CCRN Exam Questions and Answers for Critical Care Nursing, Exams of Nursing

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EXAM QUESTIONS AND CORRECT ANSWERS

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-A patient has acute kidney injury with fluid overload, and continuous renal replacement therapy(CRRT) has been ordered. Which of the following would indicate the need for CRRT rather than intermittent hemodialysis? Select single answer choice. A hyperkalemi a B. a MAP of 45 mmHg C acidosi s D severe hypoxemia {{Ans- Answer: B Hemodynamic instability, such as hypotension, is the indication for CRRT since it does not cause the rapid fluid shifts that are seen with intermittent hemodialysis. The remaining choices are not indications for CRRT. -Which of the following ventilator settings is most likely to decrease the work of breathing? A assist- control B pressure

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support C tidal volume D CPAP {{Ans- Answer: B Pressure support senses the beginning of the patient's spontaneous inspiration and provides a set pressure to assist the inspiratory effort. The primary purpose of the ventilator settings listed in choices (A), (C), and (D) is not to decrease the work of breathing. -A nurse is caring for a patient with an acute inferior wall MI, post coronary artery stent deployment. For optimal care of this patient, the nurse should: Select single answer choice. A administer an analgesic for acute back pain.clearYou selected. B apply a pressure dressing to the groin.clearYou did not select. C continuously monitor the patient in lead II. D maintain the patient in a supine position. {{Ans- Answer: C It is best practice to continuously monitor a patient, who is post coronary artery stent deployment, in the lead that was most abnormal during the acute occlusion. Lead II would most likely meet this criterion for a patient with an inferior wall MI. The remaining interventions are NOT indicated for a patientwho is post coronary artery stent deployment.

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-A patient with aortic regurgitation will have which of the following upon auscultation? Select single answer choice.

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A

a diastolic murmur, loudest at the fifth intercostal space, midclavicular a systolic murmur, loudest at the apex of the heart C a diastolic murmur, loudest at the second intercostal space, right sternal border

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D

a systolic murmur, loudest at the base of the heart {{Ans- Answer: C Aortic insufficiency (regurgitation) is the backflow of blood during the time when the aortic valve should be closed. The aortic valve is closed during diastole; therefore, this patient has a diastolic murmur. The aortic area of auscultation is at the base of the heart: the second intercostal space, right sternal border. -Which of the following patients, who are all receiving mechanical ventilation, is most likely a candidate for a spontaneous awakening trial? Select single answer choice. A a patient who is receiving PRN morphine B a patient who is receiving a propofol infusion C a patient who is receiving 100% oxygen and 20 cm H2O pressure of PEEP D a patient who is receiving a vecuronium (Norcuron) infusion {{Ans- Answer: B A spontaneous awakening trial should be considered for a patient who is receiving a continuous infusion of a sedating drug and/or an analgesic drug and who meets the hemodynamic criteria. A patient who is receiving a propofol infusion is a potential candidate for a spontaneous awakening trial

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as long as the hemodynamic criteria are met. A patient who is receiving PRN morphine may be a candidate for a spontaneous breathing trial, but that patient does not require an infusion to be stopped in order to be awakened. The remaining 2 choices do not meet the criteria for performing eithera spontaneous awakening trial or a spontaneous breathing trial. -While the code team is performing resuscitative efforts, many of the patient's family members start to cry and pray, while other family members lie down on the floor in the corner of the room. Which of the following demonstrates the best action forthe nurse to take at this time? Select single answer choice. A Ensure that a member of the code team serves as a family presence facilitator and clearly communicates the treatment strategies to the family. B Call security to escort the family members to the waiting room due to their disruptive behavior. C Encourage the family members to leave the patient care area because they are extremely distressed. D Ask the family members to leave the patient care area because they may suffer anxiety from remaining in the room. {{Ans- Answer: A It is important to offer families the opportunity to witness the efforts of the health care team during a patient's cardiopulmonary resuscitation. Research suggests that allowing family members to stay with a patient during this time may decrease their rates of post- traumatic stress disorder, depression, and anxiety related to the event. If the family interferes with the code team's ability to provide care to the patient, it may be necessary to have security remove the family; however, this scenario does not state that the family

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members are interfering with the code team's efforts, so choice (B) is incorrect. The remaining 2 choices do not allow the family to grieve in a way that may be natural to them. -Cardiogenic shock secondary to left ventricular failure will generally result in: Select single answer choice. A decreased afterload. B a narrow pulse pressure. C decreased preload. D a widening pulse pressure. {{Ans- Answer: B

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The systolic pressure decreases due to a drop in the cardiac output; however, the diastolic pressure either stays the same or increases due to a compensatory increase in the systemic vascular resistance. The remaining choices are not found in the presence of cardiogenic shock. -Massive atelectasis occurs in the presence of acute respiratory distress syndrome (ARDS). What are the 2 causes of the atelectasis that is typical of ARDS? Select single answer choice. A a surfactant deficiency and pulmonary edema B increased pulmonary vascular resistance and increased pulmonary compliance C increased pulmonary compliance and pulmonary edema D mucus plugs and bronchospasm {{Ans- Answer: A ARDS destroys Type II alveolar cells, which results in decreased surfactant production. ARDS also results in capillary leak at normal left-sided heart pressures, which results in pulmonary edema. Both a surfactant deficiency and pulmonary edema lead to atelectasis. The remaining choices are not correct because increasedpulmonary compliance and mucus plugs are not features of ARDS. -A patient was admitted with an acute inferior wall STEMI. The physician advises the nurse to monitor the patient for signs of right ventricular (RV) infarction. Which of the following are signs of RV infarction?

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Select single answer choice. A S4 heart sound, lung crackles B hypotension, flat neck veins C hypertension, a systolic murmur D distended neck veins, clear lungs {{Ans- Answer: D If the RV contractility decreases, the pressure that is proximal to the right ventricle (which is the right atrial pressure) increases, resulting in distended neck veins. As the right heart fails, the left heart preloaddecreases, and the lungs are clear. -Which of the following is an effect of hypothermia?

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Select single answer choice. A a decrease in the SaO2 B a decrease in the blood pressure C an increase in the heart rate D a shift of the oxyhemoglobin dissociation curve to the left {{Ans- Answer: D Hypothermia shifts the oxyhemoglobin dissociation curve to the left, which inhibits the release of oxygen from hemoglobin, thereby resulting in a higher SaO2 than usual at the same PaO2. The remaining choices are not relatedto hypothermia. -It is important for a nurse to identify the signs of respiratory depression during procedural sedation. Which of the following is a LATE sign of respiratory depression? Select single answer choice. A a cough B SpO 88% C ETCO2 of 50 mmHg per waveform capnography D sedation {{Ans- Answer: B

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A pulse oximetry decrease is a late sign of respiratory depression. A cough is not indicative of respiratory depression. An elevated ETCO2 per waveform capnography is an early sign of respiratory depression. Sedation precedes respiratory depression. -The most common cause of acute hepatic failure is: Select single answer choice. A alcohol abuse. B a salicylate overdose. C biliary obstruction. D an acetaminophen overdose.

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{{Ans- Answer: D Alcohol abuse results in chronic, not acute, hepatic failure. A salicylate overdose results in renal failure. Biliary obstruction may leadto pancreatitis or gallbladder disease. -Which of the following is most likely to lead to cardiopulmonary arrest for a patient with status asthmaticus? Select single answer choice. A bronchospasm

. B thick, tenacious secretions. C hypoxemi a. D air trapping. {{Ans- Answer: D Air trapping, due to the inability to effectively exhale, leads to chest hyperinflation, which in turn leads to decreased venous return and a precipitous drop in cardiac output. The remaining choices are seenwith status asthmaticus but are not directcauses of cardiopulmonary arrest. -The ECG demonstrates ST elevation in leads II, III, and aVF. The nurse needs to monitor the patient closely forwhich of the following? Select single answer choice. A tachycardia, lung

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crackles B sinus bradycardia, an acute systolic murmur in the fifth intercostal space, midclavicular C second-degree AV block (Type II), hypotension. D hypoxemia, an acute systolic murmur in the fifth intercostal space, left sternal border. {{Ans- Answer: B Complications that are likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA node and/or the AV node and papillary muscle rupture or dysfunction due to the anatomical distance between the right coronary artery and the papillary muscle. The remaining choices are not common complications of an inferior wall MI. -Which of the following statements about delirium is accurate? Select single answer choice.

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A

Hypoactive delirium is easier to identify than hyperactive delirium or mixed delirium. B Haloperidol is an effective treatment for delirium. C The severity of a patient's illness upon admission puts the patient at a greater risk for delirium. D Deep sedation will prevent delirium. {{Ans- Answer: C Studies have shown the severity of a patient's illness upon admission puts the patient at a greater risk for delirium during his or her time in critical care. The remaining choices are not true statements. -Which of the following is an early indication of adequate fluid resuscitation? Select single answer choice. A a decreased heart rate B a narrowing pulse pressure. C an S3 heart sound. D increased hematocrit. {{Ans- Answer: A As fluid resuscitation progresses and hypovolemia is addressed, there is less need for heart rate compensation to maintain the cardiac output. The remaining choices are not seen as evidence of adequate fluid resuscitation.

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-Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors, and antibiotic therapy? Select single answer choice. A right atrial pressure (RAP) 1 mmHg; pulmonary artery occlusion pressure (PAOP) 4 mmHg; systemic vascular resistance (SVR) 1,800 dynes/sec/cm-5; cardiacoutput (CO) 2 L/min. B right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 7 mmHg; systemic vascular resistance (SVR) 400 dynes/sec/cm-5; cardiacoutput (CO) 8 L/min. C right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 17 mmHg; systemic vascular resistance (SVR) 1,900 dynes/sec/cm-5; cardiacoutput (CO) 2 L/min. D

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right atrial pressure (RAP) 12 mmHg; pulmonary artery occlusion pressure (PAOP) 7 mmHg; systemic vascular resistance (SVR) 1400 dynes/sec/cm-5; cardiacoutput (CO) 5 L/min. {{Ans- Answer: B The hemodynamic profile described in choice (B) is typical of septic shock. The patient described in choice (B) would benefit from the interventions described in the question. The hemodynamic profile described in choice (A) is one of hypovolemia. The hemodynamic profile described in choice (C) is one of cardiogenic pulmonary edema. The hemodynamic profile described in choice (D) is one of right ventricular failure. The treatment plan described in the question would not be appropriate for the patients described in choices (A), (C), and (D). -Pulmonary hypertension may result in which of the following? Select single answer choice. A left-sided heart failure. c B right-sided heart failure. C increased lung compliance D arterial hypertension {{Ans- Answer: B The right ventricular wall is normally thinner than the left because the RV generally ejects into a low- pressure pulmonary system with a mean pulmonary artery pressure of approximately 20 mmHg. An increase in the mean pulmonary artery pressure may result in right-sided heart failure. -A patient received a transfusion for upper GI bleeding 4 hours ago. The patient developed acute tachypnea, and the pulse oximeter read 0.88 on room air. After examining the patient and getting

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a chest radiograph, the physician diagnosed the patient with transfusion-related acute lung injury (TRALI). The nurse anticipates an order for which of the following? Select single answer choice. A furosemide (Lasix). B diphenhydramine (Benadryl). C subcutaneous epinephrine. D aggressive respiratory support. {{Ans- Answer: D

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This patient requires titration of FiO2 to maintain an SpO2greater than 0.90. Short-term mechanical ventilation may be needed for select patients who are in a similar situation. There is no indication of fluid overload, which may occur with transfusion-associated circulatory overload (TACO). Therefore, a diuretic, such as furosemide (Lasix), is not needed. Diphenhydramine (Benadryl) and subcutaneous epinephrine are not treatments for TRALI. -A patient with a history of chronic alcohol abuse was admitted in a stuporous state with an extremely elevated serum alcohol level. Which of the following will most likely be a part of the treatment plan for this patient? Select single answer choice. A naloxone, activated charcoal, sodium bicarbonate B flumazenil (Romazicon), lactulose, calcium gluconate. C dialysis, cooling, potassium. D fluids, thiamine, phosphate. {{Ans- Answer: D This patient has signs of acute alcohol poisoning with a history of chronic alcohol abuse. Fluids are needed to prevent hypovolemia. Chronic alcohol abuse leads to a thiamine deficiency. Therefore, thiamine is needed to prevent Wernicke encephalopathy. Hypophosphatemia is commonly seen in patients with chronic alcohol abuse. Therefore, the administration of phosphate is also indicated. The remaining 3 choices are notinterventions for alcohol poisoning. -Which of the following is indicative of a mixed acid-base disorder? Select single answer choice.

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A

pH 7.18; PaCO2 25; PaO2 64; HCO3 11. B pH 7.33; PaCO2 29; PaO2 72; HCO3 15. C pH 7.35; PaCO2 61; PaO2 62; HCO3 41. D pH 7.25; PaCO2 36; PaO2 68; HCO3 18. {{Ans- Answer: B The decreased PaCO2 is evidence of respiratory alkalosis, and the decreased HCO3 is evidence of metabolic acidosis. A patient with sepsis or septic shock may present with this type of mixed acid-base disorder. Choice (A) is reflective of a patient who has metabolic acidosis with partial compensation.

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Choice (C) is reflective of a patient who has respiratory acidosis with full compensation. Choice (D) is reflectiveof apatient who has uncompensated metabolic acidosis. -A patient has an 18-gauge intravenous catheter in his right wrist. The nurse assessed the insertion site prior to administering an IV medication, and the nurse noticed that there was a red line up the arm above the insertion site, there was no swelling, the catheter blood return was brisk, and the site up the arm with the red line was tender to touch. Which assessment and intervention is appropriate at this time? Select single answer choice. A The patient has an extravasation; apply warm compresses over the insertion site. B The patient has a grade 2 infiltration; restart the IV, and apply cool compresses over the insertion site. C The patient has phlebitis; restart the IV with a 20-gauge catheter in the left arm. D The IV catheter is functional; give the IV medication, and reassess the catheter for blood return in an hour. {{Ans- Answer: C A red line above the insertion site, with tenderness, is a sign that the wall of the vein is inflamed, and the catheter needs to be removed. Reinsertion with a smaller gauge catheter is a strategy that can be used to prevent vein irritation. There is no evidence provided that this patient received a vesicant nor are there signs of an extravasation. Therefore, choice (A) is incorrect. The nurse's findings do not support an infiltration. Therefore, choice (B) is incorrect. The nurse should not administer the IV medication into avein withphlebitis. Therefore, choice (D) is also incorrect. -Which of the following treatments is appropriate for the corresponding

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overdose? Select single answer choice. A dialysis for a salicylate overdose B Romazicon for an opiate overdose. C a beta blocker for a cocaine overdose. D warming for a phencyclidine (PCP) overdose. {{Ans- Answer: A Dialysis may be initiated even before abnormal creatinine or GFR develop. The remaining choices are incorrect treatments forthe associated overdoses.

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-Which of the following would be LEAST likely to cause hypoglycemia for a patient with Type 1 diabetes? Select single answer choice. A late sepsis. B discontinuation of enteral feeding after a morning insulin dose. C a strenuous exercise session. D stress. {{Ans- Answer: D Stress will result in DKA rather than hypoglycemia. The remaining choices may cause hypoglycemia. -A patient with diastolic heart failure develops supraventricular tachycardia, with a heart rate of 220 beats/minute. The most dangerous hemodynamiceffect is a decrease in: Select single answer choice. A myocardial contractility. B coronary artery perfusion. c ejection fraction. D arterial oxygenation. {{Ans- Answer: B

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Diastolic heart failure results in a problem with left ventricular filling secondary to ventricular thickening, and myocardial contractility and the ejection fraction are maintained in diastolic heart failure. The rapid heart rate will decrease the filling time and worsen the left ventricular filling. Since coronary artery perfusion occurs during diastole, this arrhythmia may be life- threatening. -A 75-year-old patient develops frequent 6- to 10-second episodes of asystole, interspersed with normal sinus rhythm that is associated with hypotension. The priority intervention is: Select single answer choice. A transcutaneous pacing. B a fluid bolus. C transvenous pacing..

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D

vasopressors. {{Ans- Answer: A The rhythm described is sinus arrest. Since the patient is having serious signs and symptoms, the immediate treatment is transcutaneous pacing. Transvenous pacing may be done once the patient is stabilized. The remaining 2 choices are not indicated for sinus arrest. -A patient is receiving a heparin infusion for the treatment of a pulmonary embolism. There has been a 60% decrease in the platelet count and no clinical changes. Which of the following is indicated? Select single answer choice. A Administer vitamin K, and begin a direct thrombin inhibitor. B Discontinue heparin, and begin argatroban. C Order an enzyme-linked immunosorbent assay (ELISA), and infuse platelets. D Administer protamine sulfate, and decrease heparin. {{Ans- Answer: B This patient most likely has heparin-induced thrombocytopenia (HIT). Exposure to heparin needs to be immediately discontinued, and a direct thrombin inhibitor (such as argatroban) needs to be started for continued anticoagulation. Vitamin K does not address thrombocytopenia, so choice (A) is incorrect. The ELISA test will definitively confirm HIT, but the results generally take longer than 24 hours to return, whereas action needs to be taken immediately in this situation. Also, the administration of platelets is not indicated unless bleeding occurs or the platelet count is reduced to ~ 10,000. For those reasons, choice (C) is incorrect. Protamine

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sulfate is not useful for the treatment of HIT. Therefore, choice (D) is also incorrect. -Lab tests show urine sodium less than 20, urine osmolality greater than the serum osmolality, BUN 70, and creatinine 3.1. This is a sign of what type of renal failure? Select single answer choice. A renal hypoperfusion without tubular basement membrane involvement. B nephrotoxic acute tubular necrosis, intrarenal failure. C ischemic acute tubular necrosis, intrarenal failure. D cortical renal failure with tubular basement membrane involvement. {{Ans- Answer: A