CCRN - Critical Care Registered Nurse Exam Questions and Answers Latest 2023/2024, Exams of Nursing

Download CCRN - Critical Care Registered Nurse Exam Questions and Answers Latest 2023/2024 and more Exams Nursing in PDF only on Docsity! CCRN CRITICAL CARE REGISTERED NURSE EXAM QUESTIONS AND ANSWERS LATEST 2023/2024 Which of the following patients, who are all receiving mechanical ventilation, is most likely a candidate for a spontaneous awakening trial? Select single answer choice. A a patient who is receiving PRN morphine B a patient who is receiving a propofol infusion C a patient who is receiving 100% oxygen and 20 cm H2O pressure of PEEP D a patient who is receiving a vecuronium (Norcuron) infusion {{Ans- Answer: B A spontaneous awakening trial should be considered for a patient who is receiving a continuous infusion of a sedating drug and/or an analgesic drug and who meets the hemodynamic criteria. A patient who is receiving a propofol infusion is a potential candidate for a spontaneous awakening trial 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 eithera 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 forthe 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. -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. 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. {{Ans- Answer: D Alcohol abuse results in chronic, not acute, hepatic failure. A salicylate overdose results in renal failure. Biliary obstruction may lead to pancreatitis or gallbladder disease. -Which of the following is most likely to lead to cardiopulmonary arrest for a patient with status asthmaticus? Select single answer choice. A bronchospasm. B thick, tenacious secretions. C hypoxemia. D air trapping. {{Ans- Answer: D Air trapping, due to the inability to effectively exhale, leads to chest hyperinflation, which in turn leads to decreased venous return and a precipitous drop in cardiac output. The remaining choices are seen with status asthmaticus but are not directcauses of cardiopulmonary arrest. -The ECG demonstrates ST elevation in leads II, III, and aVF. The nurse needs to monitor the patient closely forwhich of the following? Select single answer choice. A tachycardia, lung crackles B sinus bradycardia, an acute systolic murmur in the fifth intercostal space, midclavicular C second-degree AV block (Type II), hypotension. D hypoxemia, an acute systolic murmur in the fifth intercostal space, left sternal border. {{Ans- Answer: B Complications that are likely to occur after an acute 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. The remaining choices are not common complications of an inferior wall MI. -Which of the following statements about delirium is accurate? Select single answer choice. A Hypoactive delirium is easier to identify than hyperactive delirium or mixed delirium. B Haloperidol is an effective treatment for delirium. C The severity of a patient's illness upon admission puts the patient at a greater risk for delirium. D Deep sedation will prevent delirium. {{Ans- Answer: C Studies have shown the severity of a patient's illness upon admission puts the patient at a greater risk for delirium during his or her time in critical care. The remaining choices are not true statements. -Which of the following is an early indication of adequate fluid resuscitation? Select single answer choice. A a decreased heart rate B a narrowing pulse pressure. C an S3 heart sound. D increased hematocrit. {{Ans- Answer: A As fluid resuscitation progresses and hypovolemia is addressed, there is less need for heart rate compensation to maintain the cardiac output. The remaining choices are not seen as evidence of adequate fluid resuscitation. -Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors, and antibiotic therapy? Select single answer choice. A right atrial pressure (RAP) 1 mmHg; pulmonary artery occlusion pressure (PAOP) 4 mmHg; systemic vascular resistance (SVR) 1,800 dynes/sec/cm-5; cardiacoutput (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; cardiacoutput (CO) 2 L/min. D Choice (C) is reflective of a patient who has respiratory acidosis with full compensation. Choice (D) is reflectiveof apatient 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 forthe associated overdoses. -Which of the following would be LEAST likely to cause hypoglycemia for a patient with Type 1 diabetes? Select single answer choice. A late sepsis. B discontinuation of enteral feeding after a morning insulin dose. C a strenuous exercise session. D stress. {{Ans- Answer: D Stress will result in DKA rather than hypoglycemia. The remaining choices may cause hypoglycemia. -A patient with diastolic heart failure develops supraventricular tachycardia, with a heart rate of 220 beats/minute. The most dangerous hemodynamiceffect is a decrease in: Select single answer choice. A myocardial contractility. B coronary artery perfusion. c ejection fraction. D arterial oxygenation. {{Ans- Answer: B 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 75-year-old patient develops frequent 6- to 10-second episodes of asystole, interspersed with normal sinus rhythm that is associated with hypotension. The priority intervention is: Select single answer choice. A transcutaneous pacing. B a fluid bolus. C transvenous pacing. . D vasopressors. {{Ans- Answer: A The rhythm described is sinus arrest. Since the patient is having serious signs and symptoms, the immediate treatment is transcutaneous pacing. Transvenous pacing may be done once the patient is stabilized. The remaining 2 choices are not indicated for sinus arrest. -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? Select single answer choice. 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. {{Ans- Answer: B 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. -Lab tests show urine sodium less than 20, urine osmolality greater than the serum osmolality, BUN 70, and creatinine 3.1. This is a sign of what type of renal failure? Select single answer choice. A renal hypoperfusion without tubular basement membrane involvement. B nephrotoxic acute tubular necrosis, intrarenal failure. C ischemic acute tubular necrosis, intrarenal failure. D cortical renal failure with tubular basement membrane involvement. {{Ans- Answer: A 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 has right middle and lower lobe pneumonia. Which of the following is an appropriate intervention forthis patient? Select single answer choice. 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. {{Ans- Answer: D 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 greaterdisease. -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? Select single answer choice. A protamine sulfate. B vitamin K. C heparin. D platelets. {{Ans- Answer: B 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. -A patient with a history of thyroid disease was admitted with elevated TSH and decreased T3 and T4. Based on these lab results and the patient history, which of the following assessments would be expected for this patient? Select single answer choice. A tremor, fever, respiratory alkalosis B enlarged neck circumference, anemia, paranoia. C hyperreflexia, tachycardia, flushed skin. D delayed tendon reflexes, shallowrespirations, bradycardia. {{Ans- Answer: D This patient's lab results are typical of hypothyroidism. The patient assessment would most likely include delayed tendon reflexes, shallowrespirations (which may lead to respiratory acidosis), and bradycardia. The assessments described in choices (A), (B), and (C) would most likely be found in the presence of hyperthyroidism. -Which of the following is a complication of acute pancreatitis? Select single answer choice. A septic shock. B pneumonia. C hypocalcemia. D hypoglycemia. {{Ans- Answer: C Calcium is used up for autodigestion, and this precipitates hypocalcemia. The remaining signs are not typical of acute pancreatitis. -The hospital wants to implement strategies to conserve blood. Of the following, which is most likely to decrease blood utilization? Select single answer choice. A Continue administering platelet inhibitors pre-op. B Monitor provider transfusion practices, and provide regular feedback. C Discontinue erythropoietin (EPO) and iron pre-op for patients with known anemia. D Default the number of packed red blood cell units to 2 units on standard order sets. {{Ans- Answer: B The identification of providers who do not adhere to blood conservation practices enables a targeted approach for improvement. The remaining choices are all practices that would hinder, rather than improve, blood conservation. 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. -A patient's chest X-ray demonstrates a right upper lobe infiltrate. The mean arterial pressure (MAP) is 55 mmHg after fluid resuscitation, and the serum lactate is elevated. At this time, which of the following medications is a priority? Select single answer choice. A dopamine (Intropin) B norepinephrine (Levophed). C hydrocortisone (Solu-Cortef). D dobutamine (Dobutrex). {{Ans- Answer: B This patient has septic shock with organ dysfunction, as evidenced by signs of an infection, hypotension despite fluid resuscitation, and elevated serum lactate. A vasopressor is indicated at this point, and norepinephrine is the vasopressor of choice. There are no indications for the administration of the remaining drugs at this time. -Which of the following clinical findings is typical of compensatory shock? Select single answer choice. A hypotension B metabolic acidosis. C blood pressure is maintained. D organ failure. {{Ans- Answer: C 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. -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? Select single answer choice. A Avoid turning the patient onto his side. B Clamp the chest tube. C Avoid a high airway pressure. D Decrease suction to the collection chamber. {{Ans- Answer: C 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? Select single answer choice. A peripheral edema. B an enlarged heart size on a chest radiograph C lung crackles. D an ejection fraction less than 40%. {{Ans- Answer: C Both issues (a problem with ejection, which occurs in systolic heart failure, and a problem with filling, which occurs in diastolic heart failure) will increase the left heart pressure and cause cardiogenic pulmonary edema (lung crackles). The remaining 3 choices are only associated with systolic heart failure and are not true of diastolicheart failure. -A patient presents with elevated serum glucose. Which of the following parameters will best differentiate DKA from HHS in this situation? Select single answer choice. A serum potassium. B serum sodium. C serum glucose. D serum osmolality. {{Ans- Answer: D Although both DKA and HHS result in elevated serum glucose, the serum osmolalityof a patient with HHS will be greater than the serum osmolality of a patient with DKA since HHS develops more slowly 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 stop the skeletal muscle seizing and to prevent skeletal muscle damage. (Note that the patient may still be seizing when clinically paralyzed; therefore, continuous EEG monitoring is indicated to determine whether or not the patient is seizing.) Hyperkalemia, elevated PaCO2, and tachycardia are also associated with status epilepticus, which makes the remaining 3 choices incorrect. -A 19-year-old male was admitted with traumatic injuries secondary to a motor vehicle accident. The ECG demonstrates a sinus rhythm with a short PR interval and the presence of a slow rise of the initial upstroke of the QRS. This patient is at risk for developing which of the following? Select single answer choice. A pre-excited atrial fibrillation. B second-degree AV block, Type II. C third-degree AV block. D atrial flutter {{Ans- Answer: A This patient has Wolff-Parkinson-White (WPW) syndrome, as evidenced by a short PR interval with the presence of a delta wave (a slow rise of the initial upstroke of the QRS). The abnormal conduction pathway of WPW may result in a supraventricular tachycardia (SVT) or cause pre-excited atrial fibrillation (an irregular rhythm, rates of 150 beats/minute or greater, and a wide QRS). WPW does not cause the remaining arrhythmias listed in choices (B), (C), and (D). -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? Select single answer choice. 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. {{Ans- Answer: C 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. -Which of the following nurse characteristics best reflects the nurse's ability to provide professional caring and ethical practice? Select single answer choice. A The nurse adheres to the rules without any exceptions. B The nurse focuses solely on the patient's physiological needs. C The nurse targets individuals, rather than system processes, when errors occur. D The nurse initiates collaboration and does not wait for others to reach out. {{Ans- Answer: D The nurse characteristic of collaboration is evidenced as the nurse's ability to work together with patients, their families, and members of the health care team rather than waiting for others to reach out. The remaining 3 choices do not reflect a nurse's ability to provide professional caring and ethical practice. -Which of the following is an effective strategy for the assessment of and management of pain for a critically ill adult? Select single answer choice. A If the patient cannot accurately self-report pain, consider asking a family member, who knows the patient, whether the patient's behavior may indicate the presence of pain. B If the patient is agitated, provide sedation first, and then treat the pain with an analgesic. C Avoid the use of the Numerical Rating Scale for a patient who is receiving mechanical ventilation. D Titrate propofol for a patient with severe pain who is receiving mechanical ventilation. {{Ans- Answer: A A recommended strategy for pain assessment, when a patient is unable to provide an accurate self- report, is to ask the patient's family member whether the patient's behavior is an indication of pain. The remaining 3 strategies are not effective for pain assessment and management. -A patient was admitted 24 hours ago with ST elevation in leads II, III, and aVF and cardiogenic shock. The patient was stabilized, but she now complains of acute dyspnea. Her PAOP is 22 mmHg with giant V - waves. The nurse anticipates: -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 maintain the patient in a supine position. C hyperoxygenate during suctioning. D deflate the ETT cuff every 4 hours. {{Ans- Answer: C The insertion of a suction catheter into a tracheal tube during a suctioning procedure may decrease the SaO2. Although oxygen desaturation may not occur during every suctioning procedure, it may occur unpredictably. Therefore, it is best practice to increase the FiO2to 1.00 prior to beginning the suctioning procedure. Most ventilators provide the FiO2 of 1.00 that is needed for hyperoxygenation for a predetermined amount of time (for example, 2 minutes). -A post-op patient is undergoing negative-pressure wound therapy. What is an appropriate nursing intervention forthis patient? Select single answer choice. A Contact the physician if there is blocked tubing. B Change the dressing daily. C Maintain the continuous negative pressure at -150 mmHg. D Discontinue negative-pressure wound therapy during the night. {{Ans- Answer: A The physician needs to be notified if it is suspected that the tubing is blocked (as evidenced by an alarm and/or a lack of drainage). The physician will order flushing of the tubing or discontinuation of the therapy and the application of a wet-to-damp dressing until therapy can be resumed. The remaining interventions are not appropriate during negative-pressure wound therapy. -Which of the following arrhythmias typically manifests itself before a person is 30 years old? Select single answer choice. A Wolff-Parkinson-White (WPW) syndrome. B ventricular tachycardia. C second-degree AV block, Type I. D atrial fibrillation. {{Ans- Answer: A WPW is a genetic conduction abnormality in which an abnormal conduction pathway allows a reentrant tachycardia pathway to bypass the normal AV node conduction pathway, resulting in supraventricular tachycardia. WPW is generally first diagnosed in those younger than 30 years old, and it can be cured with ablation therapy. The remaining 3 choices are not generally diagnosed in those younger than 30 years old. -Which of the following should be avoided for a patient with hepatic encephalopathy? Select single answer choice. A normal saline. B carbohydrates. C hypokalemia. D lactulose. {{Ans- Answer: C Hypokalemia will trigger ammoniagenesis in the kidneys, which will increase the serum ammonia and worsen the hepatic encephalopathy. The remaining 3 choices would not increase the serum NH3 and would therefore not worsen the hepaticencephalopathy. -A patient with extreme muscle weakness improves after the administration of Tensilon. What is the significance of this response? Select single answer choice. A Corticosteroids should be discontinued. B The patient has myasthenic crisis. C Pyridostigmine (Mestinon) should be discontinued. D The patient has cholinergic crisis. {{Ans- Answer: B Tensilon is administered to those with myasthenia gravis in order to determine whether the symptoms are due to myasthenic crisis (undertreatment) or cholinergic crisis (overtreatment). Clinical improvement of symptoms after the administration of Tensilon indicates undertreatment. Therefore, choice (B) is correct and choice (D) is incorrect. If undertreatment is identified, the patient will need corticosteroids and Mestinon. Therefore, choices (A) and (C) are also incorrect. -A patient presents with a rigid abdomen, rebound tenderness, and free air in the peritoneum, as seen on a KUB X-ray. Which of the following describes the condition that the nurse should anticipate and the appropriate interventions? Select single answer choice. A 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 an infection and serum lactate 8. D an infection and a positive blood culture. {{Ans- Answer: C Elevated lactate is evidence of anaerobic metabolism, and it is the best indicator of septic shock of the choices listed. The remaining choices (SIRS, a fever, and a positive blood culture) may be present in sepsis, but they are not specific to a shock state. Additionally, septic shock may be present without signs of a fever ora positive blood culture. -A patient is receiving positive inotropes, vasodilators, and diuretics. This patient most likely has which of the following problems? Select single answer choice. A right ventricular failure. B left ventricular systolic heart failure C papillary muscle rupture. D hypertrophic cardiomyopathy. {{Ans- Answer: B Positive inotropes increase contractility, vasodilators decrease afterload, and diuretics decrease preload. Since a patient with systolic heart failure has decreased contractilityand increased afterload and preload, these agents will be useful forthe treatment of this problem. -A ventricular septal defect is most likely to have which of the following clinical findings? Select single answer choice. A diastolic murmur at the apex of the heart B systolic murmur at the fifth intercostal space, midclavicular C diastolic murmur at the base of the heart D systolic murmur at the fifth intercostal space, left sternal border {{Ans- Answer: D The murmur that is caused by a ventricular septal defect occurs during left ventricular ejection (systole) and is best heard at the fifth intercostal space, left sternal border. -A patient has a fever, and a lumbar puncture is positive for protein and WBCs. This patient most likely has a positive: Select single answer choice. A Cullen's sign. B Brudzinski's sign. C Babinski reflex. D Kehr's sign. {{Ans- Answer: B This patient has signs of meningitis and is likely to have meningeal irritation as evidenced by a positive Brudzinski's sign. The remaining choices are associated with clinical problems other than meningitis. -Which of the following describes an effect of a heparin infusion? Select single answer choice. 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. {{Ans- Answer: C Choice (A) is incorrect because it is warfarin that prevents the conversion of prothrombin to thrombin. Choice (B) is incorrect because it is antiplatelet therapy, using a medication such as clopidogrel, that prevents platelet aggregation. Choice (D) is incorrect because it is a fibrinolytic agent, such as Alteplase, that will promote the conversion of plasminogen to plasmin. -A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter was placed. The hemodynamic profile demonstrated the following: right atrial (RA) pressure 0 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusion pressure (PAOP) 4 mmHg, systemic vascular resistance (SVR) 400 dynes/sec/cm-5, and SvO280%. 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 septic shock; vasopressors C cardiogenic shock; IABP 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 uppermotor 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 priority treatment, choice (C) is incorrect. Surgical debridement will be needed, not only initially, but repeatedly until the spread of the necrosis is resolved. -Prerenal failure may be precipitated by which of the following in high-risk patients? Select single answer choice. A acetaminophen B calcium channel blockers C beta blockers D NSAIDs {{Ans- Answer: D Chronic use of NSAIDs prevents dilation of the efferent renal arteriole, and this dilation may be needed when renal perfusion is stressed by hypovolemiaorother stressors. -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? Select single answer choice. 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. {{Ans- Answer: D The hemodynamic profile described is that of right ventricular (RV) failure, which may be se condary 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 elevated RA pressure is not seen in hypovolemic shock, which rules out choice (C). -A patient has a blood pressure of 78/40, a right atrial (RA) pressure of 8 mmHg, a pulmonary artery occlusion pressure (PAOP) of 19 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? Select single answer choice. 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. {{Ans- Answer: B The hemodynamic profile described is that of cardiogenic shock. In septic shock, the PAOP and the SVR would not be elevated. Thus, choice (A) is incorrect. The PAOP would not be elevated in hypovolemic shock. Thus, choice (C) is incorrect. The PAOP would also not be elevated in right ventricular infarct. Thus, choice (D) is also incorrect. -A patient presents with eye deviation to the right, left homonymous hemianopsia, left-sided weakness, and right pupil dilation. This patient most likely has which of the following? Select single answer choice. A left temporal lobe tumor B pontine infarct C right-sided cerebellar infarct D right-sided stroke {{Ans- Answer: D Eye deviation is typicallyto the side of the injury, pupil changes are ipsilateral, and motor and visual changes are contralateral to the injury. Therefore, the patient must have had a right-sided stroke. Pontine problems result in pinpoint pupils and apneustic breathing, and cerebellar problems result in problems with balance orequilibrium. -Each of the following ECG changes is indicative of an acute pulmonary embolism (PE) EXCEPT for: Select single answer choice. A tall, peaked P-waves in lead II. B a prolonged QT interval. C right bundle branch block. D ST elevation in V1 and V2. {{Ans- Answer: B An acute PE will not cause a prolonged QT interval. (However, you will be expected to know what may cause a prolonged QT interval for the Adult CCRN exam.) The remaining choices may occur with an acute PE, especially a PEthat causes elevated right ventricular pressure. -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. A The patient requires acute hemodialysis. B The patient requires frequent lab draws. C The patient is receiving mechanical ventilation. D The patient requires peripheral parenteral nutrition. {{Ans- Answer: A A patient who requires emergent hemodialysis (or CRRT) will need a central venous catheter (CVC). Each of the remaining choices alone is not a requirement formaintaining a CVC. -A patient assessment reveals a fever and nuchal rigidity. A lumbar puncture is done, and the cerebrospinal fluid (CSF) results include the following: clear in appearance, glucose 60 mg/dL, mildly elevated protein, mildly elevated WBC count, and opening pressure 150 cm H2O. Treatment for this patient will most likely includewhich of the following? Select single answer choice. A supportive care. B airborne isolation. C antibiotic therapy. D targeted temperature management. {{Ans- Answer: A Treatment for this patient includes supportive care (e.g., fluids, fever management). The clinical signs described indicate that this patient has meningitis, and the results of the lumbar puncture indicate that the meningitis is viral. Antibiotics are indicated for bacterial meningitis, not viral meningitis. Isolation and targeted temperature management are not indicated forviral meningitis. -A patient's bladder pressure has ranged between 15 and 20 mmHg over the past 12 hours. Which of the following interventions is indicated for this patient? Select single answer choice. A Level the pressure transducer at the midaxillary line. B Elevate the head of the bed to 45°. C Withhold analgesic and sedating drugs. D Optimize stool management. {{Ans- Answer: D Optimization of stool management is needed. This patient has intra-abdominal hypertension, and interventions need to be aimed at reducing the intra-abdominal pressure. The level of the pressure transducer should be at the level of the symphysis pubis (the anatomical landmark of the bladder). The remaining 2 choices will elevate, not decrease, the intra-abdominal pressure. -Which of the following clinical findings is indicative of hypertensive crisis? Select single answer choice. A blood pressure 222/126, headache. B blood pressure 218/128, mental status change. C blood pressure 220/130, anxiety. D blood pressure 230/124, fatigue. {{Ans- Answer: B End organ damage is present with hypertensive crisis. Mental status change is a sign of end organ (brain) involvement. (A stroke is a major concern in the setting of hypertensive crisis.) Headaches, anxiety, and fatigue are not evidence of organ involvement. -A patient is being treated for cocaine intoxication. Which of the following would most likely NOT be indicated for this patient? Select single answer choice. A benzodiazepines. B cooling. C a conservative administration of fluids. D vasodilators. {{Ans- Answer: C Cocaine intoxication may result in chest pain, seizure activity, agitation, hyperthermia, and rhabdomyolysis. A liberal, not conservative, administration of fluids is recommended. The remaining 3 choices may be included in the treatment plan for a patient with cocaine intoxication. -Which of the following patients has a contraindication to increasing her activity to standing and pivoting to a chair? Select single answer choice. A The patient developed atrial fibrillation 3 days ago and is receiving a diltiazem (Cardizem) drip. 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 Standardize the indwelling urinary catheter products that are available on the unit. B Develop and implement an intermittent straight catheterization protocol. C Monitor compliance with maintaining the catheter drainage system below the bladder. D Develop an RN competency assessment that focuses on insertion technique. {{Ans- Answer: B The implementation of an intermittent straight catheterization protocol provides an alternative to inserting an indwelling urinary catheter (in the event that a patient is unable to void) and has been shown to decrease indwelling urinary catheter days. Choices (A) and (D) may improve or ensure aseptic insertion technique, while choice (C) may decrease infections, but none of these strategies will specifically decrease the numberof indwelling urinary catheter days. -A patient who was admitted yesterday afternoon is demonstrating frequent yawning and lacrimation. The nurse suspects withdrawal from which of the following substances? Select single answer choice. A cocaine B benzodiazepines. C alcohol. D heroin. {{Ans- Answer: D Yawning and lacrimation are signs of opioid withdrawal. These are not signs of withdrawal from the substances described in choices (A), (B), or(C). -A patient has global ST elevation and pain with deep inspiration. Which of the following medications should the nurse expect the physician to order? Select single answer choice. A morphine. B beta-adrenergic blocker. C nitrate. D nonsteroidal anti-inflammatory drug {{Ans- Answer: D The clinical signs described are those of pericarditis, and NSAIDs may be beneficial because they decrease inflammation. The remaining choices have not been found to be beneficial for the treatment of pericarditis. -Which of the following patients may be a candidate for palliative care? Select single answer choice. A a patient with a traumatic brain injury (who is able to follow commands) and also has ARDS. B a patient with Stage 4 ovarian cancer and pneumonia. C a patient with a newly diagnosed anterior MI. D a patient who had a massive stroke 1 week ago, remains comatose, and has a history of dementia {{Ans- Answer: A A patient with a TBI (who is able to follow commands) and also has ARDS will have a long, complex period of recovery. This patient would receive the greatest benefit from additional resources that could prevent and manage her symptoms and provide support to her and her family for any emotional and/or social issues that may arise. -A patient, who is receiving assist-control ventilation, is not assisting the ventilator. An ABG revealed the following: pH 7.51; PaCO2 29; PaO2 69; HCO3 25. Which of the following statements correctly assesses this patient and describes an appropriate intervention? Select single answer choice. A The patient has uncompensated respiratory alkalosis; decrease the breath rate B The patient has uncompensated metabolic alkalosis; increase the FiO2. C The patient has uncompensated respiratory acidosis; increase the tidal volume (Vt). D The patient has partially compensated respiratory alkalosis; decrease the tidal volume (Vt). {{Ans- Answer: A A decrease in the breath rate will allow the PaCO2 to rise with a resultant decrease in the pH. -A patient is 3 days status post a head injury with the following clinical findings: a urine output of 300 mL/hour, increased serum sodium, and increased serum osmolality. The nurse should anticipate an orderfor which of the following? Select single answer choice. -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 cleardrainage 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 elevated. Which of the following problems does this patient most likelyhave, and which intervention is most appropriate? Select single answer choice. A pancreatitis; antibiotic therapy. B hemorrhagic pancreatitis; a close pulmonary assessment. C bowel perforation; immediate surgery. D small bowel obstruction; gastric decompression. {{Ans- Answer: B The clinical signs described in the question are those of acute pancreatitis, and Grey Turner's sign indicates hemorrhagic pancreatitis. Acute pancreatitis may cause the release of phospholipase A, which destroys Type II alveolar cells. Elevation of the left diaphragm, left lower lobe atelectasis, left-sided pleural effusion, and ARDS are possible pulmonary complications of acute pancreatitis. -A patient was admitted with a 4-month history of numerous medical problems, and he is malnourished with a body mass index (BMI) of 15. Enteral feeding was initiated. The nurse should monitor this patient for which of the following? Select single answer choice. A hypomagnesemia. B hypercalcemia. C hypoglycemia. D hyperphosphatemia {{Ans- Answer: A This patient is at risk for refeeding syndrome when adequate nutrition is provided after a long period of malnutrition. With the reintroduction of feeding after a prolonged period of starvation, magnesium (as well as phosphorus and potassium) shift intracellularly due to the total body depletion of magnesium (as well as phosphorus and potassium) during starvation. The remaining electrolyte abnormalities are not associated with refeeding syndrome. -A patient with chronic alcoholism presents with abdominal pain, lethargy, decreased deep tendon reflexes, and muscle weakness. What is a likely cause of this clinical presentation and a potential complication? Select single answer choice. A hypomagnesemia; arrhythmias. B hypophosphatemia; hypoventilation. C hypernatremia; hypotension. D hyperkalemia; ventricular tachycardia {{Ans- Answer: B This clinical presentation is indicative of low phosphorus. The resulting muscle weakness may affect diaphragmatic functioning and may lead to hypoventilation. -A patient, who is exhibiting alcohol withdrawal syndrome, received a lorazepam (Ativan) IV 30 minutes ago. An assessment now reveals a respiratory rate of 10 breaths/minute, and the patient snores and responds with groaning when shaken. Which of the following interventions is indicated immediately? Select single answer choice. A a CPAP mask. B a naloxone (Narcan) IV. C a stat ABG. D a flumazenil (Romazicon) IV {{Ans- Answer: D This patient has signs of respiratory depression and decreased responsiveness secondary to the administration of benzodiazepines. Flumazenil needs to be given. A CPAP mask will assist ventilation, but it will not address the cause of the hypoventilation. Thus, choice (A) is incorrect. Naloxone is the reversal agent for opioids and is not appropriate in this situation. Thus, choice (B) is incorrect. An ABG may be obtained, but it will not address the cause of the emergent situation. Thus, choice (C) is also incorrect. -A patient has a permanent pacemaker and is now receiving end-of-life care. The patient has a do-not- resuscitate order. The cardiac monitor shows that the patient has a 100% paced rhythm. The nurse should do which of the following? Select single answer choice. A Call the cardiologist to deactivate the pacemaker. B Place a magnet over the pacemaker. C Call for an ethics consult. D