CCRN Cardiovascular Practice Questions
Cardiovascular makes up 7 of every 50 questions on a Tigertest CCRN practice test. Here are 10 of the 28 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Based on the AACN Adult CCRN test plan. Original questions; 50 per test, weighted like the real exam. Not affiliated with AACN or AACN Certification Corporation.
1. A patient with an inferior STEMI has ST elevation in II, III and aVF, a BP of 84/50, clear lungs and distended neck veins. Which order should the nurse expect first?
- A.IV furosemide 40 mg
- B.IV normal saline bolus
- C.Sublingual nitroglycerin
- D.IV morphine for pain
Answer: B. Hypotension with clear lungs and jugular venous distension in an inferior MI points to right ventricular infarction, which depends on preload. Fluids support RV filling; nitrates, diuretics and morphine all lower preload and can deepen the hypotension.
2. Which ECG lead best confirms right ventricular involvement in an inferior MI?
- A.Posterior lead V8
- B.Leads I and aVL
- C.Lateral leads V5 and V6
- D.Right-sided lead V4R
Answer: D. ST elevation of 1 mm or more in V4R, recorded with the chest lead placed in the right fifth intercostal space at the midclavicular line, is the most useful sign of RV infarction. Posterior leads look for a posterior MI instead.
3. A patient has sudden tearing chest pain radiating to the back and a BP of 188/104. Aortic dissection is suspected. Which drug should the nurse expect to give first?
- A.IV beta blocker
- B.IV thrombolytic
- C.IV heparin infusion
- D.IV vasodilator alone
Answer: A. Heart rate and the force of ejection are lowered first with an IV beta blocker such as esmolol; a vasodilator given alone causes reflex tachycardia that raises shear on the tear. Anticoagulants and thrombolytics can be fatal in dissection.
4. After cardiac surgery a patient becomes hypotensive with distended neck veins. Which added finding most suggests cardiac tamponade?
- A.A widened pulse pressure
- B.A new S3 gallop
- C.Muffled heart sounds
- D.Bounding pulses
Answer: C. Hypotension, jugular venous distension and muffled heart sounds make up Beck's triad. Tamponade narrows the pulse pressure, and a new S3 points to ventricular failure rather than restricted filling.
5. Which finding defines pulsus paradoxus?
- A.Inspiratory SBP rise over 10 mm Hg
- B.Alternating strong and weak beats
- C.Inspiratory SBP fall over 10 mm Hg
- D.Expiratory DBP fall over 10 mm Hg
Answer: C. Pulsus paradoxus is an exaggerated fall in systolic pressure, more than 10 mm Hg, during inspiration; it is seen in tamponade, severe asthma and tension pneumothorax. Alternating strong and weak beats is pulsus alternans, a sign of LV failure.
6. Two hours after CABG, chest tube drainage that was 150 mL/h suddenly stops. BP falls and CVP rises. What is the most likely cause?
- A.Cardiac tamponade
- B.Hypovolemia
- C.Left ventricular failure
- D.Bleeding has stopped
Answer: A. A sudden stop in drainage with falling BP and rising filling pressures suggests clot in the tubes and blood collecting around the heart. Hypovolemia lowers CVP, and simply stopped bleeding would not drop the BP.
7. Which hemodynamic profile fits cardiogenic shock?
- A.Low PAOP, low CI, high SVR
- B.High PAOP, high CI, low SVR
- C.Low PAOP, high CI, low SVR
- D.High PAOP, low CI, high SVR
Answer: D. A failing pump backs up pressure into the lungs (high PAOP), lowers cardiac index and triggers vasoconstriction (high SVR). Low PAOP with high SVR is hypovolemic shock; high CI with low SVR is early septic shock.
8. On the arterial waveform, when should an intra-aortic balloon pump inflate?
- A.Just before the upstroke
- B.At the dicrotic notch
- C.At the systolic upstroke
- D.At peak systole
Answer: B. Inflation at the dicrotic notch, when the aortic valve closes, raises diastolic pressure and coronary perfusion. Deflation comes just before the next systolic upstroke to lower afterload; inflating during systole would block ejection.
9. Soon after an IABP is placed through the left femoral artery, the left radial pulse weakens. What should the nurse suspect?
- A.An expected counterpulsation effect
- B.The balloon has migrated up
- C.Femoral artery thrombosis
- D.The balloon has ruptured
Answer: B. The balloon tip should sit just below the left subclavian artery. Upward migration blocks that artery and weakens the left radial pulse; a migrated balloon can also block the renal arteries if it moves down, so urine output is watched too.
10. A patient with known Wolff-Parkinson-White syndrome develops atrial fibrillation with a wide, irregular QRS at 220/min and a stable BP. Which drug is appropriate?
- A.IV verapamil
- B.IV digoxin
- C.IV adenosine 6 mg
- D.IV procainamide
Answer: D. In pre-excited atrial fibrillation, drugs that block the AV node (adenosine, calcium channel blockers, digoxin, beta blockers) can speed conduction down the accessory pathway and trigger VF. Procainamide slows the pathway itself; unstable patients are cardioverted.
Practice all 28 cardiovascular questions, and the rest of the 200-question bank, in the free CCRN training sets. Questions you miss come back until you have mastered them.
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