CCRN exam #1 UPDATED ACTUAL Exam
Questions and CORRECT Answers
1. A 49-year-old male was recently admitted with an inferior wall
MI resulting from 100% occlusion of the right coronary artery
(RCA). The 12-Lead ECG reveals ST elevation in leads II, Ill, and avF.
You would expect to see reciprocal changes in which leads?
A. I, aVR
B. V, 2
C. V. VA
D. I, aVL - CORRECT ANSWER - 1. D. I, aVL. The RCA perfuses the inferior wall and
the mirror image or reciprocal changes would be seen in the high lateral Wel, V, ch i V, correlate
with the sepal on the 12 cad C.
g and y
correlate with the anterior area of the heart. The aVR lead dres not provide much diagnostic
value as all energy is depolarizing away from this lead.
2. You are summoned to the room of a 30-year-old female who is experiencing sustained tonic-
clonic convulsions while sitting in a chair. A family member states: "She was just talking to us
and suddenly she let out a shriek and started flopping like a fish out of water." What is your
initial priority of care?
1. Call for help and safely guide the patient to the floor
B. Call for help and administer a prescribed anticonvulsant medication
C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure - CORRECT ANSWER - 2. A. Call
for help and safely guide the patient to the floor. Patient safety is the first priority. Once the
patient is safe from immediate harm or injury, the seizure activity must be terminated. Seizure
abatement is accomplished by the administration of a benzodiazepine. Anticonvulsant
medication is useful in the prevention of seizure activity.
3. A 46-year-old patient presents with pneumonia and sepsis.
,He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath and is
now on 100% FiO, via non-re-breather mask. You obtain an ABG with the following results: pH
7.20 / PaCO, 68/ PaO, 102/ HCO, 28. A chest X-ray reveals bilateral pulmonary infiltrates. The
patient is likely developing:
A. Worsening pneumonia
B. Acute Respiratory Distress Syndrome
C. Pulmonary embolus
D. Atelectasis - CORRECT ANSWER - 3. B. Acute Respiratory Distress Syndrome.
Criteria for ARDS include bilateral pulmonary infiltrates on chest x-ray and a P/! ratio ≤ 300; it
is further rated as mild-moderate-severe ARDS based on the P/F ratio. To calculate the P/F ratio,
divide the PaO, by the FiO. In this case 102 (PaOz) ÷ 1.0 (100% FiO,) = 102, making it
borderline severe ARDS. Other criteria for ARDS are decreased compliance, high PEEP
requirement and low expired minute volume.
4. A 56 year old female is admitted to the ICU in Hypertensive Crisis with a blood pressure of
222/126 (158) mm Hg. She ran out of her blood pressure medication 2 weeks ago and did not get
the prescription refilled. Which of the following is a major complication of Hypertensive Crisis?
A. Encephalopathy
B. Diabetes Insipidus
C. SIADH
D. Gastrointestinal hemorrhage - CORRECT ANSWER - 4. A. Encephalopathy. A patient
in hypertensive crisis with a blood pressure > 180/120 mm Hg, is at risk of developing
hypertensive encephalopathy. Symptoms may include confusion, decreased level of
consciousness, visual changes headache, nausea and vomiting. Other signs of organ dysfunction
include acute kidney injury, retinal hemorrhage, vessel damage, and epistaxis. It is important in
hypertensive crisis to reduce blood pressure safely without reducing it too quickly. Often
intravenous vasodilating infusions are used to reduce the blood pressure. Examples include
nicardipine, clevidipine, hydralazine, and nitroprusside
5. Which of the following labs must be closely monitored when administering Lisinopril to a
patient with systolic heart failure?
A. Sodium
B. Phosphate
C. Magnesium
,D. Potassium - CORRECT ANSWER - 5. D. Potassium. Patients taking angiotensin
converting enzyme inhibitors may experience hyperkalemia. ACE inhibitors block angiotensin
II, which may lead to decreased aldosterone.
Aldosterone is responsible for excreting potassium from the kidneys. Therefore, ACE inhibitors
can cause potassium retention and potassium levels should be monitored closely.
In addition, renal labs such as BUN and creatinine should be monitored. If the patient develops
more than a 20% increase in the creatinine, the medication should be discontinued or the dose
reduced.
6. A 57-year-old man was admitted with an acute myocardial infarction in cardiogenic shock. He
has a blood pressure of 86/42
(57) mm Hg, heart rate 110 bpm, cardiac index 1.7 L/min/m, and a SVR 1929 dynes/sec/cm-s
A. Dobutamine
B. Norepinephrine
C. Amiodarone
D. Phenylephrine - CORRECT ANSWER - 6. A. Dobutamine. Dobutamine is a positive
inotropic medication used to improve myocardial dysfunction on patients with a low cardiac
index and elevated SVR. It will improve contractility and reduce afterload. Milrinone, which is a
phosphodiesterase inhibitor could also be used as an alternative to Dobutamine, in the setting of
decompensated heart failure.
It is used cautiously in patients experiencing cardiogenic shock as one of the main side effects of
Milrinone is hypotension.
The half-life of Milrinone is about 6 hours. Norepinephrine and Phenylephrine cause
vasoconstriction, which would increase the SVR and may further compromise cardiac output.
Amiodarone is an antiarrhythmic and is not indicated in this scenario.
7. You are caring for a patient post gastric bypass. Which of the following parameters should you
closely monitor after surgery?
A. HR, RR, temperature, WBC & MAP
B. Protein levels and vitamin B12
C. Albumin and pre-albumin levels
D. Signs of dumping syndrome - CORRECT ANSWER - 7. A. HR, RR, temperature,
WBC & MAP. Gastric bypass carries similar risks to any intestinal surgery, including the risk of
, 8. The ICU nurse is caring for a patient admitted after a ground level fall The patient is intubated
and unresponsive. On admission the patient is ordered to be a full code. The family arrives with
advanced directives stating the patient wishes not to have CPR performed or fe sustaining
treatment continued. The nurse approaches the provider about this discrepancy and the provider
states "I am aware of the advanced directive, but the daughter wants everything done."
What is the appropriate next step by the nurse?
A. Ask the daughter why she wants everything done
B. Collaborate with the provider and social worker to schedule a family meeting
C. Tall the doctor we have to follow the patient's
wishes
D. Discuss the situation with the nurse manager - CORRECT ANSWER - 8. B.
Collaborate with the provider and social worker to schedule a family meeting. The patient needs
and family wishes are at odds. Communication and team collaboration is vital to patient safety
and patient care that honors the patients wishes. The nurse is a driver in advocating for
collaborative communication to resolve the discrepancy in this situation.
9. Which is the best intervention to promote safety of the patient
A. Direct visualization of the connection between the machine and the access device
B. Strict intake and output monitoring
C. Strict bedrest
D. Electrolyte assessment q 4 hours - CORRECT ANSWER - 9. A. Direct visualization of
the connection between the machine and the access device. The nurse must be able to visualize
the junction of the central venous access and the dialysis unit at all times. Disconnection can
result in exsanguination within minutes.
10. A 72-year-old male patient is mechanically intubated. His respiratory rate is 20. The
ventilator is set to deliver 12 breaths/ minute at a set volume. The volume of the remaining 8
breaths varies. What is the mode of ventilation described?
A. Airway Pressure Release Ventilation (APRV)
B. Controlled Mandatory Ventilation (CMV)
C. Continuous Positive Airway Pressure (CPAP)
Questions and CORRECT Answers
1. A 49-year-old male was recently admitted with an inferior wall
MI resulting from 100% occlusion of the right coronary artery
(RCA). The 12-Lead ECG reveals ST elevation in leads II, Ill, and avF.
You would expect to see reciprocal changes in which leads?
A. I, aVR
B. V, 2
C. V. VA
D. I, aVL - CORRECT ANSWER - 1. D. I, aVL. The RCA perfuses the inferior wall and
the mirror image or reciprocal changes would be seen in the high lateral Wel, V, ch i V, correlate
with the sepal on the 12 cad C.
g and y
correlate with the anterior area of the heart. The aVR lead dres not provide much diagnostic
value as all energy is depolarizing away from this lead.
2. You are summoned to the room of a 30-year-old female who is experiencing sustained tonic-
clonic convulsions while sitting in a chair. A family member states: "She was just talking to us
and suddenly she let out a shriek and started flopping like a fish out of water." What is your
initial priority of care?
1. Call for help and safely guide the patient to the floor
B. Call for help and administer a prescribed anticonvulsant medication
C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure - CORRECT ANSWER - 2. A. Call
for help and safely guide the patient to the floor. Patient safety is the first priority. Once the
patient is safe from immediate harm or injury, the seizure activity must be terminated. Seizure
abatement is accomplished by the administration of a benzodiazepine. Anticonvulsant
medication is useful in the prevention of seizure activity.
3. A 46-year-old patient presents with pneumonia and sepsis.
,He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath and is
now on 100% FiO, via non-re-breather mask. You obtain an ABG with the following results: pH
7.20 / PaCO, 68/ PaO, 102/ HCO, 28. A chest X-ray reveals bilateral pulmonary infiltrates. The
patient is likely developing:
A. Worsening pneumonia
B. Acute Respiratory Distress Syndrome
C. Pulmonary embolus
D. Atelectasis - CORRECT ANSWER - 3. B. Acute Respiratory Distress Syndrome.
Criteria for ARDS include bilateral pulmonary infiltrates on chest x-ray and a P/! ratio ≤ 300; it
is further rated as mild-moderate-severe ARDS based on the P/F ratio. To calculate the P/F ratio,
divide the PaO, by the FiO. In this case 102 (PaOz) ÷ 1.0 (100% FiO,) = 102, making it
borderline severe ARDS. Other criteria for ARDS are decreased compliance, high PEEP
requirement and low expired minute volume.
4. A 56 year old female is admitted to the ICU in Hypertensive Crisis with a blood pressure of
222/126 (158) mm Hg. She ran out of her blood pressure medication 2 weeks ago and did not get
the prescription refilled. Which of the following is a major complication of Hypertensive Crisis?
A. Encephalopathy
B. Diabetes Insipidus
C. SIADH
D. Gastrointestinal hemorrhage - CORRECT ANSWER - 4. A. Encephalopathy. A patient
in hypertensive crisis with a blood pressure > 180/120 mm Hg, is at risk of developing
hypertensive encephalopathy. Symptoms may include confusion, decreased level of
consciousness, visual changes headache, nausea and vomiting. Other signs of organ dysfunction
include acute kidney injury, retinal hemorrhage, vessel damage, and epistaxis. It is important in
hypertensive crisis to reduce blood pressure safely without reducing it too quickly. Often
intravenous vasodilating infusions are used to reduce the blood pressure. Examples include
nicardipine, clevidipine, hydralazine, and nitroprusside
5. Which of the following labs must be closely monitored when administering Lisinopril to a
patient with systolic heart failure?
A. Sodium
B. Phosphate
C. Magnesium
,D. Potassium - CORRECT ANSWER - 5. D. Potassium. Patients taking angiotensin
converting enzyme inhibitors may experience hyperkalemia. ACE inhibitors block angiotensin
II, which may lead to decreased aldosterone.
Aldosterone is responsible for excreting potassium from the kidneys. Therefore, ACE inhibitors
can cause potassium retention and potassium levels should be monitored closely.
In addition, renal labs such as BUN and creatinine should be monitored. If the patient develops
more than a 20% increase in the creatinine, the medication should be discontinued or the dose
reduced.
6. A 57-year-old man was admitted with an acute myocardial infarction in cardiogenic shock. He
has a blood pressure of 86/42
(57) mm Hg, heart rate 110 bpm, cardiac index 1.7 L/min/m, and a SVR 1929 dynes/sec/cm-s
A. Dobutamine
B. Norepinephrine
C. Amiodarone
D. Phenylephrine - CORRECT ANSWER - 6. A. Dobutamine. Dobutamine is a positive
inotropic medication used to improve myocardial dysfunction on patients with a low cardiac
index and elevated SVR. It will improve contractility and reduce afterload. Milrinone, which is a
phosphodiesterase inhibitor could also be used as an alternative to Dobutamine, in the setting of
decompensated heart failure.
It is used cautiously in patients experiencing cardiogenic shock as one of the main side effects of
Milrinone is hypotension.
The half-life of Milrinone is about 6 hours. Norepinephrine and Phenylephrine cause
vasoconstriction, which would increase the SVR and may further compromise cardiac output.
Amiodarone is an antiarrhythmic and is not indicated in this scenario.
7. You are caring for a patient post gastric bypass. Which of the following parameters should you
closely monitor after surgery?
A. HR, RR, temperature, WBC & MAP
B. Protein levels and vitamin B12
C. Albumin and pre-albumin levels
D. Signs of dumping syndrome - CORRECT ANSWER - 7. A. HR, RR, temperature,
WBC & MAP. Gastric bypass carries similar risks to any intestinal surgery, including the risk of
, 8. The ICU nurse is caring for a patient admitted after a ground level fall The patient is intubated
and unresponsive. On admission the patient is ordered to be a full code. The family arrives with
advanced directives stating the patient wishes not to have CPR performed or fe sustaining
treatment continued. The nurse approaches the provider about this discrepancy and the provider
states "I am aware of the advanced directive, but the daughter wants everything done."
What is the appropriate next step by the nurse?
A. Ask the daughter why she wants everything done
B. Collaborate with the provider and social worker to schedule a family meeting
C. Tall the doctor we have to follow the patient's
wishes
D. Discuss the situation with the nurse manager - CORRECT ANSWER - 8. B.
Collaborate with the provider and social worker to schedule a family meeting. The patient needs
and family wishes are at odds. Communication and team collaboration is vital to patient safety
and patient care that honors the patients wishes. The nurse is a driver in advocating for
collaborative communication to resolve the discrepancy in this situation.
9. Which is the best intervention to promote safety of the patient
A. Direct visualization of the connection between the machine and the access device
B. Strict intake and output monitoring
C. Strict bedrest
D. Electrolyte assessment q 4 hours - CORRECT ANSWER - 9. A. Direct visualization of
the connection between the machine and the access device. The nurse must be able to visualize
the junction of the central venous access and the dialysis unit at all times. Disconnection can
result in exsanguination within minutes.
10. A 72-year-old male patient is mechanically intubated. His respiratory rate is 20. The
ventilator is set to deliver 12 breaths/ minute at a set volume. The volume of the remaining 8
breaths varies. What is the mode of ventilation described?
A. Airway Pressure Release Ventilation (APRV)
B. Controlled Mandatory Ventilation (CMV)
C. Continuous Positive Airway Pressure (CPAP)
