Download CCRN PRACTICE QUESTIONS AND ASSURED SOLUTION and more Exams Nursing in PDF only on Docsity!
1 / 36
CCRN PRACTICE QUESTIONS AND
ASSURED SOLUTION
1. A patient in the ED with complaints of chest pain. The 12-lead EKG shows ST elevation in leads
V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system?
A. Sinoatrial (SA) node
B. Bachmann's bundle
C. Atrioventricular (AV) node
D. Bundle of His: LAD so D. bundle of his
2. Which of the following is the preferred lead for ST segment monitoring for a patient with a
suspected RCA occlusion? A.I B. aVR C. III D. V1: c. III
3. Which of the following is not a manifestation of hypertrophic cardiomyopa- thy?
A. Syncope
B. Murmur that increases with squatting
C. Chest pain
2 / 36
D. Sudden cardiac death: *B
Classic manifestations of hypertrophic cardiomyopathy are chest pain, syncope, and an aortic stenosis type of murmur that decreases when the patient is in a squatting position. The first manifestation of this condition is occasionally sudden cardiac death during exercise.
4. In which quadrant is the mean QRS complex axis located if the QRS complex
is predominantly positive in lead I and negative in lead aVF?
A. Normal quadrant
B. Left axis deviation quadrant
C. Right axis deviation quadrant
D. Indeterminant quadrant: *B
Because the positive of lead I is the left arm, if the QRS complex is upright in lead I, the mean QRS axis is to the left. Because the positive of lead aVF (a unipolar lead) is at the foot, if the QRS complex is negative in lead aVF, the mean QRS axis is upward away from the foot. This axis would be in the upper left quadrant, described as left axis deviation.
5. A patient becomes apneic and pulseless. CPR has been initiated, and the
monitor shows asystole in two leads. Which of the following drugs would be used initially?
A. Calcium gluconate
B. Atropine
C. Epinephrine
D. Amiodarone (Cordarone): C
After CPR is initiated and an intravenous access is established, epinephrine should be given. Calcium was used in the past in asystole but is used
4 / 36
8. A patient has just returned from the cath lab. She had an angioplasty for
occlusion of her RCA. She still has femoral artery and vein sheaths in place. The patient complains of chest pain that she rates 9/10 about an hour after she returns from the cath lab. Which of the following is indicated?
A. Administer morphine IV.
B. Administer nitroglycerin sublingual spray.
C. Stop the heparin.
D. Notify the physician: D
New-onset severe chest pain after percutaneous coronary intervention suggests acute closure of the dilated coronary artery. The patient needs to be returned to the cardiac catheterization laboratory for repeat dilation and probable insertion of stent.
9. 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: C
Muffled heart sounds are a classic finding in cardiac tamponade. Remember the classic indications of cardiac tamponade referred to as Beck's triad:
5 / 36 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.
10. A patient has had an inferior MI. He now has a new holosystolic murmur
at apex, acute severe dyspnea, decreased cardiac index, and a normal cardiac silhouette on x-ray. Which of the following complications most likely is occur-
7 / 36
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: B. Absence of creatine kinase (CK) enzyme elevation
13. Substernal chest pain, low-grade fever, and pericardial friction rub are clinical
indications of which of the following?
A. Pericarditis
B. Pericardial tamponade
C. Pneumothorax
D. Pleurisy: A. Pericarditis
14. A patient sustains a myocardial contusion as a result of a MVC. Which of the following
signs and symptoms would be most likely?
A. Jugular venous distention
B. Crackles
C. Bradycardia
D. S3 at the apex: A. Jugular venous distention
15. A patient is admitted to the coronary care unit with third-degree AV heart block, and
a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient
8 / 36 complains of dizziness while lying in bed. The monitor shows third-degree AV block with a ventricular rate of 52 and no pacing spikes. This indicates which of the following?
A. Failure to capture
B. Failure to pace
C. Competition between pacemaker and intrinsic rhythm
D. Failure to sense: B. Failure to pace
16. Which one of the following structures is at greatest risk for trauma in
myocardial contusion?
A. Right atrium
B. Right ventricle
C. Aorta
D. Left ventricle: B. RV
17. Leads V8 and V9 are used to evaluate which of the following?
A. Left ventricular failure
B. Posterior myocardial infarction (MI)
C. Lateral MI
D. Left bundle branch block: B. posterior MI
10 / 36
A. Administer saline bolus.
B. Decrease dobutamine drip rate.
C. Increase nitroglycerin drip rate.
D. Replace potassium.: A. Administer saline bolus.
21. What type of AV block is characterized by a progressive prolongation of the PR interval
followed by a nonconducted P wave?
11 / 36
A. First-degree AV block
B. Second-degree AV block, type I
C. Second-degree AV block, type II
D. Third-degree AV block: B. Second-
degree AV block, type I
22. A premature P wave buried in the T wave before a run of wide QRS complex tachycardia
indicates that the wide QRS complex tachycardia is most likely which of the following?
A. Supraventricular tachycardia with aberrancy
B. Ventricular tachycardia
C. Bundle branch block
D. Wolff-Parkinson-White syndrome: A.
Supraventricular tachycardia with aberrancy
23. Which of the following drugs are used for first-line therapy for chronic
management of hypertension?
A. ACE inhibitors and vasodilators
B. Vasodilators and beta-blockers
C. Diuretics and beta-blockers
D. Diuretics and ACE inhibitors: C. Diuretics
and beta-blockers
13 / 36
B. High specificity and false-negative results
C. High sensitivity and false-positive results
D. Low sensitivity and false-negative results: C. High sensitivity and false-positive results
27. Which of the following is the most likely mechanism for atrial tachycardias?
A. Reentry
B. Triggered activity
C. Accessory pathways
D. Enhanced automaticity: A. re-entry
28. Which of the following would be a contraindication to the use of fibrinolytic drugs, such
as recombinant tissue plasminogen activator?
A. Hypotension
B. Heart block
C. Uncontrolled hypertension
D. Pain lasting more than 6 hours: C. uncontrolled hypertension
29. A patient returns to the critical care unit after insertion of a transvenous pacemaker.
There are pacing spikes not followed by a QRS. Which of the following is a method to facilitate capture during pacing?
14 / 36
A. Increase the pacing rate.
B. Increase the milliamperage.
C. Suppress the competitive rhythm.
D. Increase the sensitivity: B. Increase the milliamperage.
30. eduction in peripheral circulation and shifting of the oxyhemoglobin disso- ciation curve
can affect the accuracy of which of the following?
A. Arterial blood gases
B. Capnography
C. Hemoglobin and hematocrit
D. Pulse oximetry: D. Pulse oximetry
31. Which of the following would not be recommended for diastolic dysfunc- tion?
A. Angiotensin receptor blockers
B. Beta-blockers
C. Inotropes
D. Angiotensin-converting enzyme inhibitors: C. inotropes
32. Why does nitroprusside (Nipride) cause tachycardia?
A. Stimulation of cardioacceleratory center
16 / 36
B. Loop diuretics
C. Calcium channel blockers
D. Angiotensin-converting enzyme (ACE) inhibitors: D. Angiotensin-converting enzyme (ACE) inhibitors
36. Ashman's phenomenon is most likely to be evident in which of the following
electrocardiogram changes?
A. Second-degree atrioventricular block, type I (Wenckebach)
B. Atrial fibrillation
C. Sinus dysrhythmia
D. Premature ventricular contraction: B. A-fib
Ashman's phenomenon is more likely to be evident in rhythms that are irregular; therefore having more short cycles after long cycles. The most likely rhythm to demonstrate Ashman's phenomenon is atrial fibrillation because it is irregularly irregular. Ashman's phenomenon is also evident in early premature atrial complexes. Again, Ashman's phenomenon occurs when a short cycle follows a long cycle.
37. Which of the following is a clinical indication of diastolic dysfunction?
A. S
B. S
C. Murmur
D. Midsystolic click: B. S
38. Which of the following type of drug would be prescribed after a MI to aid in
17 / 36 prevention of remodeling?
A. Beta-blockers
B. Calcium channel blockers
C. Angiotensin-converting enzyme (ACE) inhibitors
D. Anticoagulants: C. ACE inhibitors
39. Which of the following are clinical indications of bacterial endocarditis?
A. Fever and new murmur
B. Chest pain and pericardial friction rub
C. Dyspnea and crackles
D. Chest pain and syncope: A. fever and new murmur
40. While monitoring the patient's PAP, a damped waveform is noted. Which of the
following would not be an appropriate action?
A. Ensure that the valve on the balloon lumen is open and that no air is trapped in the
balloon.
B. Reposition the patient.
C. Fast flush the distal lumen.
D.Check for a possible clot in the catheter by aspiration of the distal lumen.: C. Fast flush the distal lumen.
19 / 36
D. Inotropes: B. Cardiac transplant referral
44. The reciprocal changes of a posterior MI are evident in which leads?
A. II, III, aVF
B. V1, V
C. V5, V
D. I, aVL: B. V1, V
45. 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: B. Decrease in heart rate
46. Which of the following is the most common cause of death associated with an acute MI?
A. Heart failure
B. Ventricular dysrhythmias
20 / 36
C. Pulmonary edema
D. Thromboembolism: B. Ventricular dysrhythmias
47. If a murmur is audible at the same time that the carotid pulse is felt, the murmur is:
A. systolic.
B. diastolic.
C. always normal.
D. always pathologic.: A. systolic
48. Which drug has Class II and Class III properties?
A. Verapamil (Calan)
B. Propranolol (Inderal)
C. Sotalol (Betapace)
D. Tocainide (Tonocard): C. Sotalol (Betapace)
49. The skin changes associated with chronic peripheral arterial disease are:
A. thickened with brownish discoloration at the ankles.
B. pale and shiny.
C. ulcerations at the sides of the ankles.
