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CCRN PRACTICE QUESTIONS AND CORRECT ANSWERS
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CCRN PRACTICE QUESTIONS AND CORRECT ANSWERSThe following is a case of a patient who presents to the ED with complaints of chest
pain. In this case, the 12-lead EKG will show ST elevation in leads V3 and V4. If the
occlusion of the affected coronary artery occurs, perfusion to what portion of the
conduction system would be most likely affected?
A. Sinoatrial (SA) node
B. Bachmann's bundle
C. Atrioventricular (AV) node
D. Bundle of His - Answer LAD so D. bundle of his
Which lead is preferred for ST segment monitoring of a patient with a suspected
occlusion of the RCA?
A.I
B. aVR
C. III
D. V1 -c. III
Which of the following does not describe a manifestation of hypertrophic
cardiomyopathy?
A. Syncope
B. Murmur that increases with squatting
C. Chest pain
D. Sudden cardiac death* B
The classic manifestations of hypertrophic cardiomyopathy include chest pain,
syncope, and an aortic stenosis type of murmur that decreases when the patient
assumes a squatting position. Sudden cardiac death during exercise is an occasional
initial manifestation.
,Which of the following is the quadrant in which the mean QRS complex axis resides, if it
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 - Answer *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 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.
The patient becomes apneic and pulseless. CPR has been initiated 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) - Answer C
After CPR is begun and an intravenous access is established, epinephrine is
administered. Calcium was used in the past in asystole but today is used only for
hypocalcemia, calcium channel blocker toxicity, hyperkalemia, and hypermagnesemia.
Atropine is no longer indicated in asystole. Amiodarone is not used in asystole because
asystole represents the absolute absence of irritability.
What is associated w/ Mitral Stenosis
A. Pinkish discoloration of the cheeks
B. Systolic murmur
C. Widened pulse pressure
D. Narrow pulse pressure - Answer A
Patients with mitral stenosis may have a pinkish discoloration of the cheeks (i.e., malar
, blush). Mitral stenosis results in a diastolic murmur. Widened pulse pressure is related
to aortic regurgitation. Narrowed pulse pressure is related to mitral regurgitation.
On the fourth day post-operatively after a mitral valve replacement, the client develops
atrial fibrillation. Initially, the nurse would:
A. order a 12-lead EKG.
B. examine the patient for clinical manifestations of hypoperfusion.
C. notify the physician
D. ask the patient to strain as if having a bowel movement. -Answer B
The onset of atrial fibrillation results in loss of atrial kick. Loss of atrial kick can reduce
the cardiac output by up to 20-30%. This especially holds true for patients whose
cardiac output may be affected by chronic cardiac illness, such as mitral valve disease.
Monitor the patient for signs of hypoperfusion, including cool skin, oliguria, narrowed
pulse pressure, and hypotension.
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. About an hour after she
returns from the cath lab, the patient complains of chest pain, rating it 9/10. Which of the
following is indicated?
A. Administer morphine IV.
B. Administer nitroglycerin sublingual spray.
C. Stop the heparin.
D. Call the physician - Answer D
The onset of severe chest pain, which is new, following percutaneous coronary
intervention suggests acute closure of the dilated coronary artery. The patient must be
returned to the cardiac catheterization laboratory for repeat dilation and probable
insertion of stent.
A 35-year-old female underwent a mitral valve replacement. She has been draining
approximately 125 mL/hr for the last 3 hours and the drainage suddenly stops. 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?
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