CCRN Practice Questions – AACN Critical Care Nursing Certification –
Comprehensive Practice Questions with Answers and Rationales
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 - Correct 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. aver
C. III
D. V1 - Correct 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 - Correct 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 if?
A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. In determinant quadrant - Correct 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 if (a unipolar lead) is at the foot, if the
QRS complex is negative in lead if, 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
1
, B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone) - Correct 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 hypomagnesemia. 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 - Correct 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 hypo perfusion.
C. notify the physician.
D. ask the patient to bear down as if having a bowel movement. - Correct 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 hypo perfusion (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 - Correct 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,
and PAOP 13. What other data would indicate the development of cardiac tamponade?
2
, 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 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 - Correct 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 fan. 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
A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type
of drug is carvedilol?
A. Calcium channel blocker
B. Angiotensin-converting enzyme inhibitor
C. Alpha- and noncardioselective beta-blocker
D. Cardio selective beta-blocker - Correct Answer -C. Alpha- and noncardioselective beta-
blocker
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 creative 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 creative kinase (CK)
enzyme elevation
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Comprehensive Practice Questions with Answers and Rationales
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 - Correct 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. aver
C. III
D. V1 - Correct 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 - Correct 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 if?
A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. In determinant quadrant - Correct 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 if (a unipolar lead) is at the foot, if the
QRS complex is negative in lead if, 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
1
, B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone) - Correct 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 hypomagnesemia. 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 - Correct 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 hypo perfusion.
C. notify the physician.
D. ask the patient to bear down as if having a bowel movement. - Correct 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 hypo perfusion (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 - Correct 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,
and PAOP 13. What other data would indicate the development of cardiac tamponade?
2
, 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 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 - Correct 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 fan. 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
A patient with HF caused by diastolic dysfunction is prescribed carvedilol (Coreg). What type
of drug is carvedilol?
A. Calcium channel blocker
B. Angiotensin-converting enzyme inhibitor
C. Alpha- and noncardioselective beta-blocker
D. Cardio selective beta-blocker - Correct Answer -C. Alpha- and noncardioselective beta-
blocker
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 creative 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 creative kinase (CK)
enzyme elevation
3
