CCRN EXAM CRAM CERTIFICATION EVALUATION TESTED QUESTIONS FULL
SOLUTION GUIDE
CCRN EXAM CRAM Actual Examination 2026/2027
Questions and Answers Verified Solutions Latest
Update
Question:
A patient arrived in the emergency department with complaints of chest pain. The 12-lead
electrocardiogram shows ST segment 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
Answer:
Correct answer: d Rationale: ST segment elevation in leads V3 and V4 indicates injury to the
anterior wall, which would occur with occlusion of the left anterior descending (LAD) artery. In
most persons, the SA node, Bachmann's bundle, and AV node are supplied by the right coronary
artery. The bundle of His is supplied by the left anterior descending artery. This is why an anterior
myocardial infarction may cause type II second-degree AV block or third-degree AV heart block at
the level of the bundle of His. Test-Taking Strategy: Note that options a, b, and c are part of the
supraventricular conduction system. They usually are supplied by the right coronary artery. The
LAD artery supplies most of the interventricular conduction system, including the bundle of His and
the bundle branches.
Question:
Oxygen delivery (DO2) is the product of which of the following? a. PaO2, hemoglobin, mean
arterial pressure b. SaO2, hemoglobin, cardiac output c. SvO2, cardiac index, SaO2 d. PaO2, mean
arterial pressure, SvO2
Answer:
Correct answer: b Rationale: Ninety-seven percent of oxygen is attached to the hemoglobin
molecule, so the SaO2 (arterial oxygen saturation) is a more accurate reflection of the amount of
oxygen in blood. The PaO2 represents only the 3% that is dissolved in the plasma. The lungs must
put the oxygen in the blood, the hemoglobin must carry the oxygen, and the cardiac output is a
reflection of how well the heart is moving the blood with its hemoglobin with attached oxygen.
SvO2 (venous oxygen saturation) is a reflection of the oxygen reserve. SvO2 is what is left over
after the tissues have extracted what they need. The mean arterial pressure is a reflection of organ
tissue perfusion pressure but does not indicate anything about the amount of oxygen in that blood.
Test-Taking Strategy: Oxygen is delivered from the arterial end, so choose an option that has SaO2
,instead of SvO2. Also remember that most oxygen is carried on hemoglobin. Look for SaO2 (not
PaO2) and hemoglobin. The only option with both of these is option b.
Question:
Which of the following types of block are most likely after an anterior wall myocardial infarction
(MI)? a. Sinus block b. Second-degree atrioventricular (AV) block, type I c. Second-degree AV
block, type II d. Third-degree AV block with junctional escape rhythm
Answer:
Correct answer: c Rationale: Anterior MI is caused by a left anterior descending (LAD) artery
lesion. The LAD artery supplies the bundle of His and bundle branches, so anterior MIs may cause
blocks of the bundle of His or bundle branches. Second-degree AV block type II is a block at the
level of the bundle of His. If this patient does develop a third-degree AV block, it would be at the
level of the bundle of His, and the only escape rhythm available below the bundle of His is a
ventricular escape rhythm. Test-Taking Strategy: The sinus node is supplied by right coronary artery
(in 55% of people) or left coronary artery (in 45% of people), so eliminate option a. Type I AV
block, also called Wenckebach, is a block at the AV node, and the AV node is supplied by right
coronary artery (in 90% of people) or left coronary artery (10%), so eliminate option b. The LAD
artery supplies the bundle of His, and blocks in this area would eliminate the possibility of
junctional escape rhythms, so eliminate option d. Choose option c.
Question:
A patient develops atrial fibrillation after abdominal surgery. Her blood pressure falls from 110/70
mm Hg to 92/68 mm Hg. The hypotension is related to which of the following? a. Decrease in
ventricular contractility b. Hypovolemia c. Mural thrombi d. Decrease in ventricular filling
Answer:
Correct answer: d Rationale: The contribution that atrial contraction makes to ventricular filling
volume is approximately 15% to 30%. Atrial fibrillation results in quivering but not contracting
atria. The loss of 15% to 30% of diastolic filling volume reduces cardiac output and can have
significant hemodynamic consequences. Although mural thrombi also are a problem, they result in
an embolic phenomenon rather than a direct decrease in cardiac output. The relationship between
the development of atrial fibrillation and the decrease in cardiac output make hypovolemia and
decrease in contractility less likely. Test-Taking Strategy: Relate recent changes in patient status to
recent occurrences. The patient had a change in atrial function, so select an option that results in loss
of atrial contraction or "kick." Choose option d.
, Question:
A shift in the point of maximal impulse (PMI) to the fifth left intercostal space at the anterior
axillary line could be caused by any of these conditions except: a. left ventricular hypertrophy. b.
right tension pneumothorax. c. pericardial effusion. d. right pleural effusion.
Answer:
Correct answer: c Rationale: In pericardial effusion or tamponade, there is frequently loss of
palpability of the apical impulse because of the fluid layer. Left ventricular hypertrophy, right
tension pneumothorax, and a right pleural effusion could shift the PMI left of normal. Normally the
PMI is located at the fifth left intercostal space at the midclavicular line. Test-Taking Strategy: Look
for the process that would not shift the PMI to the left of the normal position. Picture the process. If
the left ventricle is big, it will extend farther to the left. If there is excessive pressure or volume on
the right side, it will push the heart toward the left. Pericardial effusion will decrease the intensity of
the PMI but it won't shift it. Choose option c.
Question:
An S4 is an expected physical finding in which of the following? a. Acute myocardial infarction b.
Left ventricular failure c. Pericarditis d. Bundle branch block
Answer:
Correct answer: a Rationale: An S4 is an indication of ventricular noncompliance. Noncompliance
is caused by ischemia, infarction, hypertrophy, cardiac tamponade, constrictive pericarditis, or
restrictive cardiomyopathy. Left ventricular failure would cause an S3. Pericarditis would cause a
pericardial friction rub. Bundle branch blocks cause splits (left bundle branch block causes a
paradoxical split of S2, and right bundle branch block causes a split of S1 and increased splitting of
S2 during inspiration). Test-Taking Strategy: Read the question carefully and note the key word
expected. Associate S4 with a noncompliant ventricle. Ischemia, infarction, and hypertrophy cause
noncompliance. Choose option a.
Question:
A woman, age 35 years, reports the feeling that her heart is racing out of her chest, shortness of
breath, and dizziness on admission to the critical care unit. The patient reports a history of a "floppy
valve" for the past 10 years. Which of the following is true regarding the murmur of mitral valve
prolapse? a. Early systolic with a low-pitched, blowing quality b. Radiates to the carotid arteries c.
Loudest at the lower left sternal border d. Usually accompanied by a midsystolic click
Answer:
SOLUTION GUIDE
CCRN EXAM CRAM Actual Examination 2026/2027
Questions and Answers Verified Solutions Latest
Update
Question:
A patient arrived in the emergency department with complaints of chest pain. The 12-lead
electrocardiogram shows ST segment 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
Answer:
Correct answer: d Rationale: ST segment elevation in leads V3 and V4 indicates injury to the
anterior wall, which would occur with occlusion of the left anterior descending (LAD) artery. In
most persons, the SA node, Bachmann's bundle, and AV node are supplied by the right coronary
artery. The bundle of His is supplied by the left anterior descending artery. This is why an anterior
myocardial infarction may cause type II second-degree AV block or third-degree AV heart block at
the level of the bundle of His. Test-Taking Strategy: Note that options a, b, and c are part of the
supraventricular conduction system. They usually are supplied by the right coronary artery. The
LAD artery supplies most of the interventricular conduction system, including the bundle of His and
the bundle branches.
Question:
Oxygen delivery (DO2) is the product of which of the following? a. PaO2, hemoglobin, mean
arterial pressure b. SaO2, hemoglobin, cardiac output c. SvO2, cardiac index, SaO2 d. PaO2, mean
arterial pressure, SvO2
Answer:
Correct answer: b Rationale: Ninety-seven percent of oxygen is attached to the hemoglobin
molecule, so the SaO2 (arterial oxygen saturation) is a more accurate reflection of the amount of
oxygen in blood. The PaO2 represents only the 3% that is dissolved in the plasma. The lungs must
put the oxygen in the blood, the hemoglobin must carry the oxygen, and the cardiac output is a
reflection of how well the heart is moving the blood with its hemoglobin with attached oxygen.
SvO2 (venous oxygen saturation) is a reflection of the oxygen reserve. SvO2 is what is left over
after the tissues have extracted what they need. The mean arterial pressure is a reflection of organ
tissue perfusion pressure but does not indicate anything about the amount of oxygen in that blood.
Test-Taking Strategy: Oxygen is delivered from the arterial end, so choose an option that has SaO2
,instead of SvO2. Also remember that most oxygen is carried on hemoglobin. Look for SaO2 (not
PaO2) and hemoglobin. The only option with both of these is option b.
Question:
Which of the following types of block are most likely after an anterior wall myocardial infarction
(MI)? a. Sinus block b. Second-degree atrioventricular (AV) block, type I c. Second-degree AV
block, type II d. Third-degree AV block with junctional escape rhythm
Answer:
Correct answer: c Rationale: Anterior MI is caused by a left anterior descending (LAD) artery
lesion. The LAD artery supplies the bundle of His and bundle branches, so anterior MIs may cause
blocks of the bundle of His or bundle branches. Second-degree AV block type II is a block at the
level of the bundle of His. If this patient does develop a third-degree AV block, it would be at the
level of the bundle of His, and the only escape rhythm available below the bundle of His is a
ventricular escape rhythm. Test-Taking Strategy: The sinus node is supplied by right coronary artery
(in 55% of people) or left coronary artery (in 45% of people), so eliminate option a. Type I AV
block, also called Wenckebach, is a block at the AV node, and the AV node is supplied by right
coronary artery (in 90% of people) or left coronary artery (10%), so eliminate option b. The LAD
artery supplies the bundle of His, and blocks in this area would eliminate the possibility of
junctional escape rhythms, so eliminate option d. Choose option c.
Question:
A patient develops atrial fibrillation after abdominal surgery. Her blood pressure falls from 110/70
mm Hg to 92/68 mm Hg. The hypotension is related to which of the following? a. Decrease in
ventricular contractility b. Hypovolemia c. Mural thrombi d. Decrease in ventricular filling
Answer:
Correct answer: d Rationale: The contribution that atrial contraction makes to ventricular filling
volume is approximately 15% to 30%. Atrial fibrillation results in quivering but not contracting
atria. The loss of 15% to 30% of diastolic filling volume reduces cardiac output and can have
significant hemodynamic consequences. Although mural thrombi also are a problem, they result in
an embolic phenomenon rather than a direct decrease in cardiac output. The relationship between
the development of atrial fibrillation and the decrease in cardiac output make hypovolemia and
decrease in contractility less likely. Test-Taking Strategy: Relate recent changes in patient status to
recent occurrences. The patient had a change in atrial function, so select an option that results in loss
of atrial contraction or "kick." Choose option d.
, Question:
A shift in the point of maximal impulse (PMI) to the fifth left intercostal space at the anterior
axillary line could be caused by any of these conditions except: a. left ventricular hypertrophy. b.
right tension pneumothorax. c. pericardial effusion. d. right pleural effusion.
Answer:
Correct answer: c Rationale: In pericardial effusion or tamponade, there is frequently loss of
palpability of the apical impulse because of the fluid layer. Left ventricular hypertrophy, right
tension pneumothorax, and a right pleural effusion could shift the PMI left of normal. Normally the
PMI is located at the fifth left intercostal space at the midclavicular line. Test-Taking Strategy: Look
for the process that would not shift the PMI to the left of the normal position. Picture the process. If
the left ventricle is big, it will extend farther to the left. If there is excessive pressure or volume on
the right side, it will push the heart toward the left. Pericardial effusion will decrease the intensity of
the PMI but it won't shift it. Choose option c.
Question:
An S4 is an expected physical finding in which of the following? a. Acute myocardial infarction b.
Left ventricular failure c. Pericarditis d. Bundle branch block
Answer:
Correct answer: a Rationale: An S4 is an indication of ventricular noncompliance. Noncompliance
is caused by ischemia, infarction, hypertrophy, cardiac tamponade, constrictive pericarditis, or
restrictive cardiomyopathy. Left ventricular failure would cause an S3. Pericarditis would cause a
pericardial friction rub. Bundle branch blocks cause splits (left bundle branch block causes a
paradoxical split of S2, and right bundle branch block causes a split of S1 and increased splitting of
S2 during inspiration). Test-Taking Strategy: Read the question carefully and note the key word
expected. Associate S4 with a noncompliant ventricle. Ischemia, infarction, and hypertrophy cause
noncompliance. Choose option a.
Question:
A woman, age 35 years, reports the feeling that her heart is racing out of her chest, shortness of
breath, and dizziness on admission to the critical care unit. The patient reports a history of a "floppy
valve" for the past 10 years. Which of the following is true regarding the murmur of mitral valve
prolapse? a. Early systolic with a low-pitched, blowing quality b. Radiates to the carotid arteries c.
Loudest at the lower left sternal border d. Usually accompanied by a midsystolic click
Answer:
