12-Leads on CCRN Exam

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by DNP2020 DNP2020 (New) New

I will be taking the CCRN exam in a few months, and I was wondering how much time I should spend studying 12-lead EKGs?

Cvepo

Cvepo

Specializes in CCU, SICU, CVICU. Has 3 years experience. 127 Posts

Cardiac is a huge portion of the test. Ideally if you work in an ICU, you SHOULD have a solid background of reading EKGs. You definitely need to know them, but I wouldn't spend forever on them. You for sure need to know what leads will have ST elevations for each type of MI, and you will definitely have at least one question on your exam about a patient having an inferior STEMI, for example, and asking you which leads (or even which reciprocal leads) you would expect to see changes. You probably won't see a strip with Afib asking you to interpret, though.

Cardiac is only a portion of the test, but it is the largest tested portion amongst all the body systems. Don't neglect everything else, but take the time to learn, understand, and memorize if you have to, the changes in ST segments in MIs. ACLS protocol is also testable, I believe, so knowing your VT/VF, stable vs unstable tachyarrythmias, bradyarrythmias, etc and their treatments is useful.

Okami_CCRN, BSN, RN

Specializes in Critical Care. Has 7 years experience. 845 Posts

I have mentioned this before, but I highly encourage you to look up the AACN's review course as they give you the latest test plan with testable content, as Cvepo mentioned cardiac is a rather large component of the exam, knowing your EKG is valuable, especially ST changes and its corresponding area. However, it is not the only thing about cardiac; pulmonary artery pressures, central venous pressures, and vasoactive medications all comprise cardiac, as well as disease states and treatment plans.

I studied for approx 2 weeks prior to sitting for the exam, I worked on a general medical/surgical ICU in a large community hospital and manage to pass with 109/125 questions. The test is comprised of 150 questions, 25 of which are not graded and are experimental for future iterations of the exam.

calivianya, BSN, RN

Specializes in ICU. 2,418 Posts

Cardiac, as others have said, was a huge portion of the test for me.

But honestly, I am a little concerned you are worried about knowing 12 leads for the test, implying you don't already know them. Maybe it's just me, but I think that's 100% absolutely, positively need to know right now as an ICU nurse. I think that's right up there with knowing what propofol is used for. For example, let's say your patient develops chest pain and some ST elevation. Your chest pain protocol includes giving nitroglycerin. You are waiting for your physician to call back but it's been 20 minutes, you're getting nervous because your guy is sweating and clutching his chest, so you're implementing the protocol orders without physician guidance... and you give nitro, the patient's blood pressure drops, and he codes. If you don't know what an inferior MI vs. anterior/septal/lateral looks like, you could do that very easily by mistake.

I work MICU, for the record, so I'm not just saying that as a cardiac nurse. Learn your 12 leads because you will not only save your patients' lives... you will also save your coworkers' patients' lives when your coworkers who haven't bothered to learn to interpret ECGs go to make a serious mistake and you can intervene. :)

SedatedRN

SedatedRN

15 Posts

It is also helpful to be able to know the EKG rhythms through text descriptions such as "the patient has wide or narrow complex tachycardia" vs just being able to know the rhythm by sight.

Greenclip

Greenclip

100 Posts

The test will NOT show you a 12-lead printout, although you may have a question which shows a simple strip. But you will have questions which expect you to know the significance of elevations in groups of leads. I echo what has been said above.

On 5/21/2017 at 9:05 AM, calivianya said:

Cardiac, as others have said, was a huge portion of the test for me.

But honestly, I am a little concerned you are worried about knowing 12 leads for the test, implying you don't already know them. Maybe it's just me, but I think that's 100% absolutely, positively need to know right now as an ICU nurse. I think that's right up there with knowing what propofol is used for. For example, let's say your patient develops chest pain and some ST elevation. Your chest pain protocol includes giving nitroglycerin. You are waiting for your physician to call back but it's been 20 minutes, you're getting nervous because your guy is sweating and clutching his chest, so you're implementing the protocol orders without physician guidance... and you give nitro, the patient's blood pressure drops, and he codes. If you don't know what an inferior MI vs. anterior/septal/lateral looks like, you could do that very easily by mistake.

I work MICU, for the record, so I'm not just saying that as a cardiac nurse. Learn your 12 leads because you will not only save your patients' lives... you will also save your coworkers' patients' lives when your coworkers who haven't bothered to learn to interpret ECGs go to make a serious mistake and you can intervene. :)

There is NO NURSE LEAD nitro or MI treatment in ACLS - yes there is the ACS segment but that DOES NOT give you the authority to start medications. If you see an st segment elevation the Doctor needs to come and evaluate and write orders. Knowing how to read 12 Lead EKGs to diagnose and treat an MI is WELL out of our scope of practice. They didn’t even teach me that in my residency- just ALL the lethal ACLS and st segment elevation as well as MI symptoms to order a 12 lead. You can’t do a 12 lead without an order technically.  

MunoRN, RN

Specializes in Critical Care. Has 10 years experience. 8,058 Posts

On 5/23/2022 at 11:06 PM, DoshicMethodRN said:

There is NO NURSE LEAD nitro or MI treatment in ACLS - yes there is the ACS segment but that DOES NOT give you the authority to start medications. If you see an st segment elevation the Doctor needs to come and evaluate and write orders. Knowing how to read 12 Lead EKGs to diagnose and treat an MI is WELL out of our scope of practice. They didn’t even teach me that in my residency- just ALL the lethal ACLS and st segment elevation as well as MI symptoms to order a 12 lead. You can’t do a 12 lead without an order technically.  

Unless for some reason your hospital hasn't adopted the ACLS algorithms as a protocol, which is typically required in critical care areas, then it can actually be implemented by an RN with a maintained competency in ACLS.  

The same is true for obtaining a 12-lead, this should typically be part of any RNs competency in a unit with continuous cardiac monitoring.  In order to bill for the 12-lead a provider does need to sign an order for it at some point.