Adult CCRN/PCCN Certification Practice Test: Critical Care Nursing Scenarios and Questions, Exams of Health sciences

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Adult CCRN/PCCN Certification Practice Test

One day following posterior spinal fusion surgery a 35 year old female suddenly exhibits restlessness, labored breathing and acute chest pain. Her heart rate is 122/min., she is afebrile, and exhibits slightly diminished breath sounds on the right side. The findings described above should lead the nurse to suspect that the patient has developed: A. A spontaneous pneumothorax B. A pulmonary embolus C. Aspiration pneumonia D. A pleural effusion - B. A pulmonary embolus One day following posterior spinal fusion surgery a 35 year old female suddenly exhibits restlessness, labored breathing and acute chest pain. Her heart rate is 122/min., she is afebrile, and exhibits slightly diminished breath sounds on the right side. Which of the following will most likely confirm the patient's diagnosis? A. Pulmonary radioisotope scan B. Echocardiogram C. Cardiac enzyme studies D. Chest x-ray and arterial blood gases - A. Pulmonary radioisotope scan The nursing staff does not wish to be assigned a difficult patient who continues to demonstrate disorderly behavior. Which of the following is an acceptable solution? A. Request the family control the patient's behavior.

B. Transfer the patient C. The patient assignment should be decided by the Charge Nurse. D. Alternate the patient assignment among the nursing staff. - D. Alternate the patient assignment among the nursing staff. 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. The findings described above should lead the nurse to believe that the patient has: A. Acute respiratory distress syndrome B. A pulmonary embolus C. A spontaneous pneumothorax D. Aspiration pneumonia - A. Acute respiratory distress syndrome 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, HCO

30. The correct arterial blood gas interpretation is: A. Uncompensated metabolic acidosis B. Uncompensated respiratory alkalosis C. Uncompensated respiratory acidosis D. Uncompensated metabolic alkalosis - 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 - 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 - 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 - 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 - 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. - 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 - 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 - 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. - 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 - 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. - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 students with diabetes - 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, FiO 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 - 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 - 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 pCO D. Hypothermia - 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." - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 - 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 B. The pressure recording would be falsely low by about 2 mmHg C. The pressure recording would be falsely high by about 2 mmHg D. The pressure recording would be falsely low by about 4 mmHg - A. The pressure recording would be falsely high by about 4 mmHg Which indicator would be important in differentiating unstable angina from stable angina? A. Chest pain relived by nitroglycerin B. Development of Q waves on the electrocardiogram C. Chest pain at rest D. Development of ST segment elevation or depression in affect leads - C. Chest pain at rest A 62-year-old man arrives in the emergency department with the complaints of chest pain. The 12- lead electrocardiogram shows ST segment elevation in leads V3 and V4. Occlusion of the affected coronary artery most likely would affect perfusion to which portion of the conduction system?

A. Bachmann's Bundle B. Bundle of His C. Sinoatrial (SA) node D. Atrioventricular (AV) nodes - B. Bundle of His A 44-year-old female patient is being suctioned through her endotracheal tube, and her heart rate drops dramatically. What should you do? A. Continue suctioning and then administer 100% oxygen B. Turn the head to the left side C. Instill saline down the endotracheal tube to loosen up the mucus plus D. Stop suctioning and administer 100% oxygen - D. Stop suctioning and administer 100% oxygen What location is used for an emergency decompression of a tension pneumothorax with a 14-guage needle? A. Fifth intercostal space at the midclavicular line on the affected side B. Second intercostal space at the midaxillary line on the affected side C. Second intercostal space at the midclavicular line on the affected side D. Fifth intercostal space at the midaxillary line on the affected side - C. Second intercostal space at the midclavicular line on the affected side A 46-year-old male developed an epidural hematoma after being in a motor vehicle collison. He has had a craniotomy to evacuate the clot, and an intraventricular catheter was placed during surgery. Which of the following is important in caring for the patient with intracranial pressure (ICP) monitoring?

A. Use a flush system B. Use a preservative-free isotonic saline C. Use a pressure bag D. Use heparin to maintain integrity of the line - B. Use a preservative-free isotonic saline A 30-year-old man is admitted to the critical care unit after a motor vehicle collision. The emergency department nurse reports that he was unconscious at the scene of the accident but is now alert and oriented. Skull films show a linear fracture of the right temporal bone. He is a significant risk for. A. Subdural hematoma B. Intracerebral hematoma C. Epidural hematoma D. Scalp hematoma - C. Epidural hematoma In intracranial hypertension, what is the most critical effect? A. Sensory loss B. Motor loss C. Infection D. Herniation - D. Herniation A 47-year-old male patient is scheduled for a radical laryngectomy. You are about to witness your patient signing a surgical consent when he tells you that he does not really understand what is going to be done. What should you do? A. Notify the physician that the patient needs additional explanation B. Make drawings explaining the procedure and then witness the consent

C. Explain the procedure and then witness the consent D. Tell the patient that he will receive additional information later but that he must sign the consent form now. - A. Notify the physician that the patient needs additional explanation What is the best approach to use when a patient become agitated and refused to take his/her meditation? A. "Take your medications now. Your doctor knows what is the best for you." B. "If you take your medications, I'll get you an extra pudding." C. "You always feel better after your medications." D. Take your pills now, or I will have to put a tube into your stomach to give them to you." - C. "You always feel better after your medications." The physician wrote an order for your patient that you think is unethical. Even after discussing the issue with the physician, he insists that you carry out the order. What should you do? A. Carry out the order, but report it to the supervisor B. Do not carry out the order, but report it to the medical officer for service C. Carry out the order and then discuss it with the physician D. Do not carry out the order, but report it to your charge nurse or nurse manager - D. Do not carry out the order, but report it to your charge nurse or nurse manager What ventilatory parameter would provide evidence of fluid volume excess? A. Increased lung compliance B. Increased vital capacity C. Decreased peak inspiratory pressure D. Increased A:a gradient - D. Increased A:a gradient