CCRN cerification exam 2025 questions and detailed correct answers with rationales, Exams of Nursing

Download CCRN cerification exam 2025 questions and detailed correct answers with rationales and more Exams Nursing in PDF only on Docsity! CCRN CERTIFICATION PRACTICE EXAM QUESTIONS AND DETAILED CORRECT ANSWERS WITH RATIONALES | PASS A+ GRADE A 55-year-old patient has headache, nuchal rigidity, photophobia, and positive Kernig's and Brudzinski's signs. These are consistent with which of the following? A. Intracranial hemorrhage B. Subarachnoid hemorrhage C. Epidural hemorrhage D. Subdural hemorrhage Correct Answer Subarachnoid hemorrhage When there is bleeding from an aneurysm, that blood irritates the meninges. The clinical presentation is very similar to meningitis. This clinical presentation is not consistent with intracranial, epidural, or subdural bleeding because the blood is not in contact with the meninges in those situations. An extra heart sound preceding S1 is most likely an S4 if the stethoscope's: A. diaphragm is over the apex. B. bell is over the aortic area. C. diaphragm is over the aortic area. D. bell is over the apex. Correct Answer bell is over the apex. S3 and S4 are low pitched, so choose options with the bell being used. S3 and S4 are heard at the mitral area (i.e., apex) unless the right ventricular is affected, and then they are heard in the tricuspid area. Low-Pitched is best heard with Bell The charge nurse on the 7 pm to 7 am shift was asked to assist a group of nurses to resolve their conflict so that their two opposing goals are discarded and new goals are adopted. This is an example of which of the following? A. Smoothing of conflict B. Facilitating collaboration C. Encouraging compromise D. Democratic approach Correct Answer Facilitating collaboration This is an example of facilitating collaboration. The nurse is, in essence, acting as mediator to assist these two groups in developing common goals. In smoothing, you would try to C. Only the tracheostomy tube has an inner cannula. D. The tracheostomy tube has a larger lumen. Correct Answer The laryngectomy tube does not have a cuff. A cuff is not necessary because food and fluid from the mouth can go only to the esophagus and the stomach, and air going into the laryngectomy tube can go only into the lungs. The only way this patient can aspirate is if a fistula develops because the anatomy has been surgically altered by removal of the larynx. The mean QRS axis of ventricular tachycardia is most likely to be: A. normal or left axis deviation. B. right axis deviation or indeterminate axis. C. right axis deviation or left axis deviation. D. left axis deviation or indeterminate axis. Correct Answer left axis deviation or indeterminate axis. Ventricular tachycardia is most likely to be left axis deviation of −30 or greater or indeterminate axis, whereas aberrancy is more likely to be normal axis or right axis deviation. A 58-year-old man is admitted to the critical care unit with upper gastrointestinal bleeding. He has a history of chronic renal failure. When one is administering antacids, it is important to remember to avoid: A. magnesium-containing antacids. B. phosphate-binding antacids. C. calcium-containing antacids. D. histamine2 receptor antagonists. Correct Answer magnesium- containing antacids. Magnesium-containing antacids can lead to magnesium intoxication in the patient with renal failure. A patient is complaining of dull, diffuse abdominal pain. Of the following possible causes, which is most likely to be the cause? A. Appendicitis B. Cholecystitis C. Ulcerative colitis D. Large intestinal obstruction Correct Answer Large intestinal obstruction The rest are sharp pain Vt for extubation Correct Answer 5ml/kg A 30-year-old man is in the surgical intensive care unit after exploratory laparotomy performed after he sustained a gunshot wound to the abdomen. He now has developed a pancreatic fistula. Which acid-base imbalance is this patient at risk for developing? A. Respiratory acidosis B. Metabolic acidosis C. Respiratory alkalosis D. Metabolic alkalosis Correct Answer Metabolic acidosis The stomach is acidic, but the gastrointestinal tract below the stomach is alkaline. Pancreatic secretions are rich in bicarbonate, and these losses would cause metabolic acidosis. A 65-year-old man was admitted 2 hours ago after coronary artery bypass grafting. He has had the following vital sign changes: Admission 2 Hours Later Blood pressure (mm Hg) 110/80 96/76 Heart rate (per minute) 85 100 Right atrial pressure (RAP; mm Hg) 6 2 Pulmonary artery pressure (PAP; mm Hg) 24/12 18/6 Pulmonary artery occlusive pressure (PAOP; mm Hg) 10 5 myocardium does not metabolize aerobically or anaerobically. As long as there is pain, there is salvageable myocardium. Hypotension and heart block are not contraindications to fibrinolytic drugs, and they may improve with reperfusion of the myocardium. Uncontrolled hypertension increases the risk of hemorrhagic stroke. A 72-year-old woman arrives at the emergency department after becoming unresponsive while watching television with her husband. The nurse observes paralysis of her right extremities, aphasia, and lethargy. The patient receives fibrinolytic therapy. After the patient is stabilized, a diet is offered. The nurse knows that before the patient eats, it is crucial to check which of the following cranial nerves? A. IX, X B. I, II C. III, VI D. VIII, XI Correct Answer IX, X Cranial nerves IX and X control the gag and swallow response. These must be intact bilaterally to protect the patient's airway. glossopharngeal and vagus A 23-year-old man is admitted via the emergency department after a motorcycle collision. His Glasgow Coma Scale score was 12 in the emergency department, and it is still 12 upon his admission to the neurologic intensive care unit. Both eyes are ecchymotic and swollen shut, and he has multiple abrasions on his face. Which of the following is the most likely diagnosis? A. Linear skull fracture B. Basal skull fracture C. Orbital fracture D. Mandibular fracture Correct Answer Basal skull fracture Which leads are most helpful in differentiating ventricular tachycardia from a supraventricular tachycardia with aberrancy? A. Leads II and III B. Leads V1 and V6 C. Leads I and aVL D. Leads V3 and V4 Correct Answer Leads V1 and V6 A patient has had a large anterior myocardial infarction last month and developed a ventricular aneurysm. He now has episodes of ventricular tachycardia that are not prevented or converted with antidysrhythmic agents. An implantable cardioverter-defibrillator (ICD) is implanted. Four days after surgery he develops ventricular tachycardia. The ICD has delivered three shocks but has not converted the rhythm. He is pulseless and apneic. Cardiopulmonary resuscitation is in progress. What is the priority action now? A. Administer epinephrine IV. B. Administer amiodarone. C. Defibrillate. D. Reset the ICD. Correct Answer Defibrillate A 28-year-old woman is admitted to the critical care unit from the emergency department with a diagnosis of asthma. Her initial arterial blood gases on a 28% Venturi mask are as follows: pH 7.48 PaCO2 30 mm Hg HCO3 24 mEq/L PaO2 64 mm Hg Which of the following repeat arterial blood gases on 40% oxygen indicate that the patient's condition is worsening? A. pH 7.48, PaCO2 30 mm Hg, PaO2 68 mm Hg B. pH 7.46, PaCO2 32 mm Hg, PaO2 61 mm Hg PaO2 40 mm Hg Arterial oxygen saturation 75% Why does this patient have hypoxemia without hypercapnia? A. Because carbon dioxide is more diffusible than oxygen B. Because carbon dioxide has more driving pressure C. Because carbon dioxide is less diffusible than oxygen D. Because carbon dioxide excretion by the kidney is increased Correct Answer Because carbon dioxide is more diffusible than oxygen Carbon dioxide is 20 times more diffusible than oxygen. In conditions that affect diffusion but do not affect ventilation, expect the PaO2 to be decreased and the PaCO2 to be normal (or decreased in hyperventilation, as in this patient). If ventilation were affected, such as if this patient were fatiguing, the PaCO2 then would increase. Driving pressure is the fraction of the gas in inspired air multiplied by the barometric pressure. Because carbon dioxide is ~0.5% of inspired air, the driving pressure would be very low. The kidney eliminates bicarbonate and hydrogen ions, but the lungs eliminate carbon dioxide. Looking at the heart from either side helps to identify whether the impulse originated in one ventricle or the other. Inferior, lateral, and anterior leads have a predominantly positive QRS complex because the wave of depolarization through the heart is downward and to the left. Lead V1 is the single most helpful lead to differentiate ventricular ectopy from aberrancy. Leads V1 and V6 together are the two most helpful leads. Which of the following describes the primary role of a case manager? A. Educator B. Evaluator C. Facilitator D. Advocate Correct Answer Advocate A patient develops carpopedal spasm and neuromuscular irritability manifested by Chvostek's and Trousseau's signs. Which electrolyte imbalance should you suspect? A. Hyperkalemia B. Hypercalcemia C. Hypermagnesemia D. Hyperphosphatemia Correct Answer Hyperphosphatemia The patient's signs/symptoms are associated with hypocalcemia and its reciprocal condition, hyperphosphatemia. The same signs/symptoms also are seen in hypomagnesemia. A patient with which of these conditions would have a normal serum lactate? A. Ventricular fibrillation B. Cardiogenic shock C. Severe anemia D. Renal failure Correct Answer Renal failure All of these will cause metabolic acidosis, but in renal failure the acidosis is related to accumulation of nonvolatile acids (e.g., urea and uric acid). Ventricular fibrillation, cardiogenic shock, and severe anemia would decrease tissue oxygen delivery, resulting in the conversion of metabolism from aerobic to anaerobic and the buildup of lactic acid. Lactic acidosis is reflected as an increase in serum lactate level. A patient has a diagnosis of pulmonary embolism made by pulmonary arteriography. He now is receiving 100% oxygen via a non-rebreathing mask for 24 hours. The nurse is concerned about the possibility of oxygen toxicity. What is a common, early sign of oxygen toxicity? A. Cyanosis static compliance because of the loss of intactness of the bony thorax. A 46-year-old woman is admitted to the critical care unit with acute respiratory failure as a result of pneumonia. Vital Signs Blood pressure 140/88 mm Hg Heart rate 108 beats/min Respiratory rate 26 breaths/min Temperature 39.8° C (103.8° F) Arterial Blood Gases pH 7.29 PaCO2 54 mm Hg HCO3 24 mEq/L PaO2 60 mm Hg What effect would these alterations have on the oxyhemoglobin curve and oxygen saturation? A. A shift to the right and arterial oxygen saturation (SaO2) greater than 90% for the PaO2 of 60 mm Hg B. A shift to the left and SaO2 greater than 90% for the PaO2 of 60 mm Hg C. A shift to the left and SaO2 less than 90% for the PaO2 of 60 mm Hg D. A shift to the right and SaO2 less than 90% for the PaO2 of 60 mm Hg Correct Answer This patient has hyperthermia and acidosis. Both of these cause a shift in the oxyhemoglobin dissociation curve to the right. Shift to the right causes a lower saturation for a given PaO2 because of a lower affinity between oxygen and hemoglobin. Though a PaO2 of 60 mm Hg usually is associated with an oxygen saturation of 90%, this patient would have a saturation of less than 90% for the PaO2 of 60 mm Hg. When the curve is shifted to the right, affinity is decreased. This means that the pickup of oxygen at the lung level is impaired but drop-off at the tissue level is improved. A shift of the curve to the left improves pickup of oxygen at the lung level but impairs drop- off at the tissue level. A 70-kg male patient with acute respiratory failure is being weaned from mechanical ventilation using the intermittent mandatory ventilation (IMV) method. Ventilator settings and current arterial blood gas results are as follows: Ventilator Settings Arterial Blood Gases Fraction of inspired oxygen, 0.35 pH, 7.29 Tidal volume, 700 mL HCO3, 22 mEq/L IMV, 4 breaths/min PaCO2, 52 mm Hg PaO2, 96 mm Hg The patient has copious secretions. Before suctioning the patient's endotracheal tube, the nurse should adjust the vacuum pressure so that it is: A. as high as necessary. B. 100 mm Hg of vacuum. C. 60 mm Hg of vacuum. D. 10 mm Hg below the systolic blood pressure. Correct Answer 100 mm Hg of vacuum. Using a suction level as high as necessary certainly could increase trauma to the tracheobronchial tree. Pressure as low as 60 mm Hg would be unlikely to clear copious secretions. This pressure has nothing to do with systolic blood pressure. A 24-year-old woman is admitted with a closed head injury after a fall from a cliff. She is less responsive and has a nonreactive dilated right pupil. These signs suggest pressure in which area of the brain? A. Right hemisphere B. Left hemisphere C. Cerebellum D. Hypothalamus Correct Answer Right hemisphere CN III controls pupil constriction. Hemispheric pressure on this nerve will result in a dilated pupil on the same side as the pressure. A 29-year-old woman has been a patient in the critical care unit for 2 weeks with acute tubular necrosis (ATN) as a result of crush You want to avoid impairing the movement of air out of the chest because a tension pneumothorax might occur. However, you do want to impede the movement of air into the chest. You would never reinsert a contaminated chest tube back into the chest. Which aspect of assessment is the most important in a patient with a platelet count of 10,000/mm3? A. Skin assessment for petechiae and ecchymosis B. Level of consciousness C. Blood pressure D. Urine output Correct Answer Level of consciousness Monitor for cerebral hemorrhage In patients predisposed to stress ulcer, the goal of therapy is to keep gastric pH: A. Less than 3 B. Between 3.5 and 5 C. Between 5 and 6.5 D. Above 7 Correct Answer Between 3.5 and 5 Hydrochloric acid has a pH of 1.0 to 3.0. Making the gastric secretions less acidic by using histamine2 receptor antagonists (e.g., ranitidine), proton-pump inhibitors (e.g., pantoprazole), and antacids decreases the caustic nature of the secretions and decreases the risk of stress ulcer. True alkalinization (pH greater than 7) is not desirable because it would allow proliferation of bacteria. The desirable gastric pH in prevention of stress ulcer is between 3.5 to 5. Which of the following is the most common form of bifascicular block? A. Left bundle branch block B. Right bundle branch block and left anterior hemiblock C. Right bundle branch block and left posterior hemiblock D. Left anterior and left posterior hemiblocks Correct Answer Right bundle branch block and left anterior hemiblock The three fascicles of the intraventricular conduction system are the right bundle branch, the left anterior branch of the left bundle branch, and the left posterior branch of the left bundle branch. The left anterior branch of the left bundle is long and thin and is blocked more often than the left posterior branch. A right bundle branch block along with a block of the left anterior branch of the left bundle branch (called a left anterior hemiblock) is the most common form of bifascicular block. Which of the following is the most common cause of heart failure? A. Aging B. Diabetes mellitus C. Coronary artery disease D. Hereditary factors Correct Answer Coronary artery disease Which of the following assessment findings is specific to hemothorax rather than pneumothorax? A. Chest or shoulder pain B. Diminished or absent breath sounds C. Tachypnea D. Dullness to percussion Correct Answer Dullness to percussion Pneumothorax is hyperresonant or even tympanic to percussion, and hemothorax is dull to flat. Options a, b, and c would be seen in both. Klebsiella C. Streptococcus D. Staphylococcus Correct Answer Streptococcus causes rust- colored sputum. Staphylococcus is likely to cause sputum to be pinkish. Pseudomonas is likely to cause sputum to be greenish. Klebsiella is likely to cause sputum to be currant-colored. What effect does oxygen have on pulmonary vasculature? What efect does hypoxemia have?? Correct Answer o2 is a potent vasodilator hypoxemia will cause vasoconstriction How to you calculate do2?? Correct Answer The DO2I is calculated as CaO2 (that is, SaO2 × Hgb × 1.34) × (CI × 10), What heart sound is anssociated with angina Correct Answer s4 (associated with decreased LV compliance - hypertrophy, ischemia) What is an s3 heart sound Correct Answer sound of rapid ventricle filling in an alrady fluid overloaded LV. (heart failure) Which vessel is used as a graft when the minimally invasive direct coronary artery bypass grafting (MIDCABG) procedure is performed? Correct Answer The internal thoracic (also called the internal mammary) artery is used for a MIDCABG. A 55-year-old patient has headache, nuchal rigidity, photophobia, and positive Kernig's and Brudzinski's signs. These are consistent with which of the following? Correct Answer When there is bleeding from an aneurysm, that blood irritates the meninges. The clinical presentation is very similar to meningitis. This clinical presentation is not consistent with intracranial, epidural, or subdural bleeding because the blood is not in contact with the meninges in those situations. (pick the bleed that touches the meninges. What often precipitates a worsening in guillan barre syndrome> Correct Answer viral illness - demylenates axons An S4 is an expected physical finding in which of the following? A. Acute myocardial infarction B. Left ventricular failure C. Pericarditis D. Bundle branch block Correct Answer remember that s4 is heard in a noncompliant ventricle. Noncompliance is caused by ischemia, infarction, hypertrophy, cardiac tamponade, constrictive pericarditis, or restrictive cardiomyopathy. Left ventricular failure would cause an S3. Pericarditis would cause a pericardial friction rub. Bundle branch blocks cause splits (left bundle branch block causes a paradoxical split of S2, and right bundle branch block causes a split of S1 and increased splitting of S2 during inspiration). What would be the best laboratory test to evaluate this patient's glomerular filtration rate (GFR)? Correct Answer urine creatinine clearance A patient is diagnosed with acute kidney injury (ARF) and is placed on fluid restrictions. The patient's total output for yesterday was 600 mL. Which of the following fluid volumes would be allowed for today? A. 300 mL B. 600 mL C. 1100 mL D. 1500 mL Correct Answer Fluid allowances for the patient with ARF are usually 500 mL for insensible loss added to the previous day's urine output. SOOO 1100. Which of the following would indicate right ventricular failure as a complication of inferior MI? A. Reflex tachycardia with an irregular pulse B. Diffuse crackles with shortness of breath C. ST elevation in right precordial leads, especially V4R D. A 22-year-old man is admitted to the intensive care unit after a motor vehicle collision. There are lacerations on his face and head. The nurse observes a steady drip of clear fluid coming from his left ear. Which of the following is an appropriate action to contain the drainage of cerebrospinal fluid (CSF)? A. Applying sterile ear packing B. Connecting low suction to the ear C. Applying loose sterile dressing D. Leaving ear uncovered Correct Answer It is important not to obstruct CSF flow because this could increase intracranial pressure. Introducing suction could cause bleeding, infection, or further structural damage. A 52-year-old woman developed an epidural hematoma after being in a motor vehicle collision. She has had a craniotomy to evacuate the clot, and an intraventricular catheter was placed during surgery. Which of the following is important in caring for the patient with an intracranial pressure (ICP) monitoring system? A. Use heparin to maintain integrity of the line. B. Use preservative-free isotonic saline. C. Use a flush system. D. Use a pressure bag. Correct Answer ICP monitoring systems are closed systems. A flush system with heparin and a pressure bag with an intermittent flush device is appropriate for vascular pressure monitoring (e.g., arterial catheters and pulmonary artery catheters) but not for intracranial pressure monitoring systems. Preservatives in saline vials can cause meningeal irritation or brain tissue necrosis. Only preservative-free saline should be used to prime the system. What part of the electrocardiographic waveform represents conduction through the atrioventricular node? A. P wave B. PR interval C. PR segment D. QRS interval Correct Answer The PR interval represents the time from the beginning of atrial depolarization to the beginning of ventricular depolarization. The PR segment is the time between the P wave and the QRS complex and represents the delay in the atrioventricular (AV) node. Which of the following drugs are used for first-line therapy for chronic management of hypertension? Correct Answer Diuretics and beta blockers Which of the following tests are used to differentiate the cause of jaundice? Correct Answer An increase in direct bilirubin is associated with biliary obstruction because direct bilirubin is conjugated. An increase in indirect bilirubin is associated with hepatic disease or excessive hemolysis because indirect bilirubin is unconjugated. what is the action of potassium in motility? Correct Answer hyper= hypermotility hypo=risk for ileus/hypomotility Describe causes of Guillan Barre Myesthenia gravis Correct Answer Guillan barre - demylenating MG - autoimmune versus acetocholine receptors Which of the following is the major advantage of minimally invasive direct coronary artery bypass grafting (MIDCABG)? A. Decreased cost B. Decreased length of stay C. Avoidance of cardiopulmonary bypass D. Less patient pain Correct Answer C - avoidance of cardiopulmonary bypass Dobutamine (Dobutrex) and nitroprusside (Nipride) D. Morphine sulfate and furosemide (Lasix) Correct Answer B - The answer would not be C, because nipride would to severely lower SVR and MAP Positioning for infratentorial carniotomy Correct Answer HOB flat! Which of the following best describes multiple organ dysfunction syndrome (MODS)? A. Progressive insufficiency of two or more organ systems B. Cessation of function of two or more organ systems C. Sepsis involving two or more organ systems D. Loss of function of two or more components of the same organ system Correct Answer A The definition does not require complete dysfunction, but more than 1 organ system needs to be involved. A 68-year-old woman is admitted with ischemic stroke. When the bottom of her foot is stroked, the great toe moves upward and the other toes fan out. This finding indicates which of the following? A. Upper motor neuron lesion B. Lower motor neuron lesion C. Brainstem lesion D. Normal finding Correct Answer A Upper do to stroke, and the babinski reflex is an UMN lesion always Your patient is in hepatic failure caused by chronic liver disease. She has ascites and severe peripheral edema. She is anorectic and vomiting and has developed metabolic alkalosis and hypokalemia. Which of the following would not be included in this patient's management? A. Diuretics B. Potassium supplements C. Antiemetics D. Diet high in protein Correct Answer Diuretics would worsen the metabloc alkolis and hypokalemia. The patient with liver failure does not have the appropriate proteins to pull water from the tissues into the vascular bed, thus diuretics would lose their effect in this situation. A diet high in protein would only be contraindicated if the patient had a decrease in mental status from the liver failure ( H ammonia levels) A 34-year-old man admitted with Pneumocystis carinii pneumonia asks the nurse what protective measures he should use at home to prevent transmission of human immunodeficiency virus (HIV) to family members. The best response would include which of the following? A. Wear a mask to protect the family members. B. Use plastic eating utensils and paper plates. C. Launder clothing and linens separately. D. Clean up body secretion spills with a weak chlorine bleach solution. Correct Answer D - throw out the extremes and remember than body secretions are the concern. I weak chlorine bleach will kill HIV RA, RV, PA, and PAOP pressure normals? What is a pressure for an optimally stretched wedge? Correct Answer SVC/RA = 0-6 mmHg (at this point inflate balloon with 1.5 mL of air) RV = 25/0 mmHg PA = 15-30/5-15 mmHg PAOP = 2-10 mmHg at 40-50 cm distance (if SCV/ IJ insertion) somewhere in the ballpark of 12-20 mmHg Which of the following accurately describes the normal difference between the pulmonary artery diastolic pressure (PAd) and the A 42-year-old woman is admitted with "the worst headache I've ever had." Computed tomography reveals an aneurysm in the circle of Willis. Vasospasm may be treated with which of the following? A. Fluid administration B. Loop diuretics (e.g., furosemide) C. Antifibrinolytic (aminocaproic acid [Amicar]) D. Osmotic diuretics (e.g., mannitol [Osmitrol]) Correct Answer Give fluids for treatment. Diuretics such as mannitol/lasix will excacerbate the problem with a hypovolemic state. antifibrin may cause re-bleeding and is not indicated for the treatment of vasospasm. A patient with which of these conditions would have a normal serum lactate? Why? A. Ventricular fibrillation B. Cardiogenic shock C. Severe anemia D. Renal failure Correct Answer Renal failure. Do not confuse metabolic acidosis to always having an elevated serum lactate. All 4 of these conditions will cause metabolic acidosis, however, renal failure acidosis will be caused by urea build up. A, B, and C metabolic acidosis will be caused by a decreased 02 delivery, a conversion of aerobic to anaerobic metabolism, and a rising serum lactate.