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CCRN 124 test Questions
A 72-year-old man arrived in the emergency department after 4 hours of substernal pain radiating to the left arm. He has a 100 pack-year history of cigarette smoking, chronic obstructive pulmonary disease, and intermittent claudication. His electrocardiogram on admission shows sinus tachycardia with a rate of 120 beats/min and ST segment elevation in leads I, AVL, and V3 to V6. Vital signs include blood pressure, 150/84 mm Hg; respiratory rate, 15 breaths/min; functional oxygen saturation (SpO2), 95%; and temperature, 38.3° C (100.9° F). Which of the following treatments would not be indicated for this patient at this time?
A.
Morphine and nitroglycerin B. Aspirin and fibrinolytic drugs C. β-blockers D. Lidocaine - ✔ ✔ D. Lidocaine
Lidocaine is used for symptomatic ventricular dysrhythmias. A 72-year-old woman has been complaining of chest pain for 30 min. Her medical history includes vaginal hysterectomy and angina. She was initially alert but is now drowsy. Her skin is cool and moist. Vital signs are blood pressure, 84/60 mm Hg; heart rate, 42 beats/min and regular; and respiratory rate, 28 breaths/min. Electrocardiogram monitor shows sinus bradycardia. Which of the following treatments is indicated?
A. Epinephrine 1 mg IV B.
Atropine 0.5 mg IV C. Isoproterenol IV infusion at 2 mcg/min D.
Transcutaneous pacemaker - ✔ ✔ D. Transcutaneous pacemaker A 76-year-old man is admitted with complaints of sudden, sharp, "tearing" chest pain radiating to the shoulders, neck, and back. He has been in apparent good health except for a history of hypertension. Vital signs are blood pressure, 180/96 mm Hg; heart rate, 90 beats/min; and respiratory rate, 26 breaths/min. He is dyspneic, and his electrocardiogram shows nonspecific ST-T wave changes. Which of the following would not be an important aspect of care for this patient?
A.
Control his blood pressure. B. Provide adequate analgesia. C. Initiate fibrinolytic therapy. D. Prepare the patient for surgery. - ✔ ✔ C. Initiate fibrinolytic therapy.
Fibrinolytic therapy is contraindicated if dissecting thoracic aortic aneurysm is suspected. All of the other interventions are appropriate. A 22-year-old man is admitted after a bicycle collision with a tree. He has a contusion on the right side of his head. An intraventricular catheter has been inserted via a burr hole to monitor his intracranial pressure (ICP). He develops respiratory depression and is intubated and mechanically ventilated. Which of the following is the most likely cause of an increase in ICP at this time?
A.
Positive pressure ventilation B.
36 breaths/min and deep, and temperature is 37° C (98.6° F). Which of the following would not be used to treat this condition?
A.
Calcium B. Chest tube C. Analgesia D.
Calming the patient - ✔ ✔ A. Calcium
Remember that respiratory alkalosis, caused by hyperventilation, increases the binding between albumin and calcium and, therefore, reduces the serum ionized calcium level. This is why the patient is having the symptoms of tetany. However, he does not need calcium. He needs a reduction in minute ventilation, which will decrease his pH and correct the binding between calcium and albumin, increasing the ionized calcium level. Chest tube to re-expand the lung, analgesia to treat the chest discomfort, and calming of the patient (including the use of sedatives) would be appropriate components of the treatment plan for this patient. A 24-year-old man has been diagnosed with acute kidney injury as a result of severe hemorrhaging after a motor vehicle collision. Which of the following would be expected laboratory values for this patient?
A.
Low urinary osmolality, high urinary sodium concentration B. High urinary osmolality, high urinary sodium concentration C. Low urinary osmolality, low urinary sodium concentration D.
High urinary osmolality, low urinary sodium concentration - ✔ ✔ D. High urinary osmolality, low urinary sodium concentration
Consider that the kidney would want to conserve sodium and water with blood loss. If the kidney is holding onto sodium, little is excreted into the urine, so urinary sodium is low. If the kidney is holding onto water, little is excreted into the urine, so it is concentrated and osmolality is increased. A 24-year-old man is admitted to the critical care unit after sustaining a pulmonary contusion in a motor vehicle collision. He has no history of cardiac or pulmonary disease. During the first 24 hours after admission, he has been complaining of increasing dyspnea, his respiratory rate has been increasing, and his oxygen saturation via pulse oximetry has been decreasing despite supplemental oxygen. Breath sound assessment reveals fine crackles bilaterally. Arterial blood gases reveal respiratory alkalosis and hypoxemia. Chest x-ray film reveals patchy infiltrates. Acute respiratory distress syndrome is diagnosed. Oxygen therapy is initiated, and arterial blood gases are monitored closely, but SaO continues to fall. Which of these oxygen delivery systems will provide the highest concentration of oxygen and indicated in this case?
A. Face tent B. Nonrebreathing mask C. Nasal cannula D.
Venturi mask - ✔ ✔ B. Nonrebreathing mask
The nonrebreathing mask stores oxygen in nose, pharynx, mask, and reservoir bag between breaths. This allows a concentration of close to 100%.
B.
Right ventricular strain and noncompliance C. Right ventricular failure D.
Pulmonary edema - ✔ ✔ D. Pulmonary edema A 27-year-old woman arrives in the emergency department 3 weeks after the vaginal delivery of her first child. She is transferred to the critical care unit after an acute onset of dyspnea and chest pain. Vital signs are blood pressure, 120/88 mm Hg; heart rate, 122 beats/min; and respiratory rate, 32 breaths/min. Arterial blood gases reveal a pH of 7.48, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of 55 mm Hg, and an arterial oxygen saturation of 89% on 100% oxygen by nonrebreathing mask. Jugular venous distention is evident, and cardiac auscultation reveals an accentuated P2 and an S3 and S4 of the right side. A ventilation/perfusion scan indicates high probability of a pulmonary embolism. What treatment is indicated at this time?
A.
Intubation and mechanical ventilation B. Heparin C. Fibrinolytic agents D.
Pulmonary embolectomy - ✔ ✔ C. Fibrinolytic agents
Remember that fibrinolytic agents are not contraindicated by surgery or trauma after about 2 weeks because the normal fibrinolytic process already would have broken down the clot. The exception would be brain or spinal cord trauma or surgery because the consequences of bleeding into the head or spine would be particularly dire. 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. - ✔ ✔ 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 32-year-old woman has systemic lupus erythematosus and chronic kidney disease. Over the past 2 weeks, she has complained of feeling fatigued and short of breath after minimal exertion. She is receiving hemodialysis. Her hemoglobin level is 4.5 g/dl.Which of the following is indicated?
A.
Recombinant human erythropoietin (Epogen) B. Two units of packed red blood cells C. Nitroglycerin sublingual as needed D.
Doppler stethoscope if present. Homans sign is a sign of venous obstruction or phlebitis, which would not cause a loss of arterial pulses. 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. 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. 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.
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 45-year-old woman is admitted with deep venous thrombosis and pulmonary embolism. She has received a heparin bolus and has been on a continuous heparin drip for 3 days. If the patient develops heparin- induced thrombocytopenia (HIT), what clinical sign would the nurse expect to see first?
A. Surface bleeding from wounds and IV sites B. Hematuria C. Petechiae D.
Bleeding from gums - ✔ ✔ C. Petechia
HIT is an immune-mediated adverse effect of heparin. It causes thrombosis and thrombocytopenia. The first clinical sign of a decrease in platelet quantity or quality is petechiae. A 48-year-old male patient with a history of inferior myocardial infarction (MI) is admitted with an acute anterolateral MI. He is tachycardic and hypotensive. Cardiac index is 1.9 L/min/m2. Pulmonary artery occlusive pressure (PAOP) is 20 mm Hg, and systemic vascular resistance (SVR) is 2000 dynes/sec/cm-5. Which of the following is the priority in this patient?
A.
flown to the hospital. The patient is bleeding from his IV insertion sites and continues to seep blood from the wound. Which of the following diagnostic panels is suggestive of disseminated intravascular coagulation (DIC)?
A.
Decreased platelets, decreased fibrinogen, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), prolonged thrombin time, increased fibrin degradation products (FDPs) B. Increased platelets, increased fibrinogen, normal PT, aPTT, normal thrombin time, increased fibrin degradation products (FDPs) C. Increased platelets, decreased fibrinogen, prolonged PT, aPTT, prolonged thrombin time, decreased fibrin degradation products (FDPs) D. Decreased platelet - ✔ ✔ A. Decreased platelets, decreased
fibrinogen, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), prolonged thrombin time, increased fibrin degradation products (FDPs) A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism. He is nonresponsive to verbal stimuli at this time. Which dietary restrictions would be maintained for a patient with hepatic encephalopathy?
A.
Protein and sodium B. Fat and potassium C. Potassium and carbohydrates D.
Sodium and potassium - ✔ ✔ A. Protein and sodium
Protein is restricted because its breakdown causes increased ammonia levels. Sodium is restricted because patients with hepatic disease have increased circulating levels of aldosterone, which causes increased sodium reabsorption in the distal tubule and resultant edema. Diminished breath sounds indicate diminished air flow. Atelectasis is the logical choice. Pleurisy causes a pleural friction rub. Pneumonia causes bronchial breath sounds. The chest tube does not cause any specific breath sound, though there may be gurgling audible if the suction is not clamped during auscultation A 54-year-old man is admitted to the critical care unit with acute kidney injury resulting from a bladder tumor. This would be classified as which type of acute kidney injury?
A.
Prerenal B. Intrarenal—medullary C. Intrarenal—cortical D.
Postrenal - ✔ ✔ D. Post renal 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
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 - ✔ ✔ 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. 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% What hemodynamic alteration should the nurse anticipate?
A.
Decreased cardiac output (CO) B. Increased venous oxygen saturation (SvO2) C. Increased systemic vascular resistance (SVR) D.
Increased oxygen consumption - ✔ ✔ B. Increased venous oxygen saturation (SvO2)
Early septic shock is different from most forms of shock because the main problem is oxygen extraction rather than oxygen delivery. So think opposite of hypovolemic shock. CO is increased instead of decreased. SVR is decreased instead of increased. And the SvO2 is increased instead of decreased. A 70-year-old woman, weighing 50 kg, comes to the emergency department complaining of chest pain and shortness of breath. The electrocardiogram monitor shows ventricular tachycardia at a rate of 150 beats/min. Which treatment is appropriate in this situation?
A.
Amiodarone IV B. Verapamil HCl IV C. Defibrillation beginning at 200 J D.
urine is dark amber with a specific gravity of 1.035. Vital signs are temperature 38.2° C orally; heart rate 130 beats/min and regular; respiratory rate 26 breaths/min and regular; and blood pressure 90/ mm Hg. Which of the following is of the most immediate concern?
A.
Infection B. Hypovolemia C. Nutrition D.
Skin breakdown - ✔ ✔ B. Hypovelemia
Hypovolemia, especially in an older adult, is the most life threatening A patient 5 days after an acute inferior myocardial infarction suddenly complains of severe dyspnea and palpitations. The patient appears anxious and diaphoretic. While completing the assessment of the patient, a loud holosystolic murmur at the apex that radiates to the axilla is noted. The patient also has crackles throughout the lung field but an S at the apex is not audible. Which of the following is most likely to be descriptive of the pulmonary artery occlusive pressure (PAOP) in this patient?
A. An elevated v wave and an overestimate of the left ventricular end- diastolic pressure (LVEDP) B. A dampened v wave and an underestimate of the LVEDP C. A normal v wave and an accurate reflection of the LVEDP D.
An elevated v wave and a direct correlation to the pulmonary artery diastolic pressure - ✔ ✔ A. An elevated v wave and an overestimate
of the left ventricular end-diastolic pressure (LVEDP) A patient admitted with Goodpasture syndrome has developed acute tubular necrosis. The patient's phosphorus level is 6.5 mg/dl. Control of the phosphorus is important to avoid complications from which of the following?
A.
Hyponatremia B. Hypocalcemia C. Hypernatremia D.
Hypercalcemia - ✔ ✔ B. Hypocalcemia
Associate phosphorus and calcium with a seesaw. When one side of the seesaw is up, the other is down. This process is consistent with normal and abnormal kidney function. Choose "Hypocalcemia." You do not really need to know what Goodpasture syndrome is to answer the question correctly. 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
