CCRN Critical Care Registered Nurse Exam Test Bank: Practice Questions and Answers, Exams of Nursing

Download CCRN Critical Care Registered Nurse Exam Test Bank: Practice Questions and Answers and more Exams Nursing in PDF only on Docsity! CCRN CRITICAL CARE REGISTERED NURSE EXAM TEST BANK LATEST 2024 Which of the following ventilator settings is most likely to decrease the work of breathing? - ANSWER>>Pressure support 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? - ANSWER>>continuously monitor the patient in lead II A patient with aortic regurgitation will have which of the following upon auscultation? - ANSWER>>a diastolic murmur, loudest at the second intercostal space, right sternal border Which of the following patients, who are all receiving mechanical ventilation, is most likely a candidate for a spontaneous awakening trial? - ANSWER>>a patient who is receiving a propofol infusion Cardiogenic shock secondary to left ventricular failure will generally result in: - ANSWER>>a narrow pulse pressure. 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? - ANSWER>>a surfactant deficiency and pulmonary edema Which of the following is an effect of hypothermia? - ANSWER>>a shift of the oxyhemoglobin dissociation curve to the left 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? - ANSWER>>SpO2 88% The most common cause of acute hepatic failure is - ANSWER>>an acetaminophen overdose. Which of the following is most likely to lead to cardiopulmonary arrest for a patient with status asthmaticus? - ANSWER>>air trapping The ECG demonstrates ST elevation in leads II, III, and aVF. The nurse needs to monitor the patient closely for which of the following? - ANSWER>>sinus bradycardia, an acute systolic murmur in the fifth intercostal space, midclavicular Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors, and antibiotic therapy? - ANSWER>>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 Which of the following is indicative of a mixed acid-base disorder? - ANSWER>>The decreased PaCO2 is evidence of respiratory alkalosis, and the decreased HCO3 is evidence of metabolic acidosis. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 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? - ANSWER>>BUN/creatinine ratio of ~ 20:1 indicate that the renal tubular basement membrane remains intact. renal hypoperfusion without tubular basement membrane involvement A patient with Type 1 diabetes has been started on metoprolol for heart disease. The nurse needs to inform the patient that the first sign of hypoglycemia might be which of the following? - ANSWER>>mental status change Which of the following is most likely to result in a low SvO2? - ANSWER>>A fever increases the metabolic rate and oxygen consumption, which may lead to a drop in the mixed venous oxygen saturation. 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? - ANSWER>>elevated creatine kinase (CK) The destruction of skeletal muscle cells occurs secondary to seizure activity, which results in the release of creatine kinase (CK) into the serum. 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? - ANSWER>>pre-excited atrial fibrillation This patient has Wolff-Parkinson-White (WPW) syndrome, as evidenced by a short PR interval with the presence of a delta wave 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? - ANSWER>>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 Which of the following is an effective strategy for the assessment of and management of pain for a critically ill adult? - ANSWER>>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. A patient with right ventricular infarction would most likely have which of the following hemodynamic pressure findings? - ANSWER>>right atrial (RA) pressure 14 mmHg, pulmonary artery occlusion pressure (PAOP) 5 mmHg Due to decreased RV ejection, the right atrial pressure increases. Failure of the RV results in decreased left ventricular preload (low PAOP). The lungs will be clear, but the cardiac output and the B/P may decrease A patient 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? - ANSWER>>Maintain the cerebral perfusion pressure (CPP) with 0.9 normal saline. This patient has signs of vasospasm, and maintaining the CPP (in order to prevent worsening of the vasospasm) is a priority. A patient's family has unrealistic expectations for the patient's recovery. What is the most effective strategy for the nurse to employ in this situation? - ANSWER>>Attempt to get information from the family that explains their point of view, and revise explanations accordingly. Which of the following is a priority treatment for a patient with DKA who presents with hyperglycemia, ketosis, and normal serum potassium? - ANSWER>>Administer potassium. Which of the following is a systemic effect of targeted temperature management (TTM) during the cooling phase? - ANSWER>>hyperglycemia secondary to insulin resistance A patient presented to the Emergency Department with a history of palpitations and dyspnea, persisting on and off for 1 week. The heart monitor shows atrial fibrillation with rapid ventricular response, and the blood pressure is 112/70. Treatment will most likely include: - ANSWER>>a calcium channel blocker and anticoagulation. A ventricular septal defect is most likely to have which of the following clinical findings - ANSWER>>systolic murmur 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: - ANSWER>>Brudzinski's sign. Which of the following describes an effect of a heparin infusion? - ANSWER>>It prevents the conversion of thrombin to fibrinogen. 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 SvO2 80%. What is most likely the cause of this patient's hypotension, and what is the appropriate treatment? - ANSWER>>septic shock; vasopressors The massive vasodilation, loss of vascular tone, and capillary leak caused by endotoxins results in decreased preload and decreased afterload A patient with right middle lobe pneumonia would be expected to have which of the following assessment findings over the affected area? - ANSWER>>bronchial breath sounds and whispered pectoriloquy A patient has a pulmonary embolism with hypotension, hypoxemia (which requires the patient to be on 100% oxygen), and severe tachypnea. Which of the following would provide the quickest resolution of this patient's signs and symptoms? - ANSWER>>the administration of a fibrinolytic agent 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? - ANSWER>>putting the legs in the dependent position A patient has global ST elevation and pain with deep inspiration. Which of the following medications should the nurse expect the physician to order? - ANSWER>>nonsteroidal anti- inflammatory drug Which of the following patients may be a candidate for palliative care? - ANSWER>>a patient with a traumatic brain injury (who is able to follow commands) and also has ARDS 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 order for which of the following? - ANSWER>>vasopressin The nurse notices that during inspiration and expiration, the water in the water seal chamber is bubbling for a patient with a left-sided chest tube. What does this assessment indicate? - ANSWER>>pleural air leak 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 likely have, and which intervention is most appropriate? - ANSWER>>hemorrhagic pancreatitis; a close pulmonary assessment 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? - ANSWER>>hypomagnesemia 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? - ANSWER>>hypophosphatemia; hypoventilation A 65-year-old male complains of sharp left shoulder pain, and upon a clinical exam, he demonstrates abdominal distension with absent bowel sounds. This patient most likely has: - ANSWER>>Sharp left shoulder pain (Kehr's sign) is a clinical sign that is caused by diaphragmatic irritation that occurs with splenic rupture. S1 heart sounds - ANSWER>>loudest in apex s2 sounds - ANSWER>>loudest at base louder with pulmonary embolism s3 heart sounds - ANSWER>>associated with kidney failure cor pulmonale pulmonary htn mitral, aortic, or tricuspid insufficiency s4 heart sounds - ANSWER>>associated with aortic stenosis htn ventricular hypertrophy myocardial ischemia normal pulse pressure - ANSWER>>40-60 mmHg systolic bp is an indirect measurement of - ANSWER>>CO and SV narrowing pulse pressure seen often in - ANSWER>>severe hypovolemia or severe drop in CO diastolic pressure is an indirect measurement of - ANSWER>>SVR widen pulse pressure indicates - ANSWER>>vasodilation drop in SVR often seen in septic shock when does murmur insufficiency occur - ANSWER>>when valve is closed (regurgitation) acute or chronic when does stenosis occur - ANSWER>>when valve is open chronic systolic murmur stuff semilunar valves are open during/what to know - ANSWER>>systole aortic stenosis pulmonic stenosis systolic murmur stuff AV valves close during/what to know - ANSWER>>systole mitral/tricuspid insufficiency large V waves on PAOP Ventricular septal defects Diastolic murmur stuff semilunar valves close when/which insufficiencies - ANSWER>>diastole Aortic and pulmonic Diastolic murmur stuff AV valves open during/what to know - ANSWER>>diastole mitral stenosis with afib tricuspid stenosis LABETOLOL 6 P's of PAD - ANSWER>>Pain, paralysis, pallor, paresthesia, poikilothermy, Pulselessness WHAT IS A NORMAL ABI - ANSWER>>>0.90 DO WE ELEVATE FOR PAD - ANSWER>>NO, DECREASES PERFUSION What is WPW syndrome? - ANSWER>>A syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the bundle of Kent. It is seen as a short PR interval, a U wave, and a long QRS complex. AGE SEEN FOR WPW - ANSWER>>YOUNGER THAN 30 WHAT CAN WPW PRESENT AS - ANSWER>>PRE-EXCITED ATRIAL FIBRILATION WHAT NOT TO GIVE TO PRE-EXCITED ATRIL FIBRILATION - ANSWER>>ADENOSINE DIGOXIN CALCIUM CHANNEL BLOCKERS CAN CAUSE VFIB PROLONGING OF THE QT CAN RESULT IN - ANSWER>>TORSADES DE POINTES DRUG Causes of prolonged QT - ANSWER>>AMIODARONE QUINIDINE HALOPERINOL PROCAINAMIDE ELECTROLYTE CAUSES OF PROLONGED QT - ANSWER>>HYPOKALEMIA HYPOMAGNESIA HYPOCALCEMIA PACEMAKER CODE READING - ANSWER>>FIRST INITIAL: CHAMBER PACED SECOND INITIAL: CHAMBER BEING SENSED THIRD INITIAL: RESPONSE TO SENSING main cause of DEATH FOR heart failure - ANSWER>>SUDDEN DEATH ARRHYTHMIA HYPERTROPHIC CARDIOMYOPATHY IS SILILAR TO? AND HAS TROUBLE? - ANSWER>>RIGHT SIDED HEART FAILURE FILLING DILATED CARDIOMYOPATHY IS SIMILAR TO? HAS TROUBLE? - ANSWER>>LEFT SIDED HEART FAILURE EJECTING THREE HEMODYNAMIC CHANGES IN CARDIOGENIC SHOCK - ANSWER>>ELEVATED PAOP ELEVATED SVR DROP IN CO IABP inflates during - ANSWER>>diastole Cardiac Tamponade s/s - ANSWER>>JVD, narrow pulse pressure, hypotension ( Becks Triad) pulsus parodoxus seen in - ANSWER>>CARDIAC TAMPONADE WHICH VALVE IS MOST LIKELY TO RUPTURE WITH TRAUMA - ANSWER>>AORTIC VALVE WHAT TO DO WITH THE GOOD LUNG - ANSWER>>GOOD LUNG DOWN WHEN IS PERFUSION OF THE ANTERIOR CHEST ALVEOLI SEEN - ANSWER>>WHEN YOU PRONE WHAT IS EXTREME V/Q MISMATCH - ANSWER>>100 FIO2 WITH HYPOXEMIA WHAT IS A PATHOLOGICAL SHUNT EXAMPLE - ANSWER>>ARDS BLOOD THROUGH LUNGS BUT NOT OXYGENATED REFRACTORY HYPOXEMIA TREATMENT OF RESPIRATORY SHUNT - ANSWER>>O2 AND PEEP WHAT CAUSES A SHIFT TO THE LEFT FOR RESPIRATORY - ANSWER>>"HOLD ONTO O2" HIGH FIO2, LOW TISSUE O2 ALKOLOSIS LOW PACO2 HYPOTHERMIA LOW 2,3 DPG WHAT CAUSES A SHIFT TO THE RIGHT RESPIRATORY - ANSWER>>HGB RELEASED EASIER LOW FIO2, HIGH TISSUE O2 ACIDOSIS HIGH PACO2 FEVER plateau pressure less than 30 Tidal volume 5-6 ml/kg do we use steroids for ARDS/ALI - ANSWER>>NOPE only with specific COVID patients how far above the carina do you want your ETT - ANSWER>>3-5 cm WHAT HAPPENS TO BP IN COMPENSATORY SHOCK - ANSWER>>MAINTAINS WHAT HAPPENS TO BP WITH PROGRESSIVE SHOCK - ANSWER>>HYPOTENSION HYPOVOLEMIA SHOCK DOES WHAT TO BP - ANSWER>>NARROWS PULSE PRESSURE SVR for hypovolemic shock - ANSWER>>ELEVATED WHEN GIVING BLOOD WHAT ELECTROLYTES CAN GO LOW AND WHAT ENZYME CAN CAUSE A LEFT SHIFT FROM NOT BEING IN BLOOD - ANSWER>>Ca and Mg 2,3 dpg what is the trauma triad of death - ANSWER>>hypothermia, acidosis, coagulopathy what is released in anaphylaxis - ANSWER>>IGE MEDIATED TRAUMA FIRST LINE ASSESSMENT - ANSWER>>*ABCDE* *A*irway: ensure patent airway (intubation?) *B*reathing: provide 100% oxygen and ventilation *C*irculation: 2 large-bore IVs with warm isotonic lactated ringers *D*isability: perform quick neuro exam (LOC, motor, pupils) --GCS *E*xpose/*E*nvironmental: remove clothes, provide warmth/cooling as needed TRAUMA SECOND LINE ASSESSMENT - ANSWER>>*FGHI* *F*ull set of vitals --Focused adjuncts: ECG monitor, pulse ox, CO2 detector, urinary catheter, gastric tube, radiography, FAST, CT, DPL, labs --Family presence *G*ive comfort measures (pain management) *H*istory *I*nspect posterior (turn patient over) SYSTEMIC EFFECTS OF HYPOTHERMIA - ANSWER>>Insulin resistance (hyperglycemia) Electrolyte and fluid shifts Shivering Skin breakdown Decreased cardiac output (up to 25%) Alteration in coagulation (platelet dysfunction) Increased risk for infection (neutrophil and macrophage functions decrease at temperatures <35C) What is cardiac output? - ANSWER>>heart rate x stroke volume CVP measures - ANSWER>>right ventricular preload PAOP measures - ANSWER>>left ventricular preload PVR measures - ANSWER>>right ventricular afterload SVR measures - ANSWER>>left ventricular afterload WHAT DOES CARDIAC INDEX MEASURE - ANSWER>>reflects cardiac output for body surface area normal cardiac index - ANSWER>>2.5-4 L/min/m2 normal stroke volume - ANSWER>>50-100 mL/beat Normal PVR - ANSWER>>50-250 Normal PAOP (wedge) pressure - ANSWER>>8-12 mm Hg Normal RAP - ANSWER>>2-6 mmHg Normal CAPP - ANSWER>>60-80 normal SvO2 (mixed venous oxygen saturation) - ANSWER>>60-75% HEMODYNAMIC PROFILE FOR CARDIOGENIC SHOCK - ANSWER>>BP DOWN CVP UP PAP UP PAOP UP CO DOWN What is homonymous hemianopsia? - ANSWER>>-loss of one half of the field of vision on the same side in both eyes What is uncal herniation? - ANSWER>>medial portion of temporal lobe herniates through tentorium cerebelli WHAT HAPPENS WITH A UNCAL HERNIATION - ANSWER>>LATERAL SHIFT NO INITIAL CHANGE IN LOC BLOWN PUPIL SEEN BEFORE CHANGE IN LOC MOST COMMON CAUSE OF UNCAL HERNIATION - ANSWER>>epidural hematoma WHAT IS CENTRAL HERNIATION - ANSWER>>Downward shift of cerebral hemisphere, compressing the brainstem WHAT HAPPENS DURING A CENTRAL HERNIATION - ANSWER>>PUPILS BOTH DILATE BILATERAL BABINSKI REFLEX CEREBRAL EDEMA USUALLY THE CAUSE SAH REBLEED OR VASOSPASM S/S - ANSWER>>CHANGE IN LOC WHAT THERAPY IS FOR BRAIN TUMORS - ANSWER>>STERIODAL first sign of increased ICP - ANSWER>>Change in LOC NORMAL ICP - ANSWER>>0-10 What is CPP and how is it calculated - ANSWER>>cerebral perfusion pressure CPP = MAP - ICP DO WE HYPERVENTILATE FOR INCREASED ICP - ANSWER>>NO CAUSES CEREBRAL VASOCONSTRICTION BASILAR SKULL FRACTURRE CAN RESULT IN - ANSWER>>MENIGEAL TEAR WHY DO PEOPLE DIE FROM SEIZURES - ANSWER>>CEREBRAL HYPERMETABOLISM WHEN TO DO AN ABG WITH APNEA BRAIN DEATH TEST - ANSWER>>8-12 MINUTES INTO IT Tensilon test - ANSWER>>Used to diagnose MG and to differentiate between myasthenic crisis and cholinergic crisis. WHAT TO DO WITH A BLAKEMORE TUBE IF RESP DISTRESS OCCURS - ANSWER>>CUT THE BALLOON Pulmonary complications of acute pancreatitis - ANSWER>>Atelectasis, left lower lobe Left pleural effusion Bilateral crackles ARDS What is Trousseau's sign? - ANSWER>>BP cuff inflated and causes a carpal spasm. (Low calcium) WHAT ELETROLYTE CAN GET LOW WITH ACUTE PANCREATITIS - ANSWER>>CALCIUM AND MG Signs of hemorrhagic pancreatitis - ANSWER>>Cullen's sign: periumbilical ecchymosis Grey-Turner's sign: bilateral flank ecchymosis ELEVATED NH3 IN HEPATIC FAILURE - ANSWER>>CAUSES ASTERIXIS FLAPPING HAND TREMOR FACTORS THAT INCREASE NH3 IN HEPATIC ENCEPHALOPATHY - ANSWER>>HYPOKALEMIA INCREASED BUN PROTEIN BREAKDOWN LACTIC ACIDOSIS What is Kehr's sign? - ANSWER>>Left shoulder pain => spleen rupture What is Cullen's sign? - ANSWER>>ecchymosis at the umbilicus due to retroperitoneal bleed IAP NEEDS TO BE HOW HIGH FOR ACS - ANSWER>>20 AND GREATER IS BAD normal bun - ANSWER>>10-23 Normal Creatinine - ANSWER>>0.6-1.4 SIAHD BIGGEST KILLER - ANSWER>>SEIZURES WITH METABOLIC ACIDOSIS A 0.1 DROP IN PH DOES WHAT TO POTASSIUM - ANSWER>>INCREASES K BY 0.6