Download Pass CCRN test bank Latest Update 2024-2025 Actual Exam 125 Questions and 100% Verified Co and more Exams Nursing in PDF only on Docsity!
Pass CCRN test bank Latest Update 2024-
Actual Exam 125 Questions and 100% Verified
Correct Answers Guaranteed A+
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 - CORRECT 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. 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. Hypocapnia caused by hyperventilation C. Sedatio n D. Cerebral dehydration caused by osmotic diuretics - CORRECT ANSWER: A. Positive pressure ventilation Positive pressure ventilation increases intrathoracic pressure, which leads to increased ICP. 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:
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 - CORRECT ANSWER: 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 SaO2 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 - CORRECT ANSWER: 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%. 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. Over the last few hours, he has been complaining of increasing dyspnea, his respiratory rate has been increasing, and his oxygen saturation via pulse oximetry has been decreasing. 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 (ARDS) is
Ventilated alveoli having blocked perfusion. B. Perfused alveoli having bloc - CORRECT ANSWER: B. Perfused alveoli having blocked ventilation. 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 a right-sided S3 and S4. A ventilation/perfusion scan indicates high probability of a pulmonary embolism. Which of the following is not evident by the heart sound changes? A. Pulmonary hypertension B. Right ventricular strain and noncompliance C. Right ventricular failure D. Pulmonary edema - CORRECT ANSWER: 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. Hepari n
C.
Fibrinolytic agents D. Pulmonary embolectomy - CORRECT ANSWER: 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
human erythropoietin is a more appropriate treatment. Recombinant human erythropoietin is used to treat anemia resulting from reduced renal production of erythropoietin (the hormone that promotes the production of red blood cells)
A 40-year-old patient has been admitted to the critical care unit after sustaining multiple injuries from a cave-in accident this morning. X-ray films confirm multiple fractures, including the left femur. During the afternoon, he was taken to surgery for internal fixation of the left femur. It is now 10 pm, and the patient is complaining of severe throbbing pain in his thigh. The patient received 5 mg of morphine sulfate IV 30 min ago. The anterior left thigh is firm to touch, and the pain increases when the patient flexes his left leg. Further assessment reveals that swelling extends to the knee, and popliteal, posterior tibial, and dorsalis pedis pulses are not palpable. What should be done next? A. Call the physician and prepare for fasciotomy. B. Check pulses with a Doppler stethoscope. C. Call the physician and prepare for embolectomy. D. Check for Homans sign. - CORRECT ANSWER: B. Check pulses with a Doppler stethoscope. There appears to be an arterial occlusion, but before deciding to prepare for surgical procedures, the nurse should complete the assessment by using a Doppler stethoscope to see whether pulses are audible. Swelling makes it difficult to palpate pulses, but the pulses will be audible with a 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.
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. - CORRECT ANSWER: 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 - CORRECT ANSWER: 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.
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 - CORRECT ANSWER: 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 - CORRECT ANSWER: 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. A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism. He is nonresponsive to verbal stimuli at this time. Which intervention would not specifically decrease serum ammonia levels in patients with hepatic encephalopathy? A. Administration of rifaximin B. Administration of lactulose C. Provision of adequate caloric intake D. Avoidance of all hepatotoxic agents - CORRECT ANSWER: D. Avoidance of all hepatotoxic agents A 52-year-old patient with a history of alcoholism is admitted with massive
Hematocrit less than 30% C. Inability to control bleeding via endoscopic sclerosing therapy D. Symptoms of hypoperfusion such as chest pain or dyspnea - CORRECT 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. A 54-year-old man has just returned to the critical care unit from the postanesthesia care unit. He has a 60-pack-year history of cigarette smoking and had a right lower lobectomy performed earlier today for treatment of lung cancer. He is still intubated and on a positive pressure mechanical ventilator. The next morning a short-term breathing trial is conducted. Spontaneous ventilatory parameters and arterial blood gases are measured in preparation for weaning and extubation. Which of the following ventilatory parameters are most indicative of the patient's ability to cough and clear his airways? A. Tidal volume and vital capacity B. Vital capacity and negative inspiratory pressure C. Tidal volume and minute ventilation D. Minute ventilation and maximal inspiratory pressure - CORRECT ANSWER: B. Vital capacity and negative inspiratory pressure The patient must be able to pull air into his lungs to be able to perform a forcible cough. Being able to pull a significant negative (inspiratory) pressure and take a deep breath (vital capacity) are critical in performing an effective cough. A 54-year-old man has just returned to the critical care unit from the postanesthesia care unit. He has a 60-pack-year history of cigarette smoking and had a right lower lobectomy performed earlier yesterday for treatment of lung cancer. The nurse notes diminished breath sounds in the left posterior base. What would these findings most likely indicate? A.
Pleurisy B. Pneumonia C. Atelectasis
