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CCRN EXAM 2024 with correct answers.
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CCRN EXAM 2024 with correct answers.
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CCRN EXAM 2024 with correct answersA 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T wave
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inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy was started in ED.
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Indications of successful reperfusion would include all of the following except:
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(A) pain cessation
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(B) decrease in CK or troponin
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(C) reversal of ST segment elevation with return to baseline
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(D) short runs of ventricular tachycardia - ANSWER: ➡ (B)Coronary artery reperfusion due to
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PCI or fibrinolysis results in an ELEVATION of creatinine kinase (CK) or troponin, not decrease.
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The theory is that the return of blood flow distal to the occlusion can result in 'reperfusion
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injury' of the muscle, elevating cardiac biomarkers.
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The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment
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elevation with return to baseline, short runs of ventricular tachycardia.
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Which of the following medication orders should the nurse question for the patient in question
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1-reperfusion question-patient having an MI?
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(A) metoprolol (Lopressor)
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(B) aspirin
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(C) propranolol (Inderal)
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(D) heparin - ANSWER: ➡ (C) The patient in the scenario is having an acute anterior wall MI. A
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beta blocker is beneficial for an acute MI as these agents decrease the work of the heart and
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increase the threshold for ventricular fibrillation. Propranolol, although a beta-andrenergic
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blocker like metoprolol, is NOT a cardioselective beta blocker. It affects beta receptors in heart
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muscle AND lung tissue. Therefore, it is more likely to cause bronchoconstriction than a
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cardioselective beta blocker.
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The other 3- cardioselective beta blocker, antiplatelet, and anticoagulation-are indicated in an
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acute MI.
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If heart block develops while caring for the patient in question 1 (pt with an MI who went
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through reperfusion from PCI or fibrinolytic therapy), which of the following would it most
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likely be?
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, (A) sinoatrial blockt t
(B) second degree, Type I
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(C) second degree, Type II
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(D) third degree, complete - ANSWER: ➡ (C) The patient is having an acute anterior MI, which is
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generally due to LAD occlusion. The LAD supplies the HIS bundle, which could result in a
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second-degree, type II heart block. The other 3 types are due to SA node or AV node ischemia,
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which generally occur with an RCA occlusion — interior wall MI.
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Appropriate drug therapy for dilated cardiomyopathy is aimed toward: t t t t t t t t
(A) decreasing contractility and decreasing preload and afterload
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(B) decreasing contractility and increasing preload and afterload
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(C) increasing contractility and increasing both preload and afterload
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(D) increasing contractility and decreasing both preload and afterload - ANSWER: ➡ (D)
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Dilated cardiomyopathy is likely to result in systolic dysfunction, which decreases contractility,
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causes compensatory arterial constriction , and results in a higher left ventricular preload. To
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treat this, therapy is aimed at increasing contractility, decreasing afterload (arterial
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constriction), and decreasing preload that is too high.
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An 18 year old is admitted with a history of syncopal episode at the mall and has a history of an
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eating disorder. The nurse notes a prolonged QT on the 12-lead EKG and anticipates a reduction
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in an electrolyte to be the cause. Which of the following is LEAST likely to cause this patient's
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problems?
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(A) sodium t t
(B) magnesium t t
(C) potassium t t
(D) calcium - ANSWER: ➡ (A) Abnormal sodium does NOT cause QT prolongation. In contrast,
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a low magnesium, potassium, or calcium, may cause QT prolongation and may result in
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TORSADES DE POINTES ventricular tachycardia and, if self-limiting, transient syncopal
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episodes.
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On the third day after admission for acute MI, a 67 year old male complains of chest pain and
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develops a fever. The pain is worse with deep inspiration and is relieved when he leans forward.
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