CCRN Exam: An Overview

For acute and critical care nurses who wish to become certified, it is necessary to take and pass the Adult, Pediatric, and Neonatal Critical Care Nurse (CCRN) exam. This exam is administered by the American Association of Critical-Care Nurses (AACN) Certification Corporation. If you are a practicing nurse, there are several reasons to consider becoming certified. There are the personal benefits, which include potential job advancement or a raise in salary. There is also the credibility that being certified will garner you. By passing the exam you will demonstrate your mastery of procedures and information relevant to your job. Your patients will be safer in your hands, and you will feel more confident of your qualifications when you are working.

There are three versions of the exam, each of which targets a different patient age group. These are adult, neonatal, and pediatric populations. To meet eligibility requirements, you must log a certain number of hours working with a specific patient age group. If you amass enough hours with more than one age group, you can take two different versions of the test to become certified with both of these age groups. Typically, however, most nurses will only test to become certified with one age group.

The exam consists of 150 multiple-choice questions, 125 of which count toward your actual score. The other 25 questions are used for statistical purposes. You will have 3 hours to complete the CCRN exam. The content is based on medical conditions associated with different systems of the body and different areas of medical study. These are the cardiovascular system, the pulmonary system, the endocrine system, immunology, neurology, the gastrointestinal system, the renal system, and multisystem conditions. These topics related to medical conditions and their treatment will fall into the Clinical Judgment section of the test, which will count for 80% of the test material. The remaining 20% of the exam will cover professional caring and ethical practice.

The test can be taken over a computer or with pencil and paper. Most test takers will not have a choice in which way they take it. You can take the pencil and paper form of the exam only if you do not live within a 3 hour range of a computer-based testing (CBT) location. If you are in the military, testing locations can be arranged for you overseas if you submit a formal request within 3 months of your scheduled exam date. If you are a candidate with a disability, you can fill out the appropriate information on your application form to obtain special arrangements for your testing location.

If you meet all eligibility requirements and have your application approved, you will make an appointment online at the website of the AACN. You will be able to choose from more than 150 testing locations throughout the country. These testing centers administer exams 6 days per week except on holidays, so you should have plenty of dates and time slots to choose from. On the date you scheduled your exam, you will need to show up early with two forms of identification, one of which must be government-issued and featuring a photo. The other need not have a photo of you or be government-issued. Note that this second form of identification will not be acceptable if it is issued on a temporary basis. For example, a student identification would not be acceptable, but a credit card would. Bring pencils if you are taking the pencil and paper version, but you cannot have a calculator. You will have the opportunity to take a practice test over the computer before the actual test on the day of the exam.
You will receive your score immediately after taking the test, along with percentile scores indicating your performance in individual content areas. If you pass, you will have to renew your certification within 3 years.

CCRN Exam Content: Medical Conditions

Whether you are taking the adult, pediatric, or neonatal form of the CCRN exam, you can expect content from the same general categories. The largest portion of the test will be the Clinical Judgment section, which will constitute 80% of the exam. Professional Caring and Ethical Practice will make up the other 20% of the exam. The Clinical Judgment portion of the exam will cover medical conditions and medical procedures relating to the cardiovascular system, the pulmonary system, the endocrine system, immunology, neurology, the gastrointestinal system, the renal system, multisystem conditions, and behavioral or psychosocial conditions. The best approach you can take to this material is considering the general conditions and procedures associated with these topics separately. If you try to study everything altogether, you are likely to become overwhelmed.

The cardiovascular system is the first topic covered in the Clinical Judgment section of the CCRN exam. A short, but in no way definitive, list of examples you might expect to be tested on in this area may be of help in your studying. Questions may ask you to demonstrate your knowledge of cardiac trauma, cardiogenic shock, cardiomyopathies, cardiac surgery, heart failure, hypovolemic shock, and acute coronary syndromes. These are just a few examples, but they should give you an idea of the kinds of related medical conditions you might see. Give special attention to conditions or specific treatments of conditions related to the age group you are testing in. Questions related to the cardiovascular system will roughly account for 18% of the material in the Clinical Judgment section for adults, 15% for pediatric patients, and 5% for neonatal patients.

There are a number of conditions associated with the pulmonary system you need to be familiar with. These may include lung injuries, respiratory failure, pulmonary hypertension, chronic bronchitis, asthma, emphysema, or thoracic surgery. Modify your approach to this content area according to your targeted age group. For example, if you are taking the neonatal form of the test, you should be familiar with such conditions as transient tachypnea of the newborn and apnea of prematurity. These topics would not appear on the adult form of the test. Pulmonary system material will count for about 17% of the Clinical Judgment section in the adult version of the test, 16% in the pediatric version, and 24% in the neonatal version.

Topics on the endocrine system may include immunology, hematology, gastrointestinal, renal/Genitourinary, and integumentary. The endocrine system represents 20% of the adult Clinical Judgment test material, 19% of the pediatric Clinical Judgment test material, and 24% of the neonatal Clinical Judgment test material.

Neurology makes up 13% of adult material, 16% of pediatric material, and 13% of neonatal material. Topics may include neuromuscular disorders, skull fractures, hydrocephalus, stroke, or seizure. Take into account age group-specific conditions and approaches to conditions, such as birth-related injuries in infants. Multisystem conditions such as septic shock and toxic ingestions account for 14% of the adult test, 14% of the pediatric test, and 15% of the neonatal test.

CCRN Exam Content: Medical Procedures and Ethical Practice

In the Clinical Judgment portion of your exam you will be tested on both medical conditions and medical procedures. They all fall into the same categories: cardiovascular, pulmonary, endocrine, immunology, neurology, gastrointestinal, renal, multisystem, and behavioral and psychosocial. Some of the procedures falling into these CCRN categories will be performed on only one age population. Other procedures will alter in their execution according to age population. In your study of medical procedures, focus your study on the age group you are testing to become certified in.

In terms of cardiovascular medical procedures, you may receive questions on such topics as administering cardiovascular medication, ascertaining when a cardiovascular emergency is occurring, appropriate procedures for various cardiovascular emergencies, and monitoring cardiac rhythms.

Pulmonary procedures appearing on the CCRN exam may include caring for patients in your age population needing an artificial airway, bronchoscopy, chest tubes, or respiratory monitoring devices. This is not a definitive list of examples, but it should give you an idea of the kinds of procedures you might expect to be tested on.
There are a number of procedures related to the endocrine system that may arise. Know about symptoms of emergencies related to the endocrine system and how to handle such cases. Know about the procedures entailed in your job description for dealing with patients in and recovering from surgery associated with the endocrine system. Know how to administer the appropriate medications for patients dealing with specific illnesses related to the endocrine system. You should also have a thorough understanding of the treatments for hypoglycemia and hyperglycemia.

Familiarize yourself with procedures related to immunology. The administering of medications such as steroids or chemotherapy may come up. You may be required to identify different types of immunology-related emergencies and determine what procedure is appropriate to handle the situation. Problems that may arise with blood transfusions will probably appear, so know how to identify various problems and what to do in the event that they arise.
Under the neurology category, you may have questions dealing with lumbar punctures, ICP, or head CT scans. You will need to know how to observe post-neurosurgery patients and determine whether they are recovering as they should. Know about the kinds of neurological emergencies that can arise and how to treat them. Know about neurological devices and medication and how and when to use them on patients.

Gastrointestinal procedures may include running diagnostic tests and interpreting their results, using monitoring devices such as intra-abdominal compartment pressure devices, and administering medication to patients with gastrointestinal problems. Renal procedures are directed at patients suffering from conditions related to the kidneys. Questions may cover proper protocol for emergency situations, the administering of medications, running diagnostic tests, and treating patients in recovery from renal surgery. Multisystem conditions will involve more than one affected system of the body. Know how to determine a patient’s level of pain and how to treat that pain with medication or other methods not involving medication. Know how to sedate a patient and how to monitor them throughout sedation. Know how to run and interpret diagnostic tests and what to do in emergency situations.
For behavioral or psychosocial problems, know how to administer medications such as antidepressants, how to restrain patients if necessary, and how to comfort and calm patients who are experiencing psychological trauma or distress. For all of the procedures in these categories, you must be aware of age-appropriate methods according to the age population you work with.

Aside from the Clinical Judgment section, which deals with medical conditions and procedures, there will also be a Professional Caring and Ethical Practice portion. Categories in this section include advocacy, caring practices, collaboration, systems thinking, response to diversity, clinical inquiry, and the facilitation of learning. This portion of the test will require you to demonstrate professionalism in the work place and your understanding of legal and ethical standards.

CCRN Exam: Eligibility and the Application Process

CCRN Exam: Eligibility and the Application ProcessBefore you can apply for the Adult, Pediatric, and Neonatal Critical Care Nurse (CCRN) exam, you must determine whether or not you are eligible. All of the eligibility requirements are directly related to your work experience. Requiring the necessary work experience makes sense from two standpoints. For one thing, it is to your benefit that you have a good bit of work experience before you take the exam. You can study textbooks for months in advance, but the best way to learn about and understand the medical procedures pertinent to your job is by actually performing those procedures on a routine basis. By meeting eligibility requirements, you will walk into the test more prepared than if you did not. The work experience requirement also prevents a candidate who is not prepared for the responsibilities of the job from passing the exam by studying alone. This person may have learned a good deal of information relevant to the exam, but that does not mean they are prepared for the professional expectations that come with being certified.

To meet eligibility requirements you first and foremost must have a RN or an APRN license. You then must log a certain amount of hours of work as a RN or an APRN. Within two years of the applying for the CCRN exam, candidates must have logged 1,750 hours of work experience with critically ill or injured patients. Of those 1,750 hours, 850 of them must be logged in the year prior to the candidate’s applying to take the exam. Candidates may log more work hours than this, but the only hours that will count are those spent with the patient age group featured on the test the candidate is applying to take. If your job description entails your instructing other nurses or working as a manager, you can count hours spent supervising other nurses, assuming that you are doing more than just watching.

You must actually be a participant in the care of patients. The last step in qualifying to take the exam is providing documentation from a colleague or supervisor verifying that you meet all eligibility requirements.
If you meet the minimum requirements for qualification, you can proceed to the application process. Fill out the application and honor statement forms, which can be found in the Certification Exam Handbook. If you wish to apply online, you can do so at the website for the AACN. Send in the appropriate fees at the time of application. If you are taking the computer-based exam and you are an AACN member, your fees will come out to $235. If you are taking the computer-based exam and you are not an AACN member, your fees will add up to $340. Fees for the paper and pencil form of the exam will vary according whether or not you are in the military and whether or not your test location is in the United States or a foreign country. Fees will also depend on the number of people in the group taking this form of the exam. The more test takers there are, the less it will cost each individual in fees. As with the computer-based test, being an AACN member can lower your costs. In general, fees for the paper and pencil version of the test will be similar to that for the computer-based test.

Once you finish the application process, you should receive an email and postcard within 2-3 weeks telling you whether or not you are approved to test. After you are approved, you will have 90 days to schedule an exam at one of the official testing locations or to make other arrangements if you are in the military or have a disability. After this time is up, you will have to repeat the application process again from the start to be allowed to take the exam.

CCRN Exam: Study Strategies

There are a number of ways you can prepare for the CCRN exam. The material covered on the test is extensive and detailed, and certain questions may require you to think in different ways about a given problem. The best way to absorb all of the necessary information and ensure that you are capable of being mentally and creatively flexible when it comes to different types of questions is to implement a number of different study strategies.

One of the most useful things you can do in your preparation is talk to other certified nurses. They will be able to tell you their experience of the exam—the material they felt was the most challenging, different approaches they took to different areas of content, and methods they used to mentally and emotionally prepare themselves in terms of reducing stress and anxiety. They also will be able to tell you the kinds of medical conditions and procedures they encounter most in their work. The purpose of the CCRN exam is to prepare you for a range of situations that may arise in the work place, but more attention will certainly be given to issues that arise on a regular basis.
If you have the extra money and time, consider taking an exam review course. Not only is there an AACN review course you can take, there are also courses taught by other organizations as well. These courses may give you a chance to work sample problems under a time limit, which can be very useful in preparing for the exam. They also may offer you a wealth of tips on taking the exam. For example, you will most likely encounter questions that are unfamiliar to you and offer up no immediately obvious answers. Review course instructors may be able to help you determine how to weed out a greater percentage of wrong answers on particular types of questions. Be aware that you will have to pay a fee to sign up for an exam review course.

Put together a study group with other people planning on taking the CCRN exam. Plan to meet on a regular basis in the months leading up to the exam—say, once or twice a week. With your group members you can collaborate to write up a definitive study guide to give you direction in your personal study time. You can also divide up topics and each teach a particular area of content that will be represented on the exam. Explaining concepts to others is a great way to learn more yourself, and hearing some topics taught from another person’s particular point of view may offer insight you were previously lacking. Get each group member to make flashcards in their personal study time and use them to quiz each other during group meetings.

When you are studying on your own, work at a regular time each day in the same environment. This environment should be quiet, and there should be no distractions around you. A regular study time and place will help you get into a routine and maintain your study habits. When you are studying, use textbooks and notebooks from courses you have taken that feature content related to that you will find on the test. You can also look in the Certification Exam Handbook for a list of reference books that might be of use in your preparation. Take notes as you are reading. Put stars next to items in the text that you do not fully comprehend and need to come back to later. Making flashcards will facilitate your learning of medical terminology. Before you begin studying each day, write a brief summary of the main points from your studying the day before. At the end of your study time, write another brief summary over the material you have just covered. This will help you retain information.

CCRN Recertification

CCRN RecertificationAfter you have passed the CCRN exam, you will remain certified for 3 years. Before this period has elapsed, you must renew your certification. You can do this by accumulating continuing education points or retaking the CCRN exam. If you do not recertify before the 3 year deadline, there are still other options available to you. You can request inactive status, alumnus status, or retired status.

Before renewing your certification you must meet several eligibility requirements. You must have a RN or APRN license and you must already have passed the CCRN exam for a particular patient age group. In the 3 years between passing the CCRN exam and recertifying, you must amass 432 hours of work experience with critically ill or injured patients in the age range you originally tested in. Of these 432 hours, 144 of them must be logged in the year before the renewal deadline. Nurses who instruct or supervise other nurses may draw from hours spent in supervision when documenting their total work hours. They must participate in the care of patients if they are drawing from these hours. A supervisor or colleague must present documentation verifying your work experience.

If eligible, you can renew your certification through continuing education. To do this you must accumulate Continuing Education Recognition Points (CERPs). These points come from participating in activities that fall into 3 categories. Area A is related to clinical judgment and clinical inquiry. Area B is related to caring practices, response to diversity, advocacy/moral agency, and the facilitation of learning. Area C is related to collaboration and systems thinking. At least 60 points must come from Area A, 10 from Area B, and 10 from Area C. The rest can be drawn from any one of these areas, as long as you don’t exceed the maximum amount of points you can get for a given area: 80 for Area A, 30 for Area B, and 30 for Area C.

Points are issued based on participation in activities such as workshops, seminars, conferences, courses related to the certified nurse’s job, or writing articles for scholarly journals in your field. You can determine which area an activity falls into by the content it features. For example, if you attend a workshop dealing with ethical issues, it would fall into Area B. A full list of topics relevant to each of the 3 areas as well as instructions for assigning points to an activity can be found in the Renewal Handbook.

Your other option is taking the CCRN exam over again. To do this, you will complete the same application process from the first time you took the CCRN exam. If you meet eligibility requirements and are approved, you will be notified by email and through a postcard. You’ll then make an exam appointment and take the exam. If you pass, you will renew your certification. Keep in mind that the exam must be taken before your 3 years are up.

If you do not renew your certification by the deadline, you can request inactive status, alumnus status, or retired status. If you obtain inactive status, you will lose your credential for the time being, but you will have an extra 3 years to meet all of the eligibility requirements and become recertified. You cannot request inactive status twice in a row. Alumnus status will allow you to remain affiliated with your past credentials while not working directly for the care of critically ill or injured patients. You must still be involved in nursing in some capacity, however. You can obtain retired status if you are no longer working in the nursing profession. You will no longer have the credentials, but you will be recognized for your expertise and qualifications as a nurse in the past. You can see if you meet eligibility requirements and make your request through forms found at the AACN’s website.

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