NICOLE KUPCHIK CCRN EXAM |ACTUAL
QUESTIONS AND VERIFIED ANSWERS 2026-2027
UPDATED EDITION|GRADED A+
Question 1
A 49yo male was recently admitted w/ an inferior wall MI resulting from 100% occlusion of
the R coronary artery (RCA). The 12 lead ECG reveals ST elevation in leads II, III, and aVF.
You would expect to see reciprocal changes in which leads?
A. I, aVR
B. V1, V2
C. V3, V4
D. I, aVL
CORRECT ANSWER
D. I, aVL
The RCA perfuses the inferior wall and the mirror image would seen in the high lateral
wall, which is reflected in leads I, aVL. Leads V1 and V2 correlate with the septal area.
Leads V3 and V4 correlate with the interior area of the heart. The aVR lead does not
provide much value because energy is depolarizing away from this lead.
Question 2
30yo female who is experiencing sustained tonic-clonic convulsions while sitting in a chair.
A family states: "She was talking to us and suddenly she let out a shriek and started
flopping around like a fish out of water." What is your initial priority of care?
A. Call for help and safely guide pt to the floor
B. Call for help and administer prescribed anticonvulsant medication
1
@https://www.stuvia.com/user/thestudyvault
,C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure
CORRECT ANSWER
A. Call for help and safely guide pt to the floor
Pt safety is the first priority. Once pt is safe from immediate harm/injury, seizure activity
must be terminated (by benzo aministration). Anticonvulsant is useful in seizure
prevention.
Question 3
46yo presents w/ PNA and sepsis. Treated w/ 4 days of Abx and fluids. He is increasingly
SOB and is not on 100% fio2 via NRB. You obtain an ABG w/ the following results: pH 7.2,
PaCO2 68, PaO2 102, HCO3 28. A CXR reveals bil pulm infiltrates. The pt is developing:
A. Worsening PNA
B. ARDS
C. Pulmonary embolus
D. Atelectasis
CORRECT ANSWER
B. ARDS
Criteria for ARDS include bil pulm infiltrates on CXR and P/F ratio < or = 300. To calculate
P/F ratio, 102 (PaO2) / 1.0 (100% Fio2) = 102. Other criteria are decreased vent
compliance, high peep requirements and low expired minute volume
Question 4
2
@https://www.stuvia.com/user/thestudyvault
,56yo female admitted to ICU in Hypertension crisis w/ a BP of 212/126 (58) mmHG. She
ran out of BP meds 2wks ago and did not get Rx refilled. Which of the following is a major
complication of hypertensive crisis?
A. Encephalopothy
B. Diabetes
C. SIADH
D. GI hemorrhage
CORRECT ANSWER
A. Encephalopathy
Hypertensive crisis is defined as BP > 180/120mmHg. Pt w/ this condition at risk of
developing encephalopathy. S/S included confusion, decreased LOC, visual changes
headache, N/V. Other S/S of organ dysfunction include AKI, retinal hemorrhage, vessel
damage, epistaxis. Don't lower BP too quickly. Vasodilating solutions (Nicardipine,
clevidipine, hydrazine, and nitroprusside) used to reduce BP
Question 5
Which of the following labs must be closely monitored when administering lisinopril to a
patient with systolic heart failure?
A. Sodium
B. Phosphate
C. Magnesium
D. Potassium
CORRECT ANSWER
D. Potassium
3
@https://www.stuvia.com/user/thestudyvault
, ACE inhibitors may cause hyperkalemia. They also block angiotensin II, which decreases
aldosterone. Aldosterone responsible for excreting potassium from kidneys. This leads to
potassium retention. Renal labs should also be monitored (BUN, creatinine). If pt
experiences 20% increase in creat lvl, d/c medication or reduce dosage.
Question 6
57yo man admitted w/ acute MI in cardiogenic shock. BP of 86/42 (57), HR 110, CI 1.7 and
SVR 1929
A. Dobutamine
B. Norepinephrine
C. Amiodarone
D. Phenylephrine
CORRECT ANSWER
A. Dobutamine
Positive inotrope used to improve MI on pts w/ low cardiac index and elevated SVR. It
will improve contractility and reduce after load. Milrinone could be used as an
alternative in the setting of decompensated heart failure. Milrinone used cautiously in
pts in cardiogenic shock because it can cause hotn. Half-life of Milrinone is 6hrs. Levo and
Neo cause vasoconstriction, which would increase SVR and may further compromise CO.
Amio is an anti-arrhythmic not indicated in this scenario
Question 7
Pt post gastric bypass. Which parameters should you monitor closely post op?
A. HR, RR, temp, WBC, and MAP
B. Protein lvls and vit B12
4
@https://www.stuvia.com/user/thestudyvault
QUESTIONS AND VERIFIED ANSWERS 2026-2027
UPDATED EDITION|GRADED A+
Question 1
A 49yo male was recently admitted w/ an inferior wall MI resulting from 100% occlusion of
the R coronary artery (RCA). The 12 lead ECG reveals ST elevation in leads II, III, and aVF.
You would expect to see reciprocal changes in which leads?
A. I, aVR
B. V1, V2
C. V3, V4
D. I, aVL
CORRECT ANSWER
D. I, aVL
The RCA perfuses the inferior wall and the mirror image would seen in the high lateral
wall, which is reflected in leads I, aVL. Leads V1 and V2 correlate with the septal area.
Leads V3 and V4 correlate with the interior area of the heart. The aVR lead does not
provide much value because energy is depolarizing away from this lead.
Question 2
30yo female who is experiencing sustained tonic-clonic convulsions while sitting in a chair.
A family states: "She was talking to us and suddenly she let out a shriek and started
flopping around like a fish out of water." What is your initial priority of care?
A. Call for help and safely guide pt to the floor
B. Call for help and administer prescribed anticonvulsant medication
1
@https://www.stuvia.com/user/thestudyvault
,C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure
CORRECT ANSWER
A. Call for help and safely guide pt to the floor
Pt safety is the first priority. Once pt is safe from immediate harm/injury, seizure activity
must be terminated (by benzo aministration). Anticonvulsant is useful in seizure
prevention.
Question 3
46yo presents w/ PNA and sepsis. Treated w/ 4 days of Abx and fluids. He is increasingly
SOB and is not on 100% fio2 via NRB. You obtain an ABG w/ the following results: pH 7.2,
PaCO2 68, PaO2 102, HCO3 28. A CXR reveals bil pulm infiltrates. The pt is developing:
A. Worsening PNA
B. ARDS
C. Pulmonary embolus
D. Atelectasis
CORRECT ANSWER
B. ARDS
Criteria for ARDS include bil pulm infiltrates on CXR and P/F ratio < or = 300. To calculate
P/F ratio, 102 (PaO2) / 1.0 (100% Fio2) = 102. Other criteria are decreased vent
compliance, high peep requirements and low expired minute volume
Question 4
2
@https://www.stuvia.com/user/thestudyvault
,56yo female admitted to ICU in Hypertension crisis w/ a BP of 212/126 (58) mmHG. She
ran out of BP meds 2wks ago and did not get Rx refilled. Which of the following is a major
complication of hypertensive crisis?
A. Encephalopothy
B. Diabetes
C. SIADH
D. GI hemorrhage
CORRECT ANSWER
A. Encephalopathy
Hypertensive crisis is defined as BP > 180/120mmHg. Pt w/ this condition at risk of
developing encephalopathy. S/S included confusion, decreased LOC, visual changes
headache, N/V. Other S/S of organ dysfunction include AKI, retinal hemorrhage, vessel
damage, epistaxis. Don't lower BP too quickly. Vasodilating solutions (Nicardipine,
clevidipine, hydrazine, and nitroprusside) used to reduce BP
Question 5
Which of the following labs must be closely monitored when administering lisinopril to a
patient with systolic heart failure?
A. Sodium
B. Phosphate
C. Magnesium
D. Potassium
CORRECT ANSWER
D. Potassium
3
@https://www.stuvia.com/user/thestudyvault
, ACE inhibitors may cause hyperkalemia. They also block angiotensin II, which decreases
aldosterone. Aldosterone responsible for excreting potassium from kidneys. This leads to
potassium retention. Renal labs should also be monitored (BUN, creatinine). If pt
experiences 20% increase in creat lvl, d/c medication or reduce dosage.
Question 6
57yo man admitted w/ acute MI in cardiogenic shock. BP of 86/42 (57), HR 110, CI 1.7 and
SVR 1929
A. Dobutamine
B. Norepinephrine
C. Amiodarone
D. Phenylephrine
CORRECT ANSWER
A. Dobutamine
Positive inotrope used to improve MI on pts w/ low cardiac index and elevated SVR. It
will improve contractility and reduce after load. Milrinone could be used as an
alternative in the setting of decompensated heart failure. Milrinone used cautiously in
pts in cardiogenic shock because it can cause hotn. Half-life of Milrinone is 6hrs. Levo and
Neo cause vasoconstriction, which would increase SVR and may further compromise CO.
Amio is an anti-arrhythmic not indicated in this scenario
Question 7
Pt post gastric bypass. Which parameters should you monitor closely post op?
A. HR, RR, temp, WBC, and MAP
B. Protein lvls and vit B12
4
@https://www.stuvia.com/user/thestudyvault
