CCRN Test Bank: Questions and Answers with Rationale, Exams of Nursing

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Which of the following would be the earliest auscultators finding in left ventricular failure (LVF) ? A. Crackles B. S C. Murmur of mitral regurgitation D. Pericardial friction rub - Answer - B. S LVF would be the most subtle because early changes are usually subtle changes. Choose "S3." A patient with a triple-lumen subclavian catheter has been receiving total parenteral nutrition, maintenance fluids, and antibiotics by the catheter. He has been slightly confused. Suddenly he grasps the catheter and pulls it out. He then complains of shortness of breath, and his pulse oximetry indicates an SpO2 of 84%. How should this patient be positioned? A. Head down, left side B. Head down, right side C. Head of bed elevated, left side D. Head of bed elevated, right side - Answer - A. Head down, left side Envision a big air bubble in the patient's heart. Think: what position would decrease the movement of the air embolism out of the right side of the heart. Chose "Head down, left side." Oxygen delivery (DO2) is the product of which of the following? A. PaO2, hemoglobin, mean arterial pressure B. SaO2, hemoglobin, cardiac output C. SvO2, cardiac index, SaO D. PaO2, mean arterial pressure, SvO2 - Answer - B. SaO2, hemoglobin, cardiac output Oxygen is delivered from the arterial end, so choose an option that has SaO

Which of the following is the most significant complication of status asthmaticus? A. Pulmonary embolism B . Acute respiratory failure C. Hypertension D . Anaphylaxis - Answer - B. Acute respiratory failure A 22-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 he is now alert and oriented. Skull films show a linear fracture of the right temporal bone. He is at significant risk for: A. scalp hematoma. B . subdural hematoma. C. epidural hematoma. D . intracerebral hematoma. - Answer - C. epidural hematoma. Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and cause epidural hematoma. Patients with an epidural hematoma classically present with a short period of unconsciousness followed by a lucid interval and then rapid deterioration. An epidural hematoma is usually caused by arterial bleeding. A patient is admitted to the ICU after sustaining a concussion and blunt abdominal trauma to the right upper quadrant in a domestic dispute. The patient's vital signs are BP 145/86 mm Hg, pulse 86 beats/min, respiration 15 breaths/min, and temperature 98.8° F. The nurse is monitoring the patient's bowel sounds, abdominal tenderness, and abdominal girth frequently. Which of the

following laboratory parameters is especially important for the nurse to closely monitor for bleeding in this patient? A. Platelet count B . Protime C. Hematocri t D . Mean corpuscular volume - Answer - C. Hematocrit Common injuries resulting from blunt abdominal trauma can include injury to the liver, spleen, mesenteric vessels, pancreas, or kidneys. In a nonoperative approach to blunt abdominal trauma, observation and monitoring include serial hematocrits to evaluate for intra-abdominal bleeding. The platelet count does not fluctuate unless there is a disease process (e.g. cirrhosis, leukemia) or significant blood loss. Protime is a monitor of coagulation status and can be prolonged without active bleeding. Mean corpuscular volume measures the average volume or size of a single RBC and is used in classifying anemias. Which of the following is associated with chest pain, confusion, and petechiae? Chest pain, confusion, and petechiae are suggestive of a fat embolism, especially within the first 48 to 72 hours after a long-bone fracture. The clincher is the petechiae. None of the other choices would cause petechiae. Which type of shock is most likely to be iatrogenic? A. Di ssecting aneurysm B. Fat embolism C. Pneumothorax D. Myocardial infarction - Answer - B. Fat embolism

Iatrogenic means caused by treatment or diagnostic procedures or medically induced. Septic shock is the type of shock most likely to be iatrogenic. Significant contributors include immunosuppressive medications and therapies and invasive procedures. A patient had a craniotomy 2 days ago for removal of a tumor. He is awake and talking to the nurse and demonstrates no neurologic deficit. Blood pressure is 110/80 mm Hg, pulse is 92 beats/min, and respiratory rate is 22 breaths/min. Urine outputs have been approximately 60 ml/hr over the last 2 days, but he has had a recent change. He has had 300 to 400 ml/hr of urine output over the last several hours. The urine has a specific gravity of 1.002. The nurse checks his serum glucose and finds that it is 100 mg/dl. The cause of hypernatremia in this patient is: This case is an example of diabetes insipidus, which is caused by a lack of antidiuretic hormone (ADH). ADH causes water retention in the renal tubules but not sodium retention, so eliminate sodium retention. A lack of ADH causes water loss not water gain, so eliminate water gain. Diabetes insipidus does not have anything to do with aldosterone. The hypernatremia is a concentration effect caused by water loss. This sometimes is called hypovolemic hypernatremia. A patient is admitted with unstable angina. He has a long history of hypertension and coronary artery disease. The nurse notes a split S2on expiration and a single S2 on inspiration during cardiac auscultation. Blood pressure is 150/88 mm Hg, and heart rate is 88 beats/min. On the electrocardiogram, there is a normal-appearing P wave in front of each QRS complex, the PR interval measures 0.2 second consistently, and the QRS complexes measure 0.14 second. They A. H ypovolemic B. C ardiogenic C. Septic D. Neurogenic - Answer - C. Septic A. sodium retention. B. water loss. C. water gain. D. aldosterone excess. - Answer - B. water loss

are positive in V5 and V6 and negative in V1 and V2. These findings most likely indicate which of the following? A. Left bundle branch block (LBBB) B. Right bundle branch block (RBBB) C. Third-degree atrioventricular block D. Ventricular tachycardia - Answer - A. Left bundle branch block (LBBB) Features of LBBB described here are a QRS complex greater than 0.12 second in duration and a QRS complex that is positive in leads V5 and V6 (consider these left ventricular leads) and negative in leads V1 and V2 (consider these right ventricular leads). LBBB causes a paradoxical splitting of S2. This means that it is split on expiration but not on inspiration. This is paradoxical because it is opposite of a normal physiologic split of S2, which is split on inspiration but not split on expiration Which of the following is not an indication for mechanical ventilation in patients with asthma? A. Respiratory alkalosis B . Cardiopulmonary arrest C. Respiratory muscle fatigue D . Hypercapnia and respiratory acidosis - Answer - A. Respiratory alkalosis Respiratory alkalosis is seen early in asthma because of hyperventilation.

A patient exhibiting nystagmus, ataxia, unsteady gait, and problems with rapid, alternating movements probably has a lesion in the: A. frontal lobe. B . pituitary gland. C. cerebellum. D . brainstem. - Answer - C. cerebellum The pituitary is an endocrine gland that controls release of hormones within the body, so eliminate "pituitary gland." The brainstem contains the cardiac and respiratory centers, temperature, and other basic drives, so eliminate "brainstem." The frontal lobe controls voluntary motor function and behavior, so eliminate "frontal lobe." The cerebellum controls balance and coordination. Associate bellum with ballerina, who must balance to dance. Choose "cerebellum." Which route would be preferred for the rapid administration of fluids in hypovolemic shock? A. Central venous catheter B . Large-gauge, short peripheral catheter C. Needle inserted into saline lock D . Large-gauge, long peripheral catheter - Answer - B. Large-gauge, short peripheral catheter The most rapid administration of fluids is achieved through a large-gauge, short catheter. Central venous catheters are long and, if multiple-lumen, each lumen may be smaller gauge than large- gauge peripheral catheters. Large-gauge, long peripheral catheters, including peripherally inserted central catheters, would be slower than a short peripheral catheter.

A patient received Humulin NPH insulin at 7 am. He was nauseated and vomiting at lunchtime and cannot tolerate PO. If this patient develops manifestations of hypoglycemia, treatment would include: A. 25 ml of 50% dextrose in water (D50W). B. glucagon subcutaneously. C. 4 oz of apple juice. D . 100 ml of 5% dextrose in water (D5W). - Answer - A. 25 ml of 50% dextrose in water (D50W). A volume of 25 ml of D50W would provide 12.5 g of carbohydrate and 50 calories. A patient is being treated for hypertrophic cardiomyopathy. Which of the following drugs would be contraindicated for this patient? A. Nitroprusside B. Propranolol C. Verapamil D. Digoxin - Answer - D. Digoxin Remember that with hypertrophic cardiomyopathy, it is desirable to decrease contractility and afterload; it is not desirable to increase contractility or decrease preload. How would a pneumothorax appear on chest x-ray film? A. Less radiolucent than normal lung B. Less radiopaque than normal lung C. More radiopaque than normal lung D.

More radiolucent than normal lung - Answer - D. More radiolucent than normal lung The pleura is not visible on a normal chest radiograph, but in a pneumothorax, the visceral pleura is displaced from the parietal pleura by air in the pleural space. No lung markings can be seen in this area, and it is darker than the lung. A 55-year-old man is admitted to the critical care unit with upper gastrointestinal bleeding. Endoscopy identifies esophageal varices, but bleeding continues despite sclerosing. The physician inserts a Sengstaken-Blakemore tube. The family tells you that the patient has a long history of alcohol use, drinking about one half of a fifth of Jack Daniels every day. Which of the following are early indications of alcohol withdrawal syndrome for which the nurse should monitor? A. Diaphoresis, pruritus B . Marked tachycardia, marked hypertension C. Hyperthermia, dehydration D . Delirium, hallucinations - Answer - A. Diaphoresis, pruritus Because the question says "early," look for the mildest symptoms. Diaphoresis, pruritus, mild tachycardia, mild hypertension, nausea, vomiting, visual disturbances, tremors, anxiety, agitation, and sleep disturbances are signs of early alcohol withdrawal syndrome. Options "Marked tachycardia, marked hypertension," "Hyperthermia, dehydration," and "Delirium, hallucinations" describe late signs. Altering the pH of the gastric secretions through the use of H2 receptor antagonists, antacids, and proton pump inhibitors contributes to which potential complication? A. Pulmonary

embolism B . Pneumonia C. Stress ulcer D . Acid-base imbalance - Answer - B. Pneumonia Gastric colonization is likely with a gastric pH of greater than 4. Pneumonia rates of patients receiving mechanical ventilation correlate directly with increased gastric pH levels. This is one of the risks of the use of H2 receptor antagonists, antacids, and proton pump inhibitors to prevent stress ulcers in intubated patients. You have a 76-year-old patient that is on a norepinephrine gtt. You notice the patient is complaining of severe pain and that the area around her IV is becoming translucent, cool to touch, and discolored. What stage is this and what medication should you administer to prevent extravasation? A. Stage 1, phentolamine B. Stage 4, hyaluronidase C. Stage 4, phentolamine D . Stage 3, dexrazoxane - Answer - C. Stage 4, phentolamine The patient is experiencing Stage 4 infiltration and is on a vasopressor gtt; therefore, phentolamine is the drug of choice to counteracts the effects of infiltration/extravasation. Which of the following solutions would be most appropriate for initial fluid resuscitation of a patient with severe hypovolemia caused by several days of diarrhea and vomiting? A. An isotonic crystalloid B.

A hypotonic crystalloid C. A hypertonic crystalloid D. A colloid - Answer - A. An isotonic crystalloid In this situation, the intravascular and the interstitial spaces would be depleted. The priority is the intravascular space, which would be replaced best with isotonic solution. Because isotonic fluids equilibrate across all spaces, the interstitial space also would be replaced. Consider: What did the patient lose? Crystalloid and electrolyte. Then ask: Which crystalloid would replace the intravascular and interstitial spaces? An isotonic crystalloid. Electrolytes would be added. A 28-year-old man is admitted with bowel perforation. His blood pressure is 92/64 mm Hg, heart rate is 116 beats/min and regular, respiratory rate is 22 breaths/min and regular, and urine output has only been 20 ml since being admitted 3 hours ago. Mucous membranes are dry, and there is poor skin turgor. Based on this information, you would expect his pulmonary artery occlusive pressure to be: A. 4 mm Hg. B. 8 mm Hg. C. 12 mm Hg. D. 16 mm Hg. - Answer - A. 4 mm Hg. This assessment reveals dehydration (hypotension, tachycardia, oliguria, dry mucous membranes, and poor skin turgor). A pulmonary artery occlusive pressure (PAOP) of 4 mm Hg would correlate with the physical assessment. Normal PAOP is 12 to 15 mm Hg. Clinical indications of dehydration are present in the case study. Choose the value below normal. Choose 4 mm Hg. A patient with acute kidney injury has the following arterial blood gas results: pH7.32Paco235 mm HgHCO318 mEq/L This acid-base imbalance is the result of the inability of the kidney to:

The patient has a metabolic acidosis because the kidneys are unable to excrete the acid by- products of cellular metabolism. A 42-year-old woman is admitted with myasthenic crisis after a viral illness. Which of the following are characteristics of myasthenia gravis? A. It causes muscle weakness and fatigability. B . It is associated with demyelination of peripheral nerve fibers. C. It affects the nerve roots. D . It may result in adrenergic crisis. - Answer - A. It causes muscle weakness and fatigability. Myasthenia gravis is a disorder of voluntary muscles caused by a defect in nerve impulse transmission at the neuromuscular junction. It causes muscle weakness and fatigability. A 42-year-old man is admitted to the critical care unit with smoke inhalation and acute respiratory distress syndrome (ARDS). He is intubated, and the following mechanical ventilation is initiated: fraction of inspired oxygen, 0.6; intermittent mandatory ventilation, 10 breaths/min; tidal volume, 450 ml; positive end-expiratory pressure (PEEP), 15 cm H2O. Arterial blood gases are pH, 7.39; PaCO2, 42 mm Hg; HCO3, 24 mEq/L; and PaO2, 70 mm Hg. The purpose of using PEEP in the treatment of this patient is which of the following? A. Increase pulmonary compliance. B A. excrete acid by-products of metabolism. B. excrete carbon dioxide. C. excrete bicarbonate ions. D. excrete calcium ions. - Answer - A. excrete acid by-products of metabolism.

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Decrease the chance of barotrauma. C. Increase alveolar surface tension. D . Decrease intrapulmonary shunt. - Answer - D. Decrease intrapulmonary shunt. PEEP has three primary purposes: to increase the driving pressure of oxygen, to decrease surface tension and the work of breathing, and to decrease shunt by reopening collapsed alveoli. In ARDS, the purpose of PEEP is to open alveoli that have collapsed (called alveolar recruitment) and to keep alveoli open that are still open. The effect of this action is to decrease intrapulmonary shunt. Which ventilator mode requires close monitoring for auto-PEEP (positive end-expiratory pressure) ? Pressure-controlled inverse ratio ventilation, which flips the normal 2:1 inspiration/expiration ratio to make inspiration longer than expiration, allows trapping of air in the lungs. This inadvertent PEEP is called auto-PEEP. Which of the following best differentiates hypovolemic from cardiogenic shock? A. In termittent mandatory ventilation B. Pressure support ventilation C. Pr essure - controlled inverse ratio ventilation D. Pressure-regulated, volume-controlled ventilation - Answer - C. Pressure - controlled inverse ratio ventilation

The cardiac index is decreased, the systemic vascular resistance is increased, and the urine output is decreased in hypovolemic and cardiogenic shock. The pulmonary artery occlusive pressure (PAOP) is decreased in hypovolemic shock but increased in cardiogenic shock. A patient develops carpopedal spasm and neuromuscular irritability manifested by Chvostek and Trousseau signs. Which electrolyte imbalance should you suspect? The patient's signs/symptoms are associated with hypocalcemia and its reciprocal condition, hyperphosphatemia. The same signs/symptoms also are seen in hypomagnesemia. You probably immediately looked for hypocalcemia but could not find it among the options. To answer this question correctly, you need to remember the reciprocal relationship between calcium and phosphorus. Which mode of mechanical ventilation requires the nurse to monitor closely for auto-PEEP (positive end-expiratory pressure)? A. A. Increased systemic vascular resistance B. D ecreased cardiac index C. D ecreased urine output D. Decreased pulmonary artery occlusive pressure- Answer - D. Decreased pulmonary artery occlusive pressure A. Hyperkalemia B. Hypercalcemia C. Hypermagnesemia D. Hyperphosphatemia- Answer - D. Hyperphosphatemia

Inverse ratio ventilation B . Pressure support ventilation C. Intermittent mandatory ventilation D . High-frequency jet ventilation B . Pressure support ventilation C. Intermittent mandatory ventilation D . High-frequency jet ventilation - Answer - A. Inverse ratio ventilation Inverse ratio ventilation allows more time for inspiration than for expiration. A potential danger of this mode is that expiration will be incomplete when the next inspiration begins. This means that there was unintentional positive end-expiratory pressure, also referred to as auto-PEEP. If a patient has a palpable radial pulse, the systolic blood pressure (BP) is at least: A. 50 mm Hg. B . 60 mm Hg. C. 70 mm Hg. D . 80 mm Hg.

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D. 80 mm Hg. If the radial artery can be palpated, the systolic BP is at least 80 mm Hg. If the brachial artery can be palpated, the systolic BP is at least 70 mm Hg. If only the carotid artery can be palpated, the systolic BP is approximately 60 mm Hg. Your patient has an increase in venous oxygen saturation (SvO2) along with a decrease in oxygen consumption (VO2) and pH. What do you suspect? In the early or hyperdynamic phase of septic shock, oxygen delivery (DO2) is increased but the tissues cannot extract and use the oxygen, so VO2 is decreased and SvO2 is increased. Lactic acidosis occurs because the cells are hypoxic. In multiple organ dysfunction syndrome (MODS), clinical indications of respiratory failure include: Hypoventilation would cause the PaCO2 to increase. A 52-year-old patient with a history of alcoholism is admitted with massive esophageal bleeding. Which of the following would be an indication for the administration of blood in this patient? A. A. Ea rly septic shock B. C ardiogenic shock C. H emorrhagic shock D. Anaphylactic shock - Answer - A. Early se ptic shock A. increased pH. B. increased PaCO2. C. PaO2/FiO2 (fraction of inspired oxygen) ratio of greater than 300 mm Hg. D. narrow A:a gradient.- Answer- B. increased PaCO2.

Hemoglobin less than 10 g/dl B. Hematocrit less than 30% C. Inability to control bleeding via endoscopic sclerosing therapy D. Symptoms of hypoperfusion such as chest pain or dyspnea - Answer - D. Symptoms of hypoperfusion such as chest pain or dyspnea Clinical indications of hypoperfusion such as chest pain, dyspnea, or hypotension are indications that blood should be administered. Absolute hemoglobin or hematocrit levels are no longer indications because of the risk of blood-transmitted diseases. Inability to control bleeding is an indication for surgery. Which of the following are the major sources of intracranial hypertension after craniocerebral trauma ? Cerebral edema and expanding lesions (e.g., hematoma) are the two major sources of increased intracranial pressure. A patient received one unit of packed cells. Which of the following would be the expected effects of the transfusion? A. Increase in hemoglobin by 0.5 g/dl and increase in hematocrit by 2% B. Increase in hemoglobin by 0.5 g/dl and increase in platelets by 50,000/mm C. Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3% D. A. C erebral edema and expanding lesions B. Hypervolemia and hyperthermia C. Hypovolemia and hypothermia D. Hydrocephalous and infection- Answer - A. Cerebral edema and expanding lesions

Increase in hemoglobin by 1 g/dl and increase in platelets by 50,000/mm3 - Answer - C. Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3% One unit of packed red blood cells should increase the hemoglobin by 1 g/dl and hematocrit by 3% within approximately 4 to 6 hours. Red blood cells do not provide platelets. A 20-mm S wave in lead V1 and a 25-mm R wave in lead V6 are noted on a patient's 12-lead electrocardiogram. This would indicate which of the following? A. Right bundle branch block (RBBB) B. Left ventricular hypertrophy C. Posterior wall myocardial infarction (MI) D . Right ventricular hypertrophy - Answer - B. Left ventricular hypertrophy When the depth of the S wave in lead V1 or V2 plus the height of the R wave in lead V5 or V6 is 35 mm or greater, this constitutes voltage criteria for left ventricular hypertrophy. Which of the following arterial blood gas findings supports the diagnosis of pulmonary embolism? A pulmonary embolism causes hypoxemia because there is a perfusion, and therefore diffusion, problem. Remember that diffusion problems affect PaO Which of the following sets of hemodynamic data is associated with early septic shock? A. L ow pH B. H ypercapnia C. H ypoxemia D. Elevated base excess - Answer - C. Hypoxemi a

CI (L/min/m2)PAOP (mm Hg)SVR (dynes/sec/cm-5)SvO (%) A.Greater than 3Greater than 10Less than 800Less than 70 B.Greater than 3Less than 10Less than 800Greater than 70 C.Less than 3Greater than 10Greater than 800Less than 70 D.Less than 3Less than 10Greater than 800Greater than 70 - Answer - C In the early stage (also called the hyperdynamic or warm stage), the cardiac index (CI) is increased, the pulmonary artery occlusive pressure (PAOP) is decreased (a relative hypovolemia related to massive vasodilation), the systemic vascular resistance (SVR) is decreased, and the venous oxygen saturation (SvO2) is increased (because tissue oxygen extraction is decreased). What would be the best laboratory test to evaluate this patient's glomerular filtration rate (GFR)? A. Blood urea nitrogen B. Serum creatinine C. Urine creatinine clearance D . Serum amylase - Answer - C. Urine creatinine clearance The creatinine clearance rate reflects the GFR. One hundred percent (or as close as can be achieved) oxygen should be used in cardiopulmonary arrest. There is no contraindication to 100% oxygen in cardiopulmonary arrest. Whic h of the following is the oxygen concentration to be used in patients with cardio pulmonary arrest? A. 40 % B. 80 % C. 100 % D. 100 % except for patients with chronic hypercapnia- Answer - C. 100%

A 65-year-old man is admitted to the critical care unit with a diagnosis of septic shock. He has been receiving chemotherapy for lung cancer. His skin is warm and dry, and he is restless. His white blood cell count is elevated above normal. Hemoglobin, hematocrit, and red blood cell count are normal. Vital signs are blood pressure 80/50 mm Hg, heart rate 120 beats/min and regular, respiratory rate 32 breaths/min and regular, and temperature 39° C. Arterial blood gases reveal the following: pH7.25PaO260 mm HgPaCO225 mm HgHCO313 mEq/LOxygen saturation86% Dobutamine is started at 10 mcg/kg/min. Normal saline is infusing at 150 ml/hr. Which of the following would be most indicative of improvement in this patient? A. Increase in venous oxygen saturation (SvO2) B. Decrease in arterial lactate C. Increase in cardiac output D. Increase in urine output - Answer - B. Decrease in arterial lactate Associate lactate with lactic acid. You know that a decrease in lactic acid would indicate less anaerobic metabolism. Adequate oxygen extraction and aerobic metabolism would decrease the lactic acid level. The physician has prescribed mannitol for a patient with intracranial hypertension. Which of the following is an important consideration when administering mannitol? A. The drug must be protected from light. B. The drug must be administered through an in-line filter. C. The drug must be administered into a central venous catheter. D. The drug must be refrigerated. - Answer - B. The drug must be administered through an in-line filter.

If a patient with a normal pH and temperature has a PaO2 of 60 mm Hg, his arterial oxygen saturation (SaO2) is closest to which of the following values? One way to remember this is to consider what level concerns you. At an SaO2 of less than 90%, we get concerned because we are no longer on the horizontal end of the oxyhemoglobin dissociation curve. This means that there will be significant desaturation for every drop in the PaO2 of even 1 mm Hg because we are on the vertical limb of the curve. Note how significantly the saturation dropped between the PaO2 of 60 mm Hg and 40 mm Hg. A patient had a craniotomy 2 days ago for removal of a tumor. He is awake and talking to the nurse and demonstrates no neurologic deficit. Blood pressure is 110/80 mm Hg, pulse is 92 beats/min, and respiratory rate is 22 breaths/min. Urine outputs have been approximately 60 ml/hr over the last 2 days, but he has had a recent change. He has had 300 to 400 ml/hr of urine output over the last several hours. The urine has a specific gravity of 1.002. The nurse checks his serum glucose and finds that it is 100 mg/dl. The intravenous solution most appropriate for fluid replacement would be: A. 5% dextrose in water (D5W). B. normal saline. C. lactated Ringer solution. D . 10% dextrose in water (D10W). - Answer - A. 5% dextrose in water (D5W). D5W is an isotonic solution while in the bottle, but when it is administered, the dextrose is quickly metabolized, leaving free water. The patient in this case has indications of diabetes insipidus. Patients with diabetes insipidus lose more water than sodium, and they need to be A. 75 % B. 90 % C. 95 % D. 99 % - Answer - B. 90%

treated with more water than sodium. Saline and lactated Ringer solution would contribute to the hypernatremia. D10W could cause a hypertonic diuresis. A 76-year-old man is admitted with complaints of sudden, sharp, "tearing" chest pain radiating to the shoulders, neck, and back. He has been in apparent good health except for a history of hypertension. Vital signs are blood pressure, 180/96 mm Hg; heart rate, 90 beats/min; and respiratory rate, 26 breaths/min. He is dyspneic, and his electrocardiogram shows nonspecific ST-T wave changes. Which of the following would not be an important aspect of care for this patient? A. Control his blood pressure. B . Provide adequate analgesia. C. Initiate fibrinolytic therapy. D . Prepare the patient for surgery. - Answer - C. Initiate fibrinolytic therapy. Fibrinolytic therapy is contraindicated if dissecting thoracic aortic aneurysm is suspected. All of the other interventions are appropriate. Which of the following interventions would be helpful in prevention of aspiration in a patient receiving enteral feedings? A. C heck for gastric residuals every 4 hours. B. Use a small-bore duodenal feeding tube. C. Use a high-fat feeding. D. Add blue food coloring to the enteral feeding. - Answer - B. Use a small - bore duodenal feeding tube.

A tube that is placed below the pylorus would decrease the risk of aspiration Which of the following would not cause an elevated creatine kinase-muscle/brain (CK-MB)? A. Myocarditis B . Heart failure C. Myocardial infarction D . Postcardiotomy - Answer - B. Heart failure Any injury to the myocardium would cause elevation of cardiac isoenzymes. Myocarditis, myocardial infarction, and cardiotomy cause injury to the myocardium. The ability of the brain contents to be shifted to prevent intracranial hypertension when intracranial volume increases is referred to as: A. compensation. B. autoregulation. C. normalization. D. feedback. - Answer - A. compensation. Remember the difference between compensation and autoregulation. Compensation relates to intracranial volumes and resultant pressure. Autoregulation relates to the ability of the cerebral vessels to change size to normalize blood flow Which of the following is not a therapeutic effect of nifedipine when used for angina?

Nifedipine decreases myocardial oxygen consumption by dilating veins and arteries, thereby decreasing preload and afterload. Nifedipine also decreases vasospasm and potential for vasospasm. Unlike diltiazem and verapamil, nifedipine does not significantly decrease contractility. Emergency decompression of a tension pneumothorax includes needle puncture at which of the following locations? A. Fifth intercostal space at the midclavicular line on the affected side B. Second intercostal space at the midclavicular line on the affected side C. Second intercostal space at the midaxillary line on the affected side D. Fifth intercostal space at the midaxillary line on the affected side - Answer - B. Second intercostal space at the midclavicular line on the affected side A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism. He is nonresponsive to verbal stimuli at this time. Which dietary restrictions would be maintained for a patient with hepatic encephalopathy? A. Protein and sodium B. Fat and potassium C. Potassium and carbohydrates D. Sodium and potassium - Answer - A. Protein and sodium A. Decreased preload. B. Decreased afterload. C. Decreased contractility. D. Relieve vasospasm.- Answer - C. Decreased contractility.

Protein is restricted because its breakdown causes increased ammonia levels. Sodium is restricted because patients with hepatic disease have increased circulating levels of aldosterone, which causes increased sodium reabsorption in the distal tubule and resultant edema. A 24-year-old man is admitted to the critical care unit after sustaining a pulmonary contusion in a motor vehicle collision. He has no history of cardiac or pulmonary disease. Over the last few hours, he has been complaining of increasing dyspnea, his respiratory rate has been increasing, and his oxygen saturation via pulse oximetry has been decreasing. Breath sound assessment reveals fine crackles bilaterally. Arterial blood gases reveal respiratory alkalosis and hypoxemia. Chest x-ray film reveals patchy infiltrates. Acute respiratory distress syndrome (ARDS) is diagnosed. Oxygen therapy is initiated, and arterial blood gases are monitored closely. The massive atelectasis that occurs in acute respiratory distress syndrome is a classic example of intrapulmonary shunt. Intrapulmonary shunting is best described as which of the following? A. Ventilated alveoli having blocked perfusion. B. Perfused alveoli having blocked ventilation. C. Decreased diffusion caused by an increased thickness of the alveolar-capillary membrane. D. Decreased diffusion caused by decreased driving pressure of oxygen. - Answer - B. Perfused alveoli having blocked ventilation. A patient admitted with Goodpasture syndrome has developed acute tubular necrosis. The patient's phosphorus level is 6.5 mg/dl. Control of the phosphorus is important to avoid complications from which of the following? A. Hyponatremia B. Hypocalcemia C. Hypernatremia D. Hypercalcemia - Answer - B. Hypocalcemia Associate phosphorus and calcium with a seesaw. When one side of the seesaw is up, the other is down. This process is consistent with normal and abnormal kidney function. Choose "Hypocalcemia." You do not really need to know what Goodpasture syndrome is to answer