Exam (elaborations)
CCRN PRACTICE QUESTIONS WITH CORRECT ANSWERS
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CCRN PRACTICE QUESTIONS WITH CORRECT ANSWERS
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CCRN PRACTICE QUESTIONS WITHCORRECT ANSWERS
A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation in leads
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V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which
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portion of the conduction system?
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A. Sinoatrial (SA) node
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t B. Bachmann's bundle
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t C. Atrioventricular (AV) node
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t D. Bundle of His - ANSWER: ➡ LAD so D. bundle of his
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Which of the following is the preferred lead for ST segment monitoring for a patient with a
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suspected RCA occlusion?
t t t
t A.I
t B. aVR t
t C. III t
t D. V1 - ANSWER: ➡ c. III
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Which of the following is not a manifestation of hypertrophic cardiomyopathy?
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A. Syncope t
B. Murmur that increases with squatting
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C. Chest pain
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D. Sudden cardiac death - ANSWER: ➡ *B
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Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an aortic
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stenosis type of murmur that decreases when the patient is in a squatting position. The first
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manifestation of this condition is occasionally sudden cardiac death during exercise.
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,In which quadrant is the mean QRS complex axis located if the QRS complex is predominantly
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positive in lead I and negative in lead aVF?
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t A. Normal quadrant
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t B. Left axis deviation quadrant
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t C. Right axis deviation quadrant
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t D. Indeterminant quadrant - ANSWER: ➡ *B
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Because the positive of lead I is the left arm, if the QRS complex is upright in lead I, the mean QRS
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axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the foot, if the QRS
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complex is negative in lead aVF, the mean QRS axis is upward away from the foot. This axis would
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be in the upper left quadrant, described as left axis deviation.
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A patient becomes apneic and pulseless. CPR has been initiated, and the monitor shows asystole
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in two leads. Which of the following drugs would be used initially?
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t A. Calcium gluconate
t t
t B. Atropine
t
t C. Epinephrine
t
t D. Amiodarone (Cordarone) - ANSWER: ➡ C
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After CPR is initiated and an intravenous access is established, epinephrine should be given.
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Calcium was used in the past in asystole but is used today only for hypocalcemia, calcium
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channel blocker toxicity, hyperkalemia, and hypermagnesemia. Atropine is no longer
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recommended for asystole. Amiodarone is not indicated in asystole because asystole is the
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absolute absence of irritability.
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What is associated w/ Mitral Stenosis
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A. Pinkish discoloration of the cheeks
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t B. Systolic murmur
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t C. Widened pulse pressure
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t D. Narrow pulse pressure - ANSWER: ➡ A
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, Patients with mitral stenosis may exhibit a pinkish discoloration of the cheeks (i.e., malar
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blush). Mitral stenosis causes a diastolic murmur. Widened pulse pressure is associated with
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aortic regurgitation. Narrowed pulse pressure is associated with mitral regurgitation.
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Four days after a mitral valve replacement, the patient develops atrial fibrillation. The nurse
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initially would:
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A. order a 12-lead EKG
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B. evaluate the patient for clinical indications of hypoperfusion.
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C. notify the physician.
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D. ask the patient to bear down as if having a bowel movement. - ANSWER: ➡ B
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The onset of atrial fibrillation results in the loss of atrial kick. Loss of atrial kick may reduce the
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cardiac output by as much as 20-30%. This is especially true in patients whose cardiac output
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may be affected by long-standing cardiac disease, such as mitral valve disease. Assess the
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patient for clinical indications of hypoperfusion (e.g., cool skin, decreased urine output,
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narrowed pulse pressure, and hypotension).
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A patient has just returned from the cath lab. She had an angioplasty for occlusion of her RCA.
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She still has femoral artery and vein sheaths in place. The patient complains of chest pain that
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she rates 9/10 about an hour after she returns from the cath lab. Which of the following is
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indicated?
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t A. Administer morphine IV.
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t B. Administer nitroglycerin sublingual spray.
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t C. Stop the heparin.
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t D. Notify the physician - ANSWER: ➡ D
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New-onset severe chest pain after percutaneous coronary intervention suggests acute closure t t t t t t t t t t
of the dilated coronary artery. The patient needs to be returned to the cardiac catheterization
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laboratory for repeat dilation and probable insertion of stent.
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A 35-year-old woman underwent a mitral valve replacement. Her chest tube output has been
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approximately 125 mL/hr for the last 3 hours, and now the drainage has ceased suddenly. The
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immediate assessment reveals a significant decrease in BP, RAP 12, PAP 30/15 , PAOP 13. What
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other data would indicate the development of cardiac tamponade?
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