2024-2025 CCRN Pharmacology Real Exam With Answers (72 Solved Questions)

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CCRN EXAM LATEST2024-2025 REAL EXAM350 WITH QUESTIONSAND ACCURATEDETAILEDANSWERSWITHRATIONALES|ALREADYGRADED AS BEST EXAMA+

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Which of the following medication orders shouldthe 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 scenario is having an acuteanterior wall MI. A beta blocker is beneficial for anacute MI as these agents decrease the work of theheart and increase the threshold for ventricularfibrillation. Propranolol, although a beta-andrenergic blocker like metoprolol, is NOT acardioselective beta blocker. It affects beta

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receptors in heart muscle AND lung tissue.Therefore, it is more likely to causebronchoconstriction than a cardioselective betablocker.The other 3-cardioselective beta blocker,antiplatelet, and anticoagulation-are indicated in anacute MI.If heart block develops while caring for the patientin question 1 (pt with an MI who went throughreperfusion from PCI or fibrinolytic therapy), whichof the following would it most likely be?(A) sinoatrial 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 isgenerally due to LAD occlusion. The LAD supplies

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the HIS bundle, which could result in a second-degree, type II heart block. The other 3 types aredue to SA node or AV node ischemia, whichgenerally occur with an RCA occlusion—interiorwall MI.Appropriate drug therapy for dilatedcardiomyopathy is aimed toward:(A) decreasing contractility and decreasing preloadand afterload(B) decreasing contractility and increasing preloadand afterload(C) increasing contractility and increasing bothpreload and afterloadD) increasing contractility and decreasing bothpreload and afterload-ANSWER-(D)Rationale.(Dilated cardiomyopathy is likely to result in systolicdysfunction, which decreases contractility, causescompensatory arterial constriction , and results in a

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higher left ventricular preload. To treat this, therapyis aimed at increasing contractility, decreasingafterload (arterial constriction), and decreasingpreload that is too high.An 18 year old is admitted with a history of syncopalepisode at the mall and has a history of an eatingdisorder. The nurse notes a prolonged QT on the12-lead EKG and anticipates a reduction in anelectrolyte to be the cause. Which of the followingis LEAST likely to cause this patient's problems?(A) sodium(B) magnesium(C) potassium(D) calcium-ANSWER-(A) Abnormal sodium doesNOT cause QT prolongation. In contrast, alowmagnesium, potassium, or calcium, may cause QTprolongation and may result in TORSADES DEPOINTES ventricular tachycardia and, if self-limiting,transient syncopal episodes.

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On the third day after admission for acute MI, a 67year old male complainsof chest pain and developsa fever. The pain is worse with deep inspiration andis relieved when he leans forward. There arenonspecific ST changes in the precordial leads of theEKG. The nurse anticipates that the patient willmost likely need treatment for:(A) thoracic aneurysm(B) Dressler's syndrome(C) reinfarction(D) pleuritis-ANSWER-(B) The pain described in thescenario is typical of the pain caused by pericarditis.Dressler's syndrome is the pericarditis that mayresult after an acute MI.A patient is admitted to the CCU after a PCI withstent. Femoral sheath is in place, site is dry with nohematoma. He suddenly complains of severe backpain. Neck veins are flat with head of bed 30

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degrees, heart sounds are normal. Vital signs are BP78/48, HR 124 and RR 26. What should the nursesuspect?(A) cardiac tamponade(B) retroperitoneal bleeding(C) coronary artery dissection(D) acute closure of the stented coronary artery-ANSWER-(B) Retroperitoneal bleeding may causesigns of hypovolemia andhypovolemic shock asdescribed in the scenario. It may be a complicationof a PCI if the femoral artery is the access siteduring the procedure. Only this problem results insevere back pain; none of the other 3 choicesresults in back painYour patient admitted with an NSTEMI developsacute 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 valveregurgitation(B) the patient has developed acute infarction(C) the patient has developed acute mitral wavestenosis(D) the patient has developed acute ventricularseptal defect-ANSWER-(A) The location of themurmur, at the apex of the heart (midclavicular, 5thICS), isone clue to this answer. In addition,regurgitation occurs when the valve should beclosed and the mitral valve should be closed duringsystole. Mitral stenosis, choice (C), occurs when themitral valve is open. Additionally, mitral stenosiscannot be acute, it develops gradually.A patient has just returned from the OR afterinsertion of a VVI pacemaker. In order to assessfunction of this pacemaker accurately, the nurseneeds to understand that:

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(A) both atrium and ventricle are paced and sensedand mayeither inhibit or pace in responseto sensing(B) the ventricle is paced, ventricular activity issensed and pacing is inhibited in response toventricular sensing.(C) both the atrium and ventricle are paced, butonly ventricular pacing can be inhibited by asensed intrinsic ventricular impulse.(D) the ventricle is paced in response to a sensedintrinsic atrial impulse or inhibited by a sensedintrinsic ventricular impulse.-ANSWER-(B) the firstletter indicates chamber paced (ventricle). Thesecond 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/Pacute MI (ST elevation in II, III, and aVF, with ST

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depression in I and aVL). The patient is anxious,diaphoretic, and hypotensive. Examination revealsthe development of a loud holosystolic murmur atthe apex. What is the most likely cause of thispatient's deterioration?(A) right ventricular failure related to rightventricular MI(B) ventricular septal defect(C) left ventricular failure due to extension of MI(D) acute mitral regurgitation due to papillarymuscle rupture or dysfunction-ANSWER-(D) Thescenario describes a patient having an acute inferiorwall MI, whichis generally due to occlusion of theRCA. The RCA occlusion may result in papillarymuscle dysfunction or rupture of the mitral valvebecause it supplies the area of the left ventriclewhere this valve is attached. Although RV infarctcould result with RCAocclusion, RV infarct does notresult in a systolic murmur at apex of the heart orlung crackles.

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A 59 year old male is admitted complaining of chestpain and dyspnea. ST elevation and T waveinversion were seen on the EKG in V2,V3 and V4. IVthrombolytic therapy was started in ED. Indicationsof successful reperfusion would include all of thefollowing except:(A) pain cessation(B) decrease in CK or troponin(C) reversal of ST segment elevation with return tobaseline(D) short runs of ventricular tachycardia-ANSWER-(B)Coronary artery reperfusion due to PCI orfibrinolysis results in an ELEVATIONof creatininekinase (CK) or troponin, not decrease. The theory isthat the return of blood flow distal to the occlusioncan result in 'reperfusion injury' of the muscle,elevating cardiac biomarkers.The other 3 choices are indicators of reperfusion:Pain cessation, reversal of ST segment elevationwith return to baseline, short runs of ventriculartachycardia.

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The patient with diagnosis of cardiogenic shock nowrequires high dose dopamine (greater than 10mcg/kg/min) to maintain blood pressure, and thecardiologist is planning to start IABP therapy. Thistherapy will benefit the patient because it will:(A) increase afterload with balloon inflation anddecrease diastolic augmentation with balloondeflation.(B) decrease afterload with balloon deflation andincrease diastolic augmentation with ballooninflation.(C) decrease afterload with balloon inflation anddecrease diastolic augmentation with balloondeflation(D) increase afterload with balloon deflation anddecrease diastolic augmentation with ballooninflation.-ANSWER-(B) Cardiogenic shock results ina decrease in cardiac output with a resultant drop incoronary artery perfusion and compensatoryvasoconstriction. The deflation of the balloon

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placed into the descending aorta is beneficial.Deflation decreases afterload and work of the leftventricle. Inflation of the balloon is beneficialbecause it "boluses" blood into the coronaryarteries, increasing perfusion.Four days after mitral valve replacement, thepatient goes into atrial fibrillationwith rapidventricular response. What should be the nurse'sinitial action?(A) order a 12 lead EKG(B) evaluate the patient for clinical signs ofhypoperfusion(C) notify the physician(D) ask the patient to bear down as if having abowel movement-ANSWER-(B) The patient'sresponse to the arrhythmia will determine whethertreatment needs to be emergent and what thetreatment will be. Vagal maneuvers e.g. bearing

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down, are not known to be effective for atrialfibrillation.A patient's 12 lead EKG shows sinus bradycardia at44 beats/min and ST segment elevation in leads II,III, and aVF. Which of the following treatments forbradycardia for this patient would best resolve theproblem?(A) temporary transvenous pacing(B) transcutaneous pacing(C) percutaneous coronary intervention(D) administration of atropine-ANSWER-(C) PCIwould address the cause of the problem, not onlytreat signs and symptoms. Selection of the other 3choices presumes the patient had serious signs andsymptoms. Do not read into the questions.Which drug would most likely be given to a patientwith hypertrophic cardiomyopathy?

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(A) metoprolol(B) digoxin(C) dopamine(D) dobutamine-ANSWER-(A) A decrease in heartrate, provided by a beta blocker such as metoprolol,would increase filling time. In hypertrophiccardiomyopathy, there is a problem with filling. Adecrease in heart rate would increase filling time.Diastolic dysfunction does NOT cause a problemwith ejection, and the EF is normal. The other 3choices may be indicated for systolic dysfunction.A patient is admitted with ST elevation in V2, V3,and V4. Four days after admission, the patientsuddenly developed a holosystolic murmur at thelower left sternal border, chest pain, andhypotension. What complication should the nurseexpect?(A) papillary muscle rupture(B) ventricular septal defect

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