CCRN Practice Correctly answered Questions Revised
and Graded Excellent
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 - CORRECT 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.
,A 40-year-old patient has been admitted to the critical care unit after sustaining multiple injuries
from a cave-in accident this morning. X-ray confirm multiple fractures, including the left femur.
During the afternoon he was taken to surgery for internal fixation of the left femur. It is now 10
pm, and the patient is complaining of severe throbbing pain in his thigh. The patient received 5
mg of morphine sulfate IV 30 minutes ago. The anterior left thigh is firm to touch, and the pain
increases when the patient flexes his left leg. The nurse should suspect which of the following?
A. Normal pain related to fractured femur
B. Abnormal pain related to compartment syndrome
C. Abnormal pain related to infection
D. Abnormal pain related to lumbosacral plexus injury - CORRECT ANSWER ✔️✔️ -B.
Abnormal pain related to compartment syndrome
A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute MI. EKG
shows ST elevation and T wave inversion in leads V2, V3, and V4. His history includes HTN, 80
pack-years of smoking, COPD, and HLD.
An IV and fibrinolytic therapy were initiated in the ED. Which of the following would not be an
indication of successful reperfusion?
A. Pain cessation
B. Absence of creatine kinase (CK) enzyme elevation
,C. Reversal of ST segment elevation with return of ST segment to baseline
D. Short runs of ventricular tachycardia - CORRECT ANSWER ✔️✔️ -B. Absence of creatine
kinase (CK) enzyme elevation
A 52-year-old woman arrives in the ED. started having fluttering in her chest about 1 hour ago
and now is having chest pain. She has a history of HTN. The EKG monitor shows paroxysmal
atrial tachycardia with HR 150, BP 130/88. Verapamil 5 mg is given via slow IV push. What
would be a desirable therapeutic outcome?
A. Decrease in blood pressure
B. Decrease in heart rate
C. Change in rhythm to atrial fibrillation
D. A decrease in the fluttering feeling in her chest - CORRECT ANSWER ✔️✔️ -B. Decrease in
heart rate
A 55-year-old man had a heart transplant 10 hours ago. Present assessment includes cold,
clammy skin, jugular venous distention, bilateral crackles, and tachycardia. Vital signs are
temperature 98.6° F, BP 80/60, HR 120 and RR 24 . Mediastinal tube drainage is approximately
50 mL/hr. He is diagnosed with decreased cardiac contractility. Which of the following would be
an appropriate treatment for this patient?
A. Beta-adrenergic stimulant (e.g., dobutamine)
, B. Diuretic (e.g., furosemide)
C. Normal saline bolus
D. Antibiotics - CORRECT ANSWER ✔️✔️ -A. Beta-adrenergic stimulant (e.g., dobutamine)
A 55-year-old man with a long history of alcoholism continues to drink alcohol and now has
alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of the following would this
patient not be expected to receive?
A. Angiotensin-converting enzyme inhibitors
B. Cardiac transplant referral
C. Diuretics
D. Inotropes - CORRECT ANSWER ✔️✔️ -B. Cardiac transplant referral
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.
and Graded Excellent
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 - CORRECT 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.
,A 40-year-old patient has been admitted to the critical care unit after sustaining multiple injuries
from a cave-in accident this morning. X-ray confirm multiple fractures, including the left femur.
During the afternoon he was taken to surgery for internal fixation of the left femur. It is now 10
pm, and the patient is complaining of severe throbbing pain in his thigh. The patient received 5
mg of morphine sulfate IV 30 minutes ago. The anterior left thigh is firm to touch, and the pain
increases when the patient flexes his left leg. The nurse should suspect which of the following?
A. Normal pain related to fractured femur
B. Abnormal pain related to compartment syndrome
C. Abnormal pain related to infection
D. Abnormal pain related to lumbosacral plexus injury - CORRECT ANSWER ✔️✔️ -B.
Abnormal pain related to compartment syndrome
A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute MI. EKG
shows ST elevation and T wave inversion in leads V2, V3, and V4. His history includes HTN, 80
pack-years of smoking, COPD, and HLD.
An IV and fibrinolytic therapy were initiated in the ED. Which of the following would not be an
indication of successful reperfusion?
A. Pain cessation
B. Absence of creatine kinase (CK) enzyme elevation
,C. Reversal of ST segment elevation with return of ST segment to baseline
D. Short runs of ventricular tachycardia - CORRECT ANSWER ✔️✔️ -B. Absence of creatine
kinase (CK) enzyme elevation
A 52-year-old woman arrives in the ED. started having fluttering in her chest about 1 hour ago
and now is having chest pain. She has a history of HTN. The EKG monitor shows paroxysmal
atrial tachycardia with HR 150, BP 130/88. Verapamil 5 mg is given via slow IV push. What
would be a desirable therapeutic outcome?
A. Decrease in blood pressure
B. Decrease in heart rate
C. Change in rhythm to atrial fibrillation
D. A decrease in the fluttering feeling in her chest - CORRECT ANSWER ✔️✔️ -B. Decrease in
heart rate
A 55-year-old man had a heart transplant 10 hours ago. Present assessment includes cold,
clammy skin, jugular venous distention, bilateral crackles, and tachycardia. Vital signs are
temperature 98.6° F, BP 80/60, HR 120 and RR 24 . Mediastinal tube drainage is approximately
50 mL/hr. He is diagnosed with decreased cardiac contractility. Which of the following would be
an appropriate treatment for this patient?
A. Beta-adrenergic stimulant (e.g., dobutamine)
, B. Diuretic (e.g., furosemide)
C. Normal saline bolus
D. Antibiotics - CORRECT ANSWER ✔️✔️ -A. Beta-adrenergic stimulant (e.g., dobutamine)
A 55-year-old man with a long history of alcoholism continues to drink alcohol and now has
alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of the following would this
patient not be expected to receive?
A. Angiotensin-converting enzyme inhibitors
B. Cardiac transplant referral
C. Diuretics
D. Inotropes - CORRECT ANSWER ✔️✔️ -B. Cardiac transplant referral
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.
