CCRN EXAM QUESTIONS AND ANSWERS, Exams of Nursing

Download CCRN EXAM QUESTIONS AND ANSWERS and more Exams Nursing in PDF only on Docsity! CCRN EXAM QUESTIONS AND ANSWERS A 59 year old male is admitted complaining of chest pain and dyspnea. ST elevation and T wave inversion were seen on the EKG in V2,V3 and V4. IV thrombolytic therapy was started in ED. Indications of successful reperfusion would include all of the following except: (A) pain cessation (B) decrease in CK or troponin (C) reversal of ST segment elevation with return to baseline (D) short runs of ventricular tachycardia - Answers -(B)Coronary artery reperfusion due to PCI or fibrinolysis results in an ELEVATION of creatinine kinase (CK) or troponin, not decrease. The theory is that the return of blood flow distal to the occlusion can result in 'reperfusion injury' of the muscle, elevating cardiac biomarkers. The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment elevation with return to baseline, short runs of ventricular tachycardia. Which of the following medication orders should the nurse question for the patient in question 1-reperfusion question-patient having an MI? (A) metoprolol (Lopressor) (B) aspirin (C) propranolol (Inderal) (D) heparin - Answers -(C) The patient in the scenario is having an acute anterior wall MI. A beta blocker is beneficial for an acute MI as these agents decrease the work of the heart and increase the threshold for ventricular fibrillation. Propranolol, although a beta-andrenergic blocker like metoprolol, is NOT a cardioselective beta blocker. It affects beta receptors in heart muscle AND lung tissue. Therefore, it is more likely to cause bronchoconstriction than a cardioselective beta blocker. The other 3- cardioselective beta blocker, antiplatelet, and anticoagulation-are indicated in an acute MI. . On the third day after admission for acute MI, a 67 year old male complains of chest pain and develops a fever. The pain is worse with deep inspiration and is relieved when he leans forward. There are nonspecific ST changes in the precordial leads of the EKG. The nurse anticipates that the patient will most likely need treatment for: (A) thoracic aneurysm (B) Dressler's syndrome (C) reinfarction (D) pleuritis - Answers -(B) The pain described in the scenario is typical of the pain caused by pericarditis. Dressler's syndrome is the pericarditis that may result after an acute MI. A patient is admitted to the CCU after a PCI with stent. Femoral sheath is in place, site is dry with no hematoma. He suddenly complains of severe back pain. Neck veins are flat with head of bed 30 degrees, heart sounds are normal. Vital signs are BP 78/48, HR 124 and RR 26. What should the nurse suspect? (A) cardiac tamponade (B) retroperitoneal bleeding (C) coronary artery dissection (D) acute closure of the stented coronary artery - Answers -(B) Retroperitoneal bleeding may cause signs of hypovolemia and hypovolemic shock as described in the scenario. It may be a complication of a PCI if the femoral artery is the access site during the procedure. Only this problem results in severe back pain; none of the other 3 choices results in back pain Your patient admitted with an NSTEMI develops acute shortness of breath, recurrence of chest pain, and a loud systolic murmur at the apex of the heart. Which of the following has most likely occurred? (A) the patient has developed acute mitral valve regurgitation (B) the patient has developed acute infarction (C) the patient has developed acute mitral wave stenosis (D) the patient has developed acute ventricular septal defect - Answers -(A) The location of the murmur, at the apex of the heart (midclavicular, 5th ICS), is one clue to this answer. In addition, regurgitation occurs when the valve should be closed and the mitral valve should be closed during systole. Mitral stenosis, choice (C), occurs when the mitral valve is open. Additionally, mitral stenosis cannot be acute, it develops gradually. If heart block develops while caring for the patient in question 1 (pt with an MI who went through reperfusion from PCI or fibrinolytic therapy), which of the following would it most likely be? (A) sinoatrial block (B) second degree, Type I (C) second degree, Type II (D) third degree, complete - Answers -(C) The patient is having an acute anterior MI, which is generally due to LAD occlusion. The LAD supplies the HIS bundle, which could result in a second-degree, type II heart block. The other 3 types are due to SA node or AV node ischemia, which generally occur with an RCA occlusion — interior wall MI. Appropriate drug therapy for dilated cardiomyopathy is aimed toward: (A) decreasing contractility and decreasing preload and afterload (B) decreasing contractility and increasing preload and afterload (C) increasing contractility and increasing both preload and afterload (D) increasing contractility and decreasing both preload and afterload - Answers -(D) Dilated cardiomyopathy is likely to result in systolic dysfunction, which decreases contractility, causes compensatory arterial constriction , and results in a higher left ventricular preload. To treat this, therapy is aimed at increasing contractility, decreasing afterload (arterial constriction), and decreasing preload that is too high.😃 An 18 year old is admitted with a history of syncopal episode at the mall and has a history of an eating disorder. The nurse notes a prolonged QT on the 12-lead EKG and (B) ventricular septal defect (C) acute mitral stenosis (D) acute reinfarction - Answers -The scenario describes an acute anterior STEMI, generally caused by an occlusion of the LAD. This type of MI is most likely to result in a VSD. Additionally, the location of the murmur is important. Mitral valve disease-related problems do NOT cause murmurs to be loudest at the left sternal border, whereas a VSD would result in a murmur at this location. A postoperative patient on the surgical unit suddenly develops chest pain, extreme weakness, and dyspnea and is found to have ST elevation in II, III, and aVF on the stat EKG. B/P is 92/62, heart rate 58, respiratory rate 28, lungs are clear, and heart sound assessment reveals an S4, no murmurs. In addition to preparing the patient for PCI, which of the following interventions would you anticipate? (A) nitroglycerin drip, aspirin (B) furosemide, atropine (C) transcutaneous pacing, morphine (D) aggressive fluid administration, right-sided EKG. - Answers -(D) The scenario describes a patient having an acute inferior STEMI, generally due to RCA occlusion. An RCA occlusion may result in RV infarct, which this patient has signs of (hypotension with clear lungs). The definitive treatment is emergent PCI. Fluid administration will help increase coronary artery perfusion by correcting hypotension and ensure adequate RV preload. The right-sided EKG may help confirm the RV infarct. Nitroglycerin, diuretics, and morphine may decrease preload, which would worsen hypotension. A 52 year old male presents with complaints of blurred vision and shortness of breath. B/P is 232/136, heart rate 102, respiratory rate 28 with crackles in lower lung fields bilaterally, with S3 and S4 heart sounds on auscultation. Which of the following would be indicated for this patient? (A) nitroprusside drip, admit to critical care unit (B) digoxin, furosemide (C) labetalol drip, admit to a medical unit (D) lisinopril, calcium channel blocker - Answers -(A) The patient has signs of organ dysfunction (heart failure) secondary to extreme hypertension. Therefore, he has hypertension crisis or emergency. The B/P needs to be emergently decreased. Most often this treatment is best done in an ICU. An 80 year old female presents with chief complaint of acute shortness of breath. Clinical exam reveals B/P 182/102, heart rate 105/minute, respiratory rate 32/minute, lungs with crackles bilaterally, pulse oximetry of 88%, S4 on auscultation. EKG revealed sinus tachycardia, left ventricular hypertrophy pattern, chest radiograph showed normal heart size, pulmonary vascular congestion, and echocardiogram showed EF of 55%. Which of the following should be avoided in this patient's treatment plan? (A) calcium channel blocker (B) digoxin (C) low-dose diuretics (D) oxygen - Answers -(B) The patient presents with signs of heart failure due to diastolic dysfunction (hypertension, left ventricular hypertrophy, EF > 40%). These patients have a problem with FILLING, not ejecting. Digoxin, a positive inotrope, may increase wall stress and worsen filling of the left ventricle.😳 Mrs. Jones has heart failure. 😩 Despite optimal therapy, she gets short of breath when she gets up to walk to the bathroom. Which of the following is the patient experiencing regarding heart failure? (A) NYHA Class I heart failure, may benefit from an ICD (B) NYHA Class II heart failure, may benefit from an ICD (C) NYHA Class III heart failure, may benefit from an ICD (D) heart failure cannot be classified, further information is needed - Answers -(C) The patient has symptoms with minimal activity, which describes NYHA Class III. This would qualify her for an ICD. When the above patient, Mrs. Jones, has an exacerbation of her heart failure (Class III), she develops jugular venous distention (JVD), peripheral edema, and abdominal discomfort. These are clinical signs specific to: (A) acute left ventricular failure (B) chronic right ventricular failure (C) acute right ventricular failure (D) chronic dehydration - Answers -(B) The signs described are those of chronic right- sided heart failure. Acute right ventricular failure may result in JVD but not peripheral edema or abdominal discomfort (which is due to liver engorgement). The nurse managing a post-op CABG patient assesses a sudden drop in B/P, distended neck veins, muffled heart tones, minimal chest tube of output, and a systolic pressure that fluctuates with breathing pattern. The patient most likely needs: (A) emergent return to the OR (B) clamping of the chest tube (C) transfusion of RBC's (D) high-dose dopamine - Answers -(A) The signs described in the scenario are those of cardiac tamponade. The treatment for cardiac tamponade for the post-op open heart is the return to the OR to drain the pericardial fluid that has accumulated. Development of the problem in other patient population would necessitate an emergent pericardiocentesis to drain the fluid. Physical assessment findings indicative of a significant right ventricular (RV) infarction would include: (A) bibasilar crackles (B) flat neck veins with the patient in a Semi-Fowler's position (C) jugular vein distention (D) tachypnea and frothy sputum - Answers -(C) A right ventricular infarction large enough to cause RV failure causes a problem with RV emptying, leading to an elevated right atrial pressure causing distended jugular vein distention. Choices (A) and (D) are signs of left ventricular failure. Voice (B) is a sign of dehydration What pulse change might the nurse expect associated with cardiac tamponade? (A) pulsus alternans (B) pulsus paradoxus (C) pulsus magnus (D) pulsus bisferiens - Answers -(B) Pulsus paradoxus is fluctuation of the systolic blood pressure with inspiration and expiration by more than 12 mmHg, best seen when an arterial line is in place. Inspiration increases thoracic pressure. When combined with fluid surrounding the heart in cardiac tamponade, inspiration further decreases venous return to the heart, leading to drop systolic pressure by > 12 mmHg during the inspiratory phase of breathing. Choice (A) pulsus alternans is characterized by a change in amplitude of the systolic waveform from beat to beat, usually indicative of severe left ventricular failure. Choice (C), pulsus magnus, is a bounding pulse. Choice (D), pulsus bisferiens, is a double pulse and is not covered by the CCRN test. A patient with mitral regurgitation develops atrial fibrillation with a rate of 88, B/P of 118/75. Which of the following may be indicated? (A) beta blockers and vasopressors (B) cardiac glycosides and calcium-channel blockers (C) beta blockers and calcium-channel blockers (D) antiarrhythmics and angiotensin-converting enzyme inhibitors - Answers -(B) The scenario describes development of atrial fibrillation with a controlled ventricular response and stable B/P. Even with a normal B/P, the development of atrial fibrillation drops the cardiac output by 20% to 25% due to a loss in "atrial kick" provided by normal sinus rhythm. A cardiac glycoside (such as digoxin) may be beneficial as it is a weak positive inotrope that may compensate for the loss of atrial kick and calcium-channel blockers will keep the rate controlled. Pressors are not needed in this case. Use of beta blockers and calcium-channel blockers would decrease the rate too much. ACE inhibitors would offer no benefit in this case. Which of the following are predominant signs of left ventricular systolic dysfunction? (A) pedal edema, ascites, hepatomegaly, weight gain, ejection fraction less than 40% (B) S4, bibasilar crackles, hypertension, ejection fraction greater than 40% (C) S3, frequent new cough, bibasilar crackles, ejection fraction less than 40% (D) hypertension, murmur, chest pain, weight gain, ejection fraction greater than 40% - Answers -(C) S3 heart sound in an adult is indicative of high left ventricular pressure, cough, and lung crackles are signs of pulmonary edema secondary to elevated left ventricular end-diastolic pressure (PAOP). The EF is less than 40% in systolic heart failure. The nurse was preparing a patient with the diagnosis of STEMI for a percutaneous coronary intervention (PCI). The monitor had previously shown normal sinus rhythm (NSR) and the B/P had been 128/78, chest pain improved from a "9" to a "2" on a 0-10 scale. The monitor alarm sounded, and the rhythm below (complete heart block) was observed by the nurse: What statement below is TRUE: (D) V5, V6, I, aVL - Answers -(D) V5, V6 represents the lower lateral wall of the left ventricle and I, aVL represents the high lateral wall of the left ventricle, supplied by the left circumflex artery in most of the population. Which of the following are symptoms of hypoglycemia? (A) Tachycardia and trembling (B) Bradycardia and diaphoresis (C) Anxiety and flushed dry skin (D) Flushed dry skin and tachycardia - Answers -(A) When the blood glucose drops, sympathetic stimulation occurs, (Symptoms are masked for the patient receiving beta- adrenergic blocker drugs). Flushed, dry skin is a sign of hyperglycemia. Which of the following is TRUE for a patient with a right-sided stroke who develops increased intracranial pressure? (A) pupils will change before level of consciousness, right-sided paralysis, eyes deviated to the left, left pupil change (B) pupils will change before level of consciousness, left-sided paralysis, eyes deviated to the right, right pupil change (C) level of consciousness will change before pupils, right-sided paralysis, eyes deviated to the left, left pupil change. (D) level of consciousness will change before pupils, left-sided paralysis, eyes deviated to the right , right pupil change. - Answers -(D) Higher brain centers (cerebral cortex) are the first to be affected by increased intracranial pressure. Therefore, level of consciousness is the first sign (one exception, epidural hematoma). Pupil changes are ipsilateral (same side as the injury) due to compression of cranial nerve III against the transtentorial notch. Motor changes are contralateral (opposite the side of injury) due to motor fiber crossing in the brain stem. Which of the following interventions would the nurse consider to be inappropriate for the patient with increased intracranial pressure? (A) maintaining oxygenation and normal PaCO2 (B) feeding the patient via an NGT (C) administering 5% dextrose in water (D5W) at 75 ml/hour (D) log roll when turning the patient - Answers -(C) 5% dextrose in water is a hypotonic solution. When administered, it will cause movement of the D5W into the brain cells, causing swelling and increased intracranial pressure. The other 3 choices are acceptable interventions for the patient with increased ICP. You know that research supports unrestricted access of a designated support person to the patient, but your unit restricts all patient visitors to set times. Your best response would be to: (A) gather the facts and propose a policy change to your manager for the unit (B) tell patients/visitors that the unit's policy is outdated but there is nothing you can do about it (C) continue to follow the unit policy (D) complain to colleagues about the unit's outdated policy. - Answers -(A) The AACN Synergy Model supports patient advocacy. Unrestricted access of a designated support person is evidence-based practice included in the Patient Visitation AACN Practice Alert. Choice (A) is an effective strategy for change. Your patient has just consented to a bedside chest tube insertion and requests that his wife be allowed to be present during the procedure. You should: (A) explain to the patient that this is against infection control practice (B) tell the patient he will be able to see his wife as soon as the procedure is completed (C) tell the patient it would be too much for his wife to handle (D) prepare the wife for what to expect and allow her to be present - Answers -(D) The AACN Synergy Model supports caring practice and family presence. An AACN practice alert indicates family presence may improve patient outcome. Which of the following laboratory findings are most specifically indicative of disseminated intravascular coagulation (DIC) as the cause of bleeding? (A) elevated fibrin split products and d-dimer (B) prolonged PT, PTT, and bleeding time (C) decreased platelet count (D) decreased hemoglobin and hematocrit - Answers -(A) DIC is a clotting problem, with massive coagulation. As clots break down, fibrin split products are produced. Therefore with DIC, FSPs will be high. In fact, this is the most specific test result for DIC. D-dimer is present due to the presence of clots. While not specific for DIC, it is a good rule-out test. A 29 year old female has been in the critical care unit for 2 days after a motor vehicle crash and has developed acute tubular necrosis (ATN). She was normotensive on admission. What would be the most likely cause of ATN? (A) hemorrhage (B) rhabdomyolysis (C) creatinine release (D) cardiac dysthymias - Answers -(B) The motor vehicle crash most likely resulted in a crash injury with destruction of skeletal muscle cells (rhabdomyolysis). This results in the release of massive amounts of creatinine kinase (CK) that, in turn, may CLOG renal tubules and lead to acute tubular necrosis (ATN). Choice (A) is not correct as there is no history of bleeding. Choice (C), creatinine release, is too vague, could be minor, and does not cause ATN. Arrhythmias, choice (D), are not included in the scenario.