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2024 CCRN PRACTICE QUESTIONS / CCRN EXAM LATEST ACTUAL EXAM
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2024 CCRN PRACTICE QUESTIONS / CCRN EXAM LATEST ACTUAL EXAM 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 B...

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  • August 20, 2024
  • 32
  • 2024/2025
  • Exam (elaborations)
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2024 CCRN PRACTICE
QUESTIONS / CCRN EXAM
LATEST 2023-2024 ACTUAL
EXAM




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

,Muffled heart sounds are a classic finding in cardiac tamponade. Remember the
classic indications of cardiac tamponade referred to as Beck's triad: muffled heart
sounds, jugular venous distention, and hypotension. Even though urine output is a
sensitive indicator of cardiac output and in cardiac tamponade a decreased stroke
volume results in a decreased cardiac output, by the time a nurse would notice the
decreased urine output, the patient may have already had a cardiopulmonary arrest.
The SvO2 actually would decrease because of the decrease in cardiac output. New
holosystolic murmur at the lower left sternal border is a sign of ventricular septal
rupture.


A 40-year-old patient has been admitted to the critical care unit after sustaining
multiple injuries from a cave-in accident this morning. X-ray confirm multiple
fractures, including the left femur. During the afternoon he was taken to surgery for
internal fixation of the left femur. It is now 10 pm, and the patient is complaining
of severe throbbing pain in his thigh. The patient received 5 mg of morphine
sulfate IV 30 minutes ago. The anterior left thigh is firm to touch, and the pain
increases when the patient flexes his left leg. The nurse should suspect which of
the following?


A. Normal pain related to fractured femur
B. Abnormal pain related to compartment syndrome
C. Abnormal pain related to infection
D. Abnormal pain related to lumbosacral plexus injury - ✔✔✔ANSWER-B.
Abnormal pain related to compartment syndrome


A 52-year-old man is admitted to the critical care unit with a diagnosis of an acute
MI. EKG shows ST elevation and T wave inversion in leads V2, V3, and V4. His
history includes HTN, 80 pack-years of smoking, COPD, and HLD.
An IV and fibrinolytic therapy were initiated in the ED. Which of the following
would not be an indication of successful reperfusion?

,A. Pain cessation
B. Absence of creatine kinase (CK) enzyme elevation
C. Reversal of ST segment elevation with return of ST segment to baseline
D. Short runs of ventricular tachycardia - ✔✔✔ANSWER-B. Absence of creatine
kinase (CK) enzyme elevation


A 52-year-old woman arrives in the ED. started having fluttering in her chest about
1 hour ago and now is having chest pain. She has a history of HTN. The EKG
monitor shows paroxysmal atrial tachycardia with HR 150, BP 130/88. Verapamil
5 mg is given via slow IV push. What would be a desirable therapeutic outcome?


A. Decrease in blood pressure
B. Decrease in heart rate
C. Change in rhythm to atrial fibrillation
D. A decrease in the fluttering feeling in her chest - ✔✔✔ANSWER-B. Decrease
in heart rate


A 55-year-old man had a heart transplant 10 hours ago. Present assessment
includes cold, clammy skin, jugular venous distention, bilateral crackles, and
tachycardia. Vital signs are temperature 98.6° F, BP 80/60, HR 120 and RR 24 .
Mediastinal tube drainage is approximately 50 mL/hr. He is diagnosed with
decreased cardiac contractility. Which of the following would be an appropriate
treatment for this patient?


A. Beta-adrenergic stimulant (e.g., dobutamine)
B. Diuretic (e.g., furosemide)
C. Normal saline bolus
D. Antibiotics - ✔✔✔ANSWER-A. Beta-adrenergic stimulant (e.g., dobutamine)

, A 55-year-old man with a long history of alcoholism continues to drink alcohol and
now has alcoholic cardiomyopathy, a form of dilated cardiomyopathy. Which of
the following would this patient not be expected to receive?


A. Angiotensin-converting enzyme inhibitors
B. Cardiac transplant referral
C. Diuretics
D. Inotropes - ✔✔✔ANSWER-B. Cardiac transplant referral


A 57-year-old man was admitted to the critical care unit with a diagnosis of
anteroseptal MI. A PA catheter was inserted, and initial readings were within
normal limits. BP 140/92, HR 110 and regular, RR 24. Breath sounds equal and
clear. 3 hrs after admission, the pt becomes restless with cool, pale skin. Now BP
110/72, HR 120, RR 28 and labored. Crackles are audible at the lung bases BL.
The patient is given furosemide (Lasix) at 8 am. At 9 am, the PAOP drops to 8,
with a drop in BP. Which of the following would be the most appropriate
intervention at this time?


A. Administer saline bolus.
B. Decrease dobutamine drip rate.
C. Increase nitroglycerin drip rate.
D. Replace potassium. - ✔✔✔ANSWER-A. Administer saline bolus.


A 61-year-old man is admitted to the critical care unit from the cath lab. He has
just had a PCI and stent insertion to the RCA. His leg is immobilized, and the HOB
30 degrees. Six hours later the patient is restless and complaining of back pain. The
femoral sheath is intact in the right femoral area, and there is no evidence of
bleeding or hematoma. Neck veins are flat with the HOB 30 degrees, and heart

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