CCRN EXAM 2025 VERIFIED QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES
GRADED A+.
Your patient admitted with an NSTEMI develops acute shortness of
breath, recurrence of chest pain, and a loud systolic murmur at the
apex of the heart. Which of the following has most likely occurred?
(A) the patient has developed acute mitral valve regurgitation
(B) the patient has developed acute infarction
(C) the patient has developed acute mitral wave stenosis
(D) the patient has developed acute ventricular septal defect - Correct
Answer>>(A) The location of the murmur, at the apex of the heart
(midclavicular, 5th ICS), is one clue to this answer. In addition,
regurgitation occurs when the valve should be closed and the mitral
valve should be closed during systole. Mitral stenosis, choice (C),
occurs when the mitral valve is open. Additionally, mitral stenosis
cannot be acute, it develops gradually.
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 ventricular sensing.
(C) both the atrium and ventricle are paced, but only ventricular
pacing can be inhibited by a sensed intrinsic ventricular impulse. (D)
the ventricle is paced in response to a sensed intrinsic atrial
impulse or inhibited by a sensed
intrinsic ventricular impulse. - Correct Answer>>(B) the first letter
indicates chamber paced (ventricle). The second letter indicates
chamber sensed (ventricle). The third letter indicates the response to
sensing (inhibited in response to sensing).
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 - Correct 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.
The patient with diagnosis of cardiogenic shock now requires high dose
dopamine (greater than 10 mcg/kg/min) to maintain blood pressure,
and the cardiologist is planning to start IABP therapy. This therapy will
benefit the patient because it will:
(A) increase afterload with balloon inflation and decrease diastolic
augmentation with balloon deflation.
(B) decrease afterload with balloon deflation and increase diastolic
augmentation with balloon inflation.
(C) decrease afterload with balloon inflation and decrease diastolic
augmentation with balloon deflation
(D) increase afterload with balloon deflation and decrease diastolic
augmentation with balloon inflation. - Correct Answer>>(B) Cardiogenic
shock results in a decrease in cardiac output with a resultant drop in
coronary artery perfusion and compensatory vasoconstriction. The
deflation of the balloon placed into the descending aorta is beneficial.
Deflation decreases afterload and work of the left ventricle. Inflation of
the balloon is beneficial because it "boluses" blood into the coronary
arteries, increasing perfusion.
Four days after mitral valve replacement, the patient goes into atrial
fibrillation with rapid ventricular response. What should be the nurse's
initial action?
(A) order a 12 lead EKG
(B) evaluate the patient for clinical signs of hypoperfusion
DETAILED ANSWERS WITH RATIONALES
GRADED A+.
Your patient admitted with an NSTEMI develops acute shortness of
breath, recurrence of chest pain, and a loud systolic murmur at the
apex of the heart. Which of the following has most likely occurred?
(A) the patient has developed acute mitral valve regurgitation
(B) the patient has developed acute infarction
(C) the patient has developed acute mitral wave stenosis
(D) the patient has developed acute ventricular septal defect - Correct
Answer>>(A) The location of the murmur, at the apex of the heart
(midclavicular, 5th ICS), is one clue to this answer. In addition,
regurgitation occurs when the valve should be closed and the mitral
valve should be closed during systole. Mitral stenosis, choice (C),
occurs when the mitral valve is open. Additionally, mitral stenosis
cannot be acute, it develops gradually.
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 ventricular sensing.
(C) both the atrium and ventricle are paced, but only ventricular
pacing can be inhibited by a sensed intrinsic ventricular impulse. (D)
the ventricle is paced in response to a sensed intrinsic atrial
impulse or inhibited by a sensed
intrinsic ventricular impulse. - Correct Answer>>(B) the first letter
indicates chamber paced (ventricle). The second letter indicates
chamber sensed (ventricle). The third letter indicates the response to
sensing (inhibited in response to sensing).
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 - Correct 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.
The patient with diagnosis of cardiogenic shock now requires high dose
dopamine (greater than 10 mcg/kg/min) to maintain blood pressure,
and the cardiologist is planning to start IABP therapy. This therapy will
benefit the patient because it will:
(A) increase afterload with balloon inflation and decrease diastolic
augmentation with balloon deflation.
(B) decrease afterload with balloon deflation and increase diastolic
augmentation with balloon inflation.
(C) decrease afterload with balloon inflation and decrease diastolic
augmentation with balloon deflation
(D) increase afterload with balloon deflation and decrease diastolic
augmentation with balloon inflation. - Correct Answer>>(B) Cardiogenic
shock results in a decrease in cardiac output with a resultant drop in
coronary artery perfusion and compensatory vasoconstriction. The
deflation of the balloon placed into the descending aorta is beneficial.
Deflation decreases afterload and work of the left ventricle. Inflation of
the balloon is beneficial because it "boluses" blood into the coronary
arteries, increasing perfusion.
Four days after mitral valve replacement, the patient goes into atrial
fibrillation with rapid ventricular response. What should be the nurse's
initial action?
(A) order a 12 lead EKG
(B) evaluate the patient for clinical signs of hypoperfusion
