CCRN Practice Test Exam with Correct Answers, Exams of Advanced Education

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2024 CCRN PRACTICE TEST EXAM

WITH CORRECT ANSWERS

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The patient has flushed dry skin and eyes are flickering up and down. Pupils are 3 mm dilated and equally reactive to light. While waiting for toxicology results, the nurse should suspect that the patient overdosed on A. LSD B. PCP C. metheampahtimes D. Heroin - CORRECT-ANSWERSB. PCP Which one of the following is the definitive procedure for diagnosing pulmonary emboli? A. ABG measurement B. radioisotope lung scan C. pulmonary angiography D. CXR - CORRECT-ANSWERSC. pulmonary angiography A patient with respiratory failure secondary to the PNA appears confused and lethargic. The patient takes NSAIDs for arthritis. At present, BP and CVP are within acceptable ranges, mucous membranes are moist and skin turgor is normal. The serum sodium is 129 mEq/L, and serum osmolality is low. Which of the following additional laboratory findings should the nurse anticipate? A. decrease serum bicarb and potassium levels B. elevated serum glucose and creatinine levels C. elevated uric acid and normal magnesium levels D. decreased BUN and normal serum potassium levels - CORRECT- ANSWERSD. decreased BUN and normal serum potassium levels (euvolemic hyponatremia- SIADH?) Acute lung injury (ALI) is characterized by - CORRECT-ANSWERSan antecedent event, refractory hypoxemia and tachypnea Tow hours after a complicated premature delivery with placenta abruptio, the nurse notes that the puncture wound from the patient's recent venipuncture is continuously bleeding. Which of the following laboratory tests should the nurse anticipate obtaining?

A. ionized Ca and pitocin levels B. PT and D-dimer C. fibrin split product and magnesium D. D-dimer nad Factor IX assay - CORRECT-ANSWERSB. PT and D-dimer (help diagnose DIC) Cor pulmonale is characterized by - CORRECT-ANSWERSenlargement of the right ventricle secondary to pulmonary disease (common in COPD) Left ventricular failure can be caused by which of the following? A. aortic regurgitation and HTN B. aortic stenosis and COPD C. mitral regurgitation and pulmonary embolus D. mitral stenosis and AMI - CORRECT-ANSWERSA. aortic regurgitation and HTN In a patient who has just sustained a severed head injury in a high-speed motor vehicle crash, which of the following should be a high-priority concern? A. myocardial contusion B. cervical injury C. diabetes D. status epilepticus - CORRECT-ANSWERSB. cervical injury A patient is admitted after a motor vehicle crash. The patient is currently alert and oriented but had sustained a momentary loss of consciousness at the accident scene. The only significant injury is a linear temporal skill fracture. Within 2 hours of admission, the patient's neurological status deteriorates. The nurse should anticipate A. arteriography and silicone rubber bead embolization B. ventricular and CSF drainage C. osmotic diuretic and corticosteroid therapy D. burr holes and clot evacuation - CORRECT-ANSWERSD. burr holes and clot evacuation (risk factors for epidural hematoma which requires immediate surgical intervention to remove clot) A patient is admitted postoperative following repair of an AAA with a Dacron graft. The next day, the patient's urine output decreases and serum creatinine increases the nurse should suspect A. acute renal failure B. septic shock C. acute rejection graft

D. glomerulonephritis - CORRECT-ANSWERSA. acute renal failure Which of the following nursing actions might decrease a patient's self esteem? A. discussing the negative consequences of the patient's condition B. requiring the patient to participate in all treatments C. providing opportunities to discuss issues important to the patient D. indicating acceptance pf the patient's condition - CORRECT-ANSWERSB. requiring the patient to participate in all treatments The BAG results on a 60 kg pt being mechanically ventilated during an episode of acute respiratory failure are: pH 7. pCO2 34 pO2 84 HCO3 25 Rate 12 breaths/min Vt 600 ml fiO2 60% PEEP 5 cm H The most appropriate action the nurse should do A. increase fiO B. decrease the rate C. decrease the tidal volume D. increase the PEEP - CORRECT-ANSWERSC. decrease the tidal volume (normal Vt= 608 mL/kg) Findings consistent with renal hypo-perfusion include - CORRECT- ANSWERSurine sodium less than 10 and urine osmolality greater than serum osmolality Which of the following ABG results indicates acute respiratory failure? A. pH 7.22, pCO2 48, pO2 82, HCO3 12, O2 sat 92 B. pH 7.24, pCO2 54, pO2 55, HCO3 22, O2 sat 76 C. pH 7.52, pCO2 28, pO2 76, HCO3 30, O2 sat 82 D. pH 7.36, pCO@ 24, pO2 55, HCO3 16, O2 sat 70 - CORRECT-ANSWERSB. pH 7.24, pCO2 54, pO2 55, HCO3 22, O2 sat 76 (pO2 < 60, pCO2 > 45) Which of the following is a complication of HTN crisis?

A. LV hypertrophy B. cerebral infarct C. aortic dissection D. LV failure - CORRECT-ANSWERSB. cerebral infarct Hemodynamic data for sepsis - CORRECT-ANSWERSPAOP <8, SVR < 800, SvO2 > 75% A victim of motor vehicle crash is admitted with an acute intracranial bleed. The patient has hypotension and tachycardia. These findings are most likely result of A. shock from multiple trauma B. extensive bleeding into intracranial vault C. neuro shock D. increased ICP - CORRECT-ANSWERSA. shock from multiple trauma The primary purpose of continuous venovenous hemofiltration (CVVH) is to - CORRECT-ANSWERSoptimize fluid removal One month after VP shunt placement, a patient is admitted with the IUC with positive Kernig's sign and positive Brudzinski's sign. These signs indicate - CORRECT-ANSWERSa CNS infection aka meningitis A patient is admitted with chest pain and nausea. The ECG shows new deep Q waves in leads I, aVL, and V5-V6. The patient ECG pattern is most consistent with a diagnosis of - CORRECT-ANSWERSlateral wall MI Which of the following is a normal compensatory response to a decrease in CO? A. increased O2 delivery B. decreased O2 consumption C. increased O2 extraction D. decrease serum lactate - CORRECT-ANSWERSC. increased O2 extraction Primary pharm management of the patient with sepsis inlcudes admin of - CORRECT-ANSWERSantibiotics Which of the following is most likely a complication of GBS? A. acute resp faiure B. acute pulmonary edema C. acute lung injury D. acute pulmonary fibrosis - CORRECT-ANSWERSA. acute resp faiure

A patient in hyperosolar hyperglycemic state (HHS) is being admitted with dehydration and a serum glucose level of 836 mg/dL. Which of the following additional laboratory findings should the nurse anticipate? A. decreased BUN, decreased creatinine, and elevated serum osmolality B. decreased BUN, decreased creatinine and decreased serum osmolality C. decreased BUN, elevated creatinine and decreased serum osmolality D. elevated BUN, elevated creatinine and elevated serum osmolality - CORRECT-ANSWERSD. elevated BUN, elevated creatinine and elevated serum osmolality Serum osmolality > 320 mOsm/kg distinguishes HHS from DKA On the fifth day post-admission, a patient with Q waves in V1, V2, and V develops hypotension, tachycardia, and a pan-systolic murmur that is loudest at the lower left sternal border. This patient most likely developed A. idiopathic hypertrophic cardiomyopathy B. inferior wall infarction C. cardiac tamponade D. a ruptured inter-ventricular septum - CORRECT-ANSWERSD. a ruptured inter-ventricular septum (septal wall MI) A patient with a history of chronic pain, asthma, diabetes, and heavy alcohol intake is now experiencing cognitive impairment from medications. Assessment: awake but confused, BP 155/82, HR 84, RR 16 and SpO2 95% on RA. This patient is at high risk for A. Intubation B. needing long-term psychiatric care C. attempting suicide D. over-sedation by staff - CORRECT-ANSWERSC. attempting suicide (chronic medical illness, heavy alcohol intake, and chronic pain) Which of the following 12-lead ECG changes should be expected in a patient with acute coronary syndrome involving the inferior wall? A. ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL B. ST segment elevation in leads II, III, and all precordial leads C. ST segment elevation and deeply inverted T waves in leads II, III, aVF D. ST segment depression and T wave elevation in leads II, III, aVL - CORRECT-ANSWERSC. ST segment elevation and deeply inverted T waves in leads II, III, aVF

The major effect of acute lung injury (ALI) on the lung tissue is A. decreased capillary permeability B. increased function residual capacity (FRC) C. decreased compliance D. decreased alveolar surface tension - CORRECT-ANSWERSC. decreased compliance (related to the alteration of lung endothelium and vascular tissue. Results in stiffness and fluid filled non-aerated airways) A patient with mitral regurgitation suddenly develops atrial fibrillation with a rate of 156. BP is 118/74. The nurse should anticipate medication orders for A. beta-blockers and vasopressors B. warfarin (Coumadin) and alpha-agonists C. beta-agonists and calcium-channel blockers D. cardiac glycosides and calcium channel blockers - CORRECT-ANSWERSD. cardiac glycosides (digoxin) and calcium channel blockers Which of the following pulmonary artery catheter findings would be anticipated in a patient with chronic emphysema? A. increased CVP B. decreased CI C. increased SV D. decreased PAOP - CORRECT-ANSWERSA. increased CVP (emphysema can cause cor pulmonale secondary to increased pressure) A patient is admitted complaining of chest pain and nausea. The ECG monitor reveals secondary AV block, Type II. These findings are probably a result of occlusion of which of the following coronary arteries? A. left anterior descending B. left circumflex C. posterior descending D. right - CORRECT-ANSWERSA. left anterior descending (LAD supplies blood to the septum) A patient has heart failure secondary to ischemic cardiomyopathy and end- stage coronary artery disease. Which of the following agents would be most beneficial A. digoxin and diltiazem B. carvedilol and lisinopril C. veramapril and spironolactone D. flecainide and hydralazine - CORRECT-ANSWERSB. carvedilol and lisinopril (decreases after-load and minimizes remodeling that is associated with HF)

When providing care to a patient with status epilepticus, the nurse should recognize that usually A. it is a state of continuous seizures lasting more than two minutes B. the patient comes out of the post ictal state between seizures C. it results from abrupt discontinuation of anti-seizure meds D. the cause of death is due to cerebral hemorrhage - CORRECT-ANSWERSC. it results from abrupt discontinuation of anti-seizure meds A patient with a history of angina is admitted to the units after surgical repair of an AAA. The patient is receiving a sodium nitroprusside (Nipride) gtt for severe postop hypertension. Twelve hours later, the pattient complains of back pain. BP 80/ HR 120 UO 20 mL/hr +1 left and right dorsalis pedis pulse A. Admin of NS 200 ml/hr and prepare for doppler studies B. spiral chest CT and emergent pericardiocentesis C. procedural sedation and IABP insertion D. discontinuation of Nipride and prepare for surgery - CORRECT-ANSWERSD. discontinuation of Nipride and prepare for surgery (because the patient is hypotensive-DUH! w/ s/s of postop bleeding and hypovolemic shock) A patient with head trauma is experiencing increased ICP. The ideal level at which to maintain arterial pCO A. below 20 B. between 35 and 45 C. between 25 and 30 D. above 45 - CORRECT-ANSWERSB. between 35 and 45 (normocapnia is essential for maintaining stable intracranial pressure, because CO2 directly affects the degree of vasodilation in cerebral blood vessels) Which of the following is an endpoint of volume resuscitation? A. CVP 3 mm Hg B. CI 2.4 L/min/m C. oxygen consumption 250 ml/min D. BE 4 mmol/L - CORRECT-ANSWERSC. oxygen consumption 250 ml/min (the amount of oxygen used by the body) Which of the following life-threatening dysrhythmias is most frequently associated with HF? A. bigeminy PACs

B. ventricular tachycardia C. second-degree AV Block Type II (anterior wall MI) D. junctional tachycardia (digoxin toxicity) - CORRECT-ANSWERSB. ventricular tachycardia (Low Ef leads to stretch and excitability of ventricles. Can lead to electrolyte shifts from diuretic therapy which can exacerbate VTACH) Which of the following hemodynamic profiles is most consistent with distributive shock? A. BP 88/45, CI 1.5, CVP 15, PAOP 24, SVR 1200, svO2 47% B. BP 85/40, CI 2.0, CVP 12, PAOP 20, SVR 1445, svO2 50% C. BP 84/42, CI 2.5, CVP 3, PAOP 8, SVR 475, svO2 52% D. BP 75/50, CI 2.5, CVP 8, PAOP 8, SVR 1500, svO2 68% - CORRECT- ANSWERSC. BP 84/42, CI 2.5, CVP 3, PAOP 8, SVR 475, svO2 52% (in distributive shock types: anaphylactic or neurogenic there is a decrease in venous return causing a low CVP. Loss of vessel tone results in decreased SVR) Which of the following is an advantage of pressure support ventilation? A. decreased work of breathing B. decreased inspiratory flow C. decreased muscular endurance D. decreased fiO2. - CORRECT-ANSWERSA. decreased work of breathing (assists spontaneous breathing efforts by delivering a high flow of gas early in inspiration and maintaining the level through the inspiratory phase) A patient with a four-year history of type 1 diabetes is admitted with influenza. The patient is lethargic, responds to name and follows simple commands. Skin is dry, with poor turgor. Which of the follow is the most likely cause of the patient's condition? A. hyponatremia B. hypoglycemia C. ketosis D. hypovolemia - CORRECT-ANSWERSD. hypovolemia A patient is admitted after a PCI to the RCA. four hours later, the patient complains of flank pain, and vital sings are: BP 84/50, HR 120, RR 32 A. PE B. retroperitoneal bleed C. coronary artery dissection

D. restenosis of the RCA - CORRECT-ANSWERSB. retroperitoneal bleed (caused by an arterial tear with bleeding int the flank area) The most important indicator to be used in monitoring respiratory status of a patient with Guillain Barre syndrome is A. vital capacity B. O2 sat C. negative inspiratory force D. A-a gradient (degree of shunt) - CORRECT-ANSWERSA. vital capacity A patient is admitted complaining of crushing chest pain, which began two hours ago. An ECG shows ST elevation in leads V2-V4, which is treated with a PCI procedure to the LAD. Post procedure the patient develops oliguria and bilateral, diffuse crackles. Which of the following hemodynamic findings should be expected at the point? A. CO 3.8, BP 80/50, SVR 2200, PAP 40/ B. CO 5.0, BP 86/50, SVR 1000, PAP 30/ C. CO 2.9, BP 85/56, SVR 660, PAP 20/ D. CO 6.8, BP 90/60, SVR 500, PAP 18/4 - CORRECT-ANSWERSA. CO 3.8, BP 80/50, SVR 2200, PAP 40/24 (anterior infarction predisposes him to develop LV failure and cardiogenic shock) Which of the following is a major complication following spinal cord injury surgery involving the area below the thoracolumbar junction? A. infection B. autoimmune dysfunction C. spinal shock D. thermoregulation - CORRECT-ANSWERSA. infection A patient with an acute myocardial infarction (AMI) is in critical condition. His significant other has been at the bedside providing reassurance and support since his admission. His estranged wife arrives and demands that the significant other not be allowed to visit or be given condition updates. The nurse should A. ask the physician to write an order to allow the significant other to have visitation privileges B. request multidisciplinary care conference to discuss visitation and communication of patient status C. contract the hospital's medical-legal department and request that the hospital attorney speak to the wife D. encourage the patient to speak with his wife regarding his desire to spend time with his significant other - CORRECT-ANSWERSB. request

multidisciplinary care conference to discuss visitation and communication of patient status A post-abdominal surgery patient has immediate change in LOC and is hypotensive and tachycardic. Which of the following lab results indicate an upper GI bleed in this patient? A. metabolic alkalosis and decreased prothrombin time B. elevated PTT and decreased BUN:creatinine ratio C. decreased WBC and elevated PLT count D. elevated serum sodium and BUN - CORRECT-ANSWERSD. elevated serum sodium and BUN (hyponatremia is due to loss of fluid through emesis. elevated BUN reflects a large protein load from the breakdown of blood) Following ACS affecting the anterior wall, a patient develops SOB. Assessment reveals moist bibasilar crackles and a moderately loud S3. A pulmonary artery catheter is inserted, and a PAOP of 22 mm Hg is obtained. These findings are most indicative of A. impending cardiac tamponade B. jugular vein distention (associated w/ right-sided failure an inferior wall MI) C. tricuspid valve dysfunction D. left ventricular decompensation - CORRECT-ANSWERSD. left ventricular decompensation (associated with anterior wall MI) Following his hip replacement surgery, an elderly patient with a history of diabetes, hepatic insufficiency and alcohol abuse has a post op course complicated by the development of a Staph infection at the surgical site. Which of the following interventions has the high priority? A. place the patient on struct isolation B. anticipate to return to the OR for exploration excisions C. apple negative-pressure wound therapy D. prepare the patient for wound closure - CORRECT-ANSWERSB. anticipate to return to the OR for exploration excisions (patient has risk factors and signs of necrotizing fasciitis) A patient with a history of ischemic cardiomyopathy is admitted with a BP of 102/74, HR 122 with occasional irregular heartbeats, RR 42, productive cough with frothy sputum and pitting edema in lower extremities. The patient is anxious, restless and SOB. The patient's primary problem is most likely A. pulmonary edema B. pulmonary embolism C. acute coronary syndrome (associated with ST elevation)

D. acute papillary muscle rupture (associated with early onset of acute coronary syndrome- regurgitant murmur) - CORRECT-ANSWERSA. pulmonary edema (tachypnea, dyspnea, frothy sputum) Two weeks following an AMI, a patient is readmitted with an elevated WBC count, fever, fatigue and sharp chest pain thats relieved when leaning forward. The patient dyspneic on exertion, but bilateral breath sounds are clear. Findings are most likely due to A. pericarditis B. pulmonary hypertension C. pneumonia D. left-to-right shunt - CORRECT-ANSWERSA. pericarditis (chest pain is relieved by leaning forward that can occur weeks-months after AMI and may be due to an inflammatory process) A patient is confused about time and place, despite frequent reorientation. For the patient's safety, the nurse should initially A. put a vest restraint on the patient B. ask a family member to stay with the patient C. administer mild sedative D. increase the frequent of observation of the patient - CORRECT- ANSWERSD. increase the frequent of observation of the patient Which of the following is true regarding thoracic aortic aneurysms? A. minimally invasive endovascular repair is preferred for ascending aortic aneurysms B. aneurysms are typically symptomatic and identified palpation C. surgical repair is indicated if the aneurysm diameter is 5.5 cm or more D. major risk factors for rupture include cardiac tamponade and acute MI - CORRECT-ANSWERSC. surgical repair is indicated if the aneurysm diameter is 5.5 cm or more A patient is admitted after sustaining fractures of the pelvis and the left femur in a motor vehicle crash. Vital sings are BP 90/60, HR 120, RR 28. The next day the patient is oliguric, and a 2 kg weight increase is noted. Bilateral crackles are auscultated. The follow values are obtained: BP 200/ HR 124 RR 30 BUN 100 mg/dL (elevated) Cr 2.3 mg/dL (elevated) K 6 mEq/L (elevated)

Which of the following should the nurse suspect? A. HTN Crisis B. R. sided HF C. Fat embolism D. Acute Renal Failure - CORRECT-ANSWERSD. Acute Renal Failure In a patient with acute lung injury (ALI), which of the following contribute to the development of atelectasis? A. decreased pulmonary vascular resistance and hypoxemia B. increased pulmonary compliance and hypoxemia C. loss of surfactant and interstitial fluid accumulation D. mucosal edema nad mucous plugging - CORRECT-ANSWERSC. loss of surfactant and interstitial fluid accumulation (caused by alteration of lung endothelium and vascular tissue which increases lung edema to decrease in lung compliance) A patient involved in a motor vehicle pedestrian collision sustained a pelvic fracture with open injury. The patient is hemodynamically stable, and there is no indication of internal organ damage. Which of the following has the highest priority? A. application of pelvic binder and external fixator B. surgical repair of pelvis C. initiation of antibiotic prophylaxis and tetanus booster D. admin of fluid and blood/blood products - CORRECT-ANSWERSD. admin of fluid and blood/blood products The daughter of a mechanically ventilated patient is to learn how to suction. When developing a teaching plan, the nurse must first A. obtain written information about the procedure B. determine a schedule for demonstrating the technique C. assess the knowledge and skills the daughter needs to learn D. encourage the daughter to observe the procedure on other patients - CORRECT-ANSWERSC. assess the knowledge and skills the daughter needs to learn Which of the following is an anticipated finding of a patient with status asthmaticus? A. decrease pCO2 (usually elevated) B. dehydration C. bradycardia (usually tachy)

D. tension pneumo (usually spontaneous pneumo) - CORRECT-ANSWERSB. dehydration (due to patient's rapid insensible fluid losses from the respiratory tract ) When teaching a family member to perform an aspect of patient care, the nurse should understand that family members A. are unaffected by timing of teaching B. learn the best if they perceive a need to learn C. learn best if shown a complex procedure all at once D. learn unrelated tasks first - CORRECT-ANSWERSB. learn the best if they perceive a need to learn The nurse is caring for a patient with hyper-calcemia. For which of the following imbalances should the nurse observe? A. hypokalemia B. hypo-albumnemia C. hyper-magnesmia D. hyper-phosphatemia - CORRECT-ANSWERSA. hypokalemia A patient with acute lung injury (ALI) is being mechanically ventilated on these settings: FiO2 50% Rate 6 breaths/min Vt 800 mL PEEP 15 cm H The patient's PaO2 is maintained at 70. Upon suctioning the nurse observes frequent runs of ventricular bigeminy. The nurse's most appropriate action is to A. refrain from further suctioning B. obtain an order for lidocaine to be admin before suctioning C. adapt the Ambu bag with 15 cm PEEP before suctioning again D. continuing to suction PRN, and observe the dysrhythmia closely - CORRECT-ANSWERSC. adapt the Ambu bag with 15 cm PEEP before suctioning again (maintaining PEEP during suctioning with an ambu bag will help minimize hypoxemia related complications during suctioning) A patient with an anterior cerebral arterial embolism will most likely develop which of the following? A. visual loss (posterior) B. aphasia (middle) C. hemiplegia

D. motor loss (posterior) - CORRECT-ANSWERSC. hemiplegia A 1-year old who is ventilator-dependent has been hospitalized since birth. The physician has indicated that the patient will be discharged home with a tracheostomy and gastrostomy in one week. In order to determine the discharge needs of the patient, the nurse should arrange for A. home nursing care for the first few days following discharge B. a social worker to meet with the family and assess adequacy of the home environment C. an outreach educator to determine the learning needs of the family D. a multidisciplinary care conference prior to discharge - CORRECT- ANSWERSB. a social worker to meet with the family and assess adequacy of the home environment A teenager, post cardiac arrest has a new diagnosis of hypertrophic cardiomyopathy. The parents are concerned about what to do if the patient collapses again. The nurses best response should be. A. "Now that your son has been diagnosed and treated, you need not worry" B. "Would teaching your CPR help ease your anxieties?" C. "Do you know how to access the EMS system?" D. "I Will have your son's cardiologist speak with you" - CORRECT- ANSWERSB. "Would teaching your CPR help ease your anxieties?" A patient transferring out of the ICU says, "Why can't I jus t stay a few days longer? I don't feel strong enough." Which of the following is the most appropriate response? A. "There's a very sick patient who needs this bed" B. "You sound concerned about leaving the ICU." C. "Most people do just fine after transfer" D. "Your insurance limits the time you can stay in the ICU." - CORRECT- ANSWERSB. "You sound concerned about leaving the ICU." A critically ill patient has a stage III pressure ulcer involving a large amount of tissue loss and exudate. The nurse should anticipate management to include A. use of calcium alignates on the surrounding tissue B. application of a hydrofiber dressing in the wound bed C. application of a wet-to-dry dressing D. use of a topical ointment such as bacitracin - CORRECT-ANSWERSB. application of a hydrofiber dressing in the wound bed

A 15 year old with acute leukemia has undergone multiple rounds of chemo. One night, the patient tells the nurse, "I'm tired of all the chemo and I want to stop, but no one is listening to me." The nurse should A. explain that adolescent patients cannot legally make healthcare decisions B. encourage the patient to "express these feelings to your parents C. arrange for the patient to discuss the treatment plan with the physicians D. ask the patient, "Do you realize you could die if you stop chemo?" - CORRECT-ANSWERSB. encourage the patient to "express these feelings to your parents An alert patient is emergently intubated during an episode of pulmonary edema. When family members come to visit the patient, they cry out/ "talk to me, talk to me!" The nurse should tell the family that A. they must not excite the patient while visiting B. communication is not a priority at this time C. the patient is too exhausted to converse with them D. the breathing tube temporarily prevents the patient from speaking - CORRECT-ANSWERSD. the breathing tube temporarily prevents the patient from speaking To promote effective grieving in a 6 year old sibling following the death of a neonate the nurse should A. recommend that the sibiling not attend the baby's memorial service B. encourage the parents to minimize their expression of grief when with the sibiling C. explain to the sibling that the baby went ot heaven D. explain to the sibling that thoughts and wises did not cause the baby's death - CORRECT-ANSWERSD. explain to the sibling that thoughts and wises did not cause the baby's death A patient's family expresses anxiety regarding the meaning of numbers on the patient's monitor and asks the nurse for clarification. The nurse's most appropriate response would be A. "The numbers indicate when the patient is having problems." B. The numbers help us determine the best treatment" C. "Which numbers on the monitor concern you?" D. "What don't you understand about the monitor?" - CORRECT-ANSWERSC. "Which numbers on the monitor concern you?" A hospital's current policy states that medication drips should be changed within 24 hrs after surgery. Nurses not that many postoperative cardiac

patients develop blood pressure instability after inotrope syringes are changed. The best approach to solving this problem is to A. notify the physician of patient's blood pressure instability B. disregard the policy and wait for syringes to empty C. bring the issue to the attention of the nurse manager and offer to form a committee to examine the problem D. give a bolus of inotrope prior to changing a drip - CORRECT-ANSWERSC. bring the issue to the attention of the nurse manager and offer to form a committee to examine the problem A patient who is stable after an AMI is to be transferred. The patient's spouse says, "I don't want my spouse moved; it's too soon." Discussing with the patient and spouse should focus on A. improvements in the patient's condition B. reviewing acuity of the other patients C. the spouse's ability to act as a caregiver D. the contrasting staffing ratios of the units - CORRECT-ANSWERSA. improvements in the patient's condition A patient with end-stage liver failure secondary to hepatitis C virus has been declared brain dead. The parents decide to discontinue feedings and donate their daughter's organs. In response to the parents; request, the most appropriate action by the nurse would be to A. contact the organ procurement agency B. convene a multidisciplinary care conference C. discuss that their daughters' condition D. discontinue feedings per the parents' request - CORRECT-ANSWERSA. contact the organ procurement agency A major trauma victim is transported from a rural hospital. The patient died prior to the wife's arrival to the unit. The nurse should best prepare for the wife's arrival by A. arranging for a physician to speak with her when she enters the unit B. Planning to escort her to the waiting room to await the physician's arrival C. preparing to give her information about the care her husband received prior to death D. planning to escort her to the morgue to see her husband - CORRECT- ANSWERSC. preparing to give her information about the care her husband received prior to death

A patient has been waiting two months for a heart transplant. A family member angrily tells the nurse, "This is hopeless!" The nurse's actions should be based on the knowledge that A. expressions of frustration are normal and usually require no nursing intervention B. because expressions of hopelessness may be harmful to the patient, the family member should be encouraged to keep these statement out of the patient care area C. maintaining the integrity of the family system is crucial in the transplant process D. encouraging discussion of the negative emotions can impede their resolution - CORRECT-ANSWERSC. maintaining the integrity of the family system is crucial in the transplant process Which of the following may cause development of fixed pupils? A. hyperoxia (O2 toxicity) B. opiates (cause pinpoint pupils, but they are not fixed) C. hypothermia D. oculomotor damage - CORRECT-ANSWERSC. hypothermia Respiratory therapists, physical therapists, occupational therapists, and nurses are all responsible for discharge teaching, with each discipline currently documenting on its own flow sheet. The best way to coordinate teaching is to have A. daily care conferences to review and discuss patient teaching and the flow sheets B. each discipline distribute copies of its flow sheet to each team member C. nurses review the flow sheets of all disciplines during shift change D. all disciplines documents patient teaching on the same flowsheet - CORRECT-ANSWERSD. all disciplines documents patient teaching on the same flowsheet A patient involved in a motor vehicle crash sustained severe head trauma. her father threatens to hurt someone of the staff doesn't not save his daughter. Your best response is to A. stand at right angles to the father and say, "I can see you are upset about your daughter's condition. Can we go to the conference room and talk?" B. stand facing the father and say, "I understand why you are upset. It is very hard to lose a child." C. stand in the doorway and tell the father, "You are upsetting the other patients. You must leave the unit now until you calm down."

D. approach the father cautiously, touch his arm and say, "I can understand why you are upset. Can we go into my office and talk?" - CORRECT- ANSWERSA. stand at right angles to the father and say, "I can see you are upset about your daughter's condition. Can we go to the conference room and talk?" A patient who does not speak or understand English has just undergone an aortic valve replacement. The patient is increasingly restless and splinting the chest with both hands. An effective means of communication with this patient would be A. using a letter board B. contacting the patient's family C. touching and using gestures D. asking "yes" and "no" questions - CORRECT-ANSWERSC. touching and using gestures aka Use nonverbal communication methods A survey reveals that all of the hospital's nurses feel the routine 4 a.m. chest x-rays cause an interruption in children's sleep patterns. The best strategy for addressing this issue is to A. assemble a work group to discuss the current hospital policy B. reschedule all non-emergent 4 a.m. chest x-rays during daytime hours C. request an in-service for the radiology department about the effects of sleep deprivation in children D. send the results of the survey to the hospital administrator - CORRECT- ANSWERSA. assemble a work group to discuss the current hospital policy A nurse is caring for a patient with a T5 spinal cord injury. To facilitate the patient's safe transfer to a rehab facility, the nurse should A. ensure that the patient is functionally independent prior to transfer B. ensure the patient has bowel and bladder control C. consult with the rehab staff regarding transfer criteria D. request a psychiatric evaluation to the patient's coping skills - CORRECT- ANSWERSC. consult with the rehab staff regarding transfer criteria The most important factor in caring for a patient referred for fibrinolytic therapy for a suspected stroke is to A. begin the therapy within 60 minutes of the patient's arrival B. obtain an allergy history C. establish onset of symptoms D. start an IV line - CORRECT-ANSWERSC. establish onset of symptoms (narrow window of 3-4.5 hrs for ISCHEMIC stroke)

A nurse is interested in including other disciplines in the educational process of developmental care in the NICU. The best way to convince administration that this venture is financially worthwhile is to A. present a report summarizing research relating developmental care to decreased length of stay B. request that the neonatologist present the plan C. present case studies demonstrating favorable outcomes for developmental care D. invite members of administration to attend the classes - CORRECT- ANSWERSA. present a report summarizing research relating developmental care to decreased length of stay An acutely ill infant is born to a Vietnamese family. The father asks few questions about the infant's condition, and the mother asks none. Both parents appear to be proficient in English. Which of the following is the most useful resource for a nurse caring for this infant? A. classes conducted by the primary nurse as the need arises B. an interpreter who is proficient in the parents' language C. information about the cultural background represented in the community D. ongoing classes addressing the cultural needs of the community - CORRECT-ANSWERSB. an interpreter who is proficient in the parents' language Six members of a trauma patient's family arrive asking questions about their lived one's condition. The nurse's most appropriate initial response should be to A. ensure the chaplain is available B. include the family in patient care C. offer the family a tour of the unit D. ask the family to identify a family spokesperson - CORRECT-ANSWERSD. ask the family to identify a family spokesperson Which of the following findings is most indicative of cariogenic shock? A. SvO2 greater than 70% B. CI less than 2 L/min/m C. SVR less than 1000 dynes/sec/cm- D. MAP greater than 70 mm Hg - CORRECT-ANSWERSB. CI less than 2 L/min/m2 (CI is low due to pump failure) Which of the following is a contraindication to use of IABP counter pulsation? A. aortic valve insufficiency

B. mitral valve regurg C. ventricular aneurysm D. ventricular septal detect - CORRECT-ANSWERSA. aortic valve insufficiency (balloon inflation will only increase aortic regurgitation and offer little augmentation of coronary perfusion pressure and would worsen HF) Which of the following patients is most likely to be liberated from mechanical ventilation more quickly following a lung transplantation? A patient with A. cough reflex B. pulmonary HTN C. emphysema D. a double lung transplant - CORRECT-ANSWERSC. emphysema A patient is one day post-gastroplasty and has a sudden onset of restlessness, dyspnea and chest pain. HR is 122/min, and auscultation of heart sounds reveals an increased intensity of a pulmonary S2. These findings should lead the nurse to suspect the patient has developed A. aspiration PNA B. a spontaneous pneumothorax C. a pleural effusions D. a pulmonary embolism - CORRECT-ANSWERSD. a pulmonary embolism The rational for using dobutamine (Dobutrex) an infusion rate of 10- mcg/kg/min for cardiogenic shock is to A. decrease myocardial ischemia B. improve urinary output C. improve myocardial contraction D. decrease oxygen consumption - CORRECT-ANSWERSC. improve myocardial contraction (As a beta-1 agonist, there is expected increase in contractility and cardiac output) Which of the following sings are characteristic of diabetes insipidus? A. low urine output, low serum osmolality, hyponatremia and low urine sodium B. elevated urine output, low serum osmolality, hyponatremia and low urine sodium C. low urine output, low serum osmolality, hypernatremia and elevated urine sodium D. elevated urine output, elevated serum osmolality, hypernatremia and low urine sodium - CORRECT-ANSWERSD. elevated urine output, elevated serum osmolality, hypernatremia and low urine sodium

Procainamide is associated with - CORRECT-ANSWERSQT prolongation, which can lead to development of Torsades de Pointes In the treatment of dilated cardiomyopathy, the appropriate drug therapy should be aimed at A. increasing afterload and increasing preload B. increasing afterload and decreased preload C. decreased afterload and decreasing preload D. decreasing afterload and increasing preload - CORRECT-ANSWERSC. decreased afterload and decreasing preload Which of the following therapies is indicated for a patient with pulmonary edema and cardiogenic shock? A. alpha adrenergic drugs to increase coronary perfusion B. nitrates to decrease after load C. beta-receptor blockade agents to incase cardiac contractility D. mechanical circulatory assist devices to increase coronary perfusion - CORRECT-ANSWERSD. mechanical circulatory assist devices to increase coronary perfusion During the initial assessment of a patient with pancreatitis, a nurse notices a spasm in the patient's hand when a BP cuff is inflated. This finding reflect which of the following electrolytes disturbances? A. high serum potassium B. high serum magnesium C. low serum calcium D. low serum phosphate - CORRECT-ANSWERSC. low serum calcium (Trousseau's sign seen in acute pancreatitis) Which of the following can be an effect of positive-pressure ventilation? A. decrease in carbon dioxide B. decrease in bronchial secretions C. decrease in inspiratory pressure D. decrease in plateau pressure - CORRECT-ANSWERSA. decrease in carbon dioxide (Reps alkalosis may result from excessive mechanical ventilation) A patient with a history of heroin and alcohol abuse is admitted for treatment of cellulitis the patient has flushed, slightly moist skin and is slow to respond to verbal stimuli. The affected arm is edematous, hard to touch and has yellow exudate from skin puncture wounds. VS are: BP 88/45 HR 124

RR 26

T 102 F (38.9C)

The nurse should anticipate orders for A. antipyrectics and dopamine admin B. a CT scan of head and drug screen C. blood cultures, antibiotics, and rapid admin of IV fluids D. monitoring for signs of withdrawal, antipyretics and IV fluids with vitamins

• CORRECT-ANSWERSC. blood cultures, antibiotics, and rapid admin of IV fluids A patient who does not speak or understand English is admitted to the unit. Guidelines for using a translator may include A. having the translator ask questions that you don't feel comfortable asking B. standing next to the translator and as close to the patient as possible C. providing all of the information, then allow the translation and asking of questions D. allow time for the translator to decode the medical jargon used in the teaching - CORRECT-ANSWERSB. standing next to the translator and as close to the patient as possible A nurse has noticed an increased incidence of skin breakdown under the standard wound dressing protocol. The nurse should A. experiment with dressing wounds using a different technique B. performed a literature search to identify current trends in dressing protocols C. recommend an evaluation of the present dressing protocol D. apply an antibiotics ointment to wounds when changing the dressing - CORRECT-ANSWERSC. recommend an evaluation of the present dressing protocol A patient with receptive aphasia and dementia is to be enrolled in a clinical trial. How should the nurse proceed to ensure that informed consent is properly obtained? A. Involve the patient's legal guardian in the consent process B. Ensure that the investigator is aware of the patient's condition C. Inform the institutional review board (IRB) of the potential risk to the patient D. Obtain a copy of the consent form to place in the patient's chart - CORRECT-ANSWERSA. Involve the patient's legal guardian in the consent process

Which of the following laboratory results should be expected in a patient with severe acute pancreatitis? A. decreased serum amylase, elevated serum calcium and elevated serum glucose B. elevated serum amylase, decreased serum calcium and decreased total protein C. elevated total protein, decreased serum calcium, and decreased PT D. elevated alkaline phosphatase, elevated bilirubin and decreased serum glucose - CORRECT-ANSWERSB. elevated serum amylase, decreased serum calcium and decreased total protein A patient was admitted with hepatic failure and severe dehydration. The patient is encephalopathic. Which of the following treatments would the nurse anticipate? A. potassium replacement B. volume replacement with LR (pt w/ hepatic failure cannot breakdown lactate) C. broad spectrum IV antibiotics D. benzos (metabolized ny liver) - CORRECT-ANSWERSA. potassium replacement (seen in hepatic failure and encephalopathy) A patient is on a regiment of nitroprusside (Nipride) and nitroglycerin (Tridil). Because of the combine effects of these drugs, the nurse should be alert to the possible development of A. atrial dysrhythmia, particularly paraxoysmal atrial tachycardia B. prolonged PR interval and bundle branch block C. reduced coronary artery perfusion secondary to hypotension D. increased peripheral vascular resistance - CORRECT-ANSWERSC. reduced coronary artery perfusion secondary to hypotension (both agents are vasodilators which decreases coronary artery perfusion) A patient is admitted after a motor vehicle crash. The patient is restless with cool, clammy skin and complains of chest and back pain. Breath sounds are diminished over the L. Side. An upright chest x-ray reveals fractures of the L. fifth through seventh ribs and 25% left hemothorax BP 80/50 HR 125 RR 28 and slightly labored CVP 2 mm Hg Which of the following measures is most likely to be included in the patient's initial care?

A. immediate thoracotomy, endotracheal intubation, and dopamine B. chest tube insertion, O2, fluid bolus C. thoracentesis, D5W IV and digoxin D. pericadiocentesis, fluid bolus and O2 - CORRECT-ANSWERSB. chest tube insertion, O2, fluid bolus Abdominal distention, a tympanic percussion note and ruses of high-pitched tinking sounds that coincide with abdominal cramping indicate which of the following? A. rapid GI transit time B. intestinal obstruction C. celiac artery infarction D. superior mesenteric artery occlusion - CORRECT-ANSWERSB. intestinal obstruction Which of the following mechanisms contributes to hypotension in sepsis? A. elevated afterload B. increased cardiac contractility C. peripheral vasodilation D. decreased vascular permeability - CORRECT-ANSWERSC. peripheral vasodilation Heparin should be used in treating a patient with acute pulmonary embolus, because it A. activated plasminogen, which dissolves the embolus B. potentiates the conversion of fibrinogen to fibrin C. prevents platelet aggregation on am embolus D. reacts with plasminogen to form plasmin - CORRECT-ANSWERSC. prevents platelet aggregation on am embolus Three days after admission from the PACU, a patient becomes restless and is attempting to climb out of bed and chew the IV lines, thinking they are pasta. The nurse should assess for A. ability to carry on a coherent conversation B. overdose of med C. difficulty recalling recent events D. delirium tremens (occurs 48-86 hrs after a period of ehavy drinking) - CORRECT-ANSWERSC. prevents platelet aggregation on am embolus A patient is admitted with a subarachnoid hemorrhage. The nurse should anticipate which of the following?

A. intubation at the time of resp arrest B. admin of antibiotics to prevent PNA C. initiation of parenteral nutrition D. avoiding hypoventilation - CORRECT-ANSWERSD. avoiding hypoventilation (to minimize risk of increased intracranial pressure) Which of the following is the treatment of choice for inadequate heparin reversal? A. vitamin K B. platelets C. protamine sulfate D. aminocaproic acid (Amicar) - CORRECT-ANSWERSC. protamine sulfate Which of the following lab data are consistent with DIC? A. decreased PLT, increased fibrin split products B. decreased PTT, decreased fibrin split products C. decreased prothrombin time, increased PLT D. decreased fibrinogen, decreased PTT - CORRECT-ANSWERSA. decreased PLT, increased fibrin split products In a patient with acute tubular necrosis (ATN), which of the following sequelae should be expected? A. hypercalcemia, hypertension and acidosis B. hypokalemia, anemia and HTN C. hyperkalemia, acidosis and azotemia D. hypocalcemia, anemia and alkalosis - CORRECT-ANSWERSC. hyperkalemia, acidosis and azotemia Kehr's sign (referred pain to L. shoulder) in a patient with blunt abdominal trauma most likely indicates which of the following? A. bowel injury B. diaphragm irritation C. ruptured kidney D. ruptured bladder - CORRECT-ANSWERSB. diaphragm irritation (indicated rupture spleen or irritation of diaphragm from bile or other material in peritoneum) An elderly patient in alcohol withdrawal is hallucinating about puppies biting his toes. The nurse should A. control external noise by whispering to fellow staff members