AACN Critical Care Registered Nurse (CCRN) 2024 Exam Review Questions and Answers, Exams of Nursing

Download AACN Critical Care Registered Nurse (CCRN) 2024 Exam Review Questions and Answers and more Exams Nursing in PDF only on Docsity! AACN Critical Care Registered Nurse (CCRN) 2024 Exam Review Questions and Answers 100% Pass A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and complains of a headache and nausea. He reports he ran out of blood pressure meds three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach? - Answer>> Rapidly lower the diastolic pressure to 100 with IV antihypertensive meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive meds. The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure. A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this intervention is having it's intended effect? - Answer>> ScvO2 of 72% Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%, and urine output greater than 0.5 kg/hr 72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet count decreased significantly to 43,000 and was found to have new DVT on his right upper extremity. What do you suspect is the most likely cause of these findings? - Answer>> HIT The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period (>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new development of DVT despite being on VTE prophylaxis. TRALI: - Answer>> is a complication from a blood transfusion reaction, which causes acute lung injury typically within 6 hours of a blood transfusion. 2 Hallmark signs of HIT: - Answer>> Decrease in platelet count over a 24 hr period. New development of DVT despite being on VTE prophylaxis. Values in Early compensated Hypovolemic shock? - Answer>> CO 4.0 L/min, HR 135, SV 65, SVR 1700, MAP 65 In hypovolemic states, circulating volume is depleted therefore preload and contractility are decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure to preserve CO, MAP and cerebral perfusion. Post-renal failure values: - Answer>> Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1.010 BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is typically 1-40 mEq/L. What to do in the event of HIT: - Answer>> Stop Heparin and administer an alternative direct thrombin inhibitor. Warfarin is contraindicated in HIT? T/F - Answer>> True - there is also no evidence that shows protamine, corticosteroids, and benadryl are effective treatments for HIT Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs of what? - Answer>> Cardiac tamponade A patient with hyponatremia would need what? - Answer>> Help maintaining a safe environment. HypoNa impairs judgment, and causes confusion. Peritoneal dialysis works on the principles of both? - Answer>> Diffusion and osmosis. HHNS leads to what? - Answer>> Large fluid deficits and may require multiple liters of fluid, which is determined by the patient's level of dehydration and hyperosmolality. What parameters are consistent with Pulsus Paradoxes? - Answer>> Decrease in SBP>10 during inspiration. Before administering rtPA what must happen? - Answer>> Lower the BP to at least 185/110. An elevated BP prior to rtPA can cause hemorrhage. Ibutilide can cause what? - Answer>> Torsades A person with disecting AAA would receive what drug? - Answer>> PRN IV narcotic analgesia - BP management is a priority in the care of a patient with a dissecting AAA. Pain is the primary driver of HTN. Autonomic hyperreflexia is what? - Answer>> This disorder is seen with spinal injuries occurring above the T6 spine. Cause of autonomic hyperreflexia? - Answer>> Bladder obstruction, constipation, pressure ulcers, and pain. Usually when the noxious stimulus is identified and removed, the symptoms resolve. Checking urinary catheter for obstruction is the most appropriate next action. MEDS for asymptomatic left ventricular systolic dysfunction? - Answer>> ACE or (ARB), beta-blockers and statins for all patients with a history of MI and for all patients with a reduced ejection fraction. What is the Z point technique? - Answer>> is a method used to estimate ventricular end diastolic pressure. It is taken just before the closure of the mitral valve and is especially useful when an A wave does not exist on the PAOP tracing such as in atrial fib. Ascites position for relief? - Answer>> Place pt on left side. DIC lab values? - Answer>> Fibrinogen decreased FSP elevated Platelets decreased D-dimer elevated Decreased Albumin is an indicator of what? - Answer>> Protein deficiency and poor nutrition, which are major contributors to poor wound healing. A continous infusion of Lorazepam for greater than 3 days can lead to an accumulation of? - Answer>> Propylene glycol. Inability to communicate in full sentences may be a sign of what? - Answer>> Severity of asthma (high risk) Management of high ICP includes? - Answer>> Osmotic diuretics, hypertonic saline & antihypertensives. Causes increased left atrial pressure during atrial contraction - results in a larger than normal A wave on the PAOP tracing? - Answer>> Mitral Stenosis Pulmonary htn will result in elevated PA pressures but have no impact on? - Answer>> PAOP Elevated urine osmolality; decreased serum osmolality; decreased serum sodium? - Answer>> SIADH Absolute contraindication for thrombolytic therapy? - Answer>> Aortic dissection Crackles in bilateral lower lobes and a s3 heart sounds are indicative of what? Tx? - Answer>> Fluid overload Furosemide 40 mg IV x 1 now Narrow pulse pressure - CO 3L/min, HR 135, SV 30, SVR 2100 are all signs of what? - Answer>> Cardiogenic shock HUS is marked by what? - Answer>> Renal failure Thrombocytopenia & hemolytic anemia DIC lab values? - Answer>> Decreased Fibrinogen FSP elevated Platelets decreased This is secondary to the increase in cerebral metabolism and oxygen consumption Low volume ventilation, less than 10 mL/kg to minimize what? - Answer>> Pneumothorax - over inflation can cause volutrauma, which can lead to a spontaneous pneumothorax. Decreased right atrial pressure (RAP/CVP) could be caused by? - Answer>> Sepsis High pressure alarm on ventilator is commonly caused by? - Answer>> secretions or increased resistance in the airways. Major abdominal surgery may cause which pulmonary complication? - Answer>> Atelectasis - tx would be pulmonary hygiene and chest x-ray What would minimize pancreatic stimulation? - Answer>> Begin feedings via jejunal route - enteral feedings are preferred. Utilization of jejunal feedings maintain gut integrity and minimize pancreatic stimulation. QRS complex is upright in both leads? Negative deflection in both leads depicts an extreme? Negative QRS deflection in Lead 1 and positive deflection in Lead aVF are associated with? - Answer>> Axis is normal Extreme Right axis deviation Right axis deviation Priority data to collect for delirium and changes in QTc? - Answer>> CAM-ICU and 12 lead ECG Pacemaker setting in A-fib? - Answer>> VVI Atria cannot be paced when in atrial fibrillation Alpha cells produce? Beta cells? Delta cells? - Answer>> Glucagon Insulin Somatostatin Serum Osmolality of 320 is indicative of: - Answer>> DI - profound dehydration will lead to an elevated serum osmolality because of water loss. Contraindications of rtPA include: - Answer>> Gastro or other bleeding complications (within 3 months) First sign of problems from a shunt include: - Answer>> change in LOC or mental status Ominous sign of acute asthma exacerbation: - Answer>> Hypercapnia or elevated PaCO2 indicates patient is becoming fatigued and going into acute respiratory failure. Nephrogenic DI would cause what? - Answer>> the kidneys not respond to ADH Lactated ringers at 100ml hr before and after procedure is often prescribed to prevent what? - Answer>> Contrast induced nephropathy Keeping the TV (tidal volume) low is the best way to decrease pressures and avoid what? - Answer>> Barometric trauma in ARDS Which of the following parameters most accurately estimates end- organ perfusion? - Answer>> Urinary output, lactate, ScvO2 Aortic stenosis cause increased noise during systole and impaired outflow, leading to: - Answer>> Pulmonary edema and crackles. Tx for neurogenic shock? - Answer>> Vasoconstrictor (phenylephrine) over large volume of fluid resuscitation Liver failure labs: - Answer>> Elevated bilirubin Decreased albumin elevated PTT, PT & INR When the liver fails: - Answer>> ammonia levels build causing encephalopathy. Bilirubin levels rise causing jaundice and coagulation times often prolong putting patient at risk for bleeding. Patients with HIT may develop: - Answer>> Thrombosis, DVT, PE, STROKE, MI, Renal impairment Vancomycin has a risk of nephrotoxicity and RN should monitor which lab value: - Answer>> Elevated serum creatinine tachycardia, tachypnea, and left shoulder pain indicates possible what: - Answer>> Anastomotic leak Intubation: FiO2 < 60% Maintain plateau pressures <30 Maintain Tidal volume < 8 - Answer>> Goals for ventilated pts. Position with the HOB 30 degrees with midline neck alignment: - Answer>> First line therapy for optimizing cerebral perfusion. Is Serum osmolality elevated or decreased in DI? - Answer>> Elevated due to volume loss - the urine will be dilute (decreased urine osmo) and hemoconcentration with increased sodium levels. Beta Blockers, ACE, & Aldosterone antagonists are used for: - Answer>> Heart failure pts. Right BBB & 2nd TYPE 2 heart block: - Answer>> Located in Bundle of HIS and R bundle branch are located in anterior wall, so both of these may be affected in anterior MI. Side effect of dexamethasone: - Answer>> decreased potassium and calcium levels, hypoglycemia, and myopathy that results in proximal muscle weakness. Ablify, haldol, seroquel, and droperidol can cause what? - Answer>> QT prolongation Which electrolyte is affected with hypothermia: - Answer>> Hypokalemia Cardiac tamponade is a risk after what? - Answer>> discontinuation of epicardial pacing wires. Signs include decreased cardiac output, increased preload and intra-cardiac pressures, and decreased contractility. hyperglycemia, hypocalcemia and hypokalemia are r/t to pancreatitis? - Answer>> True DIC lab values: - Answer>> Decreased fibrinogen Increased D-dimer Decreased platelets Tx for heart failure: - Answer>> Positive inotropic agents, diuretics & vasodilators ARDS tx: - Answer>> High levels of PEEP & low tidal volume What is the best indicator for neurogenic shock? - Answer>> Bradycardia Low cardiac output and hypotension are consistent across shock states. Gold standard of care for acute coronary syndrome? - Answer>> PCI PCI should be completed within 90 mins for STEMI and 24 hours for NTE-ACS. If not possible to get patient in cath lab within 90- 120 mins, fibrinolytics should be considered. Tx for metabolic syndrome: - Answer>> reduce the risk of coronary artery disease and the secondary goal is to treat or prevent the onset of type 2 diabetes. Risk factors for developing acute kidney injury: - Answer>> HTN/PAD/Diabetes Epidural hematoma are associated with what kind of skull fx: - Answer>> Arterial in origin and with a linear skull fracture ABG reveals pH 7.22, PaO2 42, PaCO 56, HCO3 28 - what is highest priority? - Answer>> Increase PEEP Which arrhythmia is commonly associated with chronic left sided heart failure? - Answer>> A-fib 2nd degree type II and 3rd degree av block are complications associated with occlusion of the left anterior descending artery during acute coronary syndrome. Which set of lab values are consistent with a patient with HHS? - Answer>> Anion gap 10 Urine ketones: negative Serum potassium: 4.3 Blood glucose 1050 Tongue swelling and difficulty breathing. You should anticipate? - Answer>> Epi: 0.3 mg IM Not Epi: 1mg IV A patient with chronic, severe mitral insufficiency is prone to which of the following dysrhythmias? - Answer>> A-fib A medication regimen for a patient with hypertrophic Cardiomyopathy would include? - Answer>> CCB & Beta blockers A pt with 3 vessel CABG with PA catheter in place. Pt has crackles in bilateral bases, s3,s4 heart sounds are audible, in addition to holosystolic murmur. The nurse suspects mitral valve insufficiency. Which set of data confirms this suspicion? - Answer>> CVP elevated PA pressure elevated PAOP elevated As mitral regurgitation develops blood moves back into the right atrium from the left ventricle. This in turn causes an increase in left atrial pressure, pulmonary artery pressure, and cvp pressure. Pt with traumatic brain injury, what intervention should you include to prevent an increase in ICP? - Answer>> Keep patient's head in a neutral midline position. You are caring for a patient with an acute episode of asthma exacerbation. The first line of treatment is: - Answer>> beta 2 agonist - immediate tx of asthma exacerbation is to bronchodilate the airways to facilitate ventilation. Beta 2 agonists such as albuterol are a mainstay in the management of asthma and can be administered via nebulizer if needed. Which of the following would be expected in a patient experiencing herniation & Cushing's triad? - Answer>> Wide pulse pressure, bradycardia, increased systolic pressure Medication to treat hyperactive delirium? - Answer>> Haloperidol An increase in PEEP complication? - Answer>> A decrease in the RAP Patient is at risk for decreased right atrial filling and decreased cardiac output due to an increased intrathoracic pressure. Any time PEEP is increased, watch for signs of decreased cardiac output resulting from decreased venous return. Elevated P2 waves in an ICP waveform are a sign of: - Answer>> Increased intracranial pressure The P2 wave of an ICP occurs just after systole and indicates the compliance of the brain, or it's ability to respond to pressure. P2 should be lower than P1; elevation indicates decreased compliance due to increased ICP The benefit of the TIPS procedure is: - Answer>> Relieve portal venous pressure Which of the following heart block complications would you monitor for in the setting of an anterior wall MI? - Answer>> 2nd degree Type II Which of the following is indicated during the embolization of an AV malformation? - Answer>> Heparin - anticoagulation will prevent clot formation. A patient was 48-hours post aortic valve replacement. Which of following would be a major goal for this patient? - Answer>> Prevent thrombus - clot formation on the valve is a major complication of valvular replacement, especially a mechanical valve. Pt has cardiogenic shock and cardiogenic pulmonary edema. Which of the following therapies would be most effective for this patient? - Answer>> Ventricular assist device to increase coronary artery perfusion. Beta blocks to what for cardiac contractility? - Answer>> Decrease What does Plateau pressure measure? - Answer>> It reflects lung pressure and is needed to calculate static (lung) compliance. Salicylate overdose treatment? - Answer>> Activated charcoal, urine alkalization, dialysis. Pericardial friction run would show what on an 12 lead EKG? - Answer>> ST elevation in II, III, aVF, and V2-V5 The doc asks the nurse to determine the capture threshold. Which of the following should the nurse do? - Answer>> Slowly decrease the mA output until the capture is lost. A pt with ARDS needs to receive how many ml/kg of tidal volume? - Answer>> 4-5ml/kg tidal volume in order to prevent volutrauma. A lower respiratory rate will help provide this. Short expiratory time, PEEP, and larger tidal volumes will all promote air trapping or auto peep. Thus increasing intrathoracic pressure and reducing cardiac output. Which of the following is an appropriate strategy when providing mechanical ventilation for the patient with status asthmaticus? - Answer>> Use lower respiratory rates A patient is admitted with serum calcium of 15.1 mEq/L. Which of the following interventions should the nurse anticipate? - Answer>> Rule out hypokalemia, then administer diuretics.