ATI CCRN CERTIFICATION
10 MODULES
40 PRACTICE TESTS
Q&A
2024
,MODULE 1
1. A patient with cardiogenic shock is receiving dobutamine, a beta-1 adrenergic agonist, to
increase cardiac output. Which of the following parameters should the nurse monitor closely to
evaluate the effectiveness of this medication?
a) Blood pressure
b) Heart rate
c) Central venous pressure (CVP)
d) Pulmonary capillary wedge pressure (PCWP)*
Rationale: PCWP reflects the left ventricular end-diastolic pressure and is a sensitive indicator
of fluid status and cardiac function. A high PCWP indicates pulmonary congestion and
impaired left ventricular function. Dobutamine aims to improve cardiac contractility and
reduce PCWP. Blood pressure, heart rate and CVP are also important to monitor, but they are
not as specific as PCWP for assessing the response to dobutamine.
2. A patient with septic shock is receiving norepinephrine, a potent vasoconstrictor, to maintain
adequate perfusion pressure. The nurse notices that the patient's urine output has decreased and
the serum creatinine has increased. What is the most likely explanation for this finding?
a) The patient has developed acute kidney injury due to decreased renal blood flow.*
b) The patient has developed a urinary tract infection due to catheterization.
c) The patient has developed fluid overload due to excessive fluid resuscitation.
d) The patient has developed metabolic acidosis due to lactic acid accumulation.
Rationale: Norepinephrine causes vasoconstriction of the peripheral and renal vessels, which
can reduce renal blood flow and cause acute kidney injury. This is manifested by decreased
urine output and increased serum creatinine. A urinary tract infection, fluid overload and
metabolic acidosis are possible complications of septic shock, but they are not directly related
to norepinephrine administration.
3. A patient with pulmonary hypertension is receiving sildenafil, a phosphodiesterase-5
inhibitor, to reduce pulmonary vascular resistance and improve right ventricular function.
Which of the following adverse effects should the nurse monitor for in this patient?
a) Hypotension*
b) Tachycardia
c) Dyspnea
d) Headache
Rationale: Sildenafil causes vasodilation of the systemic and pulmonary vessels, which can
lower blood pressure and increase the risk of hypotension. Tachycardia, dyspnea and headache
,are common symptoms of pulmonary hypertension, but they are not necessarily caused by
sildenafil.
4. A patient with heart failure is receiving digoxin, a cardiac glycoside, to increase cardiac
contractility and slow down the heart rate. The nurse observes that the patient has developed
nausea, vomiting, blurred vision and yellow halos around lights. What is the most appropriate
action for the nurse to take?
a) Administer an antiemetic and an analgesic to relieve the symptoms.
b) Check the serum potassium level and administer potassium supplements if needed.
c) Check the serum digoxin level and withhold the next dose if it is elevated.*
d) Notify the physician and prepare for electrical cardioversion if needed.
Rationale: Nausea, vomiting, blurred vision and yellow halos around lights are signs of digoxin
toxicity, which can be life-threatening. The serum digoxin level should be checked and the
next dose should be withheld if it is above the therapeutic range (0.5-2 ng/mL). Potassium
supplements may be needed if the serum potassium level is low, as hypokalemia can increase
the risk of digoxin toxicity. Electrical cardioversion is not indicated for digoxin toxicity, as it
can worsen cardiac arrhythmias.
5. A patient with acute coronary syndrome is receiving heparin, an anticoagulant, to prevent
thrombus formation and reduce the risk of myocardial infarction. Which of the following
laboratory tests should the nurse monitor closely to adjust the heparin dose?
a) Prothrombin time (PT)
b) International normalized ratio (INR)
c) Activated partial thromboplastin time (aPTT)*
d) Platelet count
Rationale: aPTT measures the intrinsic pathway of coagulation and is used to monitor heparin
therapy. The therapeutic range for aPTT is 1.5-2 times the normal value (25-35 seconds). PT,
INR and platelet count are used to monitor warfarin therapy, another anticoagulant that works
on the extrinsic pathway of coagulation.
6. A patient with hypertension is receiving lisinopril, an angiotensin-converting enzyme (ACE)
inhibitor, to lower blood pressure and prevent cardiovascular complications. Which of the
following statements by the patient indicates a need for further education by the nurse?
a) "I should avoid salt substitutes that contain potassium."
b) "I should report any cough, rash or swelling to my doctor."
c) "I should take this medication with food to prevent stomach upset."*
d) "I should check my blood pressure regularly and keep a record of it."
Rationale: Lisinopril should be taken on an empty stomach, as food can decrease its absorption
and effectiveness. Salt substitutes that contain potassium should be avoided, as lisinopril can
increase serum potassium levels and cause hyperkalemia. Cough, rash and swelling are
common adverse effects of lisinopril and should be reported to the doctor. Blood pressure
monitoring is important to evaluate the response to lisinopril and adjust the dose if needed.
7. A patient with atrial fibrillation is receiving amiodarone, an antiarrhythmic agent, to
maintain sinus rhythm and prevent thromboembolic events. Which of the following
instructions should the nurse give to the patient regarding this medication?
a) "You should avoid grapefruit juice and other citrus fruits while taking this medication."
b) "You should wear sunglasses and sunscreen when going outdoors while taking this
, medication."*
c) "You should take this medication with a full glass of water and a high-fiber diet to prevent
constipation."
d) "You should stop taking this medication if you experience any palpitations or chest pain."
Rationale: Amiodarone can cause photosensitivity and increase the risk of sunburn and skin
damage. Sunglasses and sunscreen are recommended to protect the skin from ultraviolet rays.
Grapefruit juice and other citrus fruits do not interact with amiodarone. Constipation is not a
common adverse effect of amiodarone. Palpitations and chest pain are signs of worsening
arrhythmia and should be reported to the doctor, but not a reason to stop taking amiodarone
without medical advice.
8. A patient with angina pectoris is receiving nitroglycerin, a nitrate, to dilate the coronary
arteries and relieve chest pain. The nurse teaches the patient how to use sublingual
nitroglycerin tablets in case of an anginal attack. Which of the following statements by the
patient indicates a correct understanding of the teaching?
a) "I should take one tablet every 15 minutes until the pain goes away or I take four tablets."
b) "I should take one tablet as soon as I feel chest pain and call 911 if the pain persists after 5
minutes."*
c) "I should take one tablet before any activity that may trigger chest pain and repeat it every
hour if needed."
d) "I should take one tablet under my tongue and swallow it with water after it dissolves."
Rationale: The correct way to use sublingual nitroglycerin tablets is to take one tablet under the
tongue as soon as chest pain occurs and let it dissolve without swallowing. If the pain persists
after 5 minutes, another tablet can be taken and 911 can be called. This can be repeated up to
three times (total of four tablets). Taking nitroglycerin every 15 minutes or every hour is not
recommended, as it can cause hypotension, headache and tolerance. Taking nitroglycerin
before activity may prevent angina, but it is not a substitute for lifestyle modifications or other
medications.
9. A patient with peripheral arterial disease is receiving cilostazol, a phosphodiesterase-3
inhibitor, to improve blood flow and reduce intermittent claudication. Which of the following
assessments should the nurse perform before administering this medication?
a) Auscultate the heart sounds and check for murmurs or gallops.
b) Palpate the peripheral pulses and check for strength and symmetry.
c) Measure the blood pressure and pulse rate and check for orthostatic changes.*
d) Inspect the skin and nails and check for color, temperature and lesions.
Rationale: Cilostazol causes vasodilation and can lower blood pressure and increase heart rate.
Orthostatic hypotension can occur, especially in the first weeks of therapy. Blood pressure and
pulse rate should be measured before giving cilostazol and monitored periodically thereafter.
Heart sounds, peripheral pulses and skin condition are also important to assess, but they are not
directly affected by cilostazol.
1. In hemodynamics, which of the following parameters is used to measure the resistance to
blood flow in the systemic circulation?
a) Cardiac output
b) Systemic vascular resistance
10 MODULES
40 PRACTICE TESTS
Q&A
2024
,MODULE 1
1. A patient with cardiogenic shock is receiving dobutamine, a beta-1 adrenergic agonist, to
increase cardiac output. Which of the following parameters should the nurse monitor closely to
evaluate the effectiveness of this medication?
a) Blood pressure
b) Heart rate
c) Central venous pressure (CVP)
d) Pulmonary capillary wedge pressure (PCWP)*
Rationale: PCWP reflects the left ventricular end-diastolic pressure and is a sensitive indicator
of fluid status and cardiac function. A high PCWP indicates pulmonary congestion and
impaired left ventricular function. Dobutamine aims to improve cardiac contractility and
reduce PCWP. Blood pressure, heart rate and CVP are also important to monitor, but they are
not as specific as PCWP for assessing the response to dobutamine.
2. A patient with septic shock is receiving norepinephrine, a potent vasoconstrictor, to maintain
adequate perfusion pressure. The nurse notices that the patient's urine output has decreased and
the serum creatinine has increased. What is the most likely explanation for this finding?
a) The patient has developed acute kidney injury due to decreased renal blood flow.*
b) The patient has developed a urinary tract infection due to catheterization.
c) The patient has developed fluid overload due to excessive fluid resuscitation.
d) The patient has developed metabolic acidosis due to lactic acid accumulation.
Rationale: Norepinephrine causes vasoconstriction of the peripheral and renal vessels, which
can reduce renal blood flow and cause acute kidney injury. This is manifested by decreased
urine output and increased serum creatinine. A urinary tract infection, fluid overload and
metabolic acidosis are possible complications of septic shock, but they are not directly related
to norepinephrine administration.
3. A patient with pulmonary hypertension is receiving sildenafil, a phosphodiesterase-5
inhibitor, to reduce pulmonary vascular resistance and improve right ventricular function.
Which of the following adverse effects should the nurse monitor for in this patient?
a) Hypotension*
b) Tachycardia
c) Dyspnea
d) Headache
Rationale: Sildenafil causes vasodilation of the systemic and pulmonary vessels, which can
lower blood pressure and increase the risk of hypotension. Tachycardia, dyspnea and headache
,are common symptoms of pulmonary hypertension, but they are not necessarily caused by
sildenafil.
4. A patient with heart failure is receiving digoxin, a cardiac glycoside, to increase cardiac
contractility and slow down the heart rate. The nurse observes that the patient has developed
nausea, vomiting, blurred vision and yellow halos around lights. What is the most appropriate
action for the nurse to take?
a) Administer an antiemetic and an analgesic to relieve the symptoms.
b) Check the serum potassium level and administer potassium supplements if needed.
c) Check the serum digoxin level and withhold the next dose if it is elevated.*
d) Notify the physician and prepare for electrical cardioversion if needed.
Rationale: Nausea, vomiting, blurred vision and yellow halos around lights are signs of digoxin
toxicity, which can be life-threatening. The serum digoxin level should be checked and the
next dose should be withheld if it is above the therapeutic range (0.5-2 ng/mL). Potassium
supplements may be needed if the serum potassium level is low, as hypokalemia can increase
the risk of digoxin toxicity. Electrical cardioversion is not indicated for digoxin toxicity, as it
can worsen cardiac arrhythmias.
5. A patient with acute coronary syndrome is receiving heparin, an anticoagulant, to prevent
thrombus formation and reduce the risk of myocardial infarction. Which of the following
laboratory tests should the nurse monitor closely to adjust the heparin dose?
a) Prothrombin time (PT)
b) International normalized ratio (INR)
c) Activated partial thromboplastin time (aPTT)*
d) Platelet count
Rationale: aPTT measures the intrinsic pathway of coagulation and is used to monitor heparin
therapy. The therapeutic range for aPTT is 1.5-2 times the normal value (25-35 seconds). PT,
INR and platelet count are used to monitor warfarin therapy, another anticoagulant that works
on the extrinsic pathway of coagulation.
6. A patient with hypertension is receiving lisinopril, an angiotensin-converting enzyme (ACE)
inhibitor, to lower blood pressure and prevent cardiovascular complications. Which of the
following statements by the patient indicates a need for further education by the nurse?
a) "I should avoid salt substitutes that contain potassium."
b) "I should report any cough, rash or swelling to my doctor."
c) "I should take this medication with food to prevent stomach upset."*
d) "I should check my blood pressure regularly and keep a record of it."
Rationale: Lisinopril should be taken on an empty stomach, as food can decrease its absorption
and effectiveness. Salt substitutes that contain potassium should be avoided, as lisinopril can
increase serum potassium levels and cause hyperkalemia. Cough, rash and swelling are
common adverse effects of lisinopril and should be reported to the doctor. Blood pressure
monitoring is important to evaluate the response to lisinopril and adjust the dose if needed.
7. A patient with atrial fibrillation is receiving amiodarone, an antiarrhythmic agent, to
maintain sinus rhythm and prevent thromboembolic events. Which of the following
instructions should the nurse give to the patient regarding this medication?
a) "You should avoid grapefruit juice and other citrus fruits while taking this medication."
b) "You should wear sunglasses and sunscreen when going outdoors while taking this
, medication."*
c) "You should take this medication with a full glass of water and a high-fiber diet to prevent
constipation."
d) "You should stop taking this medication if you experience any palpitations or chest pain."
Rationale: Amiodarone can cause photosensitivity and increase the risk of sunburn and skin
damage. Sunglasses and sunscreen are recommended to protect the skin from ultraviolet rays.
Grapefruit juice and other citrus fruits do not interact with amiodarone. Constipation is not a
common adverse effect of amiodarone. Palpitations and chest pain are signs of worsening
arrhythmia and should be reported to the doctor, but not a reason to stop taking amiodarone
without medical advice.
8. A patient with angina pectoris is receiving nitroglycerin, a nitrate, to dilate the coronary
arteries and relieve chest pain. The nurse teaches the patient how to use sublingual
nitroglycerin tablets in case of an anginal attack. Which of the following statements by the
patient indicates a correct understanding of the teaching?
a) "I should take one tablet every 15 minutes until the pain goes away or I take four tablets."
b) "I should take one tablet as soon as I feel chest pain and call 911 if the pain persists after 5
minutes."*
c) "I should take one tablet before any activity that may trigger chest pain and repeat it every
hour if needed."
d) "I should take one tablet under my tongue and swallow it with water after it dissolves."
Rationale: The correct way to use sublingual nitroglycerin tablets is to take one tablet under the
tongue as soon as chest pain occurs and let it dissolve without swallowing. If the pain persists
after 5 minutes, another tablet can be taken and 911 can be called. This can be repeated up to
three times (total of four tablets). Taking nitroglycerin every 15 minutes or every hour is not
recommended, as it can cause hypotension, headache and tolerance. Taking nitroglycerin
before activity may prevent angina, but it is not a substitute for lifestyle modifications or other
medications.
9. A patient with peripheral arterial disease is receiving cilostazol, a phosphodiesterase-3
inhibitor, to improve blood flow and reduce intermittent claudication. Which of the following
assessments should the nurse perform before administering this medication?
a) Auscultate the heart sounds and check for murmurs or gallops.
b) Palpate the peripheral pulses and check for strength and symmetry.
c) Measure the blood pressure and pulse rate and check for orthostatic changes.*
d) Inspect the skin and nails and check for color, temperature and lesions.
Rationale: Cilostazol causes vasodilation and can lower blood pressure and increase heart rate.
Orthostatic hypotension can occur, especially in the first weeks of therapy. Blood pressure and
pulse rate should be measured before giving cilostazol and monitored periodically thereafter.
Heart sounds, peripheral pulses and skin condition are also important to assess, but they are not
directly affected by cilostazol.
1. In hemodynamics, which of the following parameters is used to measure the resistance to
blood flow in the systemic circulation?
a) Cardiac output
b) Systemic vascular resistance
