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Certification Organization for the American Association of Critical-Care Nurses

CERTIFICATION EXAM HANDBOOK

CONGRATULATIONS!
You have taken your first step toward becoming a certified nurse.

As healthcare becomes increasingly complex and challenging, certification has emerged as a mark of
excellence showing patients, employers and the public that a nurse is qualified and competent and has
met the rigorous requirements to achieve specialty or subspecialty certification.

AACN Certification Corporation certification programs were created to protect healthcare consumers by
validating the knowledge of nurses who care for the acutely and critically ill. We are pleased to provide
you with this application handbook with information about our programs and how to apply for and take
the CCRN, PCCN, CMC and CSC certification exams.

Today, more than 58,000 practicing nurses have received one or more of these certifications from
AACN Certification Corporation:

• CCRN® specialty certification introduced in 1976 for nurses providing care to acutely and/or
critically ill adult, pediatric and neonatal patients.
• PCCN® specialty certification introduced in 2004 for progressive care nurses providing care to
acutely ill adult patients.
• CCNS® entry-level advanced practice certification launched in 1999 for clinical nurse specialists
providing care to acutely and critically ill adult, pediatric and neonatal patients. For details, refer to
the CCNS Exam Handbook, online at www.certcorp.org.
• CMC® subspecialty certification launched in 2005 for certified nurses providing care to acutely
and/or critically ill adult cardiac patients.
• CSC® subspecialty certification launched in 2005 for certified nurses providing care to acutely
and/or critically ill adult patients during the first 48 hours after cardiac surgery.
• ACNPC® entry-level advanced practice nursing certification launched in 2007 for registered nurses
educated at the graduate level to provide advanced nursing care across the continuum of health
services to meet the specialized physiologic and psychologic needs of adult patients with complex
acute, critical and/or chronic health conditions. For details, refer to the ACNPC Handbook, online at
www.certcorp.org.
• CNML certification for nurse managers launched in 2008 in partnership with the American
Organization of Nurse Executives (AONE) – visit www.certcorp.org for details.

We continually seek to provide quality certification programs that meet the changing needs of nurses
and patients. If you do not find information in this handbook about certification in your area of practice,
please visit www.certcorp.org or call (800) 899-2226.

Thank you for your commitment to patients and their families and to becoming certified.

OCTOBER 2009
CONTENTS

Application Instructions ...................................................................................................................................................3


Application Process Overview ..........................................................................................................................................4
AACN Certification Programs ...........................................................................................................................................6
Name and Address Changes ...........................................................................................................................................6
Testing Site Information ...................................................................................................................................................7
Scheduling an Exam Appointment ..................................................................................................................................8
Exam Rescheduling and Cancellation.............................................................................................................................8
On the Day of Your Exam..................................................................................................................................................9
Duplicate Score Reports ................................................................................................................................................11
Recognition of Certification and Use of Credentials....................................................................................................12
Denial of Certification ....................................................................................................................................................12
Revocation of Certification ............................................................................................................................................13
Review and Appeal of Certification Eligibility ...............................................................................................................13
Exam Fees.......................................................................................................................................................................14
CCRN Certification Program.....................................................................................................................................15-34
AACN Products for CCRN Exam Preparation.................................................................................................................21
PCCN Certification Program .....................................................................................................................................37-49
AACN Products for PCCN Exam Preparation .................................................................................................................41
CMC Subspecialty Certification Program ................................................................................................................53-61
AACN Products for CMC/CSC Exam Preparation ......……………………………………………………………………………………….65
CSC Subspecialty Certification Program .................................................................................................................67-73
AACN Synergy Model for Patient Care .....................................................................................................................76-77

Forms:
CCRN Exam Honor Statement (3rd page of application).............................................................................................35
PCCN Exam Honor Statement (3rd page of application) .............................................................................................51
CMC Exam Honor Statement (3rd page of application) ..............................................................................................63
CSC Exam Honor Statement (3rd page of application) ...............................................................................................75
Certification Exam Application (1st and 2nd pages of 3-page application) .........................................................79-80

2
APPLICATION INSTRUCTIONS

AACN Certification Corporation recommends that you be ready to take the exam
before submitting your exam application.

1. Complete 2-page exam application at back of



Fill in all requested information; print name and date.
handbook.

CCRN, PCCN, CMC and CSC applicants taking a


computer-based test may register online at
www.certcorp.org.

2. Complete 1-page honor statement page found at end of



List verifier information, RN or APRN license information,
individual exam section. sign and date.

3. CMC and CSC applicants: Attach proof of current NCCA-



Examples of proof include wallet card, wall certificate or verification
or ABNS-accredited clinical nursing specialty certification letter from certifying organization.
(applies to non-AACN certifications only).
Proof is not required if you wish to tie your CMC or CSC subspecialty
CMC and CSC subspecialty certification will be tied to this certification to your CCRN, PCCN, CCNS or ACNPC certification.
certification and must be valid for 90 days beyond the
application date.

4. Include application fee.



Make check payable to AACN Certification Corporation. Make sure
that total amount is correct and sign check. Staple check to the upper
right front corner of application. When paying by credit card provide
all requested information including expiration date.

5. When joining AACN or renewing membership at the



AACN offers a special 3-year membership discount for certificants
time of applying for the exam, write one check for the and exam applicants.
total amount payable to AACN Certification Corporation.
Total amount should equal AACN membership fee plus AACN membership may be renewed at the discounted 3-year
member fee for the exam. certification fee of $179.35 as long as the certification remains
current. This fee represents an additional 15% savings from the
published 3-year AACN membership fee.

AACN membership includes nonrefundable $12 and $15 one-year subscriptions to Critical Care Nurse® and the American Journal of
Critical Care®, respectively. AACN dues are not deductible as charitable contributions for tax purposes, but may be deducted as a business
expense in keeping with Internal Revenue Service regulations.

Please direct inquiries to:

AACN Certification Corporation, 101 Columbia, Aliso Viejo, CA 92656-4109


(800) 899-2226 • Fax: (949) 362-2020 • certcorp@aacn.org

Please include your AACN customer/member number with all correspondence to AACN Certification Corporation.

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APPLICATION PROCESS OVERVIEW

AACN Certification Corporation recommends that you be ready to take the exam before submitting your application.

1. Complete exam application and honor Register for your computer-based exam online at www.certcorp.org >
statement and pay exam fee Apply Online.

You may mail a paper application to:


AACN Certification Corporation
101 Columbia, Aliso Viejo, CA 92656
Or fax to (949) 362-2020 (DO NOT fax and mail; choose 1 method only)

AACN cannot be responsible for materials lost in the mail or the timely
performance of the post office. If you desire documentation of mailing or
verification of receipt of application, send the application "return receipt
requested" or use certified mail. Include the confirmation postcard on the
back cover of your handbook or include a self-addressed stamped postcard
(write AACN in the "from" area) and it will be mailed to you when your
application is received. Return of the postcard by AACN indicates receipt of
your application only, not approval.

2. Waiting period for application processing Allow 4 to 6 weeks from date received at AACN for your application to be
processed. Once it is processed, AACN will notify the testing service, AMP, of
eligible exam candidates. Applying online shortens this process by several
weeks.

AACN will notify you in writing when your application is incomplete or


requires clarification, or if you are ineligible for an exam.

Your eligibility period begins upon successful processing of your application.


Call the toll-free number shown on your confirmation postcard or go online promptly to select a preferred testing date.
3. Receive Approval-to-Test postcard and e-mail. AACN’s testing service (AMP) will mail a postcard and send an e-mail to
See next page for sample AMP postcard. eligible candidates. The postcard and e-mail include a toll-free number and
online instructions to schedule your testing appointment. The postcard and
If you do not receive an Approval-to-Test confirmation e-mail also include the 90-day period during which you must schedule and
or e-mail within 8 weeks of successfully applying for an take the exam.
exam, please contact AACN Certification Corporation
at (800) 899-2226. The address label and e-mail will contain the letter “C” plus your unique
AACN customer number (i.e., C00123456). Use this number for
Please ensure that AACN has your current e-mail address identification in place of your social security number.
on record. E-mail address updates may be made online
at www.aacn.org > My Account or e-mailed to
info@aacn.org.

4. Schedule your exam Immediately upon receipt of postcard schedule a date and time of your
choice that falls within your 90-day eligibility period. To locate one of more
than 170 testing centers within the U.S. visit www.goAMP.com.

You may be randomly selected for an audit of your exam eligibility, which could occur anytime after application.
Those selected will be notified by mail and will have 60 days to respond.
5. Sit for the exam Exam results with a score breakdown will be presented on-site upon
completion of computer-based exams. Paper and pencil exam results are
received by mail within 6 to 8 weeks of testing.

6. Receive congratulations packet Successful candidates will receive their wallet card and wall certificate
within 6 to 8 weeks of passing the exam.
Address changes may be made online at www.aacn.org >
My Account or e-mailed to info@aacn.org. Unsuccessful candidates are eligible for a discounted retest fee. Refer to
page 11 for more information.

Confidentiality of Exam Application Status


Information regarding the status of an exam application submitted to AACN Certification Corporation
will not be released to anyone without the exam candidate’s written authorization.

4
SAMPLE AMP POSTCARD

When you receive your postcard, make sure that your name and address are listed correctly and that you’ve been registered for the correct exam.
If not, please call AACN Customer Care at (800) 899-2226.

5
AACN CERTIFICATION PROGRAMS

What is Certification? Cognitive Levels of Questions


Certification is a process by which a nongovernmental The cognitive level of the test items is based on a
agency validates, based upon predetermined condensed version of Bloom’s Taxonomy. The
standards, an individual nurse’s qualification and majority of the items are written at the application and
knowledge for practice in a defined functional or analysis levels. Testing at higher cognitive levels
clinical area of nursing. provides a better indication of the candidate’s critical
thinking abilities when caring for acutely and critically
Certification validates your knowledge of nursing in ill patients and their families.
your specialty area to hospitals, peers, patients and,
most importantly, to yourself. Certification promotes Exam Preparation
continuing excellence in the nursing profession. AACN Certification Corporation does not endorse or
sponsor any review courses for the certification
Certification and Exam Administration exams. Study bibliographies and test plans are
The certification programs are administered by AACN included in this handbook to provide candidates with
Certification Corporation. The certification exams are resources for exam preparation. For information
conducted in cooperation with Applied Measurement about locating a local AACN chapter, contact us at
Professionals, Inc. (AMP). (800) 899-2226 or visit www.aacn.org.

Computer-based exams are administered five days a AACN Membership Not Required
week throughout the year at more than 170 locations Membership in the American Association of Critical-
across the United States. Computer experience is not Care Nurses is not an eligibility requirement for AACN
necessary as you will use only a few keystrokes or a Certification Corporation programs.
mouse and be able to take a tutorial and practice test
before the exam begins. During the exam you will be
able to move back and forth between items and mark
Non-Discrimination Policy
items for later review. You will receive final results It is the policy of AACN Certification Corporation, its
including a breakdown by question type at the end of Board of Directors, committee members and staff to
the exam. comply with all applicable laws that prohibit
discrimination in employment or service provision
because of a person’s race, color, religion, gender,
age, disability, national origin or any other protected
characteristic.

NAME AND ADDRESS CHANGES

You are responsible for notifying AACN Certification You are responsible for renewing your certification
Corporation should your name and/or address change even if you do not receive a renewal notice. Please
at any time before or after you become certified. notify us of any name, address or e-mail changes; you
Failure to do so may result in not receiving information may update your profile online at www.aacn.org > My
necessary for certification renewal. Account, e-mail info@aacn.org, or call AACN Customer
Care at (800) 899-2226.

6
TESTING SITE INFORMATION

Computer-Based Testing (CBT) professional must be submitted with the exam


application and indicated by checking the appropriate
AACN exams are offered at more than 170 CBT
box on the exam application. Special testing
locations throughout the United States. To locate the
accommodations, such as additional testing time,
testing site nearest you please visit www.goAMP.com
reader signer or amanuenses, require advance
or call Applied Measurement Professionals, Inc. (AMP)
approval. Only candidates approved by AACN
at (888) 519-9901. If you have more than a three-
Certification Corporation will receive special
hour one-way drive to the nearest computer-based
accommodations during testing. Scheduling for the
testing site please contact AACN via e-mail at
hearing impaired is available online at
certification@aacn.org to request alternate testing
www.goAMP.com.
accommodations. Discounted group pricing is
available; for information visit our Web site at
www.certcorp.org. Candidate Evaluation or Complaints
You may provide comments for any test item during a
Paper and Pencil Testing/DANTES Sites computerized exam by clicking on the button
displaying an exclamation point (!) to the left of the
Individuals residing outside the U.S. may apply to test
TIME button. This opens a dialog box to enter
at a DANTES (military) testing site. The same eligibility
comments. Only comments submitted at the test site
requirements apply, although fees for paper and
will be considered during the final scoring process.
pencil testing (with the exception of exams offered at
Because of test security considerations, you will not
NTI or TRENDS conferences) are higher than for CBT
receive individual replies about the content of test
and are priced per person. Refer to pricing
items, nor will you be permitted to review test items
information on page 14. For DANTES (Defense Activity
after completing the exam. At the conclusion of the
for Non-Traditional Education Support) inquiries or
exam, you may also complete a brief survey about test
requests please contact AACN via e-mail at
administration conditions.
certification@aacn.org.
Please mail complaints or comments about
Requests for paper and pencil testing must be
assessment site facilities, test supervision or any
submitted in writing at least 3 months before the test
other matter related to the testing program to:
date, along with all completed applications and
appropriate fees. An e-mail address for the group
AACN Certification Corporation
point of contact must be provided.
101 Columbia
Aliso Viejo, CA 92656-4109
For information about group paper and pencil exams
(large groups testing together) within the U.S., please
Or e-mail: certification@aacn.org.
contact AACN via e-mail at certification@aacn.org.
Results of paper and pencil exams are sent to
Provide your name and address in all correspondence.
candidates four to six weeks following paper and
When questions or comments concern an exam
pencil testing.
already taken, the date and time of the exam along
with the location of the testing site must also be noted.
Candidates With Each complaint will be investigated and replied to.
Disabilities or Impairments
AACN Certification Corporation is committed to
ensuring that no individual is deprived of the
opportunity to take the exam solely by reason of a
disability or impairment. Every testing site is fully
accessible and compliant with the Americans with
Disabilities Act. Special testing arrangements will be
considered for disabled individuals who submit a
request in advance. Documentation and verification
of the disability or impairment from a licensed

7
SCHEDULING AN EXAM APPOINTMENT

Exams are administered by appointment only, Monday collect social security numbers from candidates. When
through Saturday at 9:00 a.m. and 1:30 p.m. the appointment is made, you will be given a time to
Individuals are scheduled on a first-come, first-served report to the site.
basis. You must make your appointment at least two
business days before the desired testing date. Note the time and date since you will not be sent an
admission ticket.
You will receive a confirmation postcard and e-mail
after you have successfully applied for the exam. You You can only take the exam for which you made the
may schedule an exam appointment online or by appointment. Therefore, verify on your confirmation
telephone once you receive the postcard or e-mail. postcard that you are registered for the correct exam
If you have not received your postcard or e-mail and notify AACN Certification Corporation immediately
within eight weeks after applying for an exam, of any error.
please contact AACN Certification Corporation.
The exam type cannot be changed at the testing site.
Schedule online at www.goAMP.com or by phone at Unscheduled walk-in candidates will not be admitted
(888) 519-9901. to the testing site.

Be prepared to confirm a date and location for testing During 2009, exams will not be offered:
and provide your AACN Customer ID #, preceded by the January 1 May 25 November 26
letter “C,” in place of your social security number. This January 19 July 4 November 27
number will be on the label of your confirmation February 2-7 September 7 December 24
postcard. AACN Certification Corporation does not February 16 October 12 December 25
April 8-15 November 11

EXAM RESCHEDULING AND CANCELLATION

Once you have scheduled your exam with AMP, you may reschedule once within your 90-day eligibility period by
calling AMP at (888) 519-9901. This request must be made at least two business days before your previously
scheduled date according to this schedule:
When the exam is scheduled on: AMP must be called by 3:00 p.m. Central Time to
reschedule the exam by the:
Monday previous Wednesday
Tuesday previous Thursday
Wednesday previous Friday
Thursday previous Monday
Friday/Saturday previous Tuesday

There are no refunds or extensions for missed If you are unable to sit for a scheduled paper and pencil
appointments. If you are unable to sit for the exam exam at an NTI® or TRENDS conference and notify AACN
within your 90-day eligibility period, you may call AACN Certification Corporation prior to the exam date you may
Certification Corporation at (800) 899-2226 before the reschedule for computer-based testing within your 90-day
scheduled testing session to request a one-time 90-day eligibility period. You will be charged the difference
extension. A $100 change fee is required. between the paper and pencil exam fee and the computer-
based testing fee and notified when payment is due.
If you do not schedule an exam within your 90-day
eligibility period, contact AACN Certification Corporation Alternatively, if you are unable to sit for an NTI® or
to request a new 90-day period. A $100 fee is charged. TRENDS paper and pencil exam or reschedule within
If you contact AACN Certification Corporation to cancel your 90-day eligibility period, you may request a refund.
your exam after receiving confirmation of eligibility you The paper and pencil exam fee will be refunded minus
will receive a refund minus a $100 processing fee. a $100 processing fee.

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ON THE DAY OF YOUR EXAM

Report to the designated testing site no later than your Instead, use your AACN customer identification
scheduled time. The address is available when you number preceded by the letter “C,” as printed on your
schedule your exam. AMP sites are typically located in confirmation postcard label. If you do not remember
H&R Block offices. Look for signs indicating AMP this number, you may ask the proctor. You will then
Assessment Site Check-In. You will not be admitted if capture your own photograph, which will remain on-
you arrive more than 15 minutes late. screen throughout your testing session. The
photograph will also appear on your score report.
No books, papers, dictionaries, other reference
materials or personal items—including purses, Taking the Exam
briefcases, coats, etc.—may be taken into the testing Each exam consists of multiple-choice questions. The
site and must be left in a vehicle or at home. Neither number of questions answered correctly determines
AMP, AACN nor H&R Block will be responsible for loss your score.
or damage to personal items. We also recommend
layering your clothing so that you can adjust to the Answering Test Items: Only one question is presented
room’s temperature during the exam. at a time. The item number appears in the lower right-
hand corner of the screen. The entire test item will
Security Standards appear on the screen (i.e., a stem and four answer
AACN Certification Corporation and AMP maintain test options labeled A, B, C and D). Use the mouse to click
administration and test security standards designed to on your answer or use the keyboard to enter the letter
ensure that all candidates are provided the same for your answer. Your answer will appear in the lower
opportunity to demonstrate their abilities. The testing left section of the screen.
site is continuously monitored by audio and video
surveillance equipment for security purposes. Changing Your Answer: Click on a different answer or
use the keyboard to change your answer as many
Verifying Your Identity times as you wish during the exam.
You must present two forms of identification to gain
admission to the testing site. Both forms of Moving to the Next Item: Click on the forward arrow
identification must be current and include your name (>) in the lower right corner of the screen or select the
and signature, which must match the name on the NEXT key. Either action will move you forward through
confirmation postcard. You will be required to sign a the exam item by item. Click the backward arrow (<) or
roster for verification of identity. You are prohibited use the left arrow on the keyboard to return to previous
from misrepresenting your identity or falsifying items.
information to obtain admission.
Unanswered Items: You may leave an item
One form of identification must include your unanswered and return to it later. You should not
photograph. The second form need not be a photo ID spend too much time on difficult questions. Instead,
and can be a credit card as long as it bears a matching proceed to other questions and return to the difficult
name and signature. Employment, student and any ones if time permits. You may bookmark an item for
type of temporary identification cards are not later review by clicking the blank square to the right of
acceptable. Acceptable forms of photo identification the TIME button. Clicking on the hand icon or selecting
include a current: the NEXT key advances to the next unanswered or
1. Driver’s license with photograph bookmarked item on the exam. To identify all
2. State identification card with photograph unanswered and bookmarked items, repeatedly click
3. Passport with photograph on the hand icon or press the NEXT key.
4. Military identification card with photograph
Answer Every Item: When you have completed the
exam, the number of items you answered is reported.
Logging in If you have not answered every item and have time
After your identity has been confirmed, you will be remaining, return to the exam and answer them.
directed to a testing carrel where the computer screen There is no penalty for guessing.
will instruct you to enter your social security number.

9
Practice Exam: The time of a practice exam is not Contact the 24-hour weather hotline before the exam
counted as part of the timed exam. Once you are to determine if AMP has been notified that any testing
comfortable with the computer-based testing process, you sites will be closed.
may end the practice session and start the timed exam.
An exam will usually not be rescheduled if testing site
Timed Exam: After your practice session, you will begin personnel can reach and operate the site. Every attempt
the actual exam. Instructions for taking the exam are is made to administer exams as scheduled. Should an
available on-screen once you begin the exam. The time exam be canceled at an assessment site, all scheduled
limit is intended to allow you to complete the entire candidates will receive follow-up notification regarding a
exam by working quickly and efficiently. The computer rescheduled exam date or reapplication procedures.
monitors the time you spend on the exam, and the
exam ends automatically if you exceed the time limit. Dismissal From the Testing Site
You can display a digital clock showing the time The proctor may dismiss you from the exam for any of
remaining by clicking the TIME button in the lower right- these reasons:
hand corner of the screen or selecting the TIME key. If • Unauthorized admission to the exam
you find it distracting, you may turn off the digital clock
using either command anytime during the exam. • Creating a disturbance, being abusive or otherwise
uncooperative
During the Exam
• Bringing unauthorized electronic devices including
Questions About Content: You may not ask questions personal digital assistants (PDAs), other hand-held
about the content of the exam at any time. computers, calculators, telephones, pagers, alarms
and other signaling devices
Making Notes: You will be provided with scratch paper
to use during the exam. You may not remove any • Bringing notes or other resources into the testing site
documents or notes from the exam room and their
return to the proctor is required in order to receive your • Attempting to record test questions or make notes
score. All computer screens, questions, paper and
• Attempting to take the exam for someone else
written materials are the property of AACN Certification
Corporation and AMP and may not be reproduced in • Giving or receiving help or being suspected of
any form. doing so

Commenting on Items: You may comment about any • Leaving the premises without notifying the proctor
item by clicking on the exclamation point (!) to the left
You will be dismissed for any of these violations. Your
of the TIME button. This opens a dialog box where you
exam score will be voided and your fees will not be
may enter your comments.
refunded. Evidence of misconduct will be reviewed by
AACN Certification Corporation to determine whether
Breaks, Food, Drink, Smoking: Breaks are considered
you will be allowed to reapply for the exam. If a re-exam
part of your exam time. You may request a break
is granted, a complete application and fee are required
whenever you wish, but will not be allowed additional
to reapply.
make-up time. Leaving the testing site without
authorization automatically voids the exam. You may
not eat, drink or smoke in the testing site. Failure to Report for an Exam
You may reapply to take the exam in the future if you
Ending the Exam: If you finish the exam early, you may did not appear for your scheduled testing session. If
end the exam and receive your score by clicking the your original application is less than one year old, it
COVER button on the screen. may be reactivated by paying the initial exam fee. If the
application is more than one year old, you must submit
Inclement Weather or Emergency a new application and the initial exam fee.
24-Hour AMP Weather Hotline (800) 380-5416
After the Exam
In the event of inclement weather or unforeseen After you finish the exam, you will be asked to
emergencies on the day of an exam, AMP will complete a short evaluation of your testing experience.
determine whether circumstances warrant the Then the proctor will provide you with your official
cancellation and subsequent rescheduling of an exam. score report. The report will also provide the percent of

10
correct answers for each major content category. Confidentiality of Exam Scores
Refer to the exam content area of each section of this
Your exam application submitted to AACN Certification
handbook for information about how the various
Corporation constitutes written authorization for AMP
exams are scored. Successful candidates receive their
to release your exam scores to AACN Certification
certification wallet card and wall certificate suitable for
Corporation. Scores are reported only to you
framing six to eight weeks after the exam.
immediately after the exam or by U.S. mail. Scores are
not reported by telephone, electronic mail or facsimile.
Improper Behavior After the Exam Neither AMP nor AACN Certification Corporation will
Any individual who removes or attempts to remove release scores to any institution or employer without
materials from the test center, or who receives, your written consent. Or you may release a copy of your
discusses, discloses, reproduces, distributes, displays score report yourself.
or otherwise misuses a test question or any part of a
test question from a certification exam by written, If You Do Not Pass the Exam
electronic, oral or other form of communication,
If you do not pass the exam, you may reapply to AACN
including, but not limited to e-mailing, copying or
Certification Corporation for a retest. Candidates may
printing of electronic files and reconstruction through
apply for retest by phone at (800) 899-2226 if
memorization and/or dictation, will be subject to legal
applying within 12 months of the date that the exam
action and monetary damages. Any nurse who
honor statement was signed. After 12 months, signing
engages in such improper behavior also may face
a new honor statement is required. Candidates may
denial or revocation of eligibility for certification or
also apply for a retest online (two weeks after the
denial or revocation of certification.
exam was taken) at www.certcorp.org or submit a
paper application by mail or fax. Select the retest
Passing Scores option on the application to obtain the discounted
No test measures performance with perfect accuracy retest fee, which is available to candidates who took
and consistency. AACN Certification Corporation sets the exam within their most recent 90-day window but
passing scores for certification exams using a did not pass. Candidates may apply and sit for the
systematic procedure developed collaboratively by same certification exam up to four times in a 12-
experts from the corporation’s Exam Development month period.
Group and professional psychometricians from AMP.
Canceled Scores
If you take more than one version of an exam, for each
AACN Certification Corporation and AMP are
version you would probably achieve a different score
responsible for the integrity of the scores they report.
that clusters around a typical or average value. The
On occasion, occurrences such as computer
statistical estimate of the difference between the
malfunction or misconduct by a candidate may cause
average score and your actual score on a specific
a score to be suspect. AACN Certification Corporation
version is called the standard error of measurement.
and AMP are committed to rectifying such occurrences
The standard error of measurement reflects the
as quickly as possible. AACN Certification Corporation
accuracy of exam scores, and AMP determines the
may void exam results if investigation shows its
standard error of measurement for each exam. These
regulations have been violated.
statistical data are reported to AACN Certification
Corporation as a measure of the consistency of exam
scores. For each content area, the percent of Duplicate Score Reports
questions answered correctly is also reported to give You may request an additional copy of your score
candidates an idea of how well they performed in each report at $25 per copy. Submit requests and payment
area and to identify areas of weakness. by check or money order within 12 months of sitting
for the exam to: Applied Measurement Professionals,
The questions are designed to test both your ability to Inc. (AMP), 18000 W. 105th Street, Olathe, KS
remember specific facts or points of knowledge and 66061. The request must include your name, AACN
your ability to apply that knowledge in performing Customer ID# preceded by the letter “C” (e.g.,
specific knowledge, skills and abilities required of C00123456), address, telephone number, and date
acute or critical care nurses. Since an exam measures and type of exam taken. Sign and date your request.
your knowledge in all areas, you could achieve a high Duplicate score reports are mailed within
percentage of correct responses in some areas, but approximately two weeks after receipt of your request.
not pass the exam.

11
RECOGNITION OF CERTIFICATION AND USE OF CREDENTIALS

AACN certifications are not punctuated with periods. The Chris Smith, RN, CCRN; the proper use of PCCN is as
specific program of certification, i.e., CCRN, PCCN, CMC or follows: Chris Smith, RN, PCCN.
CSC and neonatal, pediatric or adult, will be noted on your
wallet card and wall certificate. AACN Certification Subspecialty Certifications
Corporation maintains a list of nurses it has certified and Candidates who meet all eligibility requirements and
may report the list in its publications. pass the CMC or CSC subspecialty certification exams
may use the corresponding credential(s) after their
Specialty Certifications licensing title, linked to a nationally accredited clinical
Candidates who meet all eligibility requirements and pass nursing specialty certification. Candidates must
a specialty certification exam may use the corresponding indicate to AACN to which certification they wish to
credential (“CCRN” or “PCCN”) after their licensing title. attach their subspecialty certification. CMC and CSC
CCRN and PCCN are registered service marks. The proper are registered service marks. The proper use of CMC is
use of CCRN is as follows: as follows: Chris Smith, RN, CCRN-CMC. The proper
use of CSC is: Chris Smith, RN, CCRN-CSC.

DENIAL OF CERTIFICATION

AACN Certification Corporation will deny certification to • Sharing exam contents


initial exam candidates for any reason deemed
appropriate including, but not limited to, the following: • Restrictions placed on RN or APRN licensure.
(A current unencumbered license is required; an
•Violating any rules of the exam unencumbered license is not currently subject to
formal discipline by any Board of Nursing and has
• Falsification of the certification application no provisions or conditions that limit the nurse’s
practice in any way.)
• Falsification of any information requested by AACN
Certification Corporation • Misrepresentation of certification status

• Failure to pay fees In the event of denial, you may be notified that you are
prohibited from reapplying for the certification exam
• Failure to meet deadlines for a period of up to three years. AACN Certification
• Failure to respond to or pass an audit Corporation may take additional actions pending
further investigation, including sending notification to
• Conviction of a felony your employer and/or state Board of Nursing, as
appropriate.
• Cheating (or reasonable evidence of intent to
cheat) on the exam

12
REVOCATION OF CERTIFICATION

AACN Certification Corporation may revoke certification • Conviction of a felony


for any reason deemed appropriate including, but not
limited to, the following: • Cheating (or reasonable evidence of intent to
cheat) on the exam
•Falsification of the certification application or • Restrictions placed on RN or APRN licensure.
renewal application (A current unencumbered license is required; an
• Falsification of any information requested by AACN unencumbered license is not currently subject to
Certification Corporation formal discipline by any Board of Nursing and has
no provisions or conditions that limit the nurse’s
• Failure to maintain eligibility requirements practice in any way.)
• Failure to pay fees In the event of revocation, notification may be sent to
your employer and state Board of Nursing, where
• Failure to meet deadlines appropriate. You will be notified that you may be
• Failure to respond to or pass an audit prohibited from reapplying for the exam for a period of
up to three years. Fees paid for certification renewal
• Misrepresentation of certification status are not refunded.

REVIEW AND APPEAL OF CERTIFICATION ELIGIBILITY

You may request a review of your certification eligibility Certification Specialist


at any time. The review process is conducted by the AACN Certification Corporation
staff of AACN Certification Corporation. The appeal 101 Columbia
process is conducted by the AACN Certification Aliso Viejo, CA 92656-4109
Corporation Appeals Panel. The review and appeal
process is available if your certification status has Or e-mail: certification@aacn.org
expired, been denied or revoked. You may appeal if you
do not meet the AACN Certification Corporation Following review, if AACN Certification Corporation staff
experience component of the clinical practice eligibility affirms the decision to deny or revoke certification, a
requirement but believe your practice conforms to the Request for Appeal form with detailed information
intent, if not the precise content and definition, of the about the appeal process will be sent to you. Once you
experience requirement. return the form and provide additional documentation,
if needed, the Appeals Panel will review the case at its
Typing or printing legibly, describe your clinical practice next scheduled review. You will be notified in writing of
and how it conforms to the certification program. the Appeals Panel’s decision. The decision of the
Submit a written request for review to: Appeals Panel is final.

For questions about this process, call AACN


Certification Corporation at (800) 899-2226.

13
EXAM FEES

Computer-Based Exams
CCRN PCCN CMC CSC

AACN Non- AACN Non- AACN Non- AACN Non-


member member member member member member member member

$220 $325 $170 $250 $135 $180 $135 $180

Payable in U.S. funds. Fees are subject to change without notice. A $15 fee will be charged for a returned check.
Computer-based testing discounts are available for groups of 10 or more exam candidates who apply together.
Employers may pre-purchase exam vouchers at a further discounted rate. For details about the group and bulk
discount programs visit www.certcorp.org or call (800) 899-2226.

Paper and Pencil Exams

Number of candidates
Testing Location testing simultaneously CCRN PCCN CMC CSC
at one site

AACN Non- AACN Non- AACN Non- AACN Non-


member member member member member member member member

U.S. Pricing 4 $240 $345 $230 $310 $220 $265 $220 $265

5 $220 $325 $200 $280 $190 $235 $190 $235

6 or more $220 $325 $180 $260 $170 $215 $170 $215

AACN Non- AACN Non- AACN Non- AACN Non-


member member member member member member member member

DANTES 4 $265 $370 $240 $320 $250 $295 $250 $295


(Military) Pricing

5 $230 $335 $200 $280 $210 $255 $210 $255

6 or more $220 $325 $175 $255 $185 $230 $185 $230

DANTES - Defense Activity for Non-Traditional Education Support

Payable in U.S. funds. Fees are subject to change without notice. A $15 fee will be charged for a returned check.

Paper and pencil exams are available to those located three hours or more from the nearest computer-based
testing center. Requests must be submitted to AACN Certification Corporation three months in advance of test
date. For details see page 7 or contact AACN via e-mail at certification@aacn.org.

The above pricing does not apply for the paper and pencil exam sessions offered at the NTI® and TRENDS
educational conferences. Visit www.certcorp.org for more information.

14
CCRN
CCRN CERTIFICATION

CCRN® certification is a specialty certification for nurses who provide care for acutely and/or critically ill patients,
regardless of the geographic location of their nursing care. Specialty nurses interested in this certification may
work in such areas as: intensive care units; cardiac care units; combined ICU-CCUs; medical/surgical ICUs; trauma
units; or critical care transport/flight.

CCRN Certification Program ..........................................................................................................................................16


CCRN Exam Eligibility .....................................................................................................................................................16
CCRN Certification Renewal ..........................................................................................................................................17
CCRN Online Registration ..............................................................................................................................................19
CCRN Application Fees ..................................................................................................................................................19
AACN Products for CCRN Exam Preparation.................................................................................................................21
CCRN Study Bibliography .........................................................................................................................................23-24
CCRN Test Plan–Adult Program ..............................................................................................................................25-26
CCRN Test Plan–Pediatric Program.........................................................................................................................27-28
CCRN Test Plan–Neonatal Program ........................................................................................................................29-30
CCRN Sample Exam Questions–Adult ..........................................................................................................................31
CCRN Sample Exam Questions–Pediatric ....................................................................................................................32
CCRN Sample Exam Questions–Neonatal..............................................................................................................33-34
CCRN Exam Honor Statement (use with application at end of handbook)................................................................35
AACN Synergy Model for Patient Care .....................................................................................................................76-77
Certification Exam Application (1st and 2nd pages of 3-page application) .........................................................79-80

15
CCRN CERTIFICATION PROGRAM

CCRN® Registered Service Mark CCRN certification is achieved by those acute and
critical care nurses who pass the CCRN exam in
CCRN is a registered service mark of AACN
neonatal, pediatric and/or adult critical care nursing.
Certification Corporation and denotes certification in
CCRN certification denotes to the public those
critical care nursing as granted by AACN Certification
practitioners who possess a distinct and clearly
Corporation. Registered nurses who have not achieved
defined body of knowledge called critical care nursing.
CCRN certification status, whose CCRN status has
lapsed or who have chosen Inactive status are not
authorized to use the CCRN credential.
CCRN Exam Content
The CCRN exams are three-hour tests consisting of
Although a common misconception, CCRN is not an 150 multiple-choice items. Of the 150 items, 125 are
acronym for “critical care registered nurse.” This scored and 25 are used to gather statistical data on
would imply that nurses are registered as critical care item performance for future exams. The CCRN exams
nurses, which is not accurate. focus on adult, pediatric and neonatal patient
populations. 80% of each exam focuses on clinical
Validated Knowledge and Specialized judgment and is age specific for the adult, pediatric
Skills and neonatal populations. The remaining 20% covers
professional caring and ethical practice. Professional
Each CCRN certification exam is based on a job caring and ethical practice questions may be asked
analysis. The most recent study, completed in 2003, about any age across the life span while clinical
defines the dimensions of critical care practice, judgment questions are restricted to adult, neonatal or
identifying what is required of registered nurses pediatric populations.
practicing in acute and critical care settings.

In the study, acute and critical care nurses across the


CCRN Test Plans
United States were surveyed to ascertain the The content of the CCRN exams is described in the test
frequency and significance of the various elements of plans included in this handbook. Candidates are
their practice. Through an extensive review and tested on a variety of patient care problems that are
evaluation process, the knowledge, skills and abilities organized under major categories. Please note the
crucial to acute and critical care nursing were defined percentage of the CCRN exam devoted to each
using the AACN Synergy Model for Patient Care as an category.
organizing framework. The CCRN certification exams
are based on these skills and abilities and the
knowledge required to perform them.

CCRN EXAM ELIGIBILITY

• Current unencumbered licensure as an RN or APRN • Practice as an RN or APRN is required for 1,750


in the United States is required. hours in direct bedside care of acutely and/or
critically ill patients during the previous two years,
An unencumbered license is not currently subject to with 875 of those hours accrued in the most recent
formal discipline by any Board of Nursing and has no year preceding application. Eligible hours are those
provisions or conditions that limit the nurse’s spent caring for the patient population (adult,
practice in any way. pediatric or neonatal) of the exam for which you are
It is the responsibility of candidates and CCRN- applying.
certified nurses to notify AACN Certification Clinical practice hours for the CCRN exam or renewal
Corporation when any restriction is placed on their eligibility must take place in a U.S.-based or Canada-
RN or APRN license. If you are randomly selected for based facility or in a facility determined to be
audit, you will be asked to provide a copy of your RN comparable to the U.S. standard of acute/critical
or APRN license copy – please do not submit with care nursing practice, as evidenced by ANCC Magnet
your application. Status or Joint Commission International
accreditation.
16
CCRN
• Nurses serving as manager, educator (in-service or • AACN Certification Corporation may adopt additional
academic), APRN or preceptor may apply their hours eligibility requirements at its sole discretion from
spent supervising nursing students or nurses at the time to time. Any such requirements will be
bedside. Nurses in these roles must be actively designed to establish, for the purposes of CCRN
involved in caring for patients at the bedside; for certification, the adequacy of a candidate's
example, demonstrating how to measure pulmonary knowledge and experience in caring for the acutely
artery pressures or supervising a new employee or and critically ill.
student nurse performing a procedure.

• The name and address of a professional associate


must be given for verification of eligibility related to
clinical practice hours. If you are randomly selected
for audit, this associate will need to verify that you
have met the clinical hour requirements. A
professional associate is defined as either a clinical
supervisor (RN or physician), or RN colleague with
whom you work.

CCRN CERTIFICATION RENEWAL

CCRN certification is conferred for a period of three with 144 of those hours in the 12-month period prior
years. Your certification period begins the first day of to the scheduled renewal date, and complete the
the month in which the CCRN certification exam is required Synergy CERPs or complete the CCRN exam.
passed and ends three years later; for example, Eligible hours are those spent caring for the patient
October 1, 2009 through September 30, 2012. The population (adult, pediatric or neonatal) in which
purpose of certification renewal is to enhance certification is held. For more details, refer to the
continued competence. CCRN Renewal Handbook, available at
www.certcorp.org.
A copy of the CCRN Renewal Handbook will be mailed
to you approximately 90 days before your scheduled Option 1 - Renewal by Synergy CERPs
CCRN renewal date. You are responsible for renewing Meet eligibility requirements for CCRN renewal and
your certification even if you do not receive renewal complete the Continuing Education Recognition Point
notification. (CERP) Program, which requires 100 CERPs in various
categories (A, B & C). For more details refer to Renewal
You may seek certification renewal via Renewal by by Synergy CERPs At-a-Glance and other Synergy CERP
Synergy CERPs or Renewal by Exam, or you may resources available online at www.certcorp.org.
choose Inactive, Retired or Alumnus status. Do not
apply for more than one option. Renewal by Exam Online Renewal by Synergy CERPs is available to all
candidates must successfully apply for and schedule active CCRNs as early as four months prior to their
their exam in enough time to complete the CCRN exam scheduled renewal date. For more information visit
before their scheduled renewal date. You may not www.certcorp.org - click Renew Your Certification.
take the exam early, then attempt to renew by CERPs if
you do not pass.
Option 2 - Renewal by Exam
To renew, you must hold a current unencumbered RN Meet the eligibility requirements for CCRN renewal and
or APRN license in the United States, complete 432 successfully apply for and schedule your exam in
hours of direct bedside care of acutely and/or critically enough time to complete the CCRN exam before your
ill patients within the three-year certification period, scheduled renewal date.

17
CCRN CERTIFICATION RENEWAL (CONTINUED)

profession with a continued sense of career identity


OPTION 3 - Inactive Status and professional connectedness. The Retired CCRN
Inactive status is available to CCRN-certified nurses designation recognizes CCRN-certified nurses for their
who do not meet the renewal eligibility requirements years of service at the bedside. It also acknowledges
but do not wish to lose their CCRN certification status. their pride and dedication in maintaining their
Inactive status provides CCRN-certified nurses certification. To be eligible for Retired CCRN status, you
additional time, up to three years from the scheduled must have been a CCRN without plans of returning to
renewal date, to meet the eligibility requirements. nursing practice or renewing certification. The retired
During the time of Inactive status candidates may not RN must not be working in any type of position that
use the CCRN credential. requires the possession of an RN license. You are not
eligible if you are changing from bedside practice to
another nursing role. The “Retired CCRN” designation,
Alternate Designations written out, may be used on your resume or below your
name and credentials on a business card, but may not
ALUMNUS STATUS be used with your signature or on a name badge.
Alumnus status is for nurses who have been CCRN- There are no CE or CERP requirements to maintain
certified but no longer provide direct bedside care to Retired CCRN status.
acutely and/or critically ill patients for enough hours to
meet the clinical hour requirement for active CCRN For more details about Alumnus and Retired status,
certification, but are still in the nursing profession in refer to the Alumnus CCRN and Retired CCRN
some other capacity and wish to remain connected applications available online at www.certcorp.org
with the credential. Renewable every three years, the under Documents and Handbooks.
“Alumnus CCRN” designation, written out, may be used
on your resume or below your name and credentials on CCRN-E STATUS
a business card, but may not be used with your If you work primarily or exclusively in a remote ICU
signature or on a name badge. To be eligible for environment (such as a virtual or electronic ICU) and
Alumnus CCRN status, you must have held CCRN do not meet the requirements for regular CCRN
certification and have no plans to renew CCRN renewal and would like to see if this renewal option is
certification in the future. There are no CE or CERP appropriate for you, refer to the CCRN-E Renewal
requirements to maintain Alumnus CCRN status. Handbook online at www.certcorp.org under
Documents and Handbooks.
RETIRED STATUS
Retired status provides the CCRN-certified nurse or
Alumnus CCRN who is retiring from the nursing

18
CCRN ONLINE REGISTRATION

CCRN
Online registration is available for the CCRN exam. This paperless registration streamlines the exam application
process by up to six weeks. Once you register online your 90-day window for testing will begin within one to two
weeks. Candidates should be prepared to sit for the exam before registering online. For more information and
to register visit www.certcorp.org.

CCRN APPLICATION FEES

CCRN Computer-Based Exam

AACN Members $220

Nonmembers $325

CCRN Retest Fee

AACN Members $170

Nonmembers $275

Current CCRN Renewal by Exam

AACN Members $170

Nonmembers $275

Payable in U.S. funds. Fees are subject to change without notice. A $15 fee will be charged for a returned check.

19
20
AACN PRODUCTS FOR CCRN EXAM PREPARATION

Description Item #

* Online Adult CCRN Self-Assessment Exam (SAE) – mirrors content of CCRN exam; includes 60 questions with correct
answers and rationale; score report upon completion to assess strengths and areas for further study; access for 90 days Purchase online only at
from purchase date. www.certcorp.org.

* Adult Practice CCRN Exam Questions, 6th ed. (2009). 190 questions. 200305
AACN Core Curriculum for Critical Care Nursing, 6th ed. (2006). Grif Alspach, J. 992 pages. 128700
AACN Procedure Manual for Critical Care, 5th ed. (2005). Lynn-McHale, D & Carlson, K. 1,280 pages. 128150
AACN Certification and Core Review for High Acuity and Critical Care, 6th ed. (2007). Grif Alspach, J. 192 pages. 128800
Adult CCRN Review Course on DVD. (2007). 301965
Adult CCRN Review Course on CD-ROM. (2007). 301950
Adult CCRN Review Course on Audio CD . (2007). 301973
Adult CCRN Review Course Additional Syllabus, to accompany 2007 review courses. 199 pages. 301995
** Adult CCRN Review Package on DVD. 302000
** Adult CCRN Review Package on Audio CD. 302005
** Adult CCRN Review Package on CD-ROM . 302010
Mosby’s Critical Care Drug Reference. (2007). 1,040 pages. 128163
ACLS Pocket Reference Cards. (2006). AHA, AACN. Set of 2. 400862
Emergency Psychiatry: Principles and Practice. (2008). Glick, R., et. al. 488 pages. 301650
Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. (2004). Hardin, S. & Kaplow, R. 160 pages. 100149
Critical Care Nursing: Synergy for Optimal Outcomes ( 2007). Kaplow, R. & Hardin, S. 778 pages. 100147
* Pediatric Practice CCRN Exam Questions, 6th ed. (2009). 130 questions. 200205
AACN Core Curriculum for Pediatric Critical Care Nursing, 2nd ed. (2006). Slota, M. 912 pages. 128870
AACN Procedure Manual for Pediatric Acute & Critical Care. (2007). Verger, J. 1,520 pages. 131104
Emergency Management of the Pediatric Patient: Cases, Algorithms, Evidence. (2006). Prentiss, K., Cummings, B.,
131109
Mick, N. & Filbi, M. 176 pages.
Resuscitation and Stabilization of the Critically Ill Child. (2009). Wheeler, D., Wong, H. & Stanley, T. 172 pages. 131106
*** Pediatric CCRN Review Package on DVD. 302006
*** Pediatric CCRN Review Package on Audio CD. 302008
Perinatal and Pediatric Respiratory Care. (2010). Walsh, B., Czervinske, M. & DiBlasi, R. 840 pages. 128744
Pediatric /Neonatal CCRN Review Course on DVD. (2006). 301850
Pediatric /Neonatal CCRN Review Course on Audio CD. (2006). 301990
* Neonatal Practice CCRN Exam Questions, 6th ed. (2009). 125 questions. 200105
Core Curriculum for Neonatal Intensive Care Nursing, 4th ed. (2009). Verklan, M. & Walden, M. 1,040 pages. 128710
Certification & Core Review for Neonatal Intensive Care Nursing, 3rd ed. (2007). Watson, R. 176 pages. 128720
Handbook of Neonatal Intensive Care, 6th ed. (2006). Merenstein, G. & Gardner, S. 928 pages. 128745
Manual of Neonatal Care. (2007). Cloherty, J. Eichenwald, E. & Stark, A. 800 pages. 128749
Perinatal Cardiology Handbook. (2008). Bader, R. & Hornberger, L. 544 pages. 128748
**** Neonatal CCRN Review Package on DVD. 302007
**** Neonatal CCRN Review Package on Audio CD. 302009

*Denotes products developed by AACN Certification Corporation.

**Adult CCRN Review Packages include Adult CCRN Review Course, Adult Practice CCRN Exam Questions and AACN Core
Curriculum for Critical Care Nursing.

***Pediatric CCRN Review Packages include Pediatric/Neonatal CCRN Review Course, Pediatric Practice CCRN Exam Questions
and AACN Core Curriculum for Pediatric Critical Care Nursing.

****Neonatal CCRN Review Packages include Pediatric/Neonatal CCRN Review Course, Neonatal Practice CCRN Exam
Questions and Certification Core Review for Neonatal Intensive Care Nursing.

For more details and to place an order, visit our Web site at www.aacn.org and click on Marketplace,
or call AACN Customer Care at (800) 899-2226, between 7:30 a.m. and 4:30 p.m., Pacific Time.
OFCRHB OCTOBER 2009 21
22
CCRN STUDY BIBLIOGRAPHY
RECOMMENDED REFERENCES FOR THE CCRN EXAM

CCRN
Clinical Judgment – Adult CCRN Stillwell, S. (2006). Mosby’s Critical Care Nursing
Reference. 4th ed. St. Louis, Mo: Mosby/Elsevier.
American Heart Association. (2005). Guidelines 2005
for Cardiopulmonary Resuscitation and Emergency
Urden, L., Lough, M. E., & Stacy, K. L. (2005). Thelan’s
Cardiovascular Care. Available at:
Critical Care Nursing: Diagnosis and Management. 5th
www.americanheart.org/presenter.jhtml?identifier=
ed. St. Louis, Mo: Mosby/Elsevier.
3035517
Wiegand, D. J. L. & Carlson, K. K. (eds.) (2005). AACN
Conover, M. B. (2003). Understanding
Procedure Manual for Critical Care. 5th ed.
Electrocardiography. 8th ed. St. Louis, Mo:
Philadelphia: Elsevier.
Mosby/Elsevier.
Woods, S., Sivarajan Froelicher, E. S., & Motzer, S. U.
Copstead, L. & Banasik, J. L. (2000). Pathophysiology:
(2004). Cardiac Nursing. 5th ed. Philadelphia:
Biological and Behavioral Perspectives. 2nd ed.
Lippincott Williams & Wilkins.
Philadelphia: W. B. Saunders/Elsevier.

Darovic, G. O. (2002). Hemodynamic Monitoring:


Clinical Judgment – Pediatric CCRN
Invasive and Noninvasive Clinical Application. 3rd ed. American Heart Association. (2005). Guidelines 2005
Philadelphia: W. B. Saunders/Elsevier. for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Available at:
Emergency Nurses Association & Newberry, L. (2005). www.americanheart.org/presenter.jhtml?identifier=
Sheehy’s Manual of Emergency Care. 6th ed. St. 3035517
Louis: Mosby/Elsevier.
Betz, C. L. & Sowden, L. A. (2004). Pediatric Nursing
Finkelmeier, B. A. (2000). Cardiothoracic Surgical Reference. 5th ed. St. Louis, Mo: Mosby/Elsevier.
Nursing, 2nd ed. Philadelphia: Lippincott Williams &
Wilkins. Boylston, M. & Beer, D. (2002). “Methemoglobinemia:
A Case Study.” Critical Care Nurse. 22 (4): 50-55.
Hickey, J. V. (2008).The Clinical Practice of
Neurological and Neurosurgical Nursing. 6th ed. Copstead, L. & Banasik, J. L. (2000). Pathophysiology:
Philadelphia: Lippincott Williams & Wilkins. Biological and Behavioral Perspectives, 2nd ed.
Philadelphia: W. B. Saunders/Elsevier.
McNally, P. (2001). GI/Liver Secrets. 2nd ed.
Philadelphia: Hanley & Belfus/Elsevier. Curley, M. A. Q. & Moloney-Harmon, P. A. (2001).
Critical Care Nursing of Infants and Children. 2nd ed.
McQuillan, K. A., Whalen, E. & Flynn Makic, M. B. Philadelphia: W. B. Saunders/Elsevier.
(2008). Trauma Nursing: From Resuscitation Through
Rehabilitation. 4th ed. Philadelphia: Elsevier. Darovic, G. O. (2002). Hemodynamic Monitoring:
Invasive and Noninvasive Clinical Application. 3rd ed.
Pagana, K. D. & Pagana, T. J. (2008). Mosby’s Philadelphia: W. B. Saunders/Elsevier.
Diagnostic and Laboratory Test Reference. 9th ed. St.
Louis, Mo: Mosby/Elsevier. Finkelmeier, B. A. (2000). Cardiothoracic Surgical
Nursing, 2nd ed. Philadelphia: Lippincott Williams &
Skidmore-Roth, L. (2008). Mosby’s 2009 Nursing Drug Wilkins.
Reference. 22nd ed. St. Louis, Mo: Mosby/Elsevier.
Hockenberry, M. J., Wilson, D., Winkelstein, M. L. &
Smeltzer, S., Bare, B. G., Hinkle J. L. & Cheever, K. H. Kline, N. E. (2007). Wong’s Nursing Care of Infants
(2008). Brunner and Suddarth’s Textbook of Medical- and Children. 8th ed. St. Louis, Mo: Mosby/Elsevier.
Surgical Nursing. 11th ed. Philadelphia: Lippincott
Williams & Wilkins. Moloney-Harmon, P. A. & Czerwinski, S. J. (2003).
Nursing Care of the Pediatric Trauma Patient.
Sole, M. L., Klein, D. G. & Moseley, M. (2008). Philadelphia: W. B. Saunders/Elsevier.
Introduction to Critical Care Nursing. 5th ed.
Philadelphia: W. B. Saunders. 23
CCRN STUDY BIBLIOGRAPHY (CONTINUED)

Pagana, K. D. & Pagana, T. J. (2008). Mosby’s Pagana, K. D. & Pagana, T. J. (2008). Mosby’s
Diagnostic and Laboratory Test Reference. 9rd ed. St. Diagnostic and Laboratory Test Reference. 9th ed. St.
Louis, Mo: Mosby/Elsevier. Louis, Mo: Mosby/Elsevier.

Skidmore-Roth, L. (2008). Mosby’s 2009 Nursing Drug Polin, R. A., Yoder, M. C. & Burg, F. D. (2001).
Reference. 22nd ed. St. Louis, Mo: Mosby/Elsevier. Workbook in Practical Neonatology. 3rd ed.
Philadelphia: W. B. Saunders/Elsevier.
Slota, M. C. (ed.). (2006). AACN Core Curriculum for
Pediatric Critical Care Nursing. 2nd ed. St. Louis: Elsevier. Urden, L., Lough, M. E. & Stacy, K. L. (2005). Thelan’s
Critical Care Nursing: Diagnosis and Management. 5th
Sole, M. L., Klein, D. G. & Moseley, M. (2008). ed. St. Louis, Mo: Mosby/Elsevier.
Introduction to Critical Care Nursing. 5th ed.
Philadelphia: W. B. Saunders. Verklan, M. T. & Walden M. (eds.) (2004). Core
Curriculum for Neonatal Intensive Care Nursing. 3rd
Urden, L., Lough, M. E. & Stacy, K. L. (2005). Thelan’s ed. St. Louis. Mo: Elsevier/Saunders.
Critical Care Nursing: Diagnosis and Management. 5th
ed. St. Louis, Mo: Mosby/Elsevier. Young, T. E. & Mangum, B. (2005). Neofax: A Manual
of Drugs Used in Neonatal Care. 18th ed. Raleigh, NC:
Clinical Judgment – Neonatal CCRN Acorn Publishing.
American Heart Association. (2005). Guidelines 2005
for Cardiopulmonary Resuscitation and Emergency Professional Caring and Ethical Practice
Cardiovascular Care. Available at: American Association of Critical-Care Nurses. (2005).
www.americanheart.org/presenter.jhtml?identifier=30 AACN Standards for Establishing and Sustaining
35517 Healthy Work Environments: A Journey to Excellence.
Available at: http://www.aacn.org/WD/HWE/Docs/
Copstead, L. & Banasik, J. L. (2000). Pathophysiology: HWEStandards.pdf.
Biological and Behavioral Perspectives, 2nd ed.
Philadelphia: W. B. Saunders/Elsevier. Dossey, B. M., Keegan, L. & Guzzetta, C. (2003).
Holistic Nursing: A Handbook for Practice. 3rd ed.
Curley, M. A. Q. & Moloney-Harmon, P. A. (eds.) Boston: Jones & Bartlett.
(2001). Critical Care Nursing of Infants and Children.
2nd ed. Philadelphia: W. B. Saunders/Elsevier. Hardin, S. R. & Kaplow, R. (eds.). (2005). Synergy for
Clinical Excellence: The AACN Synergy Model for
Finkelmeier, B. A. (2000). Cardiothoracic Surgical Patient Care. Boston: Jones & Bartlett.
Nursing. 2nd ed. Philadelphia: Lippincott Williams &
Wilkins. Lipson, J. G., Dibble, S. L. & Minarik, P. A. (eds.)
(1996). Culture and Nursing Care: A Pocket Guide.
Hockenberry, M. J., Wilson, D., Winkelstein, M. L. & San Francisco: UCSF Nursing Press.
Kline, N. E. (2007). Wong’s Nursing Care of Infants
and Children. 8th ed. St. Louis, Mo: Mosby/Elsevier. Many references available through AACN; visit
www.aacn.org > Marketplace > Online Bookstore.
Merenstein, G. B. & Gardner, S. L. (eds). (2006). More current version may be available.
Handbook of Neonatal Intensive Care. 6th ed. St.
Louis, Mo: Mosby/Elsevier.

PUBLISHER CONTACTS:
AACN – (800) 899-2226
Acorn Publishing – (919) 786-1155
American Heart Association – (800) 242-8721
Elsevier (including Mosby, W. B. Saunders, and Hanley & Belfus) – (800) 545-2522
Jones & Bartlett – (800) 832-0034
Lippincott Williams & Wilkins – (800) 638-3030
UCSF Nursing Press – (415) 476-4992

24
If you are taking the CCRN exam on January 13, 2010 or later please refer to the revised CCRN Test Plan
available online at www.certcorp.org, under Certification News > New CCRN Test Plans Effective Mid-January 2010.

CCRN TEST PLAN – ADULT


Applies to CCRN exams taken through January 12, 2010.

CCRN
I. CLINICAL JUDGMENT (80%) 8. Pulmonary pharmacology
A. Cardiovascular (32%) 9. Pulmonary trauma (e.g., pulmonary
1. Acute coronary syndromes/unstable angina hemorrhage, tracheal perforation)

2. Acute heart failure/pulmonary edema 10. Respiratory distress (e.g., emphysema,


bronchitis)
3. Acute inflammatory disease (e.g., myocarditis,
endocarditis, pericarditis) 11. Status asthmaticus, exacerbation of COPD,
emphysema
4. Acute myocardial infarction/papillary muscle
rupture 12. Thoracic surgery (e.g., lung contusions,
fractured ribs, hemothorax, pulmonary
5. Acute peripheral vascular insufficiency (e.g., hemorrhage, lung reduction, pneumonectomy,
acute arterial occlusion, carotid artery stenosis, lobectomy, tracheal surgery)
endartarectomy, peripheral stents)
13. Thoracic trauma (e.g., lung contusions,
6. Cardiac surgery (e.g., valve replacement, CABG) fractured ribs, hemothorax, pneumothorax
7. Cardiac tamponade from trauma, pulmonary hemorrhage)
8. Cardiac trauma (blunt and penetrating) 14. Ventilator management and ABG interpretation,
9. Cardiogenic shock mixed venous gases, CPAP, volutrauma and
barotraumas
10. Cardiomyopathies (e.g., hypertrophic, dilated,
restrictive, idiopathic)
11. Cardiovascular pharmacology C. Endocrine (4%)

12. Conduction defects, blocks and pacemakers 1. Acute hypoglycemia

13. Dysrhythmias/AICDs 2. Diabetes insipidus

14. Heart failure 3. Diabetic ketoacidosis

15. Hemodynamic monitoring 4. Hormones and endocrine anatomy and


physiology
16. Hypertensive crisis
5. Hyperosmolar hyperglycemic state (HHS)
17. Hypovolemic shock and volume deficit
18. Pulmonary hypertension (e.g., valvular defects,
D. Hematology/Immunology (3%)
aortic stenosis, mitral stenosis)
1. Hematology, anatomy and physiology, blood
19. Ruptured or dissecting aneurysm (e.g.,
products and plasma
thoracic, abdominal)
2. Immunosuppression-acquired (e.g., HIV, AIDS,
neoplasms)
B. Pulmonary (17%)
3. Life-threatening coagulopathies (e.g., ITP, DIC,
1. Acute pulmonary embolus, fat embolus hemophilia, HITTS, ReoPro-induced) and non
2. Acute respiratory distress syndrome (ARDS) life-threatening coagulopathies
3. Acute respiratory failure, hypoxemia 4. Organ transplantation (e.g., liver, bone marrow,
kidney, heart, pancreas, lung)
4. Acute respiratory infections
5. Sickle cell crisis
5. Air leak syndromes (e.g., spontaneous
pneumothorax, pneumopericardium,
pneumomediastinum, PIE) E. Neurology (5%)
6. Aspirations (e.g., aspiration pneumonia, 1. Aneurysm, AV malformation
hospital acquired pneumonia, foreign body
2. Encephalopathy (e.g., hypoxic-ischemic,
aspiration)
metabolic, edema, infectious)
7. Chronic lung disease 3. Head trauma (blunt, penetrating), skull
fractures
25
CCRN TEST PLAN – ADULT (CONTINUED)

4. Intracranial hemorrhage/intraventricular H. Multisystem (8%)


hemorrhage (e.g., subarachnoid, epidural, 1. Multisystem trauma
subdural)
2. Septic shock/infectious diseases (e.g., viral,
5. Neurologic infectious diseases (e.g., meningitis,
bacterial, line sepsis, nosocomial infections,
GBS, West Nile)
immunosuppression)
6. ICP monitoring
3. Systemic inflammatory response syndrome
7. Neurosurgery (e.g., evacuation of hematoma, (SIRS)/sepsis/MODS
tumor resection)
4. Toxic exposure (e.g., chemicals, radiation,
8. Seizure disorders
anaphylaxis)
9. Stroke (e.g., embolic events, hemorrhagic)
5. Toxic ingestions and inhalations (e.g.,
drug/alcohol overdose, poisoning)
F. Gastrointestinal (6%)
1. Acute abdominal trauma II. PROFESSIONAL CARING AND ETHICAL PRACTICE
2. Acute GI hemorrhage (e.g., esophageal, upper (20%)
and lower) A. Advocacy/Moral Agency (2%)
3. Bowel infarction, bowel obstruction, bowel B. Caring Practices (4%)
perforation C. Collaboration (4%)
4. GI surgeries (e.g., Whipple, esophago- D. Systems Thinking (2%)
gastrectomy, gastric bypass)
E. Response to Diversity (2%)
5. Hepatic failure/coma (e.g., portal hypertension,
cirrhosis, esophageal varicies, fulminant F. Clinical Inquiry (2%)
hepatitis) G. Facilitation of Learning (4%)
6. Pancreatitis
7. Gastro-esophageal reflux

G. Renal (5%)
1. Acute renal failure (e.g., acute tubular necrosis,
hypoxia, dialysis)
2. Chronic renal failure and dialysis
3. Life-threatening electrolyte imbalances (e.g.,
potassium, sodium, phosphorus, magnesium,
calcium)
4. Fluid balance concepts and renal anatomy &
physiology
5. Renal trauma

26
If you are taking the CCRN exam on January 13, 2010 or later please refer to the revised CCRN Test Plan
available online at www.certcorp.org, under Certification News > New CCRN Test Plans Effective Mid-January 2010.

CCRN TEST PLAN – PEDIATRIC


Applies to CCRN exams taken through January 12, 2010.

CCRN
I. CLINICAL JUDGMENT (80%) 13. Status asthmaticus
A. Cardiovascular (19%) 14. Thoracic surgery (e.g., lung contusions,
1. Acute heart failure/pulmonary edema fractured ribs, hemothorax, pulmonary
hemorrhage, lung reduction, pneumonectomy,
2. Acute inflammatory disease (e.g., myocarditis, lobectomy, tracheal surgery)
endocarditis, pericarditis)
15. Thoracic trauma (e.g., lung contusions,
3. Cardiac surgery fractured ribs, hemothorax, pulmonary
4. Cardiac trauma (blunt and penetrating) hemorrhage)
5. Cardiogenic shock 16. Ventilator management and ABG interpretation,
6. Cardiomyopathies (e.g., hypertrophic, dilated, mixed venous gases, CPAP, volutrauma and
restrictive, idiopathic) barotraumas

7. Cardiovascular pharmacology
8. Conduction defects, blocks and pacemakers C. Endocrine (5%)

9. Congenital heart defect/disease 1. Acute hypoglycemia

10. Dysrhythmias 2. Diabetes insipidus

11. Hemodynamic monitoring 3. Diabetic ketoacidosis

12. Hypertensive crisis 4. Hormones and anatomy & physiology

13. Hypovolemic shock and volume deficit 5. Inborn errors of metabolism

14. Pulmonary hypertension (e.g., aortic and mitral 6. Syndrome of inappropriate secretion of
stenosis and regurgitation) antidiuretic hormone (SIADH)

B. Pulmonary (22%) D. Hematology/Immunology (6%)

1. Acute respiratory distress syndrome (ARDS) 1. Hematology, anatomy & physiology, blood
products and plasma
2. Acute respiratory failure, hypoxemia
2. Hyperbilirubinemia
3. Acute respiratory infections (e.g., pneumonia,
croup, strep pneumonia, RSV, bronchiolitis) 3. Immunosuppression (e.g., congenital [SCID],
acquired [HIV, AIDS, neoplasms])
4. Air-leak syndromes (e.g., spontaneous
pneumothorax, bronch-fistula, emphysema, 4. Life-threatening coagulopathies (e.g., DIC, ITP,
[PIE], pneumopericardium, hemophilia)
pneumomediastinum) 5. Organ transplantation (e.g., liver, bone marrow,
5. Apnea of prematurity kidney, heart, pancreas, lung)

6. Aspirations (e.g., aspiration pneumonia, 6. Sickle cell crisis


hospital-acquired pneumonia, foreign body
aspiration) E. Neurology (10%)
7. Chronic lung disease (e.g., bronchopulmonary 1. Acute spinal cord injury
dysplasia)
2. Congenital neurological abnormalities (e.g.,
8. Congenital anomalies spina bifida, myelomeningocele, anencephaly,
9. Persistent pulmonary hypertension encephalocele)

10. Pulmonary trauma (e.g., pulmonary 3. Encephalopathy (e.g., hypoxic-ischemic,


metabolic, edema, infectious)
hemorrhage, tracheal perforation)
4. Head trauma (blunt, penetrating) including
11. Pulmonary pharmacology
shaken baby
12. Respiratory distress (e.g., epiglottitis,
5. Hydrocephalus
bronchitis)

27
CCRN TEST PLAN – PEDIATRIC (CONTINUED)

6. ICP monitoring H. Multisystem (9%)


7. Intracranial hemorrhage/intraventricular 1. Asphyxia (e.g., near-drowning, traumatic)
hemorrhage (e.g., subarachnoid, epidural,
2. Burns
subdural) including stroke
3. Hemolytic uremic syndrome
8. Neurologic infectious diseases (e.g., meningitis,
congenital infections, viral infections, West 4. Multisystem trauma
Nile) 5. Septic shock/infectious diseases (e.g.,
9. Neuromuscular disorders (e.g., muscular congenital viral, bacterial, line sepsis,
dystrophy, Werdnig-Hoffman) nosocomial infections)
10. Neurosurgery (e.g., evacuation of hematoma, 6. Systemic inflammatory response syndrome
tumor resection) (SIRS)/sepsis/MODS
11. Seizure disorders 7. Toxic exposure (e.g., fetal exposure to
12. Space-occupying lesions (e.g., brain tumors) drug/alcohol, drug withdrawal, anaphylaxis)
13. Spinal fusion 8. Toxic ingestions and inhalations (e.g.,
drug/alcohol overdose, poisoning)
F. Gastrointestinal (5%)
1. Acute abdominal trauma II. PROFESSIONAL CARING AND ETHICAL PRACTICE
(20%)
2. Acute GI hemorrhage
A. Advocacy/Moral Agency (2%)
3. Bowel infarction/obstruction/perforation (e.g.,
necrotizing enterocolitis) B. Caring Practices (4%)

4. Gastro-esophageal reflux C. Collaboration (4%)


D. Systems Thinking (2%)
5. GI abnormalities at birth (e.g., Hirschprung's)
E. Response to Diversity (2%)
6. GI surgeries
F. Clinical Inquiry (2%)
7. Hepatic failure/coma (e.g., portal hypertension,
fulminant hepatitis, biliary atresia, G. Facilitation of Learning (4%)
hyperbilirubinemia)

G. Renal (4%)
1. Acute renal failure (e.g., acute tubular necrosis)
2. Chronic renal failure and dialysis
3. Congenital renal-genitourinary abnormalities
(e.g., polycystic kidneys, exstrophy of bladder,
hydronephrosis)
4. Fluid balance concepts and renal anatomy &
physiology
5. Life-threatening electrolyte imbalances (e.g.,
potassium, sodium, phosphorus, magnesium,
calcium)
6. Renal trauma

28
If you are taking the CCRN exam on January 13, 2010 or later please refer to the revised CCRN Test Plan
available online at www.certcorp.org, under Certification News > New CCRN Test Plans Effective Mid-January 2010.

CCRN TEST PLAN – NEONATAL


Applies to CCRN exams taken through January 12, 2010.

CCRN
I. CLINICAL JUDGMENT (80%) C. Endocrine (4%)
A. Cardiovascular (10%) 1. Acute hypoglycemia
1. Acute heart failure/pulmonary edema 2. Hormones and anatomy & physiology
2. Acute inflammatory disease (e.g., myocarditis, 3. Inborn errors of metabolism
endocarditis, pericarditis) 4. Infant of diabetic mother
3. Cardiac surgery
4. Cardiovascular pharmacology D. Hematology/Immunology (4%)
5. Congenital heart defect/disease 1. Anemia of prematurity
6. Hemodynamic concepts 2. Hematology, blood products and plasma
7. Pulmonary hypertension 3. Hyperbilirubinemia
8. Shock states (e.g., cardiogenic, 4. Immunosuppression (e.g., Rh incompatibilities,
hypovolemic/volume deficit) ABO incompatibilities, hydrops fetalis)
5. Life-threatening coagulopathies (e.g., ITP, DIC)
B. Pulmonary (36%) and non life-threatening coagulopathies
1. Acute respiratory failure, hypoxemia
2. Acute respiratory infections E. Neurology (6%)
3. Air-leak syndromes (e.g., spontaneous 1. Congenital neurological abnormalities (e.g.,
pneumothorax, bronch-fistula, emphysema, spina bifida, myelomeningocele, anencephaly,
[PIE], pneumopericardium, pneumo- encephalocele)
mediastinum) 2. Encephalopathy (e.g., hypoxic-ischemic,
4. Apnea of prematurity metabolic, edema, infectious)

5. Aspirations (e.g., aspiration pneumonia, 3. Hydrocephalus


meconium aspiration) 4. ICP monitoring
6. Chronic lung disease (e.g., bronchopulmonary 5. Intracranial hemorrhage/intraventricular
dysplasia) hemorrhage
7. Congenital anomalies 6. Neurologic infectious diseases (e.g., meningitis,
congenital infections, viral infections, TORCH)
8. Pulmonary hypertension in newborn
7. Seizure disorders
9. Respiratory distress syndrome
10. Respiratory pharmacology
F. Gastrointestinal (7%)
11. Thoracic surgery (e.g., lung contusions,
1. Bowel infarction/obstruction/perforation (e.g.,
fractured ribs, hemothorax, pulmonary
necrotizing enterocolitis, adhesions, shortgut)
hemorrhage, lung reduction, pneumonectomy,
lobectomy, tracheal surgery) 2. Gastro-esophageal reflux
12. Transient tachypnea of the newborn 3. GI abnormalities at birth
13. Ventilator management and ABG interpretation, 4. Hepatic failure/coma
mixed venous gases, CPAP, volutrauma and
barotraumas

29
CCRN TEST PLAN – NEONATAL (CONTINUED)

G. Renal (2%) II. PROFESSIONAL CARING AND ETHICAL PRACTICE


1. Acute renal failure (e.g., acute tubular necrosis, (20%)
hypoxia) A. Advocacy/Moral Agency (2%)
2. Congenital renal-genitourinary abnormalities B. Caring Practices (4%)
(e.g., polycystic kidneys, exstrophy of bladder, C. Collaboration (4%)
hydronephrosis)
D. Systems Thinking (2%)
3. Fluid balance concepts and renal anatomy &
E. Response to Diversity (2%)
physiology
F. Clinical Inquiry (2%)
4. Life-threatening electrolyte imbalances (e.g.,
potassium, sodium, phosphorus, magnesium, G. Facilitation of Learning (4%)
calcium)

H. Multisystem (11%)
1. Asphyxia (e.g., neonatal-perinatal)
2. Life-threatening maternal-fetal complications
(e.g., birth trauma and birth-related injuries,
genetic disorders, maternal-fetal transfusion,
placenta abruptio, placenta previa)
3. Low birth weight/prematurity
4. Septic shock/infectious diseases (e.g.,
congenital viral, bacterial, line sepsis,
nosocomial infections)
5. Toxic exposure (e.g., fetal exposure to
drug/alcohol, drug withdrawal, anaphylaxis)

30
SAMPLE CCRN EXAM QUESTIONS – ADULT

CCRN
1. A patient with a recent myocardial infarction 5. The nursing staff is resisting being assigned to a
suddenly develops a loud systolic murmur. The disruptive patient. An appropriate resolution
most likely cause is which of the following? would be to
A. pulmonary embolism A. request the physician to transfer the patient.
B. congestive heart failure B. rotate the patient assignment among staff.
C. ruptured papillary muscle C. confront the family and demand an end to the
D. increased systemic vascular resistance disruptive behavior.
D. hold a nursing team conference to discuss
possible alternatives.
2. A patient with unstable angina has an IABP
inserted. Hemodynamics are: HR = 148 (sinus
tachycardia); MAP = 40 mm Hg; PCWP = 25 6. A patient who is 72 hours postoperative repair of a
mm Hg; CI = 1.4 L/min/m2. ruptured abdominal aortic aneurysm suddenly
becomes dyspneic with an increased respiratory
Which of the following should be included in this rate from 24 to 40/min. An arterial blood gas
patient’s plan of care? sample obtained while the patient is receiving
oxygen via a nasal cannula at 6L/min reveals the
A. checking timing of the IABP, decreasing balloon following results:
to 1:2 frequency
pH 7.50
B. stat echocardiogram, furosemide (Lasix),
checking timing of the IABP pCO2 31

C. dobutamine (Dobutrex), isoproterenol (Isuprel), pO2 48


12-lead ECG A chest x-ray is obtained and a “ground-glass-like
appearance” is reported. Auscultation of the
D. adenosine, stat Hgb and HCT, dobutamine
lungs reveals basilar crackles that were not
(Dobutrex)
previously present. On the basis of this
information, the nurse should suspect that the
3. The family of a critically ill patient wishes to spend patient has developed
the night, which is contrary to visiting policy. The A. a pulmonary embolus.
nurse’s best action would be to
B. bacterial pneumonia.
A. adhere to the visiting policy.
C. chronic obstructive pulmonary disease.
B. allow the family to stay in the room.
D. acute respiratory distress syndrome.
C. obtain a motel room near the hospital where
the family may spend the night.
7. Members of the nursing staff are developing
D. allow one or two family members to stay, then
written patient education materials for a group of
evaluate the patient’s response.
patients with diverse reading abilities. It would be
most effective for the staff to
4. A patient who is one day post-gastroplasty has a A. design individual handouts for each patient.
sudden onset of restlessness, dyspnea, and chest B. develop a computer-based education series.
pain. His heart rate is 122/min., and auscultation
of heart sound reveals an increased intensity of a C. write the materials at a fourth-grade reading level.
pulmonary S2. The most likely cause is D. limit text and provide color pictures.
A. aspiration pneumonia.
B. a spontaneous pneumothorax. Answers
C. a pleural effusion. 1. C 5. D
2. A 6. D
D. a pulmonary embolus.
3. D 7. C
4. D

31
SAMPLE CCRN EXAM QUESTIONS – PEDIATRIC

1. In caring for a patient with salicylate intoxication, 5. A 3-year-old is admitted to the ICU with a 10-hour
the critical care nurse would anticipate which of history of an acute-onset asthma attack. Initial
the following as a primary treatment measure? assessment reveals the following
A. administration of protamine sulfate HR 160
pH 7.25
B. administration of glucose RR 48
C. transfusion of packed RBCs pCO2 35
BP 112/76
D. replacement of fluid and electrolytes pO2 40
T 32°C (oral)
2. An adolescent with the developmental age of a 4- HCO3- 22
year-old requires placement of a chest tube. The In this situation, the critical care nurse would
best way to prepare the patient for this procedure expect initial treatment to include
is to A. administration of NaHCO3.
A. use short simple sentences and limit B. fluid resuscitation.
descriptions to concrete explanations.
C. racemic epinephrine.
B. show the patient a chest tube and explain how
it will feel. D. intubation.

C. explain in detail why a chest tube is needed


and how it works. 6. A 2-year-old is experiencing manifestations of
D. tell the parents what will be done so they can digoxin (Lanoxin) toxicity. BP is 94/60, capillary
explain it to their child. refill time is 2 seconds and the electrocardiogram
reveals AV block with a heart rate of 60. The
critical care nurse would anticipate which of the
3. A child is admitted with a gunshot wound to the following interventions?
head, accidentally inflicted by an older sibling. A. performance of cardioversion
The parents are overcome with grief, and appear
to be ignoring the following statements made by B. administration of Atropine
the older sibling: “It was an accident; I didn’t C. performance of vasovagal maneuvers
mean to do it; I’m sorry!” Which of the following
D. monitoring of HR and rhythm and perfusion status
actions by the nurse would be most appropriate?
A. Discuss the importance of gun safety with the
older sibling while the parents are at the bedside. 7. An adolescent with asthma is readmitted just a week
after discharge from the hospital. On questioning, the
B. Seek additional support for the parents for nurse learns that the patient refuses to use the
ways they can assist the older sibling. inhalers at school. The nurse should
C. Tell the parents that they need to provide A. talk to the teen about long-term consequences of
support for the older sibling. the disease if the treatment plan is not followed.
D. Tell the older sibling, “Accidents happen; I know B. talk to the school nurse to find out why they are
you didn’t mean to do it.” not monitoring the medications at school.
C. help the parents set up a disciplinary contract
4. Which of the following laboratory findings is with the teen.
indicative of the syndrome of inappropriate ADH D. arrange for the teen to attend an asthma
secretion (SIADH)?
support group.
A. serum sodium = 148 mEq/L
B. decreased serum osmolality Answers
C. blood urea nitrogen (BUN) = 28 mg/dl 1. D 5. D
2. A 6. D
D. serum potassium = 5.1 mEq/L
3. B 7. D
4. B
32
SAMPLE CCRN EXAM QUESTIONS – NEONATAL

CCRN
1. After application of a warm saline-soaked gauze 4. An infant at 38-weeks-gestation is born via
dressing to an infant’s abdominal wall defect, the cesarean section. At 4 hours of age, heart rate is
most effective method for preventing evaporative 155 and respiratory rate is at 60. Physical
heat loss is to assessment reveals grunting, mild retractions,
A. place the infant in a warmed isolette. and nasal flaring. A chest x-ray reveals perihilar
streaking bilaterally. The following arterial blood
B. place the infant under a radiant heat source. gas (ABG) results are obtained:
C. moisten the gauze dressing every 30 minutes. pH 7.40
D. cover the gauze dressing with plastic. pCO2 35
pO2 40
2. An infant has just been intubated for respiratory HCO3- 22
failure due to respiratory distress syndrome (RDS).
The infant’s breath sounds are heard on the right Appropriate management of this patient would
side but not on the left. Which of the following consist of
interventions would be most appropriate? A. intubation and mechanical ventilation.
A. leave the tube in position and increase bag B. surfactant replacement therapy.
pressure C. chest tube insertion.
B. advance the tube until breath sounds are D. oxygen administration via hood.
heard bilaterally
C. withdraw the tube until breath sounds are
heard bilaterally 5. A meeting is planned to discuss the parents’
ethical concerns regarding life support
D. remove the tube and re-intubate interventions for their neonate with Trisomy 18.
The nurse’s role would be to
3. A preterm infant with necrotizing enterocolitis and A. assist the parents in articulating their
resultant bowel perforation has returned from the questions and concerns.
operating room with an ileostomy. The first step B. provide legal information regarding end-of-life
in management of the ostomy should include decisions.
A. contacting the dietitian for recommendations C. describe reasons for the infant’s poor
regarding easily digested formula. prognosis.
B. contacting the enterostomal nurse to provide a D. inform the parents that the goal of the meeting
pattern for the ostomy appliance. is to obtain a DNR order.

C. applying a dry sterile dressing over the ostomy.


D. clini-testing stool to determine degree of 6. An infant with documented hypoglycemia is being
started on a continuous dextrose infusion
malabsorption. following a bolus injection of glucose. An
appropriate rate of dextrose infusion would be
A. 1 - 3 mg/kg/min.
B. 4 - 8 mg/kg/min.
C. 9 - 12 mg/kg/min.
D. 13 - 16 mg/kg/min.

33
SAMPLE CCRN EXAM QUESTIONS – NEONATAL (CONTINUED)

7. An infant with isometric hydrops is delivered 9. The mother of an infant with severe PPHN would
at 28-weeks-gestation by cesarean section. like to hold her infant. The infant’s oxygen
Which of the following interventions should be saturation is 88% to 92% at rest and mean blood
anticipated in the initial management of this pressure is 28. The nurse’s best response would
infant? be to
A. administration of sodium polystyrene sulfonate A. explain signs and symptoms that demonstrate
(Kayexalate) instability of the infant.
B. placement of an umbilical venous catheter and B. assist the mother in holding the infant skin-to-
slow push of O-positive whole blood skin.
C. thoracentesis and/or paracentesis C. encourage the mother to talk to the infant.
D. a difficult intubation D. show the mother how to provide gentle infant
massage.
8. The following results were obtained from a
cerebro spinal fluid (CSF) sample obtained by
lumbar puncture:
40 WBC/mm
65% polymorphonuclear cells
Glucose 50 mg/dl
Protein 165 mg/dl
Bacteria shown by Gram-staining
On the basis of these results, the most
appropriate additional study would include
A. drawing blood for sedimentation rate.
B. obtaining surface cultures.
C. continuing monitoring without intervention.
D. obtaining blood and urine cultures.

Answers
1. D
2. C
3. B
4. D
5. A
6. B
7. C
8. D
9. A

34
3 of 3

CCRN CERTIFICATION APPLICATION HONOR STATEMENT


Online exam registration is available at www.certcorp.org; click Apply Online.

Complete and submit with 2-page application at back of handbook.

Name: _____________________________________________________ AACN #: ___________________


LAST FIRST MIDDLE

Verification Information - List contact information for a professional associate (colleague or supervisor) who
can verify that you have met the clinical hour eligibility requirements:
ASSOCIATE’S NAME:

FACILITY ADDRESS:

City State ZIP

ASSOCIATE’S PHONE NUMBER: and/or E-MAIL ADDRESS:

Honor Statement
I have fulfilled the clinical practice hour requirements of 1,750 hours of direct bedside care of acutely and/or critically ill
(check one) Adult
Pediatric
Neonatal
patients within the previous 2-year period, with 875 hours accrued in the most recent year preceding this application.
Or if renewing by exam I have completed 432 hours of direct bedside care of acutely and/or critically ill
(check one) Adult
Pediatric
Neonatal
patients within the 3-year certification period, with 144 hours accrued in the most recent year preceding my scheduled renewal date.

I possess a current unencumbered U.S. license to practice as an RN or APRN. An unencumbered license is not currently subject to
formal discipline by any Board of Nursing and has no provisions or conditions that limit the nurse’s practice in any way. I agree to
notify AACN Certification Corporation if any disciplinary action is taken against my RN or APRN license in the future.

I hereby apply for CCRN certification offered by AACN Certification Corporation. I understand that certification depends upon the
successful completion of the specified requirements. I further understand that the information acquired in the certification process may
be used for statistical purposes and for evaluation of the certification program.

To the best of my knowledge, the information contained in the application is true, complete, correct and is made in good faith. I
understand that information supplied is subject to audit and failure to respond to a request for further information may be sufficient
cause for AACN Certification Corporation to bar me from the exam, to invalidate the results of my exam, to withhold certification, to
revoke certification or to take other appropriate action.

My signature on this form indicates my agreement to keep the contents of the exam confidential and not discuss the specific exam
content with anyone except AACN Certification Corporation. By complying with and enforcing this obligation, I help maintain the integrity
of the AACN Certification Program and the value of its certification credentials.

Applicant’s Signature: Printed Name: Date:

This form may be photocopied and is also available online at www.certcorp.org. OCTOBER 2009 35
36
PCCN
PCCN CERTIFICATION

PCCN® certification is a specialty certification for nurses who provide care for acutely ill adult patients, regardless
of the geographic location of their nursing care. Specialty nurses interested in this certification may work in such
areas as: intermediate care units; direct observation units; stepdown units; telemetry units; transitional care units;
or emergency departments.

PCCN Certification Program ..........................................................................................................................................38


PCCN Exam Eligibility .....................................................................................................................................................38
PCCN Certification Renewal ..........................................................................................................................................39
PCCN Online Registration ..............................................................................................................................................40
PCCN Application Fees...................................................................................................................................................40
AACN Products for PCCN Exam Preparation .................................................................................................................41
PCCN Study Bibliography .........................................................................................................................................43-44
PCCN Test Plan .........................................................................................................................................................45-48
PCCN Sample Exam Questions .....................................................................................................................................49
PCCN Exam Honor Statement (3rd page of 3-page application) ................................................................................51
AACN Synergy Model for Patient Care .....................................................................................................................76-77
Certification Exam Application (1st and 2nd pages of 3-page application) .........................................................79-80

37
PCCN CERTIFICATION PROGRAM

Definition In the study, progressive care nurses across the United


States were surveyed to ascertain the frequency and
Progressive Care Certified Nurse (PCCN) certification
significance of the various elements of their practice.
validates your knowledge of nursing of acutely ill adult
Through an extensive review and evaluation process,
patients in your specialty area to hospitals, peers,
the knowledge, skills and abilities crucial to
patients and, most importantly, to yourself. PCCN
progressive care nursing were defined using the AACN
certification promotes continuing excellence in the
Synergy Model for Patient Care as an organizing
progressive care nursing profession. Progressive care
framework. The PCCN certification exam is based on
is the term the American Association of Critical-Care
these skills and abilities and the knowledge required
Nurses (AACN) uses to collectively describe areas that
to perform them.
are also referred to as intermediate care units, direct
observation units, stepdown units, telemetry units,
PCCN certification is achieved by those progressive
transitional care units or emergency departments, as
care nurses who pass the PCCN exam in adult
well as to define a specific level of patient care. AACN
progressive care nursing. PCCN certification denotes to
recognizes progressive care as part of the continuum
the public those practitioners who possess a distinct
of critical care.
and clearly defined body of knowledge called
progressive care nursing.
PCCN® Registered Service Mark
PCCN is a registered service mark of AACN Exam Contents
Certification Corporation and denotes certification in
The PCCN exam is a 2 and ½ -hour test consisting of
progressive care nursing as granted by AACN
125 multiple-choice items. Of the 125 items, 100 are
Certification Corporation. Registered nurses who have
scored and 25 are used to gather statistical data on
not achieved PCCN certification status, whose PCCN
item performance for future exams. Please refer to the
status has lapsed, or who have chosen Inactive status
PCCN test plan for detailed content information. The
are not authorized to use the PCCN credential.
PCCN exam focuses on adult patient populations only.
Validated Knowledge and Specialized Test Plan
Skills
The content of the PCCN exam is described in the test
Each PCCN certification exam is based on a job plan included in this handbook. Candidates are tested
analysis. The most recent study, completed in 2008, on a variety of patient care problems that are
defines the dimensions of progressive care practice, organized under major categories. Please note the
identifying what is required of registered nurses percentage of the PCCN exam devoted to each
practicing in acute care settings. category.

PCCN EXAM ELIGIBILITY

• Current unencumbered licensure as an RN or APRN • Practice as an RN or APRN is required for 1,750


in the United States is required. hours in direct bedside care of acutely ill adult
patients during the previous two years, with 875 of
An unencumbered license is not currently subject to those hours accrued in the most recent year
formal discipline by any Board of Nursing and has no preceding application.
provisions or conditions that limit the nurse’s
practice in any way. Clinical practice hours for PCCN exam or renewal
eligibility must take place in a U.S.-based or Canada-
It is the responsibility of candidates and PCCN- based facility or in a facility determined to be
certified nurses to notify AACN Certification comparable to the U.S. standard of acute/critical
Corporation when any restriction is placed on their care nursing practice, as evidenced by ANCC Magnet
RN or APRN license. If you are randomly selected for Status or Joint Commission International
audit, you will be asked to provide a copy of your RN accreditation.
or APRN license - please do not submit with your
application.

38
PCCN
• Nurses serving as manager, educator (in-service or writing that you have met the clinical hour
academic), APRN or preceptor may apply their hours requirements. A professional associate is defined as
spent supervising nursing students or nurses at the a clinical supervisor (RN or physician), or RN
bedside. Nurses in these roles must be actively colleague with whom you work.
involved in caring for patients at the bedside; for
example, performing a procedure or supervising a • AACN Certification Corporation may adopt additional
new employee or student nurse performing a eligibility requirements at its sole discretion from
procedure at the bedside. time to time. Any such requirements will be
designed to establish, for the purposes of PCCN
• The name and address of a professional associate certification, the adequacy of a candidate's
must be given for verification of eligibility related to knowledge and experience in caring for the acutely
clinical practice hours. If you are randomly selected ill.
for audit, this associate will be asked to verify in

PCCN CERTIFICATION RENEWAL

PCCN certification is conferred for a period of three OPTION 1 - Renewal by Synergy CERPs
years. Your certification period begins the first day of
Meet eligibility requirements for PCCN renewal and
the month in which the PCCN certification exam is
complete the Continuing Education Recognition Point
passed and ends three years later; for example,
(CERP) Program, which requires 100 CERPs in various
October 1, 2009 through September 30, 2012. The
categories (A, B & C). For more details refer to Renewal
purpose of certification renewal is to enhance
by Synergy CERPs At-a-Glance and other Synergy CERP
continued competence.
resources available online at www.certcorp.org.
A copy of the PCCN Renewal Handbook will be mailed
Online Renewal by Synergy CERPs is available to all
to you approximately 90 days before your scheduled
active PCCNs as early as four months prior to their
PCCN renewal date. You are responsible for renewing
scheduled renewal date. For more information visit
your certification even if you do not receive renewal
www.certcorp.org - click Renew Your Certification.
notification.

You may seek certification renewal via Renewal by OPTION 2 - Renewal by Exam
Synergy CERPs or Renewal by Exam, or you may Meet the eligibility requirements for PCCN renewal and
choose Inactive status. Do not apply for more than one successfully apply for and schedule your exam in
option. Renewal by Exam candidates must successfully enough time to complete the PCCN exam before your
apply for and schedule their exam in enough time to scheduled renewal date.
complete the PCCN exam before their scheduled
renewal date. You may not take the exam early, then OPTION 3 - Inactive Status
attempt to renew by Synergy CERPs if you do not pass. Inactive status is available to PCCN-certified nurses
who do not meet the renewal eligibility requirements
To renew, you must hold a current unencumbered RN but do not wish to lose their PCCN certification status.
or APRN license in the United States, complete 432 Inactive status provides PCCN-certified nurses
hours of direct bedside care of acutely ill adult patients additional time, up to three years from the scheduled
within the three-year certification period, with 144 of renewal date, to meet the eligibility requirements.
those hours in the 12-month period prior to the During the time of Inactive status candidates may not
scheduled renewal date, and complete the required use the PCCN credential.
Synergy CERPs or complete the PCCN exam. For more
details, refer to the PCCN Renewal Handbook,
available at www.certcorp.org.

39
PCCN ONLINE REGISTRATION

Online registration is available for the PCCN exam. This paperless registration streamlines the exam application
process by up to six weeks. Once you register online your 90-day window for testing will begin within one to two
weeks. Candidates should be prepared to sit for the exam before registering online. For more information and to
register visit www.certcorp.org.

PCCN APPLICATION FEES

Computer-Based PCCN Exam

AACN Members $170

Nonmembers $250

PCCN Retest Fee

AACN Members $135

Nonmembers $215

Current PCCN Renewal by Exam

AACN Members $135

Nonmembers $215

Payable in U.S. funds. Fees are subject to change without notice. A $15 fee will be charged for a returned check.

40
AACN PRODUCTS FOR PCCN EXAM PREPARATION

Description Item #
*Online PCCN Self-Assessment Exam (SAE) – mirrors content of PCCN exam; includes 50 questions with correct answers
and rationale; score report upon completion to assess strengths and areas for further study; access for 90 days from Purchase online only at
purchase date. www.certcorp.org.

*Practice PCCN Exam Questions. (2008). 120 questions. 200405


Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care. (2005). Hardin, S. & Kaplow, R. 160 pages. 100149
Critical Care Nursing: Synergy for Optimal Outcomes. (2007). Kaplow, R. & Hardin, S. 778 pages. 100147
AACN Certification and Core Review for High Acuity and Critical Care, 6th ed. (2007). Grif Alspach, J. 192 pages. 128800
Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application, 3rd ed. (2002). Darovic, G. O. 676 pages. 128639
Handbook of Hemodynamic Monitoring, 2nd ed. (2004). Darovic, G. O. 400 pages. 128640
AACN Procedure Manual for Critical Care, 5th ed. (2005). Lynn-McHale, D. & Carlson, K. 1,280 pages. 128150
Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. (2005). Pagana, K. & Pagana, T. 1,280 pages. 128160
** PCCN Review Course on DVD (2009) – includes study guide and 12 hours of CE credit. 300900
** PCCN Review Course on Audio CD (2009) – includes study guide and 12 hours of CE credit. 300901
** PCCN Review Course on CD-ROM (2009) – includes study guide and 12 hours of CE credit. 300902
PCCN Review Course Additional Syllabus. (2009). 190 pages. 300903
PCCN Certification Review. (2009). CD-ROM & book. Brorsen, A. & Rogelet, K. 402 pages. 128820
AACN Essentials of Progressive Care Nursing (2006). Chulay, M. & Burns, S. 608 pages. 128765
AACN Protocols for Practice: Non-Invasive Monitoring, 2nd ed. (2005). Burns, S. 113 pages. 170680
AACN Protocols for Practice: Palliative and End-of-Life Issues in Critical Care (2006). Medina, J. & Puntillo, K. 59 pages. 170900
The Johns Hopkins Manual of Cardiac Surgical Care, 2nd ed. (2007). Conte, J., Owens, S., Dorman, T. 512 pages. 100255
Emergency Psychiatry: Principles and Practice. (2008). Glick, R., et. al., 488 pages. 301650
Hemodynamic Monitoring Made Incredibly Visual! (2006). 160 pages. 128642
ACLS Pocket Reference Cards. (2006). AHA, AACN. Set of 2. 400862

*Denotes products developed by AACN Certification Corporation.

**PCCN Review Course Packages also available; packages include PCCN Review Course, Practice PCCN Exam
Questions, and AACN Essentials of Progressive Care Nursing. Item numbers are 302015 (DVD), 302016 (CD-ROM) and
302017 (Audio CD).

For more details and to place an order, visit our Web site at www.aacn.org and click on Marketplace,
or call AACN Customer Care at (800) 899-2226, between 7:30 a.m. and 4:30 p.m., Pacific Time.

OFCRHB OCTOBER 2009 41


42
PCCN STUDY BIBLIOGRAPHY
RECOMMENDED REFERENCES FOR THE PCCN EXAM

PCCN
Clinical Judgment – PCCN McQuillan, K. A., Whalen, E. & Flynn Makic, M. B.
(2008). Trauma Nursing: From Resuscitation Through
American Association of Critical-Care Nurses. (2008).
Rehabilitation. 4th ed. Philadelphia: Elsevier.
AACN Practice Alert. ST Segment Monitoring. Available
at: http://www.aacn.org/WD/Practice/Docs/
Pagana, K. D. & Pagana, T. J. (2008). Mosby’s
ST_Segment_Monitoring_04-2008.pdf
Diagnostic and Laboratory Test Reference. 9th ed.
St. Louis, Mo: Mosby/Elsevier.
American Heart Association. (2005). Guidelines 2005
for Cardiopulmonary Resuscitation and Emergency
Skidmore-Roth, L. (2008). Mosby’s 2009 Nursing
Cardiovascular Care. Available at: www.american
Drug Reference. 22nd ed. St. Louis, Mo:
heart.org/presenter.jhtml?identifier=3035517
Mosby/Elsevier.
Chulay, M. & Burns, S. (2006). AACN Essentials of
Smeltzer, S., Bare, B.G., Hinkle, J.L. & Cheever, K.H.
Progressive Care Nursing. Dubuque, IA: McGraw-Hill.
(2008). Brunner and Suddarth’s Textbook of Medical-
Surgical Nursing. 11th ed. Philadelphia: Lippincott
Conover, M. B. (2003). Understanding
Williams & Wilkins.
Electrocardiography. 8th ed. St. Louis, Mo:
Mosby/Elsevier.
Sole, M. L., Klein, D. G. & Moseley, M. (2008).
Introduction to Critical Care Nursing. 5th ed.
Copstead, L. & Banasik, J. L. (2000). Pathophysiology:
Philadelphia: W. B. Saunders.
Biological and Behavioral Perspectives. 2nd ed.
Philadelphia: W. B. Saunders/Elsevier.
Stillwell, S. (2006). Mosby’s Critical Care Nursing
Reference. 4th ed. St. Louis, Mo: Mosby/Elsevier.
Darovic, G. O. (2004). Handbook of Hemodynamic
Monitoring. 2nd ed. St. Louis, Mo: W. B.
Urden, L., Lough, M. E. & Stacy, K. L. (2005). Thelan’s
Saunders/Elsevier.
Critical Care Nursing: Diagnosis and Management.
5th ed. St. Louis, Mo: Mosby/Elsevier.
Darovic, G. O. (2002). Hemodynamic Monitoring:
Invasive and Noninvasive Clinical Application. 3rd ed.
Wiegand, D. J. L. & Carlson, K. K. (eds.) (2005).
Philadelphia: W. B. Saunders/Elsevier.
AACN Procedure Manual for Critical Care. 5th ed.
Philadelphia: Elsevier.
Emergency Nurses Association & Newberry, L. (2005).
Sheehy’s Manual of Emergency Care. 6th ed. St.
Woods, S., Sivarajan Froelicher, E. S. & Motzer, S. U.
Louis: Mosby/Elsevier.
(2004). Cardiac Nursing. 5th ed. Philadelphia:
Lippincott Williams & Wilkins.
Hickey, J. V. (2008).The Clinical Practice of
Neurological and Neurosurgical Nursing. 6th ed.
Philadelphia: Lippincott Williams & Wilkins.
Professional Caring and Ethical Practice
American Association of Critical-Care Nurses. (2005).
Lemmer, J. H., Richenbacher, W. E. & Vlahakes, G. J. AACN Standards for Establishing and Sustaining
(2003). Handbook of Patient Care in Cardiac Surgery. Healthy Work Environments: A Journey to Excellence.
Philadelphia: Lippincott Williams & Wilkins. Available at: http://www.aacn.org/WD/HWE/Docs/
HWEStandards.pdf.

continued

43
PCCN STUDY BIBLIOGRAPHY (CONTINUED)

Dossey, B. M., Keegan, L. & Guzzetta, C. (2003).


Holistic Nursing: A Handbook for Practice. 3rd ed.
Boston: Jones & Bartlett.

Hardin, S. R. & Kaplow, R. (eds.). (2005). Synergy for


Clinical Excellence: The AACN Synergy Model for
Patient Care. Boston: Jones & Bartlett.

Lipson, J. G., Dibble, S. L. & Minarik, P. A. (eds.)


(1996). Culture and Nursing Care: A Pocket Guide.
San Francisco: UCSF Nursing Press.

Purnell, L. D. & Paulanka, B. J. (2005). Guide to


Culturally Competent Health Care. Philadelphia, PA:
F.A. Davis.

Many references available through AACN; visit


www.aacn.org > Marketplace > Online Bookstore.

More current version may be available.

PUBLISHER CONTACTS:
AACN – (800) 899-2226
American Heart Association – (800) 242-8721
Elsevier (including Mosby, W. B. Saunders, and Hanley & Belfus) – (800) 545-2522
Jones & Bartlett – (800) 832-0034
Lippincott Williams & Wilkins – (800) 638-3030
UCSF Nursing Press – (415) 476-4992

44
PCCN TEST PLAN

PCCN
I. CLINICAL JUDGMENT (80%) E. Neurology (5%)
A. Cardiovascular (36%) 1. Intracranial hemorrhage
1. Acute coronary syndromes 2. Seizure disorders
2. Acute inflammatory disease 3. Stroke
3. Cardiac surgery
4. Cardiac tamponade F. Gastrointestinal (5%)
5. Cardiogenic shock 1. GI hemorrhage
6. Cardiomyopathies 2. GI infections
7. Conduction defects 3. GI motility disorders
8. Dysrhythmias 4. Hepatic failure
9. Heart failure 5. Malnutrition
10. Hypertensive crisis 6. Pancreatitis
11. Peripheral vascular disease
12. Peripheral vascular surgery G. Renal (5%)
13. Pulmonary edema 1. Acute renal failure
14. Ruptured or dissecting aneurysm 2. Electrolyte imbalances
15. Structural heart defects 3. End-stage renal disease (ESRD)

B. Pulmonary (14%) H. Multisystem (5%)


1. Acute lung injury (ALI) 1. Infectious diseases
2. Aspirations 2. Shock states
3. Chronic ventilatory failure 3. Systemic inflammatory response syndrome
(SIRS)/sepsis/severe sepsis/septic shock/
4. Exacerbation of COPD MODS
5. Pneumothorax
6. Pulmonary embolism I. Behavioral (4%)
7. Pulmonary hypertension 1. Delirium and dementia
8. Respiratory infections 2. Mood disorders and depression
9. Severe asthma 3. Substance abuse
10. Sleep disordered breathing
11. Thoracic surgery II. PROFESSIONAL CARING AND ETHICAL PRACTICE
(20%)
C. Endocrine (4%) A. Advocacy/Moral Agency (3%)
1. Diabetic ketoacidosis B. Caring Practices (4%)
2. Hypoglycemia C. Collaboration (4%)
D. Systems Thinking (2%)
D. Hematology/Immunology (2%) E. Response to Diversity (2%)
1. Anemia F. Clinical Inquiry (2%)
2. Life-threatening coagulopathies G. Facilitation of Learning (3%)

45
PCCN EXAM TESTABLE NURSING ACTIONS

CARDIOVASCULAR PULMONARY
1. Perform a comprehensive cardiovascular 1. Perform a comprehensive pulmonary
assessment assessment
2. Identify, interpret and monitor: 2. Monitor normal and abnormal diagnostic test
• dysrhythmias results

• ST segments 3. Interpret ABGs and report findings

• QTc intervals 4. Monitor patient for response to pulmonary


medications
3. Select leads for cardiac monitoring for the
indicated disease process 5. Manage patients requiring the following non-
invasive 02 or ventilation delivery systems:
4. Recognize indications for and manage patients
requiring hemodynamic monitoring using: • nasal cannula

• an arterial line • face masks

• non-invasive hemodynamic monitoring • non-rebreather mask

5. Monitor hemodynamic status and recognize • BiPAP


signs and symptoms of hemodynamic • CPAP
instability 6. Manage patients requiring mechanical
6. Recognize indications for and monitor/manage ventilation via tracheostomy tube
patients requiring cardiovascular therapeutic 7. Manage patients requiring the following
intervention using: respiratory monitoring devices:
• cardioversion • continuous SPO2
• transcutaneous pacing • intermittent SPO2
• defibrillation 8. Recognize signs and symptoms of respiratory
7. Monitor normal and abnormal diagnostic test complications and seek assistance as needed
results 9. Maintain patient airway
8. Calculate dosages, administer cardiovascular 10. Manage patients with chest tubes
medications
11. Assist with the following procedures:
9. Titrate vasoactive medications
• thoracentesis
10. Recognize signs and symptoms of
cardiovascular emergencies, initiate • chest tube insertion
standardized interventions and seek 12. Administer medications for procedural
assistance as needed (conscious) sedation and monitor patient’s
11. Monitor patient and follow standardized response
protocols pre-, intra- and post-procedure 13. Monitor patient and follow standardized
12. Monitor and manage patients following protocols pre-, intra- and post-procedure
coronary intervention

continued

46
PCCN EXAM TESTABLE NURSING ACTIONS (CONTINUED)

PCCN
ENDOCRINE RENAL
1. Perform a comprehensive endocrine 1. Identify normal and abnormal renal assessment
assessment findings
2. Monitor normal and abnormal diagnostic test 2. Monitor normal and abnormal diagnostic test
results results
3. Administer medications, treatments or
interventions and monitor patient response MULTISYSTEM
4. Manage and titrate insulin infusions 1. Administer medications, treatments or
interventions and monitor patient response
HEMATOLOGY/IMMUNOLOGY 2. Recognize signs and symptoms of emergencies,
1. Perform a comprehensive initiate standardized interventions and seek
hematology/immunology assessment assistance as needed

2. Monitor normal and abnormal diagnostic test 3. Manage patients with complex wounds with
results fistulas, drains and vacuum-assisted closure
devices
3. Administer medications, treatments or
interventions and monitor patient response
BEHAVIORAL

NEUROLOGY 1. Perform a psychosocial assessment

1. Perform a comprehensive neurological 2. Administer medications, treatments or


assessment interventions and monitor patient response

2. Monitor normal and abnormal neurological 3. Recognize signs and symptoms of behavioral
diagnostic test results emergencies and initiate interventions

3. Administer medications, treatments or


interventions and monitor patient response

GASTROINTESTINAL
1. Perform a comprehensive gastrointestinal
assessment
2. Monitor normal and abnormal gastrointestinal
diagnostic test results
3. Recognize indications for and complications of
enteral and parenteral nutrition

47
NURSING ACTIONS EXCLUDED FROM PCCN EXAM

CARDIOVASCULAR ENDOCRINE
1. Recognize indications for and manage patients Manage patients using insulin pumps
requiring hemodynamic monitoring using:
• an arterial line NEUROLOGY
• CVP monitoring 1. Manage patients requiring:
2. Recognize indications for and manage patients • lumbar drains
requiring hemodynamic monitoring using CVP
monitoring • ventriculostomy

3. Recognize indications for and monitor/manage • neurological monitoring devices and drains
patients requiring cardiovascular therapeutic for intracranial pressure
intervention using: 2. Recognize signs and symptoms of increased
• transvenous pacing intracranial pressure

• epicardial pacing
GASTROINTESTINAL
• arterial sheath removal
Perform intra-abdominal hypertension monitoring
• venous sheath removal
• ventricular assist devices
RENAL
4. Manage continuous veno-venous
hemofiltration for heart failure Assist with:
• hemodialysis
PULMONARY • peritoneal dialysis
1. Manage patients requiring mechanical • continuous renal replacement therapy (CRRT)
ventilation via endotracheal tube
2. Manage patients requiring an ETCO2 MULTISYSTEM
respiratory monitoring device
Manage patients with intraosseous devices
3. Removal of:
• pleural chest tubes
• mediastinal tubes
4. Manage patients requiring:
• ventilator weaning
• extubation or decannulation
5. Assist with the following procedures:
• bronchoscopy
• intubation

48
SAMPLE PCCN EXAM QUESTIONS

PCCN
1. A patient who is 1 week post MI suddenly 5. Members of the nursing staff are developing
becomes agitated, restless and diaphoretic. written patient education materials for a group of
Pulse pressure drops to 20 mm Hg. Assessment patients with diverse reading abilities. It would be
also reveals faint radial and apical pulses that most effective for the staff to
weaken significantly on inspiration. This patient A. design individual handouts for each patient.
is most likely experiencing
B. develop a computer-based education series.
A. mitral valve rupture.
C. write the materials at a fourth-grade reading
B. pulmonary embolus.
level.
C. pulmonary edema.
D. limit text and provide color pictures.
D. cardiac tamponade.

6. Two days post admission for rapid atrial


2. Which of the following may predispose an fibrillation, a patient has been weaned from IV
individual to ventricular fibrillation? diltiazem (Cardizem) to PO administration. The
A. hypernatremia and hypomagnesemia patient develops new onset of hallucinations,
agitation and disorientation. The most appropriate
B. hypophosphatemia and hyperchloremia initial nursing action is to
C. hypermagnesemia and hyponatremia A. obtain an order for lorazepam (Ativan) every six
D. hyperkalemia and hypocalcemia hours.
B. assess the patient’s SpO2 and neurological
3. Chest auscultation of a patient in status status
asthmaticus commonly reveals C. obtain an order for haloperidol (Haldol) and
A. expiratory wheezes. monitor QT intervals.

B. inspiratory crackles. D. consult with the pharmacy regarding possible


drug interaction.
C. diminished bilateral breath sounds.
D. a pleural friction rub.
7. Which of the following electrolyte abnormalities
should the nurse anticipate in a patient with
4. The family of a critically ill patient wishes to spend chronic alcoholism?
the night, which is contrary to visiting policy. The A. hypomagnesemia
nurse’s best action would be to
B. hyperphosphatemia
A. adhere to the visiting policy.
C. hyponatremia
B. allow the family to stay in the room.
D. hyperkalemia
C. obtain a motel room near the hospital where
the family may spend the night.
D. allow one or two family members to stay, then
evaluate the patient’s response.
Answers
1. D
2. D
3. A
4. D
5. C
6. B
7. A

49
50
3 of 3

PCCN CERTIFICATION APPLICATION HONOR STATEMENT


Online exam registration is available at www.certcorp.org; click Apply Online.

Complete and submit with 2-page application at back of handbook.

Name: _____________________________________________________ AACN #: ___________________


LAST FIRST MIDDLE

Verification Information - List contact information for a professional associate (colleague or supervisor) who
can verify that you have met the clinical hour eligibility requirements:
ASSOCIATE’S NAME:

FACILITY ADDRESS:

City State ZIP

ASSOCIATE’S PHONE NUMBER: and/or E-MAIL ADDRESS:

Honor Statement
I have fulfilled the clinical practice hour requirements of 1,750 hours of direct bedside care of acutely ill Adult patients within the
previous 2-year period, with 875 hours accrued in the most recent year preceding this application. Or if renewing by exam, I have
completed 432 hours of direct bedside care of acutely ill Adult patients within the 3-year certification period, with 144 hours accrued in
the most recent year preceding my scheduled renewal date.

I possess a current unencumbered U.S. license to practice as an RN or APRN. An unencumbered license is not currently subject to
formal discipline by any Board of Nursing and has no provisions or conditions that limit the nurse’s practice in any way. I agree to
notify AACN Certification Corporation if any disciplinary action is taken against my RN or APRN license in the future.

I hereby apply for PCCN certification offered by AACN Certification Corporation. I understand that certification depends upon the
successful completion of the specified requirements. I further understand that the information acquired in the certification process may
be used for statistical purposes and for evaluation of the certification program.

To the best of my knowledge, the information contained in the application is true, complete, correct and is made in good faith. I
understand that information supplied is subject to audit and failure to respond to a request for further information may be sufficient
cause for AACN Certification Corporation to bar me from the exam, to invalidate the results of my exam, to withhold certification, to
revoke certification or to take other appropriate action.

My signature on this form indicates my agreement to keep the contents of the exam confidential and not discuss the specific exam
content with anyone except AACN Certification Corporation. By complying with and enforcing this obligation, I help maintain the integrity
of the AACN Certification Program and the value of its certification credentials.

Applicant’s Signature: Printed Name: Date:

This form may be photocopied and is also available online at www.certcorp.org. OCTOBER 2009 51
52
CMC
CMC CERTIFICATION

CMC® (Cardiac Medicine Certification) is a nursing subspecialty designed for specialty certified nurses who provide
care for acutely and/or critically ill cardiac patients, regardless of the geographic location of their nursing care.
Specialty nurses interested in this subspecialty certification may work in such areas as: cardiac care units;
combined ICU/CCUs; medical ICUs; telemetry units; progressive care units; heart failure clinics; home care;
interventional cardiology; cardiac catheterization laboratories; or electrophysiology units.

CMC Certification Program ............................................................................................................................................54


CMC Exam Eligibility.......................................................................................................................................................54
CMC Online Registration................................................................................................................................................55
CMC Application Fees ....................................................................................................................................................55
CMC Certification Renewal ............................................................................................................................................56
CMC Test Plan ...........................................................................................................................................................57-58
CMC Study Bibliography.................................................................................................................................................59
CMC Sample Exam Questions .......................................................................................................................................61
CMC Exam Honor Statement (3rd page of 3-page application)..................................................................................63
AACN Products for CMC Exam Preparation ..................................................................................................................65
Certification Exam Application (1st and 2nd pages of 3-page application) .........................................................79-80

53
CMC CERTIFICATION PROGRAM

CMC® Registered Service Mark component exclusively. The CMC certification exam is
based on these skills and abilities and the knowledge
CMC is a registered service mark of AACN Certification
required to perform them.
Corporation and denotes certification in cardiac
medicine nursing as granted by AACN Certification
CMC certification is achieved by those acute and
Corporation. Registered nurses who have not achieved
critical care nurses who pass the CMC exam in cardiac
CMC certification status, whose CMC status has
medicine. CMC certification denotes to the public
lapsed, or whose clinical nursing specialty certification
those practitioners who possess a distinct and clearly
has lapsed or is inactive are not authorized to use the
defined body of knowledge called cardiac medicine
CMC credential.
nursing.
Validated Knowledge and Specialized CMC Exam Content
Skills
The CMC exam is a two-hour test consisting of 90
Each CMC certification exam is based on a job multiple-choice items. Of the 90 items, 75 are scored
analysis. The most recent study, completed in 2003, and 15 are used to gather statistical data on item
defines the dimensions of acute and critical care performance for future exams. Please see the test
practice, identifying what is required of registered plan for more information. The CMC exam focuses on
nurses practicing in acute and critical care settings adult patient populations. One hundred percent
and caring for cardiac patients. (100%) of the exam focuses on clinical judgment.
In the study, acute and critical care nurses across the
United States were surveyed to ascertain the
CMC Test Plan
frequency and significance of the various elements of The content of the CMC exam is described in the test
their practice. Through an extensive review and plan. Candidates are tested on a variety of patient care
evaluation process, the knowledge, skills and abilities problems that are organized under major categories.
crucial to cardiac nursing were defined using the Please note the percentage of the CMC exam devoted
Synergy Model for Patient Care as an organizing to each category.
framework focusing on the clinical judgment

CMC EXAM ELIGIBILITY

• Current unencumbered RN or APRN licensure in the year preceding application. Of those 1,750 hours,
United States is required. 875 need to be in the care of acutely/critically ill
cardiac patients.
An unencumbered license is not currently subject to
formal discipline by any Board of Nursing and has no Clinical practice hours for the CMC exam or renewal
provisions or conditions that limit the nurse’s eligibility must take place in a U.S.-based or Canada-
practice in any way. based facility or in a facility determined to be
comparable to the U.S. standard of acute/critical
It is the responsibility of candidates and certified care nursing practice, as evidenced by ANCC Magnet
nurses to notify AACN Certification Corporation when Status or Joint Commission International
any restriction is placed on their RN or APRN license. accreditation.
If you are randomly selected for audit, you will be
asked to provide a copy of your RN or APRN license • A current, nationally accredited NCCA (National
– please do not submit with your application. Commission for Certifying Agencies) or ABNS
(American Board of Nursing Specialties) clinical
• Practice as an RN or APRN is required with 1,750 nursing specialty certification, to which your
hours in direct bedside care of acutely and/or subspecialty certification will be attached, is
critically ill patients during the previous two years, required. A clinical nursing specialty certification
with 875 of those hours accrued in the most recent refers to a specialty certification that involves direct

54
CMC
care of the patient, such as CCRN, PCCN, CCNS, clinical practice hours. If you are randomly selected
ACNPC, FNP, CEN, CRNFA, APRN,BC, etc. for audit, this associate will be asked to verify in
writing that you have met the clinical hour
• Nurses serving as manager, educator (in-service or requirements. A professional associate is defined as
academic), APRN or preceptor may apply their hours a clinical supervisor (RN or physician), or RN
spent supervising nursing students or nurses at the colleague with whom you work.
bedside. Nurses in these roles must be actively
involved in caring for patients at the bedside; for • AACN Certification Corporation may adopt additional
example, demonstrating how to measure pulmonary eligibility requirements at its sole discretion from
artery pressures or supervising a new employee or time to time. Any such requirements will be
student nurse performing a procedure. designed to establish, for the purposes of CMC
certification, the adequacy of a candidate's
• The name and address of a professional associate knowledge and experience in caring for the acutely
must be given for verification of eligibility related to and/or critically ill.

CMC ONLINE REGISTRATION

Online registration is available for the CMC exam. This paperless registration streamlines the exam application
process by up to six weeks. Once you register online your 90-day window for testing will begin within one to two
weeks. Candidates should be prepared to sit for the exam before registering online. For more information and
to register visit www.certcorp.org.

CMC APPLICATION FEES

Computer-Based CMC Exam

AACN Members $135

Nonmembers $180

CMC Retest Fee

AACN Members $110

Nonmembers $155

Current CMC Renewal by Exam

AACN Members $110

Nonmembers $155

Payable in U.S. funds. Fees are subject to change without notice. A $15 fee will be charged for a returned check.

55
CMC CERTIFICATION RENEWAL

CMC certification is conferred for a period of three Candidates for CMC renewal must meet the following
years. Your certification period begins the first day of requirements:
the month in which the CMC certification exam is
passed and ends three years later; for example, • Current unencumbered RN or APRN license in the
October 1, 2009 through September 30, 2012. The United States
purpose of certification renewal is to enhance
continued competence. An unencumbered license has not been subjected
to formal discipline by any Board of Nursing and
You may seek CMC certification renewal via Renewal has no provisions or conditions that limit the
by CERPs or Renewal by Exam. Do not apply for more nurse’s practice in any way.
than one option. For Renewal by Exam, you must • Current clinical nursing specialty certification
successfully apply for, schedule, and complete the accredited by the NCCA (National Commission for
CMC exam before your scheduled renewal date. You Certifying Agencies) or the ABNS (American Board
may not take the exam early and then attempt to of Nursing Specialties)
renew by CERPs if you do not pass.
• Completion of 432 clinical practice hours caring for
A renewal notification will be mailed to you acutely/critically ill cardiac patients within the
approximately 90 days before your CMC expiration three-year period preceding the scheduled renewal
date. You are responsible for renewing your date, with 144 of those hours accrued in the most
certification even if you do not receive a renewal recent year preceding renewal date
notification. Visit www.certcorp.org to download a
copy of the CMC/CSC Renewal Handbook. Online • Completion of twenty-five (25) Category A Clinical
Renewal by CERPs is available to all active CMCs as Judgment CERPs pertaining to cardiology (includes
early as four months prior to their renewal date. Visit all items on the CMC test plan) during the three-
www.certcorp.org - click Renew Your Certification. year certification renewal period OR successful
completion of the CMC exam

56
CARDIAC MEDICINE CERTIFICATION (CMC) TEST PLAN

CMC
I. CARDIOLOGY PATIENT PROBLEMS (43%) II. OTHER PATIENT PROBLEMS (16%)
A. Acute Coronary Syndrome (8%) A. Pulmonary (7%)
1. Unstable angina 1. Acute pulmonary embolus
2. ST segment elevation myocardial infarction 2. Acute respiratory distress syndrome (ARDS)
3. Non-ST segment elevation myocardial 3. Acute respiratory failure
infarction 4. Cor pulmonale
5. Inatrogenic problems related to line insertion
B. Dysrhythmias (11%) and ventilator management (e.g., air-leak
1. Malignant ventricular dysrhythmias syndromes including pneumothorax,
pneumopericardium, pneumomediastinum,
2. Dysrhythmias ventilator-associated pneumonia, volutrauma,
a. bradydysrhythmias and barotraumas)
b. tachydysrhythmias
c. conduction defects and blocks B. Endocrine (3%)
Diabetes mellitus
C. Other Cardiology Issues (24%)
1. Papillary muscle rupture C. Hematology (1%)
2. Ventricular septal rupture Life-threatening coagulopathies (e.g., heparin-
3. Ventricular aneurysm induced thrombocytopenia, platelet inhibitors,
anticoagulants)
4. Heart failure
a. acute exacerbation
D. Neurology (1%)
b. chronic
Stroke (e.g., ischemic, hemorrhagic)
5. Pulmonary edema
6. Cardiomyopathy (e.g., hypertrophic, dilated,
E. Renal (4%)
restrictive)
1. Acute renal failure (may be related to cardiac
7. Valvular heart disease
failure)
8. Cardiac tamponade
2. Electrolyte imbalances (e.g., potassium,
9. Blunt cardiac trauma sodium, phosphorus, magnesium, calcium;
10. Cardiogenic shock may include imbalances not caused by renal
problems)
11. Acute inflammatory disease (e.g., myocarditis,
endocarditis, pericarditis)
12. Acute peripheral vascular insufficiency III. NURSING INTERVENTIONS (21%)
a. acute arterial occlusion A. Cardiology Interventions (16%)
b. carotid artery stenosis 1. Percutaneous coronary interventions (e.g.,
PTCA, stents, lasers)
c. venous thrombosis
2. Cardiac surgery, except immediate
13. Sudden cardiac death
postoperative care (e.g., valve repair, valve
14. Hypertension replacement, CABG, aneurysm)
15. Pulmonary hypertension 3. Cardiovascular pharmacology
a. primary 4. Assist devices - intraaortic balloon pump
b. secondary (e.g., valvular disease, COPD, acute
hypoxemia defects, congenital defects)
Continued
16. Congenital heart disease in adults
57
CARDIAC MEDICINE CERTIFICATION (CMC) TEST PLAN (CONTINUED)

5. Dysrhythmia interventions
a. pacemakers
b. ICDs (e.g., defibrillation)
c. ablation
6. CPAP/BiPAP (e.g., heart failure, sleep apnea)

B. Pulmonary Interventions (5%)


1. Pulmonary pharmacology
2. Ventilators

IV. MONITORING (20%)


A. Cardiology Monitoring (15%)
1. Invasive hemodynamic monitoring (e.g.,
pulmonary artery catheter)
2. ECG monitoring
a. dysrhythmia
b. ischemia
3. Blood studies (e.g., BNP, cardiac biomarkers,
coagulation studies, chemistries)

B. Pulmonary Monitoring (5%)


1. ABGs
2. Mixed venous gases
3. Oxygen saturation

58
CARDIAC MEDICINE CERTIFICATION (CMC) STUDY BIBLIOGRAPHY
RECOMMENDED REFERENCES FOR THE CMC EXAM

CMC
American Heart Association. (2005). Guidelines 2005 Morton, P. G., Fontaine, D., Hudak C. M. & Gallo, B. M.
for Cardiopulmonary Resuscitation and Emergency (2005). Critical Care Nursing: A Holistic Approach. 8th
Cardiovascular Care. Available at: www.americanheart.org ed. Philadelphia: Lippincott Williams & Wilkins.
/presenter.jhtml?identifier=3035517
Moser, D. K. & Riegel, B. (2001). Improving Outcomes
Apple, S. & Lindsay, J. (2000). Principles and Practice of in Heart Failure: An Interdisciplinary Approach.
Interventional Cardiology. Baltimore: Lippincott Gaithersburg, MD: Aspen Publishers.
Williams & Wilkins.
Pagana, K. D. & Pagana, T. J. (2008). Mosby’s
Aschenbrenner, D. S., Cleveland, L. W. & Venable, S. J. Diagnostic and Laboratory Test Reference. 9th ed. St.
(2002). Drug Therapy in Nursing. Philadelphia: Louis, Mo: Mosby/Elsevier.
Lippincott Williams & Wilkins.
Schell, H. M. & Puntillo, K. A. (2006). Critical Care
Aschenbrenner, D. S., Cleveland, L. W. & Venable, S. J. Nursing Secrets, 2nd ed. Hanley & Belfus.
(2002). Study Guide to Accompany Drug Therapy in
Nursing. Philadelphia: Lippincott Williams & Wilkins. Skidmore-Roth, L. (2008). Mosby’s 2009 Nursing Drug
Reference. 22nd ed. St. Louis, Mo: Mosby/Elsevier.
Conover, M. B. (2003). Understanding Electrocardiography.
8th ed. St. Louis, Mo: Mosby/Elsevier. Smeltzer, S., Bare, B.G., Hinkle J.L. & Cheever, K.H.
(2008). Brunner and Suddarth’s Textbook of Medical-
Copstead, L. & Banasik, J. L. (2000). Pathophysiology: Surgical Nursing. 11th ed. Philadelphia: Lippincott
Biological and Behavioral Perspectives. 2nd ed. Williams & Wilkins.
Philadelphia: W. B. Saunders/Elsevier.
Sole, M. L., Klein, D. G. & Moseley, M. (2008).
Critical Care Challenges: Disorders, Treatments, and Introduction to Critical Care Nursing. 5th ed.
Procedures. (2003). Philadelphia: Lippincott Williams & Philadelphia: W. B. Saunders.
Wilkins.
Urden, L., Lough, M. E. & Stacy, K. L. (2005). Thelan’s
Darovic, G. O. (2004). Handbook of Hemodynamic Critical Care Nursing: Diagnosis and Management. 5th
Monitoring. 2nd ed. St. Louis, Mo: W. B. ed. St. Louis, Mo: Mosby/Elsevier.
Saunders/Elsevier.
Wiegand, D. J. L. & Carlson, K. K. (eds.) (2005). AACN
Darovic, G. O. (2002). Hemodynamic Monitoring: Procedure Manual for Critical Care. 5th ed.
Invasive and Noninvasive Clinical Application, 3rd ed. Philadelphia: Elsevier.
Philadelphia: W. B. Saunders/Elsevier.
Woods, S., Sivarajan Froelicher, E. S. & Motzer, S. U.
Davis, L. (2004). Cardiovascular Nursing Secrets. St. (2004). Cardiac Nursing. 5th ed. Philadelphia:
Louis, Mo: Mosby/Elsevier. Lippincott Williams & Wilkins.

Diepenbrock, N. H. (2004). Quick Reference to Critical Many references available through AACN; visit
www.aacn.org > Marketplace > Online Bookstore.
Care, 2nd ed. Philadelphia: Lippincott Williams & Wilkins. More current version may be available.

Finkelmeier, B. A. (2000). Cardiothoracic Surgical Nursing. PUBLISHER CONTACTS:


AACN – (800) 899-2226
2nd ed. Philadelphia: Lippincott Williams & Wilkins.
American Heart Association – (800) 242-8721
Aspen Publishers – (800) 638-8437
Hickey, J. V. (2008).The Clinical Practice of Neurological Blackwell Publishing – (800) 216-2522
and Neurosurgical Nursing. 6th ed. Philadelphia: Elsevier (including Mosby, W. B. Saunders, and Hanley & Belfus)
– (800) 545-2522
Lippincott Williams & Wilkins. Lippincott Williams & Wilkins – (800) 638-3030

59
60
CARDIAC MEDICINE CERTIFICATION (CMC) SAMPLE QUESTIONS

CMC
1. In a patient admitted with an acute MI with 3. Administration of furosemide (Lasix) in a patient
percutaneous coronary intervention 2 days ago, with acute tubular necrosis (ATN) caused by
which of the following should the nurse expect to aminoglycosides will
be ordered at discharge? A. improve the patient's renal status.
A. clopidogrel (Plavix), metoprolol (Lopressor), and B. increase drug toxicity.
ASA
C. increase blood flow to kidneys and reverse
B. enalapril (Vasotec), NTG SL, and metoprolol tubular damage.
(Lopressor)
D. improve therapeutic drug levels.
C. low-molecular-weight heparin, ASA, and statin
D. calcium channel-blocker, ASA, and NTG SL

2. One week after an ST segment elevation MI, a


patient develops a holosystolic murmur and thrill.
BP is 80/50, PAP 70/40, CVP 30, PCWP 35, and
CO 1.2. The most likely cause of these symptoms
is
A. pulmonary embolus.
B. ventricular septal defect.
C. cardiac wall rupture.
D. ventricular aneurysm.

Answers
1. A
2. B
3. B

61
62
3 of 3

CMC CERTIFICATION APPLICATION HONOR STATEMENT


Online exam registration is available at www.certcorp.org; click Apply Online.

Complete and submit with 2-page application at back of handbook.

Name: _____________________________________________________ AACN #: ___________________


LAST FIRST MIDDLE

Verification Information - List contact information for a professional associate (colleague or supervisor) who
can verify that you have met the clinical hour eligibility requirements:
ASSOCIATE’S NAME:

FACILITY ADDRESS:

City State ZIP

ASSOCIATE’S PHONE NUMBER: and/or E-MAIL ADDRESS:

Clinical Nursing Specialty Certification


To what nationally accredited clinical nursing specialty certification would you like to tie your CMC certification? (check ONE box only)
CCRN PCCN CCNS ACNPC Other ___________________________
(Attach proof of non-AACN certification, such as copy of wallet card or wall certificate, or verification letter from certifying
organization; must be valid for 90 days beyond CMC application date.)

Honor Statement
I have fulfilled the clinical practice hour requirements of 1,750 hours of direct bedside care of acutely and/or critically ill Adult patients
within the previous 2-year period, with 875 hours accrued in the most recent year preceding this application; of those 1,750 hours, 875
were in the care of acutely and/or critically ill adult cardiac patients. Or if renewing by exam I have completed 432 hours of direct
bedside care of acutely and/or critically ill Adult cardiac patients during the 3-year certification period, with 144 of those hours accrued
in the 12-month period prior to my scheduled renewal date.

I hold a current nationally accredited (NCCA and/or ABNS) clinical nursing specialty certification; and possess a current unencumbered
U.S. license to practice as an RN or APRN. An unencumbered license is not currently subject to formal discipline by any Board of
Nursing and has no provisions or conditions that limit the nurse’s practice in any way. I agree to notify AACN Certification Corporation if
any disciplinary action is taken against my RN or APRN license in the future. If my clinical nursing specialty certification is conferred
by an organization other than AACN Certification Corporation, I agree to submit proof of my certification with this application. I
agree to notify AACN Certification Corporation if my clinical nursing specialty certification lapses.

I hereby apply for CMC subspecialty certification offered by AACN Certification Corporation. I understand that certification depends upon
the successful completion of the specified requirements. I further understand that the information acquired in the certification process
may be used for statistical purposes and for evaluation of the certification program.

To the best of my knowledge, the information contained in the application is true, complete, correct and is made in good faith. I
understand that information supplied is subject to audit and failure to respond to a request for further information may be sufficient
cause for AACN Certification Corporation to bar me from the exam, to invalidate the results of my exam, to withhold certification, to
revoke certification or to take other appropriate action, including revocation of or disciplinary action related to my clinical nursing
specialty certification.

My signature on this form indicates my agreement to keep the contents of the exam confidential and not discuss the specific exam
content with anyone except AACN Certification Corporation. By complying with and enforcing this obligation, I help maintain the integrity
of the AACN Certification Program and the value of its certification credentials.

Applicant’s Signature: Printed Name: Date:

This form may be photocopied and is also available online at www.certcorp.org. OCTOBER 2009 63
64
AACN PRODUCTS FOR CMC AND CSC EXAM PREPARATION

CMC Item #

AACN Procedure Manual for Critical Care, 5th ed. (2005). Lynn-McHale, D. & Carlson, K. 1,280 pages. 128150
Critical Care Nursing Secrets. 2nd ed. (2006). Schell H.M. & Puntillo K.. A. 838 pages. 128636
Cardiac Nursing, 5th ed. (2004). Woods, S., Sivarajan Froelicher E. S. & Motzer S. U. 1,056 pages. 100151
Cardiac Nursing: A Companion to Braunwald’s Heart Disease. (2007). Moser D. & Reigel, B. 1,440 pages. 100253
CMC Review Course on CD-ROM. (2007). Includes CD-ROM, booklet & 12 hours of CE credit. 300917
CMC Review Course on DVD. (2007). Includes DVD, booklet & 12 hours of CE credit. 300916
CMC Review Course Package on CD-ROM. Includes CMC Review Course on CD-ROM, Cardiovascular Nursing Practice:
300922
A Comprehensive Resource Guide and Study Guide for Clinical Nurses and Cardiovascular Review Questions on CD-ROM.
CMC Review Course Package on DVD. Includes CMC Review Course on DVD, Cardiovascular Nursing Practice: A
300923
Comprehensive Resource Guide and Study Guide for Clinical Nurses and Cardiovascular Review Questions on CD-ROM.

CSC Item #
Cardiac Surgery Essentials for Critical Care Nursing. (2009). Hardin, S. & Kaplow R. Jones & Bartlett. 462 pages. 100257
The Johns Hopkins Manual of Cardiac Surgical Care, 2nd ed. (2007). Conte J., Owens S. & Dorman T. 512 pages. 100255
CSC Review Course on CD-ROM. (2008). Includes 7 CDs, syllabus & 12 hours of CE credit. 300910
CSC Review Course on DVD. (2008). Includes 3 DVDs, syllabus & 12 hours of CE credit. 300911
CSC Review Course on Audio CD. (2008). Includes 8 CDs, syllabus & 12 hours of CE credit. 300912
CSC Review Course Package on CD-ROM. Includes CSC Review Course on CD-ROM and Cardiac Surgery Essentials for
300924
Critical Care Nursing.
CSC Review Course Package on DVD. Includes CSC Review Course on DVD and Cardiac Surgery Essentials for Critical
300925
Care Nursing.

Applicable for both CMC and CSC Item #


Cardiovascular Nursing Practice: A Comprehensive Resource Guide and Study Guide for Clinical Nurses. (2007).
100256
Jacobson C., Marlin, K. & Werner, C. 916 pages.
Cardiovascular Nursing Secrets. (2004). Davis, L. 544 pages. 100152
Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application, 3rd ed. (2002). Darovic, G. O. 676 pages. 128639
Mosby’s Diagnostic and Laboratory Tests, 3rd ed. (2005). Pagana K. & Pagana T. 1,280 pages. 128160
Combined CMC/CSC Review Course on CD-ROM . Includes CD-ROMs and 24 contact hours of CE credit. 300920
Combined CMC/CSC Review Course on DVD . Includes DVDs and 24 contact hours of CE credit. 300921

For more details and to place an order, visit our Web site at www.aacn.org and click on Marketplace,
or call AACN Customer Care at (800) 899-2226, between 7:30 a.m. and 4:30 p.m., Pacific Time.

OFCRHB OCTOBER 2009 65


OCTOBER 2009
66
CSC
CSC CERTIFICATION

CSC® (Cardiac Surgery Certification) is a nursing subspecialty designed for specialty certified nurses who provide
care for acutely and/or critically ill cardiac surgery patients within the first 48 hours postoperatively. Specialty
nurses interested in this subspecialty certification may work in areas such as: cardiothoracic surgery;
cardiovascular surgery; or post-anesthesia care units.

CSC Certification Program .............................................................................................................................................68


CSC Exam Eligibility........................................................................................................................................................68
CSC Online Registration.................................................................................................................................................69
CSC Application Fees .....................................................................................................................................................69
CSC Certification Renewal .............................................................................................................................................70
CSC Test Plan..................................................................................................................................................................71
CSC Study Bibliography..................................................................................................................................................72
CSC Sample Exam Questions........................................................................................................................................73
AACN Products for CSC Exam Preparation ...................................................................................................................65
CSC Exam Honor Statement (3rd page of 3-page application)...................................................................................75
Certification Exam Application (1st and 2nd pages of 3-page application) .........................................................79-80

67
CSC CERTIFICATION PROGRAM

CSC® Registered Service Mark based on these skills and abilities and the knowledge
required to perform them.
CSC is a trademark of AACN Certification Corporation
and denotes certification in cardiac surgery as granted
CSC certification is achieved by those acute and
by AACN Certification Corporation. Registered nurses
critical care nurses who pass the CSC exam in cardiac
who have not achieved CSC certification status, whose
surgery. CSC certification denotes to the public those
CSC status has lapsed, or whose clinical nursing
practitioners who possess a distinct and clearly
specialty certification has lapsed or is inactive are not
defined body of knowledge called cardiac surgery
authorized to use the CSC credential.
nursing.
Validated Knowledge and Specialized CSC Exam Content
Skills
The CSC exam is a 2-hour test consisting of 90
The CSC certification exam is based on a job analysis. multiple-choice items. Of the 90 items, 75 are scored
The most recent study, completed in 2003, defines the and 15 are used to gather statistical data on item
dimensions of acute and critical care practice, performance for future exams. Please see the test
identifying what is required of registered nurses plan for more information. The CSC exam focuses on
practicing in acute and critical care settings and caring adult populations. One hundred percent (100%) of the
for cardiac surgery patients. exam focuses on clinical judgment.
In the study, acute and critical care nurses across the
United States were surveyed to ascertain the
CSC Test Plan
frequency and significance of the various elements of The content of the CSC exam is described in the test
their practice. Through an extensive review and plan. Candidates are tested on a variety of patient care
evaluation process, the knowledge, skills and abilities problems that are organized under major categories.
crucial to cardiac nursing were defined using the Please note the percentage of the CSC exam devoted
Synergy Model for Patient Care as an organizing to each category.
framework focusing on the clinical judgment
component exclusively. The CSC certification exam is

CSC EXAM ELIGIBILITY

• Current unencumbered RN or APRN licensure in the 875 need to be in the care of cardiac surgery
United States is required. patients within the first 48 hours postoperatively.

An unencumbered license is not currently subject to Clinical practice hours for the CSC exam or renewal
formal discipline by any Board of Nursing and has no eligibility must take place in a U.S.-based or
provisions or conditions that limit the nurse’s Canada-based facility or in a facility determined to
practice in any way. be comparable to the U.S. standard of acute/critical
care nursing practice, as evidenced by ANCC
It is the responsibility of candidates and certified Magnet Status or Joint Commission International
nurses to notify AACN Certification Corporation when accreditation.
any restriction is placed on their RN or APRN license.
If you are randomly selected for audit, you will be • Nurses serving as manager, educator (in-service or
asked to provide a copy of your RN or APRN license academic), APRN or preceptor may apply their hours
– please do not submit with your application. spent supervising nursing students or nurses at the
bedside. Nurses in these roles must be actively
• Practice as an RN or APRN is required for 1,750 involved in caring for patients at the bedside; for
hours in direct bedside care of acutely and/or example, demonstrating how to measure pulmonary
critically ill patients during the previous two years, artery pressures or supervising a new employee or
with 875 of those hours accrued in the most recent student nurse performing a procedure.
year preceding application. Of those 1,750 hours

68
• A current, nationally accredited NCCA (National for audit, this associate will be asked to verify in

CSC
Commission for Certifying Agencies) or ABNS writing that you have met the clinical hour
(American Board of Nursing Specialties) clinical requirements. A professional associate is defined as
nursing specialty certification, to which your a clinical supervisor (RN or physician) or RN
subspecialty certification will be attached, is colleague with whom you work.
required. A clinical nursing specialty certification
refers to a specialty certification that involves direct • AACN Certification Corporation may adopt additional
care of the patient, such as CCRN, PCCN, CCNS, eligibility requirements at its sole discretion from
ACNPC, FNP, CNOR, CRNFA, APRN,BC, etc. time to time. Any such requirements will be
designed to establish, for the purposes of CSC
• The name and address of a professional associate certification, the adequacy of a candidate's
must be given for verification of eligibility related to knowledge and experience in caring for the acutely
clinical practice hours. If you are randomly selected and/or critically ill.

CSC ONLINE REGISTRATION

Online registration is available for the CSC exam. This paperless registration streamlines the exam application
process by up to six weeks. Once you register online your 90-day window for testing will begin within one to two
weeks. Candidates should be prepared to sit for the exam before registering online. For more information and
to register visit www.certcorp.org.

CSC APPLICATION FEES

Computer-Based CSC Exam

AACN Members $135

Nonmembers $180

CSC Retest Fee

AACN Members $110

Nonmembers $155

Current CSC Renewal by Exam

AACN Members $110

Nonmembers $155

Payable in U.S. funds. Fees are subject to change without notice. A $15 fee will be charged for a returned check.

69
CSC CERTIFICATION RENEWAL

CSC certification is conferred for a period of three • Current unencumbered RN or APRN license in the
years. Your certification period begins the first day of United States
the month in which the CSC certification exam is
passed and ends three years later; for example, An unencumbered license has not been subjected
October 1, 2009 through September 30, 2012. The to formal discipline by any Board of Nursing and
purpose of certification renewal is to enhance has no provisions or conditions that limit the
continued competence. nurse’s practice in any way.

• Current clinical nursing specialty certification


You may seek CSC certification renewal via Renewal by accredited by the NCCA (National Commission for
CERPs or Renewal by Exam. Do not apply for more Certifying Agencies) or the ABNS (American Board
than one option. For Renewal by Exam, you must of Nursing Specialties)
successfully apply for, schedule and complete the CSC
exam before your scheduled renewal date. You may • Completion of 432 clinical practice hours with
not take the exam early and then attempt to renew by postoperative cardiac patients within the three-
CERPs if you do not pass. year period preceding scheduled renewal date,
with 144 of those hours accrued in the 12-month
A renewal notification will be mailed to you period preceding scheduled renewal date; all 432
approximately 90 days before your CSC expiration clinical hours for renewal must be in the care of
date. You are responsible for renewing your cardiac surgery patients within the first 48 hours
certification even if you do not receive a renewal postoperatively
notification. Visit www.certcorp.org to download a
copy of the CMC/CSC Renewal Handbook. Online • Completion of twenty-five (25) Category A Clinical
Renewal by CERPs is available to all active CSCs as Judgment CERPs pertaining to cardiac surgery
early as four months prior to their renewal date. Visit (includes all items on the CSC test plan) during the
www.certcorp.org - click Renew Your Certification. three-year certification renewal period OR
successful completion of the CSC exam
Candidates for CSC renewal must meet the following
requirements:

70
CARDIAC SURGERY CERTIFICATION (CSC) TEST PLAN

I. PATIENT PROBLEMS (52%) C. Hematology (3%)

CSC
A. Cardiothoracic Surgery (32%) 1. Inflammatory response (e.g., hyperdynamic
1. Cardiac arrhythmias (e.g., postoperative atrial state without documented infection)
fibrillation) 2. Anaphylaxis (e.g., protamine reaction)
2. Patients who have had cardiopulmonary
bypass D. Neurology/Gastrointestinal (7%)
3. Complications of cardiac surgery 1. Encephalopathy (e.g., hypoxic-ischemic,
a. tamponade metabolic)

b. postoperative bleeding 2. Postoperative impaired cognition

c. coagulopathy (e.g., DIC, HITTS, ReoPro- 3. Stroke (e.g., embolic, hemorrhagic)


induced, heparin rebound) 4. Post-pump hepatic failure
d. open chest wound from the operating
room E. Renal (5%)
4. Abnormal pulsus paradoxus 1. Acute renal failure/insufficiency/azotemia
5. Myocardial stunning/hibernation 2. Life-threatening electrolyte imbalances (e.g.,
6. Patients who have had surgery of the thoracic potassium, sodium, phosphorus, magnesium,
aorta calcium; may include imbalances not caused
by renal problems; many imbalances caused by
7. Patients who have had surgical treatment of pump)
a. cardiac rhythm disorders (e.g., MAZE
procedure/modified MAZE)
II. NURSING INTERVENTIONS (48%)
b. coronary artery disease
A. Antidysrhythmics
8. Patients with off-pump coronary artery bypass
B. Vasodilators
(OPCAB)
C. Vasopressors
9. Patients who have had minimally invasive
cardiac surgery D. Fluid volume management specific to cardiac
surgery
10. Patients who have had heart valve surgery
involving E. Hemodynamic monitoring (e.g., standard
pulmonary artery catheter, SvO2 catheter,
a. surgical repair intermittent mixed-venous sample
b. surgical replacement interpretation)
11. Radial artery as an alternate arterial conduit F. Incision assessment and management
G. Pain management
B. Pulmonary (5%) H. Epicardial pacing
1. Acute respiratory failure related to phrenic I. Intraaortic balloon pump
nerve damage J. Mediastinal drainage (characteristics of
2. Air-leak syndromes (e.g., pneumopericardium, drainage and normal amounts)
pneumomediastinum) K. Emergent reopening of the chest
3. Pleural effusions L. Assist with internal defibrillation
4. Atelectasis (e.g., left lower lobe) M. Ventilator management/weaning/ABG
interpretation
N. Management of hyperglycemia and
hypoglycemia
O. Management of recovery from anesthesia

71
CARDIAC SURGERY CERTIFICATION (CSC) STUDY BIBLIOGRAPHY
RECOMMENDED REFERENCES FOR THE CSC EXAM

American Heart Association. (2005). Guidelines 2005 Finkelmeier, B. A. (2000). Cardiothoracic Surgical
for Cardiopulmonary Resuscitation and Emergency Nursing. 2nd ed. Philadelphia: Lippincott Williams &
Cardiovascular Care. Available at: Wilkins.
www.americanheart.org/presenter.jhtml?identifier=303
5517 Hickey, J. V. (2008).The Clinical Practice of
Neurological and Neurosurgical Nursing. 6th ed.
Aschenbrenner, D. S., Cleveland, L. W. & Venable, S. J. Philadelphia: Lippincott Williams & Wilkins.
(2002). Drug Therapy in Nursing. Philadelphia:
Lippincott Williams & Wilkins. Lemmer, J. H., Richenbacher, W. E. & Vlahakes, G. J.
(2003). Handbook of Patient Care in Cardiac Surgery.
Aschenbrenner, D. S., Cleveland, L. W. & Venable, S. J. Philadelphia: Lippincott Williams & Wilkins.
(2002). Study Guide to Accompany Drug Therapy in
Nursing. Philadelphia: Lippincott Williams & Wilkins. Pagana, K. D. & Pagana, T. J. (2008). Mosby’s
Diagnostic and Laboratory Test Reference. 9th ed.
Bojar, R. (2004). Manual of Perioperative Care in Adult St. Louis, Mo: Mosby/Elsevier.
Cardiac Surgery. 4th ed. Maulden: Blackwell Publishing.
Seifert, P. C. (2002). Cardiac Surgery: Perioperative
Copstead, L. & Banasik, J. L. (2000). Pathophysiology: Patient Care. St. Louis, Mo: Mosby/Elsevier.
Biological and Behavioral Perspectives. 2nd ed.
Philadelphia: W. B. Saunders/Elsevier. Skidmore-Roth, L. (2008). Mosby’s 2009 Nursing
Drug Reference. 22nd ed. St. Louis, Mo:
Darovic, G. O. (2004). Handbook of Hemodynamic Mosby/Elsevier.
Monitoring. 2nd ed. St. Louis, Mo: W. B.
Saunders/Elsevier. Smeltzer, S., Bare, B. G., Hinkle J. L. & Cheever, K. H.
(2008). Brunner and Suddarth’s Textbook of Medical-
Darovic, G. O. (2002). Hemodynamic Monitoring: Surgical Nursing. 11th ed. Philadelphia: Lippincott
Invasive and Noninvasive Clinical Application. 3rd ed. Williams & Wilkins.
Philadelphia: W. B. Saunders/Elsevier.
Soltoski, P., Karamanoukian, H. & Salerno, T. (2003).
Davis, L. (2004). Cardiovascular Nursing Secrets. Cardiac Surgery Secrets. 2nd ed. St. Louis, Mo:
St. Louis, Mo: Mosby/Elsevier. Mosby/Elsevier.

Diepenbrock, N. H. (2004). Quick Reference to Critical Many references available through AACN; visit
www.aacn.org > Marketplace > Online Bookstore.
Care. 2nd ed. Philadelphia: Lippincott Williams &
Wilkins. More current version may be available.

PUBLISHER CONTACTS:
AACN – (800) 899-2226
American Heart Association – (800) 242-8721
Aspen Publishers – (800) 638-8437
Blackwell Publishing – (800) 216-2522– (800) 545-2522
Lippincott Williams & Wilkins – (800) 638-3030

72
CARDIAC SURGERY CERTIFICATION (CSC) SAMPLE QUESTIONS

CSC
1. A postoperative CABG patient is taken to the ICU. 2. The most important therapy ordered for a
Four hours postoperatively, the patient is noted to postoperative CABG patient who has received an
be restless, short of breath and has developed arterial graft as an alternative conduit is the use
jugular vein distention. Vital signs are as follows: of
BP 80/45 A. beta-blockers to prevent tachycardia.
HR 125 B. calcium channel-blockers to prevent artery
RR 30 spasm.

CVP 16 C. anticoagulants to prevent thrombus formation.


D. phenylephrine to maintain MAP > 75.
The patient’s chest tube output has been minimal
during the last hour. These symptoms would most
likely be indicative of which of the following?
A. cardiac tamponade
B. pulmonary contusion
C. cardiogenic shock
D. fluid volume overload

Answers
1. A
2. B

73
74
3 of 3

CSC CERTIFICATION APPLICATION HONOR STATEMENT


Online exam registration is available at www.certcorp.org; click Apply Online.

Complete and submit with 2-page application at back of handbook.

Name: _____________________________________________________ AACN #: ___________________


LAST FIRST MIDDLE

Verification Information - List contact information for a professional associate (colleague or supervisor) who
can verify that you have met the clinical hour eligibility requirements:
ASSOCIATE’S NAME:

FACILITY ADDRESS:

City State ZIP

ASSOCIATE’S PHONE NUMBER: and/or E-MAIL ADDRESS:

Clinical Nursing Specialty Certification


To what nationally accredited clinical nursing specialty certification would you like to tie your CSC certification? (check ONE box only)
CCRN PCCN CCNS ACNPC Other ___________________________
(Attach proof of non-AACN certification, such as copy of wallet card or wall certificate, or verification letter from certifying
organization; must be valid for 90 days beyond CSC application date.)

Honor Statement
I have fulfilled the clinical practice hour requirements of 1,750 hours of direct bedside care of acutely and/or critically ill Adult
patients within the previous 2-year period, with 875 hours accrued in the most recent year preceding this application; of those 1,750
hours, 875 were in the care of cardiac surgery patients within the first 48 hours postoperatively. Or if renewing by exam I have
completed 432 hours of direct bedside care of acutely and/or critically ill Adult cardiac surgery patients within the first 48 hours
postoperatively during the 3-year certification period, with 144 of those hours accrued in the 12-month period prior to my scheduled
renewal date.

I hold a current nationally accredited (NCCA and/or ABNS) clinical nursing specialty certification; and possess a current unencumbered
U.S. license to practice as an RN or APRN. I agree to notify AACN Certification Corporation if any disciplinary action is taken against my
RN or APRN license in the future.

If my clinical nursing specialty certification is conferred by an organization other than AACN Certification Corporation, I agree to
submit proof of my certification with this application. I agree to notify AACN Certification Corporation if my clinical nursing specialty
certification lapses.

I hereby apply for CSC subspecialty certification offered by AACN Certification Corporation. I understand that certification depends
upon the successful completion of the specified requirements. I further understand that the information acquired in the certification
process may be used for statistical purposes and for evaluation of the certification program.

To the best of my knowledge, the information contained in the application is true, complete, correct and is made in good faith. I
understand that information supplied is subject to audit and failure to respond to a request for further information may be sufficient
cause for AACN Certification Corporation to bar me from the exam, to invalidate the results of my exam, to revoke certification, to
withhold certification, or to take other appropriate action, including revocation of or disciplinary action related to my clinical nursing
specialty certification.

My signature on this form indicates my agreement to keep the contents of the exam confidential and not discuss the specific exam
content with anyone except AACN Certification Corporation. By complying with and enforcing this obligation, I help maintain the integrity
of the AACN Certification Program and the value of its certification credentials.

Applicant’s Signature: Printed Name: Date:

This form may be photocopied and is also available online at www.certcorp.org. OCTOBER 2009
75
AACN SYNERGY MODEL FOR PATIENT CARE™

Synergy is an evolving phenomenon that occurs when


the capacity to return to a restorative level of
individuals work together in mutually enhancing ways Resiliency functioning using compensatory/coping
toward a common goal. AACN Certification mechanisms; the ability to bounce back quickly
Corporation is committed to ensuring that certified after an insult.
nursing practice is based on the needs of patients.
susceptibility to actual or potential stressors
Integration of the AACN Synergy Model for Patient Vulnerability
that may adversely affect patient outcomes.
Care into AACN Certification Corporation’s certification
programs puts emphasis on the patient, and says to the ability to maintain a steady-state
Stability
the world that patients come first. equilibrium.

the intricate entanglement of two or more


The Synergy Model creates a comprehensive look at Complexity
systems (e.g., body, family, therapies).
the patient. It puts the patient in the center of nursing
practice. The Synergy Model identifies nursing’s extent of resources (e.g., technical, fiscal,
Resource
unique contributions to patient care and uses personal, psychological, and social) the
Availability
language to describe the professional nurse’s role. It patient/family/community bring to the situation.
provides nursing with a venue that clearly states what
Participation extent to which patient/family engages in
we do for patients and allows us to start linking in Care aspects of care.
ourselves to, and defining ourselves within, the
context of the patient and patient outcomes. Participation
extent to which patient/family engages in
in Decision
decision making.
NOTE: Making
AACN certification exams do not test for knowledge
a characteristic that allows one to expect a
of the Synergy Model or its terminology; this is the Predictability
certain course of events or course of illness.
theoretical model within which the tests have been
designed.
FOR EXAMPLE:
Patient Characteristics A healthy, uninsured, 40-year-old woman undergoing a pre-
The Synergy Model encourages nurses to view employment physical could be described as an individual
patients in a holistic manner rather than the “body who is (a) stable (b) not complex (c) very predictable (d)
systems” medical model. Each patient and family is resilient (e) not vulnerable (f) able to participate in decision
making and care, but (g) has inadequate resource
unique, with a varying capacity for health and
availability.
vulnerability to illness. Each patient, regardless of the
clinical setting, brings a set of unique characteristics On the other hand: a critically ill, insured infant with multi-
to the care situation. Depending on where they are on system organ failure can be described as an individual who
the healthcare continuum, patients may display is (a) unstable (b) highly complex (c) unpredictable (d) highly
varying levels of the following characteristics: resilient (e) vulnerable (f) unable to become involved in
decision making and care, but (g) has adequate resource
availability.

76
AACN SYNERGY MODEL FOR PATIENT CARE™ (CONTINUED)

Nurse Characteristics Nurses become competent within each continuum at


a level that best meets the fluctuating needs of their
Nursing care reflects an integration of knowledge,
population of patients. More compromised patients
skills, abilities and experience necessary to meet the
have more severe or complex needs, requiring nurses
needs of patients and families. Thus, nurse
to have advanced knowledge and skills in an
characteristics are derived from patient needs and
associated continuum.
include:
FOR EXAMPLE:
Clinical reasoning, which includes clinical If the gestalt of a patient were stable but
decision making, critical thinking and a global
unpredictable, minimally resilient and vulnerable,
Clinical grasp of the situation, coupled with nursing skills
Judgment acquired through a process of integrating primary competencies of the nurse would be centered
education, experiential knowledge and evidence- on clinical judgment and caring practices (which
based guidelines. includes vigilance). If the gestalt of a patient were
vulnerable, unable to participate in decision making
Working on another's behalf and representing the
Advocacy/ concerns of the patient/family and nursing staff;
and care, and inadequate resource availability, the
Moral serving as a moral agent in identifying and primary competencies of the nurse would focus on
Agency helping to resolve ethical and clinical concerns advocacy and moral agency, collaboration and
within and outside the clinical setting. systems thinking.
Nursing activities that create a compassionate,
supportive and therapeutic environment for Although all eight competencies are essential for
patients and staff, with the aim of promoting contemporary nursing practice, each assumes more
Caring comfort and healing and preventing unnecessary or less importance depending on a patient’s
Practices suffering. These caring behaviors include but are characteristics. Synergy results when a patient’s
not limited to vigilance, engagement and needs and characteristics are matched with the
responsiveness of caregivers. Caregivers include
family and healthcare personnel.
nurse’s competencies.

Working with others (e.g., patients, families, Results of a 1997 large-scale survey of subacute,
healthcare providers) in a way that acute and critical care nurses across the United
promotes/encourages each person's contributions
Collaboration
toward achieving optimal/realistic patient/family
States supported the applicability of the Synergy
goals. Collaboration involves intra- and inter- Model to nursing practice (Greenberg, Muenzen, and
disciplinary work with colleagues and community. Smith, 1998). A second study, including adult,
pediatric and neonatal CCRNs, identified the overall
Body of knowledge and tools that allow the nurse to
contribution of each of the eight nurse characteristics
manage whatever environmental and system
Systems
resources that exist for the patient/family and staff, to optimal patient outcomes.
Thinking
within or across healthcare systems and non-
healthcare systems. Based on these studies, as well as the 2003 job
analysis completed by AACN Certification Corporation,
The sensitivity to recognize, appreciate and
incorporate differences into the provision of care. the test plans for AACN certification exams have been
Response to Differences may include, but are not limited to, created to reflect the Synergy Model, as well as
Diversity individuality, cultural, spiritual, gender, race, current acute and critical care nursing practice.
ethnicity, lifestyle, socioeconomic, age and
values. For more information about the AACN Synergy Model
Facilitation for Patient Care visit www.certcorp.org; click on the
The ability to facilitate learning for
of Learning General Information button on the left side of the
patients/families, nursing staff, other members of
(or Patient/
the healthcare team and community. Includes page.
Family
both formal and informal facilitation of learning.
Educator

Clinical The ongoing process of questioning and evaluating


Inquiry (or practice and providing informed practice. Creating
Innovator/ changes through evidence-based practice,
Evaluator) research utilization and experiential knowledge.

OCTOBER 2009 77
78
1 of 3

CERTIFICATION EXAM APPLICATION


Online exam registration is available at www.certcorp.org; click Apply Online.

1. REGISTRATION INFORMATION PLEASE PRINT CLEARLY. PROCESSING WILL BE DELAYED IF INCOMPLETE OR NOT LEGIBLE.

AACN MEMBER NUMBER: RN/APRN LICENSE NUMBER:


Exp. Date State Exp. Date
NAME:
Last First MI Maiden
HOME ADDRESS:
City State ZIP
INSTITUTION NAME: BUSINESS PHONE:

INSTITUTION ADDRESS:
City State ZIP
PREFERRED EMAIL: HOME PHONE:

2. AACN MEMBERSHIP
I would also like to join/renew my AACN membership at this time and select member pricing for my exam fees:(check only one box)
1-year AACN membership……………………………………..............................$78
2-year AACN membership……………………………………..............................$148
3-year AACN membership………………………….………….............................$179.35 (special certification rate) Membership Fee:
3. EXAM FOR WHICH YOU ARE APPLYING: (check only one box)
Note: SPECIAL applications for NTI and TRENDS paper and pencil exams available at www.certcorp.org $__________

+
Initial Exam Initial Exam Retest or Retest or
Fee Fee Renewal by Renewal by Exam Fee:
Exam Type Exam Fee Exam Fee
$__________
AACN Member Nonmember AACN Member Nonmember
=
CCRN Adult $220 $325 $170 $275
Total Payment:
Neonatal $220 $325 $170 $275
$__________
Pediatric $220 $325 $170 $275

PCCN Adult Only $170 $250 $135 $215

CMC Adult Only $135 $180 $110 $155

CSC Adult Only $135 $180 $110 $155

Check this box if you’ve attached a request and supporting documentation for special testing accommodations.

4. PAYMENT INFORMATION – application must be accompanied by payment


Check or money order attached – payable to AACN Certification Corporation. U.S. funds only.
Bill my credit card Visa MasterCard American Express Discover Card
Credit Card # Exp. Date(mm/yy)

Name on Card _____________________________________________ Signature___________________________________________


Amount Billed $______________ Address of Payor (if different than applicant)_______________________________________________

5. IF JOINING AACN NOW, WERE YOU REFERRED BY A CURRENT MEMBER OR CHAPTER?


No Yes
Member Name / AACN # or* Chapter Name (*include only one for referral incentives)

Please do not include my name on lists sold to other organizations.

Please complete page 2 of application.


APCCHW This application form may be photocopied and is also available online at www.certcorp.org. OCTOBER 2009 79
2 of 3

CERTIFICATION EXAM APPLICATION

PRINTED NAME AACN#

6. DEMOGRAPHIC INFORMATION (check one box in each category) Information is used for statistical purposes.
Primary Area Employed Primary Position Held Is English your first language? Primary Type of Facility in Which
Acute Hemodialysis Unit (21) Academic Faculty (07) Yes No Employed
Burn Unit (13) Acute Care Nurse Practitioner (09) College/University (08)
Cardiac Rehabilitation (26) Administrator/V.P. (43) Did you graduate from nursing school in Community Hospital (Nonprofit) (01)
Cardiac Surgery/OR (36) Clinical Director (04) a country other than the U.S.? Community Hospital (Profit) (02)
Cardiovascular/Surg. ICU (09) Clinical Nurse Specialist (08) Yes No County Hospital (07)
Catheterization Lab. (22) Corporate Executive (11) HMO/Managed Care (12)
CCU (03) Elected Official (12) If yes, which country?
Home Health (13)
Combo Adult/Ped ICU (23) Inservice/Staff Dev. Instructor (06) Military/Government
Combined ICU/CCU (01) Legal Nurse Consultant (39) ______________________________ Hospital (04)
Corporate Industry (24) Manager (03) Private Industry (11)
CC Transport/Flight (17) Nurse Anesthetist (02) What year did you start Registry (10)
eICU or Virtual ICU (37) Nurse Educator (46) practicing nursing in the U.S.? Self-Employed (09)
Emergency Dept.(12) Nurse Midwife (13) Travel Nurse (15)
General Med./Surg Floor (18) Nurse Practitioner (05) University Med. Center (03)
______________________________
Home Care (25) Pharmacist (14) Other – specify below
ICU (02) Physician (16) Ethnicity
Interventional Cardiology (31) Physician Assistant (17) African-American (02)
Long-Term Care (27) Researcher (18) Asian (05) __________________________ (99)
Medical Cardiology (34) Respiratory Therapist (19) White/Non-Hispanic (01)
Medical ICU (04) Social Worker (20) Hispanic/Latino (03)
Med. Surg. ICU (35) Staff Nurse (01) Native American (04) Number of beds in Institution
Neonatal ICU (06) Unit Coordinator (22) Pacific Islander (06)
Neuro/Neurosurgical ICU (10) Other - specify below Other – specify below
Oncology Unit (19) _________________________________
Operating Room (15) ___________________________ (99) Years experience in Nursing
___________________________ (99)
Outpatient Clinic (29)
Pediatric ICU (05) Highest Nursing Degree
Private Practice (32) Gender _________________________________
Associate’s Degree
Progressive Care Unit (16) Female Male
Bachelor’s Degree Years experience in Acute Care Nursing
Recovery Room/PACU (14) Diploma
Respiratory ICU (08) Doctorate Have you completed Red Cross Disaster
Stepdown Unit (30) Master’s Degree ________________________________
Recovery training?
Subacute Care (28)
Yes (01) No (02)
Surgical ICU (07) Date of Birth (Month/Day/Year)
Telemetry (20)
Trauma Unit (11)
Other – specify below _________________________________

___________________________ (99)

7. HONOR STATEMENT - 3rd page of application that must be submitted with this form
Complete the Honor Statement, found at the end of the exam section, for your selected exam:
CCRN (p. 35), PCCN (p. 51), CMC (p. 63) or CSC (p. 75).

8. SUBMIT APPLICATION
Attach Honor Statement to this application and submit with payment to:
AACN Certification Corporation, 101 Columbia, Aliso Viejo, CA 92656-4109 or fax to: (949) 362-2020.

DO NOT mail AND fax your application - please choose only ONE method.

NOTE: Allow 4 to 6 weeks from date received by AACN Certification Corporation for application processing.

Questions? Please call us at (800) 899-2226, e-mail certcorp@aacn.org or visit www.certcorp.org.

80 Did you include your signed honor statement and fee payment? OCTOBER 2009

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