CCRN CARDIAC QUESTIONS
1. The patient is receiving positive inotropes, vasodilators, and diuretics.Thepatient most
likely has which of the following problems?
a) right ventricular failure
b) left ventricular systolic heart failure
c) papillary muscle rupture
d) Hypertrophic cardiomyopathy: Answer: B
Positive inotropes increase contractility; vasodilators decrease afterload, and diuretics decrease
preload. Since the patient with systolic heart failure has decreased contractility and increased
afterload and preload, these agents will be useful for thetreatment of this problem.
2. Ventricular septal defect is most likely to have which of the followingclinical findings?
a) diastolic murmur at the apex of the heart
b) systolic murmur at the fifth intercostal space, midclavicular
c) Diastolic murmur at the base of the heart
d) Systolic murmur at the fifth intercostal space, left sternal border: Answer: DThe murmur
caused by a ventricular septal defect occurs during left ventricular ejection (systole) and is
best heard at the left sternal border, fifth intercostal space.
3. Priority treatment for aortic dissection requires which of the following?
a) fluids and vasopressors
b) intra-aortic balloon therapy and transfusion
c) aggressive management of hypertension and emergent surgery
d) emergent aortic valve replacement and pain control: Answer: C
Emergent surgery is essential for survival, and blood pressure control is essential
preoperatively. Pain control and transfusion may be indicated, but the remaining therapies are
not beneficial.
4. The patient of an orientee experiences cardiac arrest and requires resus-citation. The
preceptor who is orienting the new nurse to the unit arrives to see that the orientee has placed
the patient in reverse Trendelenberg position.What would be the preceptor's best response at
this time?
a) Immediately begin chest compressions
b) Explain to the orientee the problem with the current position and instructon the correct
position
c) Place the patient in a supine position
d) Ask the orientee why she put the patient in this position: Answer: C
The preceptor needs to do what is best for the patient in this emergency situation. Beginning
chest compressions with the head of the bed elevated, choice (A), wouldnot be the best
intervention for the patient; using the situation to coach the orientee,choice (B), would not be
appropriate timing; discussion of the orientee's rationale, choice (D), would best be done at a
later time as well.
, 5. Which of the following clinical findings is indicative of hypertensive cri-sis?
a) BP 222/126
b) BP 218/128 and mental status change
c) BP 220/130 and anxiety
d) BP 230/124 and fatigue: Answer: B
End organ damage is present with hypertensive crisis. Mental status change is asign of end
organ (brain) involvement. (Stroke is a major concern in the setting of hypertensive crisis.)
Headache, anxiety and fatigue are not evidence of organinvolvement.
6. Short episodes of non-sustained torsade de pointes ventricular tachycardia are seen on the
cardiac monitor. The nurse should anticipate orders for which of the following infusions for
this patient?
a) amiodarone
b) magnesium
c) digoxin
d) potassium: Answer: B
Torsade de pointes VT is due to prolonged QT interval, and magnesium is indicated for this
problem. Amiodarone may worsen the problem by further prolonging the QT interval. The
remaining choices are not effective treatments for torsade de pointes.
7. The patient is status post motor vehicle accident with a large chest bruise.The nurse knows
the patient needs to be assessed for which of the following?
a) Positive troponin and aortic valve damage
b) Pain with inspiration and pericardial friction rub
c) Retroperitoneal bleed and global ST elevation
d) Atrial fibrillation and mitral valve damage: Answer: A
The chest bruise implies the patient's chest struck the steering wheel. This in turn may have
caused aortic valve trauma (the valve lying most anterior in the chest), orcaused myocardial
trauma damage.
8. The patient with ST elevation in II, III, aVF is most likely to develop a heart block,
whereas the patient with ST elevation in V1, V2, and V3 is most likely to develop a heart
block.
a) Second-degree heart block Type 2, sinus exit block
b) Second-degree heart block Type 2, third degree heart block
c) Third-degree heart block, second degree heart block Type 2
d) Second-degree heart block Type 2, sinus arrest: Answer: C
ST elevation of II, III, aVF is generally secondary to right coronary artery occlusion(inferior
wall MI), and in most of the population the RCA supplies the AV node, whichwould result in
complete heart block. ST elevation in V1 through V3 is indicative ofleft anterior descending
artery occlusion, which supplies the main bundle of HIS inmost of the population, and which
would result in a second-degree heart block TypeII.
1. The patient is receiving positive inotropes, vasodilators, and diuretics.Thepatient most
likely has which of the following problems?
a) right ventricular failure
b) left ventricular systolic heart failure
c) papillary muscle rupture
d) Hypertrophic cardiomyopathy: Answer: B
Positive inotropes increase contractility; vasodilators decrease afterload, and diuretics decrease
preload. Since the patient with systolic heart failure has decreased contractility and increased
afterload and preload, these agents will be useful for thetreatment of this problem.
2. Ventricular septal defect is most likely to have which of the followingclinical findings?
a) diastolic murmur at the apex of the heart
b) systolic murmur at the fifth intercostal space, midclavicular
c) Diastolic murmur at the base of the heart
d) Systolic murmur at the fifth intercostal space, left sternal border: Answer: DThe murmur
caused by a ventricular septal defect occurs during left ventricular ejection (systole) and is
best heard at the left sternal border, fifth intercostal space.
3. Priority treatment for aortic dissection requires which of the following?
a) fluids and vasopressors
b) intra-aortic balloon therapy and transfusion
c) aggressive management of hypertension and emergent surgery
d) emergent aortic valve replacement and pain control: Answer: C
Emergent surgery is essential for survival, and blood pressure control is essential
preoperatively. Pain control and transfusion may be indicated, but the remaining therapies are
not beneficial.
4. The patient of an orientee experiences cardiac arrest and requires resus-citation. The
preceptor who is orienting the new nurse to the unit arrives to see that the orientee has placed
the patient in reverse Trendelenberg position.What would be the preceptor's best response at
this time?
a) Immediately begin chest compressions
b) Explain to the orientee the problem with the current position and instructon the correct
position
c) Place the patient in a supine position
d) Ask the orientee why she put the patient in this position: Answer: C
The preceptor needs to do what is best for the patient in this emergency situation. Beginning
chest compressions with the head of the bed elevated, choice (A), wouldnot be the best
intervention for the patient; using the situation to coach the orientee,choice (B), would not be
appropriate timing; discussion of the orientee's rationale, choice (D), would best be done at a
later time as well.
, 5. Which of the following clinical findings is indicative of hypertensive cri-sis?
a) BP 222/126
b) BP 218/128 and mental status change
c) BP 220/130 and anxiety
d) BP 230/124 and fatigue: Answer: B
End organ damage is present with hypertensive crisis. Mental status change is asign of end
organ (brain) involvement. (Stroke is a major concern in the setting of hypertensive crisis.)
Headache, anxiety and fatigue are not evidence of organinvolvement.
6. Short episodes of non-sustained torsade de pointes ventricular tachycardia are seen on the
cardiac monitor. The nurse should anticipate orders for which of the following infusions for
this patient?
a) amiodarone
b) magnesium
c) digoxin
d) potassium: Answer: B
Torsade de pointes VT is due to prolonged QT interval, and magnesium is indicated for this
problem. Amiodarone may worsen the problem by further prolonging the QT interval. The
remaining choices are not effective treatments for torsade de pointes.
7. The patient is status post motor vehicle accident with a large chest bruise.The nurse knows
the patient needs to be assessed for which of the following?
a) Positive troponin and aortic valve damage
b) Pain with inspiration and pericardial friction rub
c) Retroperitoneal bleed and global ST elevation
d) Atrial fibrillation and mitral valve damage: Answer: A
The chest bruise implies the patient's chest struck the steering wheel. This in turn may have
caused aortic valve trauma (the valve lying most anterior in the chest), orcaused myocardial
trauma damage.
8. The patient with ST elevation in II, III, aVF is most likely to develop a heart block,
whereas the patient with ST elevation in V1, V2, and V3 is most likely to develop a heart
block.
a) Second-degree heart block Type 2, sinus exit block
b) Second-degree heart block Type 2, third degree heart block
c) Third-degree heart block, second degree heart block Type 2
d) Second-degree heart block Type 2, sinus arrest: Answer: C
ST elevation of II, III, aVF is generally secondary to right coronary artery occlusion(inferior
wall MI), and in most of the population the RCA supplies the AV node, whichwould result in
complete heart block. ST elevation in V1 through V3 is indicative ofleft anterior descending
artery occlusion, which supplies the main bundle of HIS inmost of the population, and which
would result in a second-degree heart block TypeII.
