CCRN PRACTICE QUESTIONS AND ANSWERS
A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation
in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect
perfusion to which portion of the conduction system?
A. Sinoatrial (SA) node
B. Bachmann's bundle
C. Atrioventricular (AV) node
D. Bundle of His - Answers -LAD so D. bundle of his
Which of the following is the preferred lead for ST segment monitoring for a patient with
a suspected RCA occlusion?
A.I
B. aVR
C. III
D. V1 - Answers -c. III
Which of the following is not a manifestation of hypertrophic cardiomyopathy?
A. Syncope
B. Murmur that increases with squatting
C. Chest pain
D. Sudden cardiac death - Answers -*B
Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an
aortic stenosis type of murmur that decreases when the patient is in a squatting
position. The first manifestation of this condition is occasionally sudden cardiac death
during exercise.
In which quadrant is the mean QRS complex axis located if the QRS complex is
predominantly positive in lead I and negative in lead aVF?
A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. Indeterminant quadrant - Answers -*B
Because the positive of lead I is the left arm, if the QRS complex is upright in lead I, the
mean QRS axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the
foot, if the QRS complex is negative in lead aVF, the mean QRS axis is upward away
from the foot. This axis would be in the upper left quadrant, described as left axis
deviation.
A patient becomes apneic and pulseless. CPR has been initiated, and the monitor
shows asystole in two leads. Which of the following drugs would be used initially?
A. Calcium gluconate
, B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone) - Answers -C
After CPR is initiated and an intravenous access is established, epinephrine should be
given. Calcium was used in the past in asystole but is used today only for
hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia.
Atropine is no longer recommended for asystole. Amiodarone is not indicated in
asystole because asystole is the absolute absence of irritability.
Substernal chest pain, low-grade fever, and pericardial friction rub are clinical
indications of which of the following?
A. Pericarditis
B. Pericardial tamponade
C. Pneumothorax
D. Pleurisy - Answers -A. Pericarditis
A patient sustains a myocardial contusion as a result of a MVC. Which of the following
signs and symptoms would be most likely?
A. Jugular venous distention
B. Crackles
C. Bradycardia
D. S3 at the apex - Answers -A. Jugular venous distention
A patient is admitted to the coronary care unit with third-degree AV heart block, and a
transvenous temporary ventricular pacemaker is inserted. Four hours later the patient
complains of dizziness while lying in bed. The monitor shows third-degree AV block with
a ventricular rate of 52 and no pacing spikes. This indicates which of the following?
A. Failure to capture
B. Failure to pace
C. Competition between pacemaker and intrinsic rhythm
D. Failure to sense - Answers -B. Failure to pace
Which one of the following structures is at greatest risk for trauma in myocardial
contusion?
A. Right atrium
B. Right ventricle
C. Aorta
D. Left ventricle - Answers -B. RV
Leads V8 and V9 are used to evaluate which of the following?
A. Left ventricular failure
, B. Posterior myocardial infarction (MI)
C. Lateral MI
D. Left bundle branch block - Answers -B. posterior MI
Which of the following is the major advantage of minimally invasive direct coronary
artery bypass grafting (MIDCABG)?
A. Decreased cost
B. Decreased length of stay
C. Avoidance of cardiopulmonary bypass
D. Less patient pain - Answers -C. avoidance of cardiopulmonary bypass
A patient arrives to the ED with a knife sticking out of his chest. He is stable at this time
but complaining of pain at the knife insertion site. The physician is busy resuscitating
another patient. What should be done?
A. Remove the knife so that the wound can be cleansed.
B. Remove the knife and apply a sterile, occlusive dressing.
C. Leave the knife in but stabilize it with adhesive tape.
D. Leave the knife in but apply a pressure dressing over it. - Answers -C. Leave the
knife in but stabilize it with adhesive tape.
A 57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal
MI. A PA catheter was inserted, and initial readings were within normal limits. BP
140/92, HR 110 and regular, RR 24. Breath sounds equal and clear. 3 hrs after
admission, the pt becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR
28 and labored. Crackles are audible at the lung bases BL. The patient is given
furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of
the following would be the most appropriate intervention at this time?
A. Administer saline bolus.
B. Decrease dobutamine drip rate.
C. Increase nitroglycerin drip rate.
D. Replace potassium. - Answers -A. Administer saline bolus.
What type of AV block is characterized by a progressive prolongation of the PR interval
followed by a nonconducted P wave?
A. First-degree AV block
B. Second-degree AV block, type I
C. Second-degree AV block, type II
D. Third-degree AV block - Answers -B.
Second-degree AV block, type I
A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation
in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect
perfusion to which portion of the conduction system?
A. Sinoatrial (SA) node
B. Bachmann's bundle
C. Atrioventricular (AV) node
D. Bundle of His - Answers -LAD so D. bundle of his
Which of the following is the preferred lead for ST segment monitoring for a patient with
a suspected RCA occlusion?
A.I
B. aVR
C. III
D. V1 - Answers -c. III
Which of the following is not a manifestation of hypertrophic cardiomyopathy?
A. Syncope
B. Murmur that increases with squatting
C. Chest pain
D. Sudden cardiac death - Answers -*B
Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an
aortic stenosis type of murmur that decreases when the patient is in a squatting
position. The first manifestation of this condition is occasionally sudden cardiac death
during exercise.
In which quadrant is the mean QRS complex axis located if the QRS complex is
predominantly positive in lead I and negative in lead aVF?
A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. Indeterminant quadrant - Answers -*B
Because the positive of lead I is the left arm, if the QRS complex is upright in lead I, the
mean QRS axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the
foot, if the QRS complex is negative in lead aVF, the mean QRS axis is upward away
from the foot. This axis would be in the upper left quadrant, described as left axis
deviation.
A patient becomes apneic and pulseless. CPR has been initiated, and the monitor
shows asystole in two leads. Which of the following drugs would be used initially?
A. Calcium gluconate
, B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone) - Answers -C
After CPR is initiated and an intravenous access is established, epinephrine should be
given. Calcium was used in the past in asystole but is used today only for
hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia.
Atropine is no longer recommended for asystole. Amiodarone is not indicated in
asystole because asystole is the absolute absence of irritability.
Substernal chest pain, low-grade fever, and pericardial friction rub are clinical
indications of which of the following?
A. Pericarditis
B. Pericardial tamponade
C. Pneumothorax
D. Pleurisy - Answers -A. Pericarditis
A patient sustains a myocardial contusion as a result of a MVC. Which of the following
signs and symptoms would be most likely?
A. Jugular venous distention
B. Crackles
C. Bradycardia
D. S3 at the apex - Answers -A. Jugular venous distention
A patient is admitted to the coronary care unit with third-degree AV heart block, and a
transvenous temporary ventricular pacemaker is inserted. Four hours later the patient
complains of dizziness while lying in bed. The monitor shows third-degree AV block with
a ventricular rate of 52 and no pacing spikes. This indicates which of the following?
A. Failure to capture
B. Failure to pace
C. Competition between pacemaker and intrinsic rhythm
D. Failure to sense - Answers -B. Failure to pace
Which one of the following structures is at greatest risk for trauma in myocardial
contusion?
A. Right atrium
B. Right ventricle
C. Aorta
D. Left ventricle - Answers -B. RV
Leads V8 and V9 are used to evaluate which of the following?
A. Left ventricular failure
, B. Posterior myocardial infarction (MI)
C. Lateral MI
D. Left bundle branch block - Answers -B. posterior MI
Which of the following is the major advantage of minimally invasive direct coronary
artery bypass grafting (MIDCABG)?
A. Decreased cost
B. Decreased length of stay
C. Avoidance of cardiopulmonary bypass
D. Less patient pain - Answers -C. avoidance of cardiopulmonary bypass
A patient arrives to the ED with a knife sticking out of his chest. He is stable at this time
but complaining of pain at the knife insertion site. The physician is busy resuscitating
another patient. What should be done?
A. Remove the knife so that the wound can be cleansed.
B. Remove the knife and apply a sterile, occlusive dressing.
C. Leave the knife in but stabilize it with adhesive tape.
D. Leave the knife in but apply a pressure dressing over it. - Answers -C. Leave the
knife in but stabilize it with adhesive tape.
A 57-year-old man was admitted to the critical care unit with a diagnosis of anteroseptal
MI. A PA catheter was inserted, and initial readings were within normal limits. BP
140/92, HR 110 and regular, RR 24. Breath sounds equal and clear. 3 hrs after
admission, the pt becomes restless with cool, pale skin. Now BP 110/72, HR 120, RR
28 and labored. Crackles are audible at the lung bases BL. The patient is given
furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8, with a drop in BP. Which of
the following would be the most appropriate intervention at this time?
A. Administer saline bolus.
B. Decrease dobutamine drip rate.
C. Increase nitroglycerin drip rate.
D. Replace potassium. - Answers -A. Administer saline bolus.
What type of AV block is characterized by a progressive prolongation of the PR interval
followed by a nonconducted P wave?
A. First-degree AV block
B. Second-degree AV block, type I
C. Second-degree AV block, type II
D. Third-degree AV block - Answers -B.
Second-degree AV block, type I
