ADULT CCRN CERTIFICATION MODULE 2 & 3 4 PRACTICE TESTS 2024, Exams of Nursing

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ADULT CCRN CERTIFICATION

MODULE 2 & 3

4 PRACTICE TESTS

1. A patient with cardiogenic shock is receiving dobutamine, a beta-1 adrenergic agonist, to increase cardiac output. Which of the following parameters should the nurse monitor closely to evaluate the effectiveness of this medication? a) Blood pressure b) Heart rate c) Central venous pressure (CVP) d) Pulmonary capillary wedge pressure (PCWP)* Rationale: PCWP reflects the left ventricular end-diastolic pressure and is a sensitive indicator of fluid status and cardiac function. A high PCWP indicates pulmonary congestion and impaired left ventricular function. Dobutamine aims to improve cardiac contractility and reduce PCWP. Blood pressure, heart rate and CVP are also important to monitor, but they are not as specific as PCWP for assessing the response to dobutamine.
2. A patient with septic shock is receiving norepinephrine, a potent vasoconstrictor, to maintain adequate perfusion pressure. The nurse notices that the patient's urine output has decreased and the serum creatinine has increased. What is the most likely explanation for this finding? a) The patient has developed acute kidney injury due to decreased renal blood flow.* b) The patient has developed a urinary tract infection due to catheterization. c) The patient has developed fluid overload due to excessive fluid resuscitation. d) The patient has developed metabolic acidosis due to lactic acid accumulation. Rationale: Norepinephrine causes vasoconstriction of the peripheral and renal vessels, which can reduce renal blood flow and cause acute kidney injury. This is manifested by decreased urine output and increased serum creatinine. A urinary tract infection, fluid overload and metabolic acidosis are possible complications of septic shock, but they are not directly related to norepinephrine administration.
3. A patient with pulmonary hypertension is receiving sildenafil, a phosphodiesterase- 5 inhibitor, to reduce pulmonary vascular resistance and improve right ventricular function. Which of the following adverse effects should the nurse monitor for in this patient? a) Hypotension* b) Tachycardia c) Dyspnea d) Headache Rationale: Sildenafil causes vasodilation of the systemic and pulmonary vessels, which can lower blood pressure and increase the risk of hypotension. Tachycardia, dyspnea and headache

are common symptoms of pulmonary hypertension, but they are not necessarily caused by sildenafil.

4. A patient with heart failure is receiving digoxin, a cardiac glycoside, to increase cardiac contractility and slow down the heart rate. The nurse observes that the patient has developed nausea, vomiting, blurred vision and yellow halos around lights. What is the most appropriate action for the nurse to take? a) Administer an antiemetic and an analgesic to relieve the symptoms. b) Check the serum potassium level and administer potassium supplements if needed. c) Check the serum digoxin level and withhold the next dose if it is elevated.* d) Notify the physician and prepare for electrical cardioversion if needed. Rationale: Nausea, vomiting, blurred vision and yellow halos around lights are signs of digoxin toxicity, which can be life-threatening. The serum digoxin level should be checked and the next dose should be withheld if it is above the therapeutic range (0.5-2 ng/mL). Potassium supplements may be needed if the serum potassium level is low, as hypokalemia can increase the risk of digoxin toxicity. Electrical cardioversion is not indicated for digoxin toxicity, as it can worsen cardiac arrhythmias.
5. A patient with acute coronary syndrome is receiving heparin, an anticoagulant, to prevent thrombus formation and reduce the risk of myocardial infarction. Which of the following laboratory tests should the nurse monitor closely to adjust the heparin dose? a) Prothrombin time (PT) b) International normalized ratio (INR) c) Activated partial thromboplastin time (aPTT)* d) Platelet count Rationale: aPTT measures the intrinsic pathway of coagulation and is used to monitor heparin therapy. The therapeutic range for aPTT is 1.5-2 times the normal value (25-35 seconds). PT, INR and platelet count are used to monitor warfarin therapy, another anticoagulant that works on the extrinsic pathway of coagulation.
6. A patient with hypertension is receiving lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, to lower blood pressure and prevent cardiovascular complications. Which of the following statements by the patient indicates a need for further education by the nurse? a) "I should avoid salt substitutes that contain potassium." b) "I should report any cough, rash or swelling to my doctor." c) "I should take this medication with food to prevent stomach upset."* d) "I should check my blood pressure regularly and keep a record of it." Rationale: Lisinopril should be taken on an empty stomach, as food can decrease its absorption and effectiveness. Salt substitutes that contain potassium should be avoided, as lisinopril can increase serum potassium levels and cause hyperkalemia. Cough, rash and swelling are common adverse effects of lisinopril and should be reported to the doctor. Blood pressure monitoring is important to evaluate the response to lisinopril and adjust the dose if needed.
7. A patient with atrial fibrillation is receiving amiodarone, an antiarrhythmic agent, to maintain sinus rhythm and prevent thromboembolic events. Which of the following instructions should the nurse give to the patient regarding this medication? a) "You should avoid grapefruit juice and other citrus fruits while taking this medication." b) "You should wear sunglasses and sunscreen when going outdoors while taking this

medication."* c) "You should take this medication with a full glass of water and a high-fiber diet to prevent constipation." d) "You should stop taking this medication if you experience any palpitations or chest pain." Rationale: Amiodarone can cause photosensitivity and increase the risk of sunburn and skin damage. Sunglasses and sunscreen are recommended to protect the skin from ultraviolet rays. Grapefruit juice and other citrus fruits do not interact with amiodarone. Constipation is not a common adverse effect of amiodarone. Palpitations and chest pain are signs of worsening arrhythmia and should be reported to the doctor, but not a reason to stop taking amiodarone without medical advice.

8. A patient with angina pectoris is receiving nitroglycerin, a nitrate, to dilate the coronary arteries and relieve chest pain. The nurse teaches the patient how to use sublingual nitroglycerin tablets in case of an anginal attack. Which of the following statements by the patient indicates a correct understanding of the teaching? a) "I should take one tablet every 15 minutes until the pain goes away or I take four tablets." b) "I should take one tablet as soon as I feel chest pain and call 911 if the pain persists after 5 minutes."* c) "I should take one tablet before any activity that may trigger chest pain and repeat it every hour if needed." d) "I should take one tablet under my tongue and swallow it with water after it dissolves." Rationale: The correct way to use sublingual nitroglycerin tablets is to take one tablet under the tongue as soon as chest pain occurs and let it dissolve without swallowing. If the pain persists after 5 minutes, another tablet can be taken and 911 can be called. This can be repeated up to three times (total of four tablets). Taking nitroglycerin every 15 minutes or every hour is not recommended, as it can cause hypotension, headache and tolerance. Taking nitroglycerin before activity may prevent angina, but it is not a substitute for lifestyle modifications or other medications.
9. A patient with peripheral arterial disease is receiving cilostazol, a phosphodiesterase- 3 inhibitor, to improve blood flow and reduce intermittent claudication. Which of the following assessments should the nurse perform before administering this medication? a) Auscultate the heart sounds and check for murmurs or gallops. b) Palpate the peripheral pulses and check for strength and symmetry. c) Measure the blood pressure and pulse rate and check for orthostatic changes.* d) Inspect the skin and nails and check for color, temperature and lesions. Rationale: Cilostazol causes vasodilation and can lower blood pressure and increase heart rate. Orthostatic hypotension can occur, especially in the first weeks of therapy. Blood pressure and pulse rate should be measured before giving cilostazol and monitored periodically thereafter. Heart sounds, peripheral pulses and skin condition are also important to assess, but they are not directly affected by cilostazol.
10. In hemodynamics, which of the following parameters is used to measure the resistance to blood flow in the systemic circulation? a) Cardiac output b) Systemic vascular resistance

c) Pulmonary artery pressure d) Right atrial pressure Answer: b) Systemic vascular resistance Rationale: Systemic vascular resistance (SVR) is a measure of the resistance to blood flow in the systemic circulation. It represents the resistance offered by the arterioles throughout the body.

2. Which of the following medications is classified as a positive inotropic agent? a) Nitroglycerin b) Furosemide c) Dopamine d) Verapamil Answer: c) Dopamine Rationale: Dopamine is a positive inotropic agent that increases the force of myocardial contraction. It is commonly used in the management of heart failure.
3. When administering a vasoactive medication, the nurse should monitor for potential adverse effects. Which of the following adverse effects is associated with the use of vasopressors? a) Hypotension b) Decreased heart rate c) Peripheral vasoconstriction d) Bradycardia Answer: c) Peripheral vasoconstriction Rationale: Vasopressors, such as norepinephrine or dopamine, cause peripheral vasoconstriction as one of their desired effects. This can result in increased blood pressure.
4. Which of the following medications is commonly used to treat hypertensive emergencies or severe hypertension? a) Digoxin b) Lisinopril c) Hydralazine d) Metoprolol Answer: c) Hydralazine Rationale: Hydralazine is a direct-acting peripheral vasodilator used for the treatment of hypertensive emergencies or severe hypertension. It works by relaxing the smooth muscle in the blood vessels, leading to vasodilation.
5. A patient with heart failure is prescribed a medication that inhibits the renin-angiotensin- aldosterone system. Which of the following medications does this patient most likely receive? a) Digoxin b) Hydrochlorothiazide c) Captopril d) Isosorbide dinitrate Answer: c) Captopril Rationale: Captopril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the renin-angiotensin-aldosterone system. It is commonly prescribed for patients with heart failure to reduce fluid retention and improve cardiac function.

6. Which of the following medications is a calcium channel blocker commonly used in the treatment of hypertension and angina? a) Losartan b) Amlodipine c) Metoprolol d) Enalapril Answer: b) Amlodipine Rationale: Amlodipine is a calcium channel blocker that inhibits the influx of calcium into smooth muscle cells, resulting in vasodilation. It is used to treat hypertension and angina.
7. Which of the following hemodynamic parameters is calculated as the product of heart rate and stroke volume? a) Cardiac output b) Systemic vascular resistance c) Pulmonary artery pressure d) Central venous pressure Answer: a) Cardiac output Rationale: Cardiac output (CO) is the amount of blood pumped by the heart in one minute and is calculated by multiplying the heart rate (HR) and stroke volume (SV). CO = HR x SV.
8. A patient with septic shock requires a vasoactive medication to maintain adequate perfusion. Which of the following medications is commonly used as a first-line therapy in septic shock? a) Dobutamine b) Vasopressin c) Epinephrine d) Nitroprusside Answer: c) Epinephrine Rationale: Epinephrine is a vasoactive medication commonly used as a first-line therapy in septic shock. It acts as a potent vasoconstrictor and increases cardiac output.
9. Which of the following medications is a direct arterial vasodilator that reduces afterload and is commonly used for the treatment of congestive heart failure? a) Nitroglycerin b) Isosorbide dinitrate c) Nitroprusside d) Milrinone Answer: c) Nitroprusside Rationale: Nitroprusside is a direct arterial vasodilator that reduces afterload, thereby improving cardiac output and relieving symptoms of congestive heart failure. It is administered intravenously.
10. Which of the following medications is commonly used for rate control in atrial fibrillation and atrial flutter? a) Warfarin b) Diltiazem c) Enoxaparin d) Atropine Answer: b) Diltiazem

Rationale: Diltiazem is a calcium channel blocker commonly used for rate control in atrial fibrillation and atrial flutter. It slows the conduction of electrical impulses in the atrioventricular (AV) node.

11. A patient with pulmonary hypertension is prescribed a medication that inhibits phosphodiesterase-5 (PDE-5). Which of the following medications does this patient most likely receive? a) Metoprolol b) Losartan c) Sildenafil d) Furosemide Answer: c) Sildenafil Rationale: Sildenafil is a medication that inhibits phosphodiesterase-5 (PDE-5) and is commonly used for the treatment of pulmonary hypertension. It improves vasodilation in the pulmonary arteries.
12. Which of the following medications is classified as a negative inotropic agent? a) Dobutamine b) Norepinephrine c) Digoxin d) Nitroglycerin Answer: c) Digoxin Rationale: Digoxin is a negative inotropic agent that reduces the force of myocardial contraction. It is often prescribed for patients with heart failure or atrial fibrillation.
13. The nurse is caring for a patient receiving a beta-adrenergic blocking agent. Which of the following adverse effects should the nurse monitor for? a) Tachycardia b) Hypertension c) Bronchodilation d) Hypoglycemia Answer: c) Bronchodilation Rationale: Beta-adrenergic blocking agents, also known as beta blockers, can cause bronchoconstriction in patients with underlying lung diseases. The nurse should monitor for signs of respiratory distress.
14. A patient with stable angina is prescribed a medication that selectively blocks beta- 1 adrenergic receptors on the heart. What is the primary therapeutic effect of this medication? a) Decreased heart rate b) Increased cardiac output c) Vasodilation of coronary arteries d) Reduced blood pressure Answer: a) Decreased heart rate Rationale: Selective beta-1 adrenergic blockers, such as metoprolol or atenolol, primarily reduce heart rate, resulting in decreased myocardial oxygen demand. This can help alleviate symptoms of stable angina.
15. Which of the following medications inhibits the enzyme responsible for converting

angiotensin I to angiotensin II? a) Losartan b) Amlodipine c) Metoprolol d) Enalapril Answer: d) Enalapril Rationale: Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that inhibits the enzyme responsible for converting angiotensin I to angiotensin II. It reduces vasoconstriction and promotes vasodilation. Question 1: A 60-year-old patient with a history of hypertension and heart failure is admitted to the emergency department with acute decompensated heart failure. The nurse observes the patient to be hypotensive with a blood pressure of 80/50 mmHg. Which of the following vasoactive medications would be most appropriate for initial management? a) Dopamine b) Nitroglycerin c) Norepinephrine d) Dobutamine Answer: c) Norepinephrine Rationale: Norepinephrine is a potent vasoconstrictor and inotrope, which can help improve blood pressure and cardiac output in patients with hypotension associated with heart failure. Question 2: A 45-year-old patient presents with a hypertensive emergency, with a blood pressure of 220/120 mmHg. The patient has a history of chronic kidney disease. Which of the following vasoactive medications is contraindicated in this patient's condition? a) Enalapril b) Hydralazine c) Nicardipine d) Labetalol Answer: a) Enalapril Rationale: Enalapril is an angiotensin-converting enzyme (ACE) inhibitor, which is contraindicated in patients with renal artery stenosis or severe chronic kidney disease due to the risk of acute kidney injury. Question 3: A 70-year-old patient is admitted with septic shock and hypotension. The initial fluid resuscitation has been inadequate in restoring blood pressure. Which of the following vasoactive medications is often used as a first-line agent in the management of septic shock? a) Vasopressin b) Phenylephrine c) Epinephrine

d) Dobutamine Answer: c) Epinephrine Rationale: Epinephrine is often used as a first-line agent in septic shock due to its potent vasoconstrictor and inotropic effects, which can help improve blood pressure and cardiac output. Question 4: A 55-year-old patient with atrial fibrillation and rapid ventricular response is hemodynamically unstable. The patient requires urgent rate control. Which of the following medications is the most appropriate choice for this patient? a) Adenosine b) Diltiazem c) Amiodarone d) Digoxin Answer: b) Diltiazem Rationale: Diltiazem is a calcium channel blocker that can effectively slow the ventricular rate in patients with atrial fibrillation and rapid ventricular response, thereby improving hemodynamic stability. Question 5: A 65-year-old patient with acute myocardial infarction develops cardiogenic shock. In addition to revascularization, which of the following vasoactive medications is indicated in the management of cardiogenic shock? a) Milrinone b) Nitroprusside c) Isoproterenol d) Phentolamine Answer: a) Milrinone Rationale: Milrinone is a phosphodiesterase inhibitor with potent inotropic and vasodilatory effects, which can improve cardiac output and decrease afterload in patients with cardiogenic shock. Question 6: A 50-year-old patient presents with acute pulmonary edema and severe hypertension. Which of the following vasoactive medications is commonly used to reduce preload and afterload in the management of acute pulmonary edema? a) Dopamine b) Nesiritide c) Dobutamine d) Nitroglycerin Answer: d) Nitroglycerin Rationale: Nitroglycerin is a potent venodilator and arterial vasodilator, which can reduce preload and afterload, thereby improving hemodynamics in patients with acute pulmonary edema and hypertension.

Question 7: A 70-year-old patient is admitted with decompensated cirrhosis and hepatorenal syndrome. The patient has refractory ascites and hypotension. Which of the following vasoactive medications is often used in the management of hepatorenal syndrome? a) Terlipressin b) Dobutamine c) Esmolol d) Isosorbide dinitrate Answer: a) Terlipressin Rationale: Terlipressin is a vasopressin analog that can improve renal perfusion in patients with hepatorenal syndrome by inducing vasoconstriction of splanchnic vessels and increasing systemic vascular resistance. Question 8: A 45-year-old patient with distributive shock secondary to anaphylaxis requires vasopressor support. Which of the following vasoactive medications is the first-line agent in the management of anaphylactic shock? a) Dopamine b) Epinephrine c) Vasopressin d) Phenylephrine Answer: b) Epinephrine Rationale: Epinephrine is the first-line agent in the management of anaphylactic shock due to its potent vasoconstrictor and bronchodilator effects, which can reverse hypotension and bronchoconstriction in anaphylaxis. Question 9: A 60-year-old patient with septic shock and refractory hypotension requires a vasopressor that can improve mean arterial pressure (MAP) while minimizing tachycardia. Which of the following vasoactive medications is preferred in this scenario? a) Norepinephrine b) Dopamine c) Dobutamine d) Phenylephrine Answer: a) Norepinephrine Rationale: Norepinephrine is preferred in septic shock due to its potent vasoconstrictor effects with minimal impact on heart rate, which can help improve MAP while minimizing tachycardia. Question 10: A 55-year-old patient with heart failure and reduced ejection fraction is on guideline-directed medical therapy, including a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor. The patient develops symptomatic hypotension. Which of the following vasoactive medications can be added to improve hemodynamics without compromising heart failure

therapy? a) Midodrine b) Ivabradine c) Hydralazine d) Sacubitril/valsartan Answer: a) Midodrine Rationale: Midodrine is an alpha-1 agonist that can improve hemodynamics by increasing peripheral vascular resistance without negatively impacting heart failure therapy, making it a suitable option for patients with symptomatic hypotension. Question 11: A 65-year-old patient with acute decompensated heart failure and hypotension requires inotropic support. Which of the following vasoactive medications is commonly used to improve cardiac contractility and stroke volume in patients with heart failure? a) Nitroglycerin b) Dobutamine c) Esmolol d) Enalaprilat Answer: b) Dobutamine Rationale: Dobutamine is a potent inotrope that can improve cardiac contractility and stroke volume in patients with heart failure, making it a suitable choice for those requiring inotropic support. Question 12: A 50-year-old patient with septic shock and refractory hypotension is on norepinephrine but remains hypotensive. Which of the following vasoactive medications can be added to improve cardiac output and peripheral perfusion in this scenario? a) Vasopressin b) Epinephrine c) Milrinone d) Phenylephrine Answer: c) Milrinone Rationale: Milrinone is a phosphodiesterase inhibitor with potent inotropic and vasodilatory effects, which can improve cardiac output and peripheral perfusion in patients with refractory hypotension despite norepinephrine therapy. Question 13: A 60-year-old patient with acute myocardial infarction and cardiogenic shock requires afterload reduction to improve cardiac output. Which of the following vasoactive medications is commonly used for afterload reduction in this setting? a) Dobutamine b) Nitroglycerin c) Isoproterenol d) Phenylephrine

Answer: b) Nitroglycerin Rationale: Nitroglycerin is a potent arterial vasodilator, which can reduce afterload and improve cardiac output in patients with acute myocardial infarction and cardiogenic shock. Question 14: A 55-year-old patient with hypertensive crisis and aortic dissection requires rapid reduction in blood pressure. Which of the following vasoactive medications is the first-line agent for this scenario? a) Labetalol b) Nitroprusside c) Hydralazine d) Enalapril Answer: a) Labetalol Rationale: Labetalol is a combined alpha and beta-blocker, which can rapidly reduce blood pressure without compromising organ perfusion in patients with hypertensive crisis and aortic dissection. Question 15: A 70-year-old patient with refractory hypotension and septic shock requires a vasoactive medication with selective arterial vasodilator effects. Which of the following vasoactive medications is preferred in this scenario? a) Nicardipine b) Esmolol c) Isoproterenol d) Norepinephrine Answer: a) Nicardipine Rationale: Nicardipine is a calcium channel blocker with selective arterial vasodilator effects, which can improve systemic vascular resistance and arterial pressure in patients with refractory hypotension and septic shock. A patient who is 72 hours postoperative repair of a bowel obstruction suddenly demonstrates shortness of breath and his respiratory rate increases from 22 to 45/min. His SpO2 went from 95% to 88% acutely. An arterial blood gas sample obtained while the patient is receiving oxygen via a nasal cannula at 6L/min reveals the following

results: pH 7. pCO2 27 pO2 50 A chest x-ray is obtained and a "ground-glass-like appearance" is reported. Auscultation of the lungs reveals diffuse crackles that were not present previously. On admission, your patient's arterial blood gas on room air is: pH 7.23, PaCO2 55, PaO2 90, HCO3 30. The correct arterial blood gas interpretation is: A. Uncompensated metabolic acidosis B. Uncompensated respiratory alkalosis C. Uncompensated respiratory acidosis

D. Uncompensated metabolic alkalosis - CORRECT ✓✓C. Uncompensated respiratory acidosis A patient who is 72 hours postoperative repair of a bowel obstruction suddenly demonstrates shortness of breath and his respiratory rate increases from 22 to 45/min. His SpO2 went from 95% to 88% acutely. An arterial blood gas sample obtained while the patient is receiving oxygen via a nasal cannula at 6L/min reveals the following results: pH 7. pCO2 27 pO2 50 A chest x-ray is obtained and a "ground-glass-like appearance" is reported. Auscultation of the lungs reveals diffuse crackles that were not present previously. Your patient just received 10 units of banked blood for a GI bleed. You know this will affect the oxyhemoglobin dissociation curve by: A. Shifting it to the right B. Causing a plateau in the curve C. Shifting it to the left D. Causing no change in the curve - CORRECT ✓✓C. Shifting it to the left A patient who is 72 hours postoperative repair of a bowel obstruction suddenly demonstrates shortness of breath and his respiratory rate increases from 22 to 45/min. His SpO2 went from 95% to 88% acutely. An arterial blood gas sample obtained while

the patient is receiving oxygen via a nasal cannula at 6L/min reveals the following results: pH 7. pCO2 27 pO2 50 A chest x-ray is obtained and a "ground-glass-like appearance" is reported. Auscultation of the lungs reveals diffuse crackles that were not present previously. Your patient is currently on a ventilator with the following settings: AC, FiO2 100%, Rate of 12, Tidal Volume 450, PEEP of 5. His arterial blood gas results are the following: pH 7.36, PaCO2 43, PaO2 56, HCO3 28. Which ventilator parameter do you anticipate changing? A. Decrease the FiO B. Increase the tidal volume C. Increase the PEEP D. Increase the rate - CORRECT ✓✓C. Increase the PEEP ARDS is characterized by which of the following: A. Refractory hypercarbia B. Increase in surfactant C. Increased lung compliance D. Shunting - CORRECT ✓✓D. Shunting

Rationale: ARDS is characterized by refractory hypoxia, shunting, decreased lung compliance, and decreased surfactant. A 42 y/o woman with a 6 month history of worsening anxiety, heat intolerance, and weight loss presents to the emergency department. Which of the following are indicators of hyperthyroidism? A. Constipation, lower body temperature, and edema B. High T3 and T4 and low TSH. C. Depression, dementia, and reflex changes D. Low T3 and T4 and high TSH - CORRECT ✓✓B. High T3 and T4 and low TSH. Rationale: Constipation, lower body temperature, edema, depression, dementia, reflex changes, low T3, low T4, high TSH are all indicators of hypothyroidism. An elderly man with Type 2 DM comes into the emergency department after spending all day in the mall shopping with his wife. He tells you that his heart is racing and he is sweaty and shaky. What is the best course of action for the nurse? A. Give the patient a candy bar and drink regular soda then check his BG. B. Check his blood glucose level and obtain an ECG. C. Check his blood glucose and inject NPH insulin if he's hyperglycemic. D. Give the patient 4 glucose tablets and then check his blood glucose. - CORRECT ✓✓B. Check his blood glucose level and obtain an ECG.

Successful treatment of DKA revolves around: A. Correction of orthostatic hypotension with electrolytes B. Administration of fluids, electrolytes and insulin C. Gradually decreasing a patient's excessive fluid volume from hyperosmolality D. Administration of glucagon to elevate plasma blood levels - CORRECT ✓✓B. Administration of fluids, electrolytes and insulin What is the Somogyi phenomenon generally attributed? A. Prolonged hyperglycemia that has led to neurological damage and impaired counterregulatory response B. Cyclic rise in blood glucose associated with increased need for insulin C. Nocturnal food ingestion D. Counter-regulatory response to severe hypoglycemia - CORRECT ✓✓D. Counter- regulatory response to severe hypoglycemia The serum potassium (K+) of a patient with DKA is 5.4 mEq/l. What changes would the nurse expect to see on an EKG? A. Peaked T waves and widened QRS complex. B. Abnormal Q waves and prolonged ST segments. C. Abnormal P waves and depressed T waves. D. Peaked P waves and increased T waves. - CORRECT ✓✓A. Peaked T waves and widened QRS complex.

A 55 y/o steroid dependent woman with rheumatoid arthritis undergoes a CABG x 4. She was doing well in the ICU 1 day post op, but then has a run of V-Tach and V- Fibrillation. The nurse recognizes this may be due to the following: A. Reperfusion after CABG B. Reocclusion after CABG C. Acute adrenal crisis from being off her medications preoperatively D. Hypervolemia and hypokalemia - CORRECT ✓✓C. Acute adrenal crisis from being off her medications preoperatively A 68 y/o male had a AAA repair 3 days ago but is now in renal failure. The nurse understands the likely causes for this may be: A. Post renal kidney stone obstruction B. Malignant hyperthermia C. Rhabdomyolysis D. Acute tubular necrosis due to aortic cross clamping for longer than 30 minutes in surgery. - CORRECT ✓✓D. Acute tubular necrosis due to aortic cross clamping for longer than 30 minutes in surgery. Rationale: Kidney stones, malignant hyperthermia, and rhabdomyolysis are not results of a AAA surgical procedure specifically. A 72 y/o man is in the ICU for chronic renal failure. What electrolyte abnormalities would the nurse watch for?

A. Decreased BUN and Creatinine from diseased kidneys B. High pH and alkalosis C. Hyperkalemia D. Thrombocytopenia - CORRECT ✓✓C. Hyperkalemia The nurse is providing care for a patient with pyelonephritis. What treatment is appropriate for this patient? A. Restrict oral and IV fluids to prevent renal failure B. 2 L hypertonic solution with magnesium rider C. 2 Grams Ceftriaxone D. Prepare patient for emergent dialysis - CORRECT ✓✓C. 2 Grams Ceftriaxone Rationale: Appropriate therapy for pyelonephritis includes: Give 2 L of IV fluid, Give 2 Tylenol #3 or similar pain control. Give 2 gm ceftriaxone. If the patient can tolerate two glasses of water and fever decreases by 2 degrees: Trimethoprim/Sulfamethoxazole (TMP/SMX) double-strength BID for two weeks; follow-up in two days for progress check. Toxic Shock, Myxedema coma, and Addisonian Crisis are all types of what type of shock? A. Neurogenic B. Anaphylactic

C. Distributive D. Hypovolemic - CORRECT ✓✓C. Distributive Positive cultures distinguish what two stages of the sepsis spectrum? A. SIRS and sepsis B. Sepsis and severe sepsis C. Sepsis and septic shock D. SIRS and severe shock - CORRECT ✓✓A. SIRS and sepsis Which scenario would be the best example of secondary MODS? A. Respiratory failure due to pneumonia B. Acute respiratory distress syndrome secondary to pancreatitis C. Neurologic anoxia due to hypoxemia D. Renal Failure due to prolonged hypovolemic shock - CORRECT ✓✓B. Acute respiratory distress syndrome secondary to pancreatitis Example of catecholamines are: A. Mast cells, basophils, and eosinophils B. Histamine, tryptase, and heparin C. Histamine, epinephrine, and steroids D. Epinephrine, norepinephrine, and dopamine - CORRECT ✓✓D. Epinephrine, norepinephrine, and dopamine

Which of following is a nursing priority when providing care to a patient during a seizure? A. Ensure the patient has an open airway B. Stay away from the patient C. Administer Haldol D. Padded tongue blade in mouth - CORRECT ✓✓A. Ensure the patient has an open airway The nurse assesses damage to the right cerebral hemisphere in a patient. Assessment finding would include A. Deviation of the eyes to the left B. Left homonymous hemianopia C. Right hemi paresis D. Right hemiplegia - CORRECT ✓✓B. Left homonymous hemianopia ICP continued to climb in a patient who has become unresponsive and vitals signs are as follows B/P 190 - 70 Heart rate 45. The nurse understands this reflex to be: A. Vaso-vagal response B. Cushing's response C. Slurred speech D. Hypertensive crisis - CORRECT ✓✓B. Cushing's response Management of a patient with a subarachnoid hemorrhage would include the following

A. KVO Intravenous fluids B. Beta blockers C. Maintaining mean arterial blood pressure greater than 90 D. Hyperventilation - CORRECT ✓✓C. Maintaining mean arterial blood pressure greater than 90 A 14 - year-old with diabetes is admitted for hypoglycemia. The patient admits to the nurse that he does not take insulin or check is blood sugar at school. Which of the following should the nurse do? A. Arrange for the patient to attend a diabetes support group for teenagers B. Encourage the parents to take disciplinary action C. Counsel the patient on the long term consequences of not taking insulin D. Hold a conference with the school nurse regarding the need for monitoring studentswith diabetes - CORRECT ✓✓A. Arrange for the patient to attend a diabetes support group for teenagers Mrs. Wethersby was admitted to the ICU with severe hypoxia due to bilateral pneumonia. She was emergently intubated and placed on the following ventilator settings: Mode: Assist Control, FiO2 100%, Rate 12, Tidal Volume 400, Peep 10. Thirty minutes later you draw an arterial blood gas and the results are the following: pH 7.25, PaO2 180, PaCO2 50, HCO3 28.You anticipate which of the following ventilator changes?

A. Decrease the tidal volume B. Decrease the rate C. Decrease the PEEP D. Increase the rate - CORRECT ✓✓D. Increase the rate Your patient was recently told he has portal hypertension. You know that which of the following statements about portal hypertension is true? A. Portal hypertension may lead to an enlargement of the kidneys B. Patients should adhere to a cardiac diet. C. The most common cause of portal hypertension is hepatitis D. Patients with portal hypertension are at risk for developing esophageal varices - CORRECT ✓✓D. Patients with portal hypertension are at risk for developing esophageal varices Which of the following might cause a shift to the RIGHT on the oxyhemoglobin dissociation curve? A. Low 2, 3 - DPG levels B. Acidosis C. Low pCO2 D. Hypothermia - CORRECT ✓✓B. Acidosis After telling your patient that he will be transferred out of the ICU, he begs you to allow him to stay longer because he doesn't feel healthy enough to leave. How would you best respond to this patient?

A. "Your insurance only covers a limited time in the ICU." B. "There is a crashing patient in the Emergency Department that needs this bed." C. "You sound like you have some concerns about leaving the unit." D. "Please don't worry - You will do just fine after transferring out of the ICU." - CORRECT ✓✓C. "You sound like you have some concerns about leaving the unit." An EKG was performed on Mrs. Smith and revealed peaked T waves and a widened QRS complex. Which of the following electrolyte abnormalities would you expect? A. Hyperkalemia B. Hypocalcemia C. Hypercalcemia D. Hypomagnesemia - CORRECT ✓✓A. Hyperkalemia The intra-aortic balloon pump (IABP) device is indicated for which of the following? A. Aortic regurgitation B. Abdominal aortic aneurysm C. Treatment of Right-sided heart failure D. As a bridge to LVAD or transplant - CORRECT ✓✓D. As a bridge to LVAD or transplant Cardiac Tamponade symptoms that are most common are: A. Retrosternal pain, vomiting, no change in heart sounds

B. Substernal pain, dizziness, palpitations C. Weakness on right side, fatigue, and diarrhea D. Muffled heart sounds, dyspnea, agitation - CORRECT ✓✓D. Muffled heart sounds, dyspnea, agitation Which finding is most consistent with myocardial contusion diagnosis? A. S3 at apex B. Crackles in the lung fields C. Tachycardia D. Jugular vein distention - CORRECT ✓✓D. Jugular vein distention A 70 - year-old man is readmitted to the hospital five days after a myocardial infarction. His assessment shows T-wave inversion in leads V1 to V4 and ST segment elevation. The patient has already received aspirin, morphine 3 - mgs and nitroglycerin infusion to relieve his chest pain. The patient suddenly develops a loud, holosystolic murmur at the lower left sternal border. A pulmonary artery catheter is inserted. Which of the following parameters would be noted in this patient? A. Decreased pulmonary artery occlusion pressure B. Increase in veneous oxygen saturation (SvO2) C. Increase in systolic blood pressure D. Decreased in cardiac output - CORRECT ✓✓B. Increase in veneous oxygen saturation (SvO2) Fractures of the sternum, ribs and clavicle are most often with which condition?

A. Cardiac arrest B. Pneumothorax C. Cardiac tamponade D. Myocardial contusions - CORRECT ✓✓D. Myocardial contusions How does nesiritide as a vasodilator have an advantage over nitroglycerin? A. Other vasodilators, such as nitroglycerin, decrease contractility B. Other vasodilators, such as nitroglycerin, decrease heart rate C. Nesiritide has a diuretic effect D. Nesiritide may be used with hypotensive patients - CORRECT ✓✓C. Nesiritide has a diuretic effect P-waves that are abnormally notched and wide may be seen in patients with A. Myocardial infarction B. Mitral stenosis C. Heart failure D. Chronic obstructive pulmonary disease - CORRECT ✓✓B. Mitral stenosis What effect would the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system have on the pressure measurement if it was 2 inches below the phlebostatic axis? A. The pressure recording would be falsely high by about 4 mmHg