CCRN EXAM PREPARATION TEST BANK
Comprehensive Review with 150+ Multiple
Choice Questions WITH CORRECT ANSWERS
AND IN-DEPTH RATIONALES !
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-30)
Question 1
A patient with acute decompensated heart failure is receiving intravenous
nitroglycerin. Which assessment finding indicates the medication is having the desired
therapeutic effect?
A) Heart rate increase from 88 to 102 bpm
B) Central venous pressure decrease from 18 to 12 mmHg
C) Systolic blood pressure decrease from 160 to 110 mmHg
D) Pulmonary artery wedge pressure increase from 22 to 26 mmHg
CORRECT ANSWER: B
Rationale: Intravenous nitroglycerin is a potent vasodilator that reduces preload by
venous dilation, decreasing ventricular filling pressures (CVP, PAWP). The desired effect
is reduction in pulmonary congestion and improved cardiac output. While a decrease
in BP may occur, the primary goal in ADHF is preload reduction. Option D shows
worsening, not improvement.
Question 2
A patient is in ventricular fibrillation. The defibrillator is charged to 200 J biphasic. Which
action should the nurse take immediately before delivering the shock?
,A) Ensure the defibrillator is in synchronized mode
B) Remove the oxygen mask from the patient
C) Administer a 1 mg dose of epinephrine IV push
D) Confirm all personnel are clear of the patient and bed
CORRECT ANSWER: D
Rationale: Patient and personnel safety is paramount during defibrillation. All personnel
must be clear of the patient, bed, and any equipment connected to the patient to
prevent electrical injury to staff. Defibrillation is delivered in unsynchronized mode for
VF/pulseless VT. Oxygen should be removed during shock delivery to prevent fire
hazard, but ensuring personnel safety is the immediate priority before shock delivery.
Question 3
A patient with a pulmonary artery catheter has the following hemodynamic values:
Cardiac output: 2.8 L/min
Cardiac index: 1.6 L/min/m²
Pulmonary artery wedge pressure: 24 mmHg
Central venous pressure: 16 mmHg
Systemic vascular resistance: 1800 dynes/sec/cm⁻⁵
Which condition is most consistent with these findings?
A) Cardiogenic shock
B) Septic shock
,C) Hypovolemic shock
D) Neurogenic shock
CORRECT ANSWER: A
Rationale: These values demonstrate cardiogenic shock: low cardiac output/index with
elevated filling pressures (PAWP and CVP) and elevated SVR. The elevated PAWP (>18
mmHg) indicates left ventricular failure with fluid backing up into the lungs. Low cardiac
output with high SVR indicates the heart cannot pump effectively despite
vasoconstriction.
Question 4
A patient is receiving an intravenous infusion of amiodarone for recurrent ventricular
tachycardia. Which assessment finding requires immediate intervention?
A) Heart rate of 62 bpm
B) QTc interval prolonged to 520 msec
C) Blood pressure of 110/70 mmHg
D) Mild nausea
CORRECT ANSWER: B
Rationale: Amiodarone can prolong the QT interval, increasing the risk of torsades de
pointes. A QTc >500 msec is significant and requires dose reduction or discontinuation.
While bradycardia may occur, a heart rate of 62 is acceptable. Hypotension is a
concern but 110/70 is stable. Nausea is a side effect but not immediately life-
threatening.
Question 5
A patient has just undergone placement of a permanent pacemaker for complete
heart block. Which postoperative finding is most concerning?
, A) Pain at the insertion site rated 4/10
B) Premature ventricular contractions (PVCs) with bigeminy
C) Pacemaker spikes without captured QRS complexes
D) Small amount of serosanguinous drainage at incision site
CORRECT ANSWER: C
Rationale: Pacemaker spikes without captured QRS complexes indicate failure to
capture, which is a life-threatening complication. This means the pacemaker is firing but
the heart is not responding, leaving the patient vulnerable to asystole or bradycardia.
PVCs and incisional pain are expected. Serosanguinous drainage is normal.
Question 6
Which electrocardiographic change is most specific for myocardial ischemia?
A) Tall, peaked T waves
B) ST-segment elevation
C) ST-segment depression with T-wave inversion
D) Pathologic Q waves
CORRECT ANSWER: B
Rationale: ST-segment elevation is the most specific ECG finding for acute myocardial
ischemia/injury. It represents transmural injury and is the hallmark of STEMI. ST depression
with T-wave inversion indicates subendocardial ischemia but is less specific. Pathologic
Q waves indicate necrosis (old MI). Tall peaked T waves may indicate hyperkalemia.
Question 7
A patient with acute myocardial infarction develops cardiogenic shock. Which
intervention should be initiated first?
Comprehensive Review with 150+ Multiple
Choice Questions WITH CORRECT ANSWERS
AND IN-DEPTH RATIONALES !
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-30)
Question 1
A patient with acute decompensated heart failure is receiving intravenous
nitroglycerin. Which assessment finding indicates the medication is having the desired
therapeutic effect?
A) Heart rate increase from 88 to 102 bpm
B) Central venous pressure decrease from 18 to 12 mmHg
C) Systolic blood pressure decrease from 160 to 110 mmHg
D) Pulmonary artery wedge pressure increase from 22 to 26 mmHg
CORRECT ANSWER: B
Rationale: Intravenous nitroglycerin is a potent vasodilator that reduces preload by
venous dilation, decreasing ventricular filling pressures (CVP, PAWP). The desired effect
is reduction in pulmonary congestion and improved cardiac output. While a decrease
in BP may occur, the primary goal in ADHF is preload reduction. Option D shows
worsening, not improvement.
Question 2
A patient is in ventricular fibrillation. The defibrillator is charged to 200 J biphasic. Which
action should the nurse take immediately before delivering the shock?
,A) Ensure the defibrillator is in synchronized mode
B) Remove the oxygen mask from the patient
C) Administer a 1 mg dose of epinephrine IV push
D) Confirm all personnel are clear of the patient and bed
CORRECT ANSWER: D
Rationale: Patient and personnel safety is paramount during defibrillation. All personnel
must be clear of the patient, bed, and any equipment connected to the patient to
prevent electrical injury to staff. Defibrillation is delivered in unsynchronized mode for
VF/pulseless VT. Oxygen should be removed during shock delivery to prevent fire
hazard, but ensuring personnel safety is the immediate priority before shock delivery.
Question 3
A patient with a pulmonary artery catheter has the following hemodynamic values:
Cardiac output: 2.8 L/min
Cardiac index: 1.6 L/min/m²
Pulmonary artery wedge pressure: 24 mmHg
Central venous pressure: 16 mmHg
Systemic vascular resistance: 1800 dynes/sec/cm⁻⁵
Which condition is most consistent with these findings?
A) Cardiogenic shock
B) Septic shock
,C) Hypovolemic shock
D) Neurogenic shock
CORRECT ANSWER: A
Rationale: These values demonstrate cardiogenic shock: low cardiac output/index with
elevated filling pressures (PAWP and CVP) and elevated SVR. The elevated PAWP (>18
mmHg) indicates left ventricular failure with fluid backing up into the lungs. Low cardiac
output with high SVR indicates the heart cannot pump effectively despite
vasoconstriction.
Question 4
A patient is receiving an intravenous infusion of amiodarone for recurrent ventricular
tachycardia. Which assessment finding requires immediate intervention?
A) Heart rate of 62 bpm
B) QTc interval prolonged to 520 msec
C) Blood pressure of 110/70 mmHg
D) Mild nausea
CORRECT ANSWER: B
Rationale: Amiodarone can prolong the QT interval, increasing the risk of torsades de
pointes. A QTc >500 msec is significant and requires dose reduction or discontinuation.
While bradycardia may occur, a heart rate of 62 is acceptable. Hypotension is a
concern but 110/70 is stable. Nausea is a side effect but not immediately life-
threatening.
Question 5
A patient has just undergone placement of a permanent pacemaker for complete
heart block. Which postoperative finding is most concerning?
, A) Pain at the insertion site rated 4/10
B) Premature ventricular contractions (PVCs) with bigeminy
C) Pacemaker spikes without captured QRS complexes
D) Small amount of serosanguinous drainage at incision site
CORRECT ANSWER: C
Rationale: Pacemaker spikes without captured QRS complexes indicate failure to
capture, which is a life-threatening complication. This means the pacemaker is firing but
the heart is not responding, leaving the patient vulnerable to asystole or bradycardia.
PVCs and incisional pain are expected. Serosanguinous drainage is normal.
Question 6
Which electrocardiographic change is most specific for myocardial ischemia?
A) Tall, peaked T waves
B) ST-segment elevation
C) ST-segment depression with T-wave inversion
D) Pathologic Q waves
CORRECT ANSWER: B
Rationale: ST-segment elevation is the most specific ECG finding for acute myocardial
ischemia/injury. It represents transmural injury and is the hallmark of STEMI. ST depression
with T-wave inversion indicates subendocardial ischemia but is less specific. Pathologic
Q waves indicate necrosis (old MI). Tall peaked T waves may indicate hyperkalemia.
Question 7
A patient with acute myocardial infarction develops cardiogenic shock. Which
intervention should be initiated first?
