What’s on the CCRN Exam? Test Plan Breakdown for Adult Critical Care Nurses

The CCRN (Adult) exam, administered by AACN Certification Corporation, is a 150-item multiple-choice test taken in a 3-hour window. Of those 150 items, 125 are scored and 25 are unscored pretest items used only to evaluate future exam questions, mixed in without being identified. The exam is organized into two major sections. Clinical Judgment makes up 80% of the exam and is split across five domains: Cardiovascular (13%), Respiratory (12%), Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary (21%), Musculoskeletal, Neurological, Behavioral/Psychosocial (18%), and Multisystem (16%). Professional Caring and Ethical Practice makes up the remaining 20% and covers advocacy and moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity, and systems thinking, all built around AACN’s Synergy Model for Patient Care. This structure reflects the test plan effective for exams taken on and after November 12, 2025, based on AACN’s 2024 Study of Practice. AACN sets the passing standard using a criterion-referenced modified Angoff process rather than publishing a fixed pass percentage.

Figures reflect the Adult CCRN test plan effective for exams taken on and after November 12, 2025.

Clinical Judgment: The Five Domains

Clinical Judgment covers the bedside decision-making a CCRN candidate is expected to demonstrate across five body-system and cross-system domains. The domains are not weighted evenly. Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary is the single largest domain at 21%, and Cardiovascular and Respiratory, while still substantial, are the two smallest clinical domains under the current test plan.

Cardiovascular content centers on recognizing and managing acute coronary syndrome, cardiogenic shock, cardiac tamponade, hypertensive emergencies, dysrhythmias, heart failure, and hemodynamic monitoring, along with post-catheterization and post-cardiac-surgery care. Respiratory content covers acute respiratory failure and ARDS, mechanical ventilation modes and alarms, weaning and extubation, arterial blood gas and acid-base interpretation, and airway and chest tube management. Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary, the largest domain, spans a wide range: diabetic emergencies like DKA and HHS, thyroid and adrenal crises, acute kidney injury and renal replacement therapy, GI bleeding and hepatic failure, coagulation disorders and transfusion reactions, and pressure injury and wound care. Musculoskeletal, Neurological, Behavioral/Psychosocial covers neurologic assessment and increased intracranial pressure, stroke, seizure management, spinal cord injury, and the behavioral and psychosocial dimensions of critical illness, including delirium and family-centered communication. Multisystem content is the cross-cutting category: sepsis and septic shock, shock states generally, multisystem trauma, temperature regulation, and end-of-life and palliative care all live here, since they do not belong to a single body system.

Professional Caring and Ethical Practice

The remaining 20% of the exam does not test a body system at all. It tests the nurse’s role as an advocate, collaborator, and ethical decision-maker, organized around seven areas drawn from AACN’s Synergy Model for Patient Care: Advocacy and Moral Agency, Caring Practices, Clinical Inquiry, Collaboration, Facilitation of Learning, Response to Diversity, and Systems Thinking. In practice, this section asks how a nurse navigates informed consent, surrogate decision-making, end-of-life conversations, interdisciplinary collaboration, patient and family education, and the broader systems a critically ill patient moves through, rather than asking what intervention to perform next. Candidates who study only clinical protocols and skip this section often find it is the least familiar 20% of the exam, even though the underlying judgment is the same kind experienced ICU nurses use every shift.

Test Day and Scoring Basics

The CCRN is a computer-based exam available at PSI testing centers or through live remote proctoring. On-screen results are available immediately after you finish, with a detailed score report emailed within 24 hours. AACN does not publish a fixed passing percentage; instead, a panel of subject matter experts rates the expected difficulty of every item, and a psychometrician uses that data to set a criterion-referenced cut score through a modified Angoff process. That means the number of questions you need to get right can shift slightly between exam forms, but the level of knowledge and skill required to pass stays consistent. If you do not pass, AACN’s retest fee is lower than the initial exam fee, and you will need to reapply and meet current eligibility requirements before scheduling another attempt.

Ready to see how these domains and weights show up in real practice questions? Try our CCRN practice test, or start with a free CCRN practice test to get a feel for the current test plan before you commit to a full study plan.

Frequently Asked Questions

How many questions are on the CCRN exam?

150 total: 125 scored and 25 unscored pretest items you cannot identify while testing. The exam has a 3-hour time limit.

What’s the largest domain on the CCRN exam?

Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary, at 21% of the exam under the test plan effective November 12, 2025.

What does Professional Caring and Ethical Practice cover?

Advocacy and moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity, and systems thinking, organized around AACN’s Synergy Model for Patient Care. It makes up 20% of the exam.

How is the CCRN exam scored?

AACN uses a criterion-referenced modified Angoff process to set the passing standard, based on subject matter experts rating item difficulty, rather than a published fixed pass percentage.

Sources

• aacn.org, CCRN (Adult), Direct Care Eligibility Pathway
• aacn.org, CCRN Exam Handbook, Direct Care Eligibility Pathway
• aacn.org, Revised CCRN Certification Exams Launch Nov. 12, 2025

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For educational and exam preparation purposes only. Not a substitute for formal clinical training.