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CCRN Practice Questions with 100% CORRECT
ANSWERS BEST GRADED A+
A 47-year-old male has been admitted to the CCU from the emergency room with a history of sudden diaphoresis, nausea, vomiting and radiating pain down his left arm. He reports no significant medical history, and has been a two PPD smoker since his early twenties. His admitting diagnosis is UA/NSTEMI and he is being prepped for cardiac catheterization for possible angioplasty with stent placement. What type of medication orders might the nurse see prior to his procedure? a. Clopidogrel and ASA b. Clopidogrel and prasugrel c. Clopidogrel and meperidine d. Prasugrel, ASA, and hyoscyamine - SOLUTION a. Clopidogrel and ASA Agnes is a 65-year-old white female who has a history of pulmonary fibrosis with steroid use for the past two years with concomitant hypertension. She has been on oxygen therapy at 4L per nasal cannula for the past 3 years. Recently, her first great-grandchild was born, and she decided to quit smoking. Three days ago, she experienced nausea and dizziness and was admitted to the CCU with a diagnosis of acute myocardial infarction. During shift change, Agnes' low blood pressure alarm sounds. Upon assessment, she is diaphoretic and has severe dyspnea. What is the most likely cause of her symptoms? a. Exacerbation of pulmonary fibrosis b. Pulmonary embolism c. Recurrent myocardial infarction d. Papillary muscle rupture - SOLUTION d. Papillary muscle rupture Norman is a 65-year-old paraplegic who resides in a nursing home. He presents with a 3-day history of increased temperature, productive cough, and increased weakness. His caregiver states that he had developed a decubitis ulcer, and has not been able to tolerate sitting in his wheelchair, so has been in bed for the past week. Bibasilar crackles are audible on auscultation, with overall diminished breath sounds bilaterally. Obvious respiratory distress is apparent with tachypnea, suprasternal retractions
and use of accessory muscles. Vitals: T-100.2F, HR-120, RR-28, BP 104/50, O2 Sat on RA - 88%. An initial chest x-ray reveals the "spine sign" and a normal cardiac silhouette. What is the most likely cause of Norman's condition? a. CAP b. HCAP c. NHAP d. HAP - SOLUTION c. NHAP - Nursing home acquired pneumonia What does the finding of "spine sign" on a chest x-ray indicate? a. Pre-existing spinal injury b. Kyphosis c. Pneumonia d. Scoliosis - SOLUTION c. Pneumonia If a patient is suspected of having an episode of acute hypoglycemia, which of the following is NOT the most appropriate first intervention? a. Draw a STAT blood glucose level. b. Give the patient a ½ glass of orange juice. c. Give the patient IV dextrose or IM glucagon. d. Check the blood glucose with a glucometer. - SOLUTION a. Draw a STAT blood glucose level. Marilyn is a Type I diabetic who has been admitted to the unit after a severe hypoglycemic episode in which she lost consciousness. She states that she has had many episode of hypoglycemia, but just does not seem to know when they are coming on anymore. What is the term for this phenomenon? a. Hypoglycemia tolerance b. Hypoglycemia unawareness c. Hypoglycemia latency d. Hypoglycemia neurosis - SOLUTION b. Hypoglycemia unawareness Of the following, which is included in the etiology of idiopathic thrombocytopenic purpura (ITP)?
a. Basilar skull fracture b. Retroperitoneal hemorrhage c. Pelvic fracture d. Aortic tear - SOLUTION b. Retroperitoneal hemorrhage If bowel sounds are audible when auscultating Matthew's lungs, what injury may he have sustained? a. Ruptured spleen b. Ruptured liver c. Diaphragmatic injury d. Gastric tear - SOLUTION c. Diaphragmatic injury If a patient sustains acute renal failure (ARF) secondary to cardiogenic shock, what type of renal failure is this considered? a. Intrinsic b. Prerenal c. Postrenal d. Iatrogenic - SOLUTION b. Prerenal The RIFLE classification system provides a definition and classification system for acute renal failure (ARF). What does the "R" in the RIFLE acronym refer to? a. Risk of renal dysfunction b. Rapid response to failure c. Role of dialysis d. Recurrence of intrinsic disease - SOLUTION a. Risk of renal dysfunction Andrew is a 47-year-old with advanced amyotrophic lateralizing sclerosis (ALS). He requires total assistance for positioning, bathing and mobility. His swallowing is impaired, so he takes nothing by mouth and receives nutrition through tube feedings via a gastrostomy tube. Based on his current condition, what type of asphyxia may Andrew be most susceptible to? a. Cardiac asphyxia b. Neurological asphyxia c. Foreign body asphyxia d. Positional asphyxia - SOLUTION d. Positional asphyxia
Ramona is a 21-year-old who has been admitted to the ICU after suffering an anaphylactic reaction during dinner due to peanut sauce in a dish that the host didn't tell her about. She was stabilized in the emergency room with IV epinephrine and IV diphenhydramine. However, 4 hours after being admitted to the ICU she becomes anxious, develops hives and begins to have difficulty breathing. What is the most likely cause for Ramona's symptoms? a. Persistent anaphylaxis b. Biphasic anaphylaxis c. Unresponsive anaphylaxis d. Rebound anaphylaxis - SOLUTION b. Biphasic anaphylaxis Madge is a 91-year-old nursing home resident with a history of dementia and atrial fibrillation who has been admitted to the ICU for treatment of pneumonia. As you are performing her bed bath, you note bruising around her breasts and genital area. What potential issue should be of major concern in Madge's situation? a. Idiopathic thrombocytopenia purpura (ITP) b. Embolic stroke c. Sexual abuse d. Nursing home acquired pneumonia (NHAP) - SOLUTION c. Sexual abuse Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper" for no reason, starts "ranting" and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence which includes irritability, agitation, and violent behavior during manic or psychotic episodes? a. Schizophrenia b. Post-traumatic stress disorder (PTSD) c. Bipolar disorder d. Delusional disorder - SOLUTION c. Bipolar disorder
Balloon deflation right before left ventricular (LV) ejection (prior to systole) decreases afterload. Balloon inflation after aortic valve closure at the beginning of diastole augments blood flow to the coronary arteries. Which intervention is indicated in the management of chest tubes for a postoperative cardiac surgery patient? a. Clamp the tube during patient transport b. Avoid dependent loops kinking c. Contact provider for bubbling in the suction chamber d. Strip the tubing if clots appear - SOLUTION b. Avoid dependent loops or kinking a - only should be done if provider ordered, when changing the system, or there is a disconnect c - normal d - can greatly increase pressure in system (shouldn't be done) An RN is caring for a patient post-op cardiac surgery and notes that the patient's chest tube output has been greater than 100 mL for two consecutive hours. What will the nurse do next? a. Milk the chest tubes b. Contact the physician c. Administer vasopressors d. Administer vitamin K - SOLUTION b. Contact the physician Which of the following are indicative of cardiac tamponade post-op heart surgery? a. hypotension, flat neck veins, widened pulse pressure b. muffled heart sounds, minimal chest tube output, pulsus paradoxus c. hypertension, distended neck veins, narrow pulse pressure d. crackles, hypoxemia, S3 - SOLUTION b. muffled heart sounds, minimal chest tube output, pulsus paradoxus other signs: neck veins distended, pulse pressure narrow, hypotension d - signs of elevated L heart pressure
In the presence of blunt cardiac trauma, which finding supports the diagnosis of myocardial contusion? a. Cardiac dysrhythmias b. PMI shifted to the right c. Increased myoglobin d. Bounding pulses - SOLUTION a. Cardiac dysrhythmias
- can also monitor troponins c. increase myoglobin - more specific to skeletal muscle injury The patient develops chest pain with deep inspiration, a low-grade fever, and ST elevation in all leads three days post-MI. Treatment will include which of the following? a. Nitroglycerin drip b. PCI c. anti-inflammatory agents d. anticoagulation - SOLUTION c. anti-inflammatory agents Pt has pericarditis (Dressler's syndrome) - responds well to anti- inflammatory agents. a, b, and c would be indicated for coronary artery occlusion A 66-year-old male presented with sudden-onset midsternal chest pain while sitting in a chair. The ECG demonstrated ST elevation of 2-3mm in V2 through V4. The patient's history includes cervical spine surgery two weeks ago. The hospital does not provide percutaneous coronary intervention (PCI). What is the treatment of choice? a. Administer of a fibrinolytic agent b. Emergent transfer to the nearest facility that performs PCI c. Administer to the coronary care unit (CCU) d. Administration of enoxaparin (Lovenox) and morphine - SOLUTION b. Emergent transfer to the nearest facility that performs PCI a - typically used after reperfusion c - would not improve outcome d - enoxaparin is not reversible. ASA or heparin would be preferred.
a. Close monitoring for ventricular arrhythmias b. Administration of diuretics to decrease preload c. Close monitoring for conduction disturbances d. Administration of positive inotropes to increase contractility - SOLUTION c. close monitoring for conduction disturbances The mitral, tricuspid, and aortic valves are near conduction pathways, and the need for temporary pacing needs to be considered The patient is admitted with ripping pain between the scapulae with a dissecting aortic aneurysm seen on the CT scan. In addition to preparation for immediate surgery, which agent is most likely to improve the outcome of the patient? a. nitroglycerin (Tridil) drip b. dopamine (Intropin) drip c. nitroprusside (Nipride) drip d. labetalol (Trandate) drip - SOLUTION d. labetalol (Trandate) drip Aggressive blood pressure and heart rate control are priorities for a patient with aortic dissection The patient has an S3 at the apex of the heart on auscultation. What is most likely a part of the treatment plan? a. Coronary artery reperfusion b. Heart rate control c. Pain management d. Left ventricular preload reduction - SOLUTION d. Left ventricular preload reduction S3 is due to elevated left ventricular pressure and heart failure The patient is having non-sustained runs of torsades de pointes on the cardiac monitor. Which medication will most likely be ordered for this patient? a. Magnesium IV b. Potassium drip c. Amiodarone drip
d. Synchronized cardioversion - SOLUTION a. Magnesium IV The patient, status post anterior MI, is scheduled for emergent surgery for ventricular septal defect repair. What will the nurse most likely hear on auscultation of this patient's chest? a. Diastolic murmur at the apex of the heart b. Systolic murmur at the left sternal border c. Diastolic murmur at the base of the heart d. Systolic murmur at the apex of the heart - SOLUTION b. Systolic murmur at the left sternal border The patient is status post insertion of a DDD permanent pacemaker. Which of the following indicates normal functioning of the pacemaker? a. A pacer spike after the P-wave, a spike after each QRS, a constant heart rate b. A pacer spike before the P-wave, a spike on the T-wave, an increase in heart rate with activity c. No P-wave, a pacer spike before each QRS, a constant heart rate d. A pacer spike before the P-wave, a spike before the QRS, an increase in heart rate with activity - SOLUTION d. A pacer spike before the P-wave, a spike before the QRS, an increase in heart rate with activity The DDD pacemaker is capable of pacing and sensing both the atria and the ventricles, and the response to sensing may be both inhibition of pacing in the presence of native beats or stimulation to increase the heart rate if there is a physiological need. Which of the following assessment findings would be expected for a patient with pericarditis? a. Pain with deep inspiration, ST elevation in V2-V b. Midsternal pain radiating to the back, T-wave inversion in V2-V c. Pain with deep inspiration, global ST elevation d. Pain with movement, ST elevation in II, III, and aVF - SOLUTION c. Pain with deep inspiration, global ST elevation Rewarming the post-op surgical heart patient may result in which hemodynamic change?
a. Administer morphine for the pain, ad increase the nitroglycerin (Tridil) drip b. Discontinue the nitroglycerin drip, and start a fluid bolus c. Begin a dopamine drip, and give the patient a chewable aspirin d. Decrease the nitroglycerin drip, and administer morphine - SOLUTION b. Discontinue the nitroglycerin drip, and start a fluid bolus The patient developed inferior wall STEMI with right ventricular (RV) infaract. Preload needs to be increased with fluids, and nitroglycerin, which decreases preload, should be discontinued. The patient presents with complaints of right leg and foot pain while at rest. The Ankle-Brachial index is 0.75. Which is an appropriate intervention for this patient? a. Apply warm compresses to the right lower leg and foot b. Elevate the right leg c. Place the bed in the reverse Trendelenburg position d. Give the patient morphine for the pain - SOLUTION c. Place the bed in the reverse Trendelenburg position The patient has acute peripheral arterial disease, and lowering the right leg will improve perfusion to the lower extremities The patient't temporary pacemaker is not functioning normally. The nurse repositioned the patient, and the pacemaker problem was correct. Whcih pacemaker malfunction most likely occured? a. Battery failure b. Failure to sense c. Failure to pace d. Failure to capture - SOLUTION d. Failure to capture By repositioning the patient, the pacemaker lead most likely made re- contact with the right ventricular wall and corrected the failure to capture The patient complains of midsternal chest pain, and the ECG reveals ST depression in leads I and aVL. The vital signs are stable, and the patient has no allergies. What is the preferred agent for the treatment of this patient's pain?
a. Morphine b. Oxygen c. Nitroglycerin d. Anticoagulant - SOLUTION c. Nitroglycerin The nitro (NTG) will immediately produce vasodilation, reduce preload, and decrease the oxygen demands of the heart. Morphine may relieve pain, but it does not provide postive hemodynamic benefits of NTG. The monitor alarm sounds and reveals a heart rate of 38/min, and the patient is hypotensive. The PR intervals are variable, the R-R intervals are regular, and the QRS complexes are wide. What is the cardiac rhythm and the appropriate intervention? a. third degree heart block; begin transcutaneous pacing b. type II second degree heart block; begin transcutaneous pacing c. type I second degree heart block; give atropine d. sinus bradycardia; give atropine - SOLUTION a. third degree heart block; begin transcutaneous pacing The patient, whose cardiac rhythm had been sinus rhythm in the 90s, is now receiving mechanical ventilation for respiratory failure. The sinus rhythm changes to a narrow, complex, regulator tachycardia of 170/min with BP 78/40. After administering 2 doses of adenosine, the sinus rhythm and BP remain unchanged. The nurse anticipates which of the following interventions? a. fluid boluses b. vasopressor c. cardioversion d. repeat adenosine - SOLUTION c. cardioversion The patient is unstable d/t the tachyarrhythmia. Therefore, immediate restoration to sinus rhythm with cardioversion is indicated. What is the primary effect of alpha adrenergic drugs? a. myocardial contractility b. arterial constriction
The patient has signs of dilated cardiomyopathy, which results in systolic dysfunction and a problem with ejection, not filling. Which intravenous agent is he preferred treatment for a patient with hypertensive crisis and a history of coronary artery disease? a. nitroglycerin (Tridil) b. enalaprilat (Vasotec) c. nitroprusside (Nipride) d. labetalol (Trandate) - SOLUTION d. labetalol (Trandate) Labetolol is a beta blocker that lowers BP by blocking the effects of the adrenergic system on the heart. It also offers protection to the heart in the presence of coronary artery disease. The patient is admitted with acute shortness of breath, chest pain, ST elevation on the ECG, and a loud systolic murmur at the apex of the heart. Which of the following has most likely occured? a. inferior MI with acute mitral valve insufficiency b. anterior MI with acute mitral valve stenosis c. inferior MI with acute ventricular septal defect d. anterior MI with acute aortic valve insufficiency - SOLUTION a. inferior MI with acute mitral valve insufficiency The patient suddenly develops chest pain, dyspnea, hypotension, and sinus bradycardia. An examination reveals jugular venous distention (JVD), lungs clear, S4, and no murmurs. The ECG reveals ST elevation in II, III, and aVF. In addition to preparing for PCI, which interventions should the nurse anticipate? a. nitroglycerin drip, aspirin b. furosemide (Lasix), atropine c. aggressive fluid administration, right-sided ECG d. transcutaneous pacing, morphine - SOLUTION c. aggressive fluid administration, right-sided ECG The patient admitted with acute MI received reperfusion therapy (PCI). What are signs of successful reperfusion?
a. ST depression, chest pain relief, drop in troponin b. sinus rhythm, reduction of chest pain, elevated troponin c. troponin returns to baseline, short runs of accelerated idioventricular rhythm (AIVR), chest pain relief d. chest pain relief, ST returns to baseline, short runs of VT - SOLUTION d. chest pain relief, ST returns to baseline, short runs of VT Chest pain relief and the resolution of ST segment deviation are evidence of the return of blood flow. Marked elevation of troponin results from reperfusion stunning of myocardial tissue. Reperfusion arrhythmias (VT, VF, AIVR) are also signs of successful reperfusion. What are signs of development of a ventricular septal defect? a. systolic murmur, loudest at the apex of the heart b. diastolic murmur, seen with a lateral MI c. systolic murmur, loudest at the left sternal border d. diastolic murmur, loudest at the base of the heart - SOLUTION c. systolic murmur, loudest at the left sternal border A cardiologist tells an RN that a patient has a history of a diastolic murmur and atrial fibrillation, What is associated with these signs? a. mitral stenosis b. aortic stenosis c. mitral insufficiency d. ventricular septal defect (VSD) - SOLUTION a. mitral stenosis Diastolic murmurs occur during filling, which would include mitral stenosis, tricuspid stenosis, or aortic or pulmonic insufficiency The patient is status post-PCI for acute high lateral wall MI. Which leads will the nurse continually monitor for ST changes following the procedure? a. II, III, and aVF b. Vi-V c. V5 and V d. I and aVL - SOLUTION d. I and aVL
The patient presented with chest pressure, a BP of 218/130, and an ECG with 2mm ST depression in V5 and V6. What will the patient require? a. morphine, emergent PCI b. nitroprusside (Nipride) IV, admission to the telemetry unit c. enalapril (Vasotec), morphine d. labetalol (Normadyne, Trandate) IV, admission to the critical care unit - SOLUTION d. labetalol (Normadyne, Trandate) IV, admission to the critical care unit What is an appropriate intervention for a patient with acute right leg thrombosis? a. administer a vasoconstrictor agent b. place the bed in the reverse Trendelenburg position c. elevate the right leg d. raise the head of the bed to 15 degrees - SOLUTION b. place the bed in the reverse Trendelenburg position A nurse notices that a patient's QT interval has increased to 0.50 seconds. The nurse notifies the physician, knowing that the patient may be at risk for which of the following? a. complete heart block b. hyperkalemia c. hypotension d. torsades de pointes - SOLUTION d. torsades de pointes QT prolongation increases the chance of torsades de pointes and may be caused by hyperkalemia, hypomagnesemia, procainamide (Pronestyl), amiodarone (Cordarone), and/or haloperidol (Haldol). A nurse notes that the cardiac monitor of a patient with a VVI pacemaker is intermittently showing spikes note followed by a QRS. The patient has wich of the following? a. failure to pace b. failure to sense c. failure to capture d. a normal functioning pacemaker - SOLUTION c. failure to capture
Clinical signs for SYSTOLIC heart failure: - SOLUTION Dilated left ventricle Problem emptying Clinical signs for DIASTOLIC heart failure - SOLUTION Normal ejection fraction (EF) Left ventricular hypertrophy pattern on the ECG Thickened LV walls or septum Clinical sign(s) of BOTH systolic and diastolic heart failure: - SOLUTION Pulmonary edema The patient complains of a right-sided headache on the day of discharge status post right carotid endarterectomy. The nurse will do which of the following? a. administer an analgesic, and reassess within one hour b. contact the physician; the patient has signs of carotid artery restenosis c. assess the operative site, and provider non-pharmacological intervention d. contact the physician; the patient is at risk for seizure activity - SOLUTION d. contact the physician; the patient is at risk for seizure activity. The patient may be experiencing a complication - hyperperfusion syndrome. This increases the risk of seizure activity and an ICH. The BP and the HR should be assessed prior to notifying the physician. Treatments for SYSTOLIC heart failure: - SOLUTION Positive inotrope Diuretic ACE inhibitor Avoid negative inotrope during acute phase Treatments for DIASTOLIC heart failure: - SOLUTION Diuretic ACE inhibitor Calcium-channel blocker Treatments for BOTH systolic and diastolic heart failure: - SOLUTION Diuretic ACE inhibitor
