CCRN CRITICAL CARE REGISTERED NURSE EXAM LATEST 2024-2025 QUESTIONS AND 100% CORRECT ANSW, Exams of Nursing

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CCRN CRITICAL CARE REGISTERED NURSE EXAM LATEST 2024-2025 QUESTIONS AND 100% CORRECT ANSWERS TEST BANK S1 "lub" closure of AV (mitral and tricuspid) valves marks the end of diastole and the beginning of systole SYSTOLE S2 "dub" closure of the seminar (pulmonic and aortic) valves marks the end of systole and the beginning of diastole DIASTOLE systolic murmur "lub.... shhhhb.....dub" semilunar valves are OPEN during systole - aortic stenosis -pulmonic stenosis AV valves are CLOSED during systole - mitral insufficiency (will causes large, giant V-waves on the pulmonary artery occlusion pressure tracing if the patient has a pulmonary artery catheter) - tricuspid insufficiency diastolic murmur "lub...... dub.......shhhhb" semilunar valves are CLOSED during diastole - aortic insufficiency - pulmonic insufficiency AV valves are OPEN during diastole - mitral stenosis (associate with atrial fibrillation due to atrial enlargement that occurs over time) - tricuspid stenosis when are the AV valves OPEN and semilunar valves CLOSED diastole when are the AV valves CLOSED and the semilunar valves OPEN systole abnormal heart sounds in adults filling, low pressure the semilunar valves (pulmonic and aortic) are CLOSED the AV valves (mitral and tricuspid) are OPEN diastole taken 1/3 longer than systole because the chambers need time for filling this is why blood pressure drops during tacharrhythmias, there is no time for filling and therefore less output OPEN AV valves diastole CLOSE AV valves systole OPEN semilunar valves systole CLOSE semilunar valves diastole mitral insufficiency occurs when the mitral valves is close. When is the mitral valves closed? systole mitral stenosis occurs when the mitral valves is open. When is the mitral valve open? diastole aortic insufficiency occurs when the aortic valves is closed. When is the aortic valves closed? diastole aortic stenosis occurs when the aortic valves is open. When is the aortic valves open? systole stenosis open insufficiency closure The nursing staff is resisting being assigned to a disruptive patient. An appropriate resolution would be to A. ask the provider to transfer the patient. B. rotate the patient assignment among staff. C. confront the family and demand an end to the behavior. D. hold a nursing team conference to discuss care needs. D. hold a nursing team conference to discuss care needs. A patient with unstable angina has an IABP inserted. Hemodynamics are: HR 148 (sinus tachycardia) MAP 40 mm Hg PAOP 25 mm Hg CI 1.4 L/min/m^2 Which of the following should be included in this patient's plan of care? A. checking timing of the IABP, decreasing balloon to 1:2 frequency B. obtaining an echocardiogram and administering furosemide (Lasix) C. infusing dobutamine (Dobutrex) and obtaining a 12- lead ECG pH 7.50 pCO2 31 mm Hg pO2 48 mm Hg A chest x-ray is obtained and a "ground-glass- like appearance" is reported. Lung auscultation bilaterally reveals basilar crackles that were not previously present. The nurse should suspect that the patient has developed A. a pulmonary embolus. B. bacterial pneumonia. C. chronic obstructive pulmonary disease. D. acute respiratory distress syndrome. D. acute respiratory distress syndrome. A patient on mechanical ventilation is post- operative day 5 for spinal injury sustained playing college football. He was unusually disengagedthe previous day. Today he is agitated, combative during care and forgot his family was at the bedside an hour ago. Other physiological factors ruled out. The nurse should recognize the patient is MOST LIKELY experiencing A. acute dementia. B. acute delirium. C. alcohol withdrawal. D. steroid withdrawal. B. acute delirium. A patient who is one day post-gastroplasty has a sudden onset of restlessness, dyspnea and chest pain. His heart rate is 122, and auscultation of heart sound reveals an increased intensity of a pulmonary S2. The MOST LIKELY cause is A. aspiration pneumonia. B. a spontaneous pneumothorax. C. a pleural effusion. D. a pulmonary embolus. D. a pulmonary embolus. stabe angina Chest pain with activity predictable lesions are usually fixed and calcified unstable angina chest pain that occurs at rest unpredictable may be relieved with nitroglycerin management of acute chest pain * Aspirin - encourage pt to chew * Anticoagulants - Heparin or enoxaparin * Antiplatelet agents - clopidogrel (Plavix) - abciximab (Reopro) - eptifibatide (Intgrilin) - tirofiqan (Aggrastat) * Beta blocker also the right coronary artery (RCA) anterior MI associated with left anterior descending (LAD) occlusionST elevation in V1, V2, V3 and V4 lateral MI ST elevation in I, aVL, V5 and V6 hypertensive emergency or crisis elevated BP with evidence of end organ damage, brain, heart, kidneys, retina hypertensive urgency elevated BP without evidence of acute end organ damage 6 P's of peripheral artery disease (PAD) 1. Pain 2. Pallor- unhealthy pale appearance 3. Pulse absent of diminished 4. Paresthesia- "pins and needles" 5. Paralysis 6. Poikilothermia- loss of hair, glossy, cool dry looking skin coronary artery lesions vascular calcification of the coronary arteries Ankel-Brachial Index (ABI) test to assess PAD normal is >0.90 (divide the ankle pressure by the brachial pressure on the same side) Wolff-Parkison-White (WPW) genetic conduction abnormality that can result in supra ventricular tachycardia prolongation of the QT interval may lead to tornadoes de pointes causes; drugs and electrolyte problems trasades de pointes prolongation of the QT interval hypokalemia, hypocalcemia and hypomagnesemia treatment for tornadoes magnesium systolic heart failure left ventricular systolic dysfunction (LVSD) ejection fraction EF <40% diastolic heart failure problem with filling but ejection is OK ejection fraction EF >50% BNP B-type natriuretic peptide release when the ventricle is under wall stress what causes right-sided heart failure think lungs pulmonary embolism pulmonary stenosis/insufficiency COPD pulmonary hypertension acute RV infarct septal defects what causes left-sided heart failure think body fluids overload chronic, uncontrolled hypertension chest tube output >100mL for 2 consecutive hours requires intention maintain hemodynamic stability correct the volume status administer blood products TAVR transcatheter aortic valve replacement cardiac tamponade pressure on the heart that occurs when blood or fluid build up in the space between the heart muscle and the pericardium causes of cardiac tamponade surgical-related cause, mechanical-related cause (peri- carditis, pericardial effusion), trauma signs and symptoms of cardiac tamponade restlessness and agitation hypotension increase in JVD muffled heart sounds enlarging cardiac silhouette pulsus paradoxus an excessive drop in SBP (12 mm Hg or more) during inspiration occurs because of cardiac muscle restriction causes by the tamponade with inspiration. The intrathoracic pressure increases and the venous return decreases. pericarditis swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium) myocardial contusion bruise of the cardiac muscle etiology (causes) of aneurysms arteriosclerosis hypertension smoking obesity bacterial infections congenital anomalies trauma marfan syndrom aneurysms <5cm in diameter produce no symptoms s/s of low blood sugar stimulates the sympathetic nervous system tachycardia and trembling calculating MAP MAP= (SBP + 2(DBP))/3 cor pulmonale right ventricular hypertrophy and heart failure due to pulmonary hypertension Characterized by increased pulmonary vascular resistance and right heart failure. It is associated with decreases in left ventricular filling pressure, left ventricular stroke work and cardiac output can be caused by Emphysema which increases CVP the major effect of ARDS on lung tissue is decrease compliance Patient with COPD increase PA systolic, diastolic and mean pressure secondary due to increased pulmonary vascular resistance in a patient with ARDS, which contributes to the development of atelectasis? loss of surfactant and interstitial fluid accumulation a patient in a HHS is being admitted with dehydration and a serum glucose level of 836 mg/dL. Which additional laboratory finding should the nurse anticipate? * elevated BUN * elevated creatine * elevated serum osmolality a patient with head trauma is experiencing increased intracranial pressure. The ideal level at which to maintain the arterial pCO2 is between 35 and 45 elevated CO2 causes vasodilation which will increase cerebral blood flow and subsequently intracranial pressure normal arterial pCO2 35-45 vital capacity The total volume of air that can be exhaled after maximal inhalation. the most important indicator to be used in monitoring the respiratory status of a patient with Guillain-Barre syndrome is vital capacity when providing care to a patient with status epilepticus, the nurse should recognize that usually it results from abrupt discontinuation of anti-seizure medications status epilepticus the continuous seizures last at least five minutes the cause of death from seizure is usually related to cerebral hypermetabolism which mechanism contributes to hypotension in sepsis peripheral vasodilation which may causes the development of fixed pupils hypothermia which hemodynamic profile is MOST consisted with distributive shock? BP 84/42 CVP 3 PAOP 8 CI 2.5 SVR 475 SvO2 52% oxygen consumption the amount of oxygen used by the body normal is approximately 250mL/min which PA catheter finding should be anticipated in a patient with chronic emphysema? increase CVP a patient has heart failure secondary to ischemic cardiomyopathy and end-stage coronary artery disease. Which agents would be the MOST beneficial? captopril (Capoten) and sprinolcatone (Aldactone) stays the same or increases due to a compensatory increase in the systemic vascular resistance. 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? 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 A) a surfactant deficiency and pulmonary edema 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. 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? A) S4 heart sound, lung crackles B) hypotension, flat neck veins C) hypertension, a systolic murmur D) distended neck veins, clear lungs D) distended neck veins, clear lungs 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 Right sided heart failure think "REST of BODY" Which of the following is an effect of hypothermia? 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 Hypothermia shifts the oxyhemoglobin dissociation curve to the left, which inhibits the release of oxygen from hemoglobin, thereby resulting in a higher SaO2than usual at the same PaO2. 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? A) a cough B) SpO2 88% C) ETCO2 of 50 mmHg per waveform capnography D) sedation B) SpO2 88% A pulse oximetry decrease is a late sign of respiratory depression. A cough is not indicative of respiratory depression. An elevated ETCO2 per waveform inferior wall MI include bradycardia secondary to ischemia to the SA node and/or the AV node and papillary muscle rupture or dysfunction due to the anatomical distance between the right coronary artery and the papillary muscle. Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors, and antibiotic therapy? A) right atrial pressure (RAP) 1 mmHg; pulmonary artery occlusion pressure (PAOP) 4 mmHg; systemic vascular resistance (SVR) 1,800 dynes/sec/cm-5; cardiac output (CO) 2 L/min B) right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 7 mmHg; systemic vascular resistance (SVR) 400 dynes/sec/cm-5; cardiac output (CO) 8 L/min C) right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 17 mmHg; systemic vascular resistance (SVR) 1,900 dynes/sec/cm-5; cardiac output (CO) 2 L/min D) 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 B) right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 7 mmHg; systemic vascular resistance (SVR) 400 dynes/sec/cm-5; cardiac output (CO) 8 L/min 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. A= hypovolemia B= septic shock C= cariogenic pulmonary edema D= right ventricular failure Pulmonary hypertension may result in which of the following? A) left-sided heart failure B) right-sided heart failure C) increased lung compliance D) arterial hypertension B) right-sided heart failure 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, Which of the following treatments is appropriate for the corresponding overdose? 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 A) dialysis for a salicylate overdose Which of the following would be LEAST likely to cause hypoglycemia for a patient with Type 1 diabetes? A) late sepsis B) discontinuation of enteral feeding after a morning insulin dose C) a strenuous exercise session D) stress D) stress A patient with diastolic heart failure develops supraventricular tachycardia, with a heart rate of 220 beats/minute. The most dangerous hemodynamic effect is a decrease in: A) myocardial contractility. B) coronary artery perfusion. C) ejection fraction. D) arterial oxygenation. B) coronary artery perfusion. Diastolic heart failure results in a problem with left ventricular filling secondary to ventricular thickening, and myocardial contractility and the ejection fraction are maintained in diastolic heart failure. The rapid heart rate will decrease the filling time and worsen the left ventricular filling. Since coronary artery perfusion occurs during diastole, this arrhythmia may be life-threatening. A patient is receiving a heparin infusion for the treatment of a pulmonary embolism. There has been a 60% decrease in the platelet count and no clinical changes. Which of the following is indicated? A) Administer vitamin K, and begin a direct thrombin inhibitor. B) Discontinue heparin, and begin argatroban. C) Order an enzyme-linked immunosorbent assay (ELISA), and infuse platelets. D) Administer protamine sulfate, and decrease heparin. B) Discontinue heparin, and begin argatroban. This patient most likely has heparin-induced thrombocytopenia (HIT). Exposure to heparin needs to be immediately discontinued, and a direct thrombin inhibitor (such as argatroban) needs to be started for continued anticoagulation. Vitamin K does not address thrombocytopenia, so choice (A) is incorrect. The ELISA test will definitively confirm HIT, but the results generally take longer than 24 hours to return, whereas action needs to be taken immediately in this situation. Also, the administration of platelets is not indicated unless bleeding occurs or the platelet count is reduced to ~ 10,000. For those reasons, choice (C) is incorrect. Protamine sulfate is not useful for the treatment of HIT. Therefore, choice (D) is also incorrect. B) balloon deflation increases coronary artery perfusion. C) balloon inflation optimizes aortic valve performance. D) balloon deflation decreases left ventricular afterload. D) balloon deflation decreases left ventricular afterload. 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. A patient has right middle and lower lobe pneumonia. Which of the following is an appropriate intervention for this patient? A) Provide fluids and expectorants. B) Maintain the patient in a supine position. C) Withhold enteral nutrition. D) Avoid turning the patient to his right side. D) Avoid turning the patient to his right side. Gravity will increase perfusion to the dependent lung tissue. The "good" lung in this case is the left side. Turning the patient to his right side may precipitate hypoxemia by increasing perfusion to the side with greater disease. ***good lung down, bad lung up!!! A patient was admitted post motor vehicle accident with hypotension and an INR of 8. Which of the following needs to be administered to this patient? A) protamine sulfate B) vitamin K C) heparin D) platelets B) vitamin K This patient was most likely taking warfarin (Coumadin) prior to admission, which caused an elevated INR. Warfarin works by inhibiting the effects of vitamin K, thereby preventing the conversion of prothrombin to thrombin. A rapid reversal of warfarin with vitamin K is indicated since this patient is hypotensive post MVA and may have internal bleeding. The remaining choices will not decrease the INR. Which of the following is a complication of acute pancreatitis? A) septic shock B) pneumonia C) hypocalcemia D) hypoglycemia C) hypocalcemia What is an indication for which a patient, who is receiving mechanical ventilation, is placed in the prone position? A) tachypnea B) hypoventilation C) pulmonary hypertension D) refractory hypoxemia B) metabolic acidosis C) blood pressure is maintained D) organ failure C) blood pressure is maintained During the earliest stage of shock (compensatory shock), the compensatory mechanisms are working to maintain the systemic blood pressure. The remaining 3 choices are seen in the progressive and refractory stages of shock. compensatory stage of shock * BP is MAINTAINED * tachycardia * tachypnea, respiratory alkalosis * Normal PaO2 * BP is MAINTAINED progressive stage of shock * HYPOTENSION * worsening tachycardia and tachypnea * metabolic acidosis * decreased PaO2 * clammy, mottled skin * decrease LOC Refractory stage of shock * the patient is not responsive to interventions * severe systemic hypoperfusion * multiple organ dysfunction syndrome (MODS) A patient presents with elevated serum glucose. Which of the following parameters will best differentiate DKA from HHS in this situation? A) serum potassium B) serum sodium C) serum glucose D) serum osmolality D) serum osmolality serum osmolality HHS anion gap DKA A patient who is status post thoracic surgery has bubbling in the water seal drainage chamber of his chest tube. Which of the following interventions is indicated? A) Avoid turning the patient onto his side. clearYou did not select. This answer is incorrect. B) Clamp the chest tube. C) Avoid a high airway pressure. D) Decrease suction to the collection chamber. C) Avoid a high airway pressure. Bubbling in the water seal drainage chamber is due to a pleural air leak, and a high airway pressure will either prevent the resolution of the current air leak or make the air leak worse. Which clinical sign might BOTH patients (one with systolic heart failure and one with diastolic heart failure) have in common? A) peripheral edema B) an enlarged heart size on a chest radiograph A) peak inspiratory pressure 68 cm H2O pressure; plateau pressure 25 cm H2O pressure 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. airway pressure elevated peak inspiratory pressure lung pressure plateau 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? 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 B) right pupil is dilated and nonreactive 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. 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 SvO2 48%. What is most likely the cause of this patient's hypotension and the appropriate treatment for it? A) hypovolemic shock; fluids B) septic shock; vasopressors C) cardiogenic shock; IABP D) anaphylactic shock; epinephrine IM C) cardiogenic shock; IABP Which of the following is most likely to result in a low SvO2? A) hypothermia B) sepsis C) a fever D) neuromuscular blocking agents C) a fever 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: A) may be due to pinpoint air bubbles in the tubing/transducer system. 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. A patient with acute ST elevation myocardial infarction received fibrinolytic therapy. Which of the following is a sign of successful coronary artery reperfusion? A) increased blood pressure B) return of the ST segment to baseline C) resolution of the S4 heart sound D) improved oxygenation B) return of the ST segment to baseline 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 Which of the following is a priority treatment for a patient with DKA who presents with hyperglycemia, ketosis, and normal serum potassium? A) Reduce serum glucose by 100 to 150 mg/dL/hr. B) Administer potassium. C) Administer sodium bicarbonate. D) Infuse hypertonic saline. B) Administer potassium. 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. BPS behavioral pain scale RASS Richmond Agitation Sedation Scale NRS Numerical Rating Scale (pt must be awake and able to follow commands) CAM-ICU Confusion Assessment Method for ICU Which of the following is a systemic effect of targeted temperature management (TTM) during the cooling phase? 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 provost the conversion of plasminogen to plasmin Which of the following describes an effect of a heparin infusion? A) It prevents the conversion of prothrombin to thrombin. B) It prevents platelet aggregation on the clot. C) It prevents the conversion of thrombin to fibrinogen. D) It promotes the conversion of plasminogen to plasmin. C) It prevents the conversion of thrombin to fibrinogen. A) Warfarin B) clopidogrel D) Alteplase A patient with right middle lobe pneumonia would be expected to have which of the following assessment findings over the affected area? A) inspiratory and expiratory wheezing B) expiratory wheezing and fine crackles C) bronchial breath sounds and whispered pectoriloquy D) absent breath sounds with fremitus C) bronchial breath sounds and whispered pectoriloquy 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. 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? A) mechanical compression therapy B) putting the legs in the dependent position C) the administration of a beta-adrenergic blocker D) elevating the leg B) putting the legs in the dependent position 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. variant (Prinzmetal's) angina clinical condition characterized by chest discomfort or pain at rest with transient electrocardiographic changes in the ST segment, and with a prompt response to nitrates Which of the following describes clinical signs of variant (Prinzmetal's) angina? 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 B) ST elevation, resolves with nitrate therapy This type of angina is thought to be due to an arterial spasm at the point of coronary artery plaque, not due to B) asterixis 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. 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? A) overeating B) an infection C) malabsorption D) anastomosis leak C) malabsorption Which of the following electrolyte abnormalities does NOT result in hyperreflexia? A) hypocalcemia B) hypermagnesemia C) hyperphosphatemia D) hypomagnesemia B) hypermagnesemia Hypermagnesemia results in decreased deep tendon reflexes (DTRs). The remaining electrolyte abnormalities result in hyperreflexia. 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? 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 A) positive troponin, aortic valve damage 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 ______ 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 C) third-degree AV block, a second-degree AV block (Type II) 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 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. 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? 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. C) The drainage is positive for glucose. 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. Grey Turner's sign indicates hemorrhagic pancreatitis Which of the following is a complication of SIADH? A) renal failure B) seizures C) respiratory failure D) hypovolemic shock B) seizures 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? A) pons B) uncus C) cerebellum D) cerebrum D) cerebrum 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 is most likely to be the etiology of diabetic ketoacidosis (DKA) and to require further A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 1 mmHg, a pulmonary artery occlusion pressure (PAOP) of 4 mmHg, a systemic vascular resistance (SVR) of 1,800 dynes/s/cm-5, and a cardiac output (CO) of 3 L/min. Which of the following statements about this patient is correct? A) The patient has septic shock; provide vasopressors. B) The patient has cardiogenic shock; provide positive inotropes. C) The patient has hypovolemic shock; provide fluid resuscitation. D) The patient has right ventricular infarct; provide fluids. C) The patient has hypovolemic shock; provide fluid resuscitation. The hemodynamic profile described in the question is that of hypovolemic shock. The SVR would not be elevated in septic shock, so choice (A) is incorrect. In cardiogenic shock, the PAOP would not be decreased, and the CO would be lower, so choice (B) is incorrect. The RA pressure would not be low in RV infarct, so choice (D) is also incorrect. A patient is receiving positive inotropes, vasodilators, and diuretics. This patient most likely has which of the following problems? A) right ventricular failure B) left ventricular systolic heart failure C) papillary muscle rupture D) hypertrophic cardiomyopathy B) left ventricular systolic heart failure Positive inotropes increase contractility, vasodilators decrease afterload, and diuretics decrease preload. Since a patient with systolic heart failure has decreased contractility and increased afterload and preload, these agents will be useful for the treatment of this problem. A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 13 mmHg, a pulmonary artery occlusion pressure (PAOP) of 5 mmHg, a systemic vascular resistance (SVR) of 1,900 dynes/sec/cm-5, and a cardiac output (CO) of 1.9 L/min. Which of the following statements about this patient is correct? A) The patient has septic shock; provide vasopressors. B) The patient has cardiogenic shock; provide positive inotropes. C) The patient has hypovolemic shock; provide fluid resuscitation. D) The patient has right ventricular infarct; provide fluids. D) The patient has right ventricular infarct; provide fluids. The hemodynamic profile described is that of right ventricular (RV) failure, which may be secondary to acute RV infarct. The elevated SVR is not typical of septic shock, which rules out choice (A). The low PAOP is not seen in cardiogenic shock, which rules out choice (B). The organ dysfunction BP <100 respiratory rate >22 GCS <15 what is the primary benefit of norepinephrine it will restore vascular tone and afterload Plateau pressure it is a pressure that is used to calculate static compliance and reflects pressure in the lungs nitroprusside (Nipride) potent dilator drug that decreases preload and after load low blood sugar stimulate the sympathetic nervous system hypoglycemia s/s tachycardia and trembling acute pancreatitis hypocalcemia and hyperglycemia vitamin K reversal agent for warfarin protamine sulfate reversal agent for heparin postive chvostek and trousseau hypocalcemia kernig sign meningeal irritation Cullens sign discoloration around the umbilicus (occasionally the flanks) suggestive of intraabdominal hemorrhage