Fish

CCRN Study Questions

1.  You have a patient in the ICU with a pulmonary artery catheter. Upon assessment you note the following reading: Right atrial pressure 6 mmHg, wedge pressure of 11 mmHg, cardiac output of 7L/min, and systemic vascular resistance (SVR) of 1800 dynes/sec/cm5. What IV infusion is appropriate to bring your abnormal values within normal limits?


a. Nipride
b. Dobutamine
c. Inocor
d. Lidocaine


2. A rapid response was called and you received Mrs. Jones from the telemetry floor in septic shock. A pulmonary artery catheter was inserted. The best way to determine the patients right sided afterload is by measuring: 


a. Pulmonary vascular resistance (PVR)
b. Systemic vascular resistance (SVR)
c. Left ventricular stroke index
d. Right ventricular stroke index


3. C. Smith had a CABG less than 24-hours ago and you are now caring for the patient. Upon assessment you  note increased agitation and confusion. Heart rate is 140 BPM, the blood pressure is difficult to palpable, and RR is 30 breaths minute. Auscultation of lung sounds reveals new crackles in the upper lung fields. The wedge pressure is reading 22. Based on the given information, you suspect:


a. Pulmonary edema
b. Hypovolemia
c. Cardiac tamponade
d. Myocardial infarction


4. M. Mouse is a patient who is admitted to the CCU with a diagnosis of cardiogenic shock.  Which of the following hemodynamic parameters are aligned with the diagnosis?


a. Right atrial pressure 2 mmHg 
b. Pulmonary artery wedge pressure 5 mmHg
c. Cardiac index 1.7 L/min/m2
d. Cardiac output 8.9 L/min


5. D. Donald is a 68 year old female patient admitted with a hip fracture. Her surgery was 2 weeks ago. Earlier in the day she c/o chest pain, SOB and a feeling of doom. Respiratory alkalosis and hypoxemia was revealed from Abg results. After arrival into ICU, the intensivist inserted a PA catheter with the following readings: 


Right atrial pressure 18 mmHg                             SVR 1370 dynes/sec/cm5
PA pressure 56/32                                                  PVR 625 dynes/sec/cm5
Wedge 6 mmHg                                                        BP 110/82
CO 4.5 L/min                                                            HR 110 BPM
CI 2.8 L/min/m2                                                      


What is the most likely diagnosis?
a.  Myocardial infarction
b. Septic shock
c. Pulmonary hypertension
d. Pulmonary hemorrhage


Questions #6-9 are matching. Match the receptor of the sympathetic nervous system with its physiologic effect.




6. Alpha  ______                                                        a. Increase HR, contractility, conductivity
7.  Beta-1______                                                        b. Dilation of renal & mesenteric arteries
8. Beta-2______                                                        c. Vasoconstricition
9. Dopaminergic____                                                 d. Vasodilation, bronchodilation


Questions #10-13 are matching. Match the adrenergic drugs cause the most powerful stimulation of each of these receptors.


10. Alpha ___                                                              a. Isoproterenol              
11. Beta-1___                                                              b. Dopamine 2 mcg/kg/min
12. Beta-2___                                                              c. Dobutamine
13. Dopaminergic___                                                 d. Phenylephrine



14.  You just received a patient from ER with a diagnosis of acute coronary syndrome. Which lead is recommended for ST-segments monitoring?


a. V6
b. V3
c. II
d. I


15. An ICU patient is experiencing low cardiac output syndrome.  Which of the following vasopressors is indicated when the desired effect is vasoconstriction without tachycardia?


a.  Dopamine
b.  Levophed (norepinephrine)
c.  Epinephrine
d.  Neosynephrine (phenylephrine)


16. Your critical care patient just had a trans-esophageal echo.  The findings showed a dissecting aortic aneurysm with a pericardial effusion.  The patients blood pressure is currently 80/50 mm Hg. Prior to the patient going to the operating room, what should the nurse prepare for?


a. Start levophed at 5 mcg/min to elevate blood pressure
b. Pericardiocentesis immediately to relive tamponade
c. Start large gauge IV's, get lab samples and bolus fluids
d. Give labetolol to decrease contractility and afterload


17. Patient Mr. Night just had a cardiac cath with balloon angioplasty. He suddenly developed a paradoxical pulse. What is the most likely reason for this findings?


a. Dysrhythmia
b. Vasovagal response
c. Pericardial tamponade
d. Coronary artery spasm


18. You are covering for another nurse. Her patient calls you into his room and you note the following: active chest pain, hypotension, and elevated heart rate at 190 BPM. The nurse should immediately perform which intervention?


a.  Defibrillate
b.  Adenosine 6 mg rapid IVP
c.  Amiodarone 150 mg IVP over 10 minutes
d. Perform synchronized cardioversion


19. A. Hole has just arrived from OR after having a coronary artery bypass graft (CABG).  During the first 1-3 days post op the nurse know that the patient is at risk for which dysrhythemia?


a. Atrial Flutter
b. AV nodal re-entry tachycardia
c. Atrial Fibrillation
d. Supraventricular tachycardia


20. Nurse Jackie is caring for a patient with a diagnosis of unstable angina. The medications the patient is receiving include the following: captopril, aspirin, low molecular weight heparin, IV infusion of nitroglyceryin and integrilin. After a heart cath and PCTA, the patient is a risk for what?


a. Restenosis
b. Heparin-induced thrombocytopenia
c. Bleeding at groin access site
d. Coronary artery spasm



These questions are heavy on pathophysiology. In order to pass the CCRN, you must know patho. If you have any questions please email me.


21. Prothrombin is a ____ globulin and is produced by the _____.


A. Alpha, Kidney
B. Alpha, Liver
C. Beta, Kidney
D. Beta, Liver



22. The right coronary artery divides to form the posterior interventricular artery and the ___ artery.


A. Marginal
B. LVC
C. RVC
D. LAD



23. Blood flowing into the cardiac veins enters the _______ next.


A. Coronary Sinus
B. Left Ventricle
C. Right Ventricle
D. Left Atrium



24. If you are using a stethoscope and trying to detect the tricuspid valve which of the following would be the best location?


A. Within 2 inches of the xyphoid process
B. On the right side of the sternum
C. On the left side of the sternum near the midpoint
D. On the left side of the sternum near the midpoint of the sixth rib



25. Which of the following occurs during ventricular systole?


A. Increased aortic pressure
B. Increased ventricular volume
C. Dup heart sound
D. P wave



26. Which of the following occurs during ventricular diastole?


A. Increased aortic pressure
B. Increased ventricular volume
C. Lub heart sound
D. T wave



27. What is true about systolic murmurs?


A. They are located 2nd ICS at the left sternal border
B. They are located 2nd ICS at the right sternal border
C. Due to blood filling the atrium when the tricuspid valve is closed
D. Mitral & tricupsid insufficiency, pulmonic & aortic stenosis



28. Angiotension can directly cause the release of ____ from the adrenal cortex.


A. Renin
B. Aldosterone
C. Calcitonin
D. Thyroxine



29. Cardiac output is the product of ____ and ____.


A. HR and Diastolic pressure
B. HR and Stroke Volume
C. HR and EF
D. Diastolic and Systolic pressure



30. Pulmonary edema is most like associated with a failing _____ _____.


A. Right atrium
B. Left atrium
C. Right ventricle
D. Left ventricle



31. Which of the following is the first branch off the aortic arch?


A. Common carotid
B. Brachiocephalic
C. Right Subclavian
D. Thoracic



32. The brachiocephalic artery divides to form the right common carotid and the ____ ____ artery.


A. Left subclavian
B. Right subclavian
C. Left common carotid
D. Right thoracic artery



33. Which of the following arteries creates the left spenic, hepatic and gastric arteries?


A. Left sacral artery
B. Celiac artery
C. Suprarenal artery
D. Phrenic artery



34. Which of the following is not considered a major branch off of the descending thoracic aorta?


A. Mediastinal artery
B. Renal artery
C. Bronchial artery
D. Posterior intercostals artery



35. Which of the following is not considered a major branch off of the abdominal aorta?


A. Phrenic artery
B. Common iliac artery
C. Gonadal artery
D. Mediastinal artery



36. Which of the following is not considered a major branch off of the femoral artery?


A. Superficial pudendal arteries
B. Deep external pudendal arteries
C. Superficial circumflex iliac artery
D. Deep circumflex iliac artery



37. Which of the following is not considered a tributary of the portal vein?


A. Inferior mesenteric vein
B. Splenic vein
C. Left gastric vein
D. Subclavian vein



38. Inside the cranial cavity the vertebral arteries form the ____ artery.


A. Basilar
B. Common Carotid
C. MCA
D. PCA



39. Pulse pressure (pp) is considered the _____.


A. Difference between the systolic and diastolic pressure 
B. The sum of the systolic and diastolic pressure
C. The inverse of the blood pressure
D. Half of the systolic pressure



40. _____ nerves can be found joining the SA and AV nodes in the heart.


A. Accelerator
B. Phrenic
C. Thoracic
D. Gastric