CCRN EXAM Questions And Answers
(2022/2023) LATEST SOLUTIONS
A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T wave
inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy was started in ED.
Indications of successful reperfusion would include all of the following except:
(A) pain cessation
(B) decrease in CK or troponin
(C) reversal of ST segment elevation with return to baseline
(D) short runs of ventricular tachycardia – (B)Coronary artery reperfusion due to PCI or fibrinolysis
results in an ELEVATION of creatinine kinase (CK) or troponin, not decrease. The theory is that the
return of blood flow distal to the occlusion can result in ‘reperfusion injury’ of the muscle, elevating
cardiac biomarkers.
The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment elevation
with return to baseline, short runs of ventricular tachycardia.
Which of the following medication orders should the nurse question for the patient in question 1-
reperfusion question-patient having an MI?
(A) metoprolol (Lopressor)
(B) aspirin
(C) propranolol (Inderal)
(D) heparin – (C) The patient in the scenario is having an acute anterior wall MI. A beta blocker is
beneficial for an acute MI as these agents decrease the work of the heart and increase the threshold
for ventricular fibrillation. Propranolol, although a beta-andrenergic blocker like metoprolol, is NOT
a cardioselective beta blocker. It affects beta receptors in heart muscle AND lung tissue. Therefore,
it is more likely to cause bronchoconstriction than a cardioselective beta blocker.
The other 3- cardioselective beta blocker, antiplatelet, and anticoagulation-are indicated in an acute
MI.
If heart block develops while caring for the patient in question 1 (pt with an MI who went through
reperfusion from PCI or fibrinolytic therapy), which of the following would it most likely be?
(A) sinoatrial block
(B) second degree, Type I
(C) second degree, Type II
(D) third degree, complete – (C) The patient is having an acute anterior MI, which is generally due to
LAD occlusion. The LAD supplies the HIS bundle, which could result in a second-degree, type II
heart block. The other 3 types are due to SA node or AV node ischemia, which generally occur with
an RCA occlusion — interior wall MI.
Appropriate drug therapy for dilated cardiomyopathy is aimed toward:
(A) decreasing contractility and decreasing preload and afterload
(B) decreasing contractility and increasing preload and afterload
(C) increasing contractility and increasing both preload and afterload
(D) increasing contractility and decreasing both preload and afterload – (D) Dilated cardiomyopathy
is likely to result in systolic dysfunction, which decreases contractility, causes compensatory
arterial constriction , and results in a higher left ventricular preload. To treat this, therapy is aimed
at increasing contractility, decreasing afterload (arterial constriction), and decreasing preload that
is too high.????
An 18 year old is admitted with a history of syncopal episode at the mall and has a history of an
eating disorder. The nurse notes a prolonged QT on the 12-lead EKG and anticipates a reduction in
an electrolyte to be the cause. Which of the following is LEAST likely to cause this patient’s
problems?
(A) sodium
(B) magnesium
(C) potassium
(D) calcium – (A) Abnormal sodium does NOT cause QT prolongation. In contrast, a low magnesium,
potassium, or calcium, may cause QT prolongation and may result in TORSADES DE POINTES
ventricular tachycardia and, if self-limiting, transient syncopal episodes.
On the third day after admission for acute MI, a 67 year old male complains of chest pain and
develops a fever. The pain is worse with deep inspiration and is relieved when he leans forward.
There are nonspecific ST changes in the precordial leads of the EKG. The nurse anticipates that the
patient will most likely need treatment for: