CCRN Exam (Critical Care Registered Nurse Exam), Exams of Nursing

Download CCRN Exam (Critical Care Registered Nurse Exam) and more Exams Nursing in PDF only on Docsity! CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) CCRN Exam (Critical Care Registered Nurse Exam) 2024/2025 Questions Completely Solved 100% Which Drug Would Most Likely Be Given To A Patient With Hypertrophic Cardiomyopathy? (A) METOPROLOL (B) Digoxin (C) Dopamine (D) Dobutamine A Decrease In Heart Rate, Provided By A Beta Blocker Such As Metoprolol, Would Increase Filling Time. In Hypertrophic Cardiomyopathy, There Is A Problem With Filling. A Decrease In Heart Rate Would Increase Filling Time. Diastolic Dysfunction Does Not Cause A Problem With Ejection, And The Ef Is Normal. The Other 3 Choices May Be Indicated For Systolic Dysfunction. A Patient Is Admitted With St Elevation In V2, V3, And V4. Four Days After Admission, The Patient Suddenly Developed A Holosystolic Murmur At The Lower Left Sternal Border, Chest Pain, And Hypotension. What Complication Should The Nurse Expect? (A) Papillary Muscle Rupture (B) VENTRICULAR SEPTAL DEFECT (C) Acute Mitral Stenosis (D) Acute Reinfarction The Scenario Describes An Acute Anterior Stemi, Generally Caused By An Occlusion Of The Lad. This Type Of Mi Is Most Likely To Result In A Vsd. Additionally, The Location Of The Murmur Is Important. Mitral Valve Disease-Related Problems Do Not Cause Murmurs To Be Loudest At The Left Sternal Border, Whereas A Vsd Would Result In A Murmur At This Location. A Postoperative Patient On The Surgical Unit Suddenly Develops Chest Pain, Extreme Weakness, And Dyspnea And Is Found To Have St Elevation In Ii, Iii, And CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) AVF On The Stat Ekg. B/P Is 92/62, Heart Rate 58, Respiratory Rate 28, Lungs Are Clear, And Heart Sound Assessment Reveals An S4, No Murmurs. In Addition To Preparing The Patient For Pci, Which Of The Following Interventions Would You Anticipate? (A) Nitroglycerin Drip, Aspirin (B) Furosemide, Atropine (C) Transcutaneous Pacing, Morphine (D) AGGRESSIVE FLUID ADMINISTRATION, RIGHT-SIDED EKG. The Scenario Describes A Patient Having An Acute Inferior Stemi, Generally Due To Rca Occlusion. An Rca Occlusion May Result In Rv Infarct, Which This Patient Has Signs Of (Hypotension With Clear Lungs). The Definitive Treatment Is Emergent Pci. Fluid Administration Will Help Increase Coronary Artery Perfusion By Correcting Hypotension And Ensure Adequate Rv Preload. The Right-Sided Ekg May Help Confirm The Rv Infarct. Nitroglycerin, Diuretics, And Morphine May Decrease Preload, Which Would Worsen Hypotension. A 52 Year Old Male Presents With Complaints Of Blurred Vision And Shortness Of Breath. B/P Is 232/136, Heart Rate 102, Respiratory Rate 28 With Crackles In Lower Lung Fields Bilaterally, With S3 And S4 Heart Sounds On Auscultation. Which Of The Following Would Be Indicated For This Patient? (A) NITROPRUSSIDE DRIP, ADMIT TO CRITICAL CARE UNIT (B) Digoxin, Furosemide (C) Labetalol Drip, Admit To A Medical Unit (D) Lisinopril, Calcium Channel Blocker The Patient Has Signs Of Organ Dysfunction (Heart Failure) Secondary To Extreme Hypertension. Therefore, He Has Hypertension Crisis Or Emergency. The B/P Needs To Be Emergently Decreased. Most Often This Treatment Is Best Done In An Icu. An 80 Year Old Female Presents With Chief Complaint Of Acute Shortness Of Breath. Clinical Exam Reveals B/P 182/102, Heart Rate 105/Minute, Respiratory Rate 32/Minute, Lungs With Crackles Bilaterally, Pulse Oximetry Of 88%, S4 On Auscultation. Ekg Revealed Sinus Tachycardia, Left Ventricular Hypertrophy Pattern, Chest Radiograph Showed Normal Heart Size, Pulmonary Vascular Congestion, And Echocardiogram Showed Ef Of 55%. Which Of The Following Should Be Avoided In This Patient's Treatment Plan? (A) Calcium Channel Blocker (B) DIGOXIN CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) A Patient With Mitral Regurgitation Develops Atrial Fibrillation With A Rate Of 88, B/P Of 118/75. Which Of The Following May Be Indicated? (A) Beta Blockers And Vasopressors (B) CARDIAC GLYCOSIDES AND CALCIUM-CHANNEL BLOCKERS (C) Beta Blockers And Calcium-Channel Blockers (D) Antiarrhythmics And Angiotensin-Converting Enzyme Inhibitors The Scenario Describes Development Of Atrial Fibrillation With A Controlled Ventricular Response And Stable B/P. Even With A Normal B/P, The Development Of Atrial Fibrillation Drops The Cardiac Output By 20% To 25% Due To A Loss In "Atrial Kick" Provided By Normal Sinus Rhythm. A Cardiac Glycoside (Such As Digoxin) May Be Beneficial As It Is A Weak Positive Inotrope That May Compensate For The Loss Of Atrial Kick And Calcium-Channel Blockers Will Keep The Rate Controlled. Pressors Are Not Needed In This Case. Use Of Beta Blockers And Calcium-Channel Blockers Would Decrease The Rate Too Much. Ace Inhibitors Would Offer No Benefit In This Case. Which Of The Following Are Predominant Signs Of Left Ventricular Systolic Dysfunction? (A) Pedal Edema, Ascites, Hepatomegaly, Weight Gain, Ejection Fraction Less Than 40% (B) S4, Bibasilar Crackles, Hypertension, Ejection Fraction Greater Than 40% (C) S3, FREQUENT NEW COUGH, BIBASILAR CRACKLES, EJECTION FRACTION LESS THAN 40% (D) Hypertension, Murmur, Chest Pain, Weight Gain, Ejection Fraction Greater Than 40% S3 Heart Sound In An Adult Is Indicative Of High Left Ventricular Pressure, Cough, And Lung Crackles Are Signs Of Pulmonary Edema Secondary To Elevated Left Ventricular End-Diastolic Pressure (Paop). The Ef Is Less Than 40% In Systolic Heart Failure. The Nurse Was Preparing A Patient With The Diagnosis Of Stemi For A Percutaneous Coronary Intervention (Pci). The Monitor Had Previously Shown Normal Sinus Rhythm (Nsr) And The B/P Had Been 128/78, Chest Pain Improved From A "9" To A "2" On A 0-10 Scale. The Monitor Alarm Sounded, And The Rhythm Below (Complete Heart Block) Was Observed By The Nurse: What Statement Below Is True: CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) (A) This Change Is Most Commonly Seen With Acute Inferior Mi. Assess The Patient. If Serious Signs And Symptoms Develop, Begin Transcutaneous Pacing (Tcp). (B) This Change Is Most Commonly Seen With Acute Anterior Mi. Assess The Patient. If Serious Signs And Symptoms Develop, Give Atropine. (C) This Change Is Most Commonly Seen With Acute Inferior Mi. Assess The Patient. If Serious Signs And Symptoms Develop, Begin Dobutamine. (D) This Change Is Most Commonly Seen With Anterior Mi. Assess The Patient. If Serious Signs And Symptoms Develop, [Correct Ans Is: - (A) The Patient Clinical Status Describes A Stable B/P But Development Of Bradyarrhythmia, Specifically A Complete Heart Block With A Ventricular Rate Of 30 / Minute. This Is Usually Seen With Rca Disease, Generally Associated With Inferior Mi. Patient Assessment Will Determine Patient Treatment. Transcutaneous Pacing Would Be An Appropriate Treatment For An Unstable Patient With This Arrhythmia. A 58 Year Old Patient Developed Chest Pain That He Scored As An "8" Rapid Assessment Included Profuse Diaphoresis, B/P 78/52, Heart Rate 104/Minute, Respiratory Rate 20/Minute, Lungs Clear, And Spo2 98%. The Patient Is Currently Connected To The Bedside Monitor With A Nasal Cannula At 2 L/Min In Place And Intravenous Fluids, 0.9 Ns At A Rate Of 10 Ml/Hour. Which Of The Following Sequences Of Interventions Would Be The Most Appropriate For The Nurse At This Time? (A) Give A Chewable Aspirin, Do An Ekg, And Start A Fluid Bolus (B) Give Ntg Sublingual, Increase The Fio2 And Give Morphine (C) Do An Ekg, Give Ntg Sublingual, And Give A Chewable Aspirin (D) Start A Fluid Bolus, Give A Chewable Aspirin, And Do An Ekg [Correct Ans Is: - (D) The Clinical Description May Be That Of Acute Coronary Syndrome Complicated By Hypotension. Addressing The Hypotension Is A Priority As This Is Further Decreasing Coronary Artery Perfusion. A Fluid Bolus Would Address Hypotension, And No Contraindications Seem To Be Present For A Fluid Bolus As Lungs Are Clear. Aspirin Is Indicated For Acutely Chest Pain And Could Be Given While Preparing To Do The Ekg, Which Is Needed To Help Make The Diagnosis. The Location Or Type Of Acute Mi Is Often Associated With Specific Clinical Findings. Which Of The Following Statements Related To Location Of Mi Is True? (A) Anterior Mi Is Often Associated With Heart Blocks And Bradyarrythmias (B) Inferior Mi Is Often Associated With Right Ventricular Wall Infarction CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) (C) Lateral Mi Is Most Likely To Be Associated With Posterior Mi (D) Posterior Mi Is Most Likely To Lead To The Complication Of Heart Failure [Correct Ans Is: - (B) Because Most Inferior Mi Are Due To Rca Occlusion And The Rca Also Supplies Blood To The Right Ventricular Muscle Wall, Inferior Mi Is Associated With Rv Infarct. Which Of Following Statements Is Accurate Regarding Heart Valves? (A) The Aortic Valve Is Closed During Systole (B) The Mitral Valve Is Closed During Systole (C) The Mitral Valve Is Closed During Diastole (D) The Aortic Valve Is Open During Diastole [Correct Ans Is: - (B) During Systole (Left Ventricular Ejection) The Aortic Valve Is Open, Allowing For Ejection, And The Mitral Valve Is Closed At This Time. The Mitral Valve Is Open During Filling (Diastole). The Following Drugs Are All Considered Positive Inotropic Drugs Primarily Affecting The Beta-1 Reception In The Heart, Except For: (A) Dopamine Drip At 12 Mcg/Kg/Min Dose (B) Dopamine Drip At 5 Mcg/Kg/Min Dose (C) Dobutamine Drip At 7 Mcg/Kg/Min Dose (D) Milrinone At 7 Mcg/Kg/Min Dose [Correct Ans Is: - (A) At High Doses (> 10 Mcg/Kg/Min), Dopamine Stimulates Alpha Receptors In Arteries And Causes Vasoconstriction. The Other 3 Drugs/Doses Affect Mainly Beta-1 Receptors In The Heart, Producing A Positive Inotropic Effect. Which Of The Following Is Associated With Mitral Regurgitation? (A) Systolic Murmur, Sinus Bradycardia (B) Diastolic Murmur, Heart Failure (C) Systolic Murmur, Inferior Wall Myocardial Infarction (D) Diastolic Murmur, Complete Heart Block [Correct Ans Is: - (C) Inferior Wall Mi May Result In Ischemia And Dysfunction (Regurgitation) Of The Mitral Valve. The Mitral Valve Is Closed During Systole (Left CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) On The Third Day After Admission For Acute Mi, A 67 Year Old Male Complains Of Chest Pain And Develops A Fever. The Pain Is Worse With Deep Inspiration And Is Relieved When He Leans Forward. There Are Nonspecific St Changes In The Precordial Leads Of The Ekg. The Nurse Anticipates That The Patient Will Most Likely Need Treatment For: (A) Thoracic Aneurysm (B) Dressler's Syndrome (C) Reinfarction (D) Pleuritis [Correct Ans Is: - (B) The Pain Described In The Scenario Is Typical Of The Pain Caused By Pericarditis. Dressler's Syndrome Is The Pericarditis That May Result After An Acute Mi. A Patient Is Admitted To The Ccu After A Pci With Stent. Femoral Sheath Is In Place, Site Is Dry With No Hematoma. He Suddenly Complains Of Severe Back Pain. Neck Veins Are Flat With Head Of Bed 30 Degrees, Heart Sounds Are Normal. Vital Signs Are Bp 78/48, Hr 124 And Rr 26. What Should The Nurse Suspect? (A) Cardiac Tamponade (B) Retroperitoneal Bleeding (C) Coronary Artery Dissection (D) Acute Closure Of The Stented Coronary Artery [Correct Ans Is: - (B) Retroperitoneal Bleeding May Cause Signs Of Hypovolemia And Hypovolemic Shock As Described In The Scenario. It May Be A Complication Of A Pci If The Femoral Artery Is The Access Site During The Procedure. Only This Problem Results In Severe Back Pain; None Of The Other 3 Choices Results In Back Pain Your Patient Admitted With An Nstemi Develops Acute Shortness Of Breath, Recurrence Of Chest Pain, And A Loud Systolic Murmur At The Apex Of The Heart. Which Of The Following Has Most Likely Occurred? (A) The Patient Has Developed Acute Mitral Valve Regurgitation (B) The Patient Has Developed Acute Infarction (C) The Patient Has Developed Acute Mitral Wave Stenosis (D) The Patient Has Developed Acute Ventricular Septal Defect CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) [Correct Ans Is: - (A) The Location Of The Murmur, At The Apex Of The Heart (Midclavicular, 5th Ics), Is One Clue To This Answer. In Addition, Regurgitation Occurs When The Valve Should Be Closed And The Mitral Valve Should Be Closed During Systole. Mitral Stenosis, Choice (C), Occurs When The Mitral Valve Is Open. Additionally, Mitral Stenosis Cannot Be Acute, It Develops Gradually. A Patient Has Just Returned From The Or After Insertion Of A Vvi Pacemaker. In Order To Assess Function Of This Pacemaker Accurately, The Nurse Needs To Understand That: (A) Both Atrium And Ventricle Are Paced And Sensed And May Either Inhibit Or Pace In Response To Sensing (B) The Ventricle Is Paced, Ventricular Activity Is Sensed And Pacing Is Inhibited In Response To Ventricular Sensing. (C) Both The Atrium And Ventricle Are Paced, But Only Ventricular Pacing Can Be Inhibited By A Sensed Intrinsic Ventricular Impulse. (D) The Ventricle Is Paced In Response To A Sensed Intrinsic Atrial Impulse Or Inhibited By A Sensed Intrinsic Ventricular Impulse. [Correct Ans Is: - (B) The First Letter Indicates Chamber Paced (Ventricle). The Second Letter Indicates Chamber Sensed (Ventricle). The Third Letter Indicates The Response To Sensing (Inhibited In Response To Sensing). A Patient Complains Of Sudden Dyspnea 5 Days S/P Acute Mi (St Elevation In Ii, Iii, And Avf, With St Depression In I And Avl). The Patient Is Anxious, Diaphoretic, And Hypotensive. Examination Reveals The Development Of A Loud Holosystolic Murmur At The Apex. What Is The Most Likely Cause Of This Patient's Deterioration? (A) Right Ventricular Failure Related To Right Ventricular Mi (B) Ventricular Septal Defect (C) Left Ventricular Failure Due To Extension Of Mi (D) Acute Mitral Regurgitation Due To Papillary Muscle Rupture Or Dysfunction [Correct Ans Is: - (D) The Scenario Describes A Patient Having An Acute Inferior Wall Mi, Which Is Generally Due To Occlusion Of The Rca. The Rca Occlusion May Result CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) In Papillary Muscle Dysfunction Or Rupture Of The Mitral Valve Because It Supplies The Area Of The Left Ventricle Where This Valve Is Attached. Although Rv Infarct Could Result With Rca Occlusion, Rv Infarct Does Not Result In A Systolic Murmur At Apex Of The Heart Or Lung Crackles. The Patient With Diagnosis Of Cardiogenic Shock Now Requires High Dose Dopamine (Greater Than 10 Mcg/Kg/Min) To Maintain Blood Pressure, And The Cardiologist Is Planning To Start Iabp Therapy. This Therapy Will Benefit The Patient Because It Will: (A) Increase Afterload With Balloon Inflation And Decrease Diastolic Augmentation With Balloon Deflation. (B) Decrease Afterload With Balloon Deflation And Increase Diastolic Augmentation With Balloon Inflation. (C) Decrease Afterload With Balloon Inflation And Decrease Diastolic Augmentation With Balloon Deflation (D) Increase Afterload With Balloon Deflation And Decrease Diastolic Augmentation With Balloon Inflation. [Correct Ans Is: - (B) Cardiogenic Shock Results In A Decrease In Cardiac Output With A Resultant Drop In Coronary Artery Perfusion And Compensatory Vasoconstriction. The Deflation Of The Balloon Placed Into The Descending Aorta Is Beneficial. Deflation Decreases Afterload And Work Of The Left Ventricle. Inflation Of The Balloon Is Beneficial Because It "Boluses" Blood Into The Coronary Arteries, Increasing Perfusion. Four Days After Mitral Valve Replacement, The Patient Goes Into Atrial Fibrillation With Rapid Ventricular Response. What Should Be The Nurse's Initial Action? (A) Order A 12 Lead Ekg (B) Evaluate The Patient For Clinical Signs Of Hypoperfusion (C) Notify The Physician (D) Ask The Patient To Bear Down As If Having A Bowel Movement [Correct Ans Is: - (B) The Patient's Response To The Arrhythmia Will Determine Whether Treatment Needs To Be Emergent And What The Treatment Will Be. Vagal Maneuvers E.G. Bearing Down, Are Not Known To Be Effective For Atrial Fibrillation. A Patient's 12 Lead Ekg Shows Sinus Bradycardia At 44 Beats/Min And St Segment Elevation In Leads Ii, Iii, And Avf. Which Of The Following Treatments For Bradycardia For This Patient Would Best Resolve The Problem? CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) (B) Feeding The Patient Via An Ngt (C) Administering 5% Dextrose In Water (D5w) At 75 Ml/Hour (D) Log Roll When Turning The Patient [Correct Ans Is: - (C) 5% Dextrose In Water Is A Hypotonic Solution. When Administered, It Will Cause Movement Of The D5w Into The Brain Cells, Causing Swelling And Increased Intracranial Pressure. The Other 3 Choices Are Acceptable Interventions For The Patient With Increased Icp. You Know That Research Supports Unrestricted Access Of A Designated Support Person To The Patient, But Your Unit Restricts All Patient Visitors To Set Times. Your Best Response Would Be To: (A) Gather The Facts And Propose A Policy Change To Your Manager For The Unit (B) Tell Patients/Visitors That The Unit's Policy Is Outdated But There Is Nothing You Can Do About It (C) Continue To Follow The Unit Policy (D) Complain To Colleagues About The Unit's Outdated Policy. [Correct Ans Is: - (A) The Aacn Synergy Model Supports Patient Advocacy. Unrestricted Access Of A Designated Support Person Is Evidence-Based Practice Included In The Patient Visitation Aacn Practice Alert. Choice (A) Is An Effective Strategy For Change. Your Patient Has Just Consented To A Bedside Chest Tube Insertion And Requests That His Wife Be Allowed To Be Present During The Procedure. You Should: (A) Explain To The Patient That This Is Against Infection Control Practice (B) Tell The Patient He Will Be Able To See His Wife As Soon As The Procedure Is Completed (C) Tell The Patient It Would Be Too Much For His Wife To Handle (D) Prepare The Wife For What To Expect And Allow Her To Be Present [Correct Ans Is: - (D) The Aacn Synergy Model Supports Caring Practice And Family Presence. An Aacn Practice Alert Indicates Family Presence May Improve Patient Outcome. Which Of The Following Laboratory Findings Are Most Specifically Indicative Of Disseminated Intravascular Coagulation (Dic) As The Cause Of Bleeding? (A) Elevated Fibrin Split Products And D-Dimer CCRN EXAM (CRITICAL CARE REGISTERED NURSE EXAM) (B) Prolonged Pt, Ptt, And Bleeding Time (C) Decreased Platelet Count (D) Decreased Hemoglobin And Hematocrit [Correct Ans Is: - (A) Dic Is A Clotting Problem, With Massive Coagulation. As Clots Break Down, Fibrin Split Products Are Produced. Therefore With Dic, Fsps Will Be High. In Fact, This Is The Most Specific Test Result For Dic. D-Dimer Is Present Due To The Presence Of Clots. While Not Specific For Dic, It Is A Good Rule-Out Test. A 29 Year Old Female Has Been In The Critical Care Unit For 2 Days After A Motor Vehicle Crash And Has Developed Acute Tubular Necrosis (Atn). She Was Normotensive On Admission. What Would Be The Most Likely Cause Of Atn? (A) Hemorrhage (B) Rhabdomyolysis (C) Creatinine Release (D) Cardiac Dysthymias [Correct Ans Is: - (B) The Motor Vehicle Crash Most Likely Resulted In A Crash Injury With Destruction Of Skeletal Muscle Cells (Rhabdomyolysis). This Results In The Release Of Massive Amounts Of Creatinine Kinase (Ck) That, In Turn, May Clog Renal Tubules And Lead To Acute Tubular Necrosis (Atn). Choice (A) Is Not Correct As There Is No History Of Bleeding. Choice (C), Creatinine Release, Is Too Vague, Could Be Minor, And Does Not Cause Atn. Arrhythmias, Choice (D), Are Not Included In The Scenario.