CCRN CRITICAL CARE REGISTERED NURSE EXAM LATEST 2023/2024 QUESTIONS AND 100% CORRECT ANSWE, Exams of Nursing

Download CCRN CRITICAL CARE REGISTERED NURSE EXAM LATEST 2023/2024 QUESTIONS AND 100% CORRECT ANSWE and more Exams Nursing in PDF only on Docsity! TEST BANK The information contained on this document has been tested and edited by professors from various universities. By purchasing this product, we guarantee you that you will get an A+. Wishing you success in your studies! With a 100 % Approved Questions and Answers Guaranteed A+ Grade CCRN CRITICAL CARE REGISTERED NURSE EXAM LATEST 2023/2024 QUESTIONS AND 100% CORRECT ANSWERS TEST BANK -Which of the following ventilator settings is most likely to decrease the work of breathing? A assist-control B pressure support C tidal volume D CPAP {{Ans- Answer: B Pressure support senses the beginning of the patient's spontaneous inspiration and provides a set pressure to assist the inspiratory effort. The primary purpose of the ventilator settings listed in choices (A), (C), and (D) is not to decrease the work of breathing. -A nurse is caring for a patient with an acute inferior wall MI, post coronary artery stent deployment. For optimal care of this patient, the nurse should: Select single answer choice. A administer an analgesic for acute back pain.clearYou selected. B apply a pressure dressing to the groin.clearYou did not select. C continuously monitor the patient in lead II. D maintain the patient in a supine position. {{Ans- Answer: C It is best practice to continuously monitor a patient, who is post coronary artery stent deployment, in the lead that was most abnormal during the acute occlusion. Lead II would most likely meet this criterion for a patient with an inferior wall MI. The remaining interventions are NOT indicated for a patient who is post coronary artery stent deployment. -A patient with aortic regurgitation will have which of the following upon auscultation? Select single answer choice. A as long as the hemodynamic criteria are met. A patient who is receiving PRN morphine may be a candidate for a spontaneous breathing trial, but that patient does not require an infusion to be stopped in order to be awakened. The remaining 2 choices do not meet the criteria for performing either a spontaneous awakening trial or a spontaneous breathing trial. -While the code team is performing resuscitative efforts, many of the patient's family members start to cry and pray, while other family members lie down on the floor in the corner of the room. Which of the following demonstrates the best action for the nurse to take at this time? Select single answer choice. A Ensure that a member of the code team serves as a family presence facilitator and clearly communicates the treatment strategies to the family. B Call security to escort the family members to the waiting room due to their disruptive behavior. C Encourage the family members to leave the patient care area because they are extremely distressed. D Ask the family members to leave the patient care area because they may suffer anxiety from remaining in the room. {{Ans- Answer: A It is important to offer families the opportunity to witness the efforts of the health care team during a patient's cardiopulmonary resuscitation. Research suggests that allowing family members to stay with a patient during this time may decrease their rates of post-traumatic stress disorder, depression, and anxiety related to the event. If the family interferes with the code team's ability to provide care to the patient, it may be necessary to have security remove the family; however, this scenario does not state that the family members are interfering with the code team's efforts, so choice (B) is incorrect. The remaining 2 choices do not allow the family to grieve in a way that may be natural to them. -Cardiogenic shock secondary to left ventricular failure will generally result in: Select single answer choice. A decreased afterload. B a narrow pulse pressure. C decreased preload. D a widening pulse pressure. {{Ans- Answer: B The systolic pressure decreases due to a drop in the cardiac output; however, the diastolic pressure either stays the same or increases due to a compensatory increase in the systemic vascular resistance. The remaining choices are not found in the presence of cardiogenic shock. -Massive atelectasis occurs in the presence of acute respiratory distress syndrome (ARDS). What are the 2 causes of the atelectasis that is typical of ARDS? Select single answer choice. A a surfactant deficiency and pulmonary edema B increased pulmonary vascular resistance and increased pulmonary compliance C increased pulmonary compliance and pulmonary edema D mucus plugs and bronchospasm {{Ans- Answer: A ARDS destroys Type II alveolar cells, which results in decreased surfactant production. ARDS also results in capillary leak at normal left-sided heart pressures, which results in pulmonary edema. Both a surfactant deficiency and pulmonary edema lead to atelectasis. The remaining choices are not correct because increased pulmonary compliance and mucus plugs are not features of ARDS. -A patient was admitted with an acute inferior wall STEMI. The physician advises the nurse to monitor the patient for signs of right ventricular (RV) infarction. Which of the following are signs of RV infarction? Select single answer choice. A S4 heart sound, lung crackles B hypotension, flat neck veins C hypertension, a systolic murmur D distended neck veins, clear lungs {{Ans- Answer: D If the RV contractility decreases, the pressure that is proximal to the right ventricle (which is the right atrial pressure) increases, resulting in distended neck veins. As the right heart fails, the left heart preload decreases, and the lungs are clear. -Which of the following is an effect of hypothermia? Select single answer choice. A a decrease in the SaO2 B a decrease in the blood pressure C an increase in the heart rate D a shift of the oxyhemoglobin dissociation curve to the left {{Ans- Answer: D Hypothermia shifts the oxyhemoglobin dissociation curve to the left, which inhibits the release of oxygen from hemoglobin, thereby resulting in a higher SaO2 than usual at the same PaO2. The remaining choices are not related to hypothermia. -It is important for a nurse to identify the signs of respiratory depression during procedural sedation. Which of the following is a LATE sign of respiratory depression? Select single answer choice. A a cough B SpO2 88% C ETCO2 of 50 mmHg per waveform capnography D sedation {{Ans- Answer: B A pulse oximetry decrease is a late sign of respiratory depression. A cough is not indicative of respiratory depression. An elevated ETCO2 per waveform capnography is an early sign of respiratory depression. Sedation precedes respiratory depression. -The most common cause of acute hepatic failure is: Select single answer choice. A alcohol abuse. B a salicylate overdose. C biliary obstruction. D an acetaminophen overdose. right atrial pressure (RAP) 12 mmHg; pulmonary artery occlusion pressure (PAOP) 7 mmHg; systemic vascular resistance (SVR) 1400 dynes/sec/cm-5; cardiac output (CO) 5 L/min. {{Ans- Answer: B The hemodynamic profile described in choice (B) is typical of septic shock. The patient described in choice (B) would benefit from the interventions described in the question. The hemodynamic profile described in choice (A) is one of hypovolemia. The hemodynamic profile described in choice (C) is one of cardiogenic pulmonary edema. The hemodynamic profile described in choice (D) is one of right ventricular failure. The treatment plan described in the question would not be appropriate for the patients described in choices (A), (C), and (D). -Pulmonary hypertension may result in which of the following? Select single answer choice. A left-sided heart failure. c B right-sided heart failure. C increased lung compliance D arterial hypertension {{Ans- Answer: B The right ventricular wall is normally thinner than the left because the RV generally ejects into a low- pressure pulmonary system with a mean pulmonary artery pressure of approximately 20 mmHg. An increase in the mean pulmonary artery pressure may result in right-sided heart failure. -A patient received a transfusion for upper GI bleeding 4 hours ago. The patient developed acute tachypnea, and the pulse oximeter read 0.88 on room air. After examining the patient and getting a chest radiograph, the physician diagnosed the patient with transfusion-related acute lung injury (TRALI). The nurse anticipates an order for which of the following? Select single answer choice. A furosemide (Lasix). B diphenhydramine (Benadryl). C subcutaneous epinephrine. D aggressive respiratory support. {{Ans- Answer: D This patient requires titration of FiO2 to maintain an SpO2greater than 0.90. Short-term mechanical ventilation may be needed for select patients who are in a similar situation. There is no indication of fluid overload, which may occur with transfusion-associated circulatory overload (TACO). Therefore, a diuretic, such as furosemide (Lasix), is not needed. Diphenhydramine (Benadryl) and subcutaneous epinephrine are not treatments for TRALI. -A patient with a history of chronic alcohol abuse was admitted in a stuporous state with an extremely elevated serum alcohol level. Which of the following will most likely be a part of the treatment plan for this patient? Select single answer choice. A naloxone, activated charcoal, sodium bicarbonate B flumazenil (Romazicon), lactulose, calcium gluconate. C dialysis, cooling, potassium. D fluids, thiamine, phosphate. {{Ans- Answer: D This patient has signs of acute alcohol poisoning with a history of chronic alcohol abuse. Fluids are needed to prevent hypovolemia. Chronic alcohol abuse leads to a thiamine deficiency. Therefore, thiamine is needed to prevent Wernicke encephalopathy. Hypophosphatemia is commonly seen in patients with chronic alcohol abuse. Therefore, the administration of phosphate is also indicated. The remaining 3 choices are not interventions for alcohol poisoning. -Which of the following is indicative of a mixed acid-base disorder? Select single answer choice. A pH 7.18; PaCO2 25; PaO2 64; HCO3 11. B pH 7.33; PaCO2 29; PaO2 72; HCO3 15. C pH 7.35; PaCO2 61; PaO2 62; HCO3 41. D pH 7.25; PaCO2 36; PaO2 68; HCO3 18. {{Ans- Answer: B The decreased PaCO2 is evidence of respiratory alkalosis, and the decreased HCO3 is evidence of metabolic acidosis. A patient with sepsis or septic shock may present with this type of mixed acid-base disorder. Choice (A) is reflective of a patient who has metabolic acidosis with partial compensation. Choice (C) is reflective of a patient who has respiratory acidosis with full compensation. Choice (D) is reflective of a patient who has uncompensated metabolic acidosis. -A patient has an 18-gauge intravenous catheter in his right wrist. The nurse assessed the insertion site prior to administering an IV medication, and the nurse noticed that there was a red line up the arm above the insertion site, there was no swelling, the catheter blood return was brisk, and the site up the arm with the red line was tender to touch. Which assessment and intervention is appropriate at this time? Select single answer choice. A The patient has an extravasation; apply warm compresses over the insertion site. B The patient has a grade 2 infiltration; restart the IV, and apply cool compresses over the insertion site. C The patient has phlebitis; restart the IV with a 20-gauge catheter in the left arm. D The IV catheter is functional; give the IV medication, and reassess the catheter for blood return in an hour. {{Ans- Answer: C A red line above the insertion site, with tenderness, is a sign that the wall of the vein is inflamed, and the catheter needs to be removed. Reinsertion with a smaller gauge catheter is a strategy that can be used to prevent vein irritation. There is no evidence provided that this patient received a vesicant nor are there signs of an extravasation. Therefore, choice (A) is incorrect. The nurse's findings do not support an infiltration. Therefore, choice (B) is incorrect. The nurse should not administer the IV medication into a vein with phlebitis. Therefore, choice (D) is also incorrect. -Which of the following treatments is appropriate for the corresponding overdose? Select single answer choice. A dialysis for a salicylate overdose B Romazicon for an opiate overdose. C a beta blocker for a cocaine overdose. D warming for a phencyclidine (PCP) overdose. {{Ans- Answer: A Dialysis may be initiated even before abnormal creatinine or GFR develop. The remaining choices are incorrect treatments for the associated overdoses. A urine sodium less than 20, the renal tubules' ability to concentrate urine, and a BUN/creatinine ratio of ~ 20:1 indicate that the renal tubular basement membrane remains intact. The remaining 3 choices involve an injury to the renal tubular basement membrane and would not produce the lab results described in the question. -Which of the following statements about the provision of enteral nutrition for a critically ill pati ent is accurate? Select single answer choice. A It is preferred over the parenteral nutrition route. B It should be initiated 48 to 72 hours after the first day of mechanical ventilation. C It should be initiated after the patient has bowel sounds and passing flatus. D Enteral nutrition should be withheld if the gastric residual volume is greater than 100 mL. {{Ans- Answer: A If the gut can be used, that is the preferred nutrition route because it is more natural and has fewer complications than the parenteral nutrition route. The remaining choices are not accurate in regard to enteral nutritional support. -A patient with Type 1 diabetes has been started on metoprolol for heart disease. The nurse needs to inform the patient that the first sign of hypoglycemia might be which of the following? Select single answer choice. A mental status change. B palpitations. C diaphoresis. D irritability. {{Ans- Answer: A The beta blocker (metoprolol) will mask the early signs of hypoglycemia that are due to sympathetic stimulation (tachycardia, palpitations, irritability, headache, shakiness, and diaphoresis). The presenting signs will be the later signs of hypoglycemia (mental status change, slurred speech, seizure, and coma). -Which of the following are appropriate interventions for the treatment of anaphylaxis? Select single answer choice. A vasopressors, inotropes, fluids. B epinephrine SQ, antihistamines, beta-1 blockers. C vasopressors, fluids, antibiotics. D epinephrine IM, antihistamines, corticosteroids. {{Ans- Answer: D Inotropes (choice (A)), beta-1 blockers (choice (B)), and antibiotics (choice (C)) are not appropriate treatment options for anaphylaxis. -Which of the following is most likely to be the etiology of diabetic ketoacidosis (DKA) and to require further investigation? Select single answer choice. A an infection. B Type 2 diabetes. C pancreatitis. D steroid use. {{Ans- Answer: A The physiological stress of an infection may trigger DKA, even when the patient is compliant with the diabetes treatment plan. The remaining 3 choices are more often associated with HHS. -One hemodynamic benefit of intra-aortic balloon pump therapy is that: Select single answer choice. A balloon inflation prevents right-to-left shunt. B balloon deflation increases coronary artery perfusion. C balloon inflation optimizes aortic valve performance. D balloon deflation decreases left ventricular afterload. {{Ans- Answer: D Balloon deflation in the descending aortic arch right before systole creates a drop in afterload. When the balloon inflates during diastole, blood is displaced into the coronary arteries, increasing coronary artery perfusion. -Which of the following patient diagnoses has the greatest degree of predictability? Select single answer choice. A an acute inferior wall MI B septic shock. C heart failure. D acute leukemia. {{Ans- Answer: A Of the diagnoses listed, the diagnosis of an acute inferior wall MI has the greatest degree of predictability. Predictability is a patient characteristic that considers the degree to which the patient outcome is expected. The remaining 3 choices are more likely to involve unforeseen complications and are therefore are less predictable. -A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter is placed. The hemodynamic profile demonstrates right atrial (RA) pressure 1 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusion pressure (PAOP) 4 mmHg, systemic vascular resistance (SVR) 1,500 dynes/sec/cm-5, and SvO255%. What is most likely the cause of this patient's hypotension, and what is the appropriate treatment? Select single answer choice. A hypovolemic shock; fluids B septicshock; vasopressors. C cardiogenic shock; IABP. D anaphylactic shock; epinephrine IM. {{Ans- Answer: A Volume depletion results in decreased preload. A compensatory response to volume depletion results in an increase in the SVR in an attempt to maintain pressure. Fluids will restore the filling pressure (preload), and the SVR will return to normal as compensatory mechanisms will no longer be needed. -A patient with oat cell carcinoma has the following clinical findings: low urine output, low serum osmolality, hyponatremia, and elevated urine sodium. The nurse anticipates which of the following as part of the treatment plan? Select single answer choice. A vasopressin, free water B vasopressin, hypertonic saline. C phenytoin (Dilantin), 3% saline. D phenytoin (Dilantin), 0.45 normal saline. {{Ans- Answer: C This patient has signs of SIADH, which results in the production of excessive ADH. Phenytoin (Dilantin) will inhibit ADH secretion, and 3% saline will increase the serum sodium. The remaining choices (vasopressin, free water, 0.45 normal saline) will worsen the problem. -What is an indication for which a patient, who is receiving mechanical ventilation, is placed in the prone position? Select single answer choice. A tachypnea. B hypoventilation. C pulmonary hypertension. D refractory hypoxemia. {{Ans- Answer: D The prone position helps alleviate refractory hypoxemia (e.g., ARDS) by allowing for the perfusion of lung units that were not able to be perfused while the patient was in the supine position. P lacing the patient in the prone position is not an intervention that is used for the remaining 3 problems. -Which of the following is NOT needed to calculate the creatinine clearance? Select single answer choice. A serum BUN B the patient's age. C the patient's sex. D ideal body weight. {{Ans- Answer: A The serum BUN is not needed to calculate the creatinine clearance. The remaining 3 values (as well as the serum creatinine) are used for this calculation. The creatinine clearance is the best clinical indicator of the glomerular filtration rate (GFR). -A 70 kg patient required intubation for status asthmaticus. A propofol infusion was started at 40 mcg/kg/min, and the patient appears calm. The ventilator settings are: FiO20.30, assist-control mode 12 breaths/minute, tidal volume 400 mL, and an increased peak flow rate. The patient's respiratory rate is 28 breaths/minute, and the SpO2 is 0.98. Which of the following interventions should the nurse anticipate? Select single answer choice. A Administer vecuronium (Norcuron) PRN. B Decrease the tidal volume. C Increase the assist-control rate. D Increase the FiO2. {{Ans- Answer: A The elevated respiratory rate needs to be immediately addressed since it puts the patient at risk for auto-PEEP. The goal of ventilation for a patient with status asthmaticus is to provide low breath rates, a short inspiratory time, and a longer expiratory time, as well as to prevent auto-PEEP. Although neuromuscular blocking agents should be avoided, if possible, the benefit of administering Norcuron PRN outweighs the risk in this particular situation. The tidal volume is already low, so choice (B) is incorrect. An increase in the assist-control rate would not be beneficial, so choice (C) is incorrect. This patient does not have hypoxemia. Therefore, an increase in the FiO2 is not indicated, which means that choice (D) is also incorrect. -A patient has a flattened diaphragm, as confirmed on a chest X-ray, and a decreased expiratory flow rate. This patient most likely has which of the following? Select single answer choice. A pulmonary embolism. B ARDS. C pneumonia. D obstructive pulmonary disease. {{Ans- Answer: D Of the choices available, only obstructive pulmonary disease results in a problem "getting air out," which in turn results in air trapping; the flattening of the diaphragm on the chest X-ray is a sign of air trapping. -What would be expected for a patient with intrarenal failure who requires hemodialysis? Select single answer choice. A low urine osmolality, low urine sodium. B high urine osmolality, low urine sodium. C low urine osmolality, high urine sodium. D high urine osmolality, high urine sodium. {{Ans- Answer: C Low urine osmolality and elevated urine sodium are signs of damage to the renal tubular basement membrane, which indicates intrarenal failure. -PEEP therapy and mechanical ventilation are ordered for a patient with acute respiratory failure. Which of the following is a possible complication? Select single answer choice. A barotrauma. B atelectasis. C increased venous return. D decreased lung compliance. {{Ans- Answer: A The addition of positive end-expiratory pressure will increase alveolar recruitment, prevent atelectasis, and improve oxygenation. However, the increase in the intrathoracic pressure may lead to a pneumothorax or subcutaneous emphysema. than DKA, which results in a higher serum glucose. The higher serum glucose of HHS results in a higher serum osmolality. An additional differentiating finding is that a patient with DKA will have positive ketones. -A patient presented with status asthmaticus and required mechanical ventilation. Which of the following findings would be expected shortly after intubation? Select single answer choice. A peak inspiratory pressure 68 cm H2O pressure; plateau pressure 25 cm H2O pressure. B peak inspiratory pressure 68 cm H2O pressure; plateau pressure 40 cm H2O pressure. C peak inspiratory pressure 28 cm H2O pressure; plateau pressure 22 cm H2O pressure. D peak inspiratory pressure 28 cm H2O pressure; plateau pressure 42 cm H2O pressure. {{Ans- Answer: A Due to bronchospasm, the airway pressure will be elevated (elevated peak inspiratory pressure), but the lung pressure itself (plateau pressure) will not be elevated above 30 cm H2O pressure. -A man is admitted with a gunshot wound to the head. The nurse is told by the trauma surgeon that the patient has cranial nerve III involvement. Which of the following is evidence of cranial nerve III involvement? Select single answer choice. A loss of gag reflex. B right pupil is dilated and nonreactive. C decerebrate posturing. D loss of vision in the right visual field bilaterally. {{Ans- Answer: B Cranial nerve III is the oculomotor nerve, which controls the pupillary response. Compression of this nerve on the side of the injury (ipsilateral) results in pupil dilation on that side. -Which of the following is a contraindication to noninvasive ventilation? Select single answer choice. A a need for FiO2 of 0.60. B hypoventilation. c obtunded mental status. D positive blood cultures. {{Ans- Answer: C In order for a patient to derive benefits from noninvasive ventilation, the patient needs a spontaneous ventilatory effort and needs to be able to protect her airway. An obtunded mental status is a contraindication to the safe use of noninvasive ventilation. A patient with any of the other choices may benefit from this treatment option, and those choices do not represent contraindications to that form of treatment. -A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter was placed. The hemodynamic profile revealed the following: right atrial (RA) pressure 10 mmHg, pulmonary artery pressure (PAP) 49/25 mmHg, pulmonary artery occlusion pressure (PAOP) 24 mmHg, systemic vascular resistance (SVR) 1,900 dynes/sec/cm-5, and SvO248%. What is most likely the cause of this patient's hypotension and the appropriate treatment for it? Select single answer choice. A hypovolemic shock; fluids. B septic shock; vasopressors. C cardiogenic shock; IABP. D anaphylactic shock; epinephrine IM. {{Ans- Answer: C This patient's hemodynamic profile includes an elevated RA pressure, PAP, PAOP, and SVR. This is reflective of cardiogenic shock. Mechanical support with an IABP is an effective treatment for this patient. The hemodynamic profiles of hypovolemic shock, septic shock, and anaphylactic shock would not include an elevated RA pressure, PAP, and/or PAOP. Also, the hemodynamic profile of a patient with septic shock or anaphylactic shock would include a low SVR. -Which of the following is most likely to result in a low SvO2? Select single answer choice. A hypothermia. B sepsis C a fever D neuromuscular blocking agents {{Ans- Answer: C A fever increases the metabolic rate and oxygen consumption, which may lead to a drop in the mixed venous oxygen saturation. The remaining choices may increase the SvO2 since they are associated with a decrease in oxygen utilization. -A patient's arterial line waveform on the bedside monitor appears overdamped. The nurse understands that this: Select single answer choice. A may be due to pinpoint air bubbles in the tubing/transducer system. B leads to a false high pressure reading. C may be due to add-on pressure tubing. D leads to a false low pressure reading. {{Ans- Answer: D An overdamped arterial line waveform leads to a false low pressure reading, and the arterial pressure reading from the monitor should not be used to assess and treat the patient until the overdamped waveform is corrected. The remaining 3 choices relate to an underdamped arterial line waveform. -A patient is being treated for status epilepticus, and he requires intubation and mechanical ventilation. Which of the following possible pathophysiological changes might the nurse anticipate? Select single answer choice. A hypokalemia. B decreased PaCO2.. C bradycardia D elevated creatine kinase (CK). {{Ans- Answer: D The destruction of skeletal muscle cells occurs secondary to seizure activity, which results in the release of creatine kinase (CK) into the serum. If skeletal muscle cell destruction is not controlled, the elevated CKs may lead to rhabdomyolysis and acute kidney injury. Neuromuscular blocking agents may be used to Select single answer choice. A papillary muscle rupture. B mitral stenosis. C a pulmonary embolism. D reinfarction. {{Ans- Answer: A This clinical picture describes acute cardiogenic pulmonary edema, and giant V-waves are a sign of acute backflow of blood into the left atrium during systole. A patient with an inferior wall MI is more likely to develop acute mitral valve papillary muscle dysfunction or rupture, leading to mitral valve regurgitation. -A patient with right ventricular infarction would most likely have which of the following hemodynamic pressure findings? Select single answer choice. A right atrial (RA) 4 mmHg, pulmonary artery occlusion pressure (PAOP) 18 mmHg. B right atrial (RA) pressure 14 mmHg, pulmonary artery occlusion pressure (PAOP) 5 mmHg. C right atrial (RA) 14 mmHg, pulmonary artery occlusion pressure (PAOP) 18 mmHg. D right atrial (RA) 0 mmHg, pulmonary artery occlusion pressure (PAOP) 5 mmHg. {{Ans- Answer: B Due to decreased RV ejection, the right atrial pressure increases. Failure of the RV results in decreased left ventricular preload (low PAOP). The lungs will be clear, but the cardiac output and the B/P may decrease. -A patient requires fluid resuscitation and 8 units of PRBCs status post traumatic injury. Which of the following interventions is most appropriate? Select single answer choice. A Warm both blood products and crystalloids. B Monitor for hypercalcemia. C Start norepinephrine for a systolic pressure less than 90 mmHg. D Infuse platelets for thrombocytopenia. {{Ans- Answer: A Warming both blood products and fluids that are needed to treat a traumatic injury will prevent hypothermia and its related adverse effects. The remaining 3 choices are not indicated for treating a patient who requires massive fluid/transfusion therapy. -Which of the following patients is a candidate for an internal fecal management system (FMS)? Select single answer choice. A a patient with excoriated skin and frequent, incontinent liquid stool. B a patient with reddened skin and frequent, incontinent soft stools. C a patient who is status post large bowel resection. D a patient with diarrhea who can use the bedside commode. {{Ans- Answer: A An internal fecal management system (FMS) is indicated for a patient with excoriated skin and frequent, incontinent liquid stool. An external device is not an alternative since this type of device should not be applied over excoriated skin. An internal device cannot be used successfully if the stool is soft (since the catheter would clog) or if there has been recent large bowel surgery. For those reasons, choices (B) and (C) are incorrect. A patient who can use the bedside commode and whose stool is not involuntary is not a candidate for an FMS. Therefore, choice (D) is also incorrect. -A patient has been diagnosed with a fat embolism. Which of the following clinical findings is most likely present for this patient? Select single answer choice. A deep vein thrombosis, hypoxemia. B a long bone fracture, petechiae. C pulmonary edema, hypotension. D positive D-dimer, delirium. {{Ans- Answer: B A patient with a long bone fracture has an increased chance of developing a fat embolism, and a petechiae rash may develop—the result of fat occluding the dermal capillaries. -A Jehovah's Witness was admitted with a bleeding, perforated gastric ulcer. The patient's hemoglobin and hematocrit have decreased. Which of the following interventions is most appropriate for this patient? Select single answer choice. A Explain the consequences of refusing blood transfusions. B Administer washed PRBCs. C Ask the patient to sign a "No CPR" order. D Administer platelets. {{Ans- Answer: A The health care team would need to explain the consequences of refusing blood transfusions, as well as possible options, and ensure that the patient and her family understand this information. The hospital legal team may need to get involved. Choices (B) and (D) are not acceptable to a Jehovah's Witness. A "No CPR" order may need to be discussed, but that is not the priority intervention at this time. -A patient is 5 days status post subarachnoid hemorrhage, and she develops a change in level of consciousness and hyponatremia. Which of the following orders should the nurse anticipate? Select single answer choice. A Administer furosemide (Lasix). B Infuse 3% saline. C Maintain the cerebral perfusion pressure (CPP) with 0.9 normal saline. D Obtain a CT scan of the brain. {{Ans- Answer: C This patient has signs of vasospasm, and maintaining the CPP (in order to prevent worsening of the vasospasm) is a priority. Administering a diuretic may lead to hypotension and could worsen the vasospasm. 3% saline is generally indicated for extreme hyponatremia or an increased ICP, neither of which are described in this scenario. Diagnosing vasospasm is done with a Transcranial Doppler, not with a CT scan. -To provide appropriate care for a patient who requires mechanical ventilation, the nurse needs to: Select single answer choice. A instill saline during suctioning. B acute pancreatitis; provide gastric decompression and analgesia. B bowel perforation; provide fluids, prepare for surgery. C small bowel obstruction; provide fluids and gastric decompression D large bowel obstruction; provide antibiotics, prepare for surgery. {{Ans- Answer: B The clinical signs are those of bowel perforation. These clinical signs are not typical of the problems listed in the remaining 3 choices. -A patient with acute ST elevation myocardial infarction received fibrinolytic therapy. Which of the following is a sign of successful coronary artery reperfusion? Select single answer choice. A increased blood pressure. B return of the ST segment to baseline. C resolution of the S4 heart sound. D improved oxygenation. {{Ans- Answer: B Since ST segment elevation is a result of a myocardial infarction (MI) secondary to a lack of perfusion, the return of the ST segment to baseline is a sign of a return of perfusion. The remaining 3 choices are not signs of successful coronary artery reperfusion. -Which of the following is a priority treatment for a patient with DKA who presents with hyperglycemia, ketosis, and normal serum potassium? Select single answer choice. A Reduce serum glucose by 100 to 150 mg/dL/hr. B Administer potassium. C Administer sodium bicarbonate. D Infuse hypertonic saline. {{Ans- Answer: B A patient with DKA will have a low pH and metabolic acidosis. In a state of metabolic acidosis, hydrogen ions (H+) move into the intracellular space. In exchange, potassium leaves the intracellular space. The movement of K+ into the extracellular space results in hyperkalemia (although the total body K+ has not increased). Since this patient presented with acidosis and a normal serum potassium, the total body K+ is deficient, and potassium should be administered immediately. The remaining 3 choices are not indicated for the treatment of DKA. -A patient is receiving mechanical ventilation and is not able to follow commands. What is the preferred strategy for assessing this patient's pain? Select single answer choice. A Assess with the BPS. . B Assess with the RASS. c Assess with the NRS. D Assess with the CAM-ICU. {{Ans- Answer: A This patient cannot follow commands. Therefore, a valid behavioral assessment tool, such as the BPS or the CPOT, needs to be used. The RASS assesses for agitation, so choice (B) is incorrect. The NRS requires the patient to give a number rating to his or her pain, which this patient does not seem capable of doing. For that reason, choice (C) is incorrect. The CAM-ICU assesses the patient for delirium, not pain, so choice (D) is also incorrect. -Which of the following is a systemic effect of targeted temperature management (TTM) during the cooling phase? Select single answer choice. A increased cardiac output secondary to vasodilation. B decreased risk for infection secondary to increased neutrophil production. C hyperkalemia secondary to shivering. D hyperglycemia secondary to insulin resistance. {{Ans- Answer: D During the cooling (induction) phase of TTM, there is typically insulin resistance. Additionally, during this phase, there is vasoconstriction and decreased neutrophil production. During the rewarming phase, rebound hyperkalemia may occur. -A patient presented to the Emergency Department with a history of palpitations and dyspnea, persisting on and off for 1 week. The heart monitor shows atrial fibrillation with rapid ventricular response, and the blood pressure is 112/70. Treatment will most likely include: Select single answer choice. A a calcium channel blocker and anticoagulation. B cardioversion and a beta blocker. C digoxin and aspirin. D amiodarone and oxygen. {{Ans- Answer: A The patient history seems to be one of intermittent atrial fibrillation over the past week. Controlling the heart rate (with a calcium channel blocker) and addressing potential left atrial clot formation (with anticoagulation) are the priority treatments. Cardioversion is reserved for an unstable patient. Digoxin may be used to control the heart rate (although the onset of that effect is slow), and aspirin is not an anticoagulant. Amiodarone may result in a conversion to sinus rhythm, but the administration of this drug should not be attempted until the patient has been anticoagulated. -A patient with hypoparathyroidism demonstrates a positive Chvostek sign and a positive Trousseau sign. What electrolyte imbalance (that is associated with hypoparathyroidism) is the most likely cause of these signs, and for what other potential sign (related to this electrolyte imbalance) does this patient need to be monitored for? Select single answer choice. A hypokalemia; arrhythmias. B hypercalcemia; kidney stones. C hypophosphatemia; hypoventilation. D hypocalcemia; laryngospasm. {{Ans- Answer: D Hypocalcemia is an electrolyte imbalance that is associated with hypoparathyroidism, and a positive Chvostek sign and/or a positive Trousseau sign are manifestations of hypocalcemia. Laryngospasm is another sign caused by hypocalcemia; therefore, this patient needs to be monitored for this sign as well. The remaining electrolyte imbalances are not associated with a diagnosis of hypoparathyroidism. -Which of the following are the best indicators for a diagnosis of septic shock? Select single answer choice. A an infection and SIRS. B an infection and a fever. C D anaphylactic shock; epinephrine IM{{Ans- Answer: B The massive vasodilation, loss of vascular tone, and capillary leak caused by endotoxins results in decreased preload and decreased afterload. Endotoxins prevent oxygen utilization, which results in a high SvO2. Vasopressors will restore the vascular tone. None of the remaining choices results in an elevated SvO2. -A patient with right middle lobe pneumonia would be expected to have which of the following assessment findings over the affected area? Select single answer choice. A inspiratory and expiratory wheezing B expiratory wheezing and fine crackles C bronchial breath sounds and whispered pectoriloquy D absent breath sounds with fremitus {{Ans- Answer: C Over an area of lung consolidation, the breath sounds are louder (bronchial) than over normal lung tissue. Words that are whispered by the patient will be heard clearly through the stethoscope (whispered pectoriloquy) because sound travels faster through liquids or solids than it does through air. -What would increase the risk of developing contrast media nephropathy, and what intervention may prevent it? Select single answer choice. A age less than 18 years old; NSAIDs pre-procedure B edema; using low-osmolar contrast media C calcium channel blockers; diuretics pre-procedure D diabetes; hydration pre-procedure {{Ans- Answer: D Prolonged exposure to elevated serum glucose has an adverse effect on the tubular basement membrane, and exposure to contrast media may trigger renal failure. Pre-procedure hydration causes the release of prostaglandins, which leads to dilation of the efferent arteriole and possible prevention of renal failure. The remaining choices are not known to lead to contrast media nephropathy. -A patient has a pulmonary embolism with hypotension, hypoxemia (which requires the patient to be on 100% oxygen), and severe tachypnea. Which of the following would provide the quickest resolution of this patient's signs and symptoms? Select single answer choice. A the administration of heparin B intubation with mechanical ventilation C the administration of a fibrinolytic agent D fluid resuscitation {{Ans- Answer: C This patient's signs and symptoms are due to a massive pulmonary embolism. The administration of a fibrinolytic agent would dissolve the clot in a short period of time, with relief from the life-threatening symptoms. Anticoagulation with heparin will be needed, but the therapeutic effects are not immediate, so choice (A) does not represent the quickest resolution of this patient's signs and symptoms. The administration of a fibrinolytic agent as a first step could possibly eliminate the need for mechanical ventilation or fluid resuscitation. For that reason, choices (B) and (D) are incorrect. -A patient presents with left leg pain. The ankle brachial index (ABI) is 0.7. This patient would benefit from which of the following interventions? Select single answer choice. A mechanical compression therapy B putting the legs in the dependent position C the administration of a beta-adrenergic blocker D elevating the leg {{Ans- Answer: B The clinical signs described in the question are indicative of peripheral artery occlusive disease. Putting the legs in the dependent position will aid perfusion. The remaining choices would not be beneficial. -Which of the following describes clinical signs of variant (Prinzmetal's) angina? Select single answer choice. A ST depression precipitated by activity B ST elevation, resolves with nitrate therapy C T-wave inversion, elevated troponin D ST depression, unrelenting chest pain {{Ans- Answer: B This type of angina is thought to be due to an arterial spasm at the point of coronary artery plaque, not due to plaque rupture. The ST elevation is transient because the spasm is relieved with nitrates; therefore, infarction does not occur. -The most specific clinical sign for the presence of brain death would include which of the following? Select single answer choice. A absent oculocephalic reflex B negative apnea test C coma D positive Babinski reflex {{Ans- Answer: A An absent oculocephalic reflex (the eyes remain midline or turn to the side of head rotation) is a sign of cranial nerve VIII damage and possible brain death. The apnea test is positive in the presence of brain death. While a coma is present during brain death, most patients in a coma do not have brain death. A positive Babinski reflex is a sign of upper motor neuron damage, not brain death. -A patient was admitted to the ICU status post removal of a cancerous skin lesion on the right upper chest. The patient complained of intense pain surrounding the surgical area and the underlying muscle. There was initially minor redness surrounding the surgical area, but now there is an area of necrosis with purplish discoloration over the surrounding area. The initial wound culture was positive for clostridial myonecrosis. The nurse knows that: Select single answer choice. A the patient is at risk for developing anaphylactic shock. B the patient will require treatment for gas gangrene. C hyperbaric oxygen therapy is a priority treatment. D a single surgical debridement intervention will resolve the problem. {{Ans- Answer: B Clostridial myonecrosis is also known as gas gangrene. This patient most likely has necrotizing fasciitis, which may progress to septic shock, not anaphylactic shock, so choice (A) is incorrect. Hyperbaric oxygen therapy is not a priority treatment, but it may be useful for select patients. Since it is not a -The physician determines that the patient has ARDS. The patient has developed refractory hypoxemia, bilateral infiltrates, and pulmonary edema, as confirmed by a chest X-ray. Which of the following findings would be expected for a patient with this diagnosis? Select single answer choice. A increased lung compliance B PAOP is normal or low C decreased work of breathing D decreased cardiac output {{Ans- Answer: B The pulmonary edema of ARDS is due to lung capillary leak at a normal or even low left heart pressure (PAOP). This is unlike cardiogenic pulmonary edema, which results in pulmonary edema at a higher than normal left heart pressure (a PAOP of 18 mmHg or greater). -A patient has hepatic encephalopathy and elevated serum ammonia (NH3). Which of the following is a clinical sign of elevated NH3? Select single answer choice. A jaundice B asterixis C ascites D hyperglycemia {{Ans- Answer: B Asterixis is a motor disorder that is manifested as a tremor of the hand when the wrist is extended. Elevated serum ammonia results in abnormal functioning of the diencephalic motor centers in the brain, and these motor centers regulate the muscles that are involved in maintaining position. The remaining 3 choices are not clinical signs of elevated serum ammonia. -Which of the following ABG results (which were obtained from patients with status asthmaticus who were receiving oxygen at 3 L/minute via a nasal cannula) most likely indicates an immediate need for intubation and mechanical ventilation? Select single answer choice. A pH 7.40; PaCO2 39; HCO3 24; PaO2 100 B pH 7.49; PaCO2 28; HCO3 25; PaO2 92 C pH 7.34; PaCO2 47; HCO3 28; PaO2 68 D pH 7.29; PaCO2 50; HCO3 25; PaO2 70 {{Ans- Answer: D The ABG results in choice (D) demonstrate hypoventilation, as evidenced by an uncompensated respiratory acidosis with mild hypoxemia. This patient needs assisted ventilation in order to prevent respiratory arrest. Choice (A) is a normal ABG result (a highly unlikely finding in a tachypneic patient with status asthmaticus). Although not considered normal, the ABG results in choice (B) and choice (C) would not indicate an immediate need for intubation and mechanical ventilation. -A patient presents 1 month status post gastric bypass bariatric surgery with vomiting, a headache, diplopia, and memory loss. These are clinical signs of which of the following? Select single answer choice. A overeating. B an infection C malabsorption. D anastomosis leak. {{Ans- Answer: C These signs and symptoms are those of malabsorption, which results in vitamin deficiency and may occur after bariatric surgery. The remaining choices are not manifested by the signs and symptoms described in the question. -Which of the following is a priority treatment for an aortic dissection? Select single answer choice. A fluids and vasopressors. B intra-aortic balloon pump therapy and a transfusion. C aggressive management of hypertension and emergent surgery. D emergent aortic valve replacement and pain control. {{Ans- Answer: C Emergent surgery is essential for survival, and blood pressure control is essential preoperatively. A transfusion and pain control may be indicated, but the remaining therapies are not beneficial. -Which of the following clinical findings is indicative of impending brain herniation? Select single answer choice. A a cerebral perfusion pressure of 80 mmHg. B a change in the level of consciousness. C sustained A waves on an ICP tracing. D a Glasgow Coma Scale score of 13. {{Ans- Answer: C A waves are "awful." They are a sign of a sustained increase in the intracranial pressure (ICP), which, if not lowered, will result in brain stem herniation. A cerebral perfusion pressure (CPP) of 80 mmHg is normal. A change in the level of consciousness (LOC) is not normal, but that is not a sign of impending brain herniation. A Glasgow Coma Scale score of 13 is also not normal, but that is not a sign of impending brain herniation. -An orientee's patient experiences cardiac arrest and requires resuscitation. The preceptor, who is orienting the new nurse to the unit, sees that the orientee has placed the patient in the reverse Trendelenburg position. What would be the preceptor's best response at this time? Select single answer choice. A Immediately begin chest compressions. B Explain the problem with the current position to the orientee, and teach the orientee what the correct position should be. C Place the patient in a supine position D Ask the orientee why he put the patient in that position. {{Ans- Answer: C The preceptor needs to do what is best for the patient in this emergency situation. Beginning chest compressions with the head of the bed elevated would not be the best intervention for the patient. For that reason, choice (A) is incorrect. This is not the appropriate time to use the situation to coach the orientee. For that reason, choice (B) is incorrect. Discussing the orientee's rationale for putting the patient in that position would best be done at a later time. For that reason, choice (D) is also incorrect. -The hospital Nursing Practice Committee wants to provide criteria for the maintenance of a central venous catheter in order to decrease the CLABSI rate. Which of the following is a reason to maintain a central venous catheter? Select single answer choice. B The patient is receiving mechanical ventilation, with an SpO2 of 0.94, an FiO2 of 0.40, and a PEEP of 5 cm H2O pressure. C The patient is arousable to vigorous shaking but is not arousable to voice or touch. D The patient is receiving norepinephrine 5 mcg/min and is being weaned off of it. {{Ans- Answer: C The patient described in choice (C) is not ready for weight-bearing if she is not responsive to verbal stimulation. According to the MOVE criteria, the patients described in choices (A), (B), and (D) do not have contraindications to mobility progression. -Which of the following electrolyte abnormalities does NOT result in hyperreflexia? Select single answer choice. A hypocalcemia B hypermagnesemia. C hyperphosphatemia. D hypomagnesemia {{Ans- Answer: B Hypermagnesemia results in decreased deep tendon reflexes (DTRs). The remaining electrolyte abnormalities result in hyperreflexia. -Which of the following patients is NOT at a high risk for a fall? Select single answer choice. A The patient has an indwelling urinary catheter. B The patient requires an antidepressant. C The patient fell at home last month. D The patient is restrained. {{Ans- Answer: B A need for antidepressants has not been shown to increase the risk for falling. The remaining circumstances have been shown to contribute to a patient's risk for a fall. -A patient is status post motor vehicle accident with a large chest bruise. The nurse knows that this patient needs to be assessed for which of the following? Select single answer choice. A positive troponin, aortic valve damage. B pain with inspiration, pericardial friction rub. C retroperitoneal bleed, global ST elevation. D atrial fibrillation, mitral valve damage. {{Ans- Answer: A The chest bruise implies that the patient's chest struck the steering wheel. This in turn may have caused aortic valve trauma (trauma to the valve that is lying most anterior in the chest), or it may have caused myocardial trauma damage. -A patient with ST elevation in leads II, III, and aVF is most likely to develop a , whereas a patient with ST elevation in V1, V2, and V3 is most likely to develop . Select single answer choice. A second-degree AV block (Type II), a sinus exit block B second-degree AV block (Type II), a third-degree AV block. C third-degree AV block, a second-degree AV block (Type II). D second-degree AV block (Type II), sinus arrest. {{Ans- Answer: C ST elevation in leads II, III, and aVF is generally secondary to right coronary artery occlusion (an inferior wall MI), and in most of the population, the RCA supplies the AV node, so an occlusion of the RCA would result in complete heart block. ST elevation in V1 through V3 is indicative of left anterior descending artery occlusion. Since the left anterior descending artery supplies the main bundle of His in most of the population, occlusion of that artery would result in a second-degree AV block (Type II). -A patient sustained a crush injury at a construction site. The patient's urine is tea-colored with a urine output of 20 mL/hour. The creatine kinase (CK) is 20,000 U/L. The nurse should anticipate which of the following interventions? Select single answer choice. A the administration of 0.9 normal saline to maintain a urine output of 30 mL/hour. B pain management and preparation for emergent surgery. C the insertion of a dialysis catheter and immediate hemodialysis. D the administration of a loop diuretic and 50 mL of sodium bicarbonate. {{Ans- Answer: A The patient history and clinical presentation suggest the presence of rhabdomyolysis. The massive amount of creatine kinase that is released with massive skeletal muscle damage needs to be "flushed" through the renal tubules with aggressive fluid administration. -A 70 kg patient with ARDS is receiving mechanical ventilation with the following settings: assist-control mode, breath rate of 18 breaths/minute; FiO280%; Vt 350 mL; PEEP 5 cm H2O. An ABG was obtained, and it revealed the following: pH 7.33, PaCO2 50, PaO2 48, HCO3 26. Which of the following would the nurse anticipate increasing? Select single answer choice. A FiO2. B the breath rate. C the tidal volume (Vt). D PEEP. {{Ans- Answer: D The PEEP setting of 5 cm H2O is not sufficient for treating the severe hypoxemia of ARDS. Generally, at least 10 to 15 cm of PEEP is required. -A patient is status post motor vehicle accident. Which of the following assessments of this patient is part of the trauma second-line assessment? Select single answer choice. A Perform a neurological exam. B Evaluate oxygenation and ventilation. C Remove the patient's clothes, and provide warmth/cooling as needed. D Assess for and treat pain. {{Ans- Answer: D The assessment for and treatment of pain is considered a part of the second-line assessment of a trauma patient. The remaining 3 choices are part of the first-line assessment of a trauma patient. -The unit Quality Council is considering strategies for decreasing the number of indwelling urinary catheter days. Which of the following is a strategy that would accomplish this goal? Select single answer choice. A hypertonic saline and diuretics. B fluid restriction. C vasopressin. D phenytoin (Dilantin) {{Ans- Answer: C The patient history and clinical findings are those of diabetes insipidus (DI). There is insufficient production of ADH in DI, and vasopressin is an antidiuretic hormone that is indicated for this problem. The remaining choices are not indicated for this problem. -The nurse notices that during inspiration and expiration, the water in the water seal chamber is bubbling for a patient with a left-sided chest tube. What does this assessment indicate? Select single answer choice. A tension pneumothorax B pleural air leak. C pneumonia. D an adequate suction source. {{Ans- Answer: B There should not be bubbling in the water seal chamber—that is a sign of a pleural air leak, which may be present immediately after thoracic surgery. However, bubbling that has not been present and then develops should be reported to the physician. -Which of the following needs to be done as soon as possible for a patient who presents with sepsis and hypotension? Select single answer choice. A Initiate a vasopressor. B Obtain the central venous pressure. C Insert an indwelling urinary catheter. D Measure the serum lactate. {{Ans- Answer: D It is important to measure the serum lactate to determine the extent of anaerobic metabolism and the impact of organ dysfunction. If the first lactate is > 2 mmol/L, it needs to be remeasured within 2-4 hours. A vasopressor is only needed if the patient is unresponsive to an initial fluid administration of 30 mL/kg of crystalloids. Thus, choice (A) is incorrect. The central venous pressure is not required initially, but it may be considered if the patient is unresponsive to fluids. Thus, choice (B) i s incorrect. An indwelling urinary catheter is not required for all patients, and if it is needed, it is not always a priority. Thus, choice (C) is also incorrect. -A nurse preceptor is talking to an orientee and describing the importance of gentle milking and frequent assessments of the output of a mediastinal chest tube. Occlusion of a mediastinal chest tube may result in: Select single answer choice. A lung collapse. B tension pneumothorax. C cardiac tamponade. D coagulopathy. {{Ans- Answer: C The purpose of a mediastinal chest tube is to drain the mediastinal space of serosanguinous fluid post cardiac surgery. If the fluid cannot drain, cardiac tamponade may result. Pleural chest tube blockage may result in lung collapse or tension pneumothorax, so choices (A) and (B) are incorrect. Choice (D) is not related to mediastinal chest tube patency. -Which of the following patients most likely has delirium? Select single answer choice. A a patient who is attentive but is acutely agitated. B a patient who is unresponsive. C a patient who is lethargic and inattentive. D a patient who is angry {{Ans- Answer: C The patient described in choice (C) is demonstrating an acute change in the level of consciousness, altered mental status, and inattention, all of which are required in order to make the diagnosis of delirium. If the patient is attentive, as described in choice (A), delirium is not present. Unresponsiveness alone, as described in choice (B), does not meet the criteria for delirium. Anger, as described in choice (D), is not a characteristic of delirium. -A patient was admitted status post motor vehicle accident. Breath sounds are diminished on the right side, and the trachea is deviated to the left. The patient's vital signs include: a B/P of 80/54, a heart rate of 130 beats/minute, and a respiratory rate of 32 breaths/minute. Which of the following immediate interventions is indicated? Select single answer choice. A a right chest needle decompression. B fluids, pressors. C left-sided chest tube insertion. D endotracheal tube {{Ans- Answer: A The clinical signs described in the question are those of a tension pneumothorax. The immediate release of the trapped pleural air is indicated in order to restore venous return and an adequate cardiac output. Once the tension is relieved, the patient will require insertion of a pleural chest tube in order to restore lung inflation. -A 19-year-old presents with raccoon eyes and bruising behind his right ear after falling from a 1-story roof. The nurse notices clear fluid draining from his nose. What would lead the nurse to believe that the clear drainage is CSF and not normal nasal drainage? Select single answer choice. A The drainage decreases after the patient blows his nose. B The drainage turns only yellow when placed on white gauze. C The drainage is positive for glucose. D The patient complains of the worst headache of his life. {{Ans- Answer: C This patient most likely has a basilar skull fracture, which results in a meningeal tear and leakage of cerebrospinal fluid (CSF). CSF consists of about 60% serum glucose and will therefore test positive for glucose. This patient should NOT blow his nose if a basilar skull fracture is suspected. Thus, choice (A) is incorrect. A positive "halo sign" is when the drainage turns yellow with a red spot in the middle; it would not only turn yellow. Thus, choice (B) is incorrect. A headache is not a sign that would differentiate CSF from normal nasal drainage. Thus, choice (D) is also incorrect. -A patient complains of boring abdominal pain. The abdomen is rigid with no rebound tenderness. Grey Turner's sign and Trousseau's sign are present. The amylase, lipase, WBC count, and serum glucose are Continue to monitor the patient. {{Ans- Answer: D Continued patient monitoring is indicated in this situation. The permanent pacemaker will not prevent the development of cardiopulmonary arrest because the patient's heart will no longer respond to the pacemaker once the patient stops breathing and hypoxemia develops. It is acceptable to deactivate a pacemaker if the patient or the patient's family requests deactivation, but pacemaker deactivation was not requested in this case. Thus, choice (A) is incorrect. Placing a magnet over the pacemaker will change the mode to asynchronous, which is not needed in this case. Thus, choice (B) is incorrect. There is no need for an ethics consult at this point. Thus, choice (C) is also incorrect. -Which of the following is a complication of SIADH? Select single answer choice. A renal failure. B seizures. C respiratory failure. D hypovolemic shock {{Ans- Answer: B SIADH results in excess ADH, which results in fluid retention and dilutional hyponatremia. Serum sodium less than 120 mEq/L may result in seizures. -Which area of the brain is responsible for the level of consciousness? Select single answer choice. A pons. B uncus. C cerebellum. D cerebrum {{Ans- Answer: D Level of consciousness (LOC) is a function of the cerebrum, the "highest" anatomical level of the brain. As a result of this anatomical fact, the first sign of neurological pathology is a change in the LOC. The remaining choices are located lower than the cerebrum. The pons is part of the brain stem. The uncus is part of the temporal lobe. The cerebellum, or hindbrain, is behind the upper portion of the brain stem. -Which of the following statements most likely indicates that a patient is ready for a spontaneous breathing trial? Select single answer choice. A The patient had a tracheostomy 5 days ago. B The problem for which the patient required mechanical ventilation is resolving. C The patient is breathing over the set ventilator breath rate. D The patient has been on a ventilator for 1 week. {{Ans- Answer: B Generally, when the problem for which a patient required mechanical ventilation is resolving, a spontaneous breathing trial is indicated. Having a tracheostomy is not an indication for initiating a spontaneous breathing trial, so choice (A) is incorrect. Breathing over the set ventilator breath rate could be a sign of distress and is not an indication for initiating a spontaneous breathing trial. Thus, choice (C) is incorrect. The length of time that a patient has been on a ventilator is not indication for initiating a spontaneous breathing trial, so choice (D) is also incorrect. -Which of the following problems is a contraindication to receiving the influenza vaccine? Select single answer choice. A COPD B Guillain-Barré syndrome. C cirrhosis. D chronic kidney disease {{Ans- Answer: B The influenza vaccine has been associated with the development of Guillain-Barré syndrome; therefore, the influenza vaccine needs to be avoided for patients who are at risk for developing GBS. The remaining problems do not pose contraindications to receiving the influenza vaccine. -A 65-year-old male complains of sharp left shoulder pain, and upon a clinical exam, he demonstrates abdominal distension with absent bowel sounds. This patient most likely has: Select single answer choice. A a ruptured spleen. B acute coronary syndrome. C abdominal aortic dissection. D retroperitoneal bleeding. {{Ans- Answer: A Sharp left shoulder pain (Kehr's sign) is a clinical sign that is caused by diaphragmatic irritation that occurs with splenic rupture. Abdominal distension and absent bowel sounds are also clinical signs of a ruptured spleen. The clinical problems listed in the remaining choices do not manifest the signs described in the question. -A patient with septic shock has refractory hypotension despite fluid resuscitation with crystalloids and high-dose norepinephrine (Levophed). What order does the nurse anticipate immediately? Select single answer choice. A a sodium bicarbonate IV. B a phenylephrine infusion. C a vasopressin infusion. D IV steroids {{Ans- Answer: C A vasopressin infusion is the recommended next intervention for a patient who is refractory to fluids/a high-dose of the initial vasopressor. It is thought that the vasopressin decreases refractoriness of the alpha receptors in the arteries to catecholamines. Sodium bicarbonate as an infusion may be used if metabolic acidosis is severe and refractory to treatment, although it is not a first-line treatment. Thus, choice (A) is incorrect. Adding another pressor at this time, such as the one described in choice (B), is not an evidence-based solution. Thus, choice (B) is incorrect. Steroids may be needed if vasopressin is not effective and if the patient is thought to have corticosteroid deficiency secondary to septic shock. Since this is not the immediate order that is needed, choice (D) is also incorrect.