CCRN PRACTICE QUESTIONS 2
1. An RN is caring for a patient post-op cardiac surgery and notes that the patient's chest
tube output has been greater than 100 mL for two consecutivehours. What will the nurse do
next?
a. Milk the chest tubes
b. Contact the physician
c. Administer vasopressors
d. Administer vitamin K: b. Contact the physician
2. Which of the following are indicative of cardiac tamponade post-op heartsurgery?
a. hypotension, flat neck veins, widened pulse pressure
b. muffled heart sounds, minimal chest tube output, pulsus paradoxus
c. hypertension, distended neck veins, narrow pulse pressure
d. crackles, hypoxemia, S3: b. muffled heart sounds, minimal chest tube output,pulsus
paradoxus other signs: neck veins distended, pulse pressure narrow, hypotensiond - signs of
elevated L heart pressure
3. In the presence of blunt cardiac trauma, which finding supports the diag-nosis of
myocardial contusion?
a. Cardiac dysrhythmias
b. PMI shifted to the right
c. Increased myoglobin
d. Bounding pulses: a. Cardiac dysrhythmias
- can also monitor troponins
c. increase myoglobin - more specific to skeletal muscle injury
4. The patient develops chest pain with deep inspiration, a low-grade fever,and ST elevation
in all leads three days post-MI. Treatment will include whichof the following?
a. Nitroglycerin drip
b. PCI
c. anti-inflammatory agents
d. anticoagulation: c. anti-inflammatory agents
Pt has pericarditis (Dressler's syndrome) - responds well to anti-inflammatoryagents.
,a, b, and c would be indicated for coronary artery occlusion
5. A 66-year-old male presented with sudden-onset midsternal chest pain while sitting in a
chair. The ECG demonstrated ST elevation of 2-3mm in V2 through V4. The patient's history
includes cervical spine surgery two weeks ago. The hospital does not provide percutaneous
coronary intervention (PCI).What is the treatment of choice?
a. Administer of a fibrinolytic agent
b. Emergent transfer to the nearest facility that performs PCI
c. Administer to the coronary care unit (CCU)
d. Administration of enoxaparin (Lovenox) and morphine: b. Emergent transferto the nearest
facility that performs PCI
a - typically used after reperfusionc - would not improve outcome
d - enoxaparin is not reversible. ASA or heparin would be preferred.
6. A patient had an episode of chest pain at rest with ST elevation on theECG after the
ingestion of cocaine. The chest pain was relieved, and the
ST segments normalized after the administration of sublingual nitroglycerin.What did the
patient most likely have?
a. Stable angina
b. Prinzmetal's or variant angina
c. Non-ST elevation myocardial infarction (NSTEMI)
d. ST elevation myocardial infarction (STEMI): b. Prinzmetal's or variant angina
7. The patient has acute dyspnea, hypoxemia, bilateral lung crackles to thescapulae, S3 heart
sounds, and apical shift to the left. Which of the followingchronic problems may lead to these
signs and symptoms?
a. pulmonary embolism, aortic stenosis
b. mitral stenosis, acute coronary syndrome
c. tricuspid stenosis, COPD
d. hypertension, aortic regurgitation: d. Hypertension, aortic regurgitation
8. The patient has cardiomyopathy with an ejection fraction (EF) 50%, an enlarged
ventricular septum on the echocardiogram (ECHO), and a normal heart size on the chest
radiograph. Then nurse anticipates that which of thefollowing drugs may be part of the
patient's plan of care?
a. diltiazem (Cardizem)
b. digoxin (Lanoxin)
,c. dobutamine (Dobutrex)
d. milrinone (Primacor): a. diltiazem (Cardizem)
It's a negative inotropic agent that will improve filling of the left ventricle
b, c, and d are positive inotropic agents - the improve ejection
9. The patient is day 2 post-aortic valve replacement. In addition to preventing thrombus
formation, the RN will anticipate which of the following as part of thepatient's plan of care?
a. Close monitoring for ventricular arrhythmias
b. Administration of diuretics to decrease preload
c. Close monitoring for conduction disturbances
d. Administration of positive inotropes to increase contractility: c. close monitoring for
conduction disturbances
The mitral, tricuspid, and aortic valves are near conduction pathways, and the needfor
temporary pacing needs to be considered
10. The patient is admitted with ripping pain between the scapulae with a dissecting aortic
aneurysm seen on the CT scan. In addition to preparation for immediate surgery, which agent
is most likely to improve the outcome ofthe patient?
a. nitroglycerin (Tridil) drip
b. dopamine (Intropin) drip
c. nitroprusside (Nipride) drip
d. labetalol (Trandate) drip: d. labetalol (Trandate) drip
Aggressive blood pressure and heart rate control are priorities for a patient withaortic
dissection
11. The patient has an S3 at the apex of the heart on auscultation.What is mostlikely a part of
the treatment plan?
a. Coronary artery reperfusion
b. Heart rate control
c. Pain management
d. Left ventricular preload reduction: d. Left ventricular preload reduction
S3 is due to elevated left ventricular pressure and heart failure
, 12. The patient is having non-sustained runs of torsades de pointes on the cardiac monitor.
Which medication will most likely be ordered for this patient?
a. Magnesium IV
b. Potassium drip
c. Amiodarone drip
d. Synchronized cardioversion: a. Magnesium IV
13. The patient, status post anterior MI, is scheduled for emergent surgery for ventricular
septal defect repair. What will the nurse most likely hear onauscultation of this patient's chest?
a. Diastolic murmur at the apex of the heart
b. Systolic murmur at the left sternal border
c. Diastolic murmur at the base of the heart
d. Systolic murmur at the apex of the heart: b. Systolic murmur at the left sternalborder
14. The patient is status post insertion of a DDD permanent pacemaker. Whichof the following
indicates normal functioning of the pacemaker?
a. A pacer spike after the P-wave, a spike after each QRS, a constant heart rate
b. A pacer spike before the P-wave, a spike on the T-wave, an increase in heartrate with activity
c. No P-wave, a pacer spike before each QRS, a constant heart rate
d. A pacer spike before the P-wave, a spike before the QRS, an increase in heart rate with
activity: d. A pacer spike before the P-wave, a spike before the QRS, an increase in heart rate
with activity
The DDD pacemaker is capable of pacing and sensing both the atria and the ventricles, and
the response to sensing may be both inhibition of pacing in thepresence of native beats or
stimulation to increase the heart rate if there is a physiological need.
15. Which of the following assessment findings would be expected for apatient with
pericarditis?
a. Pain with deep inspiration, ST elevation in V2-V6
b. Midsternal pain radiating to the back, T-wave inversion in V2-V6
c. Pain with deep inspiration, global ST elevation
d. Pain with movement, ST elevation in II, III, and aVF: c. Pain with deep inspira-tion, global
ST elevation
16. Rewarming the post-op surgical heart patient may result in which hemo-dynamic change?
1. An RN is caring for a patient post-op cardiac surgery and notes that the patient's chest
tube output has been greater than 100 mL for two consecutivehours. What will the nurse do
next?
a. Milk the chest tubes
b. Contact the physician
c. Administer vasopressors
d. Administer vitamin K: b. Contact the physician
2. Which of the following are indicative of cardiac tamponade post-op heartsurgery?
a. hypotension, flat neck veins, widened pulse pressure
b. muffled heart sounds, minimal chest tube output, pulsus paradoxus
c. hypertension, distended neck veins, narrow pulse pressure
d. crackles, hypoxemia, S3: b. muffled heart sounds, minimal chest tube output,pulsus
paradoxus other signs: neck veins distended, pulse pressure narrow, hypotensiond - signs of
elevated L heart pressure
3. In the presence of blunt cardiac trauma, which finding supports the diag-nosis of
myocardial contusion?
a. Cardiac dysrhythmias
b. PMI shifted to the right
c. Increased myoglobin
d. Bounding pulses: a. Cardiac dysrhythmias
- can also monitor troponins
c. increase myoglobin - more specific to skeletal muscle injury
4. The patient develops chest pain with deep inspiration, a low-grade fever,and ST elevation
in all leads three days post-MI. Treatment will include whichof the following?
a. Nitroglycerin drip
b. PCI
c. anti-inflammatory agents
d. anticoagulation: c. anti-inflammatory agents
Pt has pericarditis (Dressler's syndrome) - responds well to anti-inflammatoryagents.
,a, b, and c would be indicated for coronary artery occlusion
5. A 66-year-old male presented with sudden-onset midsternal chest pain while sitting in a
chair. The ECG demonstrated ST elevation of 2-3mm in V2 through V4. The patient's history
includes cervical spine surgery two weeks ago. The hospital does not provide percutaneous
coronary intervention (PCI).What is the treatment of choice?
a. Administer of a fibrinolytic agent
b. Emergent transfer to the nearest facility that performs PCI
c. Administer to the coronary care unit (CCU)
d. Administration of enoxaparin (Lovenox) and morphine: b. Emergent transferto the nearest
facility that performs PCI
a - typically used after reperfusionc - would not improve outcome
d - enoxaparin is not reversible. ASA or heparin would be preferred.
6. A patient had an episode of chest pain at rest with ST elevation on theECG after the
ingestion of cocaine. The chest pain was relieved, and the
ST segments normalized after the administration of sublingual nitroglycerin.What did the
patient most likely have?
a. Stable angina
b. Prinzmetal's or variant angina
c. Non-ST elevation myocardial infarction (NSTEMI)
d. ST elevation myocardial infarction (STEMI): b. Prinzmetal's or variant angina
7. The patient has acute dyspnea, hypoxemia, bilateral lung crackles to thescapulae, S3 heart
sounds, and apical shift to the left. Which of the followingchronic problems may lead to these
signs and symptoms?
a. pulmonary embolism, aortic stenosis
b. mitral stenosis, acute coronary syndrome
c. tricuspid stenosis, COPD
d. hypertension, aortic regurgitation: d. Hypertension, aortic regurgitation
8. The patient has cardiomyopathy with an ejection fraction (EF) 50%, an enlarged
ventricular septum on the echocardiogram (ECHO), and a normal heart size on the chest
radiograph. Then nurse anticipates that which of thefollowing drugs may be part of the
patient's plan of care?
a. diltiazem (Cardizem)
b. digoxin (Lanoxin)
,c. dobutamine (Dobutrex)
d. milrinone (Primacor): a. diltiazem (Cardizem)
It's a negative inotropic agent that will improve filling of the left ventricle
b, c, and d are positive inotropic agents - the improve ejection
9. The patient is day 2 post-aortic valve replacement. In addition to preventing thrombus
formation, the RN will anticipate which of the following as part of thepatient's plan of care?
a. Close monitoring for ventricular arrhythmias
b. Administration of diuretics to decrease preload
c. Close monitoring for conduction disturbances
d. Administration of positive inotropes to increase contractility: c. close monitoring for
conduction disturbances
The mitral, tricuspid, and aortic valves are near conduction pathways, and the needfor
temporary pacing needs to be considered
10. The patient is admitted with ripping pain between the scapulae with a dissecting aortic
aneurysm seen on the CT scan. In addition to preparation for immediate surgery, which agent
is most likely to improve the outcome ofthe patient?
a. nitroglycerin (Tridil) drip
b. dopamine (Intropin) drip
c. nitroprusside (Nipride) drip
d. labetalol (Trandate) drip: d. labetalol (Trandate) drip
Aggressive blood pressure and heart rate control are priorities for a patient withaortic
dissection
11. The patient has an S3 at the apex of the heart on auscultation.What is mostlikely a part of
the treatment plan?
a. Coronary artery reperfusion
b. Heart rate control
c. Pain management
d. Left ventricular preload reduction: d. Left ventricular preload reduction
S3 is due to elevated left ventricular pressure and heart failure
, 12. The patient is having non-sustained runs of torsades de pointes on the cardiac monitor.
Which medication will most likely be ordered for this patient?
a. Magnesium IV
b. Potassium drip
c. Amiodarone drip
d. Synchronized cardioversion: a. Magnesium IV
13. The patient, status post anterior MI, is scheduled for emergent surgery for ventricular
septal defect repair. What will the nurse most likely hear onauscultation of this patient's chest?
a. Diastolic murmur at the apex of the heart
b. Systolic murmur at the left sternal border
c. Diastolic murmur at the base of the heart
d. Systolic murmur at the apex of the heart: b. Systolic murmur at the left sternalborder
14. The patient is status post insertion of a DDD permanent pacemaker. Whichof the following
indicates normal functioning of the pacemaker?
a. A pacer spike after the P-wave, a spike after each QRS, a constant heart rate
b. A pacer spike before the P-wave, a spike on the T-wave, an increase in heartrate with activity
c. No P-wave, a pacer spike before each QRS, a constant heart rate
d. A pacer spike before the P-wave, a spike before the QRS, an increase in heart rate with
activity: d. A pacer spike before the P-wave, a spike before the QRS, an increase in heart rate
with activity
The DDD pacemaker is capable of pacing and sensing both the atria and the ventricles, and
the response to sensing may be both inhibition of pacing in thepresence of native beats or
stimulation to increase the heart rate if there is a physiological need.
15. Which of the following assessment findings would be expected for apatient with
pericarditis?
a. Pain with deep inspiration, ST elevation in V2-V6
b. Midsternal pain radiating to the back, T-wave inversion in V2-V6
c. Pain with deep inspiration, global ST elevation
d. Pain with movement, ST elevation in II, III, and aVF: c. Pain with deep inspira-tion, global
ST elevation
16. Rewarming the post-op surgical heart patient may result in which hemo-dynamic change?
