CCRN PRACTICE EXAM
1. A patient in cardiogenic shock is most likely to exhibit:
A. High cardiac output and low SVR
B. Low cardiac output and high SVR
C. High preload and low SVR only
D. Low preload and low SVR
Answer: B
Rationale: Cardiogenic shock results from pump failure. Cardiac output decreases while systemic
vascular resistance increases as a compensatory mechanism. Preload is often elevated due to
ventricular failure.
2. Which ECG finding is characteristic of hyperkalemia?
A. Tall peaked T waves
B. U waves
C. Prolonged QT interval
D. ST depression
Answer: A
Rationale: Hyperkalemia classically causes tall, narrow peaked T waves. Severe hyperkalemia may
progress to widened QRS complexes and ventricular dysrhythmias.
3. Which assessment finding suggests right-sided heart failure?
A. Pulmonary crackles
B. Orthopnea
C. Jugular venous distention
D. Pink frothy sputum
Answer: C
Rationale: JVD reflects systemic venous congestion and is a hallmark of right ventricular failure.
4. A patient with an ICP of 18 mmHg and MAP of 92 mmHg has a CPP of:
A. 74 mmHg
B. 110 mmHg
C. 56 mmHg
D. 92 mmHg
Answer: A
Rationale: CPP = MAP − ICP = 92 − 18 = 74 mmHg.
𝐶𝑃𝑃 = 𝑀𝐴𝑃 − 𝐼𝐶𝑃
,5. The earliest sign of increased intracranial pressure is often:
A. Fixed pupils
B. Bradycardia
C. Altered level of consciousness
D. Decerebrate posturing
Answer: C
Rationale: Changes in mental status are usually the earliest indicator of deteriorating neurological
function.
6. Which ABG indicates respiratory acidosis?
A. pH 7.30, PaCO₂ 55
B. pH 7.50, PaCO₂ 30
C. pH 7.48, HCO₃ 34
D. pH 7.30, HCO₃ 18
Answer: A
Rationale: Low pH and elevated PaCO₂ indicate respiratory acidosis.
7. A patient develops sudden dyspnea and pleuritic chest pain. The nurse suspects:
A. Pulmonary embolism
B. COPD exacerbation
C. Atelectasis
D. Pleural effusion
Answer: A
Rationale: Sudden onset dyspnea and pleuritic chest pain are classic findings of pulmonary embolism.
8. Which medication is most likely to increase myocardial oxygen demand?
A. Nitroglycerin
B. Dobutamine
C. Morphine
D. Furosemide
Answer: B
Rationale: Dobutamine increases contractility and heart rate, thereby increasing myocardial oxygen
consumption.
9. The primary goal of PEEP is to:
, A. Reduce blood pressure
B. Increase cardiac output
C. Prevent alveolar collapse
D. Eliminate secretions
Answer: C
Rationale: PEEP maintains alveolar recruitment and improves oxygenation.
10. Which laboratory value confirms acute myocardial injury?
A. Troponin elevation
B. Elevated sodium
C. Increased platelets
D. Elevated bilirubin
Answer: A
Rationale: Troponin is highly sensitive and specific for myocardial injury.
11. Cushing's triad includes:
A. Hypotension, tachycardia, fever
B. Hypertension, bradycardia, irregular respirations
C. Bradycardia, hypotension, hypothermia
D. Tachycardia, hypertension, fever
Answer: B
Rationale: Cushing's triad signals increasing ICP and impending brain herniation.
12. Which electrolyte imbalance is associated with U waves?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Answer: C
Rationale: U waves are a classic ECG finding in hypokalemia.
13. Septic shock is primarily characterized by:
A. Increased SVR initially
B. Decreased SVR
C. Decreased cardiac output only
D. Increased preload
1. A patient in cardiogenic shock is most likely to exhibit:
A. High cardiac output and low SVR
B. Low cardiac output and high SVR
C. High preload and low SVR only
D. Low preload and low SVR
Answer: B
Rationale: Cardiogenic shock results from pump failure. Cardiac output decreases while systemic
vascular resistance increases as a compensatory mechanism. Preload is often elevated due to
ventricular failure.
2. Which ECG finding is characteristic of hyperkalemia?
A. Tall peaked T waves
B. U waves
C. Prolonged QT interval
D. ST depression
Answer: A
Rationale: Hyperkalemia classically causes tall, narrow peaked T waves. Severe hyperkalemia may
progress to widened QRS complexes and ventricular dysrhythmias.
3. Which assessment finding suggests right-sided heart failure?
A. Pulmonary crackles
B. Orthopnea
C. Jugular venous distention
D. Pink frothy sputum
Answer: C
Rationale: JVD reflects systemic venous congestion and is a hallmark of right ventricular failure.
4. A patient with an ICP of 18 mmHg and MAP of 92 mmHg has a CPP of:
A. 74 mmHg
B. 110 mmHg
C. 56 mmHg
D. 92 mmHg
Answer: A
Rationale: CPP = MAP − ICP = 92 − 18 = 74 mmHg.
𝐶𝑃𝑃 = 𝑀𝐴𝑃 − 𝐼𝐶𝑃
,5. The earliest sign of increased intracranial pressure is often:
A. Fixed pupils
B. Bradycardia
C. Altered level of consciousness
D. Decerebrate posturing
Answer: C
Rationale: Changes in mental status are usually the earliest indicator of deteriorating neurological
function.
6. Which ABG indicates respiratory acidosis?
A. pH 7.30, PaCO₂ 55
B. pH 7.50, PaCO₂ 30
C. pH 7.48, HCO₃ 34
D. pH 7.30, HCO₃ 18
Answer: A
Rationale: Low pH and elevated PaCO₂ indicate respiratory acidosis.
7. A patient develops sudden dyspnea and pleuritic chest pain. The nurse suspects:
A. Pulmonary embolism
B. COPD exacerbation
C. Atelectasis
D. Pleural effusion
Answer: A
Rationale: Sudden onset dyspnea and pleuritic chest pain are classic findings of pulmonary embolism.
8. Which medication is most likely to increase myocardial oxygen demand?
A. Nitroglycerin
B. Dobutamine
C. Morphine
D. Furosemide
Answer: B
Rationale: Dobutamine increases contractility and heart rate, thereby increasing myocardial oxygen
consumption.
9. The primary goal of PEEP is to:
, A. Reduce blood pressure
B. Increase cardiac output
C. Prevent alveolar collapse
D. Eliminate secretions
Answer: C
Rationale: PEEP maintains alveolar recruitment and improves oxygenation.
10. Which laboratory value confirms acute myocardial injury?
A. Troponin elevation
B. Elevated sodium
C. Increased platelets
D. Elevated bilirubin
Answer: A
Rationale: Troponin is highly sensitive and specific for myocardial injury.
11. Cushing's triad includes:
A. Hypotension, tachycardia, fever
B. Hypertension, bradycardia, irregular respirations
C. Bradycardia, hypotension, hypothermia
D. Tachycardia, hypertension, fever
Answer: B
Rationale: Cushing's triad signals increasing ICP and impending brain herniation.
12. Which electrolyte imbalance is associated with U waves?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypercalcemia
Answer: C
Rationale: U waves are a classic ECG finding in hypokalemia.
13. Septic shock is primarily characterized by:
A. Increased SVR initially
B. Decreased SVR
C. Decreased cardiac output only
D. Increased preload
