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Barron CCRN Practice Test 1 Questions
with Accurate Answers
A 19yo pt who was admitted with sickle cell crisis and acute kidney injury requests to use a phone to update her friends on her condition. The nurse's best response would be to: A. explain to the patient that calls can be made when she is transferred out of the critical care unit B. allow the patient to make the phone calls in order to meet the pt's need for social support. C. explain to the patient that she needs to rest in order for the analgesic medication to take effect. D. allow the patient to make the calls in order to reduce the patient's anxiety correct answer B. Social support is very important for a young adult to cope. Choices A and C do not allow the patient to utilize social support. The scenario does not indicate that the patient is anxious, therefore D is incorrect. 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 correct answer A. SIADH causes excessive production of ADH, which results in fluid retention, dilutional hyponatremia, low serum osmolality, and elevated urine
specific gravity. Dilantin will decrease the production of ADH. The serum sodium would NOT be elevated, the urine output would NOT be elevated, and the urine specific gravity would NOT be low. SIADH does not cause hypokalemia or acidosis. A 70kg patient with ARDS is mechanically ventilated with the following settings: FiO2 70%, vT 450, assist control mode at 10 breaths/min, and PEEP 20. On these settings the patient's PaO2 is 76, the PaCO2 is 58. The patient's core temp is 37 C, HR is 116, BP is 78/58. Which of the following interventions should the nurse now anticipate? A. Decrease PEEP to decrease intrathoracic pressure B. Administer 500ml fluid bolus of NS C. Initiate a norepinephrine drip to maintain SBP of 80 D. Increase the vT to 750 correct answer B. The primary problem is hypotension, and it should be treated with fluids. Although a reduction of PEEP would most likely increase the BP, it would result in derecruitment of alveoli and hypoxemia. A norepinephrine drip should be initiated only if fluids alone do not correct the hypotension. An increase in the vT would not increase the BP and would cause volutrauma in a patient with ARDS. A 70kg pt 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, the PaO2 is 60. The physician orders the following ventilator settings: SIMV mode, vT 700, rate 12 breaths/min, FiO2 1.0, and PEEP
- 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. correct answer B. The patient with ARDS needs to receive a 4-5ml/kg vT in order to prevent volutrauma. This patient is receiving 10ml/kg vT, and this
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 correct answer A. Mechanical devices such as an IABP or VAD will increase coronary artery perfusion, which is a positive hemodynamic effect in the presence of cardiogenic shock. Beta blockers decrease myocardial contractility. Alpha-adrenergic drugs, such as phenylephrine or norepinephrine, constrict arteries, decrease perfusion, and increase the work of the heart. Afterload reduction will decrease the work of the heart, but it will not increase coronary artery perfusion. A patient has a history chronic respiratory failure secondary to COPD and now has acute resp failure secondary to pneumonia. Upon arrival to the ICU the ABGs were pH of 7.29, PaCO2 of 77, PaO2 of 51, and an HCO3 of 31. The pt is placed on noninvasive ventilation with settings of Fio2 0.40, IPAP 12, EPAP 5. After 1 hr of therapy, the ABG is pH 7.20, PaCO2 of 89, PaO2 of 48, and HCO3 of 32. What is the correct evaluation of this data? A. alveolar hyperventilation is getting worse; BIPAP settings need adjustment B. Metabolic acidosis is worse; FiO2 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 current therapy. correct answer C. The patient did not respond to noninvasive ventilation since the PaCO increased, respiratory acidosis is worse, and severe hypoxemia was not corrected. BIPAP should not be continued. The issue is not metabolic acidosis. The pH is not acceptable. A patient has a temporary transvenous VVI pacemaker with a set rate of 72 beats/min and an mA output of 5. The monitor shows 1:1 pacing at the set rate. The physician asks the nurse to determine the capture threshold. Which of the following should the nurse do? A. slowly increase the sensitivity until the heart rate increases
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. correct answer D. Capture threshold is assessed by decreasing the mA output until pacer spikes are seen without a QRS. This is the point at which capture is lost. The output is then set at about double the capture threshold. 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. correct answer B. The RA pressure is elevated in RV failure secondary to RV infarct, and a decrease in that pressure is evidence that the treatment is effective. The PAOP is a left heart pressure. It is often already low in the setting of RV infarct/failure since the preload to the left heart drops, and a further decrease is not warranted. An increase in the RV pressure is a sign of worsening RV failure. The PAD pressure is already low with RV infarct, thus a further decrease is not desirable. A patient is admitted with a salicylate overdose. Which of the following treatments is most effective for this patient? A. N-acetylcysteine, support the airway, fluids B. gastric lavage, an antidote, fluids C. activated charcoal, urine alkalinization, dialysis D. support the airway, gastric lavage, ethanol correct answer C. A salicylate overdose will cause renal failure. Activated charcoal will help neutralize the salicylates. Alkalinization of urine, by the administration of sodium bicarbonate in the IV fluids, will protect the kidneys. Emergent dialysis will ensure the clearance
to progress to weight bearing and sitting in a chair, it is best to go step by step and then reassess. A patient is receiving patient-controlled analgesia, an IV infusion of morphine at 1 mg per hour, and 2 mg of morphine every 15 min as PRN bolus doses. The patient is having episodes of sleep apnea and is arousable only by touch. Priority interventions include: A. stopping the continuous infusion and giving a slow IV push of naloxone until the patient awakens B. decreasing the morphine continuous infusion rate to 0.5 mg per hour and continuing to monitor that rate C. discontinuing the PRN bolus doses and given a 2mg IV bolus of naloxone. D. discontinuing PCA, checking the SpO2, and giving naloxone. correct answer A. This patient has signs of sedation that precede hypoventilation, plus signs of sleep apnea that increase the risk of hypoventilation. The continuous infusion needs to be discontinued, not reduced. Sedation needs to be gradually (not suddenly) reversed. The patient will still need analgesia with PRN doses. A drop in SpO2 is a late sign of hypoventilation. Although it is not a choice in this scenario, ideally the patient should have continuous waveform capnography. A patient presents with a productive cough, hypoxemia, a fever, hypotension, tachycardia, and tachypnea. Hypoxemia was corrected with the administration of oxygen. Which of the following should be done next? A. administer antibiotics B. start a vasopressor C. Collect a sputum culture D. Initiate 0.9 NS correct answer D. Correcting the hypotension (with isotonic fluid resuscitation in order to maintain organ perfusion) is the priority. Antibiotics will need be started after blood cultures are obtained. A vasopressor may not be
needed if the MAP is restored with fluids. Although a sputum culture may be indicated, blood cultures need to be drawn first in order to start antibiotics. A patient with a head injury was admitted last night. This morning, she is increasingly less responsive, and her right pupil has become unresponsive to light. Now, her systolic pressure has increased, her HR has slowed, and her respirations have also slowed. These vital sign changes are referred to as: A. Battle's sign B. Cushing' triad C. halo sign D. Chvostek sign correct answer B. The systolic pressure increases in order to try to perfuse the brain better as the pressure in the cranial vault increases. This widens the pulse pressure. HR slowing and respiratory depression are the other 2 signs of the triad. Battle's sign is a sign of basilar skull fracture. The halo sign is seen when CSF is put on sterile white gauze and results in a red center color surrounded by yellow. Chvostek sign is a cheek/facial spasm that is caused by low serum calcium. A patient with a UTI presented with a temperature of 39 C (102.2 F), a HR of 132, RR 24, a BP of 78/49 (59), and a lactate of 2.8. The pt received 2L NS within 1 hr. The BP is now 100/52 (68), HR is 118, RR is 20, and lactate is 2.1. The pt requires treatment of: A. bacteremia B. sepsis C. SIRS D. septic shock correct answer B. This pt has sepsis as evidenced by infection, organ dysfunction (hypotension), and elevated lactate. With the administration of fluids, the BP improved and lactate decreased, therefore does not have septic
A. diuretic therapy B. stabilizing the blood pressure C. prophylactic antibiotics D. preventing a thrombus correct answer D. Clot formation on the valve is a major complication of valve replacement, especially for a mechanical valve, therefore anticoagulation will be needed. Fluid overload, a labile BP, and infection are possible complications, but are not as likely as the formation of a thrombus and a resultant stroke. A trauma patient's morning labs return with the following values: H/H 8.2/30, Plt 50, PTT 50, INR 3.0, fibrinogen 150, and fibrin split products 45. What is most likely the cause of this patient's lab profile? A. Autoimmune reaction B. consumption of clotting factors C. occult blood loss D. drug reaction correct answer B. This patient has DIC, a problem that causes excessive clotting, resulting in the consumption of clotting factors, the eventual inability to clot, and bleeding. The lab profile reveals a coagulopathy. However, the key parameter is the elevated fibrin split products of 45, which is evidence of excessive clot breakdown. After attending an educational session that reviewed drug dosing and provided a review of the literature, the nurse would like to start using the admission weight to calculate drug dosing during titration of vasoactive drugs rather than the current practice of using daily weights. What would be the most effective next step for the nurse to take to implement this change? A. begin the adaptation of the practice by using the admission weight for patients B. Identify the key stakeholders related to the proposed change in practice
C. ask the attending physician on rounds what her thoughts are about the practice C. Discuss the educational session with nurse colleagues correct answer B. An experienced nurse realizes that an organizational change will require input from the key stakeholders and their acceptance of the proposed changes. Changing one's own practice will not effect broad-based change and may cause confusion. Getting a physician's thoughts will not effect organizational change. Discussing with nurse colleagues provide information on possible resistance, but is not the optimal broad-based approach that will be effective. At day 1 status AAA repair with a Dacron graft, the patient' serum BUN and creatinine increase, and the urine output decreases. Which of the following is the most likely etiology of these new patient findings? A. acute renal failure B. graft rejection C. septic shock D. acute hemorrhage correct answer A. during an AAA repair, there may be prolonged decreased perfusion to the renal artery and resulting damage to the renal tubules. This population is at high risk for acute renal failure. The care team is considering whether a patient is a candidate for hospice care. Which of the following is a specific service provided by hospice care? (A) advance care planning (B) symptom management (C) care for a terminal illness (D) consideration of patient/family wishes correct answer C. Hospice referrals are considered for patients with a terminal illness or a chronic illness in the terminal stage. The other options refer to palliative care, which all critically ill patients have a right to receive.
Confirmatory testing may be hospital policy, but is not needed to make the diagnosis of brain death. Which of the following is an appropriate strategy to use when providing mechanical ventilation to a patient with status asthmaticus? A. Provide a long inspiratory time and short expiratory time B. Utilize a PEEP setting of 10- C. Use a lower respiratory rate D. Set the tidal volume to 10-12ml/kg correct answer C. A patient with asthma requires a longer expiratory time in order to decrease air trapping. A lower respiratory rate will help provide this. A short expiratory time, PEEP, and larger tidal volume all promote air trapping or auto PEEP, which will increase intrathoracic pressure, decrease the venous return, and reduce the cardiac output. Which of the following is contraindicated when providing enteral feeding? A. checking for gastric residuals every 4 hours B. using a small-bore duodenal feeding tube C. keeping the head of the bed flat D. ensuring that free water is provided correct answer C. The head of the bed should be kept at least >30 degrees elevated when providing enteral feeding in order to prevent aspiration. Choices A, B, and D are correct interventions for a patient who is receiving enteral nutrition Which of the following is true regarding plateau pressure? A. It is a pressure that is used to calculate static compliance and reflects pressure in the lungs.
B. It is a pressure that is used to calculate vital capacity and reflects pressure in the lungs C. It is a pressure that is used to calculate dynamic compliance and reflects pressure in the airways. D. It is a pressure that is used to measure tidal volume and reflects pressure in the airways correct answer A. Plateau pressure reflects lung pressure and is needed to calculate static (lung) compliance. It is not used to calculate vital capacity, dynamic compliance, or tidal volume. Peak inspiratory pressure is used to calculate dynamic compliance. Which of the following may be a reason to use restraints for a patient? A. the patient is screaming obscenities B. the patient is spitting C. The patient is pulling at his central venous catheter. D. The patient has an endotracheal tube correct answer C. If the patient is pulling at his central venous catheter, he is exhibiting behavior that may cause harm to himself. Assuming the alternatives to restraints were already attempted, the application of restraints to address this patient's nonviolent behavior would be appropriate. Screaming and spitting are behaviors that can not be controlled by restraints, and the presence of an ET tube alone is not reason to restrain the patient. Which of the following nursing behaviors is usually most helpful to patients and families regarding end of life decisions? A. avoiding the use of words such as " death", "dying", and "suffering" B. consulting the clergy for support C. acting as an arbitrator between family members D. requesting that only 1 person be the spokesperson correct answer C. When end of life decisions are required, a certain amount of family conflict usually
