CCRN PRACTICE QUESTIONS AND -
ANSWER S 2025/2026 UPDATE
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 - - ✔✔answer LAD so D. bundle of his
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 - - ✔✔answer c. III
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 - - ✔✔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.
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 - - ✔✔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.
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) - - ✔✔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.
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure - - ✔✔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.
, 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. - - ✔✔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).
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 - - ✔✔answer D
New-onset severe chest pain after percutaneous coronary intervention suggests acute closure of the
dilated coronary artery. The patient needs to be returned to the cardiac catheterization laboratory for
repeat dilation and probable insertion of stent.
A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been
approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The
immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What other
data would indicate the development of cardiac tamponade?
A. Increased venous oxygen saturation (SvO2)
B. Decreased UO
C. Muffled heart sounds
D. New holosystolic murmur at the sternum - - ✔✔answer C
ANSWER S 2025/2026 UPDATE
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 - - ✔✔answer LAD so D. bundle of his
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 - - ✔✔answer c. III
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 - - ✔✔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.
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 - - ✔✔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.
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) - - ✔✔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.
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure - - ✔✔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.
, 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. - - ✔✔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).
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 - - ✔✔answer D
New-onset severe chest pain after percutaneous coronary intervention suggests acute closure of the
dilated coronary artery. The patient needs to be returned to the cardiac catheterization laboratory for
repeat dilation and probable insertion of stent.
A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been
approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The
immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What other
data would indicate the development of cardiac tamponade?
A. Increased venous oxygen saturation (SvO2)
B. Decreased UO
C. Muffled heart sounds
D. New holosystolic murmur at the sternum - - ✔✔answer C
