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CCRN CRITICAL CARE REGISTERED NURSE EXAM
LATEST 2025/2026 VERIFIED QUESTIONS
AND ANSWERS TEST BANK.
Normal SvO2 - correct answer>>Systemic venous oxygen saturation: 60-80% Normal VO2 (demand) - correct answer>>250 ml/min Nrsg management of a PA cath? 7 - correct answer>>-CXR to ensure placement
- pneumo
- possible vent arrhythmias during insertion
- infection
- balloon rupture
- PA rupture
- valve injury Nrsg management of art line? 4 - correct answer>>-zeroing the transducer Q8- 12
- pressurized system
- square wave test
- change pressure bag Q NRSG management of art lines 8 - correct answer>>-test patency
- keep system sterile
- assess insertion site (make sure no kinks)
- monitor values/trends
- consider pt clinical status
- document
- change bag Q
- Make sure alarms are on! If pulled out major bleeding can happen Nrsg priorities for a artificial airway 5 - correct answer>>1. Humidification
- Suctioning (only as needed)
- Communication
- Safety (#1 protecting airway)
- Comfort Nurse is caring for a pt that CVP is - 1mmHg, what tx is most helpful? - correct answer>>Administer additional IV fluids Nursing priorities with ARF II - correct answer>>1 correct hypoxemia 2 mechanical vent 3 tx underlying problem 4 turning - "good lung down" Nutritional needs for ARDS - correct answer>> 35 - 45 kcal/kg/day. Use TPN if needed P wave: what does it represent? - correct answer>>Atrial depolarization P-Q:what does it represent? - correct answer>>Atrial kick or AV node delay P-R interval: what is the normal range? - correct answer>>.12-.2 secs Patho of ARF II (increased ___ causing ___ & ____ response causing increased what?) - correct answer>>Hypoxemia causing
- Hypercapnia (headache, CNS changes, confusion, decreased LOC)
- SNS response = (Increased HR, RR, BP) PP calculation - correct answer>>PP = SBP-DBP
Tx for sinus bradycardia - correct answer>>No treatment unless symptomatic!! O2, Atropine, Pacemaker Tx goals for ARDS 7 (Tx what?, Reverse what?. Open what?, Ph?, Tv?, PCO2?, Fluids?) - correct answer>>1 treat precipitating factor 2 reverse hypoxia 3 distend alveoli --> (TV <6ml/kg & PEEP 5-20) 4 pH > 7. 6 pco2 60-100 (permissive hypercapnea) 7 don't fluid overload but maintain BP What 3 things does perfusion count on? - correct answer>>Pumping ability of heart Blood volume Size of vascular space What 3 things make up SV - correct answer>>Preload, afterload, contractility What are 4 common causes for bradycardia? - correct answer>>Acute MI, increase ICP, beta blockers, sick sinus syndrome What are colloid fluids and how do they affect osmotic pressure? - correct answer>>Blood products that increase osmotic pressure such as albumin What are crystalline fluids and how do they affect osmotic pressure? - correct answer>>IV fluids like Lactated ringers, NS etc that decrease osmotic pressure What are NIVs? - correct answer>>Non invasive vents: BiPap, CPAP/PEEP, What are normal causes of bubbling in the water seal chamber of a chest tube? (2) - correct answer>>1. Expiration
- Coughing
What are some safety concerns with NIVs? (4) - correct answer>>-Make sure to completely take off the mask when giving meds, may need to be put on a cannula
- Ensure the seal is complete
- Watch for nasal pressure ulcers
- make sure to perform mouth care because they get dry real quick What are the 2 reasons that a ETT cuff would be deflated? - correct answer>>1. Reposition
- Suction on top of cuff What are the 3 major components of oxygen supply/delivery? (SvO2) - correct answer>>CO SaO Hgb What are the 3 resistances to blood flow? - correct answer>>Diameter of vessels Viscosity of blood Elastic recoil of vessels What are the 4 most common unstable hemodynamic symptoms? - correct answer>>1. LOC 2. Hypotension
- Chest pain
- SOB What are the interventions for decreased contractility and what are the medications to treat it? - correct answer>>Positive inotropes Dobutamine & Dopamine
- Silent unit - Neither perfusion or ventilation What body chemicals decrease the heart rate? - correct answer>>parasympathetic acetylcholine What body chemicals increase the heart rate? - correct answer>>Sympathetic epi/norepi What causes decreased contractility? 4 - correct answer>>Decreased SV, LVEF, CO, CI What causes the dicrotic notch in PA cath waveforms as opposed to normal arterial waveforms? - correct answer>>PA; closing of tricuspid vavle OTher art lines: pulm/aortic What decreases Hgb? (2) - correct answer>>Anemia Hemorrhage What do our bodies tolerate better, acidosis or alkalosis - correct answer>>Acidosis What do you do after setting up a vent or changing the settings? - correct answer>>Assess ABGs again to ensure the settings are adequate What do you do when the doc orders a water seal order? - correct answer>>Disconnect wall suction from the pleurovac unit. Observe pt for deterioration in respiratory status while on water seal only What do you monitor in the water seal chamber? - correct answer>>that the water is filled to the 2cm water line What does asynchronis mean? - correct answer>>Pt is fighting the vent What does the absence of tidaling indicate for a pt with a chest tube? (2) - correct answer>>1. Lung has re-expanded
- Obstruction in the system (check for any kinks in the tube)
What does the distal port on a PA catheter do - correct answer>>Distal (yellow, PA pressure or L side preload pressure gotten through a balloon): Always connected to pressure flush system and transducer. No fluid or meds What does the proximal port on a PA catheter do? - correct answer>>-Proximal (BLUE think veins), measures CVP or R side preload pressure): can be given a bolus to measure CO. Can give fluids and meds What generates electrical impulses spontaneously & generate an action potential with pacemaker heart cells? - correct answer>>Automaticity What happens during diastole and what two valves are open? - correct answer>>Atriums fill w/ blood Mitral & tricuspid What happens during systole and what two valves are open? - correct answer>>Ventricles contract & empty contents Pulmonic & aortic What happens if the tissues are not receiving adequate oxygen? - correct answer>>Cells switch to anaerobic metabolism and produce lactic acid What happens if you over inflate a ETT cuff - correct answer>>Possible esophagotracheal fistula What is a bite block? - correct answer>>Prevents pt from biting down on the tube What is a CVP and how can you assess it with a central line? - correct answer>>Central venous pressure, directly monitors pressure of superior vena cava. Can be assessed by attaching monitor to brown port on triple lumen central line
RR/TV
What is a sub-glottic suction? - correct answer>>A special tube that has the ability to suction secretions that lay on top of the inflated cuff What is a swan-ganz catheter and what does it measure? - correct answer>>Pulmonary artery catheter Can measure both R & L sided heart pressures What is a tidal volume and the normal levels? - correct answer>>The normal breath that you breath in & out. 6 - 8ml/kg (leaning more towards 6) What is afterload? - correct answer>>Resistance against which the ventricle must work to pump blood What is an abnormal cause of bubbling the water seal chamber of a chest tube and what is the nursing priorities to do if found? - correct answer>>- Air leak - Clamp tube closest to insertion site (no more than 10 secs) & continue clamping down the tube until bubbling stops.
- Where the bubbling stops when clammed shows where the air leak might be.
- Call the doctor What is an arterial line? - correct answer>>Direct monitoring of pressure in an artery. "Gold standard" for BP monitoring. Also used for ABG's What is an early sign of decreased preload? - correct answer>>increased HR What is an example of colloid fluids? - correct answer>>Albumin What is an high frequency (jet) ventilator? - correct answer>>Not commonly used with adults - more common is pediatrics. Produces a high respiratory rate (40-70) and doesn't stretch the lungs.
What is an pressure-cycled ventilators? - correct answer>>Controls pressure in lungs and used as an alternative if volume-cycled ventilators don't work What is an volume-cycled ventilator? - correct answer>>It is volume driven with pressure limits. A set tidal volume is determined by pts size to what each breath will be. What is ARDS - correct answer>>Acute respiratory distress syndrome, severe ARF that follows a precipitating event that damages the alveoli capillary membrane & causes decreased diffusion What is ARDS characterized by - correct answer>>Refractive hypoxemia What is ARF - correct answer>>Acute respiratory failure, the inability of cardiopulmonary system to provide adequate oxygenation & or carbon dioxide removal to meet tissue metabolic needs What is ARF type II? - correct answer>>Decreased ventilation characterized by increased CO2 levels and preservation of O What is cardiac output - correct answer>>Volume of blood ejected from left ventricle over 1 min What is contractility and what electrolyte is it most influenced by? - correct answer>>Contractile force or inotropy of the heart, independent of preload/afterload. Calcium What is CPAP? - correct answer>>Constant airway pressure. PS + PEEP = CPAP (inspiration & expiration) no Vt or rate, just PEEP/PS. Pt takes own breaths What is DO2 and what are the two crucial components of it? - correct answer>>Oxygen delivery to the tissues
What is PP and what does it reflect? - correct answer>>Pulse pressure, reflects perfusion pressure, SV and arterial compliance What is preload? - correct answer>>Wall tension created by volume in ventricle at end of diastole (RVEDV, LVEDV) What is pressure support (PS)? - correct answer>>Inspiratory pressure at beginning of spontaneous inspiration. Helps decrease WOB & increase spontaneous tidal volumes What is refractive hypoxemia - correct answer>>Low oxygenation despite high FiO2 levels What is stroke volume? - correct answer>>Volume of blood ejected from left ventricle each contraction What is SvO2? What balance does it reflect? - correct answer>>Mixed venous oxygen saturation. Amount of O2 that returns to the R side of the heart after O2 delivered to tissues (250 to tissues & 750 to R heart) Reflects balance btw O2 supply (DO2) vs O2 demand (VO2) What is the A/C mode? - correct answer>>Assist controlled mode(most common), all breaths are given by vent, not pt. However, pt can trigger additional breaths but will always get the set rate What is the antidote for an infiltrated or extravasated vasoconstrictor and what is the route? - correct answer>>phentolamine/rigitine SQ What is the best mode for ARDS - correct answer>>Pressure controlled is the best for hemodynamics stability What is the best way to determine if a pt needs suctioned ?, what bs would you hear? - correct answer>>Auscultate upper airways for coarse Rhonci What
is the calculation for LVEF - correct answer>>SV/EDV (end diastolic volume) What is the function of alpha 1 agents? - correct answer>>Vasoconstriction of arteries Increasing afterload What is the function of Beta 1 agents? - correct answer>>Increase contractility of heart What is the function of Beta 2 agents? - correct answer>>Bronchodilation of lungs What is the function of dopaminergic agents? - correct answer>>-Increases perfusion to renal & abdominal visceral
- Can cause vasodilation/vasoconstriction/increased contractility based on dose and place What is the main function of the capillaries? - correct answer>>Exchange btw gas, nutrients, and waste in our vascular systems What is the minimum occlusive volume? - correct answer>>Smallest amount of air in cuff to get occlusive seal What is the most accurate place for art lines? - correct answer>>Radial artery Femoral artery (increased risk for infections) What is the natural pacemaker of the heart called and what is its intrinsic rate? - correct answer>>SA node 60 - 100bpm What is the normal size of a chest tube? - correct answer>>14 french What is the normal value for PAWP/PAOP? - correct answer>>Pulmonary artery Wedge/occlusion pressure 5-12mmHg
What is tidaling in the chest tube? - correct answer>>When the fluid level in the water seal chamber fluctuates during respiration. This normal to see and indicates an open system between the chest and pleurovac. What is tubal compensation? - correct answer>>Used as a weaning trial. The minimum amount of support while on vent & is taking over resistance of tube. (Larger tube = less airway resistance=vent adjusts) What lung sounds/assessment findings would you look for ARF type II, for COPD and nonCOPD - correct answer>>COPD: distant wheezes and crackles Non-COPD: head trauma, OD, PE What pH is lethal? - correct answer>><6.8 and >7. What pH requires aggressive management? - correct answer>><7.2 and >7. What setting do you start at the PS? - correct answer>>Start at 10 and increase by 5 to 10 What setting do you start at with PEEP? - correct answer>>Start with 5 and increase in increments of 2.5 to 5 What should always be done before initially using any central line? - correct answer>>Verify its placement with a chest xray What should the HOB be at with an artificial airway? - correct answer>>At least 30 degrees What should you do after chest tube insertion? (7) - correct answer>>CXR, monitor vitals Q1 hour (watch for decrease BP & increase HR & RR), listen to lungs, cough and deep breath Q2hrs, access pain, check dressing for bleeding/crepitus, check drainage of chest tube Q1hr
What should you do before chest tube insertion? (5) - correct answer>>Explain procedure, pt. consent, give analgesic, set up pleurovac (fill water seal chamber) & set up suction What should you not hear if the ETT tube is in the correct place? - correct answer>>Vocal noises What to do when intubating? 4 (Get what? Remove what? Know what? Preoxygenate how?) - correct answer>>1get supplies
- remove dentures
- know code status
- preoxygenate with 15L O2 in bag mask device, get to 100% saturation What to evaluate when assessing hemodynamic status? 4 - correct answer>>- Cardiac function/how strong is the heart
- Adequacy of circulating blood volume
- vascular pressures
- physiologic response to RX What usually causes a pneumothorax in the ICU? - correct answer>>1 Vent barotrauma 2 trauma due to central placement, after thoracentesis, post lung biopsy/CPR or after chest trauma What ventilator settings have an effect on CO2? (4) - correct answer>>Tidal volume, Rate, Mode, Pressure support What ventilator settings have an effect on O2? (2) - correct answer>>FiO2 & PEEP What will decrease a SvO2? 4 - correct answer>>-decrease in CO
- decreased Hgb
What would be the interventions for increased afterload and what are the medications to treat it? (3) - correct answer>>Vasodilators Nipride, Nitroglycerine, & Cardene What would cause a dead space unit? (4) - correct answer>>-pulm embolus
- severe anemia
- shock
- low CO What would cause a shunt unit? (5) - correct answer>>-asthma
- CNS Issue (head trauma)
- sedatives
- NM disease
- SC injury What would increase CO? 2 drugs/disease - correct answer>>Early sepsis Intoropic drugs What would increase Hgb? - correct answer>>Polycythemia Blood transfusion What would increase SaO2? - correct answer>>Increased FiO What's some EBP for preventing VAP 8 - correct answer>>-Q12 teeth brushing
- use Chlorohexidine
- HOB
- subglottic suctioning - verify OG placement - check TF residual Q4 - closed suction system - daily sedation holiday
When a person hyperventilates what is the primary effect on ABGs? - correct answer>>pCO2 will decrease When calculating a tidal volume what is it important to do? - correct answer>>- Calculate the pts ideal body weight not their actual because obese ppl dont have bigger lungs When someone comes in with ARF II What is a common oxygen amount it start them on - correct answer>>100% When would you do a modified allens test? - correct answer>>To assess patency of ulnar for an art line insertion Which has higher pressure, arteries or veins? - correct answer>>arteries Which is better nasal or oral ETT AND WHY - correct answer>>Oral, less infection risk Which part of the vascular system functions as a blood reservoir and contains over 60% of the body's blood? - correct answer>>Veins Which phase of the refractory period cardiac cells have not repolarized to their threshold potential and are unable to respond to any stiumlus?
- correct answer>>Absolute refractory period Which phase of the refractory period is called the vulnerable period of repolarization since a strong stimulus may take possession as pacemaker of the heart? - correct answer>>Relative refractory period Which position should the wrist be in to insure accuracy of art line pressure reading?
- correct answer>>Mild extension Why do we have to routinely zero and level the transducer on an art line and how often should it be done? - correct answer>>Check integrity of
