CCNS Examination Content

The CCNS examinations are three-and-a-half (3 ½) hour tests consisting of 175 multiple-choice items, 25 of which are unscored pre-test items. On each exam, 78% of the items address content where the age of the patient spans the developmental spectrum. The remaining 22% of each exam addresses adult, neonatal, or pediatric patients.

Each question on the CCNS examination assesses one or more of the nurse characteristics identified in the
AACN Synergy Model for Patient Care and focuses on a particular impact area of CNS activities: patient/population, nursing personnel, and other disciplines/organizations/systems. A 1997 study of subacute, acute, and critical care nurses conducted by the AACN Certification Corporation supported the applicability of the Synergy Model to nursing practice (Greenberg, Muenzen, and Smith, 1998). A second study, including clinical nurse specialists, identified sets of activities which CNSs perform in connection with each of the eight nurse characteristics (Muenzen and Greenberg, 1998).

The most recent study of practice, completed in 2003, defines the dimensions of acute/critical care nursing practice and identifies the actual tasks, knowledge and experiences required of an advanced practice nurse practicing in a neonatal, pediatric or adult critical care setting. In the study, neonatal, pediatric and adult advanced practice critical care nurses across the United States were surveyed to ascertain the frequency and significance of the various elements of their practice. Through an extensive review and evaluation process, the tasks crucial to advanced practice critical care nursing were defined using the Synergy Model as an organizing framework. CCNS examinations are based on these tasks and the knowledge required to perform them. The Executive Summary of the 2003 Job Analysis is available by clicking here .

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Some questions on the CCNS examination incorporate information about patient care problems commonly encountered by CNS's who care for acute and critically ill patients. The patient care problems were reviewed and revised in a study completed by the AACN Certification Corporation in 1998 (Muenzen and Greenberg, 1998). See below for a complete listing of these patient care problem areas.

Cognitive Levels of Questions

The cognitive levels of the examination questions are based on a condensed version of Bloom's Taxonomy and reflect the mental processes of Recall, Application and Analysis. Testing at higher cognitive levels provides a better indication of the candidate's ability to identify problems and plan, implement and evaluate solutions.

Review for the Exam

AACN Certification Corporation does not endorse or sponsor any review courses for the CCNS examination. Many local chapters of AACN sponsor review courses or may be aware of CCNS review courses in their local area. For information about a local chapter, click here or contact the AACN national office at (800) 899-2226.

CNS Patient Care Problem Areas
These problems are only found in the clinical judgment-based questions of the exam.


Adult CCNS Test Plan

I. Clinical Judgment (22%)

  • Cardiovascular
    • Acute coronary syndromes/unstable angina
    • Acute heart failure/pulmonary edema
    • Acute inflammatory disease (e.g., myocarditis, endocarditis, pericarditis)
    • Acute myocardial infarction/papillary muscle rupture
    • Acute peripheral vascular insufficiency (e.g., acute arterial occlusion, carotid artery stenosis, endartarectomy, peripheral stents)
    • Cardiac surgery (e.g., valve replacement, CABG)
    • Cardiac tamponade
    • Cardiac trauma (blunt and penetrating)
    • Cardiogenic shock
    • Cardiomyopathies (e.g., hypertrophic, dilated, restrictive, idiopathic)
    • Cardiovascular pharmacology
    • Conduction defects, blocks and pacemakers
    • Dysrhythmias/AICDs
    • Heart failure
    • Hemodynamic monitoring
    • Hypertensive crisis
    • Hypovolemic shock and volume deficit
    • Pulmonary hypertension (e.g., valvular defects, aortic stenosis, mitral stenosis)
    • Ruptured or dissecting aneurysm (e.g., thoracic, abdominal)
  • Pulmonary
    • Acute pulmonary embolus, fat embolus
    • Acute respiratory distress syndrome (ARDS)
    • Acute respiratory failure, hypoxemia
    • Acute respiratory infections
    • Air-leak syndromes (e.g., spontaneous pneumothorax, pneumopericardium, pneumomediastinum, PIE)
    • Aspirations (e.g., aspiration pneumonia, hospital acquired pneumonia, foreign-body aspiration)
    • Chronic lung disease
    • Pulmonary pharmacology
    • Pulmonary trauma (e.g., pulmonary hemorrhage, tracheal perforation)
    • Respiratory distress (e.g., emphysema, bronchitis)
    • Status asthmaticus, exacerbation of COPD, emphysema
    • Thoracic surgery (e.g., lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage, lung reduction, pneumonectomy, lobectomy, tracheal surgery)
    • Thoracic trauma (e.g., lung contusions, fractured ribs, hemothorax, pneumothorax from trauma, pulmonary hemorrhage)
    • Ventilator management and ABG interpretation, mixed venous gases, CPAP, volutrauma and barotraumas
  • Endocrine
    • Acute hypoglycemia
    • Diabetes insipidus
    • Diabetic ketoacidosis
    • Hormones and endocrine anatomy and physiology
    • Hyperglycemic hyperosmolar nonketotic coma (HHNK)
  • Hematology/Immunology
    • Hematology, anatomy and physiology, blood products and plasma
    • Immunosuppression-acquired (e.g., HIV, AIDS, neoplasms)
    • Life-threatening coagulopathies (e.g., ITP, DIC, hemophilia, HITTS, ReoPro-induced) and non life-threatening coagulopathies
    • Organ transplantation (e.g., liver, bone marrow, kidney, heart, pancreas, lung)
    • Sickle cell crisis
  • Neurologic
    • Aneurysm, AV malformation
    • Encephalopathy (e.g., hypoxic-ischemic, metabolic, edema, infectious)
    • Head trauma (blunt, penetrating), skull fractures
    • Intracranial hemorrhage/intraventricular hemorrhage (e.g., subarachnoid, epidural, subdural)
    • Neurologic infectious diseases (e.g., meningitis, GBS, West Nile)
    • ICP monitoring
    • Neurosurgery (e.g., evacuation of hematoma, tumor resection)
    • Seizure disorders
    • Stroke (e.g., embolic events, hemorrhagic)
  • Gastrointestinal
    • Acute abdominal trauma
    • Acute GI hemorrhage (e.g., esophageal, upper and lower)
    • Bowel infarction, bowel obstruction, bowel perforation
    • GI surgeries (e.g., Whipple, esophago-gastrectomy, gastric bypass)
    • Hepatic failure/coma (e.g., portal hypertension, cirrhosis, esophageal varicies, fulminant hepatitis)
    • Pancreatitis
    • Gastro-esophageal reflux
  • Renal
    • Acute renal failure (e.g. acute tubular necrosis, hypoxia)
    • Chronic renal failure and dialysis
    • Life-threatening electrolyte imbalances (e.g., potassium, sodium, phosphorus, magnesium, calcium)
    • Fluid balance concepts and renal anatomy & physiology
    • Renal trauma
  • Multisystem
    • Multisystem trauma
    • Septic shock/infectious diseases (e.g., viral, bacterial, line sepsis, nosocomial infections, immunosuppression)
    • Systemic inflammatory response syndrome (SIRS)/sepsis/MODS
    • Toxic exposure (e.g., chemicals, radiation, anaphylaxis)
    • Toxic ingestions and inhalations (e.g., drug/alcohol overdose, poisoning)

II. Professional Caring and Ethical Practice (78%)

  • Advocacy/Moral Agency (7%)
  • Caring Practices (11%)
  • Collaboration (14%)
  • Systems Thinking (8%)
  • Response to Diversity (4%)
  • Facilitation of Learning (21%)

Neonatal CCNS Test Plan

I. Clinical Judgment (22%)
  • Cardiovascular
    • Acute heart failure/pulmonary edema
    • Acute inflammatory disease (e.g., myocarditis, endocarditis, pericarditis)
    • Cardiac surgery
    • Cardiovascular pharmacology
    • Congenital heart defect/disease
    • Hemodynamic concepts
    • Pulmonary hypertension
    • Shock states (e.g. cardiogenic, hypovolemic)/volume deficit
  • Pulmonary
    • Acute respiratory failure, hypoxemia
    • Acute respiratory infections
    • Air-leak syndromes (e.g., spontaneous pneumothorax, bronch-fistula, emphysema, [PIE], pneumopericardium, pneumomediastinum)
    • Apnea of prematurity
    • Aspirations (e.g., aspiration pneumonia, meconium aspiration)
    • Chronic lung disease (e.g., bronchopulmonary dysplasia)
    • Congenital anomalies
    • Pulmonary hypertension in newborn
    • Respiratory distress syndrome
    • Respiratory pharmacology
    • Thoracic surgery (e.g. lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage, lung reduction, pneumonectomy, lobectomy, tracheal surgery)
    • Transient tachypnea of the newborn
    • Ventilator management and ABG interpretation, mixed venous gases, CPAP, volutrauma and barotrauma
  • Endocrine
    • Acute hypoglycemia
    • Hormones and anatomy & physiology
    • Inborn errors of metabolism
    • Infant of diabetic mother
  • Hematology/Immunology
    • Anemia of prematurity
    • Hematology, blood products and plasma
    • Immunosuppression (e.g. Rh incompatibilities, ABO incompatibilities, hydrops fetalis)
    • Life-threatening coagulopathies (e.g., ITP, DIC) and non life-threatening coagulopathies
  • Neurology
    • Congenital neurological abnormalities (e.g. spina bifida, myelomeningocele, anencephaly, encephalocele)
    • Encephalopathy (e.g., hypoxic-ischemic, metabolic, edema, infectious)
    • Hydrocephalus
    • ICP monitoring
    • Intracranial hemorrhage/intraventricular hemorrhage
    • Neurologic infectious diseases (e.g., meningitis, congenital infections, viral infections, TORCH)
    • Seizure disorders
  • Gastrointestinal
    • Bowel infarction /obstruction/ perforation (e.g. necrotizing enterocolitis, adhesions, shortgut)
    • Gastro-esophageal reflux
    • GI abnormalities at birth
    • Hepatic failure/coma
  • Renal
    • Acute renal failure (e.g. acute tubular necrosis, hypoxia)
    • Congenital renal-genitourinary abnormalities (e.g. polycystic kidneys, exstrophy of bladder, hydronephrosis)
    • Fluid balance concepts and renal anatomy & physiology
    • Life-threatening electrolyte imbalances (e.g., potassium, sodium, phosphorus, magnesium, calcium)
  • Multisystem
    • Asphyxia (e.g., neonatal-perinatal)
    • Life-threatening maternal-fetal complications (e.g. birth trauma and birth-related injuries, genetic disorders, maternal-fetal transfusion, abruption placenta, placenta previa)
    • Low birth weight/prematurity
    • Septic shock/infectious diseases (e.g. congenital viral, bacterial, line sepsis, nosocomial infections)
    • Toxic exposure (e.g. fetal exposure to drug/alcohol, drug withdrawal, anaphylaxis)

II. Professional Caring and Ethical Practice (78%)

  • Advocacy/Moral Agency (7%)
  • Caring Practices (11%)
  • Collaboration (14%)
  • Systems Thinking (8%)
  • Response to Diversity (4%)
  • Clinical Inquiry (13%)
  • Facilitation of Learning (21%)

Pediatric CCNS Test Plan

I. Clinical Judgment (22%)

  • Cardiovascular
    • Acute heart failure/pulmonary edema
    • Acute inflammatory disease (e.g., myocarditis, endocarditis, pericarditis)
    • Cardiac surgery
    • Cardiac trauma (blunt and penetrating)
    • Cardiogenic shock
    • Cardiomyopathies (e.g. hypertrophic, dilated, restrictive, idiopathic)
    • Cardiovascular pharmacology
    • Conduction defects, blocks and pacemakers
    • Congenital heart defect/disease
    • Dysrhythmias
    • Hemodynamic monitoring
    • Hypertensive crisis
    • Hypovolemic shock and volume deficit
    • Pulmonary hypertension (e.g., aortic and mitral stenosis and regurgitation)
  • Pulmonary
    • Acute respiratory distress syndrome (ARDS)
    • Acute respiratory failure, hypoxemia
    • Acute respiratory infections (e.g. pneumonia, croup, strep pneumonia, RSV, bronchiolitis
    • Air-leak syndromes (e.g., spontaneous pneumothorax, bronch-fistula, emphysema, [PIE], pneumopericardium, pneumomediastinum)
    • Apnea of prematurity
    • Aspirations (e.g., aspiration pneumonia, hospital acquired pneumonia, foreign-body aspiration)
    • Chronic lung disease (e.g., bronchopulmonary dysplasia)
    • Congenital anomalies
    • Persistent pulmonary hypertension
    • Pulmonary trauma (e.g. pulmonary hemorrhage, tracheal perforation)
    • Pulmonary pharmacology
    • Respiratory distress (e.g., epiglottitis, bronchitis)
    • Status asthmaticus
    • Thoracic surgery (e.g. lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage, lung reduction, pneumonectomy, lobectomy, tracheal surgery)
    • Thoracic trauma (e.g., lung contusions, fractured ribs, hemothorax, pulmonary hemorrhage)
    • Ventilator management and ABG interpretation, mixed venous gases, CPAP, volutrauma and barotraumas
  • Endocrine
    • Acute hypoglycemia
    • Diabetes insipidus
    • Diabetic ketoacidosis
    • Hormones and anatomy & physiology
    • Inborn errors of metabolism
    • Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
  • Hematology/Immunology
    • Hematology, anatomy & physiology, blood products and plasma
    • Hyperbilirubinemia
    • Immunosuppression (e.g., congenital [SCIDS], acquired [HIV, AIDS, neoplasms])
    • Life-threatening coagulopathies (e.g., DIC, ITP, hemophilia)
    • Organ transplantation (e.g., liver, bone marrow, kidney, heart, pancreas, lung)
    • Sickle cell crisis
  • Neurology
    • Acute spinal cord injury
    • Congenital neurological abnormalities (e.g. spina bifida, myelomeningocele, anencephaly, encephalocele)
    • Encephalopathy (e.g., hypoxic-ischemic, metabolic, edema, infectious)
    • Head trauma (blunt, penetrating) including shaken baby
    • Hydrocephalus
    • ICP monitoring
    • Intracranial hemorrhage/intraventricular hemorrhage (e.g., subarachnoid, epidural, subdural) including stroke
    • Neurologic infectious diseases (e.g., meningitis, congenital infections, viral infections, West Nile)
    • Neuromuscular disorders (e.g., muscular dystrophy, Werdnig-Hoffman)
    • Neurosurgery (e.g., evacuation of hematoma, tumor resection
    • Seizure disorders
    • Space-occupying lesions (e.g., brain tumors)
    • Spinal fusion
  • Gastrointestinal
    • Acute abdominal trauma
    • Acute GI hemorrhage
    • Bowel infarction /obstruction/ perforation (e.g. necrotizing enterocolitis)
    • Gastro-esophageal reflux
    • GI abnormalities at birth(e.g., Hirshprungs)
    • GI surgeries
    • Hepatic failure/coma (e.g., portal hypertension, fulminant hepatitis, biliary atresia, hyperbilirubinemia)
  • Renal
    • Acute renal failure (e.g. acute tubular necrosis)
    • Chronic renal failure and dialysis
    • Congenital renal-genitourinary abnormalities (e.g. polycystic kidneys, exstrophy of bladder, hydronephrosis)
    • Fluid balance concepts and renal anatomy & physiology
    • Life-threatening electrolyte imbalances (e.g., potassium, sodium, phosphorus, magnesium, calcium)
    • Renal trauma
  • Multisystem
    • Asphyxia (e.g., near-drowning, traumatic)
    • Burns
    • Hemolytic uremic syndrome
    • Multisystem trauma
    • Septic shock/infectious diseases (e.g. congenital viral, bacterial, line sepsis, nosocomial infections)
    • Systemic inflammatory response syndrome (SIRS)/sepsis/MODS
    • Toxic exposure (e.g. fetal exposure to drug/alcohol, drug withdrawal, anaphylaxis)
    • Toxic ingestions and inhalations (e.g., drug/alcohol overdose, poisoning)
II. Professional Caring and Ethical Practice (78%)

  • Advocacy/Moral Agency (7%)
  • Caring Practices (11%)
  • Collaboration (14%)
  • Systems Thinking (8%)
  • Response to Diversity (4%)
  • Clinical Inquiry (13%)
  • Facilitation of Learning (21%)