CCRN EXAM CRAM REVIEW SHEET COMPLETE QUESTIONS ANSWERS GRADED A PLUS
CCRN EXAM CRAM Comprehensive TEST Paper
2026/2027 Complete Answers Accurate Questions
and Answers Verified Solutions Latest Update
Question:
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
Question:
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.
Question:
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.
Question:
,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.
Question:
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.
Question:
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).
Question:
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.
Question:
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.
Question:
A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute severe
dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following
complications most likely is occurring in this patient? A. Acute mitral regurgitation B. Rupture of
left ventricular free wall C. Ventricular septal rupture D. Acute aortic stenosis
Answer:
A With an inferior MI, the risk of the papillary muscles being affected is greater. The papillary
muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral regurgitation occurs
and is manifested by a new holosystolic murmur at the apex, acute pulmonary edema, and decreased
cardiac output/index
CCRN EXAM CRAM Comprehensive TEST Paper
2026/2027 Complete Answers Accurate Questions
and Answers Verified Solutions Latest Update
Question:
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
Question:
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.
Question:
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.
Question:
,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.
Question:
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.
Question:
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).
Question:
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.
Question:
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.
Question:
A patient has had an inferior MI. He now has a new holosystolic murmur at apex, acute severe
dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following
complications most likely is occurring in this patient? A. Acute mitral regurgitation B. Rupture of
left ventricular free wall C. Ventricular septal rupture D. Acute aortic stenosis
Answer:
A With an inferior MI, the risk of the papillary muscles being affected is greater. The papillary
muscles of the LV maintain normal mitral valve fxn. If damaged, acute mitral regurgitation occurs
and is manifested by a new holosystolic murmur at the apex, acute pulmonary edema, and decreased
cardiac output/index
