What's on the CCRN (Adult) Exam? The 2025 Test Plan Categories and Weights

The six CCRN (Adult) test plan categories and their weights

The Adult CCRN Test Plan from AACN Certification Corporation applies to exams taken on and after November 12, 2025. The exam has 150 items, and 125 of them are scored. The plan assigns its content to two parts: Clinical Judgment at 80%, divided into five categories, and Professional Caring and Ethical Practice at 20%.

The item counts are Passy estimates: each weight multiplied by 125 and rounded. AACN publishes only the percentages. It notes that they may not total exactly 100 because of rounding and that the order of the list does not reflect importance. The 25 unscored items are not part of these numbers.

Read the weights before you plan anything. Category C (21%) and Professional Caring (20%) are each larger than any single organ system, and Cardiovascular, at 13%, now accounts for roughly one scored item in eight.

The free Passy set follows these six categories. It splits its 20 items 3, 2, 4, 4, 3 and 4 in the order of the table, in proportion to the weights, and the result screen shows how you did in each category. Before you decide where to start, check your baseline across all six CCRN test plan categories →. Twenty items cannot match the real exam's topic mix or difficulty, so treat the breakdown as a pointer, not a score.

What each CCRN Clinical Judgment category lists

For each category, the test plan names patient problems, and separate pages list the "testable nursing actions" AACN expects you to manage. The summaries below group them in plain words. The handbook has the full lists on pages 10 to 13.

Cardiovascular (13%)

The 16 listed problems cover coronary and heart-muscle disease (acute coronary syndrome, heart failure, cardiomyopathy, cardiogenic shock), rhythm and conduction problems (dysrhythmias, a prolonged QT interval, Wolff-Parkinson-White), and the emergencies: tamponade, cardiac trauma, aortic aneurysm, dissection or rupture, and hypertensive crisis. The rest is procedural and structural care, from catheterization and cardiac surgery to valve and other structural defects, vascular disorders, vascular interventions, and cardiac infection or inflammation. The nursing actions center on interpreting rhythms, catching early signs of falling cardiac output, invasive and non-invasive hemodynamic monitoring, temporary pacing, pericardiocentesis and mechanical circulatory support devices.

Respiratory (12%)

The 13 problems include ARDS, acute respiratory failure, pneumonia and other acute infections, pulmonary embolism and acute pulmonary edema, chronic lung disease such as COPD and asthma, and status asthmaticus. They also include pleural problems (pneumothorax, hemothorax, empyema, effusion), pulmonary hemorrhage, pulmonary hypertension, chest and airway trauma, thoracic surgery, and complications of mechanical ventilation. Actions include airway management and rapid sequence intubation, mechanical ventilation and noninvasive support such as BiPAP, CPAP and high-flow nasal cannula, preventing ventilator complications, chest tubes, prone positioning, tracheostomy, and monitoring with SpO2, SvO2 and ETCO2.

Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary (21%)

The broadest category covers five subsystems:

• Endocrine: DKA, HHS and other hyperglycemia, diabetes types 1 and 2, diabetes insipidus, SIADH, adrenal insufficiency and thyroid disorders.
• Hematology and immunology: anemia, low blood counts, bleeding and clotting disorders such as ITP, DIC and HIT, oncologic complications such as tumor lysis syndrome, autoimmune disease (lupus, myasthenia gravis, Guillain-Barré syndrome), and transfusion reactions such as TRALI and TACO.
• Gastrointestinal: GI bleeding, abdominal trauma and abdominal compartment syndrome, bowel ischemia, obstruction or perforation, pancreatitis, peritonitis, liver failure and liver disease, malnutrition, and major GI surgery.
• Renal and genitourinary: acute kidney injury and acute tubular necrosis, chronic kidney disease, and infections such as urosepsis.
• Integumentary: pressure injury, wounds, cellulitis, necrotizing fasciitis, IV infiltration and skin failure.

The actions include transfusion up to massive transfusion, identifying nephrotoxic agents, dialysis and CRRT, enteral and parenteral nutrition and feeding tubes, EGD and GI drains, and pressure-injury prevention with devices such as wound VACs.

Musculoskeletal, Neurological, Behavioral/Psychosocial (18%)

The musculoskeletal list is short: compartment syndrome, fractures, other trauma and deconditioning. The neurological list has 15 problems, among them stroke, traumatic brain injury, acute spinal cord injury, seizures, brain death, neurogenic shock, neurological storming, encephalopathy, hydrocephalus, nervous system infections, neuromuscular disorders, and brain and spinal surgery. The behavioral and psychosocial list has 10: delirium, agitation, aggression and violence, mood disorders, post-traumatic stress, post-intensive care syndrome, substance use disorder, self-harm, suicidal ideation, and medical non-adherence. Actions include ICP monitoring and ventricular drains, continuous EEG, neuroendovascular procedures such as coiling and thrombectomy, seizure and spinal precautions, swallow evaluation, early mobility, assessment tools for delirium and alcohol withdrawal, and de-escalation in behavioral emergencies.

Multisystem (16%)

The 22 problems cross body systems: sepsis, SIRS, shock states and multi-organ dysfunction; acid-base, fluid and electrolyte imbalances; burns, rhabdomyolysis, submersion, anoxic injury, thermoregulation and toxic ingestions or exposures; healthcare-associated and other infections; transplant history, obesity-related complications and life-threatening maternal or fetal complications; and pain, sleep disruption, failure to thrive, and palliative and end-of-life care. Actions include early sepsis identification, preventing hospital-acquired infections, managing toxin and drug exposures, recognizing and managing malignant hyperthermia risk, ECMO, intra-abdominal pressure monitoring, targeted temperature management and organ donation.

A set of general actions applies across every category: pain assessment, responding to device alarms, fluid and electrolyte balance, sedation, vascular access, capnography, safe medication use, intrahospital transport, pre- and post-operative care, family-centered care, and recognizing an emergency and calling for help.

What Professional Caring and Ethical Practice asks for (20%)

Part II carries one weight, with no percentages for its seven areas. Those areas are seven of the eight nurse competencies in the AACN Synergy Model for Patient Care, which is the organizing framework for AACN's exams. The eighth competency, clinical judgment, is Part I. The model's core idea is that care works best when a patient's needs and characteristics are matched by the nurse's competencies.

Passy's reading: because these areas describe how a nurse acts, expect them inside clinical scenarios that ask for the best response to a family, the most appropriate way to raise a concern, or the right way to teach. The ethics and advocacy guide works through patient and family scenarios.

Where the Adult CCRN weights come from

AACN builds each test plan from a study of practice, which its handbook says is conducted at least every five years. For the current plan, a practice analysis task force met in September 2023 and wrote a survey whose adult version asked about 78 nursing actions and 142 patient care problems. The survey drew 2,337 usable responses, 1,383 of them from adult critical care nurses. The task force set the category weights from those results, and a separate committee checked every item in the pool against at least one reference on the exam bibliography.

AACN's launch announcement adds that the test plans went through a "100% consensus process," analysis by PSI's psychometrician and approval by the AACN Certification Corporation board. For the weight changes from the 2020 plan, see what changed on November 12, 2025.

What the Adult CCRN test plan does not cover

The Pediatric and Neonatal CCRN exams have their own test plans, printed in the same handbook. This page covers only the Adult exam. Nurses who qualify through the Knowledge Professional or Tele-critical Care pathway take the same Adult exam under the same test plan. The handbook also prints five Adult sample questions on pages 14 and 15 to show AACN's item style.

Turning the CCRN test plan into a study checklist

Copy the test plan's problem list and the testable nursing actions, then mark each line as confident, shaky or unfamiliar. Count the shaky and unfamiliar lines in each category and multiply by the category's weight. Start where that number is largest, not where the list is longest. The CCRN study guide turns the result into 6-, 8- or 12-week schedules.

Once you know which category to lead with, turn your weakest CCRN test plan category into a dated weekly outline →. The free study-plan generator uses your exam date, your daily minutes and that one category, and it does not predict a result.