CCRN PRACTICE QUESTIONS &
ELABORATED CORRECT ANSWERS
PASSED 100% UPDATED VERSION
A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation
in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect
perfusion to which portion of the conduction system?
A. Sinoatrial (SA) node
B. Bachmann's bundle
C. Atrioventricular (AV) node
D. Bundle of His - Correct Answer ✔✔ LAD so D. bundle of his
Which of the following is the preferred lead for ST segment monitoring for a patient with
a suspected RCA occlusion?
A.I
B. aVR
C. III
D. V1 - Correct Answer ✔✔ c. III
Which of the following is not a manifestation of hypertrophic cardiomyopathy?
A. Syncope
B. Murmur that increases with squatting
C. Chest pain
D. Sudden cardiac death - Correct Answer ✔✔ *B
Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an
aortic stenosis type of murmur that decreases when the patient is in a squatting
position. The first manifestation of this condition is occasionally sudden cardiac death
during exercise.
In which quadrant is the mean QRS complex axis located if the QRS complex is
predominantly positive in lead I and negative in lead aVF?
A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. Indeterminant quadrant - Correct Answer ✔✔ *B
Because the positive of lead I is the left arm, if the QRS complex is upright in lead I, the
mean QRS axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the
foot, if the QRS complex is negative in lead aVF, the mean QRS axis is upward away
from the foot. This axis would be in the upper left quadrant, described as left axis
deviation.
,A patient becomes apneic and pulseless. CPR has been initiated, and the monitor
shows asystole in two leads. Which of the following drugs would be used initially?
A. Calcium gluconate
B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone) - Correct Answer ✔✔ C
After CPR is initiated and an intravenous access is established, epinephrine should be
given. Calcium was used in the past in asystole but is used today only for
hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia.
Atropine is no longer recommended for asystole. Amiodarone is not indicated in
asystole because asystole is the absolute absence of irritability.
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure - Correct Answer ✔✔ A
Patients with mitral stenosis may exhibit a pinkish discoloration of the cheeks (i.e.,
malar blush). Mitral stenosis causes a diastolic murmur. Widened pulse pressure is
associated with aortic regurgitation. Narrowed pulse pressure is associated with mitral
regurgitation.
Four days after a mitral valve replacement, the patient develops atrial fibrillation. The
nurse initially would:
A. order a 12-lead EKG
B. evaluate the patient for clinical indications of hypoperfusion.
C. notify the physician.
D. ask the patient to bear down as if having a bowel movement. - Correct Answer ✔✔ B
The onset of atrial fibrillation results in the loss of atrial kick. Loss of atrial kick may
reduce the cardiac output by as much as 20-30%. This is especially true in patients
whose cardiac output may be affected by long-standing cardiac disease, such as mitral
valve disease. Assess the patient for clinical indications of hypoperfusion (e.g., cool
skin, decreased urine output, narrowed pulse pressure, and hypotension).
A patient has just returned from the cath lab. She had an angioplasty for occlusion of
her RCA. She still has femoral artery and vein sheaths in place. The patient complains
of chest pain that she rates 9/10 about an hour after she returns from the cath lab.
Which of the following is indicated?
A. Administer morphine IV.
B. Administer nitroglycerin sublingual spray.
C. Stop the heparin.
D. Notify the physician - Correct Answer ✔✔ D
, New-onset severe chest pain after percutaneous coronary intervention suggests acute
closure of the dilated coronary artery. The patient needs to be returned to the cardiac
catheterization laboratory for repeat dilation and probable insertion of stent.
A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has
been approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased
suddenly. The immediate assessment reveals a significant decrease in BP, RAP 12,
PAP 30/15 , PAOP 13. What other data would indicate the development of cardiac
tamponade?
A. Increased venous oxygen saturation (SvO2)
B. Decreased UO
C. Muffled heart sounds
D. New holosystolic murmur at the sternum - Correct Answer ✔✔ C
Muffled heart sounds are a classic finding in cardiac tamponade. Remember the classic
indications of cardiac tamponade referred to as Beck's triad: muffled heart sounds,
jugular venous distention, and hypotension. Even though urine output is a sensitive
indicator of cardiac output and in cardiac tamponade a decreased stroke volume results
in a decreased cardiac output, by the time a nurse would notice the decreased urine
output, the patient may have already had a cardiopulmonary arrest. The SvO2 actually
would decrease because of the decrease in cardiac output. New holosystolic murmur at
the lower left sternal border is a sign of ventricular septal rupture.
A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute
severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray.
Which of the following complications most likely is occurring in this patient?
A. Acute mitral regurgitation
B. Rupture of left ventricular free wall
C. Ventricular septal rupture
D. Acute aortic stenosis - Correct Answer ✔✔ A
With an inferior MI, the risk of the papillary muscles being affected is greater. The
papillary muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral
regurgitation occurs and is manifested by a new holosystolic murmur at the apex, acute
pulmonary edema, and decreased cardiac output/index
A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What
type of drug is carvedilol?
A. Calcium channel blocker
B. Angiotensin-converting enzyme inhibitor
C. Alpha- and noncardioselective beta-blocker
D. Cardioselective beta-blocker - Correct Answer ✔✔ C. Alpha- and noncardioselective
beta-blocker
ELABORATED CORRECT ANSWERS
PASSED 100% UPDATED VERSION
A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation
in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect
perfusion to which portion of the conduction system?
A. Sinoatrial (SA) node
B. Bachmann's bundle
C. Atrioventricular (AV) node
D. Bundle of His - Correct Answer ✔✔ LAD so D. bundle of his
Which of the following is the preferred lead for ST segment monitoring for a patient with
a suspected RCA occlusion?
A.I
B. aVR
C. III
D. V1 - Correct Answer ✔✔ c. III
Which of the following is not a manifestation of hypertrophic cardiomyopathy?
A. Syncope
B. Murmur that increases with squatting
C. Chest pain
D. Sudden cardiac death - Correct Answer ✔✔ *B
Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an
aortic stenosis type of murmur that decreases when the patient is in a squatting
position. The first manifestation of this condition is occasionally sudden cardiac death
during exercise.
In which quadrant is the mean QRS complex axis located if the QRS complex is
predominantly positive in lead I and negative in lead aVF?
A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. Indeterminant quadrant - Correct Answer ✔✔ *B
Because the positive of lead I is the left arm, if the QRS complex is upright in lead I, the
mean QRS axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the
foot, if the QRS complex is negative in lead aVF, the mean QRS axis is upward away
from the foot. This axis would be in the upper left quadrant, described as left axis
deviation.
,A patient becomes apneic and pulseless. CPR has been initiated, and the monitor
shows asystole in two leads. Which of the following drugs would be used initially?
A. Calcium gluconate
B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone) - Correct Answer ✔✔ C
After CPR is initiated and an intravenous access is established, epinephrine should be
given. Calcium was used in the past in asystole but is used today only for
hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia.
Atropine is no longer recommended for asystole. Amiodarone is not indicated in
asystole because asystole is the absolute absence of irritability.
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure - Correct Answer ✔✔ A
Patients with mitral stenosis may exhibit a pinkish discoloration of the cheeks (i.e.,
malar blush). Mitral stenosis causes a diastolic murmur. Widened pulse pressure is
associated with aortic regurgitation. Narrowed pulse pressure is associated with mitral
regurgitation.
Four days after a mitral valve replacement, the patient develops atrial fibrillation. The
nurse initially would:
A. order a 12-lead EKG
B. evaluate the patient for clinical indications of hypoperfusion.
C. notify the physician.
D. ask the patient to bear down as if having a bowel movement. - Correct Answer ✔✔ B
The onset of atrial fibrillation results in the loss of atrial kick. Loss of atrial kick may
reduce the cardiac output by as much as 20-30%. This is especially true in patients
whose cardiac output may be affected by long-standing cardiac disease, such as mitral
valve disease. Assess the patient for clinical indications of hypoperfusion (e.g., cool
skin, decreased urine output, narrowed pulse pressure, and hypotension).
A patient has just returned from the cath lab. She had an angioplasty for occlusion of
her RCA. She still has femoral artery and vein sheaths in place. The patient complains
of chest pain that she rates 9/10 about an hour after she returns from the cath lab.
Which of the following is indicated?
A. Administer morphine IV.
B. Administer nitroglycerin sublingual spray.
C. Stop the heparin.
D. Notify the physician - Correct Answer ✔✔ D
, New-onset severe chest pain after percutaneous coronary intervention suggests acute
closure of the dilated coronary artery. The patient needs to be returned to the cardiac
catheterization laboratory for repeat dilation and probable insertion of stent.
A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has
been approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased
suddenly. The immediate assessment reveals a significant decrease in BP, RAP 12,
PAP 30/15 , PAOP 13. What other data would indicate the development of cardiac
tamponade?
A. Increased venous oxygen saturation (SvO2)
B. Decreased UO
C. Muffled heart sounds
D. New holosystolic murmur at the sternum - Correct Answer ✔✔ C
Muffled heart sounds are a classic finding in cardiac tamponade. Remember the classic
indications of cardiac tamponade referred to as Beck's triad: muffled heart sounds,
jugular venous distention, and hypotension. Even though urine output is a sensitive
indicator of cardiac output and in cardiac tamponade a decreased stroke volume results
in a decreased cardiac output, by the time a nurse would notice the decreased urine
output, the patient may have already had a cardiopulmonary arrest. The SvO2 actually
would decrease because of the decrease in cardiac output. New holosystolic murmur at
the lower left sternal border is a sign of ventricular septal rupture.
A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute
severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray.
Which of the following complications most likely is occurring in this patient?
A. Acute mitral regurgitation
B. Rupture of left ventricular free wall
C. Ventricular septal rupture
D. Acute aortic stenosis - Correct Answer ✔✔ A
With an inferior MI, the risk of the papillary muscles being affected is greater. The
papillary muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral
regurgitation occurs and is manifested by a new holosystolic murmur at the apex, acute
pulmonary edema, and decreased cardiac output/index
A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What
type of drug is carvedilol?
A. Calcium channel blocker
B. Angiotensin-converting enzyme inhibitor
C. Alpha- and noncardioselective beta-blocker
D. Cardioselective beta-blocker - Correct Answer ✔✔ C. Alpha- and noncardioselective
beta-blocker
