CCRN PRACTICE UPDATED ACTUAL
Exam Questions and CORRECT
ANSWERS
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. aVR
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 aVF?
,A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. Indeterminant 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 aVF (a unipolar lead) is at the foot,
if the QRS complex is negative in lead aVF, 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
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 hypermagnesemia. 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 hypoperfusion.
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 hypoperfusion (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 , 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
Exam Questions and CORRECT
ANSWERS
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. aVR
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 aVF?
,A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. Indeterminant 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 aVF (a unipolar lead) is at the foot,
if the QRS complex is negative in lead aVF, 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
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 hypermagnesemia. 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 hypoperfusion.
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 hypoperfusion (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 , 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
