CCRN EXAM
1. A postoperative patient on the surgical unit suddenly develops chest pain, extreme
weakness, and dyspnea and is found to have ST elevation in II, III, and aVF on the stat EKG. B/P
is 92/62, heart rate 58, respiratory rate 28, lungs are clear, and heart sound assessment reveals
an S4, no murmurs. In addition to preparing the patient for PCI, which of the following
interventions would youanticipate?
(A) nitroglycerin drip, aspirin
(B) furosemide, atropine
(C) transcutaneous pacing, morphine
(D) aggressive fluid administration, right-sided EKG.: (D) The scenario de- scribes a patient
having an acute inferior STEMI, generally due to RCA occlusion. AnRCA occlusion may result
in RV infarct, which this patient has signs of (hypotensionwith clear lungs). The definitive
treatment is emergent PCI. Fluid administration will help increase coronary artery perfusion
by correcting hypotension and ensureadequate RV preload. The right-sided EKG may help
confirm the RV infarct. Ni- troglycerin, diuretics, and morphine may decrease preload, which
would worsen hypotension.
2. A 52 year old male presents with complaints of blurred vision and short- ness of breath.
B/P is 232/136, heart rate 102, respiratory rate 28 with cracklesin lower lung fields bilaterally,
with S3 and S4 heart sounds on auscultation. Which of the following would be indicated for
this patient?
(A) nitroprusside drip, admit to critical care unit
(B) digoxin, furosemide
(C) labetalol drip, admit to a medical unit
(D) lisinopril, calcium channel blocker: (A) The patient has signs of organ dys-function
(heart failure) secondary to extreme hypertension. Therefore, he has hy- pertension crisis or
emergency. The B/P needs to be emergently decreased. Mostoften this treatment is best done
in an ICU.
3. An 80 year old female presents with chief complaint of acute shortness ofbreath. Clinical
exam reveals B/P 182/102, heart rate 105/minute, respiratory rate 32/minute, lungs with
crackles bilaterally, pulse oximetry of 88%, S4 on auscultation. EKG revealed sinus
tachycardia, left ventricular hypertrophy pattern, chest radiograph showed normal heart size,
pulmonary vascular congestion, and echocardiogram showed EF of 55%. Which of the
following should be avoided in this patient's treatment plan?
(A) calcium channel blocker
(B) digoxin
(C) low-dose diuretics
(D) oxygen: (B) The patient presents with signs of heart failure due to diastolic dysfunction
(hypertension, left ventricular hypertrophy, EF > 40%). These patients have a problem with
FILLING, not ejecting. Digoxin, a positive inotrope, may increasewall stress and worsen filling
of the left ventricle.=3
, 4. Mrs. Jones has heart failure. =D)espite optimal therapy, she gets short of breath when she
gets up to walk to the bathroom. Which of the following is the patient experiencing regarding
heart failure?
(A) NYHA Class I heart failure, may benefit from an ICD
(B) NYHA Class II heart failure, may benefit from an ICD
(C) NYHA Class III heart failure, may benefit from an ICD
(D) heart failure cannot be classified, further information is needed: (C) The patient has
symptoms with minimal activity, which describes NYHA Class III. This would qualify her for
an ICD.
5. When the above patient, Mrs. Jones, has an exacerbation of her heart failure (Class III),
she develops jugular venous distention (JVD), peripheraledema, and abdominal discomfort.
These are clinical signs specific to:
(A) acute left ventricular failure
(B) chronic right ventricular failure
(C) acute right ventricular failure
(D) chronic dehydration: (B) The signs described are those of chronic right-sidedheart failure.
Acute right ventricular failure may result in JVD but not peripheral edema or abdominal
discomfort (which is due to liver engorgement).
6. The nurse managing a post-op CABG patient assesses a sudden drop in B/P, distended
neck veins, muffled heart tones, minimal chest tube of output,and a systolic pressure that
fluctuates with breathing pattern. The patient most likely needs:
(A) emergent return to the OR
(B) clamping of the chest tube
(C) transfusion of RBC's
(D) high-dose dopamine: (A) The signs described in the scenario are those of cardiac
tamponade. The treatment for cardiac tamponade for the post-op open heartis the return to the
OR to drain the pericardial fluid that has accumulated. Development of the problem in other
patient population would necessitate an emergent pericardiocentesis to drain the fluid.
7. Physical assessment findings indicative of a significant right ventricular(RV) infarction
would include:
(A) bibasilar crackles
(B) flat neck veins with the patient in a Semi-Fowler's position
(C) jugular vein distention
(D) tachypnea and frothy sputum: (C) A right ventricular infarction large enoughto cause RV
failure causes a problem with RV emptying, leading to an elevated rightatrial pressure causing
distended jugular vein distention. Choices (A) and (D) are signs of left ventricular failure.
Voice (B) is a sign of dehydration
8. What pulse change might the nurse expect associated with cardiac tam-ponade?
(A) pulsus alternans
1. A postoperative patient on the surgical unit suddenly develops chest pain, extreme
weakness, and dyspnea and is found to have ST elevation in II, III, and aVF on the stat EKG. B/P
is 92/62, heart rate 58, respiratory rate 28, lungs are clear, and heart sound assessment reveals
an S4, no murmurs. In addition to preparing the patient for PCI, which of the following
interventions would youanticipate?
(A) nitroglycerin drip, aspirin
(B) furosemide, atropine
(C) transcutaneous pacing, morphine
(D) aggressive fluid administration, right-sided EKG.: (D) The scenario de- scribes a patient
having an acute inferior STEMI, generally due to RCA occlusion. AnRCA occlusion may result
in RV infarct, which this patient has signs of (hypotensionwith clear lungs). The definitive
treatment is emergent PCI. Fluid administration will help increase coronary artery perfusion
by correcting hypotension and ensureadequate RV preload. The right-sided EKG may help
confirm the RV infarct. Ni- troglycerin, diuretics, and morphine may decrease preload, which
would worsen hypotension.
2. A 52 year old male presents with complaints of blurred vision and short- ness of breath.
B/P is 232/136, heart rate 102, respiratory rate 28 with cracklesin lower lung fields bilaterally,
with S3 and S4 heart sounds on auscultation. Which of the following would be indicated for
this patient?
(A) nitroprusside drip, admit to critical care unit
(B) digoxin, furosemide
(C) labetalol drip, admit to a medical unit
(D) lisinopril, calcium channel blocker: (A) The patient has signs of organ dys-function
(heart failure) secondary to extreme hypertension. Therefore, he has hy- pertension crisis or
emergency. The B/P needs to be emergently decreased. Mostoften this treatment is best done
in an ICU.
3. An 80 year old female presents with chief complaint of acute shortness ofbreath. Clinical
exam reveals B/P 182/102, heart rate 105/minute, respiratory rate 32/minute, lungs with
crackles bilaterally, pulse oximetry of 88%, S4 on auscultation. EKG revealed sinus
tachycardia, left ventricular hypertrophy pattern, chest radiograph showed normal heart size,
pulmonary vascular congestion, and echocardiogram showed EF of 55%. Which of the
following should be avoided in this patient's treatment plan?
(A) calcium channel blocker
(B) digoxin
(C) low-dose diuretics
(D) oxygen: (B) The patient presents with signs of heart failure due to diastolic dysfunction
(hypertension, left ventricular hypertrophy, EF > 40%). These patients have a problem with
FILLING, not ejecting. Digoxin, a positive inotrope, may increasewall stress and worsen filling
of the left ventricle.=3
, 4. Mrs. Jones has heart failure. =D)espite optimal therapy, she gets short of breath when she
gets up to walk to the bathroom. Which of the following is the patient experiencing regarding
heart failure?
(A) NYHA Class I heart failure, may benefit from an ICD
(B) NYHA Class II heart failure, may benefit from an ICD
(C) NYHA Class III heart failure, may benefit from an ICD
(D) heart failure cannot be classified, further information is needed: (C) The patient has
symptoms with minimal activity, which describes NYHA Class III. This would qualify her for
an ICD.
5. When the above patient, Mrs. Jones, has an exacerbation of her heart failure (Class III),
she develops jugular venous distention (JVD), peripheraledema, and abdominal discomfort.
These are clinical signs specific to:
(A) acute left ventricular failure
(B) chronic right ventricular failure
(C) acute right ventricular failure
(D) chronic dehydration: (B) The signs described are those of chronic right-sidedheart failure.
Acute right ventricular failure may result in JVD but not peripheral edema or abdominal
discomfort (which is due to liver engorgement).
6. The nurse managing a post-op CABG patient assesses a sudden drop in B/P, distended
neck veins, muffled heart tones, minimal chest tube of output,and a systolic pressure that
fluctuates with breathing pattern. The patient most likely needs:
(A) emergent return to the OR
(B) clamping of the chest tube
(C) transfusion of RBC's
(D) high-dose dopamine: (A) The signs described in the scenario are those of cardiac
tamponade. The treatment for cardiac tamponade for the post-op open heartis the return to the
OR to drain the pericardial fluid that has accumulated. Development of the problem in other
patient population would necessitate an emergent pericardiocentesis to drain the fluid.
7. Physical assessment findings indicative of a significant right ventricular(RV) infarction
would include:
(A) bibasilar crackles
(B) flat neck veins with the patient in a Semi-Fowler's position
(C) jugular vein distention
(D) tachypnea and frothy sputum: (C) A right ventricular infarction large enoughto cause RV
failure causes a problem with RV emptying, leading to an elevated rightatrial pressure causing
distended jugular vein distention. Choices (A) and (D) are signs of left ventricular failure.
Voice (B) is a sign of dehydration
8. What pulse change might the nurse expect associated with cardiac tam-ponade?
(A) pulsus alternans
