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CCRN TEST BANK QUESTIONS
ANSWERS AND RATIONALES GRADED
A+ 2024-2025 UPDATED (ACTUAL
EXAM).
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 - Precise answer 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 D. Head of bed elevated, right side - Precise answer 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 - Precise answer B. SaO2, hemoglobin, cardiac output Oxygen is delivered from the arterial end, so choose an option that has SaO Which of the following is the most significant complication of status asthmaticus? A. Pulmonary embolism B. Acute respiratory failure C. Hypertension D. Anaphylaxis - Precise answer 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. B. subdural hematoma. C. epidural hematoma. D. intracerebral hematoma. - Precise answer C. epidural hematoma. Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and cause epidural hematoma. Patients with an epidural
D.
Myocardial infarction - Precise answer 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. Cardiogenic C. Septic D. Neurogenic - Precise answer 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: A. sodium retention. B. water loss. C.
water gain. D. aldosterone excess. - Precise answer 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-appearing P wave in front of each QRS complex, the PR interval measures 0.2 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 - Precise answer A. Left bundle branch block (LBBB) Features of LBBB described here are a QRS complex greater than 0. second in duration and a QRS complex that is positive in leads V5 and V (consider these left ventricular leads) and negative in leads V1 and V (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 normal physiologic split of S2, which is split on inspiration but not split on expiration
B.
Large-gauge, short peripheral catheter C. Needle inserted into saline lock D. Large-gauge, long peripheral catheter - Precise answer 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: 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). - Precise answer 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 C. Verapamil
D.
Digoxin - Precise answer 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 - Precise answer D. More radiolucent than normal lung 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 - Precise answer A. Diaphoresis, pruritus
D.
Stage 3, dexrazoxane - Precise answer 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. A colloid - Precise answer 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 92/64 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. 8 mm Hg.
C.
12 mm Hg. D. 16 mm Hg. - Precise answer 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: A. excrete acid by-products of metabolism. B. excrete carbon dioxide. C. excrete bicarbonate ions. D. excrete calcium ions. - Precise answer 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. C.
B.
Pressure support ventilation C. Pressure-controlled inverse ratio ventilation D. Pressure-regulated, volume-controlled ventilation - Precise answer C. Pressure-controlled inverse ratio ventilation Pressure-controlled inverse ratio ventilation, which flips the normal 2: 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. Decreased pulmonary artery occlusive pressure - Precise answer 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 - Precise answer D. Hyperphosphatemia The patient's signs/symptoms are associated with hypocalcemia and its reciprocal condition, hyperphosphatemia. The same signs/symptoms also are seen in hypomagnesemia. You probably immediately looked for hypocalcemia but could not find it among the options. To answer this question correctly, you need to remember the reciprocal relationship between calcium and phosphorus. Which mode of mechanical ventilation requires the nurse to monitor closely for auto-PEEP (positive end-expiratory pressure)? A. Inverse ratio ventilation B. Pressure support ventilation C. Intermittent mandatory ventilation D. High-frequency jet ventilation B. Pressure support ventilation C. Intermittent mandatory ventilation D. High-frequency jet ventilation - Precise answer A. Inverse ratio ventilation Inverse ratio ventilation allows more time for inspiration than for expiration. A potential danger of this mode is that expiration will be incomplete when the next inspiration begins. This means that there was unintentional positive end-expiratory pressure, also referred to as auto-PEEP. If a patient has a palpable radial pulse, the systolic blood pressure (BP) is at least: A. 50 mm Hg.
narrow A:a gradient. - Precise answer B. increased PaCO2. Hypoventilation would cause the PaCO2 to increase. A 52-year-old patient with a history of alcoholism is admitted with massive esophageal bleeding. Which of the following would be an indication for the administration of blood in this patient? A. Hemoglobin less than 10 g/dl B. Hematocrit less than 30% C. Inability to control bleeding via endoscopic sclerosing therapy D. Symptoms of hypoperfusion such as chest pain or dyspnea - Precise answer D. Symptoms of hypoperfusion such as chest pain or dyspnea Clinical indications of hypoperfusion such as chest pain, dyspnea, or hypotension are indications that blood should be administered. Absolute hemoglobin or hematocrit levels are no longer indications because of the risk of blood-transmitted diseases. Inability to control bleeding is an indication for surgery. Which of the following are the major sources of intracranial hypertension after craniocerebral trauma? A. Cerebral edema and expanding lesions B. Hypervolemia and hyperthermia C. Hypovolemia and hypothermia D. Hydrocephalous and infection - Precise answer A. Cerebral edema and expanding lesions Cerebral edema and expanding lesions (e.g., hematoma) are the two major sources of increased intracranial pressure.
A patient received one unit of packed cells. Which of the following would be the expected effects of the transfusion? A. Increase in hemoglobin by 0.5 g/dl and increase in hematocrit by 2% B. Increase in hemoglobin by 0.5 g/dl and increase in platelets by 50,000/mm C. Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3% D. Increase in hemoglobin by 1 g/dl and increase in platelets by 50,000/mm3 - Precise answer C. Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3% One unit of packed red blood cells should increase the hemoglobin by 1 g/dl and hematocrit by 3% within approximately 4 to 6 hours. Red blood cells do not provide platelets. A 20-mm S wave in lead V1 and a 25-mm R wave in lead V6 are noted on a patient's 12-lead electrocardiogram. This would indicate which of the following? A. Right bundle branch block (RBBB) B. Left ventricular hypertrophy C. Posterior wall myocardial infarction (MI) D. Right ventricular hypertrophy - Precise answer B. Left ventricular hypertrophy When the depth of the S wave in lead V1 or V2 plus the height of the R wave in lead V5 or V6 is 35 mm or greater, this constitutes voltage criteria for left ventricular hypertrophy. Which of the following arterial blood gas findings supports the diagnosis of pulmonary embolism?
Serum amylase - Precise answer C. Urine creatinine clearance The creatinine clearance rate reflects the GFR. Which of the following is the oxygen concentration to be used in patients with cardiopulmonary arrest? A. 40% B. 80% C. 100% D. 100% except for patients with chronic hypercapnia - Precise answer C. 100% One hundred percent (or as close as can be achieved) oxygen should be used in cardiopulmonary arrest. There is no contraindication to 100% oxygen in cardiopulmonary arrest. A 65-year-old man is admitted to the critical care unit with a diagnosis of septic shock. He has been receiving chemotherapy for lung cancer. His skin is warm and dry, and he is restless. His white blood cell count is elevated above normal. Hemoglobin, hematocrit, and red blood cell count are normal. Vital signs are blood pressure 80/50 mm Hg, heart rate 120 beats/min and regular, respiratory rate 32 breaths/min and regular, and temperature 39° C. Arterial blood gases reveal the following: pH7.25PaO260 mm HgPaCO225 mm HgHCO313 mEq/LOxygen saturation86% Dobutamine is started at 10 mcg/kg/min. Normal saline is infusing at 150 ml/hr. Which of the following would be most indicative of improvement in this patient?
A.
Increase in venous oxygen saturation (SvO2) B. Decrease in arterial lactate C. Increase in cardiac output D. Increase in urine output - Precise answer B. Decrease in arterial lactate Associate lactate with lactic acid. You know that a decrease in lactic acid would indicate less anaerobic metabolism. Adequate oxygen extraction and aerobic metabolism would decrease the lactic acid level. The physician has prescribed mannitol for a patient with intracranial hypertension. Which of the following is an important consideration when administering mannitol? A. The drug must be protected from light. B. The drug must be administered through an in-line filter. C. The drug must be administered into a central venous catheter. D. The drug must be refrigerated. - Precise answer B. The drug must be administered through an in-line filter. If a patient with a normal pH and temperature has a PaO2 of 60 mm Hg, his arterial oxygen saturation (SaO2) is closest to which of the following values? A. 75% B. 90% C. 95% D. 99% - Precise answer B. 90%
