CCRN (Adult) Practice Exam| YEAR 2026–
2027 | Comprehensive 100-Question Practice
Test with Answers & Rationales| Pdf Access
ALREADY GRADED A+.
SECTION I: CARDIOVASCULAR (20 Questions)
1. A patient with acute decompensated heart failure is receiving a continuous infusion of
milrinone. Which assessment finding requires immediate intervention?
A. Heart rate 92 bpm
B. Blood pressure 78/44 mm Hg
C. Serum potassium 4.1 mEq/L
D. Urine output 40 mL/hr
Answer: B
Rationale: Milrinone is a phosphodiesterase-3 inhibitor with positive inotropic and vasodilatory
effects. It commonly causes hypotension. A BP of 78/44 mm Hg indicates significant
hypotension requiring immediate intervention (fluid bolus, vasopressor, or discontinuation).
2. The nurse is caring for a patient following coronary artery bypass graft (CABG) surgery. Which
finding is most concerning?
A. Mediastinal chest tube drainage of 150 mL in the first hour
B. Temperature 99.8°F (37.7°C)
C. Atrial fibrillation with a rate of 112 bpm
D. Hemoglobin 10.2 g/dL
Answer: A
Rationale: Chest tube drainage > 100-150 mL/hr for 2+ consecutive hours may indicate
,postoperative hemorrhage or tamponade. This requires immediate provider notification and
possible re-exploration.
3. A patient with a temporary transvenous pacemaker has a heart rate of 38 bpm. The monitor
shows pacing spikes with no subsequent QRS complexes. The nurse should:
A. Increase the sensitivity setting
B. Increase the milliamperage output
C. Place the patient in Trendelenburg position
D. Administer atropine 0.5 mg IV
Answer: B
Rationale: Pacing spikes without capture indicate failure to capture. The initial intervention is to
increase the milliamperage (output) to ensure the electrical stimulus depolarizes the
myocardium.
4. Which hemodynamic parameter is most consistent with cardiogenic shock?
A. Cardiac index 1.8 L/min/m², SVR 1800 dynes/sec/cm⁻⁵
B. Cardiac index 4.2 L/min/m², SVR 600 dynes/sec/cm⁻⁵
C. CVP 2 mm Hg, PAOP 4 mm Hg
D. CVP 18 mm Hg, PAOP 8 mm Hg
Answer: A
Rationale: Cardiogenic shock is characterized by low cardiac index (< 2.2 L/min/m²) and
elevated SVR (compensatory vasoconstriction). PAOP would also be elevated (> 18 mm Hg).
5. A patient with an acute inferior wall myocardial infarction develops bradycardia and
hypotension unresponsive to atropine. The nurse should anticipate preparation for:
A. Emergent pericardiocentesis
B. Transcutaneous pacing
C. Intra-aortic balloon pump insertion
D. Synchronized cardioversion
Answer: B
Rationale: Inferior MI often involves the right coronary artery, which supplies the SA and AV
,nodes. Bradycardia unresponsive to atropine requires transcutaneous pacing as the next
intervention.
6. A patient is admitted with an acute ST-elevation myocardial infarction (STEMI). The nurse
understands that the primary goal of reperfusion therapy is to achieve door-to-balloon time
within:
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
Answer: C
Rationale: The American College of Cardiology/American Heart Association recommends a
door-to-balloon time of ≤ 90 minutes for primary PCI in STEMI patients.
7. A patient with heart failure is prescribed furosemide 80 mg IV. Which laboratory value should
the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: Loop diuretics like furosemide cause significant potassium loss, which can lead to
hypokalemia and potentially fatal dysrhythmias, especially in patients on digoxin.
8. A nurse is assessing a patient with a suspected abdominal aortic aneurysm (AAA) rupture.
Which finding is most indicative?
A. Sudden onset of severe back pain with hypotension
B. Gradual onset of abdominal discomfort
C. Bilateral lower extremity edema
D. Elevated BNP level
, Answer: A
Rationale: The classic triad of AAA rupture is sudden severe abdominal or back pain,
hypotension, and a pulsatile abdominal mass. This is a surgical emergency.
9. A patient is receiving a heparin infusion for DVT treatment. The nurse notes the aPTT is 95
seconds (therapeutic range 60-80 seconds). The priority action is to:
A. Increase the heparin infusion rate
B. Stop the heparin infusion and notify the provider
C. Continue the current rate and recheck in 6 hours
D. Administer protamine sulfate
Answer: B
Rationale: An aPTT of 95 seconds is supratherapeutic, indicating increased bleeding risk. The
infusion should be stopped and the provider notified for dose adjustment.
10. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. Prominent U waves
D. ST elevation
Answer: B
Rationale: Hyperkalemia causes tall, peaked T waves, widened QRS, and eventually a sine wave
pattern. This is a life-threatening emergency requiring immediate treatment.
11. A patient with a ventricular assist device (VAD) has a mean arterial pressure (MAP) of 55
mm Hg. The nurse should:
A. Increase the VAD speed
B. Decrease the VAD speed
C. Administer a fluid bolus
D. Notify the provider immediately
Answer: D
Rationale: A MAP < 60 mm Hg in a VAD patient may indicate inadequate perfusion, device
malfunction, or tamponade. This requires immediate provider notification and assessment.
2027 | Comprehensive 100-Question Practice
Test with Answers & Rationales| Pdf Access
ALREADY GRADED A+.
SECTION I: CARDIOVASCULAR (20 Questions)
1. A patient with acute decompensated heart failure is receiving a continuous infusion of
milrinone. Which assessment finding requires immediate intervention?
A. Heart rate 92 bpm
B. Blood pressure 78/44 mm Hg
C. Serum potassium 4.1 mEq/L
D. Urine output 40 mL/hr
Answer: B
Rationale: Milrinone is a phosphodiesterase-3 inhibitor with positive inotropic and vasodilatory
effects. It commonly causes hypotension. A BP of 78/44 mm Hg indicates significant
hypotension requiring immediate intervention (fluid bolus, vasopressor, or discontinuation).
2. The nurse is caring for a patient following coronary artery bypass graft (CABG) surgery. Which
finding is most concerning?
A. Mediastinal chest tube drainage of 150 mL in the first hour
B. Temperature 99.8°F (37.7°C)
C. Atrial fibrillation with a rate of 112 bpm
D. Hemoglobin 10.2 g/dL
Answer: A
Rationale: Chest tube drainage > 100-150 mL/hr for 2+ consecutive hours may indicate
,postoperative hemorrhage or tamponade. This requires immediate provider notification and
possible re-exploration.
3. A patient with a temporary transvenous pacemaker has a heart rate of 38 bpm. The monitor
shows pacing spikes with no subsequent QRS complexes. The nurse should:
A. Increase the sensitivity setting
B. Increase the milliamperage output
C. Place the patient in Trendelenburg position
D. Administer atropine 0.5 mg IV
Answer: B
Rationale: Pacing spikes without capture indicate failure to capture. The initial intervention is to
increase the milliamperage (output) to ensure the electrical stimulus depolarizes the
myocardium.
4. Which hemodynamic parameter is most consistent with cardiogenic shock?
A. Cardiac index 1.8 L/min/m², SVR 1800 dynes/sec/cm⁻⁵
B. Cardiac index 4.2 L/min/m², SVR 600 dynes/sec/cm⁻⁵
C. CVP 2 mm Hg, PAOP 4 mm Hg
D. CVP 18 mm Hg, PAOP 8 mm Hg
Answer: A
Rationale: Cardiogenic shock is characterized by low cardiac index (< 2.2 L/min/m²) and
elevated SVR (compensatory vasoconstriction). PAOP would also be elevated (> 18 mm Hg).
5. A patient with an acute inferior wall myocardial infarction develops bradycardia and
hypotension unresponsive to atropine. The nurse should anticipate preparation for:
A. Emergent pericardiocentesis
B. Transcutaneous pacing
C. Intra-aortic balloon pump insertion
D. Synchronized cardioversion
Answer: B
Rationale: Inferior MI often involves the right coronary artery, which supplies the SA and AV
,nodes. Bradycardia unresponsive to atropine requires transcutaneous pacing as the next
intervention.
6. A patient is admitted with an acute ST-elevation myocardial infarction (STEMI). The nurse
understands that the primary goal of reperfusion therapy is to achieve door-to-balloon time
within:
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
Answer: C
Rationale: The American College of Cardiology/American Heart Association recommends a
door-to-balloon time of ≤ 90 minutes for primary PCI in STEMI patients.
7. A patient with heart failure is prescribed furosemide 80 mg IV. Which laboratory value should
the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B
Rationale: Loop diuretics like furosemide cause significant potassium loss, which can lead to
hypokalemia and potentially fatal dysrhythmias, especially in patients on digoxin.
8. A nurse is assessing a patient with a suspected abdominal aortic aneurysm (AAA) rupture.
Which finding is most indicative?
A. Sudden onset of severe back pain with hypotension
B. Gradual onset of abdominal discomfort
C. Bilateral lower extremity edema
D. Elevated BNP level
, Answer: A
Rationale: The classic triad of AAA rupture is sudden severe abdominal or back pain,
hypotension, and a pulsatile abdominal mass. This is a surgical emergency.
9. A patient is receiving a heparin infusion for DVT treatment. The nurse notes the aPTT is 95
seconds (therapeutic range 60-80 seconds). The priority action is to:
A. Increase the heparin infusion rate
B. Stop the heparin infusion and notify the provider
C. Continue the current rate and recheck in 6 hours
D. Administer protamine sulfate
Answer: B
Rationale: An aPTT of 95 seconds is supratherapeutic, indicating increased bleeding risk. The
infusion should be stopped and the provider notified for dose adjustment.
10. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. Prominent U waves
D. ST elevation
Answer: B
Rationale: Hyperkalemia causes tall, peaked T waves, widened QRS, and eventually a sine wave
pattern. This is a life-threatening emergency requiring immediate treatment.
11. A patient with a ventricular assist device (VAD) has a mean arterial pressure (MAP) of 55
mm Hg. The nurse should:
A. Increase the VAD speed
B. Decrease the VAD speed
C. Administer a fluid bolus
D. Notify the provider immediately
Answer: D
Rationale: A MAP < 60 mm Hg in a VAD patient may indicate inadequate perfusion, device
malfunction, or tamponade. This requires immediate provider notification and assessment.
