CCRN- Critical Care Registered Nurse REAL EXAM 2025 (QUESTIONS AND ANSWERS) GUARANTEED P, Exams of Nursing

Download CCRN- Critical Care Registered Nurse REAL EXAM 2025 (QUESTIONS AND ANSWERS) GUARANTEED P and more Exams Nursing in PDF only on Docsity! SCORE MORE CCRN- Critical Care Registered Nurse REAL EXAM 2025 (QUESTIONS AND ANSWERS) GUARANTEED PASS A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and complains of a headache and nausea. He reports he ran out of blood pressure meds three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach? Rapidly lower the diastolic pressure to 100 with IV antihypertensive meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive meds. The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure. A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this intervention is having it's intended effect? ScvO2 of 72% Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%, and urine output greater than 0.5 kg/hr 72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet count decreased significantly to 43,000 and was found to have new DVT on his right upper extremity. What do you suspect is the most likely cause of these findings? HIT SCORE MORE The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period (>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new development of DVT despite being on VTE prophylaxis. TRALI: is a complication from a blood transfusion reaction, which causes acute lung injury typically within 6 hours of a blood transfusion. 2 Hallmark signs of HIT: Decrease in platelet count over a 24 hr period. New development of DVT despite being on VTE prophylaxis. Values in Early compensated Hypovolemic shock? CO 4.0 L/min, HR 135, SV 65, SVR 1700, MAP 65 In hypovolemic states, circulating volume is depleted therefore preload and contractility are decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure to preserve CO, MAP and cerebral perfusion. Post-renal failure values: Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1.010 BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is typically 1-40 mEq/L. SCORE MORE No - pacing is the best instrument for symptomatic bradycardia. Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is what symptom? SIADH - causes retention of water. Urine production is minimal and concentrated & leads to an increased urine osmolality. What does Neo drug increase? SVR - Peripheral constriction Treatment for narrow complex, regular rhythm? Administer 6mg adenosine rapidly IVP Half life of metformin? 6 hours - close monitoring is required to ensure the blood glucose level does not climb too quickly while dextrose is being administered. Most accurate reflection of daily fluid balance? Record a daily weight at the same time each day. Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs of what? Cardiac tamponade SCORE MORE A patient with hyponatremia would need what? Help maintaining a safe environment. HypoNa impairs judgment, and causes confusion. Peritoneal dialysis works on the principles of both? Diffusion and osmosis. HHNS leads to what? Large fluid deficits and may require multiple liters of fluid, which is determined by the patient's level of dehydration and hyperosmolality. What parameters are consistent with Pulsus Paradoxes? Decrease in SBP>10 during inspiration. Before administering rtPA what must happen? Lower the BP to at least 185/110. An elevated BP prior to rtPA can cause hemorrhage. Ibutilide can cause what? Torsades A person with disecting AAA would receive what drug? PRN IV narcotic analgesia - BP management is a priority in the care of a patient with a dissecting AAA. Pain is the primary driver of HTN. SCORE MORE Autonomic hyperreflexia is what? This disorder is seen with spinal injuries occurring above the T6 spine. Cause of autonomic hyperreflexia? Bladder obstruction, constipation, pressure ulcers, and pain. Usually when the noxious stimulus is identified and removed, the symptoms resolve. Checking urinary catheter for obstruction is the most appropriate next action. MEDS for asymptomatic left ventricular systolic dysfunction? ACE or (ARB), beta-blockers and statins for all patients with a history of MI and for all patients with a reduced ejection fraction. What is the Z point technique? is a method used to estimate ventricular end diastolic pressure. It is taken just before the closure of the mitral valve and is especially useful when an A wave does not exist on the PAOP tracing such as in atrial fib. Ascites position for relief? Place pt on left side. DIC lab values? Fibrinogen decreased FSP elevated SCORE MORE FSP elevated Platelets decreased D-dimer elevated HOB position for ICP? Other tx? 45 degrees Increase sedation or mannitol as prescribed. Opening the Ventriculostomy drain requires specific orders? True Brain death criteria? Positive Apnea test Absent Oculovestibular and Oculocephalic reflex Respiratory acidosis ST elevation is indicative of what? Cardiac ischemia and should be treated as myocardial infarction SCORE MORE CDC indications for urinary catheter include: end-of-life care, strict I&O, immobility, select surgical procedures, sacral wounds, urinary retention/obstruction A saddle embolus is life threatening and requires which immediate intervention? IV thrombolytic for clot lysis. Subcutaneous and IV heparin inhibit thrombus growth and promote resolution of the formed clot, but will treat the a saddle pulmonary embolus. Indiscrimate pacing spikes indicate that the pacer is not what? Not sensing or seeing the cardiac activity present. Sensitivity should be decreased. A sudden increase in left atrial diastolic pressure will result in? Mitral regurgitation Late stages of shock results in what lab values? Increased Potassium Decreased Bicarbonate Increased Lactic acid SCORE MORE Juxtaglomerular cells secrete what? Renin in response to reduced glomerular filtration pressure. Secondary adrenal insufficiency is caused by: Long term steroid use, additional stress can overwhelm the hypothalamic -pitutary-adrenal system. Neosynephrine stimulates what? Side effects would include: alpha receptors - causes vasoconstriction, resulting in increase BP Reflexive bradycardia Heptojugular Reflex is suggestive of which following condition? Right sided heart failure Fever is associated with what? Worse neuro outcomes. This is secondary to the increase in cerebral metabolism and oxygen consumption Low volume ventilation, less than 10 mL/kg to minimize what? Pneumothorax - over inflation can cause volutrauma, which can lead to a spontaneous pneumothorax. SCORE MORE Gastro or other bleeding complications (within 3 months) First sign of problems from a shunt include: change in LOC or mental status Ominous sign of acute asthma exacerbation: Hypercapnia or elevated PaCO2 indicates patient is becoming fatigued and going into acute respiratory failure. Nephrogenic DI would cause what? the kidneys not respond to ADH Lactated ringers at 100ml hr before and after procedure is often prescribed to prevent what? Contrast induced nephropathy Keeping the TV (tidal volume) low is the best way to decrease pressures and avoid what? Barometric trauma in ARDS Which of the following parameters most accurately estimates end-organ perfusion? Urinary output, lactate, ScvO2 Aortic stenosis cause increased noise during systole and impaired outflow, leading to: SCORE MORE Pulmonary edema and crackles. Tx for neurogenic shock? Vasoconstrictor (phenylephrine) over large volume of fluid resuscitation Liver failure labs: Elevated bilirubin Decreased albumin elevated PTT, PT & INR When the liver fails: ammonia levels build causing encephalopathy. Bilirubin levels rise causing jaundice and coagulation times often prolong putting patient at risk for bleeding. Patients with HIT may develop: Thrombosis, DVT, PE, STROKE, MI, Renal impairment Vancomycin has a risk of nephrotoxicity and RN should monitor which lab value: Elevated serum creatinine Cerebral insults include: SCORE MORE ipsilateral pupil changes and contralateral motor extremity changes. Diuretic phase of ATN would include which lab value: Decreased urine osmolality Kernig's sign is indicative of: Meningitis - pt cannot extend the knee when the hip is flexed. DKA patients have a profound decrease in what: Fluids Pancreatitis leads to what? ARDS, DIC, hypovolemic shock Glycopyrrolate is part of medical mgmnt for: Respiratory failure in patient with chronic pulmonary dz. Thrombolytic therapy using rtPA is most common tx for: ischemic stroke Inclusion criteria for thrombolytic therapy: over the age of 18 SCORE MORE Anastomotic leak Intubation: FiO2 < 60% Maintain plateau pressures <30 Maintain Tidal volume < 8 Goals for ventilated pts. Position with the HOB 30 degrees with midline neck alignment: First line therapy for optimizing cerebral perfusion. Is Serum osmolality elevated or decreased in DI? Elevated due to volume loss - the urine will be dilute (decreased urine osmo) and hemoconcentration with increased sodium levels. Beta Blockers, ACE, & Aldosterone antagonists are used for: Heart failure pts. Right BBB & 2nd TYPE 2 heart block: Located in Bundle of HIS and R bundle branch are located in anterior wall, so both of these may be affected in anterior MI. Side effect of dexamethasone: SCORE MORE decreased potassium and calcium levels, hypoglycemia, and myopathy that results in proximal muscle weakness. Ablify, haldol, seroquel, and droperidol can cause what? QT prolongation Which electrolyte is affected with hypothermia: Hypokalemia Cardiac tamponade is a risk after what? discontinuation of epicardial pacing wires. Signs include decreased cardiac output, increased preload and intra-cardiac pressures, and decreased contractility. hyperglycemia, hypocalcemia and hypokalemia are r/t to pancreatitis? True DIC lab values: Decreased fibrinogen Increased D-dimer Decreased platelets Tx for heart failure: Positive inotropic agents, diuretics & vasodilators SCORE MORE ARDS tx: High levels of PEEP & low tidal volume What is the best indicator for neurogenic shock? Bradycardia Low cardiac output and hypotension are consistent across shock states. Gold standard of care for acute coronary syndrome? PCI PCI should be completed within 90 mins for STEMI and 24 hours for NTE-ACS. If not possible to get patient in cath lab within 90-120 mins, fibrinolytics should be considered. Tx for metabolic syndrome: reduce the risk of coronary artery disease and the secondary goal is to treat or prevent the onset of type 2 diabetes. Risk factors for developing acute kidney injury: HTN/PAD/Diabetes Epidural hematoma are associated with what kind of skull fx: SCORE MORE May bleed and accumulate rapidly since they result from arterial bleeding. Cerebral Aneurysm rupture? Is associated with patient complaining of "worst HA in their life." During a pt's admission to the ICU, the RN notes Hgb 9g/dl and Hct 27 ml/dl. Which meds should be confirmed with the provider prior to administration? Sulfa-trimethoprim (Bactrim) Anemia can be caused or exacerbated by some meds, including sulfa, antibiotics and ACE. A 56 yr male presents in heart block with a ventricular rate of 38 caused from an intentional overdose from CCB. What is appropriate antidote? Calcium Which is the earliest sign of Supratentorial (Uncal) herniation? Ipsilateral pupil dilation. Pt post-operative day 2 after a right hemicolectomy for ischemic bowel. The post-operative course has been complicated with pain control concerns. As the patient is getting out of bed for the first time the patient complains of sudden wet sounding cough. The assesses new onset tachycardia Pulmonary embolism - clinical signs of sudden SOB, anxiety points to PE Glucagon is an antidote for? SCORE MORE Beta blockers Which port do you get to measure mixed venous blood? Distal port DIC - which medication does the nurse anticipate to be ordered and started urgently? Heparin continous infusion 4 units/kg/hr Other tx would be to eliminate the cause. Which lab value would expect to see in a patient with pancreatitis? Decreased Albumin, elevated amylase and lipase Reversal for warfarin overdose? Vit K A pt with 3 vessel CABG with PA catheter in place. Pt has crackles in bilateral bases, s3,s4 heart sounds are audible, in addition to holosystolic murmur. The nurse suspects mitral valve insufficiency. Which set of data confirms this suspicion? CVP elevated PA pressure elevated PAOP elevated As mitral regurgitation develops blood moves back into the right atrium from the left ventricle. This in turn causes an increase in left atrial pressure, pulmonary artery pressure, and cvp pressure. SCORE MORE Pt with traumatic brain injury, what intervention should you include to prevent an increase in ICP? Keep patient's head in a neutral midline position. You are caring for a patient with an acute episode of asthma exacerbation. The first line of treatment is: beta 2 agonist - immediate tx of asthma exacerbation is to bronchodilate the airways to facilitate ventilation. Beta 2 agonists such as albuterol are a mainstay in the management of asthma and can be administered via nebulizer if needed. Which of the following would be expected in a patient experiencing herniation & Cushing's triad? Wide pulse pressure, bradycardia, increased systolic pressure Medication to treat hyperactive delirium? Haloperidol An increase in PEEP complication? A decrease in the RAP Patient is at risk for decreased right atrial filling and decreased cardiac output due to an increased intrathoracic pressure. Any time PEEP is increased, watch for signs of decreased cardiac output resulting from decreased venous return. Elevated P2 waves in an ICP waveform are a sign of: Increased intracranial pressure SCORE MORE A patient is admitted with serum calcium of 15.1 mEq/L. Which of the following interventions should the nurse anticipate? Rule out hypokalemia, then administer diuretics. Which of the following patients is likely to experience a heart block? Mitral Valve repair The patient with chronic alcohol abuse is admitted with a serum phosphorus of 1.8 mEq/L. The nurse will need to observe the patient closely for: Hypoventilation Low phosphorous causes what? constipation, not diarrhea Which of following nursing behaviors is usually most helpful to patients and families regarding end-of- life decisions? acting as an arbitrator between family members. Pt receiving PCA, morphine 1 mg per hour IV infusion, and 2 mg q 15 minutes as PRN doses. Pt is having episodes of sleep apnea and is arousable only by touch. Priority interventions include: STOP the continuous infusion and give naloxone slow IV until patient awakens. SCORE MORE Which patient according to ranson's criteria has poorest prognosis when it comes to acute pancreatitis? WBC 32,000; Glucose 220; LDH 400 A shunt requires more than oxygen to correct hypoxemia, for example: PEEP Will a V/Q mismatch respond to oxygen administration? True What should the patient watch out for when it comes to Myasthenia gravis: Muscle weakness Which of the following is the earliest indication that the patient may be aspirating oral feedings? Tachypnea and tachycardia The patient was admitted status post motor vehicle crash. The patients sustained an intracranial bleed, is hypotensive, and is tachycardic. The patient's clinical status is most likely due to which of the following? Shock from multiple trauma Neurogenic shock and brain herniation result in bradycardia? True SCORE MORE Pt states he is "sick of it all." Which is the best intervention: Consult with Doc regarding a psych consult. Traumatic injury, patient's arterial blood gas shows Respiratory alkalosis - what interventions is best at this time? Increase FIO2/assess for pain. Acute anterior wall myocardial infarction and suddenly develops a loud holosystolic murmur, loudest at the left sternal border, 5th intercostal space, tachypnea, and bibasilar crackles. Which of the following would provide most definitive diagnosis of this problem? Increased oxygen saturation in the pulmonary artery and the right ventricle. Patient agitated with a RASS score of +3 and behavioral pain scale of 10 (range 3-13). Spo2 AND BREATH sounds are unchanged. BP and heart rate are somewhat higher. Interventions? Give morphine 2mg IV Increasing prop won't do anything for the pain.