CCRN EXAM
A 29 year old female has been in the critical care unit for 2 days after a motor vehicle crash and has
developed acute tubular necrosis (ATN). She was normotensive on admission. What would be the most
likely cause of ATN?
(A) hemorrhage
(B) rhabdomyolysis
(C) creatinine release
(D) cardiac dysthymias - ANSWER-(B) The motor vehicle crash most likely resulted in a crash injury with
destruction of skeletal muscle cells (rhabdomyolysis). This results in the release of massive amounts of
creatinine kinase (CK) that, in turn, may CLOG renal tubules and lead to acute tubular necrosis (ATN).
Choice (A) is not correct as there is no history of bleeding. Choice (C), creatinine release, is too vague,
could be minor, and does not cause ATN. Arrhythmias, choice (D), are not included in the scenario.
A 52 year old male presents with complaints of blurred vision and shortness of breath. B/P is 232/136,
heart rate 102, respiratory rate 28 with crackles in lower lung fields bilaterally, with S3 and S4 heart
sounds on auscultation. Which of the following would be indicated for this patient?
(A) nitroprusside drip, admit to critical care unit
(B) digoxin, furosemide
(C) labetalol drip, admit to a medical unit
(D) lisinopril, calcium channel blocker - ANSWER-(A) The patient has signs of organ dysfunction (heart
failure) secondary to extreme hypertension. Therefore, he has hypertension crisis or emergency. The
B/P needs to be emergently decreased. Most often this treatment is best done in an ICU.
A 58 year old patient developed chest pain that he scored as an "8" Rapid assessment included profuse
diaphoresis, B/P 78/52, heart rate 104/minute, respiratory rate 20/minute, lungs clear, and SpO2 98%.
The patient is currently connected to the bedside monitor with a nasal cannula at 2 L/min in place and
intravenous fluids, 0.9 NS at a rate of 10 ml/hour. Which of the following sequences of interventions
would be the most appropriate for the nurse at this time?
(A) give a chewable aspirin, do an EKG, and start a fluid bolus
(B) give NTG sublingual, increase the FiO2 and give morphine
(C) do an EKG, give NTG sublingual, and give a chewable aspirin
(D) start a fluid bolus, give a chewable aspirin, and do an EKG - ANSWER-(D) The clinical description may
be that of acute coronary syndrome complicated by hypotension. Addressing the hypotension is a
priority as this is further decreasing coronary artery perfusion. A fluid bolus would address hypotension,
and no contraindications seem to be present for a fluid bolus as lungs are clear. Aspirin is indicated for
, CCRN EXAM
acutely chest pain and could be given while preparing to do the EKG, which is needed to help make the
diagnosis.
A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T wave
inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy was started in ED. Indications
of successful reperfusion would include all of the following except:
(A) pain cessation
(B) decrease in CK or troponin
(C) reversal of ST segment elevation with return to baseline
(D) short runs of ventricular tachycardia - ANSWER-(B)Coronary artery reperfusion due to PCI or
fibrinolysis results in an ELEVATION of creatinine kinase (CK) or troponin, not decrease. The theory is
that the return of blood flow distal to the occlusion can result in 'reperfusion injury' of the muscle,
elevating cardiac biomarkers.
The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment elevation with
return to baseline, short runs of ventricular tachycardia.
A patient complains of sudden dyspnea 5 days S/P acute MI (ST elevation in II, III, and aVF, with ST
depression in I and aVL). The patient is anxious, diaphoretic, and hypotensive. Examination reveals the
development of a loud holosystolic murmur at the apex. What is the most likely cause of this patient's
deterioration?
(A) right ventricular failure related to right ventricular MI
(B) ventricular septal defect
(C) left ventricular failure due to extension of MI
(D) acute mitral regurgitation due to papillary muscle rupture or dysfunction - ANSWER-(D) The scenario
describes a patient having an acute inferior wall MI, which is generally due to occlusion of the RCA. The
RCA occlusion may result in papillary muscle dysfunction or rupture of the mitral valve because it
supplies the area of the left ventricle where this valve is attached. Although RV infarct could result with
RCA occlusion, RV infarct does not result in a systolic murmur at apex of the heart or lung crackles.
A patient has just returned from the OR after insertion of a VVI pacemaker. In order to assess function of
this pacemaker accurately, the nurse needs to understand that:
(A) both atrium and ventricle are paced and sensed and may either inhibit or pace in response
to sensing
(B) the ventricle is paced, ventricular activity is sensed and pacing is inhibited in response to
A 29 year old female has been in the critical care unit for 2 days after a motor vehicle crash and has
developed acute tubular necrosis (ATN). She was normotensive on admission. What would be the most
likely cause of ATN?
(A) hemorrhage
(B) rhabdomyolysis
(C) creatinine release
(D) cardiac dysthymias - ANSWER-(B) The motor vehicle crash most likely resulted in a crash injury with
destruction of skeletal muscle cells (rhabdomyolysis). This results in the release of massive amounts of
creatinine kinase (CK) that, in turn, may CLOG renal tubules and lead to acute tubular necrosis (ATN).
Choice (A) is not correct as there is no history of bleeding. Choice (C), creatinine release, is too vague,
could be minor, and does not cause ATN. Arrhythmias, choice (D), are not included in the scenario.
A 52 year old male presents with complaints of blurred vision and shortness of breath. B/P is 232/136,
heart rate 102, respiratory rate 28 with crackles in lower lung fields bilaterally, with S3 and S4 heart
sounds on auscultation. Which of the following would be indicated for this patient?
(A) nitroprusside drip, admit to critical care unit
(B) digoxin, furosemide
(C) labetalol drip, admit to a medical unit
(D) lisinopril, calcium channel blocker - ANSWER-(A) The patient has signs of organ dysfunction (heart
failure) secondary to extreme hypertension. Therefore, he has hypertension crisis or emergency. The
B/P needs to be emergently decreased. Most often this treatment is best done in an ICU.
A 58 year old patient developed chest pain that he scored as an "8" Rapid assessment included profuse
diaphoresis, B/P 78/52, heart rate 104/minute, respiratory rate 20/minute, lungs clear, and SpO2 98%.
The patient is currently connected to the bedside monitor with a nasal cannula at 2 L/min in place and
intravenous fluids, 0.9 NS at a rate of 10 ml/hour. Which of the following sequences of interventions
would be the most appropriate for the nurse at this time?
(A) give a chewable aspirin, do an EKG, and start a fluid bolus
(B) give NTG sublingual, increase the FiO2 and give morphine
(C) do an EKG, give NTG sublingual, and give a chewable aspirin
(D) start a fluid bolus, give a chewable aspirin, and do an EKG - ANSWER-(D) The clinical description may
be that of acute coronary syndrome complicated by hypotension. Addressing the hypotension is a
priority as this is further decreasing coronary artery perfusion. A fluid bolus would address hypotension,
and no contraindications seem to be present for a fluid bolus as lungs are clear. Aspirin is indicated for
, CCRN EXAM
acutely chest pain and could be given while preparing to do the EKG, which is needed to help make the
diagnosis.
A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T wave
inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy was started in ED. Indications
of successful reperfusion would include all of the following except:
(A) pain cessation
(B) decrease in CK or troponin
(C) reversal of ST segment elevation with return to baseline
(D) short runs of ventricular tachycardia - ANSWER-(B)Coronary artery reperfusion due to PCI or
fibrinolysis results in an ELEVATION of creatinine kinase (CK) or troponin, not decrease. The theory is
that the return of blood flow distal to the occlusion can result in 'reperfusion injury' of the muscle,
elevating cardiac biomarkers.
The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment elevation with
return to baseline, short runs of ventricular tachycardia.
A patient complains of sudden dyspnea 5 days S/P acute MI (ST elevation in II, III, and aVF, with ST
depression in I and aVL). The patient is anxious, diaphoretic, and hypotensive. Examination reveals the
development of a loud holosystolic murmur at the apex. What is the most likely cause of this patient's
deterioration?
(A) right ventricular failure related to right ventricular MI
(B) ventricular septal defect
(C) left ventricular failure due to extension of MI
(D) acute mitral regurgitation due to papillary muscle rupture or dysfunction - ANSWER-(D) The scenario
describes a patient having an acute inferior wall MI, which is generally due to occlusion of the RCA. The
RCA occlusion may result in papillary muscle dysfunction or rupture of the mitral valve because it
supplies the area of the left ventricle where this valve is attached. Although RV infarct could result with
RCA occlusion, RV infarct does not result in a systolic murmur at apex of the heart or lung crackles.
A patient has just returned from the OR after insertion of a VVI pacemaker. In order to assess function of
this pacemaker accurately, the nurse needs to understand that:
(A) both atrium and ventricle are paced and sensed and may either inhibit or pace in response
to sensing
(B) the ventricle is paced, ventricular activity is sensed and pacing is inhibited in response to
