CCRN EXAM ACTUAL EXAM 2024-2025
WITH QUESTIONS AND VERIFIED
SOLUTIONS WITH DETAILED RATIONALES
ALREADY GRADED A+
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 Correct 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 Correct 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
Correct 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 Correct 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 Correct 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 Correct 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. Correct
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?
(A) maintaining oxygenation and normal PaCO2
(B) feeding the patient via an NGT
(C) administering 5% dextrose in water (D5W) at 75 ml/hour
(D) log roll when turning the patient Correct Answer (C) 5%
dextrose in water is a hypotonic solution. When administered, it
will cause movement of the D5W into the brain cells, causing
swelling and increased intracranial pressure. The other 3 choices
are acceptable interventions for the patient with increased ICP.
You know that research supports unrestricted access of a
designated support person to the patient, but your unit restricts all
patient visitors to set times. Your best response would be to:
(A) gather the facts and propose a policy change to your manager
for the unit
, (B) tell patients/visitors that the unit's policy is outdated but there
is nothing you can do about it
(C) continue to follow the unit policy
(D) complain to colleagues about the unit's outdated policy.
Correct Answer (A) The AACN Synergy Model supports patient
advocacy. Unrestricted access of a designated support person is
evidence-based practice included in the Patient Visitation AACN
Practice Alert. Choice (A) is an effective strategy for change.
Your patient has just consented to a bedside chest tube insertion
and requests that his wife be allowed to be present during the
procedure. You should:
(A) explain to the patient that this is against infection control
practice
(B) tell the patient he will be able to see his wife as soon as the
procedure is completed
(C) tell the patient it would be too much for his wife to handle
(D) prepare the wife for what to expect and allow her to be
present Correct Answer (D) The AACN Synergy Model supports
caring practice and family presence. An AACN practice alert
indicates family presence may improve patient outcome.
Which of the following laboratory findings are most specifically
indicative of disseminated intravascular coagulation (DIC) as the
cause of bleeding?
(A) elevated fibrin split products and d-dimer
(B) prolonged PT, PTT, and bleeding time
(C) decreased platelet count
(D) decreased hemoglobin and hematocrit Correct Answer (A)
DIC is a clotting problem, with massive coagulation. As clots
break down, fibrin split products are produced. Therefore with
DIC, FSPs will be high. In fact, this is the most specific test result
for DIC. D-dimer is present due to the presence of clots. While not
specific for DIC, it is a good rule-out test.
