CCRN PCCN Review Course Pretest

Pamela D. Bartley, BSN, RN, CEN, TCRN, CCRN, CFRN, CTRN, CPEN
www.pdbnurseeducationllc.com

1. The closing of the atrioventricular valves (tricuspid and mitral) produces which heart sound? (Pg. 21)
a. S1
b. S2
c. S3
d. S4
2. The highest chance of auscultating a ventricular gallop (S3) is in patients with: (Barron’s pg. 22)
a. Pericarditis
b. Mitral regurgitation
c. Mitral stenosis
d. Congestive heart failure (CHF)
3. When the nurse auscultates a murmur heard loudest at the apex, it may be related to a: (Pg. 25)
a. Mitral valve regurgitation
b. Tricuspid valve defect
c. Stenotic aortic valve
d. Regurgitant pulmonic valve
4. During auscultation of the chest, which of the following heart murmurs would NOT occur during
systole? (Barron’s pg. 25)
a. Tricuspid insufficiency
b. Aortic stenosis
c. Mitral stenosis
d. Mitral insufficiency
5. The nurse expects a patient with Prinzmetal’s angina to experience: (Barron’s pg. 26)
a. No EKG changes with chest pain
b. ST segment depression with chest pain
c. Chest pain at rest
d. Chest pain relieved by nitrates
6. Your patient exhibits ST segment elevation in EKG leads II, III, and aVF with reciprocal changes in
leads I and aVL. These findings indicate which type MI? (Barron’s pg. 27)
a. Anterior
b. Inferior
c. Lateral
d. Posterior
7. Administration of nitrates in right ventricular MI (RVMI) may lead to: (Barron’s pg. 29)
a. Severe hypotension
b. Relief of pain
c. Respiratory distress
d. Heart blocks
8. Common complications from an acute inferior MI include: (Barron’s pg. 29)
a. Sinus tachycardia and RBBB
b. Sinus bradycardia and 2nd degree type 1 AV block
c. Cardiogenic shock
d. CHF

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 9. The patient has ST segment elevation in V1, V2, and V3. Which of the following is the patient at highest
risk of developing? (Barron’s pg. 30)
a. Sinus arrest
b. 2nd degree heart block, type 1
c. 2nd degree heart block, type 2
d. 4th degree AV heart block
10. All the following findings would be of concern related to femoral sheath removal, EXCEPT: (Pg. 32)
a. HTN post removal
b. Uncontrolled bleeding and hematoma at the puncture site
c. Severe low back pain
d. Bradycardia and dizziness
11. Which of the following would the nurse anticipate with the initiation of a nitroprusside (Nipride) infusion?
(Barron’s pg. 33)
a. Decrease contractility
b. Increase pulmonary vascular resistance
c. Decrease afterload
d. Increase preload
12. Which of the following are symptoms of right ventricular heart failure? (Barron’s pg. 39)
a. Dyspnea on exertion (DOE) and diffuse wet crackles
b. Elevated PAOP and HTN
c. JVD and peripheral edema
d. Paroxysmal nocturnal dyspnea (PND) and an S3 gallop
13. When your patient’s ABG shows an elevated PaCO2, the oxyhemoglobin dissociation curve: (Pg. 67)
a. Shifts to the right
b. Shifts to the left
c. Elevates
d. Stays neutral
14. A non-smoking patient presents from a house fire with a carboxyhemoglobin level of 40%, and a pulse
oximetry reading of 99%. He is alert but confused; and c/o a headache. What is the priority treatment
for this patient? (Barron’s pg. 68)
a. Provide 100% O2 until carboxyhemoglobin < 10%
b. Intubate STAT
c. Apply a nasal cannula at 2 L/min and administer the cyanide kit
d. Administer acetylcysteine prior to hyperbarics (HBO)
15. ABG results are pH =7.31, pCO2=35, and HCO3=18. What is the correct interpretation of these
results? (Barron’s pg. 72)
a. Compensated respiratory acidosis
b. Uncompensated respiratory acidosis
c. Uncompensated metabolic acidosis
d. Uncompensated metabolic alkalosis
16. The nurse would anticipate that CPAP might decrease which vital sign? (Barron’s pg. 76)
a. Temperature
b. Heart rate
c. Respiratory rate
d. Blood pressure

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 17. The patient with status asthmaticus will most likely have which of the following? (Barron’s pg. 78)
a. Atrial fibrillation and expiratory wheezing
b. Silent chest and a diastolic murmur
c. Inspiratory wheezing and giant V-waves
d. Silent chest and pulsus paradoxus
18. The patient with status asthmaticus requires mechanical ventilation. Which of the following needs to be
utilized? (Barron’s pg. 78)
a. Increased inspiratory phase
b. Increased PEEP
c. Increased expiratory phase
d. Increased rate
19. Which of the following may be the RESULT of pulmonary hypertension? (Barron’s pg. 81)
a. Pulmonary stenosis
b. Left ventricular failure
c. Tricuspid regurgitation
d. Increased lung compliance
20. An increase in tactile fremitus, dullness to percussion, bronchial breath sounds, and egophony may be
noted in patients with: (Barron’s pg. 83)
a. Pneumothorax
b. Emphysema
c. Pneumonia
d. Pleural effusions
21. Which of the following pathophysiological conditions will cause refractory hypoxemia, not treatable with
oxygen alone? (Barron’s pg. 86)
a. Shunt
b. Hyperventilation
c. Diffusion defects
d. V/Q mismatch
22. Treatment strategies for ARDS include: (Barron’s pg. 88)
a. Minimal use of PEEP to maximize lung compliance
b. Use of a smaller tidal volume, higher rate, and higher PEEP
c. Use of 100% FiO2 to correct hypoxemia
d. Increased IVF rate to treat hypotension
23. A 70-kg mechanically ventilated patient has ARDS. Which of the following tidal volumes is most
appropriate? (Barron’s pg. 88)
a. 200 ml
b. 300 ml
c. 500 ml
d. 700 ml
24. The earliest sign of neurologic deterioration (except in epidural hematoma) is: (Barron’s pg. 109)
a. Pupillary changes
b. Change in level of consciousness
c. Widened pulse pressure
d. Seizure

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 25. A patient was diagnosed with diffuse axonal injury, is unresponsive, hypertensive with widened pulse
pressure, and is bradycardic. This is known as: (Barron’s pg. 112)
a. Beck’s triad
b. Cushing’s triad
c. Virchow’s triad
d. Hypertensive crisis
26. Glasgow Coma Score (GCS) includes all the following, EXCEPT? (Barron’s pg. 113)
a. Eye opening
b. Pupillary response
c. Verbal response
d. Motor response
27. The nurse understands a GCS of 8 indicates: (Barron’s pg. 113)
a. Cardiovascular compromise
b. Severe head injury
c. Paraplegia
d. Mild diffuse brain injury
28. The earliest sign of Uncal herniation seen in epidural bleeds is: (Barron’s pg. 114)
a. Central neurogenic breathing
b. Ipsilateral pupil dilation
c. Decerebrate posturing
d. Bradycardia
29. A patient presents with eye deviation to the left, right homonymous hemianopsia, right-sided weakness,
and left pupil dilation. The patient is most likely experiencing: (Barron’s pg. 116)
a. Left-sided ischemic stroke
b. Right-sided ischemic stroke
c. Guillain-Barre syndrome
d. Bell’s palsy
30. Your patient is unresponsive with pinpoint pupils unchanged by naloxone and has apneustic
respirations. These findings are most indicative of a(n): (Barron’s pg. 117)
a. Epidural hematoma
b. Pontine infarct
c. Subarachnoid hemorrhage
d. AV malformation
31. A leading complication of subarachnoid hemorrhage is (Barron’s pg. 119)
a. SIADH
b. Diabetes Insipidus
c. Vasospasm
d. DVT
32. In intracranial monitoring, the transducer should be level with the: (Barron’s pg. 121)
a. Phlebostatic axis
b. Foramen Magnum
c. Foramen of Monroe (external auditory meatus)
d. Chin

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 33. A roofer fell off a house and briefly loses consciousness. He was alert as he entered the ED but is
vomiting and complaining of a headache. He loses consciousness again while in CT, and his right pupil
is dilated. The nurse suspects: (Barron’s pg. 124)
a. Epidural hematoma
b. Subdural hematoma
c. Subarachnoid hemorrhage
d. Intracerebral hemorrhage
34. An elderly patient with a history of alcoholism fell hitting his head yesterday. He was found
unresponsive this am. You suspect which hemorrhage? (Barron’s pg. 125)
a. Epidural
b. Subdural
c. Subarachnoid
d. Intracerebral
35. The nurse knows that nuchal rigidity, fever, Brudzinski’s sign, and Kernig’s sign are signs of: (Pg. 128)
a. Basilar skull fracture
b. Ischemic stroke
c. Meningitis
d. Epidural hematoma
36. A patient had a viral illness 2 weeks ago and is now experiencing symmetrical ascending paralysis. The
nurse knows this is suggestive of: (Barron’s pg. 131)
a. Parkinson’s disease
b. Myasthenia gravis
c. Guillain-Barre syndrome
d. Peripheral neuropathy
37. Which of the following treatments are most effective for the patient with a salicylate overdose? (P. 163)
a. N-acetylcysteine and fluids
b. Gastric lavage and fluids
c. Activated charcoal, urine alkalization, dialysis
d. Syrup of ipecac and gastric lavage
38. A patient being treated for pancreatitis develops carpopedal spasms. The nurse anticipates an order
for: (Barron’s pg. 173 & 197)
a. Magnesium sulfate
b. Calcium chloride
c. Potassium chloride
d. Sodium bicarbonate
39. Abnormal flapping movements of the hand and wrist often seen in patients with liver failure is known as:
(Barron’s pg. 174)
a. Asterixis
b. Carpopedal spasms
c. Tetany
d. Pill-rolling
40. Referred shoulder pain in a patient with a ruptured spleen is known as which sign? (Barron’s pg. 176)
a. Rovsing’s
b. Ballance’s
c. Kehr’s
d. Murphy’s

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 41. A patient admitted after an assault has a bluish discoloration to her left flank. The most likely has:
(Barron’s pg. 176)
a. Retroperitoneal bleeding
b. Hemorrhagic pancreatitis
c. Ruptured spleen
d. Hypocalcemia
42. The patient presents one-month status post gastric bypass bariatric surgery with vomiting, headache,
diplopia, and memory loss. The patient most likely needs which of the following? (Barron’s pg. 178)
a. Vitamins
b. Antibiotics
c. Potassium
d. Emergency surgery
43. After a CT scan with contrast, which of the following is the most important nursing intervention? (P.193)
a. Ensuring adequate fluid intake
b. Maintaining fluid restriction
c. Providing extra doses of sodium
d. Administering antibiotics
44. A patient’s laboratory results show a serum sodium level of 105mEq/L. The nurse knows the primary
complication of hyponatremia is: (Barron’s pg. 198)
a. Hypertension
b. Decreased urine output
c. Seizure activity
d. Tetany
45. The patient with chronic alcoholism is at risk for which of the following? (Barron’s pg. 198)
a. Hyperkalemia
b. Hypomagnesemia
c. Hyperphosphatemia
d. Hyponatremia
46. Which value would differentiate DKA from HHNK? (Barron’s pg. 206)
a. Glucose of 600 mg/dl
b. K+ of 4.0 mEq/L
c. pH 7.30
d. Serum osmolality of 320 mOsm/L
47. A head trauma patient has now polyuria, a urine specific gravity or 1.001, and an elevated serum
osmolality. Which of the following interventions is expected to be administered? (Barron’s pg. 206)
a. 3% saline
b. Phenytoin
c. Pitressin (ADH)
d. D5W
48. Which of the following are early symptoms of hypoglycemia? (Barron’s pg. 207)
a. Tachycardia and diaphoresis
b. Bradycardia and flushed dry skin
c. Slurred speech and seizures
d. Confusion and lethargy

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 49. The diabetic patient with hypoglycemia is most likely to present in an unresponsive state if the patient is
also receiving which of the following? (Barron’s pg. 207)
a. Glipizide
b. Phenytoin
c. Hydrochlorothiazide
d. Metoprolol
50. Results of laboratory studies for a patient in DIC most likely reveals: (Barron’s pg. 214)
a. Decreased clotting times
b. Normal fibrinogen levels
c. Decreased PT & PTT
d. Elevation of fibrin degradation (split) products

CCRN/PCCN Pretest Answers

1. A S1 represents the beginning of systole, loudest at the apex

2. D An S3 is best heard with the bell of stethoscope, loudest at apex
3. A Suspect papillary muscle rupture post AMI if heard best at the apex
4. C Memorize valves open/closed at systole/diastole. Open/stenosis (OS), Insufficient/closed (IC)
5. C Coronary artery vasospasm precipitated by nicotine, ETOH, or cocaine, cyclical pain
6. B Memorize Inferior II, III, aVF. Anterior V1-V4, Lateral 1, aVL, V5, V6 & reciprocal changes
7. A Avoid preload-reducing agents and use caution with beta-blockers in RVMI
8. B Also monitor for systolic murmur – may be papillary muscle rupture
9. C 2nd type 2 or RBBB. Also monitor for systolic murmur – may be ventricular septal rupture
10. A Hypotension, not HTN from vasovagal response
11. C Nipride decreases preload, afterload, and SVR
12. C Right – body, measured by CVP. Left – lungs, measured by PAOP
13. A Right release – CADET right – increased CO2; Acidosis; 2,3, DPG; Exercise; Temperature
14. A Oxygen is antidote for CO toxicity
15. C Memorize ABG, lots of You Tube videos
16. D CPAP pressure causes hemodynamic instability (lowers BP)
17. D Pulsus paradoxus – weaker pulse and lower BP with inspiration
18. C I:E ratio 1:3 or 1:4 to allow extra time to exhale CO2
19. C Right heart failure “Cor pulmonale” PAP > 25, PAOP < 16
20. C all indications of pneumonia, position patient “good lung down”
21. A Non cardiogenic pulmonary edema, ALI – P:F ratio 201-300, ARDS < 201
22. B Tidal volume 4-6 ml/kg, PEEP 15 or greater
23. B 70 times 4 = 280 ml, 70 times 6 = 360 ml. TV 4-6 ml/kg for ARDS
24. B Epidural bleed = pupillary changes first, others decreased LOC first change
25. B Cushing’s Triad = increased systolic BP, widened PP, bradycardia, altered respiratory
26. B GCS = eye, verbal, motor. Score 3-15, < 9 significant injury. Obtunded better than Stuporous
27. B GCS 8 or less = poor outcome
28. B Ipsilateral = same side as injury. Pupil dilates before change in LOC in epidural bleeds
29. A Memorize right side versus left side
30. B Parasympathetic – Pinpoint – Apneustic = Pons
31. C Triple H therapy - hydration
32. C Normal ICP = 0-10, abnormal sustained > 20. CPP = MAP-ICP. “A” waves are Awful.
33. A Epidural bleed – rapid deterioration. Middle meningeal artery from temporal injury.
34. B Subdural bleed is delayed bridging veins bleed; more in older (anticoagulants) and alcoholics

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 35. C S/S of meningitis, bacterial – increased pressure, purulent, low glucose in CSF
36. C GB – ascending symmetrical; Myasthenia – ptosis, diplopia, progression in weakness
37. C Salicylates = dialysis. N-acetylcysteine for acetaminophen OD
38. B Trousseau’s sign (carpopedal spasm) and Chvostek sign (facial twitch) due to hypocalcemia
39. A Asterixis due to increased ammonia levels
40. C Kehr’s sign (left shoulder pain) due to diaphragmatic irritation
41. A Grey-Turner’s Sign is ecchymosis over flank from retroperitoneal bleed
42. A Vitamin loss due to malabsorption
43. A Hydrate before and after or alkalinize urine with contrast dye
44. C Normal sodium is 135-145, risk is seizures
45. B Alcoholics - risk of hypomagnesemia is Torsades
46. C DKA = diabetic ketoacidosis (metabolic acidosis (pH < 7.30), Ketones, Kussmaul’s, low K+)
47. C Diabetes Insipidus – needs ADH (DDAVP). SIADH – TX: hypertonic saline, Lasix, phenytoin
48. A Early signs of hypoglycemia are tachycardia and sweating
49. D Early signs of hypoglycemia masked by beta-blockers (olols)
50. D DIC – Low platelets, fibrinogen, H & H. Elevated PT, PTT, INR, D-dimer, FDP’s

• Consider purchasing Barron’s CCRN Exam (ISBN: 13:978-1-43380-0458-7).

• Take a practice test at http://barronsbooks.com/TP/CCRN/

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