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CCRN final exam question with best

answers verified by an expert 2024 latest

updated.

1. S3 occurs where and when? - Correct answer heard best at the apex of the heart right after S
2. what is S3 associated with? - Correct answer Heart failure, Pulmonary hypertension, cor pulmonale, and mitral/aortic/tricuspid insufficiency
3. what is S3? - Correct answer rapid rush of blood into a dilated ventricle
4. what is S4? - Correct answer atrial constriction of blood into a non-compliant ventricle
5. Where and when does S4 occur? - Correct answer Best heard over the apex with the bell right before S
6. what is s4 associated with? - Correct answer myocardial ischemia, infarction, hypertension, ventricular hypertrophy, aortic stenosis
7. Pericardial friction rub is associated with what? - Correct answer Pain during deep inspiration and positional pain
8. Pulse pressure equation - Correct answer systolic - diastolic = pulse pressure
9. normal pulse pressure values - Correct answer 40-
10. systolic BP represents what? - Correct answer Cardiac output and stroke volume
11. what does a decrease in systolic pressure mean if diastolic doesn't change? - Correct answer This = narrowing pulse pressure. Seen often with severe hypovolemia or a severe drop in Cardiac output.
12. diastolic BP represents what? - Correct answer Systemic vascular resistance (SVR)
13. what does a decrease in diastolic BP mean? - Correct answer this = widening pulse pressure. May indicate vasodilation, severe sepsis, septic shock.
14. time ratio for systolic vs. diastolic - Correct answer 1.0/1.

15. what is perfused during diastole? - Correct answer Coronary arteries
16. causes of valvular heart disease - Correct answer - coronary heart disease
    • dilated cardiomyopathy
    • Degeneration
    • Bicuspid aortic valve
    • Rheumatic fever
    • Infection
    • Connective tissue diseases
17. murmurs of insufficiency are? - Correct answer regurgitation when the valve is close
18. murmurs of stenosis are? - Correct answer regurgitation when the valve is open
19. are these murmurs acute or chronic? - Correct answer Stenosis = chronic
20. Insufficiency = acute or chronic
21. systolic murmurs sound like what? - Correct answer lub...shhhhh...dub
22. what are the valves doing during a systolic murmur? - Correct answer aortic and pulmonic valve stenosis (they are open)
23. Mitral and tricuspid insufficiency (they are closed)
24. how does a mitral valve insufficiency show up on a pulmonary artery catheter? - Correct answer giant v waves
25. what other defect can cause systolic murmurs? - Correct answer ventricular septal defect (heard on the left sternal border)
26. what do diastolic murmurs sound like? - Correct answer lub...dub...shhhhh
27. what are the valves doing during diastolic murmurs? - Correct answer aortic/pulmonic insufficiency (closed)
28. Mitral/Tricuspid stenosis (open)
29. mitral valve stenosis is particularly associated with what? - Correct answer atrial fibrillation due to atrial enlargement
30. grades of acute MI - Correct answer grade 1/2 -- papillary muscle dysfunction
31. grade 5/6 -- papillary muscle rupture (emergency)
32. unstable angina = - Correct answer chest pain at rest, unpredictable
33. relievers for Unstable angina? what do labs look like? ECG? - Correct answer Nitroglycerin. Troponin negative. ST depression or T wave inversion.

34. NSTEMI labs? ECG? Relievers? - Correct answer troponin positive. ST depression or T wave inversion. Unrelenting pain.
35. STEMI labs? ECG? Relievers? - Correct answer Troponin positive. ST elevation in 2 or more contiguous leads. Unrelenting chest pain
36. Prinzmetal's angina = - Correct answer unstable angina w/ transient ST elevation
37. What causes prinzmetal's angina? - Correct answer Right coronary artery spasms w/ or w/o atherosclerotic lesions.
38. Prinzmetal's pain & relief? Labs? - Correct answer Pain at rest/cyclic. Nitroglycerin to change ST wave. Troponin negative.
39. what may precipitate prinzmetal's angina? - Correct answer ETOH, nicotine, cocaine ingestion.
40. Management of chest pain - Correct answer - Stat ECG and read within 10 minutes
    • aspirin
    • Anticoagulants
    • Antiplatelet agents
    • Beta Blockers
    • Treat pain
41. what should one do w/ aspirin? - Correct answer chew it (improves morbidity and mortality)
42. what anticoagulants? - Correct answer heparin or enoxaparin (lovenox)
43. What antiplatelet drugs? - Correct answer - Clopidrogrel (plavix)
    • Abciximab (reopro)
    • Eptifibatide (integrilin)
    • Tirofiban (aggrastat)
44. What beta blockers? - Correct answer cardioselective BB's --> metoprolol
45. contraindications of BB's? - Correct answer - hypotension
    • Bradycardia
    • use of phosphodiesterase inhibitors (like sildenafil (viagra))
    • acute chest pain due to cocaine
46. What BB's should not be used? - Correct answer non-cardioselective BB's --> propanolol

47. what to treat pain with? - Correct answer Nitroglycerin & Morphine
48. Labs that help diagnosis/treatment? - Correct answer - Cardiac biomarkers
    • Lipid profile
    • CBC
    • Electrolytes
    • BUN
    • Creatinine
    • magnesium
    • Pt
    • PTT
49. ECG changes in II, III, aVF - Correct answer right coronary artery (RCA), Inferior Left Ventricle
50. ECG changes in V1, V2, V3, V4 - Correct answer Left anterior descending (LAD), Anterior LV
51. ECG changes in V5, V6, I, aVL - Correct answer Circumflex, Lateral LV
52. ECG changes in V5, V6 - Correct answer Low lateral LV
53. ECG changes in I, aVL - Correct answer High lateral LV
54. ECG changes in V1, V2 - Correct answer Right coronary artery, Posterior LV
55. ECG changes in V3R, V4R - Correct answer right coronary artery, Right ventricular infarct
56. Treatment of a STEMI - Correct answer - Determine onset
    • reperfuse if symptoms are less than 12 hours
57. interventions for reperfusion - Correct answer - percutaneous coronary Intervention (PCI) -- within 90 minutes
    • Fibrinolytic drug therapy -- within 30 minutes
58. eligibility for reperfusion intervention - Correct answer - ST elevation in 2 or more contiguous leads or new onset of left bundle branch block
    • chest pain in last 12 hours
    • Chest pain lasting at least 30 minutes
    • pain unresponsive to nitroglycerin
59. Signs of reocclusion? Treatment? - Correct answer s/s - Chest pain and ST elevation
60. Tx - Contact the physician

61. Signs of a vasovagal response? Treatment? - Correct answer s/s - Hypotension (<90 systolic) w/ or w/o bradycardia, Pallor, Nausea, Yawning, Diaphoresis
62. Tx - Give fluids and atropine
63. Treatment for sheath site bleeding? - Correct answer Tx - apply manual pressure 2 inches above the site for minimum of 20 minutes (30 if still on GP IIb/IIIa inhibitors) for hemostasis
64. Signs of retroperitoneal bleeding? Treatment? - Correct answer s/s - sudden hypotension and severe lower back pain
65. tx - fluids and blood products
66. Contradindications for fibrinolytic therapy? - Correct answer - any prior intracranial hemorrhage
    • known structural cerebral vascular lesion
    • malignant intracranial neoplasm
    • Ischemic stroke within 3 months except acute ischemic stroke within 3 hours
    • possible aortic dissection
    • active bleeding/diathesis (except menses)
    • closed head fracture or facial trauma in 3 months.
67. Signs of reperfusion? - Correct answer - chest pain relief
    • resolution of ST segment deviation
    • marked elevation of troponin/CK-MB (due to stunning when vessel opens
    • Reperfusion arrhythmias
68. What are some reperfusion arrythmias? - Correct answer Ventricular tachycardia, Ventricular fibrillation, accelerated idioventricular rhythm (AIVR)
69. how do you treat a STEMI? - Correct answer same as a STEMI, but no need for immediate reperfusion.
70. what is an inferior MI associated with? what leads are ST elevation noted in? - Correct answer - Right coronary artery occlusion (RCA occlusion)
    • ST elevation in II, III, aVF
71. what AV conduction disturbances can happen? - Correct answer 2nd degree type I, 3rd degree block, Sick sinus syndrome (SSS), bradycardia
72. what sign w/ an inferior MI will increase mortality? - Correct answer tachycardia
73. which 2 infarcts should be associated together? - Correct answer Right ventricular and posterior infarct

74. What should be used with caution in an inferior MI? - Correct answer beta blockers
75. what does the RCA supply? - Correct answer inferior wall of the left ventricle and the right ventricle --> why about 30% of inferior MI pts also have RV infracts
76. how do you see ECG changes in a RV infract? - Correct answer With a right sided ECG (ST changes occur in V4R)
77. s/s of RV infract? Tx? - Correct answer s/s - Jugular venous distention @ 45 degrees, high CVP, hypotension, clear lungs, bradyrhythmis.
78. Tx - fluids, positive inotropes
79. What to avoid with a RV infarct? - Correct answer - Preload reducers --> nitrates, diuretics
    • beta blockers
80. what is an anterior MI associated with? - Correct answer Left anterior Descending (LAD) occlusion
81. what will the ECG look like? - Correct answer ST elevation in V1-V4 (precordial leads, V leads) and ST depression in inferior wall (II, III, aVF)
82. what ominous signs do you look for in an anterior MI? - Correct answer second degree type II block or RBBB (due to lack of blood flow to the bundle of HIS)
83. what can one develop from an anterior MI? does anterior or inferior have higher mortality? - Correct answer - systolic murmur (possible ventricular septal defect)
    • High mortality in anterior.
84. what ECG changes occur with Low lateral MIs? - Correct answer ST elevation in V5, V
85. what ECG changes occur in high lateral MIs? - Correct answer ST elevation in I, aVL
86. what does a lateral MI involve artery wise? - Correct answer Left circumflex artery
87. what are some cardiac catheterization lab procedures? - Correct answer - percutaneous coronary interventions (PCI) -- intracoronary stenting and balloon angioplasty w/o stent
    • Percutaneous balloon valvotomy
    • Pacemaker implentation
    • electrophysiology studies -- ICD, cardiac ablation

88. complications of PCI? - Correct answer - death rate 0.71%; in hospital MI 0.4%
    • coronary artery perforation
    • distal coronary embolization
    • Stent thrombosis -- usually acute (less than 24 hours) or subacute (less than 30 days)
    • stroke or TIA
    • arrhythmias
    • Renal Failure
    • retroperitoneal bleed
89. what to watch for with sheath removal - Correct answer - baseline vitals and pulses
    • pain
    • BP q 5-10 mins during removal
    • vasovagal response
90. what happens with a vasovagal response? - Correct answer hypotension < 90 systolic w/ or w/o bradycardia, absence of compensatory tachycardia, pallor, nausea, yawning, diaphoresis
91. management of vasovagal response - Correct answer - hold nitrates
    • atropine 0.5mg IV
    • IV bolus 250cc normal saline if atropine doesn't work immediately
92. what is hypertensive emergency/crisis - Correct answer elevated BP with evidence or end-organ damage from acute HTN
93. what is hypertensive urgency? - Correct answer elevated BP without evidence of acute end-organ damage
94. how to treat HTN emergency? - Correct answer Nitroprusside and Labetalol
95. how does nitroprusside work? what do you watch for? - Correct answer - reduces preload and afterload
    • watch for cyanide toxicity --> mental status change, tachycardia, seizure, need for increase in dose, unexplained metabolic acidosis (esp. renal pts)
96. Best method for giving labetalol? What is the max dose? Durations effect? - Correct answer - Preferred to give intermittent doses rather than continuous.
    • max dose = 300 mg
    • Duration = 4-6 hrs after IV discontinue
97. what is the biggest risk for HTN emergency and urgency? - Correct answer STROKE
98. s/s of peripheral arterial disease (6 Ps) - Correct answer - pain

• pallor
• Pulse absence or diminishing pulse
• paresthesia
• paralysis
• Poikilothermia

99. what is poikilothermia? - Correct answer loss of hair on toes/lower legs, glossy, thin, cool, dry skin, cool to touch, minimal edema
100. what is the ankle-brachial index? - Correct answer the ankle BP divided by the brachial pressure on the same side
101. what is the normal value for the ABI? - Correct answer normal is > 1
102. what is the ABI used for? - Correct answer it is used to test for Peripheral arterial disease
103. What is diagnostic testing used for acute peripheral vascular insufficiency (APVI)? - Correct answer Doppler and ateriography
104. pt management for APVI? - Correct answer - bed in reverse Trendelenburg

• Do not elevate the affected limb
• medications: Thrombolytics, anticoagulants, antiplatelet agents, vasodilators.

105. what does QT prolongation possibly lead to? - Correct answer Torsades de pointes
106. Causes of QT prolongation - drugs? Electrolyte issues? treatment? - Correct answer drugs - amiodarone, quinidine, haloperidol, procainamide
107. Electrolyte - hypokalemia, hypocalcemia, hypomagnesemia
108. Tx - magnesium
109. What is the pacemaker code? 1st? 2nd? 3rd initial? I, D, O? A, V, D? - Correct answer 1st - Chamber paced
110. 2nd - Chamber sensed
111. 3rd - Response to sensing
112. I = inhibits demand (withholds stimulus)
113. D = inhibits and triggers (responds to heart activity)  = None
114. A = atria
115. V = Ventricle
116. D = Both

117. What types of therapy can an ICD do? - Correct answer programmed to shock (defibrillate and cardiovert), Burst pace (senses tachyarrhythmias and stops it), and pacing (for bradyarrhythmias)
118. where should pads go if someone needs to be shocked? - Correct answer Pads should never go over the ICD
119. Heart failure definition - Correct answer clinical syndrome characterized by s/s associated with high intracardiac pressures and decreased cardiac output
120. Acute decompensated heart failure - Correct answer abrupt onset of s/s that leaves a person hospitalized
121. heart failure with systolic dysfunction - Correct answer EF < 40% (left ventricle systolic dysfunction)
122. Heart failure with diastolic dysfunction - Correct answer EF > 50% problems with filling; ejection is ok.
123. what is BNP? - Correct answer Beta natriuretic peptide = released by the ventricle when under stress in an attempt to dilate and decrease ventricular pressure
124. what will BNP be high in? - Correct answer Heart failure -- indicated the ventricle is under stress
125. primary problem of systolic vs. Diastolic - Correct answer systolic = ejection problem; dilated chamber
126. Diastolic = Filling problem; hypertrophied chamber or septum.
127. s/s of systolic HF - Correct answer - dilated left ventricle

- PMI shifted to the left - Valvular insufficiency - EF < 40% - pulmonary edema due to poor ventricle emptying - S - BP normal or low - BNP elevated 

128. s/s of diastolic HF - Correct answer - normal ventricle sign

- Thick ventricle walls and/or thick septum - Normal contractile function - Normal EF - Pulmonary edema due to high ventricular pressure - S4 w/ HTN - BP often high 

• BNP elevated

129. Tx for systolic HF - Correct answer - Beta blockers

• Arbs/ACEI
• Diuretics
• Dilators
• Aldosterone antagonists
• Positive inotropes

130. Tx for diastolic HF - Correct answer - Beta blockers

• ACEI/Arbs
• Calcium channel blockers
• Diuretics (low dose)
• Aldosterone antagonists

131. Contraindications of systolic/Diastolic HF - Correct answer systolic - Negative inotropes (calcium channel blockers beta blockers)
132. Diastolic - Positive inotropes, Dehydration, Tachyarrhythmias.
133. Cardiomyopathy in systolic HF - Correct answer dilated may cause systolic HF, mitral valve insufficiency
134. Cardiomyopathy in diastolic HF - Correct answer idiopathic hypertrophic subaortic stenosis (IHSS), hypertrophic cardiomyopathy (HCM), Hypertrophic obstructive cardiomyopathy (HOCM)
135. what will you find on the chest X-ray w/ systolic HF - Correct answer large, dilated heart (will often see a shift of the point of maximal impulse from midclavicular to left) or normal heart size
136. what will you find on the chest X-ray w/ diastolic HF - Correct answer Normal heart size
137. Class 1 CHF - Correct answer extraordinary activity results in heart failure symptoms. Normal activity does not cause symptoms.
138. Class 2 CHF - Correct answer Ordinary physical activity causes symptoms. Resting will be comfortable.
139. Class 3 CHF - Correct answer Minimal activity results in symptoms. Resting will be comfortable.
140. Class 4 CHF - Correct answer Symptoms will occur at rest.
141. a pt qualifies for what with a Class 2-4 CHF? - Correct answer an ICD

142. Dilated Cardiomyopathy physical aspects - Correct answer - Systolic dysfunction (problem ejecting)
     • thinning dilation and enlargement of LV chamber
     • Mitral valve regurgitation common
143. Dilated cardiomyopathy shares symptoms with what problem? - Correct answer Systolic Heart failure
144. Diastolic Cardiomyopathy physical aspects - Correct answer - Diastolic dysfunction (problem filling)
     • Increased thickening of the heart muscle and septum inwardly affecting the LV chamber
145. symptoms of dilated cardiomyopathy - Correct answer - fatigue

- dyspnea - chest pain - palpitations - S3, S - presyncope or syncope 

146. an extreme drop in stroke volume secondary to systolic dysfunction results in... - Correct answer - elevated LV preload with associated pulmonary symptoms
     • elevated LV afterload due to vasoconstrictive compensatory mechanisms
     • drop in cardiac output which creates inadequate perfusion to organs.
147. etiologies of cardiogenic shock - Correct answer Acute MI
148. chronic heart failure
149. cardiomyopathy
150. Dysrhythmias
151. cardiac tamponade
152. papillary muscle rupture
153. Compensatory stage of Cardiogenic shock - Correct answer tachycardia
154. tachypnea
155. crackles w/ mild hypoxia
156. ABG w/ resp. alkalosis or early metabolic acidosis
157. Anxiety/irritability
158. Neck vein distention
159. S
160. cool skin
161. urine output down
162. narrow pulse pressure
163. BP maintained but lower than baseline
164. Progressive stage of cardiogenic shock - Correct answer hypotension
165. worsening tachycardia, tachypnea, oliguria

166. met. Acidosis
167. worsening crackles and hypoxemia
168. skin clammy, mottled
169. Anxiety/lethargy
170. treatment of cardiogenic shock - Correct answer Identify cause
171. manage arrhythmias
172. reperfusion if STEMI
173. emergent surgery if mechanical issue
174. Ways to enhance pump effectiveness in cardiogenic shock - Correct answer positive inotropics:
     • norepinephrine (levophed)
     • Dopamine 4-10 mcg/kg/min
     • Dobutamine, milirinone (primacor)
175. what do we avoid with cardiogenic shock? - Correct answer negative inotropes
176. ways to decrease demand on pump in cardiogenic shock - Correct answer preload/afterload reduction
177. optimize oxygenation
178. mechanical ventilation
179. treat pain
180. VAD
181. balloon therapy for cardiogenic shock (VAD) - Correct answer inflation increases coronary artery perfusion
182. Deflation decreases afterload
183. who qualifies for a CABG? - Correct answer people with:

- Chronic disabling angina unresponsive to medical therapy and not a candidate for PCI - Left main lesion - 3 vessel disease 

184. what to watch for after a CABG? - Correct answer tamponade
185. pericarditis
186. bleeding
187. arrhythmias
188. hemodynamic abnormalities
189. infection
190. maintaining patency for chest tube - Correct answer - don't allow dependent loops

• milking or stripping the tubing is not routinely indicated (ok if clots appear, but be careful)

191. where does the chest tube go? - Correct answer below the pts chest
192. mediatinal vs pleural chest tubes - Correct answer mediastinal = removes serosanguinous fluid
193. pleural = removes air, blood, serous fluid from pleural space
194. when to clamp tubing? - Correct answer only when changing out the system
195. what should one do if output > 100mL for 2 consecutive hours? - Correct answer Maintain hemodynamic stability
196. Correct volume status
197. Administer blood products
198. Pros/Cons of a mechanical valve - Correct answer pros:

• easy to insert
• reliable
• lasts longer

199. Cons:

• high risk of thrombosis
• permanent anticoagulation therapy

200. pros/cons of biological valve - Correct answer pro:

• anticoagulation only for short term
• Some cases with only ASA

201. Cons:

• wears down esp. in high pressure systems

202. what should a nurse consider after Valve repair/replace - Correct answer avoid any drop in preload
203. anticoagulation will be needed (sometimes dual therapy)
204. anticipate conduction disturbances (temporary or permanent pacing may be required)
205. etiologies of a cardiac tamponade - Correct answer surgical
206. medical (pericarditis, etc...)
207. trauma
208. S/S of tamponade - Correct answer Narrowed pulse pressure
209. Pulses paradoxus
210. restlessness and agitation
211. hypotension
212. increased JVD

213. Muffled heart sounds
214. Enlarging cardiac silhouette and mediastinum
215. equalization of CVP
216. pulses paradoxus - Correct answer excessive drop in systolic BP during inspirations best seen in an ART line --> caused by increase intrathoracic pressure which decreases venous return
217. which valve is at most risk for rupture in a trauma? - Correct answer Aortic valve -- the most anterior in the chest
218. pericarditis etiologies - Correct answer dressler's syndrome (immune response after an MI, surgery, or trauma)
219. Idiopathic
220. Radiation
221. Post-op cardiac surgery
222. Post MI
223. Viral
224. s/s of pericarditis - Correct answer chest pain (pain worsens with inspiration)
225. Dyspnea
226. low grade temp
227. increased sedimentation rate
228. ST elevation in all leads
229. Tamponade
230. MI/Dressler's syndrome
231. tx for pericarditis - Correct answer analgesics
232. NSAIDS
233. anti-inflammatory drugs
234. steroids
235. antibiotics
236. monitor for worsening symptoms, constrictive pericarditis, tamponade
237. How does trauma compare to pericarditis? - Correct answer - it has worse outcomes
     • broken vessels bleed into the heart
     • Dysrhythmias
     • first 48 hours are very critical
238. s/s of trauma - Correct answer chest pain (worsens on inspiration)
239. dyspnea
240. low grade temp
241. ST elevation in area of injury

242. tx for trauma - Correct answer monitor for arrhythmias
243. Analgesics PRN
244. etiology of aneurysms - Correct answer arteriosclerosis
245. HTN
246. smoking/obesity
247. bacterial infections
248. congenital defects
249. Trauma
250. Marfan's syndrome (connective tissue disorder)
251. Abd aortic aneurysm (75% of all aneurysms) - Correct answer - asymptomatic if small
     • pulsations in the ABD area
252. s/s: N&V, shock
253. s/s Thoracic Aortic Aneurysm (25%) - Correct answer sudden tearing, ripping pain in the chest radiation into the shoulders, neck, and back
254. Cough
255. hoarseness
256. dysphagia
257. dyspnea
258. dizziness
259. widening of the mediastinum.
260. tx of aneurysms - Correct answer < 5cm in diameter:

- monitor regularly (US or CT) - treat HTN (prefer beta blockers) - treat earlier with marfan's syndrome  6cm in diameter: - surgical repair - aggressive HTN and HR control = labetalol drip - Dissection = immediate surgery