CCRN EXAM
A 29 year antique female has been in the important care unit for two days after a motor car
crash and has advanced acute tubular necrosis (ATN). She became normotensive on
admission. What would be the most likely motive of ATN?
(A) hemorrhage
(B) rhabdomyolysis
(C) creatinine release
(D) cardiac dysthymias - ANS-(B) The motor car crash most in all likelihood ended in a crash
harm with destruction of skeletal muscle cells (rhabdomyolysis). This consequences inside
the release of huge quantities of creatinine kinase (CK) that, in flip, may additionally CLOG
renal tubules and cause acute tubular necrosis (ATN). Choice (A) is not correct as there is
no records of bleeding. Choice (C), creatinine release, is too indistinct, could be minor, and
does no longer reason ATN. Arrhythmias, preference (D), aren't included inside the scenario.
A 52 12 months vintage male offers with lawsuits of blurred vision and shortness of breath.
B/P is 232/136, coronary heart rate 102, respiratory price 28 with crackles in lower lung
fields bilaterally, with S3 and S4 heart sounds on auscultation. Which of the following might
be indicated for this affected person?
(A) nitroprusside drip, admit to important care unit
(B) digoxin, furosemide
(C) labetalol drip, admit to a medical unit
(D) lisinopril, calcium channel blocker - ANS-(A) The patient has signs and symptoms of
organ dysfunction (coronary heart failure) secondary to severe hypertension. Therefore, he
has hypertension crisis or emergency. The B/P needs to be emergently reduced. Most often
this remedy is first-rate finished in an ICU.
A fifty eight 12 months antique affected person advanced chest ache that he scored as an
"8" Rapid evaluation covered profuse diaphoresis, B/P seventy eight/52, heart price
104/minute, respiration rate 20/minute, lungs clean, and SpO2 98%. The affected person is
currently related to the bedside monitor with a nasal cannula at 2 L/min in location and
intravenous fluids, zero.9 NS at a fee of 10 ml/hour. Which of the following sequences of
interventions would be the most appropriate for the nurse at this time?
(A) provide a chewable aspirin, do an EKG, and start a fluid bolus
(B) deliver NTG sublingual, growth the FiO2 and give morphine
(C) do an EKG, give NTG sublingual, and give a chewable aspirin
(D) begin a fluid bolus, provide a chewable aspirin, and do an EKG - ANS-(D) The clinical
description can be that of acute coronary syndrome complex by hypotension. Addressing the
hypotension is a priority as that is similarly decreasing coronary artery perfusion. A fluid
bolus could deal with hypotension, and no contraindications appear to be gift for a fluid bolus
as lungs are clean. Aspirin is indicated for acutely chest pain and can be given at the same
time as preparing to do the EKG, which is wanted to assist make the diagnosis.
A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T
wave inversion have been visible at the EKG in V2,V3 and V4. IV thrombolytic remedy
turned into started out in ED. Indications of a hit reperfusion could include all of the following
except:
, (A) ache cessation
(B) decrease in CK or troponin
(C) reversal of ST section elevation with go back to baseline
(D) brief runs of ventricular tachycardia - ANS-(B)Coronary artery reperfusion because of
PCI or fibrinolysis outcomes in an ELEVATION of creatinine kinase (CK) or troponin, no
longer lower. The idea is that the go back of blood go with the flow distal to the occlusion can
bring about 'reperfusion damage' of the muscle, raising cardiac biomarkers.
The other three alternatives are indicators of reperfusion: Pain cessation, reversal of ST
section elevation with return to baseline, quick runs of ventricular tachycardia.
A patient complains of surprising dyspnea 5 days S/P acute MI (ST elevation in II, III, and
aVF, with ST depression in I and aVL). The affected person is aggravating, diaphoretic, and
hypotensive. Examination reveals the development of a noisy holosystolic murmur at the
apex. What is the maximum probable reason of this patient's deterioration?
(A) right ventricular failure associated with proper ventricular MI
(B) ventricular septal defect
(C) left ventricular failure because of extension of MI
(D) acute mitral regurgitation due to papillary muscle rupture or dysfunction - ANS-(D) The
scenario describes a affected person having an acute inferior wall MI, which is normally
because of occlusion of the RCA. The RCA occlusion may additionally bring about papillary
muscle dysfunction or rupture of the mitral valve as it substances the place of the left
ventricle wherein this valve is connected. Although RV infarct may want to end result with
RCA occlusion, RV infarct does now not bring about a systolic murmur at apex of the heart
or lung crackles.
A affected person has simply returned from the OR after insertion of a VVI pacemaker. In
order to assess characteristic of this pacemaker correctly, the nurse needs to understand
that:
(A) both atrium and ventricle are paced and sensed and can both inhibit or pace in response
to sensing
(B) the ventricle is paced, ventricular hobby is sensed and pacing is inhibited in response to
ventricular sensing.
(C) each the atrium and ventricle are paced, however handiest ventricular pacing may be
inhibited by a
sensed intrinsic ventricular impulse.
(D) the ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by way
of a sensed
intrinsic ventricular impulse. - ANS-(B) the primary letter indicates chamber paced
(ventricle). The 2nd letter shows chamber sensed (ventricle). The 0.33 letter shows the
response to sensing (inhibited in response to sensing).
A affected person is admitted to the CCU after a PCI with stent. Femoral sheath is in vicinity,
web page is dry with out a hematoma. He suddenly complains of severe again pain. Neck
veins are flat with head of bed 30 degrees, heart sounds are regular. Vital signs and
symptoms are BP 78/forty eight, HR 124 and RR 26. What must the nurse suspect?
(A) cardiac tamponade
(B) retroperitoneal bleeding
(C) coronary artery dissection
(D) acute closure of the stented coronary artery - ANS-(B) Retroperitoneal bleeding can also
cause symptoms of hypovolemia and hypovolemic surprise as defined in the situation. It may
be a difficulty of a PCI if the femoral artery is the get entry to web page in the course of the
A 29 year antique female has been in the important care unit for two days after a motor car
crash and has advanced acute tubular necrosis (ATN). She became normotensive on
admission. What would be the most likely motive of ATN?
(A) hemorrhage
(B) rhabdomyolysis
(C) creatinine release
(D) cardiac dysthymias - ANS-(B) The motor car crash most in all likelihood ended in a crash
harm with destruction of skeletal muscle cells (rhabdomyolysis). This consequences inside
the release of huge quantities of creatinine kinase (CK) that, in flip, may additionally CLOG
renal tubules and cause acute tubular necrosis (ATN). Choice (A) is not correct as there is
no records of bleeding. Choice (C), creatinine release, is too indistinct, could be minor, and
does no longer reason ATN. Arrhythmias, preference (D), aren't included inside the scenario.
A 52 12 months vintage male offers with lawsuits of blurred vision and shortness of breath.
B/P is 232/136, coronary heart rate 102, respiratory price 28 with crackles in lower lung
fields bilaterally, with S3 and S4 heart sounds on auscultation. Which of the following might
be indicated for this affected person?
(A) nitroprusside drip, admit to important care unit
(B) digoxin, furosemide
(C) labetalol drip, admit to a medical unit
(D) lisinopril, calcium channel blocker - ANS-(A) The patient has signs and symptoms of
organ dysfunction (coronary heart failure) secondary to severe hypertension. Therefore, he
has hypertension crisis or emergency. The B/P needs to be emergently reduced. Most often
this remedy is first-rate finished in an ICU.
A fifty eight 12 months antique affected person advanced chest ache that he scored as an
"8" Rapid evaluation covered profuse diaphoresis, B/P seventy eight/52, heart price
104/minute, respiration rate 20/minute, lungs clean, and SpO2 98%. The affected person is
currently related to the bedside monitor with a nasal cannula at 2 L/min in location and
intravenous fluids, zero.9 NS at a fee of 10 ml/hour. Which of the following sequences of
interventions would be the most appropriate for the nurse at this time?
(A) provide a chewable aspirin, do an EKG, and start a fluid bolus
(B) deliver NTG sublingual, growth the FiO2 and give morphine
(C) do an EKG, give NTG sublingual, and give a chewable aspirin
(D) begin a fluid bolus, provide a chewable aspirin, and do an EKG - ANS-(D) The clinical
description can be that of acute coronary syndrome complex by hypotension. Addressing the
hypotension is a priority as that is similarly decreasing coronary artery perfusion. A fluid
bolus could deal with hypotension, and no contraindications appear to be gift for a fluid bolus
as lungs are clean. Aspirin is indicated for acutely chest pain and can be given at the same
time as preparing to do the EKG, which is wanted to assist make the diagnosis.
A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T
wave inversion have been visible at the EKG in V2,V3 and V4. IV thrombolytic remedy
turned into started out in ED. Indications of a hit reperfusion could include all of the following
except:
, (A) ache cessation
(B) decrease in CK or troponin
(C) reversal of ST section elevation with go back to baseline
(D) brief runs of ventricular tachycardia - ANS-(B)Coronary artery reperfusion because of
PCI or fibrinolysis outcomes in an ELEVATION of creatinine kinase (CK) or troponin, no
longer lower. The idea is that the go back of blood go with the flow distal to the occlusion can
bring about 'reperfusion damage' of the muscle, raising cardiac biomarkers.
The other three alternatives are indicators of reperfusion: Pain cessation, reversal of ST
section elevation with return to baseline, quick runs of ventricular tachycardia.
A patient complains of surprising dyspnea 5 days S/P acute MI (ST elevation in II, III, and
aVF, with ST depression in I and aVL). The affected person is aggravating, diaphoretic, and
hypotensive. Examination reveals the development of a noisy holosystolic murmur at the
apex. What is the maximum probable reason of this patient's deterioration?
(A) right ventricular failure associated with proper ventricular MI
(B) ventricular septal defect
(C) left ventricular failure because of extension of MI
(D) acute mitral regurgitation due to papillary muscle rupture or dysfunction - ANS-(D) The
scenario describes a affected person having an acute inferior wall MI, which is normally
because of occlusion of the RCA. The RCA occlusion may additionally bring about papillary
muscle dysfunction or rupture of the mitral valve as it substances the place of the left
ventricle wherein this valve is connected. Although RV infarct may want to end result with
RCA occlusion, RV infarct does now not bring about a systolic murmur at apex of the heart
or lung crackles.
A affected person has simply returned from the OR after insertion of a VVI pacemaker. In
order to assess characteristic of this pacemaker correctly, the nurse needs to understand
that:
(A) both atrium and ventricle are paced and sensed and can both inhibit or pace in response
to sensing
(B) the ventricle is paced, ventricular hobby is sensed and pacing is inhibited in response to
ventricular sensing.
(C) each the atrium and ventricle are paced, however handiest ventricular pacing may be
inhibited by a
sensed intrinsic ventricular impulse.
(D) the ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by way
of a sensed
intrinsic ventricular impulse. - ANS-(B) the primary letter indicates chamber paced
(ventricle). The 2nd letter shows chamber sensed (ventricle). The 0.33 letter shows the
response to sensing (inhibited in response to sensing).
A affected person is admitted to the CCU after a PCI with stent. Femoral sheath is in vicinity,
web page is dry with out a hematoma. He suddenly complains of severe again pain. Neck
veins are flat with head of bed 30 degrees, heart sounds are regular. Vital signs and
symptoms are BP 78/forty eight, HR 124 and RR 26. What must the nurse suspect?
(A) cardiac tamponade
(B) retroperitoneal bleeding
(C) coronary artery dissection
(D) acute closure of the stented coronary artery - ANS-(B) Retroperitoneal bleeding can also
cause symptoms of hypovolemia and hypovolemic surprise as defined in the situation. It may
be a difficulty of a PCI if the femoral artery is the get entry to web page in the course of the
