CCRN |ACTUAL QUESTIONS AND VERIFIED
ANSWERS 2026-2027 UPDATED EDITION|GRADED
A+
Question 1
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
Question 2
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
1
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,Question 3
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.
Question 4
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.
2
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,Question 5
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.
Question 6
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.
3
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, Question 7
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).
Question 8
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
4
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ANSWERS 2026-2027 UPDATED EDITION|GRADED
A+
Question 1
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
Question 2
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
1
@https://www.stuvia.com/user/thestudyvault
,Question 3
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.
Question 4
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.
2
@https://www.stuvia.com/user/thestudyvault
,Question 5
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.
Question 6
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.
3
@https://www.stuvia.com/user/thestudyvault
, Question 7
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).
Question 8
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
4
@https://www.stuvia.com/user/thestudyvault
