Download CCRN EXAM LATEST 2023-2024 ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIO and more Exams Nursing in PDF only on Docsity! CCRN EXAM LATEST 2023-2024 ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES/ GUARANTEED PASS/ GRADED A+ A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T wave inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy was started in ED. Indications of successful reperfusion would include all of the following except: (A) pain cessation (B) decrease in CK or troponin (C) reversal of ST segment elevation with return to baseline (D) short runs of ventricular tachycardia - ANSWER (B)Coronary artery reperfusion due to PCI or fibrinolysis results in an ELEVATION of creatinine kinase (CK) or troponin, not decrease. The theory is that the return of blood flow distal to the occlusion can result in 'reperfusion injury' of the muscle, elevating cardiac biomarkers. The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment elevation with return to baseline, short runs of ventricular tachycardia. Which of the following medication orders should the nurse question for the patient in question 1- reperfusion question-patient having an MI? (A) metoprolol (Lopressor) (B) aspirin (C) propranolol (Inderal) (D) heparin - ANSWER (C) The patient in the scenario is having an acute anterior wall MI. A beta blocker is beneficial for an acute MI as these agents decrease the work of the heart and increase the threshold for ventricular fibrillation. Propranolol, although a beta-andrenergic blocker like metoprolol, is NOT a cardioselective beta blocker. It affects beta receptors in heart muscle AND lung tissue. Therefore, it is more likely to cause bronchoconstriction than a cardioselective beta blocker. The other 3- cardioselective beta blocker, antiplatelet, and anticoagulation-are indicated in an acute MI. If heart block develops while caring for the patient in question 1 (pt with an MI who went through reperfusion from PCI or fibrinolytic therapy), which of the following would it most likely be? (A) sinoatrial block (B) second degree, Type I (C) second degree, Type II (D) third degree, complete - ANSWER (C) The patient is having an acute anterior MI, which is generally due to LAD occlusion. The LAD supplies the HIS bundle, which could result in a second-degree, type II heart block. The other 3 types are due to SA node or AV node ischemia, which generally occur with an RCA occlusion — interior wall MI. Appropriate drug therapy for dilated cardiomyopathy is aimed toward: (A) decreasing contractility and decreasing preload and afterload (B) decreasing contractility and increasing preload and afterload (C) increasing contractility and increasing both preload and afterload (D) increasing contractility and decreasing both preload and afterload - ANSWER (D) Dilated cardiomyopathy is likely to result in systolic dysfunction, which decreases contractility, causes compensatory arterial constriction , and results in a higher left ventricular preload. To treat this, therapy is aimed at increasing contractility, decreasing afterload (arterial constriction), and decreasing preload that is too high. An 18 year old is admitted with a history of syncopal episode at the mall and has a history of an eating disorder. The nurse notes a prolonged QT on the 12-lead EKG and anticipates a reduction in an electrolyte to be the cause. Which of the following is LEAST likely to cause this patient's problems? (A) sodium (B) magnesium (C) potassium (D) calcium - ANSWER (A) Abnormal sodium does NOT cause QT prolongation. In contrast, a low magnesium, potassium, or calcium, may cause QT prolongation and may result in TORSADES DE POINTES ventricular tachycardia and, if self-limiting, transient syncopal episodes. descending aorta is beneficial. Deflation decreases afterload and work of the left ventricle. Inflation of the balloon is beneficial because it "boluses" blood into the coronary arteries, increasing perfusion. Four days after mitral valve replacement, the patient goes into atrial fibrillation with rapid ventricular response. What should be the nurse's initial action? (A) order a 12 lead EKG (B) evaluate the patient for clinical signs of hypoperfusion (C) notify the physician (D) ask the patient to bear down as if having a bowel movement - ANSWER (B) The patient's response to the arrhythmia will determine whether treatment needs to be emergent and what the treatment will be. Vagal maneuvers e.g. bearing down, are not known to be effective for atrial fibrillation. A patient's 12 lead EKG shows sinus bradycardia at 44 beats/min and ST segment elevation in leads II, III, and aVF. Which of the following treatments for bradycardia for this patient would best resolve the problem? (A) temporary transvenous pacing (B) transcutaneous pacing (C) percutaneous coronary intervention (D) administration of atropine - ANSWER (C) PCI would address the cause of the problem, not only treat signs and symptoms. Selection of the other 3 choices presumes the patient had serious signs and symptoms. Do not read into the questions. Which drug would most likely be given to a patient with hypertrophic cardiomyopathy? (A) metoprolol (B) digoxin (C) dopamine (D) dobutamine - ANSWER (A) A decrease in heart rate, provided by a beta blocker such as metoprolol, would increase filling time. In hypertrophic cardiomyopathy, there is a problem with filling. A decrease in heart rate would increase filling time. Diastolic dysfunction does NOT cause a problem with ejection, and the EF is normal. The other 3 choices may be indicated for systolic dysfunction. A patient is admitted with ST elevation in V2, V3, and V4. Four days after admission, the patient suddenly developed a holosystolic murmur at the lower left sternal border, chest pain, and hypotension. What complication should the nurse expect? (A) papillary muscle rupture (B) ventricular septal defect (C) acute mitral stenosis (D) acute reinfarction - ANSWER The scenario describes an acute anterior STEMI, generally caused by an occlusion of the LAD. This type of MI is most likely to result in a VSD. Additionally, the location of the murmur is important. Mitral valve disease-related problems do NOT cause murmurs to be loudest at the left sternal border, whereas a VSD would result in a murmur at this location. A postoperative patient on the surgical unit suddenly develops chest pain, extreme weakness, and dyspnea and is found to have ST elevation in II, III, and aVF on the stat EKG. B/P is 92/62, heart rate 58, respiratory rate 28, lungs are clear, and heart sound assessment reveals an S4, no murmurs. In addition to preparing the patient for PCI, which of the following interventions would you anticipate? (A) nitroglycerin drip, aspirin (B) furosemide, atropine (C) transcutaneous pacing, morphine (D) aggressive fluid administration, right-sided EKG. - ANSWER (D) The scenario describes a patient having an acute inferior STEMI, generally due to RCA occlusion. An RCA occlusion may result in RV infarct, which this patient has signs of (hypotension with clear lungs). The definitive treatment is emergent PCI. Fluid administration will help increase coronary artery perfusion by correcting hypotension and ensure adequate RV preload. The right-sided EKG may help confirm the RV infarct. Nitroglycerin, diuretics, and morphine may decrease preload, which would worsen hypotension. A 52 year old male presents with complaints of blurred vision and shortness of breath. B/P is 232/136, heart rate 102, respiratory rate 28 with crackles in lower lung fields bilaterally, with S3 and S4 heart sounds on auscultation. Which of the following would be indicated for this patient? (A) nitroprusside drip, admit to critical care unit (B) digoxin, furosemide (C) labetalol drip, admit to a medical unit (D) lisinopril, calcium channel blocker - ANSWER (A) The patient has signs of organ dysfunction (heart failure) secondary to extreme hypertension. Therefore, he has hypertension crisis or emergency. The B/P needs to be emergently decreased. Most often this treatment is best done in an ICU. An 80 year old female presents with chief complaint of acute shortness of breath. Clinical exam reveals B/P 182/102, heart rate 105/minute, respiratory rate 32/minute, lungs with crackles bilaterally, pulse oximetry of 88%, S4 on auscultation. EKG revealed sinus tachycardia, left ventricular hypertrophy pattern, chest radiograph showed normal heart size, pulmonary vascular congestion, and echocardiogram showed EF of 55%. Which of the following should be avoided in this patient's treatment plan? (A) calcium channel blocker (B) digoxin (C) low-dose diuretics (D) oxygen - ANSWER (B) The patient presents with signs of heart failure due to diastolic dysfunction (hypertension, left ventricular hypertrophy, EF > 40%). These patients have a problem with FILLING, not ejecting. Digoxin, a positive inotrope, may increase wall stress and worsen filling of the left ventricle. Mrs. Jones has heart failure. Despite optimal therapy, she gets short of breath when she gets up to walk to the bathroom. Which of the following is the patient experiencing regarding heart failure? (A) NYHA Class I heart failure, may benefit from an ICD (B) NYHA Class II heart failure, may benefit from an ICD (C) NYHA Class III heart failure, may benefit from an ICD (D) heart failure cannot be classified, further information is needed - ANSWER (C) The patient has symptoms with minimal activity, which describes NYHA Class III. This would qualify her for an ICD. When the above patient, Mrs. Jones, has an exacerbation of her heart failure (Class III), she develops jugular venous distention (JVD), peripheral edema, and abdominal discomfort. These are clinical signs specific to: (A) acute left ventricular failure (B) chronic right ventricular failure (C) acute right ventricular failure (D) chronic dehydration - ANSWER (B) The signs described are those of chronic right-sided heart failure. Acute right ventricular failure may result in JVD but not peripheral edema or abdominal discomfort (which is due to liver engorgement). The nurse managing a post-op CABG patient assesses a sudden drop in B/P, distended neck veins, muffled heart tones, minimal chest tube of output, and a systolic pressure that fluctuates with breathing pattern. The patient most likely needs: A 58 year old patient developed chest pain that he scored as an "8" Rapid assessment included profuse diaphoresis, B/P 78/52, heart rate 104/minute, respiratory rate 20/minute, lungs clear, and SpO2 98%. The patient is currently connected to the bedside monitor with a nasal cannula at 2 L/min in place and intravenous fluids, 0.9 NS at a rate of 10 ml/hour. Which of the following sequences of interventions would be the most appropriate for the nurse at this time? (A) give a chewable aspirin, do an EKG, and start a fluid bolus (B) give NTG sublingual, increase the FiO2 and give morphine (C) do an EKG, give NTG sublingual, and give a chewable aspirin (D) start a fluid bolus, give a chewable aspirin, and do an EKG - ANSWER (D) The clinical description may be that of acute coronary syndrome complicated by hypotension. Addressing the hypotension is a priority as this is further decreasing coronary artery perfusion. A fluid bolus would address hypotension, and no contraindications seem to be present for a fluid bolus as lungs are clear. Aspirin is indicated for acutely chest pain and could be given while preparing to do the EKG, which is needed to help make the diagnosis. The location or type of acute MI is often associated with specific clinical findings. Which of the following statements related to location of MI is TRUE? (A) anterior MI is often associated with heart blocks and bradyarrythmias (B) inferior MI is often associated with right ventricular wall infarction (C) lateral MI is most likely to be associated with posterior MI (D) posterior MI is most likely to lead to the complication of heart failure - ANSWER (B) Because most inferior MI are due to RCA occlusion and the RCA also supplies blood to the right ventricular muscle wall, inferior MI is associated with RV infarct. Which of following statements is accurate regarding heart valves? (A) the aortic valve is closed during systole (B) the mitral valve is closed during systole (C) the mitral valve is closed during diastole (D) the aortic valve is open during diastole - ANSWER (B) During systole (left ventricular ejection) the aortic valve is open, allowing for ejection, and the mitral valve is closed at this time. The mitral valve is open during filling (diastole). The following drugs are all considered positive inotropic drugs primarily affecting the beta-1 reception in the heart, EXCEPT for: (A) dopamine drip at 12 mcg/kg/min dose (B) dopamine drip at 5 mcg/kg/min dose (C) dobutamine drip at 7 mcg/kg/min dose (D) milrinone at 7 mcg/kg/min dose - ANSWER (A) At high doses (> 10 mcg/kg/min), dopamine stimulates alpha receptors in arteries and causes vasoconstriction. The other 3 drugs/doses affect mainly beta-1 receptors in the heart, producing a positive inotropic effect. Which of the following is associated with mitral regurgitation? (A) Systolic murmur, sinus bradycardia (B) Diastolic murmur, heart failure (C) Systolic murmur, inferior wall myocardial infarction (D) Diastolic murmur, complete heart block - ANSWER (C) Inferior wall MI may result in ischemia and dysfunction (regurgitation) of the mitral valve. The mitral valve is closed during systole (left ventricular ejection). A murmur is produced when the mitral valve is not fully closed during systole. Nitrate therapy is indicated for the treatment of unstable angina and acute heart failure because it: (A) decreases preload and increases myocardial O2 demand (B) increases preload and increases myocardial O2 demand (C) increases preload and decreases myocardial O2 demand (D) decreases preload and decreases myocardial O2 demand - ANSWER (D) Nitrates cause venodilation, which results in a decrease in venous return to the heart (left ventricular preload reduction). The decrease in preload decreases the work of the left ventricle and myocardial oxygen demand. All of the following support the diagnosis of cardiac tamponade EXCEPT: (A) widening pulse pressure (B) equalization of right and left heart pressures (C) pulsus paradoxus (D) enlarged heart on CXR - ANSWER The pulse pressure NARROWS with cardiac tamponade. The other 3 choices ARE seen with cardiac tamponade. EKG changes associated with ST-elevation myocardial infarction (STEMI) affecting the lateral wall would include changes in which of the following leads? (A) II, III, and aVF (B) V1, V2, V3 (C) V2, V3, V4 (D) V5, V6, I, aVL - ANSWER (D) V5, V6 represents the lower lateral wall of the left ventricle and I, aVL represents the high lateral wall of the left ventricle, supplied by the left circumflex artery in most of the population. Which of the following are symptoms of hypoglycemia? (A) Tachycardia and trembling (B) Bradycardia and diaphoresis (C) Anxiety and flushed dry skin (D) Flushed dry skin and tachycardia - ANSWER (A) When the blood glucose drops, sympathetic stimulation occurs, (Symptoms are masked for the patient receiving beta-adrenergic blocker drugs). Flushed, dry skin is a sign of hyperglycemia. Which of the following is TRUE for a patient with a right-sided stroke who develops increased intracranial pressure? (A) pupils will change before level of consciousness, right-sided paralysis, eyes deviated to the left, left pupil change (B) pupils will change before level of consciousness, left-sided paralysis, eyes deviated to the right, right pupil change (C) level of consciousness will change before pupils, right-sided paralysis, eyes deviated to the left, left pupil change. (D) level of consciousness will change before pupils, left-sided paralysis, eyes deviated to the right , right pupil change. - ANSWER (D) Higher brain centers (cerebral cortex) are the first to be affected by increased intracranial pressure. Therefore, level of consciousness is the first sign (one exception, epidural hematoma). Pupil changes are ipsilateral (same side as the injury) due to compression of cranial nerve III against the transtentorial notch. Motor changes are contralateral (opposite the side of injury) due to motor fiber crossing in the brain stem. Which of the following interventions would the nurse consider to be inappropriate for the patient with increased intracranial pressure?