CCRN 124 Test Questions: Critical Care Nursing, Exams of Nursing

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CCRN 124 test Questions

A 72-year-old man arrived in the emergency department after 4 hours of substernal pain radiating to the left arm. He has a 100 pack-year history of cigarette smoking, chronic obstructive pulmonary disease, and intermittent claudication. His electrocardiogram on admission shows sinus tachycardia with a rate of 120 beats/min and ST segment elevation in leads I, AVL, and V3 to V6. Vital signs include blood pressure, 150/84 mm Hg; respiratory rate, 15 breaths/min; functional oxygen saturation (SpO2), 95%; and temperature, 38.3° C (100.9° F). Which of the following treatments would not be indicated for this patient at this time?

A.

Morphine and nitroglycerin B. Aspirin and fibrinolytic drugs C. β-blockers D. Lidocaine - ✔ ✔ D. Lidocaine

Lidocaine is used for symptomatic ventricular dysrhythmias. A 72-year-old woman has been complaining of chest pain for 30 min. Her medical history includes vaginal hysterectomy and angina. She was initially alert but is now drowsy. Her skin is cool and moist. Vital signs are blood pressure, 84/60 mm Hg; heart rate, 42 beats/min and regular; and respiratory rate, 28 breaths/min. Electrocardiogram monitor shows sinus bradycardia. Which of the following treatments is indicated?

A. Epinephrine 1 mg IV B.

Atropine 0.5 mg IV C. Isoproterenol IV infusion at 2 mcg/min D.

Transcutaneous pacemaker - ✔ ✔ D. Transcutaneous pacemaker 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. - ✔ ✔ C. Initiate fibrinolytic therapy.

Fibrinolytic therapy is contraindicated if dissecting thoracic aortic aneurysm is suspected. All of the other interventions are appropriate. A 22-year-old man is admitted after a bicycle collision with a tree. He has a contusion on the right side of his head. An intraventricular catheter has been inserted via a burr hole to monitor his intracranial pressure (ICP). He develops respiratory depression and is intubated and mechanically ventilated. Which of the following is the most likely cause of an increase in ICP at this time?

A.

Positive pressure ventilation B.

Hypocapnia caused by hyperventilation C. Sedation D.

Cerebral dehydration caused by osmotic diuretics - ✔ ✔ A. Positive pressure ventilation

Positive pressure ventilation increases intrathoracic pressure, which leads to increased ICP. 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. - ✔ ✔ 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 22-year-old man is admitted with spontaneous pneumothorax. He is extremely dyspneic and anxious. He also is complaining of tingling around his mouth and his fingertips and feeling light-headed. Blood pressure is 120/82 mm Hg, heart rate is 110 beats/min, respiratory rate is

36 breaths/min and deep, and temperature is 37° C (98.6° F). Which of the following would not be used to treat this condition?

A.

Calcium B. Chest tube C. Analgesia D.

Calming the patient - ✔ ✔ A. Calcium

Remember that respiratory alkalosis, caused by hyperventilation, increases the binding between albumin and calcium and, therefore, reduces the serum ionized calcium level. This is why the patient is having the symptoms of tetany. However, he does not need calcium. He needs a reduction in minute ventilation, which will decrease his pH and correct the binding between calcium and albumin, increasing the ionized calcium level. Chest tube to re-expand the lung, analgesia to treat the chest discomfort, and calming of the patient (including the use of sedatives) would be appropriate components of the treatment plan for this patient. A 24-year-old man has been diagnosed with acute kidney injury as a result of severe hemorrhaging after a motor vehicle collision. Which of the following would be expected laboratory values for this patient?

A.

Low urinary osmolality, high urinary sodium concentration B. High urinary osmolality, high urinary sodium concentration C. Low urinary osmolality, low urinary sodium concentration D.

High urinary osmolality, low urinary sodium concentration - ✔ ✔ D. High urinary osmolality, low urinary sodium concentration

Consider that the kidney would want to conserve sodium and water with blood loss. If the kidney is holding onto sodium, little is excreted into the urine, so urinary sodium is low. If the kidney is holding onto water, little is excreted into the urine, so it is concentrated and osmolality is increased. 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. During the first 24 hours after admission, he has been complaining of increasing dyspnea, his respiratory rate has been increasing, and his oxygen saturation via pulse oximetry has been decreasing despite supplemental oxygen. 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 is diagnosed. Oxygen therapy is initiated, and arterial blood gases are monitored closely, but SaO continues to fall. Which of these oxygen delivery systems will provide the highest concentration of oxygen and indicated in this case?

A. Face tent B. Nonrebreathing mask C. Nasal cannula D.

Venturi mask - ✔ ✔ B. Nonrebreathing mask

The nonrebreathing mask stores oxygen in nose, pharynx, mask, and reservoir bag between breaths. This allows a concentration of close to 100%.

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 bloc - ✔ ✔ B. Perfused alveoli having blocked ventilation. A 27-year-old woman arrives in the emergency department 3 weeks after the vaginal delivery of her first child. She is transferred to the critical care unit after an acute onset of dyspnea and chest pain. Vital signs are blood pressure, 120/88 mm Hg; heart rate, 122 beats/min; and respiratory rate, 32 breaths/min. Arterial blood gases reveal a pH of 7.48, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of 55 mm Hg, and an arterial oxygen saturation of 89% on 100% oxygen by nonrebreathing mask. Jugular venous distention is evident, and cardiac auscultation reveals an accentuated P2 and a right-sided S3 and S4. A ventilation/perfusion scan indicates high probability of a pulmonary embolism. Which of the following is not evident by the heart sound changes?

A.

Pulmonary hypertension

B.

Right ventricular strain and noncompliance C. Right ventricular failure D.

Pulmonary edema - ✔ ✔ D. Pulmonary edema A 27-year-old woman arrives in the emergency department 3 weeks after the vaginal delivery of her first child. She is transferred to the critical care unit after an acute onset of dyspnea and chest pain. Vital signs are blood pressure, 120/88 mm Hg; heart rate, 122 beats/min; and respiratory rate, 32 breaths/min. Arterial blood gases reveal a pH of 7.48, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of 55 mm Hg, and an arterial oxygen saturation of 89% on 100% oxygen by nonrebreathing mask. Jugular venous distention is evident, and cardiac auscultation reveals an accentuated P2 and an S3 and S4 of the right side. A ventilation/perfusion scan indicates high probability of a pulmonary embolism. What treatment is indicated at this time?

A.

Intubation and mechanical ventilation B. Heparin C. Fibrinolytic agents D.

Pulmonary embolectomy - ✔ ✔ C. Fibrinolytic agents

Remember that fibrinolytic agents are not contraindicated by surgery or trauma after about 2 weeks because the normal fibrinolytic process already would have broken down the clot. The exception would be brain or spinal cord trauma or surgery because the consequences of bleeding into the head or spine would be particularly dire. 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. - ✔ ✔ 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 32-year-old woman has systemic lupus erythematosus and chronic kidney disease. Over the past 2 weeks, she has complained of feeling fatigued and short of breath after minimal exertion. She is receiving hemodialysis. Her hemoglobin level is 4.5 g/dl.Which of the following is indicated?

A.

Recombinant human erythropoietin (Epogen) B. Two units of packed red blood cells C. Nitroglycerin sublingual as needed D.

Azathioprine - ✔ ✔ A. Recombinant human erythropoietin (Epogen)

This patient is having symptoms of decreased tissue oxygenation. In acute situations, this would be an indication for blood. In this patient, recombinant human erythropoietin is a more appropriate treatment. Recombinant human erythropoietin is used to treat anemia resulting from reduced renal production of erythropoietin (the hormone that promotes the production of red blood cells) A 40-year-old patient has been admitted to the critical care unit after sustaining multiple injuries from a cave-in accident this morning. X-ray films confirm multiple fractures, including the left femur. During the afternoon, he was taken to surgery for internal fixation of the left femur. It is now 10 pm, and the patient is complaining of severe throbbing pain in his thigh. The patient received 5 mg of morphine sulfate IV 30 min ago. The anterior left thigh is firm to touch, and the pain increases when the patient flexes his left leg. Further assessment reveals that swelling extends to the knee, and popliteal, posterior tibial, and dorsalis pedis pulses are not palpable. What should be done next?

A.

Call the physician and prepare for fasciotomy. B. Check pulses with a Doppler stethoscope. C. Call the physician and prepare for embolectomy. D.

Check for Homans sign. - ✔ ✔ B. Check pulses with a Doppler stethoscope.

There appears to be an arterial occlusion, but before deciding to prepare for surgical procedures, the nurse should complete the assessment by using a Doppler stethoscope to see whether pulses are audible. Swelling makes it difficult to palpate pulses, but the pulses will be audible with a

Doppler stethoscope if present. Homans sign is a sign of venous obstruction or phlebitis, which would not cause a loss of arterial pulses. 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. Decrease the chance of barotrauma. C. Increase alveolar surface tension. D.

Decrease intrapulmonary shunt. - ✔ ✔ 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. 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. - ✔ ✔ 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 45-year-old woman is admitted with deep venous thrombosis and pulmonary embolism. She has received a heparin bolus and has been on a continuous heparin drip for 3 days. If the patient develops heparin- induced thrombocytopenia (HIT), what clinical sign would the nurse expect to see first?

A. Surface bleeding from wounds and IV sites B. Hematuria C. Petechiae D.

Bleeding from gums - ✔ ✔ C. Petechia

HIT is an immune-mediated adverse effect of heparin. It causes thrombosis and thrombocytopenia. The first clinical sign of a decrease in platelet quantity or quality is petechiae. A 48-year-old male patient with a history of inferior myocardial infarction (MI) is admitted with an acute anterolateral MI. He is tachycardic and hypotensive. Cardiac index is 1.9 L/min/m2. Pulmonary artery occlusive pressure (PAOP) is 20 mm Hg, and systemic vascular resistance (SVR) is 2000 dynes/sec/cm-5. Which of the following is the priority in this patient?

A.

Prevent dysrhythmias. B. Increase myocardial perfusion. C. Decrease preload. D. Decrease afterload. - ✔ ✔ B. Increase myocardial perfusion

The primary way to reverse the hemodynamic changes that are occurring is to restore blood flow to the myocardium and improve the ejection fraction. Reperfusion is the priority. This may be done mechanically with percutaneous coronary interventions or pharmacologically with fibrinolytics. If the myocardium is reperfused and the muscle is restored, the cardiac index will improve, the PAOP will decrease, and the SVR will decrease. A 50-year-old patient is transferred to the critical care unit from the emergency department. A rattlesnake bit him approximately 6 hours ago. He is having a severe reaction to the venom, and antivenom is being flown to the hospital. The patient is bleeding from his IV insertion sites and continues to seep blood from the wound. Treatment for disseminated intravascular coagulation in this particular case would include which of the following?

A.

Clotting factors and antivenom B. Clotting factors and heparin C. IV fluids and antivenom D. IV fluids and heparin - ✔ ✔ A. Clotting factors and antivenom

A 50-year-old patient is transferred to the critical care unit from the emergency department. A rattlesnake bit him approximately 6 hours ago. He is having a severe reaction to the venom, and antivenom is being

flown to the hospital. The patient is bleeding from his IV insertion sites and continues to seep blood from the wound. Which of the following diagnostic panels is suggestive of disseminated intravascular coagulation (DIC)?

A.

Decreased platelets, decreased fibrinogen, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), prolonged thrombin time, increased fibrin degradation products (FDPs) B. Increased platelets, increased fibrinogen, normal PT, aPTT, normal thrombin time, increased fibrin degradation products (FDPs) C. Increased platelets, decreased fibrinogen, prolonged PT, aPTT, prolonged thrombin time, decreased fibrin degradation products (FDPs) D. Decreased platelet - ✔ ✔ A. Decreased platelets, decreased

fibrinogen, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), prolonged thrombin time, increased fibrin degradation products (FDPs) 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 - ✔ ✔ A. Protein and sodium

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. Diminished breath sounds indicate diminished air flow. Atelectasis is the logical choice. Pleurisy causes a pleural friction rub. Pneumonia causes bronchial breath sounds. The chest tube does not cause any specific breath sound, though there may be gurgling audible if the suction is not clamped during auscultation A 54-year-old man is admitted to the critical care unit with acute kidney injury resulting from a bladder tumor. This would be classified as which type of acute kidney injury?

A.

Prerenal B. Intrarenal—medullary C. Intrarenal—cortical D.

Postrenal - ✔ ✔ D. Post renal 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 - ✔ ✔ 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. A 65-year-old man had a thoracotomy for removal of a lung mass yesterday. He has two chest tubes in place with a Y-connector to one Pleur-Evac. He is on a positive pressure ventilator, but he is to be weaned this morning. Why is it important to wean this patient as early as possible?

A.

The positive pressure of the ventilator may maintain the air leak. B. The positive pressure of the ventilator may increase bleeding. C. He is likely to be difficult to wean. D.

So that he can be transferred out of the intensive care unit. - ✔ ✔ A. The positive pressure of the ventilator may maintain the air leak.

Positive pressure ventilation in this patient is likely to maintain an air leak. Patients after thoracotomy should be weaned as soon as possible. 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 - ✔ ✔ 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. 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% What hemodynamic alteration should the nurse anticipate?

A.

Decreased cardiac output (CO) B. Increased venous oxygen saturation (SvO2) C. Increased systemic vascular resistance (SVR) D.

Increased oxygen consumption - ✔ ✔ B. Increased venous oxygen saturation (SvO2)

Early septic shock is different from most forms of shock because the main problem is oxygen extraction rather than oxygen delivery. So think opposite of hypovolemic shock. CO is increased instead of decreased. SVR is decreased instead of increased. And the SvO2 is increased instead of decreased. A 70-year-old woman, weighing 50 kg, comes to the emergency department complaining of chest pain and shortness of breath. The electrocardiogram monitor shows ventricular tachycardia at a rate of 150 beats/min. Which treatment is appropriate in this situation?

A.

Amiodarone IV B. Verapamil HCl IV C. Defibrillation beginning at 200 J D.

Synchronized cardioversion beginning at 100 J - ✔ ✔ D. Synchronized cardioversion beginning at 100 J

Treatment for an unstable ventricular tachycardia is sedation and synchronized cardioversion beginning at 100 J. Amiodarone would be used in stable ventricular tachycardia. Verapamil is used for supraventricular tachycardias and would be inappropriate for ventricular tachycardia. Defibrillation is indicated if the patient is pulseless. A 72-year-old man arrived in the emergency department after 4 hours of substernal pain radiating to the left arm. He has a 100 pack-year history of cigarette smoking, chronic obstructive pulmonary disease, and intermittent claudication. His electrocardiogram on admission shows sinus tachycardia with a rate of 120 beats/min and ST segment elevation in leads I, AVL, and V3 to V6. Vital signs include blood pressure, 150/84 mm Hg; respiratory rate, 15 breaths/min; functional oxygen saturation (SpO2), 95%; and temperature, 38.3° C (100.9° F). This patient is at particular risk for which of the following?

A.

Sinoatrial (SA) blocks B. Type I second-degree AV block C. Type II second-degree AV block D.

Third-degree AV heart block with junctional escape rhythm - ✔ ✔

C. Type II second-degree AV block

SA blocks, second-degree AV block type I, and third-degree AV heart block at the level of the AV node would occur in right coronary artery occlusion and inferior myocardial infarction rather than in this example of left coronary artery occlusion and anterolateral myocardial infarction. A 77-year-old woman reports explosive diarrhea for 48 hours. She is extremely lethargic. Mucous membranes are dry and sticky, and the

urine is dark amber with a specific gravity of 1.035. Vital signs are temperature 38.2° C orally; heart rate 130 beats/min and regular; respiratory rate 26 breaths/min and regular; and blood pressure 90/ mm Hg. Which of the following is of the most immediate concern?

A.

Infection B. Hypovolemia C. Nutrition D.

Skin breakdown - ✔ ✔ B. Hypovelemia

Hypovolemia, especially in an older adult, is the most life threatening A patient 5 days after an acute inferior myocardial infarction suddenly complains of severe dyspnea and palpitations. The patient appears anxious and diaphoretic. While completing the assessment of the patient, a loud holosystolic murmur at the apex that radiates to the axilla is noted. The patient also has crackles throughout the lung field but an S at the apex is not audible. Which of the following is most likely to be descriptive of the pulmonary artery occlusive pressure (PAOP) in this patient?

A. An elevated v wave and an overestimate of the left ventricular end- diastolic pressure (LVEDP) B. A dampened v wave and an underestimate of the LVEDP C. A normal v wave and an accurate reflection of the LVEDP D.

An elevated v wave and a direct correlation to the pulmonary artery diastolic pressure - ✔ ✔ A. An elevated v wave and an overestimate

of the left ventricular end-diastolic pressure (LVEDP) 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 - ✔ ✔ 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 the question correctly. A patient develops carpopedal spasm and neuromuscular irritability manifested by Chvostek and Trousseau signs. Which electrolyte imbalance should you suspect?

A.

Hyperkalemia B. Hypercalcemia C. Hypermagnesemia D.

Hyperphosphatemia - ✔ ✔ D. Hyperphosphatemia

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. A patient develops diabetes insipidus after a craniotomy. Which group of findings would be most characteristic of diabetes insipidus?

A. Oliguria, low serum osmolality, hyponatremia, and high urine specific gravity B. Polyuria, high serum osmolality, hypernatremia, and low urine specific gravity C. Oliguria, high serum osmolality, hypernatremia, and low urine specific gravity D. Polyuria, low serum osmolality, hyponatremia, and high urine specific

gravity - ✔ ✔ B. Polyuria, high serum osmolality, hypernatremia, and low urine specific gravity 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. - ✔ ✔ 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." 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:

A.

sodium retention. B. water loss. C. water gain. D.

aldosterone excess. - ✔ ✔ B. water loss

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 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). - ✔ ✔ 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 treated with more water than sodium. Saline and lactated Ringer solution would contribute to the hypernatremia. D10W could cause a hypertonic diuresis. A patient had a nephrectomy 2 days ago. He is reluctant to breathe deeply because he says it hurts, despite narcotic administration by patient-controlled analgesia. It is suspected that he has developed atelectasis. Which of the following is not characteristic of atelectasis?

A.

Crackles audible over lung bases B. Decrease in SpO2 C. Temperature of 38.3° C (101° F) D. Dullness on percussion - ✔ ✔ D. Dullness on percussion

A patient has developed a third-degree atrioventricular block. Which of the following rates would be indicative of a ventricular escape rhythm?

A.

20 to 40 beats/min B. 40 to 60 beats/min C. 60 to 80 beats/min D.

80 to 100 beats/min - ✔ ✔ A. 20 to 40 beats/min

The intrinsic rate of the Purkinje system is 20 to 40 beats/min. You also should remember that it is unreliable.

Because the ventricles would be the last chance for an escape rhythm and you know that sinus and atrial rates are high, choose the slowest rate. A patient is admitted with subarachnoid hemorrhage. He develops a fever of 38.5° C. Which of the following is of greatest concern for this patient?

A.

The effect of the febrile state on the immune system B. The shift of the oxyhemoglobin dissociation curve C.

The impact of the febrile state on coagulation D.

The resultant increase in cerebral oxygen consumption - ✔ ✔ D. The resultant increase in cerebral oxygen consumption

With each increase in temperature of 1° C, the cerebral oxygen consumption increases approximately 7%. This increase in body temperature has a significant adverse effect on cerebral oxygenation. 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 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 - ✔ ✔ 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