10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free CCM questions are organized by exam domain, so you can see how each part of the Certified Construction Manager blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Project Management Planning 15% of exam
Question 1
Dobutamine is increased for postoperative hypotension. Heart rate rises from 105 to 138/min, arterial pressure falls from 92/54 to 70/40 mmHg, and a systolic murmur becomes louder. Transesophageal echocardiography shows a small, hyperdynamic left ventricle, systolic movement of the anterior mitral leaflet toward the septum, and a posteriorly directed mitral regurgitant jet. What explains the paradoxical deterioration after the increase in dobutamine?
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Correct answer: A - Increased contractility and reduced cavity size intensify dynamic left ventricular outflow obstruction.
Question 2
An arterial blood gas obtained before intubation in a patient with sepsis shows pH 7.44, PaCO2 20 mmHg, and bicarbonate 13 mmol/L. Serum sodium is 139 mmol/L, chloride 100 mmol/L, and albumin 4.0 g/dL. The lactate is 6.2 mmol/L. Which acid-base interpretation accounts for both the electrolyte results and the measured PaCO2?
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Correct answer: B - High-anion-gap metabolic acidosis with superimposed respiratory alkalosis.
Question 3
Sepsis has resolved, but a previously independent 61-year-old remains unable to sustain spontaneous ventilation after three weeks in the ICU. She is awake, follows commands, and has symmetric limb weakness, reduced tendon reflexes, and distal sensory loss. Nerve-conduction studies show low motor and sensory response amplitudes with relatively preserved conduction velocities and no conduction block. Where is the predominant injury responsible for this pattern?
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Correct answer: A - Motor and sensory axons.
Question 4
Forty-five minutes into a red-cell transfusion, a postoperative patient develops hypoxemia, a temperature of 38.3 C, and hypotension. The chest radiograph shows new bilateral alveolar opacities. Oxygenation had been stable for the preceding 24 hours. Fluid balance is only 300 mL positive, the neck veins are not distended, and echocardiography shows preserved ventricular function without evidence of elevated left-sided filling pressure. There is no rash, wheezing, hemoglobinuria, or biochemical evidence of hemolysis. The transfusion has been stopped. Which process most likely produced the pulmonary edema?
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Correct answer: C - Increased pulmonary capillary permeability from transfusion-triggered inflammation.
Domain 2: Cost Management 15% of exam
Question 5
After 18 hours of invasive ventilation for pneumonia-associated ARDS, a 52-year-old remains supine with a PaO2/FiO2 ratio of 90 mmHg. Tidal volume is 6 mL/kg predicted body weight, PEEP is 12 cm H2O, and plateau pressure is 27 cm H2O. Ventilator synchrony is adequate, and blood pressure is stable on low-dose norepinephrine. There is no spinal instability or other contraindication to repositioning. Which addition to lung-protective ventilation offers the best-supported survival benefit at this stage?
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Correct answer: C - Prone the patient for 16-hour sessions.
Question 6
By the morning after admission for diabetic ketoacidosis, a patient with type 1 diabetes is alert and eating. Glucose is 176 mg/dL, potassium 4.0 mmol/L, beta-hydroxybutyrate 0.4 mmol/L, venous pH 7.34, and bicarbonate 17 mmol/L. Sodium is 140 mmol/L and chloride 113 mmol/L; urine ketones remain 2+. IV insulin and dextrose are still running. A subcutaneous basal-bolus regimen has been selected, but no basal insulin has yet been given. How should the IV insulin be discontinued?
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Correct answer: D - Administer subcutaneous basal insulin, maintain a 2-hour overlap, then stop the IV infusion.
Question 7
Source control and antimicrobial therapy have been provided for a 54-year-old with septic shock. After 30 mL/kg of balanced crystalloid, the MAP remains 58 mmHg despite a norepinephrine dose that has risen to 0.34 mcg/kg/min. Echocardiography shows normal biventricular systolic function. Passive leg raising increases measured stroke volume by only 2%, and lung ultrasound now shows diffuse B-lines. Which hemodynamic adjustment is most appropriate now?
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Correct answer: D - Add vasopressin to the norepinephrine infusion.
Question 8
Eight hours after cesarean delivery for preeclampsia with severe features, a patient receiving magnesium sulfate at 2 g/hour becomes difficult to arouse. Respiratory rate is 6/min, heart rate 48/min, and patellar reflexes are absent. Urine output has fallen to 10 mL/hour, and creatinine has increased to 2.1 mg/dL. The magnesium infusion is stopped and assisted ventilation is begun. Which medication directly reverses the drug effect responsible for this deterioration?
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Correct answer: C - Calcium gluconate 1 g intravenously.
Question 9
Creatinine rises from a documented baseline of 0.9 to 3.4 mg/dL over 48 hours after repair of a ruptured abdominal aortic aneurysm. Urine output is 0.7 mL/kg/hour, potassium 4.7 mmol/L, BUN 65 mg/dL, and arterial pH 7.36. The patient is euvolemic, cognitively intact, and breathing comfortably without supplemental oxygen. Which assessment correctly combines KDIGO staging with the current need for renal replacement therapy?
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Correct answer: A - Stage 3 AKI; close monitoring without immediate renal replacement therapy.
Domain 3: Time Management 10% of exam
Question 10
During an afternoon delirium assessment, an intubated patient who was attentive that morning now has fluctuating alertness. She awakens to voice and maintains eye contact for 20 seconds before drifting back to sleep, corresponding to a RASS of -1. She makes four errors on the CAM-ICU letter-attention task but answers all disorganized-thinking questions correctly. How should this examination be interpreted?
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Correct answer: B - The CAM-ICU is positive despite intact performance on the thinking questions.