CCRN Cardiovascular Practice Questions
Updated October 30, 2026
Cardiovascular is still one of the biggest single areas on the CCRN (Adult) exam, even after the new test plan trimmed its share. The questions rarely ask you to recall a fact on its own. They give you a patient, a set of vital signs or hemodynamic numbers, and ask what is MOST LIKELY happening or what the nurse should do FIRST.
The 12 questions below are original, written for this page in the style of the real exam. They are independent practice and are not official AACN material. Each one shows the answer and a rationale as soon as you pick.
Cardiovascular on the CCRN at a glance
| Item | Details |
|---|---|
| Share of the exam | 13% of the scored questions, about 16 of 125 |
| Test plan | Adult CCRN test plan for exams on or after November 12, 2025 |
| Question style | Bedside vignettes with vitals, rhythms and hemodynamics, four choices, one best answer |
| Previous share | 17% under the 2020 plan, so older review books overweight this area |
What the cardiovascular questions cover
The test plan lists acute coronary syndrome, aortic aneurysm and dissection, cardiac infection and inflammatory disease, cardiac surgery, tamponade, cardiac trauma, cardiac and vascular catheterization, cardiogenic shock, cardiomyopathy, dysrhythmias, heart failure, hypertensive crisis, conduction defects such as prolonged QT and Wolff-Parkinson-White, structural and valve disease, vascular disorders, and vascular interventions such as stents and carotid endarterectomy.
The nursing actions it names include interpreting and responding to rhythms, recognizing early signs of low cardiac output, and managing cardiac catheterization, invasive and noninvasive hemodynamic monitoring, mechanical circulatory support devices, pericardiocentesis and temporary pacing.
Tips for cardiovascular questions
- Name the problem before you pick the action. Many stems are two-step: first work out that it is a right ventricular infarct or tamponade, then choose the treatment that fits it.
- Follow the trend, not one number. A chest tube that suddenly stops draining or a pulse that weakens on one side is often the whole clue.
- Watch for drugs that make the problem worse. Nitrates in a preload-dependent patient and AV nodal blockers in preexcitation are classic traps.
- For hemodynamics, think in directions. See the hemodynamics guide for shock profiles.
CCRN cardiovascular practice questions
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A 64-year-old patient with an inferior STEMI has ST elevation in leads II, III, aVF and right-sided lead V4R. BP is 82/50 mm Hg, HR 58, lungs are clear and the jugular veins are distended. Which intervention should the nurse anticipate FIRST?Answer: CST elevation in V4R with hypotension, clear lungs and distended neck veins points to right ventricular infarction, which depends on preload to fill the left side of the heart. A fluid bolus supports output, while nitrates, diuretics and morphine lower preload and can deepen the hypotension.
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Six hours after coronary artery bypass surgery, chest tube drainage that had been 150 mL/h for 3 hours drops to 10 mL/h. BP is 78/60 mm Hg, HR 128, CVP has risen from 8 to 18 mm Hg, PA diastolic and PAOP are both 18 mm Hg, and breath sounds are equal. Which complication is MOST LIKELY?Answer: AA sudden stop in drainage after heavy bleeding suggests clot in the tubes, and rising, equal right and left filling pressures with a narrow pulse pressure are the pattern of tamponade. Hypovolemia would lower the CVP, and equal breath sounds make tension pneumothorax unlikely.
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A 58-year-old patient reports tearing chest pain that radiates to the back. BP is 196/104 mm Hg in the right arm and 150/88 mm Hg in the left, HR 104. CT confirms an aortic dissection. Which medication should the nurse anticipate starting FIRST?Answer: BIn aortic dissection, heart rate and the force of ventricular contraction are lowered first with an IV beta blocker, which reduces shear stress on the aortic wall. Starting a vasodilator alone can cause reflex tachycardia and worsen the tear, and anticoagulation is contraindicated.
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On day 4 after an anterior wall MI, a patient develops a new loud holosystolic murmur at the left sternal border and becomes hypotensive. Oxygen saturation is 64% in a right atrial blood sample and 82% in a pulmonary artery sample. Which complication is MOST LIKELY?Answer: DA step-up in oxygen saturation between the right atrium and the pulmonary artery means oxygenated blood is crossing from the left ventricle to the right, which is a ventricular septal rupture. Papillary muscle rupture causes acute mitral regurgitation without an oxygen step-up.
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A patient with known Wolff-Parkinson-White syndrome has an irregular, wide-complex rhythm at 210 with varying QRS widths. BP is 104/68 mm Hg and the patient is alert. Which order should the nurse QUESTION?Answer: CThis is atrial fibrillation conducted down an accessory pathway. Blocking the AV node with diltiazem can speed conduction through the accessory pathway and trigger ventricular fibrillation, so it should be questioned. Pads, a 12-lead ECG and readiness for cardioversion are all appropriate.
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A patient receiving methadone and IV haloperidol has a QTc of 590 ms and repeated short runs of polymorphic ventricular tachycardia with a twisting QRS axis. Between runs the patient is alert with a BP of 118/72 mm Hg. Which medication should the nurse anticipate?Answer: ATorsades de pointes with a long QT is treated with IV magnesium, along with stopping QT-prolonging drugs and correcting potassium. Amiodarone, sotalol and procainamide all prolong the QT interval and can make it worse.
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A patient arrives with BP 238/134 mm Hg, severe headache, confusion and papilledema. A nicardipine infusion is ordered. Which goal for the first hour is MOST appropriate?Answer: BIn a hypertensive emergency without aortic dissection, the pressure is lowered gradually, by no more than about 25% in the first hour, because the brain and kidneys have adapted to high pressures and a rapid fall can cause ischemia. Treatment should not wait for imaging.
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A patient has an intra-aortic balloon pump inserted through the right femoral artery. The nurse notes the left radial pulse has become much weaker than the right, while urine output is unchanged. What is the MOST LIKELY cause?Answer: DThe balloon tip should sit just below the left subclavian artery. A weaker left radial pulse suggests the balloon has moved up and is blocking that artery, while a downward move would more often reduce urine output by blocking the renal arteries.
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A patient with heart failure has BP 168/96 mm Hg, HR 112, RR 30, SpO2 88% on 4 L/min, crackles to the mid lung fields, and warm extremities. Which treatment should the nurse anticipate?Answer: CThis patient is warm and wet: congested, with adequate perfusion and high blood pressure. A loop diuretic removes volume and nitroglycerin lowers preload and afterload. A beta blocker can worsen acute decompensation, and inotropes, vasopressors and fluid do not fit a hypertensive, congested patient.
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A patient with a transvenous pacemaker set at a rate of 70 has a heart rate of 38. The monitor shows pacing spikes at the set rate, but most spikes are not followed by a QRS complex. Which adjustment is MOST likely to correct this problem?Answer: ASpikes without a following QRS is failure to capture: the pacemaker fires but the impulse does not depolarize the ventricle. Raising the output, along with checking connections and lead position, is the usual fix. Sensitivity and mode settings address sensing problems, not capture.
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Four hours after a right carotid endarterectomy, a patient has a rapidly enlarging neck swelling, new inspiratory stridor and an SpO2 of 92%. What is the PRIORITY?Answer: DAn expanding hematoma after carotid surgery can compress the airway quickly. The surgeon needs to evacuate it, and the team must be ready to secure the airway; waiting, comfort measures or a trip to CT delay treatment of a threat to the airway.
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Three hours after a cardiac catheterization through the right femoral artery, a patient reports new back and flank pain. BP has fallen from 132/80 to 90/56 mm Hg and HR has risen from 78 to 116. The groin site is soft with no hematoma. Which complication is MOST LIKELY?Answer: BBack or flank pain with signs of blood loss after femoral access, and no visible groin hematoma, suggests bleeding into the retroperitoneum from a high arterial puncture. A pseudoaneurysm shows as a pulsatile groin mass with a bruit, and stent thrombosis usually causes chest pain and ST changes.
Keep practicing
Our Cardiovascular practice exam has 16 questions, the same share as the real exam, and the full practice exams mix all six areas into 125 scored questions with 83 to pass. Start from the home page.
Next, try the respiratory questions or the multisystem questions, or read the CCRN exam guide for the format, fees and a study plan.
Pass the CCRN exam on your first try
- All 338 questions across every area of the 2025 Adult CCRN test plan
- A rationale for every answer, including why the tempting choice is wrong
- Unlimited full 125-question practice exams, scored like the real one (83 to pass)