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Cardiovascular CCRN Practice Questions

10 free CCRN-style cardiovascular practice questions with full rationales. Perfect for last-minute review or rapid drilling on high-yield concepts.

Question Index

  1. Q1: A patient with an acute MI develops new hypotension with a BP of 78/50 mmHg, HR …
  2. Q2: Which ECG finding is MOST indicative of hyperkalemia?
  3. Q3: A patient in hypertrophic obstructive cardiomyopathy (HOCM) becomes hypotensive.…
  4. Q4: The nurse is caring for a patient post-PCI. Which finding requires IMMEDIATE int…
  5. Q5: What is the door-to-balloon time goal for STEMI patients undergoing primary PCI?…
  6. Q6: A patient with heart failure has a BNP of 850 pg/mL. This indicates:
  7. Q7: Which heart sound indicates ventricular compliance issues often seen in left ven…
  8. Q8: A patient presents with sudden-onset tearing chest pain radiating to the back wi…
  9. Q9: Normal Pulmonary Artery Occlusion Pressure (PAOP/PCWP) is:
  10. Q10: What is the primary action of nitroprusside in hypertensive emergency?
Question 1

A patient with an acute MI develops new hypotension with a BP of 78/50 mmHg, HR 110, and cool extremities. The PA catheter shows: CO 3.2 L/min, CI 1.8 L/min/m², PAOP 22 mmHg, SVR 1800 dynes. What is the most likely diagnosis?

  1. Hypovolemic shock
  2. Cardiogenic shock
  3. Septic shock
  4. Neurogenic shock

Correct Answer: B. Cardiogenic shock

Rationale: The hemodynamic profile shows low CO/CI, elevated PAOP (indicating fluid overload/LV failure), and elevated SVR (compensatory vasoconstriction). This is classic for cardiogenic shock. Hypovolemic shock would show low PAOP. Septic shock typically shows low SVR with warm extremities. The patient has signs of poor perfusion (cool extremities) following MI.
Question 2

Which ECG finding is MOST indicative of hyperkalemia?

  1. Prolonged QT interval
  2. Peaked T waves
  3. U waves
  4. ST depression

Correct Answer: B. Peaked T waves

Rationale: Peaked T waves are the earliest and most characteristic ECG finding of hyperkalemia. As potassium rises, the progression includes: peaked T waves → PR prolongation → loss of P wave → widened QRS → sine wave pattern → cardiac arrest. Prolonged QT and U waves are associated with hypokalemia. ST depression can indicate ischemia.
Question 3

A patient in hypertrophic obstructive cardiomyopathy (HOCM) becomes hypotensive. Which intervention should be AVOIDED?

  1. IV fluids
  2. Beta blockers
  3. Dobutamine
  4. Phenylephrine

Correct Answer: C. Dobutamine

Rationale: Dobutamine (an inotrope) should be AVOIDED in HOCM. Increasing contractility worsens the left ventricular outflow tract (LVOT) obstruction. Treatment focuses on decreasing contractility (beta blockers) and maintaining preload (IV fluids). Phenylephrine (pure vasoconstrictor) increases afterload and can actually help by reducing the pressure gradient.
Question 4

The nurse is caring for a patient post-PCI. Which finding requires IMMEDIATE intervention?

  1. Groin site ecchymosis
  2. Back pain with decreasing hemoglobin
  3. Heart rate of 62 bpm
  4. Blood pressure 138/82 mmHg

Correct Answer: B. Back pain with decreasing hemoglobin

Rationale: Back pain with decreasing hemoglobin suggests retroperitoneal bleeding, a serious complication of femoral artery access. This requires immediate intervention including holding anticoagulation and possible emergent CT/surgery. Groin ecchymosis is common and expected. The HR and BP values are acceptable.
Question 5

What is the door-to-balloon time goal for STEMI patients undergoing primary PCI?

  1. Within 30 minutes
  2. Within 60 minutes
  3. Within 90 minutes
  4. Within 120 minutes

Correct Answer: C. Within 90 minutes

Rationale: The goal for door-to-balloon time in STEMI is within 90 minutes. This is based on evidence that shorter times to reperfusion are associated with better outcomes. The saying "time is muscle" emphasizes the importance of rapid reperfusion to limit myocardial damage. Door-to-needle for fibrinolytics is 30 minutes when PCI is not available.
Question 6

A patient with heart failure has a BNP of 850 pg/mL. This indicates:

  1. Normal cardiac function
  2. Mild heart failure
  3. Significant ventricular wall stress
  4. Pulmonary embolism

Correct Answer: C. Significant ventricular wall stress

Rationale: BNP (Brain Natriuretic Peptide) is released by ventricular myocytes in response to wall stress/stretch. A BNP >100 pg/mL suggests heart failure, and 850 pg/mL indicates significant ventricular wall stress. BNP helps differentiate cardiac from pulmonary causes of dyspnea. Normal BNP is typically <100 pg/mL.
Question 7

Which heart sound indicates ventricular compliance issues often seen in left ventricular hypertrophy?

  1. S1
  2. S2
  3. S3
  4. S4

Correct Answer: D. S4

Rationale: S4 (atrial gallop) occurs when the atrium contracts against a stiff, non-compliant ventricle during late diastole. It is commonly heard in conditions causing ventricular hypertrophy such as hypertension, aortic stenosis, and hypertrophic cardiomyopathy. S3 indicates volume overload/heart failure. S1 and S2 are normal heart sounds.
Question 8

A patient presents with sudden-onset tearing chest pain radiating to the back with BP difference of 25 mmHg between arms. What is the priority intervention?

  1. Administer aspirin 325 mg
  2. Prepare for immediate PCI
  3. Start IV beta blocker
  4. Give IV morphine for pain

Correct Answer: C. Start IV beta blocker

Rationale: This presentation is classic for aortic dissection. The priority is BP control, starting with beta blockers to reduce heart rate and contractility (shear stress) before vasodilators. Aspirin and PCI would be harmful if dissection is confirmed. The target is SBP <120 and HR <60. Pain control is important but beta blockade takes priority.
Question 9

Normal Pulmonary Artery Occlusion Pressure (PAOP/PCWP) is:

  1. 2-6 mmHg
  2. 8-12 mmHg
  3. 20-30 mmHg
  4. 15-25 mmHg

Correct Answer: B. 8-12 mmHg

Rationale: Normal PAOP (also called PCWP or wedge pressure) is 8-12 mmHg. This reflects left heart filling pressure (preload). RAP/CVP of 2-6 mmHg reflects right heart preload. Elevated PAOP >18 mmHg suggests left heart failure or volume overload. PA systolic pressure is normally 20-30 mmHg.
Question 10

What is the primary action of nitroprusside in hypertensive emergency?

  1. Arterial vasodilation only
  2. Venous vasodilation only
  3. Both arterial and venous vasodilation
  4. Increased cardiac contractility

Correct Answer: C. Both arterial and venous vasodilation

Rationale: Nitroprusside is a potent vasodilator affecting both arterial and venous systems. It reduces both preload (venodilation) and afterload (arteriodilation), making it effective for rapid BP reduction. Important: Watch for cyanide/thiocyanate toxicity with prolonged use. It requires continuous monitoring due to its potent effect.

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Here are 3 questions from our premium bank. The full rationale explains exactly why the right answer is right — and why the 3 distractors trap most test-takers.

Premium Practice Question

A 71-year-old arrives with dyspnea and chest pressure. Skin is cool and clammy. VS: HR 118, BP 78/44, SpO₂ 92% on 4 L NC. Crackles present bilaterally. Hemodynamics: CI 1.7, CVP 18, PAOP 24, SVR 1750, SvO₂ 54%. Which shock type best fits?

  1. Hypovolemic
  2. Distributive (early septic)
  3. Cardiogenic
  4. Neurogenic
Rationale: Low CI + high CVP/PAOP + high SVR + low SvO₂ with pulmonary congestion is classic cardiogenic shock (pump failure with backup and compensatory vasoconstriction)....
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Premium Practice Question

A patient on an IABP reports worsening chest pain. The arterial waveform shows balloon deflation occurring after the next systolic upstroke begins, and assisted systolic pressure appears higher than expected. What is the most likely problem/effect?

  1. Early inflation → decreased coronary perfusion
  2. Late inflation → decreased diastolic augmentation
  3. Late deflation → increased afterload and myocardial oxygen demand
  4. Early deflation → improved unloading
Rationale: Late deflation means the balloon is still inflated as systole starts, which increases afterload and myocardial O₂ demand—can worsen ischemia and hemodynamics....
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Premium Practice Question

A 63-year-old is 24 hours post–inferior MI. Suddenly develops acute respiratory distress, frothy sputum, hypotension, and a new loud holosystolic murmur at the apex. SpO₂ 84% on NRB. What is the most likely cause?

  1. Acute pericarditis
  2. Papillary muscle rupture → acute severe mitral regurgitation
  3. Right ventricular infarct causing preload collapse
  4. Dressler syndrome
Rationale: Sudden pulmonary edema + shock + new holosystolic murmur post-MI strongly suggests papillary muscle rupture leading to acute severe MR (a surgical emergency)....
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