CCRN Practice Exam- Cardiovascular/Barron's CCRN Cardiac Focused Exam
Prep
CCRN PRACTICE EXAM- CARDIOVASCULAR/BARRON'S CCRN CARDIAC
FOCUSED EXAM PREP NEWEST 2026/2027 ACTUAL EXAM COMPLETE
100 QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) WITH DETAILED RATIONALES |ALREADY GRADED
A+||BRAND NEW VERSION!!
A woman, age 35 years, reports the feeling that her heart is racing out of her
chest, shortness of breath, and dizziness on admission to the critical care unit. The
patient reports a history of a "floppy valve" for the past 10 years. Which of the
following is true regarding the murmur of mitral valve prolapse?
a. Early systolic with a low-pitched, blowing quality
b. Radiates to the carotid arteries
c. Loudest at the lower left sternal border
d. Usually accompanied by a midsystolic click
Correct answer: d
Rationale: The murmur of mitral valve prolapse is caused by mitral regurgitation.
Mitral regurgitation murmurs are high-pitched, blowing, systolic murmurs that are
loudest at the apex and radiate to the axilla. When specific to mitral valve
prolapse, a midsystolic click usually is heard at the apex, and the murmur follows
the click such as S1, click, murmur, S2.
Test-Taking Strategy: Remember that all murmurs are high-pitched with the
exceptions of mitral stenosis and tricuspid stenosis, so eliminate option a.
Radiation is in the direction of blood flow. In this case, the direction is from the
left ventricle to the left atrium, which causes the radiation to the axilla, not the
carotid arteries. Eliminate option b. Mitral regurgitation murmurs are loudest at
the apex, also called the mitral area. Eliminate option c. The click is associated
with a mitral valve leaflet bulging toward the left atrium during midsystole.
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, CCRN Practice Exam- Cardiovascular/Barron's CCRN Cardiac Focused Exam
Prep
Remember that mitral valve prolapse also is called click-murmur syndrome.
Choose option d.
Which of the following describes the timing of the murmur of aortic stenosis?
a. Holosystolic
b. Systolic ejection
c. Early diastolic
d. Middiastolic to late diastolic
Correct answer: b
Rationale: Aortic stenosis causes a high-pitched, harsh systolic ejection murmur
that is loudest at the second right intercostal space (i.e., aortic area) and radiating
to the carotid arteries. Mitral regurgitation is a holosystolic murmur. Aortic
regurgitation is an early diastolic murmur. Mitral stenosis is a middiastolic to late
diastolic murmur.
Test-Taking Strategy: Stenosis means that the valve does not open well, so
consider the following: When is the aortic valve open? The valve is open during
systole, so if the valve does not open well, the turbulence (and the murmur) must
occur during systole. Eliminate options c and d. Now, is the answer holosystolic or
systolic ejection? Focus further on systole. When does blood go through the aortic
valve? The first subphase of systole is isovolumetric contraction when all four
valves are closed, no blood is moving, and the pressure in the ventricle is
increasing to the point that it exceeds the pressure in the aorta and the aortic
valve is opened. The turbulence (and murmur) does not begin until blood starts to
go through the aortic valve. Choose systolic ejection, option b.
A 25-year-old semicomatose woman is admitted to the critical care unit. The
patient's friend reports the patient's use of illegal drugs. General assessment
reveals a cachectic body. A prolonged QT segment is noted on the 12-lead
electrocardiogram. Which electrolyte is least likely to be the cause of the
observed electrical changes?
a. Potassium
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, CCRN Practice Exam- Cardiovascular/Barron's CCRN Cardiac Focused Exam
Prep
b. Calcium
c. Sodium
d. Magnesium
Correct answer: c
Rationale: Sodium affects phase 0 of the action potential or the cellular response
to a stimulus that results in depolarization. A prolonged QT segment represents
prolonged repolarization. Calcium, magnesium, or potassium imbalances may
affect phases 2 and 3 of the action potential by shortening or lengthening this
phase. Low levels of any of these would result in prolonged repolarization, which
would be seen as a prolonged QT segment.
Test-Taking Strategy: If you have no idea of the correct answer, use a common
sense approach. Potassium, calcium, and magnesium abnormalities almost always
are seen together. Also, abnormal levels are most likely to result in more severe
abnormal body functions. Abnormal sodium levels are less likely to have as
dramatic findings unless levels are extremely abnormal, as may be seen in
endocrine abnormalities.
Which of the following is a manifestation of left atrial enlargement on the
electrocardiogram?
a. Increased amplitude of the P wave on a rhythm strip
b. Wide, notched P waves in lead II on 12-lead electrocardiogram
c. Diphasic P wave in lead V1 on 12-lead electrocardiogram
d. Tall, peaked P waves in lead II on 12-lead electrocardiogram
Correct answer: b
Rationale: P waves represent atrial contraction, so look for changes in the P waves
as an indication of atrial enlargement. Leads II and V1 are the two best P wave
leads. P waves on a voltage standardized 12-lead electrocardiogram should be
about 2½ blocks tall and 2½ blocks wide. The P wave in lead II becomes tall and
peaked in right atrial enlargement and wide and notched in left atrial
enlargement. The P wave is normally diphasic in lead V1. The initial half of the
3|Page
, CCRN Practice Exam- Cardiovascular/Barron's CCRN Cardiac Focused Exam
Prep
normal diphasic P wave in lead V1 represents right atrial depolarization, and the
terminal half of the normal diphasic P wave in lead V1 represents left atrial
depolarization. Therefore right atrial enlargement causes a dominant initial half of
the diphasic P wave in lead V1, whereas left atrial enlargement causes a dominant
terminal half of the diphasic P wave in lead V1.
Test-Taking Strategy: Rhythm strips have no standardization for voltage, and
enlargement and hypertrophy are manifested by changes in voltage. So eliminate
option a because anyone can increase the size of the P wave by increasing the size
or gain. Diphasic P waves (ones that are positive and negative) are normal in lead
V1, so eliminate option c. Tall, peaked P waves in lead II are called P pulmonale
and are associated with right atrial enlargement, so eliminate option d. Wide,
notched P waves in lead II are called P mitrale and are associated with left atrial
enlargement. Choose option b.
A patient is admitted with unstable angina. He has a long history of hypertension
and coronary artery disease. The nurse notes a split S2 on expiration and a single
S2 on inspiration during cardiac auscultation. Blood pressure is 150/88 mm Hg,
and heart rate is 88 beats/min. On the electrocardiogram, there is a normal-
appearing P wave in front of each QRS complex, the PR interval measures 0.2
second consistently, and the QRS complexes measure 0.14 second. They are
positive in V5 and V6 and negative in V1 and V2. These findings most likely
indicate which of the following?
a. Left bundle branch block (LBBB)
b. Right bundle branch block (RBBB)
c. Third-degree atrioventricular block
d. Ventricular tachycardia
Correct answer: a
Rationale: Features of LBBB described here are a QRS complex greater than 0.12
second in duration and a QRS complex that is positive in leads V5 and V6 (consider
these left ventricular leads) and negative in leads V1 and V2 (consider these right
ventricular leads). LBBB causes a paradoxical splitting of S2. This means that it is
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Prep
CCRN PRACTICE EXAM- CARDIOVASCULAR/BARRON'S CCRN CARDIAC
FOCUSED EXAM PREP NEWEST 2026/2027 ACTUAL EXAM COMPLETE
100 QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) WITH DETAILED RATIONALES |ALREADY GRADED
A+||BRAND NEW VERSION!!
A woman, age 35 years, reports the feeling that her heart is racing out of her
chest, shortness of breath, and dizziness on admission to the critical care unit. The
patient reports a history of a "floppy valve" for the past 10 years. Which of the
following is true regarding the murmur of mitral valve prolapse?
a. Early systolic with a low-pitched, blowing quality
b. Radiates to the carotid arteries
c. Loudest at the lower left sternal border
d. Usually accompanied by a midsystolic click
Correct answer: d
Rationale: The murmur of mitral valve prolapse is caused by mitral regurgitation.
Mitral regurgitation murmurs are high-pitched, blowing, systolic murmurs that are
loudest at the apex and radiate to the axilla. When specific to mitral valve
prolapse, a midsystolic click usually is heard at the apex, and the murmur follows
the click such as S1, click, murmur, S2.
Test-Taking Strategy: Remember that all murmurs are high-pitched with the
exceptions of mitral stenosis and tricuspid stenosis, so eliminate option a.
Radiation is in the direction of blood flow. In this case, the direction is from the
left ventricle to the left atrium, which causes the radiation to the axilla, not the
carotid arteries. Eliminate option b. Mitral regurgitation murmurs are loudest at
the apex, also called the mitral area. Eliminate option c. The click is associated
with a mitral valve leaflet bulging toward the left atrium during midsystole.
1|Page
, CCRN Practice Exam- Cardiovascular/Barron's CCRN Cardiac Focused Exam
Prep
Remember that mitral valve prolapse also is called click-murmur syndrome.
Choose option d.
Which of the following describes the timing of the murmur of aortic stenosis?
a. Holosystolic
b. Systolic ejection
c. Early diastolic
d. Middiastolic to late diastolic
Correct answer: b
Rationale: Aortic stenosis causes a high-pitched, harsh systolic ejection murmur
that is loudest at the second right intercostal space (i.e., aortic area) and radiating
to the carotid arteries. Mitral regurgitation is a holosystolic murmur. Aortic
regurgitation is an early diastolic murmur. Mitral stenosis is a middiastolic to late
diastolic murmur.
Test-Taking Strategy: Stenosis means that the valve does not open well, so
consider the following: When is the aortic valve open? The valve is open during
systole, so if the valve does not open well, the turbulence (and the murmur) must
occur during systole. Eliminate options c and d. Now, is the answer holosystolic or
systolic ejection? Focus further on systole. When does blood go through the aortic
valve? The first subphase of systole is isovolumetric contraction when all four
valves are closed, no blood is moving, and the pressure in the ventricle is
increasing to the point that it exceeds the pressure in the aorta and the aortic
valve is opened. The turbulence (and murmur) does not begin until blood starts to
go through the aortic valve. Choose systolic ejection, option b.
A 25-year-old semicomatose woman is admitted to the critical care unit. The
patient's friend reports the patient's use of illegal drugs. General assessment
reveals a cachectic body. A prolonged QT segment is noted on the 12-lead
electrocardiogram. Which electrolyte is least likely to be the cause of the
observed electrical changes?
a. Potassium
2|Page
, CCRN Practice Exam- Cardiovascular/Barron's CCRN Cardiac Focused Exam
Prep
b. Calcium
c. Sodium
d. Magnesium
Correct answer: c
Rationale: Sodium affects phase 0 of the action potential or the cellular response
to a stimulus that results in depolarization. A prolonged QT segment represents
prolonged repolarization. Calcium, magnesium, or potassium imbalances may
affect phases 2 and 3 of the action potential by shortening or lengthening this
phase. Low levels of any of these would result in prolonged repolarization, which
would be seen as a prolonged QT segment.
Test-Taking Strategy: If you have no idea of the correct answer, use a common
sense approach. Potassium, calcium, and magnesium abnormalities almost always
are seen together. Also, abnormal levels are most likely to result in more severe
abnormal body functions. Abnormal sodium levels are less likely to have as
dramatic findings unless levels are extremely abnormal, as may be seen in
endocrine abnormalities.
Which of the following is a manifestation of left atrial enlargement on the
electrocardiogram?
a. Increased amplitude of the P wave on a rhythm strip
b. Wide, notched P waves in lead II on 12-lead electrocardiogram
c. Diphasic P wave in lead V1 on 12-lead electrocardiogram
d. Tall, peaked P waves in lead II on 12-lead electrocardiogram
Correct answer: b
Rationale: P waves represent atrial contraction, so look for changes in the P waves
as an indication of atrial enlargement. Leads II and V1 are the two best P wave
leads. P waves on a voltage standardized 12-lead electrocardiogram should be
about 2½ blocks tall and 2½ blocks wide. The P wave in lead II becomes tall and
peaked in right atrial enlargement and wide and notched in left atrial
enlargement. The P wave is normally diphasic in lead V1. The initial half of the
3|Page
, CCRN Practice Exam- Cardiovascular/Barron's CCRN Cardiac Focused Exam
Prep
normal diphasic P wave in lead V1 represents right atrial depolarization, and the
terminal half of the normal diphasic P wave in lead V1 represents left atrial
depolarization. Therefore right atrial enlargement causes a dominant initial half of
the diphasic P wave in lead V1, whereas left atrial enlargement causes a dominant
terminal half of the diphasic P wave in lead V1.
Test-Taking Strategy: Rhythm strips have no standardization for voltage, and
enlargement and hypertrophy are manifested by changes in voltage. So eliminate
option a because anyone can increase the size of the P wave by increasing the size
or gain. Diphasic P waves (ones that are positive and negative) are normal in lead
V1, so eliminate option c. Tall, peaked P waves in lead II are called P pulmonale
and are associated with right atrial enlargement, so eliminate option d. Wide,
notched P waves in lead II are called P mitrale and are associated with left atrial
enlargement. Choose option b.
A patient is admitted with unstable angina. He has a long history of hypertension
and coronary artery disease. The nurse notes a split S2 on expiration and a single
S2 on inspiration during cardiac auscultation. Blood pressure is 150/88 mm Hg,
and heart rate is 88 beats/min. On the electrocardiogram, there is a normal-
appearing P wave in front of each QRS complex, the PR interval measures 0.2
second consistently, and the QRS complexes measure 0.14 second. They are
positive in V5 and V6 and negative in V1 and V2. These findings most likely
indicate which of the following?
a. Left bundle branch block (LBBB)
b. Right bundle branch block (RBBB)
c. Third-degree atrioventricular block
d. Ventricular tachycardia
Correct answer: a
Rationale: Features of LBBB described here are a QRS complex greater than 0.12
second in duration and a QRS complex that is positive in leads V5 and V6 (consider
these left ventricular leads) and negative in leads V1 and V2 (consider these right
ventricular leads). LBBB causes a paradoxical splitting of S2. This means that it is
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