Caring for critically ill children takes a special mix of clinical judgment, calm, and compassion. The CCRN® (Pediatric) certification from the American Association of Critical-Care Nurses (AACN) shows that pediatric ICU nurses have that mix. The exam covers a lot of ground, from congenital heart defects to sepsis to family-centered ethics, so it’s normal to feel a little overwhelmed at first.

The good news is that AACN publishes exactly what it tests. In this guide, we’ll walk you through the exam format, the current test plan and its six content areas, the official resources worth downloading, and the questions candidates ask most often.

What Is the AACN CCRN (Pediatric) Exam?

CCRN is AACN’s specialty certification in acute/critical care nursing, and it comes in three population-specific versions: Adult, Pediatric, and Neonatal. The Pediatric exam is for registered nurses (RNs) and advanced practice registered nurses (APRNs) who care for acutely or critically ill children, most often in pediatric intensive care units (PICUs), pediatric cardiac ICUs, and pediatric transport or step-down settings.

The exam is not a memorization test. Most questions describe a child at the bedside and ask you to recognize what is happening, choose the priority action, or respond to a family, ethical, or systems issue. Eighty percent of the exam is Clinical Judgment, and the remaining 20% is Professional Caring and Ethical Practice, based on AACN’s Synergy Model for Patient Care.

What Is the CCRN (Pediatric) Exam Format?

Here are the key facts from the CCRN Exam Handbook – Direct Care, the AACN Certification Exam Policy Handbook, and AACN’s exam statistics and passing scores page:

  • Questions: 150 multiple-choice questions.
  • Scored vs. unscored: 125 scored questions and 25 unscored pretest questions used to gather data for future exams. You can’t tell them apart, so give every question your full attention.
  • Time: 3 hours (180 minutes).
  • Delivery: Computer-based through PSI at more than 300 testing centers in the U.S., or via live remote proctoring on your own computer. Testing is available year-round.
  • Passing score: 83 of 125 scored questions correct, effective November 12, 2025. AACN sets the cut score with a modified Angoff process, in which subject matter experts judge what a competent entry-level CCRN should know.
  • Results: Your pass/fail result appears on screen when you finish, and a detailed score report is emailed within 24 to 48 hours.

With 180 minutes for 150 questions, you have about 72 seconds per question. That’s comfortable for most candidates, as long as you practice reading clinical stems efficiently.

What Test Plan Does the CCRN (Pediatric) Exam Use?

The current exam follows the test plan in the CCRN Exam Handbook – Direct Care, which launched with AACN’s revised CCRN exams on November 12, 2025. AACN’s 2024 study of acute/critical care practice drove the revision. The old test plan grouped topics similarly, but the weights and several topic lists changed, so make sure any older review book or course you use has been updated.

Here is how the exam breaks down. Approximate scored-question counts are calculated from AACN’s percentages and 125 scored items.

  • Cardiovascular: 11% (about 14 questions)
  • Respiratory: 13% (about 16 questions)
  • Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary: 25% (about 31 questions)
  • Musculoskeletal, Neurological, Behavioral/Psychosocial: 15% (about 19 questions)
  • Multisystem: 17% (about 21 questions)
  • Professional Caring and Ethical Practice: 20% (about 25 questions)

Cardiovascular (11%)

This area centers on the child with a structural or functional heart problem, including care before and after cardiac surgery. Expect to connect anatomy and physiology to what you see on the monitor and at the bedside.

  • Cardiac malformations, cardiac surgery, and cardiac/vascular catheterization
  • Heart failure, cardiomyopathies, cardiogenic shock, and cardiac transplant
  • Dysrhythmias and conduction defects such as prolonged QT and Wolff-Parkinson-White
  • Cardiac infection and inflammatory diseases, hypertensive crisis, and vascular occlusions

Study tip: Know which lesions are ductal dependent, how shunting changes oxygen saturation, and what a sudden rise in chest tube output or a drop in blood pressure after surgery might mean.

Respiratory (13%)

Respiratory failure is a leading reason children end up in the PICU, and this area tests your ability to spot and manage it early.

  • Acute respiratory failure, acute respiratory infection, and ARDS
  • Status asthmaticus and chronic pulmonary conditions
  • Airway malformations, pulmonary hypertension, and acute pulmonary embolus
  • Thoracic and airway trauma and thoracic surgery

What questions look like: A child with asthma who was wheezing loudly becomes quiet with poor air movement. The correct reading is worsening obstruction, not improvement.

Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary (25%)

This is the largest and broadest content area, so it deserves the most study time. It spans five body systems with dozens of topics.

  • Endocrine: diabetes mellitus, DKA, hyper- and hypoglycemia, and diabetes insipidus vs. SIADH vs. cerebral salt wasting
  • Hematology/Immunology: anemia, coagulopathies (ITP, DIC, HIT), sickle cell crisis, bone marrow transplant, oncologic complications such as tumor lysis syndrome, and transfusion reactions (TRALI, TACO)
  • GI: GI hemorrhage, bowel obstruction or perforation, abdominal compartment syndrome, hepatic failure, liver transplant, and malnutrition
  • Renal/GU: AKI, chronic kidney disease, hemolytic uremic syndrome, kidney transplant, and life-threatening electrolyte imbalances
  • Integumentary: IV infiltration and extravasation, pressure injury, and wounds

Study tip: Sodium disorders show up often. Practice telling DI, SIADH, and cerebral salt wasting apart by urine output, serum sodium, and volume status.

Musculoskeletal, Neurological, Behavioral/Psychosocial (15%)

Most of this area is neurological, but don’t overlook the behavioral topics, which are specific to pediatrics.

  • Neurological: traumatic brain injury, seizures, hydrocephalus, intracranial hemorrhage, stroke, spinal cord injury, brain death, delirium, and neurosurgery
  • Musculoskeletal: compartment syndrome, trauma, and rhabdomyolysis
  • Behavioral/Psychosocial: abuse, neglect, and maltreatment; suicidal ideation; mood disorders; medical non-adherence; and post-intensive care syndrome (PICS)

What questions look like: An infant has injuries that don’t match the caregiver’s story. Know your mandatory reporting duty and the findings that raise suspicion of abusive head trauma.

Multisystem (17%)

Multisystem questions involve problems that affect several organ systems at once. Topics include sepsis and SIRS, shock states, MODS, acid-base imbalance, burns, submersion injuries, toxic ingestions, acute and chronic pain, healthcare-acquired conditions, palliative and end-of-life care, and tissue and organ donation.

Study tip: Many candidates find this area the hardest because it rewards pattern recognition across systems. Practice identifying the type of shock from a few vital signs and exam findings.

Professional Caring and Ethical Practice (20%)

This area is organized around the eight nurse competencies of the Synergy Model: advocacy/moral agency, caring practices, clinical inquiry, collaboration, facilitation of learning, response to diversity, systems thinking, and clinical judgment (tested throughout the clinical sections). In a pediatric exam, family-centered care is woven through almost every question.

What questions look like: Parents disagree with the team about continuing aggressive treatment. The best answer usually involves listening, arranging a family meeting, and involving ethics or palliative care resources, not simply deferring to the physician.

How Should You Use the Blueprint to Build a Study Plan?

Treat the test plan as your checklist. A few practical steps:

  1. Take a baseline. Answer a mixed set of questions before you review so you know where you stand in each area.
  2. Weight your time. The combined Endocrine/Heme/GI/Renal/Integumentary area and Professional Caring and Ethical Practice make up 45% of the exam together. Give them time in proportion to their weight.
  3. Map every miss. Tag each missed question to a specific test plan topic, such as “SIADH” or “TRALI,” rather than just “renal.”
  4. Study outside your unit. If you work in a cardiac ICU, burns, toxicology, and oncology complications may need extra time, and vice versa.
  5. Finish with timed, mixed practice. The real exam doesn’t label questions by system, so your final weeks should mirror that.

What Official Resources Should You Use?

Commonly used reference:

  • AACN Core Curriculum for Pediatric High Acuity, Progressive, and Critical Care Nursing, 3rd Edition (ISBN 978-0826133021)
  • AACN Core Curriculum for Pediatric Acute and Critical Care Nursing, 4th Edition (ISBN 978-0443115134) will be released in January 2027

Frequently Asked Questions About the CCRN (Pediatric) Exam

What score do I need to pass?
You need 83 correct out of the 125 scored questions. The 25 pretest questions don’t count toward your score.

What is the pass rate?
AACN reports a 2025 first-time pass rate of 68.72% for CCRN (Pediatric), based on 1,474 candidates tested. Roughly two out of three first-time candidates pass, so a structured plan matters.

Did the test plan change recently?
Yes. AACN launched revised CCRN exams on November 12, 2025, based on its 2024 practice analysis. The six content areas are the same, but the weights and topic lists were updated.

Can I take the exam online?
Yes. PSI offers live remote proctoring in addition to in-person testing centers.

What if I don’t pass?
You can take the same certification exam up to four times in a rolling 12-month period. Retests are discounted: $185 for AACN members and $290 for nonmembers.

How long is the certification valid?
CCRN is granted for three years. You renew through practice hours plus continuing education (Synergy CERPs) or by retaking the exam.

Is the test plan enough to study from?
The test plan tells you what’s tested, but it isn’t a textbook. Pair it with a current pediatric critical care reference and plenty of practice questions with explanations.

Start Preparing for the CCRN (Pediatric) Exam With Pocket Prep

Pocket Prep’s AACN CCRN (Pediatric) exam prep includes 400 practice questions organized by test plan area, each with a detailed explanation, plus a full-length 150-question mock exam. Use the Weakest Subject quiz to find gaps and the Timed Quiz to build your pacing. You’ve already done the hard work at the bedside, and you can walk into exam day with confidence.