CCRN Test Bank
Which 12-lead ECG changes should be expected in a patient with ACS involving the inferior
wall?
a) ST segment elevation in leads II, III and all the precordial leads
b) ST segment elevation and deeply inverted T waves in leads II, III and AvF
c) ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL
d) ST segment depression and T wave elevation in leads II, III and AvL - ANSCorrect
Answer: ST segment elevation and deeply inverted T waves in leads II, III and AvF
An inferior wall MI is associated with changes in leads II, III and aVF. ST segment elevation
in leads V4-V6 and aVL are associated with an anterolateral MI. ST elevation in leads II, III,
and all of the precordial leads are consistent with a lateral wall MI. ACS is not associated
with changes in leads II, III and aVL. Leads I and aVL are the lateral leads. ST segment
depression is indicative of ischemia or an NSTEMI.
REF: Morton PG, Fontaine DK. 2018.
When teaching a family member to perform an aspect of patient care, the nurse should
understand that family members...
a) learn best if shown a complex procedure all at once.
b) are unaffected by the timing of teaching.
c) learn unrelated tasks first.
d) learn best if they perceive a need to learn. - ANSLearn best if they percieve a need to
learn;
Family members learn best if they perceive a need to learn. This is consistent with adult
learning theory. Establishing a "need to know" is an important first step for optimal
educational efforts. The timing of education is important for an optimal outcome to be
realized. Teaching unrelated tasks will not enhance learning and is a waste of the family's and
provider's time. Learners are goal-oriented and want to make a connection between what they
are being taught and the goal (skill or knowledge) needed to solve a problem. If they
recognize the relevance of the task, they are more likely to be successful
Which may cause the development of fixed pupils?
a) hyperoxia
b) olfactory damage
c) hypothermia
d) opiates - ANSHypothermia;
Hypothermia may cause fixed pupils. Hyperoxia (oxygen toxicity) does not result in fixed
pupils. However, hypoxia may cause wide and fixed pupils due to midbrain damage. Opiates
may cause pinpoint pupils, but they are not fixed. The olfactory nerve is responsible for the
sense of smell.REF: Morton PG, Fontaine DK. 2018.
Which places the older adult at greater risk for alcohol-induced disease? - ANSUse of
psychotropic drugs is a risk factor for older adults developing alcohol-induced disease. This
is due to the synergetic effects of psychotropic drugs and alcohol. Alcohol enhances the
sedative effects of frequently used psychotropic drugs. Older adults have a slower
, metabolism, a smaller volume of body water, and a decrease in lean body tissue associated
with aging.
Following hip replacement surgery, an elderly patient with a history of diabetes, hepatic
insufficiency and alcohol abuse has a postoperative course complicated by the development
of a STAPHYLOCOCCUS infection at the surgical site. Which intervention has the highest
priority? a) Anticipate a return to the operating room.
b) Prepare the patient for wound closure.
c) Apply negative-pressure wound therapy.
d) Place the patient on strict isolation. - ANSAnticipate a return to the operating room.
The patient has risk factors (elderly, diabetes, alcohol and liver disease) and signs ( Staph
infection) of necrotizing fasciitis. Necrotic tissue must be completely excised and explored to
clean tissue and ensure the infection does not directly inoculate bone tissue. Strict isolation is
not required as necrotizing fasciitis is not contagious. Negative-pressure wound therapy could
be used once the wound has undergone debridement of necrotic tissue. Local and systemic
infection must be completely controlled before wound closure is addressed.REF: Morton,
P.G. & Fontaine, D.K. (2018).
A patient has heart failure secondary to ischemic cardiomyopathy and end-stage coronary
artery disease. Which agents would be the MOST beneficial? a) flecainide (Tambocor) and
hydralazine (Apresoline)
b) verapamil (Calan) and spironolactone (Aldactone)
c) digoxin (Lanoxin) and diltiazem (Cardizem)
d) carvedilol (Coreg) and lisinopril (Zestril) - ANSCorrect Answer: carvedilol (Coreg) and
lisinopril (Zestril)
The patient has end-stage coronary artery disease causing systolic dysfunction. These drugs
decrease afterload and minimize remodeling that is associated with heart failure. Calcium-
channel blockers are contraindicated in heart failure. Digoxin may be used in heart failure.
Spironolactone is given to block the aldosterone effect. Hydralazine is an alpha-blocker,
which reduces afterload and is used in heart failure. Flecainide is contraindicated with
structural heart disease.
Which hemodynamic profile is MOST consistent with distributive shock?
a) BP 88/44, CVP 15, PAOP 24, CI 1.5, SVR 1200, SvO2 47%
b) BP 85/40, CVP 12, PAOP 20, CI 2.0, SVR 1445, SvO2 50%
c) BP 84/42, CVP 3, PAOP 8, CI 2.5, SVR 475, SvO2 52%
d) BP 75/50, CVP 8, PAOP 8, CI 2.5, SVR 1500, SvO2 68% - ANSCorrect Answer: BP
84/42, CVP 3, PAOP 8, CI 2.5, SVR 475, SvO2 52%
In distributive shock types (e.g., anaphylactic or neurogenic), there is a decrease in venous
return, which causes a low CVP. Loss of vessel tone results in a decreased SVR. A higher
CVP indicates a high preload. The SvO2 will be lower in shock states.
The major effect of ARDS on lung tissue is - ANSDecreased compliance
Decreased compliance is related to alteration of lung endothelium and vascular tissue.
Pathophysiologic changes in lung vascular tissue and increased lung edema contribute to the
decrease in compliance. The end result is stiffness of the fluid-filled non-aerated airways.
Which 12-lead ECG changes should be expected in a patient with ACS involving the inferior
wall?
a) ST segment elevation in leads II, III and all the precordial leads
b) ST segment elevation and deeply inverted T waves in leads II, III and AvF
c) ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL
d) ST segment depression and T wave elevation in leads II, III and AvL - ANSCorrect
Answer: ST segment elevation and deeply inverted T waves in leads II, III and AvF
An inferior wall MI is associated with changes in leads II, III and aVF. ST segment elevation
in leads V4-V6 and aVL are associated with an anterolateral MI. ST elevation in leads II, III,
and all of the precordial leads are consistent with a lateral wall MI. ACS is not associated
with changes in leads II, III and aVL. Leads I and aVL are the lateral leads. ST segment
depression is indicative of ischemia or an NSTEMI.
REF: Morton PG, Fontaine DK. 2018.
When teaching a family member to perform an aspect of patient care, the nurse should
understand that family members...
a) learn best if shown a complex procedure all at once.
b) are unaffected by the timing of teaching.
c) learn unrelated tasks first.
d) learn best if they perceive a need to learn. - ANSLearn best if they percieve a need to
learn;
Family members learn best if they perceive a need to learn. This is consistent with adult
learning theory. Establishing a "need to know" is an important first step for optimal
educational efforts. The timing of education is important for an optimal outcome to be
realized. Teaching unrelated tasks will not enhance learning and is a waste of the family's and
provider's time. Learners are goal-oriented and want to make a connection between what they
are being taught and the goal (skill or knowledge) needed to solve a problem. If they
recognize the relevance of the task, they are more likely to be successful
Which may cause the development of fixed pupils?
a) hyperoxia
b) olfactory damage
c) hypothermia
d) opiates - ANSHypothermia;
Hypothermia may cause fixed pupils. Hyperoxia (oxygen toxicity) does not result in fixed
pupils. However, hypoxia may cause wide and fixed pupils due to midbrain damage. Opiates
may cause pinpoint pupils, but they are not fixed. The olfactory nerve is responsible for the
sense of smell.REF: Morton PG, Fontaine DK. 2018.
Which places the older adult at greater risk for alcohol-induced disease? - ANSUse of
psychotropic drugs is a risk factor for older adults developing alcohol-induced disease. This
is due to the synergetic effects of psychotropic drugs and alcohol. Alcohol enhances the
sedative effects of frequently used psychotropic drugs. Older adults have a slower
, metabolism, a smaller volume of body water, and a decrease in lean body tissue associated
with aging.
Following hip replacement surgery, an elderly patient with a history of diabetes, hepatic
insufficiency and alcohol abuse has a postoperative course complicated by the development
of a STAPHYLOCOCCUS infection at the surgical site. Which intervention has the highest
priority? a) Anticipate a return to the operating room.
b) Prepare the patient for wound closure.
c) Apply negative-pressure wound therapy.
d) Place the patient on strict isolation. - ANSAnticipate a return to the operating room.
The patient has risk factors (elderly, diabetes, alcohol and liver disease) and signs ( Staph
infection) of necrotizing fasciitis. Necrotic tissue must be completely excised and explored to
clean tissue and ensure the infection does not directly inoculate bone tissue. Strict isolation is
not required as necrotizing fasciitis is not contagious. Negative-pressure wound therapy could
be used once the wound has undergone debridement of necrotic tissue. Local and systemic
infection must be completely controlled before wound closure is addressed.REF: Morton,
P.G. & Fontaine, D.K. (2018).
A patient has heart failure secondary to ischemic cardiomyopathy and end-stage coronary
artery disease. Which agents would be the MOST beneficial? a) flecainide (Tambocor) and
hydralazine (Apresoline)
b) verapamil (Calan) and spironolactone (Aldactone)
c) digoxin (Lanoxin) and diltiazem (Cardizem)
d) carvedilol (Coreg) and lisinopril (Zestril) - ANSCorrect Answer: carvedilol (Coreg) and
lisinopril (Zestril)
The patient has end-stage coronary artery disease causing systolic dysfunction. These drugs
decrease afterload and minimize remodeling that is associated with heart failure. Calcium-
channel blockers are contraindicated in heart failure. Digoxin may be used in heart failure.
Spironolactone is given to block the aldosterone effect. Hydralazine is an alpha-blocker,
which reduces afterload and is used in heart failure. Flecainide is contraindicated with
structural heart disease.
Which hemodynamic profile is MOST consistent with distributive shock?
a) BP 88/44, CVP 15, PAOP 24, CI 1.5, SVR 1200, SvO2 47%
b) BP 85/40, CVP 12, PAOP 20, CI 2.0, SVR 1445, SvO2 50%
c) BP 84/42, CVP 3, PAOP 8, CI 2.5, SVR 475, SvO2 52%
d) BP 75/50, CVP 8, PAOP 8, CI 2.5, SVR 1500, SvO2 68% - ANSCorrect Answer: BP
84/42, CVP 3, PAOP 8, CI 2.5, SVR 475, SvO2 52%
In distributive shock types (e.g., anaphylactic or neurogenic), there is a decrease in venous
return, which causes a low CVP. Loss of vessel tone results in a decreased SVR. A higher
CVP indicates a high preload. The SvO2 will be lower in shock states.
The major effect of ARDS on lung tissue is - ANSDecreased compliance
Decreased compliance is related to alteration of lung endothelium and vascular tissue.
Pathophysiologic changes in lung vascular tissue and increased lung edema contribute to the
decrease in compliance. The end result is stiffness of the fluid-filled non-aerated airways.
