CCRN Exam Cram Actual Exam 2026/2027 with Detailed Rationales |
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EXAM INFORMATION
Total Questions: 60
Recommended Time: 90 minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs)
Question Style: Scenario-Based, Applied, and Professional Decision-Making Questions
==============================
SECTION 1: Cardiovascular System
Question 1: A 68-year-old patient is admitted to the ICU with acute ST-elevation
myocardial infarction (STEMI) and is scheduled for primary percutaneous coronary
intervention (PCI). The nurse notes that the patient has received aspirin and clopidogrel
in the emergency department. Which of the following interventions should the nurse
prioritize during the immediate pre-procedure period?
A. Administer a bolus of unfractionated heparin to achieve an activated clotting time of
200-250 seconds
B. Verify that the patient has received a loading dose of a P2Y12 inhibitor and assess
for any bleeding risk factors
C. Initiate an infusion of nitroglycerin at 10 mcg/min to prevent coronary vasospasm
D. Administer intravenous metoprolol 5 mg to reduce myocardial oxygen demand
regardless of heart rate
,Correct Answer: B
Rationale: For primary PCI in STEMI, dual antiplatelet therapy with aspirin and a P2Y12
inhibitor (such as clopidogrel, prasugrel, or ticagrelor) is essential. The nurse must verify
that the loading dose was administered and assess for contraindications such as active
bleeding, recent surgery, or history of stroke before proceeding. Option A is incorrect
because heparin is administered during the procedure, not typically as a pre-procedure
bolus in the ICU setting. Option C is incorrect because nitroglycerin is not routinely given
to prevent vasospasm before PCI. Option D is incorrect because beta-blockers should
be withheld if the patient is hypotensive, bradycardic, or in acute heart failure.
Question 2: A patient with acute decompensated heart failure is receiving dobutamine
at 5 mcg/kg/min via continuous infusion. The nurse notes a sudden increase in heart
rate from 88 to 128 beats per minute and the development of frequent premature
ventricular contractions (PVCs). Which action should the nurse take first?
A. Increase the dobutamine infusion rate to improve cardiac output
B. Decrease the dobutamine infusion rate and notify the provider
C. Administer a bolus of normal saline to increase preload
D. Prepare the patient for synchronized cardioversion
Correct Answer: B
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and
heart rate. Tachycardia and ventricular ectopy are signs of dobutamine toxicity or
excessive beta-1 stimulation. The nurse should first decrease the infusion rate to reduce
myocardial oxygen demand and arrhythmogenic potential, then notify the provider.
,Option A would worsen the situation. Option C is inappropriate because the patient
likely has adequate or elevated preload. Option D is not indicated for PVCs and
tachycardia in this context.
Question 3: A patient with aortic stenosis develops syncope during a walk to the
bathroom. Which hemodynamic parameter would the nurse expect to find during
assessment?
A. Narrow pulse pressure with a delayed upstroke in the carotid pulse
B. Wide pulse pressure with a bounding carotid pulse
C. Normal pulse pressure with a brisk carotid upstroke
D. Pulsus paradoxus greater than 10 mmHg
Correct Answer: A
Rationale: Aortic stenosis obstructs left ventricular outflow, resulting in a narrow pulse
pressure and delayed, weak carotid upstroke (pulsus parvus et tardus). Option B
describes aortic regurgitation. Option C describes a normal finding. Option D describes
cardiac tamponade or severe asthma.
Question 4: A patient is postoperative day 2 following coronary artery bypass grafting
(CABG) and has a chest tube to water seal. The nurse observes continuous bubbling in
the water seal chamber. Which interpretation and action is most appropriate?
A. This indicates a pneumothorax and the nurse should apply suction immediately
, B. This indicates an air leak and the nurse should assess the tubing and connections for
integrity
C. This indicates normal function and no action is needed
D. This indicates a hemothorax and the nurse should prepare for chest tube removal
Correct Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which
may be from the patient or from a disconnection in the system. The nurse should
systematically assess the chest tube insertion site, tubing connections, and drainage
system to locate the source. Option A is incorrect because suction is already applied if
ordered, and bubbling does not specifically indicate pneumothorax. Option C is incorrect
because intermittent bubbling with respiration is normal, not continuous bubbling.
Option D is incorrect because hemothorax would present with bloody drainage, not air
bubbling.
Question 5: A patient with hypertrophic cardiomyopathy (HCM) develops chest pain and
dyspnea. Which intervention should the nurse avoid?
A. Administering intravenous fluids to maintain preload
B. Administering sublingual nitroglycerin for chest pain
C. Maintaining the patient in a semi-Fowler position
D. Ensuring a calm environment to reduce sympathetic stimulation
Correct Answer: B
Rationale: In hypertrophic cardiomyopathy, the left ventricular outflow tract is
dynamically obstructed. Vasodilators such as nitroglycerin reduce preload and
100% Verified | Complete Exam-Style Questions | Pass Guaranteed –
A+ Graded
EXAM INFORMATION
Total Questions: 60
Recommended Time: 90 minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs)
Question Style: Scenario-Based, Applied, and Professional Decision-Making Questions
==============================
SECTION 1: Cardiovascular System
Question 1: A 68-year-old patient is admitted to the ICU with acute ST-elevation
myocardial infarction (STEMI) and is scheduled for primary percutaneous coronary
intervention (PCI). The nurse notes that the patient has received aspirin and clopidogrel
in the emergency department. Which of the following interventions should the nurse
prioritize during the immediate pre-procedure period?
A. Administer a bolus of unfractionated heparin to achieve an activated clotting time of
200-250 seconds
B. Verify that the patient has received a loading dose of a P2Y12 inhibitor and assess
for any bleeding risk factors
C. Initiate an infusion of nitroglycerin at 10 mcg/min to prevent coronary vasospasm
D. Administer intravenous metoprolol 5 mg to reduce myocardial oxygen demand
regardless of heart rate
,Correct Answer: B
Rationale: For primary PCI in STEMI, dual antiplatelet therapy with aspirin and a P2Y12
inhibitor (such as clopidogrel, prasugrel, or ticagrelor) is essential. The nurse must verify
that the loading dose was administered and assess for contraindications such as active
bleeding, recent surgery, or history of stroke before proceeding. Option A is incorrect
because heparin is administered during the procedure, not typically as a pre-procedure
bolus in the ICU setting. Option C is incorrect because nitroglycerin is not routinely given
to prevent vasospasm before PCI. Option D is incorrect because beta-blockers should
be withheld if the patient is hypotensive, bradycardic, or in acute heart failure.
Question 2: A patient with acute decompensated heart failure is receiving dobutamine
at 5 mcg/kg/min via continuous infusion. The nurse notes a sudden increase in heart
rate from 88 to 128 beats per minute and the development of frequent premature
ventricular contractions (PVCs). Which action should the nurse take first?
A. Increase the dobutamine infusion rate to improve cardiac output
B. Decrease the dobutamine infusion rate and notify the provider
C. Administer a bolus of normal saline to increase preload
D. Prepare the patient for synchronized cardioversion
Correct Answer: B
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and
heart rate. Tachycardia and ventricular ectopy are signs of dobutamine toxicity or
excessive beta-1 stimulation. The nurse should first decrease the infusion rate to reduce
myocardial oxygen demand and arrhythmogenic potential, then notify the provider.
,Option A would worsen the situation. Option C is inappropriate because the patient
likely has adequate or elevated preload. Option D is not indicated for PVCs and
tachycardia in this context.
Question 3: A patient with aortic stenosis develops syncope during a walk to the
bathroom. Which hemodynamic parameter would the nurse expect to find during
assessment?
A. Narrow pulse pressure with a delayed upstroke in the carotid pulse
B. Wide pulse pressure with a bounding carotid pulse
C. Normal pulse pressure with a brisk carotid upstroke
D. Pulsus paradoxus greater than 10 mmHg
Correct Answer: A
Rationale: Aortic stenosis obstructs left ventricular outflow, resulting in a narrow pulse
pressure and delayed, weak carotid upstroke (pulsus parvus et tardus). Option B
describes aortic regurgitation. Option C describes a normal finding. Option D describes
cardiac tamponade or severe asthma.
Question 4: A patient is postoperative day 2 following coronary artery bypass grafting
(CABG) and has a chest tube to water seal. The nurse observes continuous bubbling in
the water seal chamber. Which interpretation and action is most appropriate?
A. This indicates a pneumothorax and the nurse should apply suction immediately
, B. This indicates an air leak and the nurse should assess the tubing and connections for
integrity
C. This indicates normal function and no action is needed
D. This indicates a hemothorax and the nurse should prepare for chest tube removal
Correct Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak, which
may be from the patient or from a disconnection in the system. The nurse should
systematically assess the chest tube insertion site, tubing connections, and drainage
system to locate the source. Option A is incorrect because suction is already applied if
ordered, and bubbling does not specifically indicate pneumothorax. Option C is incorrect
because intermittent bubbling with respiration is normal, not continuous bubbling.
Option D is incorrect because hemothorax would present with bloody drainage, not air
bubbling.
Question 5: A patient with hypertrophic cardiomyopathy (HCM) develops chest pain and
dyspnea. Which intervention should the nurse avoid?
A. Administering intravenous fluids to maintain preload
B. Administering sublingual nitroglycerin for chest pain
C. Maintaining the patient in a semi-Fowler position
D. Ensuring a calm environment to reduce sympathetic stimulation
Correct Answer: B
Rationale: In hypertrophic cardiomyopathy, the left ventricular outflow tract is
dynamically obstructed. Vasodilators such as nitroglycerin reduce preload and
