CCRN EXAM 2024 QUESTIONS AND ANSWERS GRADED A+
LATEST UPDATE NEW!!!
A 59 year old male is admitted complaining of chest pain and dyspnea.
ST elevation and T wave inversion were seen on the EKG in V2,V3 and
V4. IV thrombolytic therapy was started in ED. Indications of successful
reperfusion would include all of the following except:
(A) pain cessation
(B) decrease in CK or troponin
(C) reversal of ST segment elevation with return to baseline
(D) short runs of ventricular tachycardia - CORRECT ANSWER✔✔
(B)Coronary artery reperfusion due to PCI or fibrinolysis results in an
ELEVATION of creatinine kinase (CK) or troponin, not decrease. The
theory is that the return of blood flow distal to the occlusion can result
in 'reperfusion injury' of the muscle, elevating cardiac biomarkers.
The other 3 choices are indicators of reperfusion: Pain cessation,
reversal of ST segment elevation with return to baseline, short runs of
ventricular tachycardia.
Which of the following medication orders should the nurse question for
the patient in question 1-reperfusion question-patient having an MI?
(A) metoprolol (Lopressor)
(B) aspirin
(C) propranolol (Inderal)
(D) heparin - CORRECT ANSWER✔✔(C) The patient in the scenario is
having an acute anterior wall MI. A beta blocker is beneficial for an
acute MI as these agents decrease the work of the heart and increase
the threshold for ventricular fibrillation. Propranolol, although a beta-
andrenergic blocker like metoprolol, is NOT a cardioselective beta
blocker. It affects beta receptors in heart muscle AND lung tissue.
,Therefore, it is more likely to cause bronchoconstriction than a
cardioselective beta blocker.
The other 3- cardioselective beta blocker, antiplatelet, and
anticoagulation-are indicated in an acute MI.
If heart block develops while caring for the patient in question 1 (pt
with an MI who went through reperfusion from PCI or fibrinolytic
therapy), which of the following would it most likely be?
(A) sinoatrial block
(B) second degree, Type I
(C) second degree, Type II
(D) third degree, complete - CORRECT ANSWER✔✔(C) The patient is
having an acute anterior MI, which is generally due to LAD occlusion.
The LAD supplies the HIS bundle, which could result in a second-degree,
type II heart block. The other 3 types are due to SA node or AV node
ischemia, which generally occur with an RCA occlusion — interior wall
MI.
Appropriate drug therapy for dilated cardiomyopathy is aimed toward:
(A) decreasing contractility and decreasing preload and afterload
(B) decreasing contractility and increasing preload and afterload
(C) increasing contractility and increasing both preload and afterload
(D) increasing contractility and decreasing both preload and afterload -
CORRECT ANSWER✔✔(D) Dilated cardiomyopathy is likely to result in
systolic dysfunction, which decreases contractility, causes
compensatory arterial constriction , and results in a higher left
ventricular preload. To treat this, therapy is aimed at increasing
contractility, decreasing afterload (arterial constriction), and decreasing
preload that is too high.�
An 18 year old is admitted with a history of syncopal episode at the
mall and has a history of an eating disorder. The nurse notes a
prolonged QT on the 12-lead EKG and anticipates a reduction in an
, electrolyte to be the cause. Which of the following is LEAST likely to
cause this patient's problems?
(A) sodium
(B) magnesium
(C) potassium
(D) calcium - CORRECT ANSWER✔✔(A) Abnormal sodium does NOT
cause QT prolongation. In contrast, a low magnesium, potassium, or
calcium, may cause QT prolongation and may result in TORSADES DE
POINTES ventricular tachycardia and, if self-limiting, transient syncopal
episodes.
On the third day after admission for acute MI, a 67 year old male
complains of chest pain and develops a fever. The pain is worse with
deep inspiration and is relieved when he leans forward. There are
nonspecific ST changes in the precordial leads of the EKG. The nurse
anticipates that the patient will most likely need treatment for:
(A) thoracic aneurysm
(B) Dressler's syndrome
(C) reinfarction
(D) pleuritis - CORRECT ANSWER✔✔(B) The pain described in the
scenario is typical of the pain caused by pericarditis. Dressler's
syndrome is the pericarditis that may result after an acute MI.
A patient is admitted to the CCU after a PCI with stent. Femoral sheath
is in place, site is dry with no hematoma. He suddenly complains of
severe back pain. Neck veins are flat with head of bed 30 degrees, heart
sounds are normal. Vital signs are BP 78/48, HR 124 and RR 26. What
should the nurse suspect?
(A) cardiac tamponade
(B) retroperitoneal bleeding
(C) coronary artery dissection
LATEST UPDATE NEW!!!
A 59 year old male is admitted complaining of chest pain and dyspnea.
ST elevation and T wave inversion were seen on the EKG in V2,V3 and
V4. IV thrombolytic therapy was started in ED. Indications of successful
reperfusion would include all of the following except:
(A) pain cessation
(B) decrease in CK or troponin
(C) reversal of ST segment elevation with return to baseline
(D) short runs of ventricular tachycardia - CORRECT ANSWER✔✔
(B)Coronary artery reperfusion due to PCI or fibrinolysis results in an
ELEVATION of creatinine kinase (CK) or troponin, not decrease. The
theory is that the return of blood flow distal to the occlusion can result
in 'reperfusion injury' of the muscle, elevating cardiac biomarkers.
The other 3 choices are indicators of reperfusion: Pain cessation,
reversal of ST segment elevation with return to baseline, short runs of
ventricular tachycardia.
Which of the following medication orders should the nurse question for
the patient in question 1-reperfusion question-patient having an MI?
(A) metoprolol (Lopressor)
(B) aspirin
(C) propranolol (Inderal)
(D) heparin - CORRECT ANSWER✔✔(C) The patient in the scenario is
having an acute anterior wall MI. A beta blocker is beneficial for an
acute MI as these agents decrease the work of the heart and increase
the threshold for ventricular fibrillation. Propranolol, although a beta-
andrenergic blocker like metoprolol, is NOT a cardioselective beta
blocker. It affects beta receptors in heart muscle AND lung tissue.
,Therefore, it is more likely to cause bronchoconstriction than a
cardioselective beta blocker.
The other 3- cardioselective beta blocker, antiplatelet, and
anticoagulation-are indicated in an acute MI.
If heart block develops while caring for the patient in question 1 (pt
with an MI who went through reperfusion from PCI or fibrinolytic
therapy), which of the following would it most likely be?
(A) sinoatrial block
(B) second degree, Type I
(C) second degree, Type II
(D) third degree, complete - CORRECT ANSWER✔✔(C) The patient is
having an acute anterior MI, which is generally due to LAD occlusion.
The LAD supplies the HIS bundle, which could result in a second-degree,
type II heart block. The other 3 types are due to SA node or AV node
ischemia, which generally occur with an RCA occlusion — interior wall
MI.
Appropriate drug therapy for dilated cardiomyopathy is aimed toward:
(A) decreasing contractility and decreasing preload and afterload
(B) decreasing contractility and increasing preload and afterload
(C) increasing contractility and increasing both preload and afterload
(D) increasing contractility and decreasing both preload and afterload -
CORRECT ANSWER✔✔(D) Dilated cardiomyopathy is likely to result in
systolic dysfunction, which decreases contractility, causes
compensatory arterial constriction , and results in a higher left
ventricular preload. To treat this, therapy is aimed at increasing
contractility, decreasing afterload (arterial constriction), and decreasing
preload that is too high.�
An 18 year old is admitted with a history of syncopal episode at the
mall and has a history of an eating disorder. The nurse notes a
prolonged QT on the 12-lead EKG and anticipates a reduction in an
, electrolyte to be the cause. Which of the following is LEAST likely to
cause this patient's problems?
(A) sodium
(B) magnesium
(C) potassium
(D) calcium - CORRECT ANSWER✔✔(A) Abnormal sodium does NOT
cause QT prolongation. In contrast, a low magnesium, potassium, or
calcium, may cause QT prolongation and may result in TORSADES DE
POINTES ventricular tachycardia and, if self-limiting, transient syncopal
episodes.
On the third day after admission for acute MI, a 67 year old male
complains of chest pain and develops a fever. The pain is worse with
deep inspiration and is relieved when he leans forward. There are
nonspecific ST changes in the precordial leads of the EKG. The nurse
anticipates that the patient will most likely need treatment for:
(A) thoracic aneurysm
(B) Dressler's syndrome
(C) reinfarction
(D) pleuritis - CORRECT ANSWER✔✔(B) The pain described in the
scenario is typical of the pain caused by pericarditis. Dressler's
syndrome is the pericarditis that may result after an acute MI.
A patient is admitted to the CCU after a PCI with stent. Femoral sheath
is in place, site is dry with no hematoma. He suddenly complains of
severe back pain. Neck veins are flat with head of bed 30 degrees, heart
sounds are normal. Vital signs are BP 78/48, HR 124 and RR 26. What
should the nurse suspect?
(A) cardiac tamponade
(B) retroperitoneal bleeding
(C) coronary artery dissection
