CCRN PRACTICE QUESTIONS AND ANSWERS | NEW
2026 UPDATE | WITH COMPLETE SOLUTION, GRADED
A+
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 Answer - 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 Answer - 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 Answer - *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 Answer - *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) Answer - 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.
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure Answer - A
Patients with mitral stenosis may exhibit a pinkish discoloration of the cheeks
(i.e., malar blush). Mitral stenosis causes a diastolic murmur. Widened pulse
pressure is associated with aortic regurgitation. Narrowed pulse pressure is
associated with mitral regurgitation.
Four days after a mitral valve replacement, the patient develops atrial
fibrillation. The nurse initially would:
A. order a 12-lead EKG
B. evaluate the patient for clinical indications of hypoperfusion.
C. notify the physician.
D. ask the patient to bear down as if having a bowel movement. Answer - B
The onset of atrial fibrillation results in the loss of atrial kick. Loss of atrial kick
may reduce the cardiac output by as much as 20-30%. This is especially true in
patients whose cardiac output may be affected by long-standing cardiac
disease, such as mitral valve disease. Assess the patient for clinical indications
of hypoperfusion (e.g., cool skin, decreased urine output, narrowed pulse
pressure, and hypotension).
A patient has just returned from the cath lab. She had an angioplasty for
occlusion of her RCA. She still has femoral artery and vein sheaths in place. The
, patient complains of chest pain that she rates 9/10 about an hour after she
returns from the cath lab. Which of the following is indicated?
A. Administer morphine IV.
B. Administer nitroglycerin sublingual spray.
C. Stop the heparin.
D. Notify the physician Answer - D
New-onset severe chest pain after percutaneous coronary intervention
suggests acute closure of the dilated coronary artery. The patient needs to be
returned to the cardiac catheterization laboratory for repeat dilation and
probable insertion of stent.
A 35-year-old woman underwent a mitral valve replacement. Her chest tube
output has been approximately 125 mL/hr for the last 3 hours, and now the
drainage has ceased suddenly. The immediate assessment reveals a significant
decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What other data would indicate
the development of cardiac tamponade?
A. Increased venous oxygen saturation (SvO2)
B. Decreased UO
C. Muffled heart sounds
D. New holosystolic murmur at the sternum Answer - C
Muffled heart sounds are a classic finding in cardiac tamponade. Remember
the classic indications of cardiac tamponade referred to as Beck's triad: muffled
heart sounds, jugular venous distention, and hypotension. Even though urine
output is a sensitive indicator of cardiac output and in cardiac tamponade a
decreased stroke volume results in a decreased cardiac output, by the time a
nurse would notice the decreased urine output, the patient may have already
had a cardiopulmonary arrest. The SvO2 actually would decrease because of
the decrease in cardiac output. New holosystolic murmur at the lower left
sternal border is a sign of ventricular septal rupture.
2026 UPDATE | WITH COMPLETE SOLUTION, GRADED
A+
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 Answer - 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 Answer - 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 Answer - *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 Answer - *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) Answer - 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.
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure Answer - A
Patients with mitral stenosis may exhibit a pinkish discoloration of the cheeks
(i.e., malar blush). Mitral stenosis causes a diastolic murmur. Widened pulse
pressure is associated with aortic regurgitation. Narrowed pulse pressure is
associated with mitral regurgitation.
Four days after a mitral valve replacement, the patient develops atrial
fibrillation. The nurse initially would:
A. order a 12-lead EKG
B. evaluate the patient for clinical indications of hypoperfusion.
C. notify the physician.
D. ask the patient to bear down as if having a bowel movement. Answer - B
The onset of atrial fibrillation results in the loss of atrial kick. Loss of atrial kick
may reduce the cardiac output by as much as 20-30%. This is especially true in
patients whose cardiac output may be affected by long-standing cardiac
disease, such as mitral valve disease. Assess the patient for clinical indications
of hypoperfusion (e.g., cool skin, decreased urine output, narrowed pulse
pressure, and hypotension).
A patient has just returned from the cath lab. She had an angioplasty for
occlusion of her RCA. She still has femoral artery and vein sheaths in place. The
, patient complains of chest pain that she rates 9/10 about an hour after she
returns from the cath lab. Which of the following is indicated?
A. Administer morphine IV.
B. Administer nitroglycerin sublingual spray.
C. Stop the heparin.
D. Notify the physician Answer - D
New-onset severe chest pain after percutaneous coronary intervention
suggests acute closure of the dilated coronary artery. The patient needs to be
returned to the cardiac catheterization laboratory for repeat dilation and
probable insertion of stent.
A 35-year-old woman underwent a mitral valve replacement. Her chest tube
output has been approximately 125 mL/hr for the last 3 hours, and now the
drainage has ceased suddenly. The immediate assessment reveals a significant
decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What other data would indicate
the development of cardiac tamponade?
A. Increased venous oxygen saturation (SvO2)
B. Decreased UO
C. Muffled heart sounds
D. New holosystolic murmur at the sternum Answer - C
Muffled heart sounds are a classic finding in cardiac tamponade. Remember
the classic indications of cardiac tamponade referred to as Beck's triad: muffled
heart sounds, jugular venous distention, and hypotension. Even though urine
output is a sensitive indicator of cardiac output and in cardiac tamponade a
decreased stroke volume results in a decreased cardiac output, by the time a
nurse would notice the decreased urine output, the patient may have already
had a cardiopulmonary arrest. The SvO2 actually would decrease because of
the decrease in cardiac output. New holosystolic murmur at the lower left
sternal border is a sign of ventricular septal rupture.
