generally avoided in HLHS as they can increase pulmonary blood flow at the expense of systemic circulation.

3Which of the following ECG findings would be most concerning in a neonate receiving digoxin for supraventricular tachycardia?

A.Heart rate of 145 beats per minute

B.Prolonged PR interval with occasional dropped beats

C.Sinus arrhythmia varying with respiration

D.Right axis deviation

Explanation: A prolonged PR interval with dropped beats indicates second-degree AV block, a sign of digoxin toxicity. Neonates are particularly vulnerable to digoxin toxicity due to immature renal clearance. A heart rate of 145 bpm is normal for neonates. Sinus arrhythmia is a normal variant. Right axis deviation is common in neonates due to right ventricular dominance.

4A preterm infant with respiratory distress syndrome (RDS) on bubble CPAP at 6 cm H2O develops increasing respiratory distress. The nurse notes increased work of breathing with nasal flaring and seesaw respirations. The SpO2 is 88% on 35% oxygen. What is the most appropriate initial action?

A.Increase CPAP pressure to 8 cm H2O and increase FiO2

B.Administer surfactant via endotracheal tube

C.Intubate and initiate mechanical ventilation

D.Perform suctioning and assess for mask leak

Explanation: The infant shows signs of CPAP failure but is not in immediate respiratory failure. The first step is to optimize CPAP support by increasing pressure and FiO2. If the infant does not improve after optimization, escalation to intubation may be needed. Suctioning should be done regularly but is unlikely to be the primary cause of this deterioration.

5An infant born at 28 weeks gestation develops pulmonary interstitial emphysema (PIE) following mechanical ventilation. Which ventilator strategy is most appropriate?

A.Increase peak inspiratory pressure to improve tidal volume

B.Decrease rate and allow permissive hypercapnia

C.Increase positive end-expiratory pressure (PEEP) to 10 cm H2O

D.Switch to high-frequency oscillatory ventilation (HFOV)

Explanation: PIE results from alveolar rupture with air tracking into the interstitium. The primary treatment is lung protective ventilation with decreased tidal volumes and rates, allowing permissive hypercapnia (PaCO2 up to 55-65 mmHg) to minimize barotrauma. HFOV may be considered in severe cases but is not the first-line strategy. Increasing pressures or PEEP would worsen PIE.

6Which arterial blood gas result would be most consistent with a diagnosis of persistent pulmonary hypertension of the newborn (PPHN)?

A.pH 7.35, PaCO2 45, PaO2 65, preductal SaO2 95%, postductal SaO2 93%

B.pH 7.25, PaCO2 55, PaO2 50, preductal SaO2 85%, postductal SaO2 65%

C.pH 7.40, PaCO2 38, PaO2 85, preductal SaO2 98%, postductal SaO2 97%

D.pH 7.30, PaCO2 50, PaO2 70, preductal SaO2 92%, postductal SaO2 90%

Explanation: PPHN is characterized by elevated pulmonary vascular resistance causing right-to-left shunting through the ductus arteriosus and foramen ovale. This results in significant preductal-postductal oxygen saturation differences (typically >10%) and hypoxemia. Option B shows the classic pattern: acidosis, hypercapnia, hypoxemia, and a 20% saturation difference between preductal and postductal measurements.

7An infant with meconium aspiration syndrome (MAS) is receiving mechanical ventilation. The nurse notes sudden deterioration with bradycardia, decreased breath sounds on the right, and shifting of the cardiac apex beat. What is the priority intervention?

A.Increase ventilator rate and administer surfactant

B.Perform needle decompression followed by chest tube insertion

C.Administer inhaled nitric oxide (iNO) therapy

D.Suction the endotracheal tube and increase PEEP

Explanation: The presentation is classic for tension pneumothorax, a known complication of MAS. Sudden deterioration with unilateral decreased breath sounds and mediastinal shift (cardiac apex movement) requires immediate needle decompression (14-gauge angiocatheter in the 2nd intercostal space, midclavicular line) followed by chest tube placement. This is a life-threatening emergency requiring immediate action.

8A premature infant with bronchopulmonary dysplasia (BPD) is being weaned from mechanical ventilation. Which finding best indicates readiness for extubation to nasal CPAP?

A.FiO2 0.40, respiratory rate 55, spontaneous tidal volume 4 mL/kg, negative inspiratory force -15 cm H2O

B.FiO2 0.25, respiratory rate 40, spontaneous tidal volume 6 mL/kg, negative inspiratory force -30 cm H2O

C.FiO2 0.60, respiratory rate 35, spontaneous tidal volume 5 mL/kg, negative inspiratory force -25 cm H2O

D.FiO2 0.35, respiratory rate 65, spontaneous tidal volume 3 mL/kg, negative inspiratory force -20 cm H2O

Explanation: Successful extubation criteria include: FiO2 ≤ 0.30-0.40, adequate spontaneous tidal volume (>5 mL/kg), respiratory rate 30-60, and negative inspiratory force > -25 cm H2O. Option B meets all criteria. Option A has inadequate NIF, Option C requires too much oxygen, and Option D has tachypnea and low tidal volume.

9Which nursing intervention is most appropriate for an infant with congenital diaphragmatic hernia (CDH) immediately post-surgery?

A.Position the infant prone to promote lung expansion

B.Avoid suctioning to prevent irritation of the surgical site

C.Allow permissive hypercapnia and avoid high peak pressures

D.Wean sedation to assess neurologic status frequently

Explanation: Post-surgical management of CDH focuses on gentle ventilation strategies to protect the hypoplastic lung. Permissive hypercapnia (PaCO2 50-60 mmHg) with avoidance of high peak inspiratory pressures (<25 cm H2O) is the standard of care. Suctioning is necessary to maintain airway patency. Sedation is typically maintained to prevent ventilator asynchrony.

10An infant with apnea of prematurity is being started on caffeine citrate therapy. Which statement by the nurse indicates correct understanding of this medication?

A.Caffeine works by depressing the central nervous system to reduce metabolic demand

B.Therapeutic levels should be maintained between 5-20 mcg/mL

C.The loading dose is typically 20 mg/kg followed by 5-10 mg/kg daily

D.Adverse effects primarily include respiratory depression and hypotension

Explanation: Caffeine citrate for apnea of prematurity has a loading dose of 20 mg/kg (equivalent to 10 mg/kg caffeine base) followed by maintenance of 5-10 mg/kg daily. Caffeine is a CNS stimulant, not depressant. Therapeutic levels are 5-25 mcg/mL (some sources say 5-20). Adverse effects include tachycardia, jitteriness, and diuresis—not respiratory depression.

About the CCRN Neonatal Exam

CCRN Neonatal validates specialty knowledge for neonatal critical care nurses in NICU settings. The exam covers Clinical Judgment (80%): Cardiovascular (5%), Respiratory (21%), Endocrine/Hematology/GI/Renal/Integumentary (27%), Neuro/Musculoskeletal/Psychosocial (13%), Multisystem (14%); plus Professional Caring and Ethical Practice (20%). Organized by the AACN Synergy Model for Patient Care framework effective November 2025.

Questions

150 scored questions

Time Limit

3 hours

Passing Score

84 out of 125 scored items (67.2%)

Exam Fee

$255 AACN members / $370 non-members (AACN Certification Corporation / PSI)

CCRN Neonatal Exam Content Outline

Cardiovascular

PDA, congenital heart defects (TOF, TGA, HLHS), heart failure, dysrhythmias, hemodynamic monitoring

21%

Respiratory

RDS, BPD, MAS, PPHN, apnea, mechanical ventilation, surfactant therapy, iNO, HFOV, air leak syndromes

27%

Endocrine/Hematology/GI/Renal/Integumentary

Hypoglycemia, thyroid disorders, polycythemia, hyperbilirubinemia, NEC, feeding intolerance, renal agenesis, skin integrity, thermoregulation

13%

Neurologic/Musculoskeletal/Psychosocial

IVH, HIE, therapeutic hypothermia, seizures, neural tube defects, brachial plexus injury, NAS, family support, developmental care

14%

Multisystem

Sepsis, shock, DIC, birth asphyxia, congenital infections, metabolic disorders, pharmacology, transfusions

20%

Professional Caring & Ethical Practice

AACN Synergy Model, advocacy, collaboration, cultural competence, family-centered care, ethics, end-of-life, research

How to Pass the CCRN Neonatal Exam

What You Need to Know

Passing score: 84 out of 125 scored items (67.2%)
Exam length: 150 questions
Time limit: 3 hours
Exam fee: $255 AACN members / $370 non-members

Keys to Passing

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

CCRN Neonatal Study Tips from Top Performers

1Master neonatal-specific normal values including vital signs, lab values, and weight-based calculations

2Focus on respiratory management including surfactant therapy, iNO, and ventilator strategies for neonates

3Study congenital heart defect pathophysiology and pre/post-operative care (PDA, TOF, TGA, HLHS)

4Understand IVH grading, HIE management, and therapeutic hypothermia protocols

5Know neonatal pharmacology including dosing (weight-based), PK differences, and common NICU medications

6Review family-centered care and developmental support principles in the NICU

Frequently Asked Questions

What is the CCRN Neonatal pass rate?

AACN's 2024 data shows a 65.57% first-time pass rate for CCRN Neonatal (305 candidates tested). This is slightly lower than CCRN Pediatric, reflecting the specialized knowledge required for neonatal critical care.

How many questions are on the CCRN Neonatal exam?

The CCRN Neonatal exam contains 150 questions total, with 125 scored and 25 unscored pretest questions. You have 3 hours to complete the computer-based exam at a PSI testing center.

What score is needed to pass CCRN Neonatal?

The CCRN Neonatal passing score is 84 correct out of 125 scored items (67.2%), effective November 2025 per AACN's standard-setting process. This is lower than CCRN Pediatric (88/125) due to exam difficulty.

What are the CCRN Neonatal eligibility requirements?

To sit for CCRN Neonatal, you must have a current, unencumbered RN license and 1,750 hours of direct neonatal critical care bedside nursing within the past 2 years (875 hours in the most recent year). Clinical practice hours must involve direct care of acutely/critically ill neonatal patients.

How is the CCRN Neonatal exam organized?

CCRN Neonatal follows the AACN Synergy Model framework with Clinical Judgment (80%) and Professional Caring/Ethical Practice (20%). The largest clinical domain is Endocrine/Hematology/GI/Renal/Integumentary (27%), followed by Respiratory (21%) and Multisystem (14%).

How long is CCRN Neonatal certification valid?

CCRN Neonatal certification is valid for 3 years. Renewal options include: (1) Completing 100 CERPs (Continuing Education Recognition Points) with 60 in Category A and 10 each in Categories B and C, or (2) Passing the exam again.

What is the best way to study for CCRN Neonatal?

Study systematically across all clinical domains using AACN exam blueprint weightings. Focus on high-yield areas: Endocrine/Heme/GI/Renal (27%), Respiratory (21%), and Multisystem (14%). Use neonatal-specific resources including Core Curriculum for Neonatal Intensive Care Nursing, AACN practice questions, and NICU clinical guidelines. Plan for 3-6 months of study.