Think you are ready for the CCRN (Critical Care Registered Nurse) exam? Our deck rates 501 of its 1000 flashcards as hard. Try the free samples below; if they feel comfortable, you are in good shape.
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A patient with chest pain has an initial hs-cTnT of 14 ng/L (normal <14). A 1-hour repeat is 18 ng/L. Based on 2026 rapid protocols, what is the next diagnostic step and the physiological rationale for the delta?
Show answer →The patient requires further observation or a 3-hour troponin (Gray Zone). A delta (change) of ≥3-5 ng/L within 1-2 hours suggests acute myocardial injury rather than chronic elevation (e.g., CKD). In ACS, plaque rupture leads to progressive cardiomyocyte necrosis and continuous protein release. If the delta was >10-12, rule-in for NSTEMI would occur. AACN emphasizes interpreting troponin in context of clinical symptoms.
A patient with resolved chest pain presents with deeply inverted T-waves in V2-V4. Cardiac enzymes are currently negative. What is the pathophysiological significance of this finding, and what is the definitive management?
Show answer →Wellens' Syndrome (Type B). Pathophysiology: Critical stenosis of the proximal Left Anterior Descending (LAD) artery. Though pain has subsided (reperfusion), the patient is at extremely high risk for a massive anterior wall MI (widow maker). Management: Urgent cardiac catheterization. Exam Strategy: Do NOT choose stress testing for these patients; it may provoke a fatal MI due to the critical nature of the lesion.
ECG shows upsloping ST-segment depression at the J-point in leads V1-V6, transitioning into tall, symmetrical, peaked T-waves. The patient has active chest pain. What does this pattern represent in the context of ACS?
Show answer →De Winter T-waves. This is a STEMI equivalent indicating acute proximal LAD occlusion. Pathophysiology: Unlike classic ST elevation, this pattern represents a specific electrophysiological state of transmural ischemia. Recognition is critical because these patients require immediate reperfusion therapy (PCI) despite the absence of traditional ST elevation. AACN often tests recognition of STEMI equivalents.
A patient post-anterior MI develops a harsh holosystolic murmur at the left sternal border and signs of right heart failure. PA catheterization reveals an SpO2 of 65% in the RA and 82% in the RV. What is the diagnosis?
Show answer →Ventricular Septal Defect (VSD). The oxygen step-up (a significant increase in O2 saturation from the Right Atrium to the Right Ventricle) confirms a left-to-right shunt through a ruptured septum. This occurs most commonly with LAD/Anterior MI. It results in volume overload of the right heart and decreased systemic cardiac output. This is a classic hard CCRN question involving hemodynamics.
A septic patient with a heart rate of 140 bpm has an elevated hs-cTn. Coronary angiography shows no obstructive CAD. What is the classification of this MI, and what is the pathophysiology?
Show answer →Type 2 Myocardial Infarction (T2MI). Pathophysiology: Myocardial injury caused by a mismatch between oxygen supply and demand, NOT by acute plaque rupture (which is Type 1 MI). In sepsis, increased demand (tachycardia) and decreased supply (hypotension/hypoxemia) lead to necrosis. CCRN strategy: Focus on treating the underlying cause (e.g., infection, anemia) rather than standard ACS antiplatelet therapy.
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Try 30 free CCRN cards first501 of the 1000 flashcards in the CCRN deck carry a "hard" difficulty rating. 5 free samples are on this page.
Difficulty ratings describe our deck, not the official exam. Practicing above test level builds a margin of safety — check the official AACN materials for representative difficulty.
Assessment
40 cards
Diagnostics
40 cards
Ethics
30 cards
Management
230 cards
Pathology
370 cards
Pharmacology
50 cards
Procedures
170 cards
Professional
10 cards
Toxicology
30 cards
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