2024-2025 CCRN Pharmacology Real Exam With Answers (72 Solved Questions)
- Critical Care Registered Nurse
- 53 pages
- Shared May 2025
2024-2025 CCRN Pharmacology Real Exam With Answers provides a hands-on approach to exam preparation with real questions and expert solutions.
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CCRN EXAM LATEST 2024 - 2025 REAL EXAM 350 WITH QUESTIONS AND ACCURATE DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED AS BEST EXAM A+
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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 - ANSWER - (C) Rationale. The patient in the s cenario 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 metoprol ol, is NOT a cardioselective beta blocker. It affects beta
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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, a nd 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) sinoatri al block (B) second degree, Type I (C) second degree, Type II (D) third degree, complete - ANSWER - (C) Rationale. The patient is having an acute anterior MI, which is generally due to LAD occlusion. The LAD supplies
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the HIS bundle, which could result in a second - degre e, 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 decreas ing 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 - ANSWER - (D) Rationale. ( Dilate d cardiomyopathy is likely to result in systolic dysfunction, which decreases contractility, causes compensatory arterial constriction , and results in a
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higher left ventricular preload. To treat this, therapy is aimed at increasing contractility, decreasi ng 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 antic ipates 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 - ANSWER - (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.
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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 f or: (A) thoracic aneurysm (B) Dressler's syndrome (C) reinfarction (D) pleuritis - ANSWER - (B) The pain described in the scenario is typical of the pain caused by pericarditis. Dressler's syndrome is the pericarditis that may result after an acute MI. A patient is admitted to the CCU after a PCI with stent. Femoral sheath is in place, site is dry with no hematoma. He suddenly complains of severe back pain. Neck veins are flat with head of bed 30
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degrees, heart sounds are normal. Vital signs are BP 78/48 , HR 124 and RR 26. What should the nurse suspect? (A) cardiac tamponade (B) retroperitoneal bleeding (C) coronary artery dissection (D) acute closure of the stented coronary artery - ANSWER - (B) Retroperitoneal bleeding may cause signs of hypovolemia and hypovolemic shock as described in the scenario. It may be a complication of a PCI if the femoral artery is the access site during the procedure. Only this problem results in severe back pain; none of the other 3 choices results in back pain Your patient a dmitted with an NSTEMI develops acute shortness of breath, recurrence of chest pain, and a loud systolic murmur at the apex of the heart. Which of the following has most likely occurred?
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(A) the patient has developed acute mitral valve regurgitation (B) th e patient has developed acute infarction (C) the patient has developed acute mitral wave stenosis (D) the patient has developed acute ventricular septal defect - ANSWER - (A) The location of the murmur, at the apex of the heart (midclavicular, 5th ICS), is one clue to this answer. In addition, regurgitation occurs when the valve should be closed and the mitral valve should be closed during systole. Mitral stenosis, choice (C), occurs when the mitral valve is open. Additionally, mitral stenosis cannot be acu te, it develops gradually. A patient has just returned from the OR after insertion of a VVI pacemaker. In order to assess function of this pacemaker accurately, the nurse needs to understand that:
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(A) both atrium and ventricle are paced and sensed and may either inhibit or pace in response to sensing (B) the ventricle is paced, ventricular activity is sensed and pacing is inhibited in response to ventricular sensing. (C) both the atrium and ventricle are paced, but only ventricular pacing can be inhibi ted by a sensed intrinsic ventricular impulse. (D) the ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by a sensed intrinsic ventricular impulse. - ANSWER - (B) the first letter indicates chamber paced (ventricle). The sec ond letter indicates chamber sensed (ventricle). The third letter indicates the response to sensing (inhibited in response to sensing). A patient complains of sudden dyspnea 5 days S/P acute MI (ST elevation in II, III, and aVF, with ST
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depression in I an d aVL). The patient is anxious, diaphoretic, and hypotensive. Examination reveals the development of a loud holosystolic murmur at the apex. What is the most likely cause of this patient's deterioration? (A) right ventricular failure related to right ventr icular MI (B) ventricular septal defect (C) left ventricular failure due to extension of MI (D) acute mitral regurgitation due to papillary muscle rupture or dysfunction - ANSWER - (D) The scenario describes a patient having an acute inferior wall MI, which is generally due to occlusion of the RCA. The RCA occlusion may result in papillary muscle dysfunction or rupture of the mitral valve because it supplies the area of the left ventricle where this valve is attached. Although RV infarct could result with RCA occlusion, RV infarct does not result in a systolic murmur at apex of the heart or lung crackles.
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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 followin g 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 - ANSWER - (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: Pai n cessation, reversal of ST segment elevation with return to baseline, short runs of ventricular tachycardia.
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The patient with diagnosis of cardiogenic shock now requires high dose dopamine (greater than 10 mcg/kg/min) to maintain blood pressure, and the cardiologist is planning to start IABP therapy. This therapy will benefit the patient because it will: (A) increase afterload with balloon inflation and decrease diastolic augmentation with balloon deflation. (B) decrease afterload with balloon deflation a nd increase diastolic augmentation with balloon inflation. (C) decrease afterload with balloon inflation and decrease diastolic augmentation with balloon deflation (D) increase afterload with balloon deflation and decrease diastolic augmentation with ball oon inflation. - ANSWER - (B) Cardiogenic shock results in a decrease in cardiac output with a resultant drop in coronary artery perfusion and compensatory vasoconstriction. The deflation of the balloon
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placed into the descending aorta is beneficial. Deflati on decreases afterload and work of the left ventricle. Inflation of the balloon is beneficial because it "boluses" blood into the coronary arteries, increasing perfusion. Four days after mitral valve replacement, the patient goes into atrial fibrillation with rapid ventricular response. What should be the nurse's initial action? (A) order a 12 lead EKG (B) evaluate the patient for clinical signs of hypoperfusion (C) notify the physician (D) ask the patient to bear down as if having a bowel movement - ANSW ER - (B) The patient's response to the arrhythmia will determine whether treatment needs to be emergent and what the treatment will be. Vagal maneuvers e.g. bearing
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down, are not known to be effective for atrial fibrillation. A patient's 12 lead EKG shows s inus bradycardia at 44 beats/min and ST segment elevation in leads II, III, and aVF. Which of the following treatments for bradycardia for this patient would best resolve the problem? (A) temporary transvenous pacing (B) transcutaneous pacing (C) percutan eous coronary intervention (D) administration of atropine - ANSWER - (C) PCI would address the cause of the problem, not only treat signs and symptoms. Selection of the other 3 choices presumes the patient had serious signs and symptoms. Do not read into th e questions. Which drug would most likely be given to a patient with hypertrophic cardiomyopathy?
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(A) metoprolol (B) digoxin (C) dopamine (D) dobutamine - ANSWER - (A) A decrease in heart rate, provided by a beta blocker such as metoprolol, would increase filling time. In hypertrophic cardiomyopathy, there is a problem with filling. A decrease in heart rate would increase filling time. Diastol ic dysfunction does NOT cause a problem with ejection, and the EF is normal. The other 3 choices may be indicated for systolic dysfunction. A patient is admitted with ST elevation in V2, V3, and V4. Four days after admission, the patient suddenly develope d a holosystolic murmur at the lower left sternal border, chest pain, and hypotension. What complication should the nurse expect? (A) papillary muscle rupture (B) ventricular septal defect
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