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CCRN 150 Practice Review Test 1
A patient had a pulmonary artery catheter, and the following values were obtained on the initial shift assessment:
Blood pressure 82/48, heart rate 126 beats/minute, pulmonary artery pressure 22/10, central venous pressure (CVP) 1 mmHg, pulmonary artery occlusion pressure 4 mmHg, cardiac output 3 L/minute, and systemic vascular resistance 1,600 dynes/s/cm-
This patient requires the administration of:
(A) a fluid bolus of 500 mL of 0.9 normal saline.
(B) dopamine at 5 mcg/kg/min.
(C) dobutamine (Dobutrex) at 10 mcg/kg/min.
(D) nitroprusside (Nipride) at 1 mcg/kg/min. - ✔ ✔ (A) a
fluid bolus of 500 mL of 0.9 normal saline.
A patient had an episode of chest pain at rest with ST elevation on the ECG. The chest pain was relieved, and the ST segments were normalized after the administration of nitroglycerin sublingual. This patient most likely had:
(A) stable angina.
(B) an ST-elevation myocardial infarction.
(C) Prinzmetal's, or variant, angina.
(D) Wellens syndrome. - ✔ ✔ (C) Prinzmetal's, or variant,
angina.
A patient has a history of chronic respiratory failure secondary to COPD and now has acute respiratory failure secondary to pneumonia. Upon arrival at the critical care unit, his ABGs were a pH of 7.29, a PaCO2 of 77, a PaO2 of 51, and an HCO3 of 31. He is receiving noninvasive ventilation with settings that read as follows: FiO2 0.40, IPAP 12 cm, and EPAP 5 cm. After 1 hour of therapy, the patient's ABG results are a pH of 7.20, a PaCO2 of 89, a PaO2 of 48, and an HCO3 of 32.
What is the correct evaluation of this data?
(A) Alveolar hyperventilation is getting worse; the BiPAP settings need adjustment.
(B) Metabolic acidosis is worse; the FiO, needs to be increased.
(C) Alveolar hypoventilation is getting worse; the patient needs to be intubated.
(D) The pH is acceptable for a patient with COPD; continue the current therapy. - ✔ ✔ (C) Alveolar hypoventilation is
getting worse; the patient needs to be intubated.
A patient was admitted with diabetic ketoacidosis, a serum glucose of 450 mg/dL, and a pH of 7.12. An IV insulin
(A) Discontinue opiate and sedating drugs.
(B) Administer mannitol.
(C) Infuse isotonic solutions.
(D) Drain CSF from the ventricular catheter. - ✔ ✔
A 22-year-old male patient, with a known history of Wolff- Parkinson-White (WPW) syndrome, developed preexcited atrial fibrillation (AF) at a rate of 170 beats/ minute. The nurse should anticipate the administration of which of the following medications?
(A) adenosine (Adenocard)
(B) diltiazem (Cardizem)
(C) esmolol (Brevibloc)
(D) digoxin (Lanoxin) - ✔ ✔
A 23-year-old patient with head trauma begins to have polyuria with a urine output of 900 mL in 1 hour, a urine specific gravity of 1.001, and an elevated serum osmolality. Which of the following interventions would be expected for this patient?
(A) Administer 3% saline.
(B) Administer phenytoin.
(C) Administer Pitressin.
(D) Administer dextrose 5% in water. - ✔ ✔ (C)
Administer Pitressin.
A 28-year-old male patient with muscular dystrophy is admitted with acute respiratory failure secondary to heart failure. He tells the nurse that he is tired of frequent hospitalizations related to his disease and does not want invasive or noninvasive ventilation since he is tired of living. Which of the following would be the nurse's best response?
(A) "You will need to sign a 'No CPR' form as soon as possible."
(B) "You are very uncomfortable right now, but you will feel differently when you are feeling better."
(C) "This is an acute problem that can be resolved with treatment, allowing you to return home to your family."
(D) "Have you discussed this decision with or your family and your physician?" - ✔ ✔ (D) "Have you discussed this
decision with or your family and your physician?"
A 28-year-old woman is in the ICU with a gunshot wound to the head. One week after admission, the physician has declared the patient brain-dead. The nurse is present when the diagnosis is shared with the patient's mother. What is one of the first issues the nurse needs to anticipate for this type of situation specifically?
Emergency Department. Indications of successful reperfusion would include all of the following EXCEPT:
(A) the cessation of pain.
(B) the absence of troponin elevation.
(C) the reversal of ST segment elevation with a return to baseline.
(D) short runs of ventricular tachycardia. - ✔ ✔ (B) the
absence of troponin elevation.
A 68-year-old patient is admitted with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following lab findings and interventions would the nurse anticipate for this patient?
(A) serum sodium low, serum osmolality low, urine output low; order for phenytoin (Dilantin)
(B) serum sodium elevated, serum osmolality elevated, urine output low; order for Pitressin
(C) serum sodium low, urine specific gravity low, urine output elevated; order for 3% saline
(D) serum sodium elevated, urine output elevated, hypokalemia, arterial pH low - ✔ ✔ (A) serum sodium
low, serum osmolality low, urine output low; order for phenytoin (Dilantin)
A 70 kg patient with ARDS is intubated and mechanically ventilated. The patient is on continuous infusions of an opiate, a sedative, and neuromuscular blocking drugs. The plateau pressure is 45 cm H2O. The PaO2 is 60 mmHg. The physician orders the following ventilator settings: SIMV mode, tidal volume 700 mL, rate 12 breaths/ minute, FiO 1.00, and PEEP 15 cm H2O pressure. Which of the following needs to be discussed with the physician?
(A) the ventilator mode
(B) the tidal volume
(C) the PEEP
(D) the FiO2 - ✔ ✔ (B) the tidal volume
A 70 kg patient with ARDS is mechanically ventilated with the following settings: FiO2 70%, tidal volume 450 mL, assist-control mode 10 breaths/minute, and PEEP 20 cm H2O pressure. On these settings, the patient's PaO2 is 76 mmHg and the PaCO2 is 58 mmHg. The patient's core temperature is 37°C, his heart rate is 116 beats/minute, and his BP is 78/58. Which of the following interventions should the nurse now anticipate?
(A) Decrease PEEP to decrease the intrathoracic pressure.
(B) Administer a 500 mL fluid bolus of normal saline.
Which of the following should the nurse anticipate administering?
(A) antibiotics
(B) nutrition
(C) isotonic fluids
(D) furosemide - ✔ ✔ (C) isotonic fluids
A 79-year-old male comes to the critical care unit with left- sided paralysis and paresthesia, eye deviation to the right, and a dilated right pupil. He cannot remember falling and has no signs of physical trauma. His family states that he has been "acting differently" for approximately 1 month. The patient denies having a headache. Based on this information, he probably has which of the following?
(A) a left-hemispheric epidural hematoma
(B) a right-hemispheric subdural hematoma
(C) a basilar skull fracture
(D) central herniation - ✔ ✔ (B) a right-hemispheric
subdural hematoma
A nurse evaluates the results of a patient's lumbar puncture and anticipates that the physician will order antibiotics. Which of the following results explains the nurse's evaluation of the CSF report?
(A) elevated protein
(B) clear CSF
(C) glucose 30 mg/dL
(D) elevated WBC - ✔ ✔ (C) glucose 30 mg/dL
A nurse is initiating a vasopressin drip for a patient with GI bleeding. What is a priority assessment that is specific to a patient who is receiving this medication?
(A) Monitor for hypertension.
(B) Monitor the ECG for ST changes.
(C) Monitor for a cardiac arrhythmia.
(D) Monitor for a bowel obstruction. - ✔ ✔ (B) Monitor
the ECG for ST changes.
A nurse is preparing to suction a patient who is receiving mechanical ventilation and has a history of increased ICP due to a head injury. Which of the following interventions is contraindicated for this patient?
(A) increasing the FiO2 to 100% during suctioning
(B) providing sedation
(C) limiting the procedure to 1 to 2 quick passes
(D) stimulating coughing - ✔ ✔ (D) stimulating coughing
(A) turning the patient every hour.
(B) preventing the MAP from becoming greater than 65 mmHg.
(C) maintaining the PaCO, at less than 30 mmHg.
(D) maintaining a neutral head position. - ✔ ✔
A patient arrives in the critical care unit 4 hours postpartum with bleeding that is thought to be secondary to severe uterine atony. Her blood pressure is 78/40, her heart rate is 140 beats/minute, and her respiratory rate is 30 breaths/minute. Her hemoglobin is 11.2 g/dL. Which of the following interventions is appropriate?
(A) This patient has lost 1,500-2,000 mL of blood and is at a high risk for DIC. Initiate fluid resuscitation, transfuse blood, and check the coagulation profile.
(B) The patient has lost 500-1,000 mL of blood and is at a high risk for septic shock. Initiate fluid resuscitation, give pressors, and obtain blood cultures.
(C) The patient has lost 250-500 mL of blood and is at a high risk for a pulmonary embolism. Initiate fluid resuscitation, get a chest CT scan, and obtain a D-dimer.
(D) The patient has lost over 2,000 mL of blood and is at a high risk for uterine rupture. Initiate fluid resusci - ✔ ✔
A patient complains of chest pain with deep inspiration that is worse when lying supine. There is a friction rub upon auscultation and sinus tachycardia. Which of the following would you expect to find on the stat 12-lead ECG?
(A) ST depression in V1-V
(B) ST elevation in II, III, aVF and V2-V
(C) ST depression in V2 and V
(D) ST elevation in II, III, and aVF - ✔ ✔ (B) ST elevation
in II, III, aVF and V2-V
A patient complains of chest tightness and shortness of breath shortly after an IV antibiotic is initiated. Hives have appeared across her face and chest. Her vital signs include a BP of 84/34, a heart rate of 130 beats/minute, sinus tachycardia, a respiratory rate of 28 breaths/minute with wheezing, and SpO2 94% on room air. Which of the following interventions is most. appropriate for this patient?
(A) stat ECG, aspirin, oxygen, pressor
(B) albuterol, steroids, oxygen, fluids
(C) fluids, oxygen, a CT scan of the chest, heparin
(D) epinephrine IM, steroids IV, an antihistamine, fluids - ✔
✔ (D) epinephrine IM, steroids IV, an antihistamine,
fluids
(B) Slowly decrease the sensitivity until the capture is lost.
(C) Slowly increase the mA output until the native beats are seen.
(D) Slowly decrease the mA output until the capture is lost. - ✔ ✔ (D) Slowly decrease the mA output until the capture
is lost.
A patient has acute renal failure secondary to septic shock, had prolonged hypotension, and now requires hemodialysis (since his BUN is 90 mg/dL and his creatinine is 9.2 mg/dL). Which of the following findings would the nurse expect this patient to have?
(A) low urine osmolality, high urine sodium
(B) high urine osmolality, high urine sodium
(C) low urine osmolality, low urine sodium
(D) high urine osmolality, low urine sodium - ✔ ✔ (A)
low urine osmolality, high urine sodium
A patient has acute right ventricular infarct and RV failure. Which of the following is an indication that this patient's condition has improved?
(A) The PAOP has decreased.
(B) The RA pressure has decreased.
(C) The RV pressure has increased.
(D) The PA diastolic pressure has decreased. - ✔ ✔ (B)
The RA pressure has decreased.
A patient has an ankle-brachial index of 0.8. Which of the following is important in the care of this patient?
(A) Place the bed in reverse Trendelenburg.
(B) Provide an antihypertensive.
(C) Elevate the lower extremities.
(D) Elevate the affected arm. - ✔ ✔ (A) Place the bed in
reverse Trendelenburg.
A patient has an esophageal balloon tube (Sengstaken- Blakemore) for the treatment of bleeding esophageal varices. What nursing assessment/intervention is specific to the care of a patient with this type of tube?
(A) Ensure that suction is maintained.
(B) Monitor for recurrent bleeding.
(C) Initiate fluid resuscitation as needed.
(D) Keep scissors at the bedside. - ✔ ✔ (D) Keep scissors
at the bedside.
A patient has been admitted to the ICU with a diagnosis of esophageal varices and upper GI bleeding, the third such
(D) Contact the physician for a change in the analgesic orders. - ✔ ✔ (A) Administer naloxone (Narcan) 0.4 mg
IV
A patient has cardiogenic shock and cardiogenic pulmonary edema. Which of the following therapies would be most effective for this patient?
(A) an intra-aortic balloon pump to increase coronary artery perfusion
(B) a beta blocker to increase cardiac contractility
(C) an alpha-adrenergic drug to increase coronary artery perfusion
(D) angiotensin-converting enzyme inhibitors to decrease afterload - ✔ ✔ (A) an intra-aortic balloon pump to
increase coronary artery perfusion
A patient has right middle and lower lobe bacterial pneumonia and is expectorating rust-colored sputum. Which of the following interventions is most appropriate for this patient?
(A) Provide antibiotic therapy to cover MRSA.
(B) Turn the patient to the left to prevent hypoxemia.
(C) Withhold the enoxaparin that is prescribed for DVT prophylaxis.
(D) Maintain the head of the bed at less than 30°. - ✔ ✔
(B) Turn the patient to the left to prevent hypoxemia.
A patient in septic shock received a pulmonary artery catheter. Which of the following hemodynamic profiles would this patient most likely exhibit?
(A) SVR 1,400 dynes/s/cm-5, cardiac output 5 L/min, SvO 58%
(B) SVR 1,800 dynes/s/cm-5, cardiac output 6 L/min, SvO 60%
(C) SVR 500 dynes/s/cm-5, cardiac output 7 L/min, SvO 78%
(D) SVR 700 dynes/s/cm-5, cardiac output 2 L/min, SvO 68% - ✔ ✔ (C) SVR 500 dynes/s/cm-5, cardiac output 7
L/min, SvO2 78%
A patient is 1 day post open heart surgery. The patient's spouse inquires if she might bring in the patient's favorite CD of classical music to help control the pain. Which of the following is the nurse's best response?
(A) "The use of music may reduce pain and tension."
(B) "We will give your spouse as much pain medication as needed. Music will not be necessary."
