• CCRN PRACTICE 09/09/2026
EXAM
CCRN PRACTICE EXAM 3 PREP NEW 2026/2027
ACTUAL EXAM COMPLETE 250 QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) WITH RATIONALES |ALREADY
GRADED A+||BRAND NEW VERSION!!
A 58-year-old male presents with chest pain radiating to the left arm. ECG shows ST elevations in V1-
V4. Which artery is most likely occluded?
A. Left circumflex artery
B. Right coronary artery
P 1
, • CCRN PRACTICE 09/09/2026
EXAM
C. Left anterior descending artery
D. Posterior descending artery
C. Left anterior descending artery
ST elevation in leads V1-V4 indicates an anterior wall myocardial infarction, which is typically due to
occlusion of the left anterior descending (LAD) artery. The LAD supplies the anterior wall of the left
ventricle, and occlusion is associated with a high risk of mortality.
A 67-year-old female post-cardiac surgery becomes hypotensive with muffled heart sounds and jugular
venous distension. What is the most likely cause?
A. Pulmonary embolism
B. Tension pneumothorax
C. Cardiac tamponade
D. Right ventricular infarction
C. Cardiac tamponade
Beck's triad—hypotension, muffled heart sounds, and jugular venous distension—is classic for cardiac
tamponade. This can occur post-cardiac surgery due to pericardial effusion compressing the heart and
impairing filling, leading to obstructive shock.
A patient with a hypertensive emergency presents with BP 240/130 mmHg and signs of encephalopathy.
Which medication is preferred initially?
A. Nitroprusside IV
B. Hydralazine IV
C. Esmolol IV
D. Nifedipine PO
A. Nitroprusside IV
In hypertensive emergencies with evidence of end-organ damage like encephalopathy, a rapid-acting IV
vasodilator such as nitroprusside is preferred. It allows tight control of blood pressure to prevent further
neurologic damage. Oral agents are inappropriate for acute management.
P 2
, • CCRN PRACTICE 09/09/2026
EXAM
A patient post-MI develops a new systolic murmur and signs of heart failure. Which complication is
most likely?
A. Papillary muscle rupture
B. Ventricular septal defect
C. Pericardial effusion
D. Cardiac tamponade
A. Papillary muscle rupture
Papillary muscle rupture following an MI causes acute mitral regurgitation, presenting with a new
systolic murmur and signs of heart failure. It is a surgical emergency. Ventricular septal defects also
occur but often produce a holosystolic murmur at the lower sternal border.
A 73-year-old with dilated cardiomyopathy is admitted with severe dyspnea and crackles. Which
hemodynamic profile is expected?
A. Decreased CVP and decreased PCWP
B. Increased CVP and increased PCWP
C. Increased CVP and decreased PCWP
D. Decreased CVP and increased PCWP
B. Increased CVP and increased PCWP
In dilated cardiomyopathy, both right and left heart failure occur, leading to elevated central venous
pressure (CVP) and pulmonary capillary wedge pressure (PCWP). This reflects volume overload and
impaired ventricular function.
Following a valve replacement surgery, a patient develops hypotension and a widened mediastinum on
chest X-ray. What is the priority intervention?
A. Administer vasopressors
B. Initiate CPR
C. Prepare for emergent surgery
D. Increase IV fluids
C. Prepare for emergent surgery
A widened mediastinum after valve replacement surgery suggests cardiac tamponade or mediastinal
P 3
, • CCRN PRACTICE 09/09/2026
EXAM
bleeding, both of which are surgical emergencies. Immediate surgical intervention is necessary to
prevent cardiovascular collapse.
A patient with aortic dissection presents with chest pain radiating to the back and unequal pulses. Which
diagnostic test is most definitive?
A. Chest X-ray
B. ECG
C. CT angiography
D. Transthoracic echocardiogram
C. CT angiography
CT angiography is the gold standard for diagnosing aortic dissection. It allows visualization of the
intimal tear and extent of dissection. Chest X-ray may show a widened mediastinum but is not
definitive.
Which finding is most indicative of cardiogenic shock?
A. Low CVP, low PCWP, low SVR
B. High CVP, high PCWP, low SVR
C. High CVP, high PCWP, high SVR
D. Low CVP, low PCWP, high SVR
C. High CVP, high PCWP, high SVR
Cardiogenic shock is characterized by failure of the heart to pump effectively, leading to high filling
pressures (CVP and PCWP) and systemic vasoconstriction (high SVR) as the body attempts to maintain
perfusion.
A patient with prolonged QT interval is at highest risk for developing which dysrhythmia?
A. Atrial fibrillation
B. Torsades de Pointes
P 4
EXAM
CCRN PRACTICE EXAM 3 PREP NEW 2026/2027
ACTUAL EXAM COMPLETE 250 QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) WITH RATIONALES |ALREADY
GRADED A+||BRAND NEW VERSION!!
A 58-year-old male presents with chest pain radiating to the left arm. ECG shows ST elevations in V1-
V4. Which artery is most likely occluded?
A. Left circumflex artery
B. Right coronary artery
P 1
, • CCRN PRACTICE 09/09/2026
EXAM
C. Left anterior descending artery
D. Posterior descending artery
C. Left anterior descending artery
ST elevation in leads V1-V4 indicates an anterior wall myocardial infarction, which is typically due to
occlusion of the left anterior descending (LAD) artery. The LAD supplies the anterior wall of the left
ventricle, and occlusion is associated with a high risk of mortality.
A 67-year-old female post-cardiac surgery becomes hypotensive with muffled heart sounds and jugular
venous distension. What is the most likely cause?
A. Pulmonary embolism
B. Tension pneumothorax
C. Cardiac tamponade
D. Right ventricular infarction
C. Cardiac tamponade
Beck's triad—hypotension, muffled heart sounds, and jugular venous distension—is classic for cardiac
tamponade. This can occur post-cardiac surgery due to pericardial effusion compressing the heart and
impairing filling, leading to obstructive shock.
A patient with a hypertensive emergency presents with BP 240/130 mmHg and signs of encephalopathy.
Which medication is preferred initially?
A. Nitroprusside IV
B. Hydralazine IV
C. Esmolol IV
D. Nifedipine PO
A. Nitroprusside IV
In hypertensive emergencies with evidence of end-organ damage like encephalopathy, a rapid-acting IV
vasodilator such as nitroprusside is preferred. It allows tight control of blood pressure to prevent further
neurologic damage. Oral agents are inappropriate for acute management.
P 2
, • CCRN PRACTICE 09/09/2026
EXAM
A patient post-MI develops a new systolic murmur and signs of heart failure. Which complication is
most likely?
A. Papillary muscle rupture
B. Ventricular septal defect
C. Pericardial effusion
D. Cardiac tamponade
A. Papillary muscle rupture
Papillary muscle rupture following an MI causes acute mitral regurgitation, presenting with a new
systolic murmur and signs of heart failure. It is a surgical emergency. Ventricular septal defects also
occur but often produce a holosystolic murmur at the lower sternal border.
A 73-year-old with dilated cardiomyopathy is admitted with severe dyspnea and crackles. Which
hemodynamic profile is expected?
A. Decreased CVP and decreased PCWP
B. Increased CVP and increased PCWP
C. Increased CVP and decreased PCWP
D. Decreased CVP and increased PCWP
B. Increased CVP and increased PCWP
In dilated cardiomyopathy, both right and left heart failure occur, leading to elevated central venous
pressure (CVP) and pulmonary capillary wedge pressure (PCWP). This reflects volume overload and
impaired ventricular function.
Following a valve replacement surgery, a patient develops hypotension and a widened mediastinum on
chest X-ray. What is the priority intervention?
A. Administer vasopressors
B. Initiate CPR
C. Prepare for emergent surgery
D. Increase IV fluids
C. Prepare for emergent surgery
A widened mediastinum after valve replacement surgery suggests cardiac tamponade or mediastinal
P 3
, • CCRN PRACTICE 09/09/2026
EXAM
bleeding, both of which are surgical emergencies. Immediate surgical intervention is necessary to
prevent cardiovascular collapse.
A patient with aortic dissection presents with chest pain radiating to the back and unequal pulses. Which
diagnostic test is most definitive?
A. Chest X-ray
B. ECG
C. CT angiography
D. Transthoracic echocardiogram
C. CT angiography
CT angiography is the gold standard for diagnosing aortic dissection. It allows visualization of the
intimal tear and extent of dissection. Chest X-ray may show a widened mediastinum but is not
definitive.
Which finding is most indicative of cardiogenic shock?
A. Low CVP, low PCWP, low SVR
B. High CVP, high PCWP, low SVR
C. High CVP, high PCWP, high SVR
D. Low CVP, low PCWP, high SVR
C. High CVP, high PCWP, high SVR
Cardiogenic shock is characterized by failure of the heart to pump effectively, leading to high filling
pressures (CVP and PCWP) and systemic vasoconstriction (high SVR) as the body attempts to maintain
perfusion.
A patient with prolonged QT interval is at highest risk for developing which dysrhythmia?
A. Atrial fibrillation
B. Torsades de Pointes
P 4
