CCRN Test Bank Questions and Answers, Exams of Nursing

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Which of the following would be the earliest auscultatory finding in left ventricular failure (LVF)? A. Crackles B. S C. Murmur of mitral regurgitation D. Pericardial friction rub - B. S LVF would be the most subtle because early changes are usually subtle changes. Choose "S3." A patient with a triple-lumen subclavian catheter has been receiving total parenteral nutrition, maintenance fluids, and antibiotics by the catheter. He has been slightly confused. Suddenly he grasps the catheter and pulls it out. He then complains of shortness of breath, and his pulse oximetry indicates an SpO2 of 84%. How should this patient be positioned? A. Head down, left side B. Head down, right side C. Head of bed elevated, left side

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D. Head of bed elevated, right side - A. Head down, left side Envision a big air bubble in the patient's heart. Think: what position would decrease the movement of the air embolism out of the right side of the heart. Chose "Head down, left side." Oxygen delivery (DO2) is the product of which of the following? A. PaO2, hemoglobin, mean arterial pressure B. SaO2, hemoglobin, cardiac output C. SvO2, cardiac index, SaO D. PaO2, mean arterial pressure, SvO2 - B. SaO2, hemoglobin, cardiac output Oxygen is delivered from the arterial end, so choose an option that has SaO

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Which of the following is the most significant complication of status asthmaticus? A. Pulmonary embolism B. Acute respiratory failure C. Hypertension D. Anaphylaxis - B. Acute respiratory failure A 22-year-old man is admitted to the critical care unit after a motor vehicle collision. The emergency department nurse reports that he was unconscious at the scene of the accident, but he is now alert and oriented. Skull films show a linear fracture of the right temporal bone. He is at significant risk for: A. scalp hematoma.

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B.

subdural hematoma. C. epidural hematoma. D. intracerebral hematoma. - C. epidural hematoma. Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and cause epidural hematoma. Patients with an epidural hematoma classically present with a short period of unconsciousness followed by a lucid interval and then rapid deterioration. An epidural hematoma is usually caused by arterial bleeding. A patient is admitted to the ICU after sustaining a concussion and blunt abdominal trauma to the right upper quadrant in a domestic dispute. The patient's vital signs are BP 145/86 mm Hg, pulse 86 beats/min, respiration 15 breaths/min, and temperature 98.8° F. The nurse is monitoring the patient's bowel sounds, abdominal tenderness, and abdominal girth frequently. Which of the following laboratory parameters is especially important for the nurse to closely monitor for bleeding in this patient?

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A.

Platelet count B. Protime C. Hematocrit D. Mean corpuscular volume - C. Hematocrit Common injuries resulting from blunt abdominal trauma can include injury to the liver, spleen, mesenteric vessels, pancreas, or kidneys. In a nonoperative approach to blunt abdominal trauma, observation and monitoring include serial hematocrits to evaluate for intra-abdominal bleeding. The platelet count does not fluctuate unless there is a disease process (e.g. cirrhosis, leukemia) or significant blood loss. Protime is a monitor of coagulation status and can be prolonged without active bleeding. Mean corpuscular volume measures the average volume or size of a single RBC and is used in classifying anemias. Which of the following is associated with chest pain, confusion, and petechiae?

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A.

Dissecting aneurysm B. Fat embolism C. Pneumothorax D. Myocardial infarction - B. Fat embolism Chest pain, confusion, and petechiae are suggestive of a fat embolism, especially within the first 48 to 72 hours after a long-bone fracture. The clincher is the petechiae. None of the other choices would cause petechiae. Which type of shock is most likely to be iatrogenic? A. Hypovolemic B.

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Cardiogenic C. Septic D. Neurogenic - C. Septic Iatrogenic means caused by treatment or diagnostic procedures or medically induced. Septic shock is the type of shock most likely to be iatrogenic. Significant contributors include immunosuppressive medications and therapies and invasive procedures. A patient had a craniotomy 2 days ago for removal of a tumor. He is awake and talking to the nurse and demonstrates no neurologic deficit. Blood pressure is 110/80 mm Hg, pulse is 92 beats/min, and respiratory rate is 22 breaths/min. Urine outputs have been approximately 60 ml/hr over the last 2 days, but he has had a recent change. He has had 300 to 400 ml/hr of urine output over the last several hours. The urine has a specific gravity of 1.002. The nurse checks his serum glucose and finds that it is 100 mg/dl. The cause of hypernatremia in this patient is:

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A.

sodium retention. B. water loss. C. water gain. D. aldosterone excess. - B. water loss This case is an example of diabetes insipidus, which is caused by a lack of antidiuretic hormone (ADH). ADH causes water retention in the renal tubules but not sodium retention, so eliminate sodium retention. A lack of ADH causes water loss not water gain, so eliminate water gain. Diabetes insipidus does not have anything to do with aldosterone. The hypernatremia is a concentration effect caused by water loss. This sometimes is called hypovolemic hypernatremia. A patient is admitted with unstable angina. He has a long history of hypertension and coronary artery disease. The nurse notes a split S2on expiration and a single S2 on inspiration during cardiac auscultation. Blood pressure is 150/88 mm Hg, and heart rate is 88 beats/min. On the electrocardiogram, there is a normal-

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appearing P wave in front of each QRS complex, the PR interval measures 0. second consistently, and the QRS complexes measure 0.14 second. They are positive in V5 and V6 and negative in V1 and V2. These findings most likely indicate which of the following? A. Left bundle branch block (LBBB) B. Right bundle branch block (RBBB) C. Third-degree atrioventricular block D. Ventricular tachycardia - A. Left bundle branch block (LBBB) Features of LBBB described here are a QRS complex greater than 0.12 second in duration and a QRS complex that is positive in leads V5 and V6 (consider these left ventricular leads) and negative in leads V1 and V2 (consider these right ventricular leads). LBBB causes a paradoxical splitting of S2. This means that it is split on expiration but not on inspiration. This is paradoxical because it is opposite of a

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normal physiologic split of S2, which is split on inspiration but not split on expiration Which of the following is not an indication for mechanical ventilation in patients with asthma? A. Respiratory alkalosis B. Cardiopulmonary arrest C. Respiratory muscle fatigue D. Hypercapnia and respiratory acidosis - A. Respiratory alkalosis Respiratory alkalosis is seen early in asthma because of hyperventilation. A patient exhibiting nystagmus, ataxia, unsteady gait, and problems with rapid, alternating movements probably has a lesion in the:

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A.

frontal lobe. B. pituitary gland. C. cerebellum. D. brainstem. - C. cerebellum The pituitary is an endocrine gland that controls release of hormones within the body, so eliminate "pituitary gland." The brainstem contains the cardiac and respiratory centers, temperature, and other basic drives, so eliminate "brainstem." The frontal lobe controls voluntary motor function and behavior, so eliminate "frontal lobe." The cerebellum controls balance and coordination. Associate bellum with ballerina, who must balance to dance. Choose "cerebellum." Which route would be preferred for the rapid administration of fluids in hypovolemic shock?

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A.

Central venous catheter B. Large-gauge, short peripheral catheter C. Needle inserted into saline lock D. Large-gauge, long peripheral catheter - B. Large-gauge, short peripheral catheter The most rapid administration of fluids is achieved through a large-gauge, short catheter. Central venous catheters are long and, if multiple-lumen, each lumen may be smaller gauge than large-gauge peripheral catheters. Large-gauge, long peripheral catheters, including peripherally inserted central catheters, would be slower than a short peripheral catheter. A patient received Humulin NPH insulin at 7 am. He was nauseated and vomiting at lunchtime and cannot tolerate PO. If this patient develops manifestations of hypoglycemia, treatment would include:

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A.

25 ml of 50% dextrose in water (D50W). B. glucagon subcutaneously. C. 4 oz of apple juice. D. 100 ml of 5% dextrose in water (D5W). - A. 25 ml of 50% dextrose in water (D50W). A volume of 25 ml of D50W would provide 12.5 g of carbohydrate and 50 calories. A patient is being treated for hypertrophic cardiomyopathy. Which of the following drugs would be contraindicated for this patient? A. Nitroprusside B. Propranolol

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C.

Verapamil D. Digoxin - D. Digoxin Remember that with hypertrophic cardiomyopathy, it is desirable to decrease contractility and afterload; it is not desirable to increase contractility or decrease preload. How would a pneumothorax appear on chest x-ray film? A. Less radiolucent than normal lung B. Less radiopaque than normal lung C. More radiopaque than normal lung D. More radiolucent than normal lung - D. More radiolucent than normal lung

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The pleura is not visible on a normal chest radiograph, but in a pneumothorax, the visceral pleura is displaced from the parietal pleura by air in the pleural space. No lung markings can be seen in this area, and it is darker than the lung. A 55-year-old man is admitted to the critical care unit with upper gastrointestinal bleeding. Endoscopy identifies esophageal varices, but bleeding continues despite sclerosing. The physician inserts a Sengstaken-Blakemore tube. The family tells you that the patient has a long history of alcohol use, drinking about one half of a fifth of Jack Daniels every day. Which of the following are early indications of alcohol withdrawal syndrome for which the nurse should monitor? A. Diaphoresis, pruritus B. Marked tachycardia, marked hypertension C. Hyperthermia, dehydration D. Delirium, hallucinations - A. Diaphoresis, pruritus

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Because the question says "early," look for the mildest symptoms. Diaphoresis, pruritus, mild tachycardia, mild hypertension, nausea, vomiting, visual disturbances, tremors, anxiety, agitation, and sleep disturbances are signs of early alcohol withdrawal syndrome. Options "Marked tachycardia, marked hypertension," "Hyperthermia, dehydration," and "Delirium, hallucinations" describe late signs. Altering the pH of the gastric secretions through the use of H2 receptor antagonists, antacids, and proton pump inhibitors contributes to which potential complication? A. Pulmonary embolism B. Pneumonia C.

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Stress ulcer D. Acid-base imbalance - B. Pneumonia Gastric colonization is likely with a gastric pH of greater than 4. Pneumonia rates of patients receiving mechanical ventilation correlate directly with increased gastric pH levels. This is one of the risks of the use of H2 receptor antagonists, antacids, and proton pump inhibitors to prevent stress ulcers in intubated patients. You have a 76-year-old patient that is on a norepinephrine gtt. You notice the patient is complaining of severe pain and that the area around her IV is becoming translucent, cool to touch, and discolored. What stage is this and what medication should you administer to prevent extravasation? A. Stage 1, phentolamine B. Stage 4, hyaluronidase C.

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Stage 4, phentolamine D. Stage 3, dexrazoxane - C. Stage 4, phentolamine The patient is experiencing Stage 4 infiltration and is on a vasopressor gtt; therefore, phentolamine is the drug of choice to counteracts the effects of infiltration/extravasation. Which of the following solutions would be most appropriate for initial fluid resuscitation of a patient with severe hypovolemia caused by several days of diarrhea and vomiting? A. An isotonic crystalloid B. A hypotonic crystalloid C. A hypertonic crystalloid D.

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A colloid - A. An isotonic crystalloid In this situation, the intravascular and the interstitial spaces would be depleted. The priority is the intravascular space, which would be replaced best with isotonic solution. Because isotonic fluids equilibrate across all spaces, the interstitial space also would be replaced. Consider: What did the patient lose? Crystalloid and electrolyte. Then ask: Which crystalloid would replace the intravascular and interstitial spaces? An isotonic crystalloid. Electrolytes would be added. A 28-year-old man is admitted with bowel perforation. His blood pressure is 92/ mm Hg, heart rate is 116 beats/min and regular, respiratory rate is 22 breaths/min and regular, and urine output has only been 20 ml since being admitted 3 hours ago. Mucous membranes are dry, and there is poor skin turgor. Based on this information, you would expect his pulmonary artery occlusive pressure to be: A. 4 mm Hg. B.

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8 mm Hg. C. 12 mm Hg. D. 16 mm Hg. - A. 4 mm Hg. This assessment reveals dehydration (hypotension, tachycardia, oliguria, dry mucous membranes, and poor skin turgor). A pulmonary artery occlusive pressure (PAOP) of 4 mm Hg would correlate with the physical assessment. Normal PAOP is 12 to 15 mm Hg. Clinical indications of dehydration are present in the case study. Choose the value below normal. Choose 4 mm Hg. A patient with acute kidney injury has the following arterial blood gas results: pH7.32Paco235 mm HgHCO318 mEq/L This acid-base imbalance is the result of the inability of the kidney to:

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A.

excrete acid by-products of metabolism. B. excrete carbon dioxide. C. excrete bicarbonate ions. D. excrete calcium ions. - A. excrete acid by-products of metabolism. The patient has a metabolic acidosis because the kidneys are unable to excrete the acid by-products of cellular metabolism. A 42-year-old woman is admitted with myasthenic crisis after a viral illness. Which of the following are characteristics of myasthenia gravis? A. It causes muscle weakness and fatigability. B. It is associated with demyelination of peripheral nerve fibers.

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C.

It affects the nerve roots. D. It may result in adrenergic crisis. - A. It causes muscle weakness and fatigability. Myasthenia gravis is a disorder of voluntary muscles caused by a defect in nerve impulse transmission at the neuromuscular junction. It causes muscle weakness and fatigability. A 42-year-old man is admitted to the critical care unit with smoke inhalation and acute respiratory distress syndrome (ARDS). He is intubated, and the following mechanical ventilation is initiated: fraction of inspired oxygen, 0.6; intermittent mandatory ventilation, 10 breaths/min; tidal volume, 450 ml; positive end- expiratory pressure (PEEP), 15 cm H2O. Arterial blood gases are pH, 7.39; PaCO2, 42 mm Hg; HCO3, 24 mEq/L; and PaO2, 70 mm Hg. The purpose of using PEEP in the treatment of this patient is which of the following? A. Increase pulmonary compliance. B.

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Decrease the chance of barotrauma. C. Increase alveolar surface tension. D. Decrease intrapulmonary shunt. - D. Decrease intrapulmonary shunt. PEEP has three primary purposes: to increase the driving pressure of oxygen, to decrease surface tension and the work of breathing, and to decrease shunt by reopening collapsed alveoli. In ARDS, the purpose of PEEP is to open alveoli that have collapsed (called alveolar recruitment) and to keep alveoli open that are still open. The effect of this action is to decrease intrapulmonary shunt. Which ventilator mode requires close monitoring for auto-PEEP (positive end- expiratory pressure)? A. Intermittent mandatory ventilation B. Pressure support ventilation

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C.

Pressure-controlled inverse ratio ventilation D. Pressure-regulated, volume-controlled ventilation - C. Pressure-controlled inverse ratio ventilation Pressure-controlled inverse ratio ventilation, which flips the normal 2:1 inspiration/expiration ratio to make inspiration longer than expiration, allows trapping of air in the lungs. This inadvertent PEEP is called auto-PEEP. Which of the following best differentiates hypovolemic from cardiogenic shock? A. Increased systemic vascular resistance B. Decreased cardiac index C. Decreased urine output D.

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Decreased pulmonary artery occlusive pressure - D. Decreased pulmonary artery occlusive pressure The cardiac index is decreased, the systemic vascular resistance is increased, and the urine output is decreased in hypovolemic and cardiogenic shock. The pulmonary artery occlusive pressure (PAOP) is decreased in hypovolemic shock but increased in cardiogenic shock. A patient develops carpopedal spasm and neuromuscular irritability manifested by Chvostek and Trousseau signs. Which electrolyte imbalance should you suspect? A. Hyperkalemia B. Hypercalcemia C. Hypermagnesemia D. Hyperphosphatemia - D. Hyperphosphatemia