2024 CCRN Test Bank Exam: Critical Care Nursing Practice Questions, Exams of Advanced Education

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2024 CCRN TEST BANK EXAM

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A patient who has been on prolonged bed rest is now allowed to have physical therapy. Which is an indication of tolerance after 2 days of therapy? a) SvO2 58% b) HR 84 (resting HR 68) c) RR 24 d) SBP 140 mm Hg (resting SBP 118 mm Hg) - CORRECT-ANSWERSCorrect Answer: HR 84 (resting HR 68) The following are indications of tolerance to physical therapy: an SBP of 20 mm Hg over or under resting SBP, a RR less than or equal to 20 breaths/min, a HR less than or equal to 20 beats per minute over resting HR, and a SvO greater than or equal to 60%. When providing care to a patient with status epilepticus, the nurse should recognize that usually a) it is a state of continuous seizures lasting more than two minutes. b) it results from abrupt discontinuation of anti-seizure medications. c) the patient comes out of the post ictal state between seizures. d) the cause of death is due to cerebral hemorrhage. - CORRECT- ANSWERSCorrect Answer: it results from abrupt discontinuation of anti- seizure medications. Abrupt discontinuation of anti-seizure medications can cause continuous seizures or status epilepticus. In status epilepticus, the continuous seizures last at least five minutes. The patient remains in status epilepticus while in the post ictal state. The cause of death is usually related to cerebral hypermetabolism. REF: Urden LD, et al. 2018. The nurse is caring for a patient with hypercalcemia. For which imbalance should the nurse observe? a) hypoalbuminemia b) hypokalemia c) hyperphosphatemia d) hypermagnesemia - CORRECT-ANSWERSCorrect Answer: hypokalemia Hypokalemia accompanies hypercalcemia. In rare cases, an increase in albumin may cause a pseudohypercalcemia. Hypercalcemia leads to urinary

excretion of magnesium. Hypophosphatemia is associated with hypercalcemia. REF: Morton PG, Fontaine DK. 2018. Which is an advantage of pressure support ventilation? a) decreased muscular endurance b) decreased inspiratory flow c) decreased work of breathing d) decreased FiO2 - CORRECT-ANSWERSCorrect Answer: decreased work of breathing Pressure support ventilation assists spontaneous breathing efforts by delivering a high flow of gas early in inspiration and maintaining that level through the inspiratory phase. Specific uses of pressure support ventilation are to promote patient comfort and synchrony with the ventilator, decrease work of breathing necessary to overcome resistance of the endotracheal tube, and weaning. The patient's effort determines the rate, inspiratory flow and tidal volume. As a weaning tool, pressure support ventilation is thought to increase endurance of respiratory muscles by decreasing physical work and oxygen demands during spontaneous breathing. Because the level of pressure support can be gradually decreased, endurance conditioning is enhanced. Pressure support ventilation does not impact oxygen delivery or lead to decreased FiO Which is an endpoint of volume resuscitation? a) base deficit 4 mmol/L b) CVP 3 mm Hg c) CI 2.4 L/min/m d) oxygen consumption 250 mL/min - CORRECT-ANSWERSCorrect Answer: oxygen consumption 250 mL/min Oxygen consumption is the amount of oxygen used by the body; normal is approximately 250 mL/min. CVP below the normal range or at the lower end of normal and CI below normal range are not therapeutic endpoints for volume resuscitation. An elevated base deficit is not an indicator of adequate volume resuscitation. REF: Urden LD, et al. 2018. Which 12-lead ECG changes should be expected in a patient with ACS involving the inferior wall? a) ST segment elevation in leads II, III and all the precordial leads b) ST segment elevation and deeply inverted T waves in leads II, III and AvF c) ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL

d) ST segment depression and T wave elevation in leads II, III and AvL - CORRECT-ANSWERSCorrect Answer: ST segment elevation and deeply inverted T waves in leads II, III and AvF An inferior wall MI is associated with changes in leads II, III and aVF. ST segment elevation in leads V4-V6 and aVL are associated with an anterolateral MI. ST elevation in leads II, III, and all of the precordial leads are consistent with a lateral wall MI. ACS is not associated with changes in leads II, III and aVL. Leads I and aVL are the lateral leads. ST segment depression is indicative of ischemia or an NSTEMI. REF: Morton PG, Fontaine DK. 2018. When teaching a family member to perform an aspect of patient care, the nurse should understand that family members... a) learn best if shown a complex procedure all at once. b) are unaffected by the timing of teaching. c) learn unrelated tasks first. d) learn best if they perceive a need to learn. - CORRECT-ANSWERSLearn best if they percieve a need to learn; Family members learn best if they perceive a need to learn. This is consistent with adult learning theory. Establishing a "need to know" is an important first step for optimal educational efforts. The timing of education is important for an optimal outcome to be realized. Teaching unrelated tasks will not enhance learning and is a waste of the family's and provider's time. Learners are goal-oriented and want to make a connection between what they are being taught and the goal (skill or knowledge) needed to solve a problem. If they recognize the relevance of the task, they are more likely to be successful Which may cause the development of fixed pupils? a) hyperoxia b) olfactory damage c) hypothermia d) opiates - CORRECT-ANSWERSHypothermia; Hypothermia may cause fixed pupils. Hyperoxia (oxygen toxicity) does not result in fixed pupils. However, hypoxia may cause wide and fixed pupils due to midbrain damage. Opiates may cause pinpoint pupils, but they are not fixed. The olfactory nerve is responsible for the sense of smell.REF: Morton PG, Fontaine DK. 2018. Which places the older adult at greater risk for alcohol-induced disease? - CORRECT-ANSWERSUse of psychotropic drugs is a risk factor for older adults developing alcohol-induced disease. This is due to the synergetic effects of

psychotropic drugs and alcohol. Alcohol enhances the sedative effects of frequently used psychotropic drugs. Older adults have a slower metabolism, a smaller volume of body water, and a decrease in lean body tissue associated with aging. Following hip replacement surgery, an elderly patient with a history of diabetes, hepatic insufficiency and alcohol abuse has a postoperative course complicated by the development of a STAPHYLOCOCCUS infection at the surgical site. Which intervention has the highest priority? a) Anticipate a return to the operating room. b) Prepare the patient for wound closure. c) Apply negative-pressure wound therapy. d) Place the patient on strict isolation. - CORRECT-ANSWERSAnticipate a return to the operating room. The patient has risk factors (elderly, diabetes, alcohol and liver disease) and signs ( Staph infection) of necrotizing fasciitis. Necrotic tissue must be completely excised and explored to clean tissue and ensure the infection does not directly inoculate bone tissue. Strict isolation is not required as necrotizing fasciitis is not contagious. Negative-pressure wound therapy could be used once the wound has undergone debridement of necrotic tissue. Local and systemic infection must be completely controlled before wound closure is addressed.REF: Morton, P.G. & Fontaine, D.K. (2018). A patient has heart failure secondary to ischemic cardiomyopathy and end- stage coronary artery disease. Which agents would be the MOST beneficial? a) flecainide (Tambocor) and hydralazine (Apresoline) b) verapamil (Calan) and spironolactone (Aldactone) c) digoxin (Lanoxin) and diltiazem (Cardizem) d) carvedilol (Coreg) and lisinopril (Zestril) - CORRECT-ANSWERSCorrect Answer: carvedilol (Coreg) and lisinopril (Zestril) The patient has end-stage coronary artery disease causing systolic dysfunction. These drugs decrease afterload and minimize remodeling that is associated with heart failure. Calcium-channel blockers are contraindicated in heart failure. Digoxin may be used in heart failure. Spironolactone is given to block the aldosterone effect. Hydralazine is an alpha-blocker, which reduces afterload and is used in heart failure. Flecainide is contraindicated with structural heart disease. Which hemodynamic profile is MOST consistent with distributive shock? a) BP 88/44, CVP 15, PAOP 24, CI 1.5, SVR 1200, SvO2 47% b) BP 85/40, CVP 12, PAOP 20, CI 2.0, SVR 1445, SvO2 50% c) BP 84/42, CVP 3, PAOP 8, CI 2.5, SVR 475, SvO2 52%

d) BP 75/50, CVP 8, PAOP 8, CI 2.5, SVR 1500, SvO2 68% - CORRECT- ANSWERSCorrect Answer: BP 84/42, CVP 3, PAOP 8, CI 2.5, SVR 475, SvO 52% In distributive shock types (e.g., anaphylactic or neurogenic), there is a decrease in venous return, which causes a low CVP. Loss of vessel tone results in a decreased SVR. A higher CVP indicates a high preload. The SvO will be lower in shock states. The major effect of ARDS on lung tissue is - CORRECT-ANSWERSDecreased compliance Decreased compliance is related to alteration of lung endothelium and vascular tissue. Pathophysiologic changes in lung vascular tissue and increased lung edema contribute to the decrease in compliance. The end result is stiffness of the fluid-filled non-aerated airways. There is an increase in capillary permeability due to the release of cytokines and a decrease in functional residual capacity due to pathophysiologic changes in the lung. The inflammatory process of ARDS causes inactivation, destruction and decreased production of surfactant. This leads to increased surface tension at the alveolar air-fluid interface, which causes microatelectasis. Which PA catheter finding should be anticipated in a patient with chronic emphysema? a) increased CVP b) increased stroke volume c) decreased PAOP d) decreased CI - CORRECT-ANSWERSincreased CVP Emphysema can cause cor pulmonale secondary to increased pressure. Cor pulmonale is failure of the heart brought on by long-term high BP in the lung arterioles and RV. An increased CVP is a sign consistent with cor pulmonale. An abnormal CI is not a unique finding in patients with chronic emphysema. Cor pulmonale is characterized by increased pulmonary vascular resistance and right heart failure. It is associated with decreases in left ventricular filling pressure, left ventricular stroke work and cardiac output. Patients with COPD have increased PA systolic, diastolic and mean pressures secondary to increased pulmonary vascular resistance.REF: Urden LD. et. al. 2018. Which life-threatening dysrhythmia is most FREQUENTLY associated with heart failure? a) ventricular tachycardia b) bigeminy premature atrial contractions c) junctional tachycardia d) second-degree AV block, Type II - CORRECT-ANSWERSCorrect Answer: ventricular tachycardia

Low EF leads to stretch and excitability of the ventricles. Heart failure can result in electrolyte shifts from diuretic therapy, which can exacerbate ventricular tachycardia. Premature atrial contractions (PACs) are often single and isolated but may be frequent or occur in a bigeminal pattern. PACs are not life-threatening by themselves but may precede other dysrhythmias. Second-degree AV block, Type II is not associated with heart failure but is associated with an anterior wall MI. Junctional tachycardia is associated with digoxin toxicity but not with heart failure. A patient transferring out of the unit says, "Why can't I just stay a few days longer? I don't feel strong enough". Which is the MOST APPROPRIATE response?a) "There's a very sick patient who needs this bed." b) "You sound concerned about leaving the unit." c) "Your insurance limits the time you can stay in the unit." d) "Most people do just fine after transfer." - CORRECT-ANSWERSCorrect Answer: "You sound concerned about leaving the unit." Acknowledging that the patient may have concerns about leaving the unit is an example of Caring Practices. It encompasses creating a compassionate, supportive and therapeutic environment for the patient to express their concerns. Telling the patient there is a very sick patient who needs the bed or their insurance limits unit time is not addressing the patient's concerns and is not consistent with Caring Practices. Telling the patient that most people do fine after being transferred is not consistent with Caring Practices and provides false reassurance, which is not a component of therapeutic communication.REF: Hardin SR, Kaplow R. 2017. Which mechanism contributes to hypotension in sepsis? - CORRECT- ANSWERSCorrect Answer: peripheral vasodilation In sepsis, proinflammatory mediators circulate in high amounts. These mediators cause profound vasodilation and capillary leak, both of which result in hypotension. SVR (afterload) is low in sepsis due to vasodilation. Contractility is decreased in sepsis due to the release of myocardial depressant factor, one of the proinflammatory mediators released in sepsis. A patient with a history of angina is admitted to the unit after surgical repair of an AAA. The patient is receiving a sodium nitroprusside (Nipride) drip for severe postoperative hypertension. Twelve hours later, the patient complains of back pain. Assessment at this time reveals: BP 80/60HR 120UO 20 mL/hr +1 left dorsalis pedis pulse

+1 right dorsalis pedis pulse After notifying the provider of the change in the patient's condition, the nurse should anticipate which IMMEDIATE intervention? - CORRECT- ANSWERSCorrect Answer: discontinuation of Nipride and preparation for surgery Nipride must be discontinued because the patient is hypotensive. The patient is also demonstrating signs of postoperative bleeding/hypovolemic shock. A return to the operating room is indicated. Pulses are present, so there is no need for Doppler studies. Volume resuscitation is an acceptable intervention. Since the pulse pressure is normal, the patient is not manifesting signs of cardiac tamponade. A pericardiocentesis is not indicated at this time. Spiral CT is not a priority. IABP therapy is contraindicated in patients with a potentially ruptured thoracic aneurysm. Further afterload reduction is not needed at this time. The MOST IMPORTANT indicator to be used in monitoring the respiratory status of a patient with Guillain-Barre syndrome is - CORRECT- ANSWERSCorrect Answer: vital capacity. Guillain-Barré syndrome results in damage to myelin and adjacent axons that involve motor, sensory and autonomic nerves. If respiratory muscles are affected, a decrease in vital capacity can ensue, which may result in respiratory failure. While oxygen saturation may eventually decrease if the patient develops respiratory failure, it is not used to monitor the respiratory status of a patient with Guillain-Barré syndrome. Muscle paralysis is the main issue. Negative inspiratory force may become less negative with Guillain- Barré syndrome. However, this parameter is not used to monitor the patient's respiratory status. A patient's A-a gradient (or degree of the shunt) is not used to measure respiratory status. A patient with an AMI is in critical condition. His significant other has been at the bedside providing reassurance and support since his admission. His estranged wife arrives and demands that the significant other not be allowed to visit or be given condition updates. The nurse should.. a) ask the provider to write an order to allow the significant other to have visitation privileges. b) request a multidisciplinary care conference to discuss visitation and communication of patient status. c) contact the hospital's medical-legal department and request that the hospital attorney speak to the wife. d) encourage the patient to speak with his wife regarding his desire to spend time with his significant other. - CORRECT-ANSWERSCorrect Answer: request a multidisciplinary care conference to discuss visitation and communication of patient status.

This action is consistent with Caring Practices and high levels of patient Advocacy and Moral Agency. Collaboration with the multidisciplinary team is indicated to identify all relevant patient issues and have shared decision making based on all information and what is best for the patient. The other options are not consistent with caring practices or being a patient advocate. A provider's order or calling the legal department is not required in this scenario. Encouraging the patient to speak with his wife puts the patient in the middle of the controversy and will not optimize the patient's outcomes.REF: Hardin SR, Kaplow R. 2017. In a patient with ARDS, which contributes to the development of atelectasis? a) loss of surfactant and interstitial fluid accumulation b) increased pulmonary compliance and hypoxemia c) decreased pulmonary vascular resistance and hypoxemia d) mucosal edema and mucus plugging - CORRECT-ANSWERSCorrect Answer: loss of surfactant and interstitial fluid accumulation ARDS results in loss of surfactant from interstitial fluid accumulation caused by alteration of lung endothelium and vascular tissue. Changes in lung vascular tissue and increased lung edema contribute to the decrease in compliance. ALI is characterized by diffuse alveolar damage and is often complicated by pulmonary hypertension. Pulmonary vascular resistance is elevated in ALI, which results in decreased pulmonary compliance related to alteration of lung endothelium and vascular tissue. Pathophysiologic changes in lung vascular tissue and increased lung edema contribute to the decrease in compliance. The end result is stiffness of the fluid-filled non-aerated airways.REF: Morton PG, Fontaine DK. 2018. An adolescent patient with acute leukemia has undergone multiple rounds of chemotherapy. One night, the patient tells the nurse, "I'm tired of all the chemo and I want to stop, but no one is listening to me. " The nurse should... a) ask the patient, "Do you realize you could die if you stop chemotherapy?" b) encourage the patient to "express these feelings to your family." c) arrange for the patient to discuss the treatment plan with the providers. d) explain that adolescent patients cannot legally make healthcare decisions

• CORRECT-ANSWERSCorrect Answer: encourage the patient to "express these feelings to your family." The patient's thoughts are critical in the decision-making process. Although the parents may have legal say, adolescents want to be involved in decision making - including the decision not to be treated. Exploring the reasons for

the patient's decision is important. Explaining that adolescent patients cannot legally make healthcare decisions is not consistent with Caring Practices. It is not addressing the patient's concerns. Further, the patient has the capacity to make healthcare decisions. Parental consent may be required from a legal standpoint, but the patient's thoughts are critical in the decision- making process. Arranging for the patient to discuss the treatment plan with the provider may need to occur but does not specifically address the patient's issues. Asking the patient if they realize they could die if they stop chemotherapy would not be an effective strategy, as adolescents do not believe anything bad will ever happen to them, in part because their frontal lobe is not yet fully developed. A patient in a HHS is being admitted with dehydration and a serum glucose level of 836 mg/dL. Which additional laboratory findings should the nurse anticipate? - CORRECT- ANSWERSCorrect Answer: elevated BUN, elevated creatinine, elevated serum osmolality A typical presentation of HHS includes elevations in BUN and creatinine levels resulting from hypovolemia. Serum osmolality greater than 320 mOsm/kg distinguishes HHS from DKA. In HHS, BUN, creatinine and serum osmolarity are elevated. REF: Urden, L.D., et. al. 2018. Which signs are characteristic of diabetes insipidus? a) increased urine output, elevated serum osmolality, hypernatremia, and low urine sodium b) increased urine output, low serum osmolality, hyponatremia, and low urine sodium c) low urine output, low serum osmolality, hypernatremia, and elevated urine sodium d) low urine output, low serum osmolality, hyponatremia, and low urine sodium - CORRECT-ANSWERSCorrect Answer: increased urine output, elevated serum osmolality, hypernatremia, and low urine sodium Diabetes insipidus results from inadequate antidiuretic hormone (ADH), which causes more water and sodium to be absorbed. The renal tubules and collecting ducts are impermeable to water, causing excretion of large volumes of dilute urine and a rise in serum osmolality and sodium, all of which result in dehydration.REF: Morton PG, Fontaine DK. 2018. Which set of lab data is consistent with a diagnosis of diabetes insipidus? a) decreased serum ADH, increased serum osmolality, serum Na 150 mEq/L b) increased serum ADH, decreased serum osmolality, serum Na 140 mEq/L

c) increased serum ADH, increased serum osmolality, serum Na 130 mEq/L d) decreased serum ADH, decreased serum osmolality, serum Na 160 mEq/L

• CORRECT-ANSWERSCorrect Answer: decreased serum ADH, increased serum osmolality, serum Na 150 mEq/L In diabetes insipidus, serum ADH level is decreased, serum osmolality is greater than 300 mOsm/kg, and serum sodium is greater than 145 mEq/L.REF: Morton PG, Fontaine DK. 2018. A patient is confused about time and place, despite frequent reorientation. For the patient's safety, the nurse should INITIALLY: a) administer a mild sedative. b) put a vest restraint on the patient. c) increase the frequency of observation of the patient. d) ask a family member to stay with the patient. - CORRECT- ANSWERSCorrect Answer: increase the frequency of observation of the patient. This intervention is consistent with Caring Practices. Disorientation to time and place initially requires increased observation to determine if the patient is a safety risk. The use of a restraint should be considered only when all other measures to keep the patient safe have been exhausted. The nurse cannot assume a family member will be available to stay with the patient at all times. Family presence at all times may not be indicated. Sedation is considered a chemical restraint and would not be the initial intervention indicated in this situation.REF: Hardin SR, Kaplow R. 2017.