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CCRN Review Questions from Class
Which of the following types of shock is incorrectly matched with its causes? Distributive: Anaphylactic Cardiogenic: Dysrhythmia Obstructive: Adrenal Insufficiency Hemorrhage: Plasma loss - C A patient having which condition is at higher risk for developing infective endocarditis? Cystic Fibrosis Hydrocephalus Patent ductus arteriosus Bronchopulmonary dysplasia - C Which hemodynamic pressures would be increased in mitral stenosis? Right atrial and central venous pressure Left atrial and pulmonary capillary wedge Left atrial and left ventricular Systemic arterial and pulmonary capillary wedge - B Cindy is diagnosed with Kawasaki's disease. While reviewing her clinical exam, the nurse should note which of the following characteristics of this disease? Fever > 5 days, unresponsive to antibiotics Fever > 5 days, unresponsive to antibiotics, rash, oral mucosal changes Bilateral conjunctivitis Cervical lymphadenopathy - B
A child is admitted after sustaining a head injury. The most important aspect of the nurse's continuing neurological assessment is: Level of consciousness Pupillary response Motor response Assessment of the cranial nerves - A For the patient in renal failure, potential metabolic derangements include all of the following except: Metabolic acidosis Hyperkalemia Hypocalcemia Metabolic alkalosis - D Betsy, age 13 is diagnosed as having a pheochromocytoma. Appropriate initial nursing care would include: Administration of large doses of xylometazoline to help control disease symptoms Close monitoring of Betsy's vital signs, especially blood pressure Preparing Betsy and her parents for imminent death Have the parents discuss the condition with the doctor before informing Betsy of the disease because of the protracted recovery period after treatment. - B An 11 year old patient admitted to the PICU in respiratory distress. Patient is sinus tachycardia at 150 BPM with a BP of 89/50 and RR at 48. Patient is diaphoretic and is unable to speak. Patient's parents are screaming in the background "help my child"! Chest X-ray has not been developed but there are no audible breath sounds on the left chest after auscultation. ABG reads: pH: 7.3, PaCo2: 75, PaO2: 50, HCO3: 26 This ABG reflects: Respiratory acidosis with metabolic compensation Respiratory acidosis with severe hypoxemia Combined respiratory and metabolic acidosis Respiratory alkalosis with severe hypoxemia -
Which of the following is NOT a contraindication to ECMO Grade 3 IVH Irreversible disease process Septic shock LRefusal to receive blood products - C Which of the following drugs can NOT be administered via the ETT? Lidocaine Epi Vasopressin Amiodarone - D What level of EtCO2 general indicates inadequate compressions during CPR? < 5 mmHg <10 mmHg <20 mmHg <30 mmHg - B Which of the following electrolyte abnormalities is most associated with increased mortality in the setting of digoxin ingestion? Hyperkalemia Hypokalemia Hypermagnesemia Hypomagnesemia - A Simulation of the symptomatic nervous system has which effect on the cardiovascular system?
a) Decreases stroke volume and increases blood pressure b_ increases stroke volumee and decreases blood pressure c) slows conduction throug the av node d) increases stroke volume and heart rate - D (the sns simulates a fight or flight reaction ARDS is best desribed as: A) Hypoxemia, congestive heart failure, bilateral diffuse infiltrates B) Hypoxemia, elevated wedge pressure in the absence of cardiac disease and bilateral diffuse infiltrates C) Hypoxemia, hyperinflation, bilater diffuse infiltrates D) Hypoxemia, normal pulmonary wedge pressures and bilateral diffuse infiltrates - D Which of the following are not considered to be potential complication of the management of pediatric ARDS? A) Barotrauma, oxygen toxicity, secondary infections and siadh B) diminished cardiac output, air leaks, acute lung injury and pneumothorax C) Diminished cardiac output, tracheal ulceration and DI D) Oxygen toxicity, MOSF, pressure ulcers, pna - C The patient with acute respiratory distress syndrome would exhibit which of the following symptoms? A) Decreasing PaO2 levels despite increased FiO2 administration B) Elevated alveolar surfactant levels C) Increased lung compliance with increased fiO2 administration D) Respiratory acidosis associated with hyperventilation - A Intrapulmonary shunting refers to:
C) Increased cardiac output and hypertension D) Increased venous return and decreased renal perfusion - B Which of the following acid base disturbances commmonly occurs with the hyperventilation seen in acute exacerbation of asthma? A) Met Acidosis B) Met alkalosis C) Resp Acidosis D) Resp Alkalosis - D ADH has what mechanism of action? A) Causes an active retention of sodium which results in a passive retention of water B) Decreases the permeability of the glomerulus so that less filtrate is formed C) Increases the permeability of the collective ducts so that more water is reabsorbed D) Decreases sodium retention which increases urinary output - C Which of the following statements regarding DKA is true? A) An increase in urine ouptput results primarily from an increase in oral intake B) Ketoacidosis is often associated with hyponatremia and hyperkalemia C) The patient in DKA has an increase in respiratory acids (pCO2) D) The seizure threshold is increased so stimulation should be minimized - B A 10yo boy has been admitted to the intensive care unit following a head injury from a skateboarding accident. He has a urine output of 11 cc/kg/hr, a urine spec grav of 1.003, a serum osmolality of 326, and serum sodium of 163. Which of the following signs and symptoms would the critical care nurse expect to find during the assessment of this child? A) Bounding pulses, tachycardia, seizures, and cyanosis B) Stupor, hypertension, mottling of extttremities
C) Weak and thready pulse, hypotension, pale extremities D) Tachycardia, hypertension, thirst, equivocal pulses - C What would be the most immediate priority in treating this patient? A) restoration of intravascular fluid volume B) Administration of DDAVP C) Administration of anticonvulsant pharmacologic agents D) Restoration of normal serum sodium levels - A A 15yo girl develops SIADH following neurosurgery. Her serum sodium level is 128. Serum osmolality is 256, urine spec grav is 1.022, and urine output is 1 cc /kg/hr. Which of the following would be the treatment of choice? A) Fluid restriction of 50% of maintenance requirements B) Administration of 3cc/kg of 3% NaCl solution C) Lasix 3mg/kg D) Administration of hypertonic saline and diuretics - A All of the following are potential complications related to administration of stored blood except A) Hypocalcemia B) Hypokalemia C) Bleeding D) Acidosis - B A neutropenic Patient is admitted showing signs of respiratory infection. Blood and sputum cultures are obtained. the RN should anticipate: A) Starting abx immediately B) Placing pt in iso C) No intervention until a causative organism is identified
D) Consumptive coagulopathy - A Baby Girl Sami was admitted to the PICU 2 weeks ago with RSV. She was nasally intubated and mechanically ventilated soon after admission. Her respiratory status has significantly improved and she was extubated 2 days ago. She has had some minor bleeding from her naires but is otherwise doing well. 2 hours into your shift you notice that the bleeding from her nares has increased and that she has 2 large bruises on her chest and petechiae on all extremitties. The nurse notifies the critical care physician and sends off a CBC, coags, and D-Dimer. Lab findings are significant for: decreased Plt count, Pt/Ptt is normal, D-dimer is normal Based on this information you suspect that the patient may have developed which of the following? A) Disseminated Intravascular Coagulopathy (DIC) B) Thrombotic Thrombocytopenic Coagulation (TTC) C) Idiopathic Thrombocytopenia Purpura (ITP) D) Hemolytic Uremic Syndrome (HUS) - C Glomerula filtration is affected by all of the following factors. Which has the most significant effect on glomerular filtration rate? A) Osmotic pressure of the blood B) Hydrostatic pressure of the blood C) Dilation of the afferent arteriole D) Constriction of the efferent arteriole - B The kidneys help regulate acid base balance by all of the following mechanisms except: A) Reabsorption of bicarbonate ions B) Secretion of hydrogen ions C) Increased filtration of ions D) Productions of buffers - C An example of a cause of prerenal failure would be:
A) Potters Syndrome B) Hypovolemic shock C) Neurogenic Bladder D) Glomerulonephritis - B The kidneys conserve or eliminate water in the body primarily in response to levels of A) Potassium B) Antidiuretic hormone (ADH) C) Aldosterone D) Angiotensin II - B Creatinine level is a valuable iindicator of glomerular filtration rate for which reason? A) Once filtered in the glomerulus, creatinine is not reabsorbed in the tubular system B) Creatinine enters the glomerulus only when glomerular filtration pressures exceed 60 mmHg C) Creatinine filtration is unaffected by renal disease D) Creatinine is formed in the glomerulus and decreases only in filtration, causing creatinine levels to change - A During acidosis the kidneys compensate by: A) increasing bicarb excretion B) Forming ammonia C) Decreasing hydrogen ion excretion D) Decreasing urine pH - B (H+ ion excretion is buffered by phosphates and ammonia) Normal sodium is primarily regulated by: A) Aldosterone B) Antidiuretic hormone
D
A 3mo is admitted to the PICU for respiratory compromise secondary to ascites and hepatosplenomegaly. The child is on oxygen per nasal cannula and is started on aggressive diuretic therapy What is the most likely diagnosis for this infant? A) Tylenol oversode B) Biliary atresia C) Wilson's disease D) Hepatocellular carcinoma - B A 3mo is admitted to the PICU for respiratory compromise secondary to ascites and hepatosplenomegaly. The child is on oxygen per nasal cannula and is started on aggressive diuretic therapy What is the etiology of the ascites and hepatosplonmegaly? A) Portal HTN B) Hepatic Encephalopathy C) Jaundice D) Coagulopathy - A Clay colored stools may indicate A) Necrotizing enterocoliitis B) Liver disease C) Esophageal atresia D) Malrotation of the bowel - B Clay colored stools show liver or biliary tract disease. This comes from absence of bile in the stool. (Bilirubin is a major pigment in bile) The liver forms all of the following substances except:
A) Cholesterol B) Vitamin K C) Iron D) Amino Acids - C Iron is stored in the liver. Liver forms cholesterol, vitamin K, amino acids, albumin, globulins, and clotting factors Which of the following is the most common form of child maltreatment? A) Sexual abuse B) Child Neglect C) Physical Abuse D) Emotional Abuse - B Which of the following is the most important factor in regulating cerebral blood flow? A) PO B) PCO C) Acidosis D) Alkalosis - B After receiving a blow to the head, an 8yo is diagnosed with having an epidural bleed. This type of bleed is associated with: A) Arterial bleeding B) Venous Bleeding C) Bleeding into the brain tissue D) Intraventricular bleeding - A
Which of the following nursing interventions will assist in preventing increased ICP in the patient who has a head injury? A) Draining a ventriculostomy whenever the ICP rises above 15 B) Providing rest periods between interventions C) Trendelenburg position with neck in alignment D) Using aseptic technique when changing ICP dressing - B The patient who suffers a basilar skull fracture is at risk for A) Battle sign B) Meningitis C) Stroke D) Subdural hematoma - B A 21 yo male was hit on the head with a hammer. He was unconscious briefly at the scene but awake in the ED> Skull films show a linear right tempoparietal fracture. Approximately 6 hours after the injury, he complains of a headache. Additional symptoms include his right pupil being larger than his left pupil and no consensual response in the left eye. He quickly becomes unresponsive. These symptoms are likely caused by: A) Brainstem contusion B) Chronic subdural hematoma C) Epidural hematoma D) Post concussion syndrome - C CSF is formed by the: A) Choroid plexus B) Cerebral ventricles C) Arachnoid villae D) Pia mater - A
The mechanism of the development of hydrocephalus is most commonly related to A) Increased flow of CSF B) Increased reabsorption of CSF C) Obstructed flow of CSF D) Decreased production of CSF - C What is the initial independent nursing intervention that should be used to maintain cerebral perfusion? A)Mannitol/Lasix B) Maintain head midline C) Transfuse with pRBC D) Sedate with morphine sulfate - B A 1week presents with a history of poor feeding, lethargy, and rapid breathing for 1 days. Examiination reveals a sick-appearing infant whose extremities are pale and mottle.d His weight is 3kg. His vital signs are: rectal temp 33C, HR 145, RR: 48, BP: 64/40, pulses are equal in all extremities. His cap refill is 4 seconds. Multiple petechiae are noted on his trunk and extremities. His chest is clear to auscultation, his heart sounds are normal, and no abdnormality is noted on abdominal examination Pulse ox is 100%. IV access is obtained. Of the following, the most appropriate next step is: A) Endotracheal intubation B) Infusion of 60mL 0.9% saline over the next 20 mins C) Infusion of 60mL fresh frozen plasma over the next hour D) Infusion of dopamine at 5mcg/kg per minute E) Lumbar Puncture - B A 2 week old girl presents with poor feeding and rapid respirations for 1 day. Examination reveals pale, cool, and mottled extremities. Her vital signs are temp: 38, RR: 60, HR: 130, BP: 80/
B) Increased pulmonary occlusion pressure C) Decreased MAP D) Increase systemic vascular resistance - D 3 yo with eczema and asthma comes in febrile, tachycardic, hypertensive, and tachypneic. His pupils are dilated and his skin is dry and flushed. He appears agitated and his parents note that he has not been making much urine. What type of ingestion would be most consistent with this clinical presentation? A) Hallucinogen B) Serotonin Syndrome C) Sympathomimetic D) Anticholinergic - D Antidote for Acetaminophen - Mucomyst (N-acetylcystene) Antidote for Benzodiazepines - Flumazenil Examples of benzos: ativan, diazepam Antidote for Botulism - Baby Big Antidote for Beta Blockers - Glucagon Antidote for Calcium Channel Blockers - Calcium
Examples of CCB: amiodipine, nicardipine, verapimil Antidote for carbon monoxide - Hyperbaric O2, O Antidote for cyanide, Nitrites - Sodium Thiosulfate Antidote for Digoxin - Digibind Antidote for Ethylene Glycol - Ethanol Ethylene glycol is sweet and it is antifreeze Antidote for Heparin - Protamine Antidote for Iron - Deferoxamine Antidote for Lead - EDTA, BAL, DMSA Antidote for Methanol - Ethanol Antidote for Methemoglobin - Methylene Blue
