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CCRN CRITICAL CARE REGISTERED NURSE EXAM
1 LATEST 2025 VERIFIED QUESTIONS AND
ANSWERS TEST BANK
2 types of chest tubes - correct answer>>wet and dry suction 3 primary lung functions and what are they? - correct answer>>1. Ventilation - moving air in & out of the lungs
- Perfusion - flow of blood through the pulmonary capillary bed
- Diffusion - gas exchange of O2 & CO2 across the capillary membrane and the alveoli 3 things Dx of ARDS - correct answer>>1 assessment 2 ABGS 3 CXR 4 Purposes of a chest tube 4 - correct answer>>1 Removal of air, pus, or blood 2 restore negative pressure to pleural space 3 Re-expand a collapsed lung 4 Drain blood from around heart 5 things to assess for ARF II - correct answer>>-abnormal lung sounds
- ABGS
- CXR
- V/Q, CT for PE
- SvO 6 steps to analyzing an EKG - correct answer>>1 Reg rhythm? R-R 2 Determine HR (count QRS in 6 sec) 3 Identify that all the P waves are the sam 4 Measure PR interval (count the small squares then x .04)
5 Measure QRS complexes (small squares x .04) 6 Measure QT A slight delay in conduction at the AV node serves what purposes? - correct answer>>Slows the conduction of the electrical impulses to allow time for atria to contract & empty contents into ventricles ABG goals for a pt with ARF II and COPD (PaO2, SpO2, PCO2, pH) - correct answer>>PaO2: 60- 80 SpO2: >90% Pco2: 50-60/ Pts baseline Normal pH ABG/vent settings goals for ARDS (5) - correct answer>>PO2 > spo2 >88% PEEP 5- 15 FiO2 < PCO2 60- 100 After how many days on intubation is it recommended to insert a trach ? - correct answer>> 21 After intubation the RN hears no breath sounds anteriorly bilaterally, where do you suspect the tube is - correct answer>>Esophagus ARDS assessment findings - correct answer>>1 acute dyspnea with dry cough & increased WOB 2 SPO2 and po2 trend 3 increased resp rate 4 crackles rhonci wheezes 5 increased HR BP and CO 6 anxious
Loss of acid due: vomiting of gastric fluid & prologned GI suctioning Causes of resp acidosis - correct answer>>Interference in gas exchange btw alveoli & blood. Increased CO (drug OD, COPD, CHF, low RR/TV on machine) Causes of resp alkalosis - correct answer>>Too fast of a RR or high tidal volume (blows off CO2). Can occur with mechanical ventilation CI calculation - correct answer>>CO/BSA (body surface area) CO calculation - correct answer>>HR x SV/1000ml Complications of central line insertion 5 - correct answer>>-pneumo
- air emboli
- infection
- local obstruction
- clot embolization Complications of PEEP/CPAP? (3) - correct answer>>1. Heart = decreased BP, preload, & CO)
- Brain = increased ICP
- Barotrauma = (pneumothorax, broncho/pleural fistula) Criteria for ARF type II 4 - correct answer>>-acute dyspnea
- PaO2 <50/60 on >50% oxygen (50/50 rule)
- PaCO2 >
- acidotic pH Criteria to wean someone from a vent 4 - correct answer>>-hemodynamically stable
- resolving patho cause of intubation/ventilation
- settings at minimal levels
- ABG results
DO2 calculation - correct answer>>DO2 = CO x Arterial Oxygen content Dobutamine/dobutrex (5)
- Class of drug:
- ___ Stimulation:
- Dose: - correct answer>>- Positive inotrope/ adrenergic
- B1 stimulation: increase contractility & CO & HR
- dose:2-20mcg/kg/min DOC for tachycardia - correct answer>>Adenosine DOC of bradycardia - correct answer>>atropine Dopamine/inotropin
- Class of drug
- Main function
- Low dose?
- Mid dose?
- High dose? - correct answer>>1. sympathomimetic & dopaminergic
- drug of choice for maintaining BP
- low dose 1-5mcg/kg/min
- Mid dose: 5-10mcg/kg/min
- high dose: 10-20mcg/kg/min During depolarization of the myocardial cell, _____ & _____ move into cardiac cells and _____ moves out of the cells - correct answer>>1. Na+ & Ca+
- K+ During repolarization of the myocardial cell, ____ moves back into the cardiac cells and ____ & ____ move out of the cell - correct answer>>1. K+
- Na+ & Ca+ End stage ARDS 6 (Profound what?, PH?, What will happen to the
Push the pass button or pull the cord on art line to flush the line and make a square wave on the EKG. Can be normal, overdampened, underdampened How do you know a line is obstructed? - correct answer>>Dampened of flattened waveform created How long does it take for the kidneys to compensate for acidosis - correct answer>> 24 - 48hrs How many more times at risk is an intubated pt for pneumonia? - correct answer>>3x How many ports are there on a PA catheter? - correct answer>> 4
- proximal/distal
- one port to inflate balloon w/ air to measure PAOP
- Thermos connector to measure temp How much higher is an arterial line pressure than standard cuff? - correct answer>> 5 - 10 mmHg How much pee should a human produce? - correct answer>>.5ml/kg/hr How much pressure do you need to perfuse capillary beds? - correct answer>>30ml How much pressure does an Art. line fluid bag need to be under & how much normal saline running? - correct answer>>300ml of pressure under a 500 ml bag How much pressure should be in a ETT cuff - correct answer>>Less than 20 mmHg How much shunting is occurring based on P/F ratio - correct answer>>Normal =
300 <5%shunt Mild ARDS = 200-300 about 15%
Moderate ARDS = 100-200 about 20% Severe ARDS <100 about 30% How to assess brain perfusion - correct answer>>LOC How to confirm ETT tube placement 3 - correct answer>>End tidal CO2 detector Auscultate Portable CXR How to measure afterload of left ventricle? - correct answer>>SVR, systemic vasc resistance How to measure afterload of right ventricle? - correct answer>>PVR, pulm vasc resistance How to measure preload pressure of left ventricle? - correct answer>>PAWP/PAOP, lungs before L heart How to measure preload pressure of right ventricle? - correct answer>>CVP/RAP, superior vena cava before the R heart How would you know that a tube has gone too deep and entered the right lung? - correct answer>>Unequal, chest rise and unilateral breath sounds If a pt core temp is 39.6, you would expect to see what? - correct answer>>Decreased SvO If a pt has a glasgow coma scale (GCS) of less than 8 what needs to happen - correct answer>>Pt needs intubated their neural control is not good enough to breathe If there is backflow on left side of the heart where would it go and what would be the symptoms? (3) - correct answer>>Back up into the lungs Crackles, Dyspnea, & Increased pressures If there is backflow on the right side of the heart where would it go and what would be the symtoms? (2) - correct answer>>Back up into the body
- Coma/ respiratory arrest Long term risk of intubations 3 - correct answer>>-T/E fistula
- sinusitis
- vocal cord paralysis MAP calculation - correct answer>>Systolic BP + (Diastolic BP x2)/ Meds for COPD w/ ARFII - correct answer>>Bronchodilators Steroids if they wheezing Mucolytics Meds for intubation (3) & what do they each do? - correct answer>>Anectine/Sux as a neural block Etomidate short acting anaesthetic Versed: benzo to decrease anxiety Nicardipine/cardene
- Class of drug
- Main function
- Decreases ___?
- Maintains ___?
- Doesn't cause ___?
- Route? - correct answer>>1. CA channel blocker
- arteriolar vasodilation - HTN crisis/hemorrhage
- decreases SVR
- Maintains CO
- Doesn't cause bradycardia
- only IV Nitroglycerine/tridil (4)
- Class of drug:
- Main function:
- Decreases ____ & ____
- Main side effect?
- Route: ___ & ___ - correct answer>>1. Antianginal vasodilator
- dilates veins/arteries AND coronary arteries. Decrease chest pain
- decreases pre/afterload
- SE: decreased BP
- Route: sublingual, IV Nitroprusside/nipride
- Class of drug:
- Main function:
- Major SE: - correct answer>>1. Anti-HTN, vasodilator
- used for severe HTN crisis (dilates the veins/arteries right ****in quick)
- Side effect: thiocyanate toxicity (protect from light) Norepi/levophed (4)
- Class of drug:
- Main function:
- ___ & ___ stimulation?
- Watch for what? - correct answer>>1. Vasoconstrictor & sympathomimetic
- Main function: Increase BP & Contractility
- Alpha 1 stimulation: arterial vasoconstriction & B1 stimulation: increased contractility
- Watch for infiltration (potent) Normal CI - correct answer>>Cardiac index 2.2-4L/min Normal CO - correct answer>> 4 - 8L/min
- document
- change bag Q
- Make sure alarms are on! If pulled out major bleeding can happen Nrsg priorities for a artificial airway 5 - correct answer>>1. Humidification
- Suctioning (only as needed)
- Communication
- Safety (#1 protecting airway)
- Comfort Nurse is caring for a pt that CVP is - 1mmHg, what tx is most helpful? - correct answer>>Administer additional IV fluids Nursing priorities with ARF II - correct answer>>1 correct hypoxemia 2 mechanical vent 3 tx underlying problem 4 turning - "good lung down" Nutritional needs for ARDS - correct answer>> 35 - 45 kcal/kg/day. Use TPN if needed P wave: what does it represent? - correct answer>>Atrial depolarization P-Q:what does it represent? - correct answer>>Atrial kick or AV node delay P-R interval: what is the normal range? - correct answer>>.12-.2 secs Patho of ARF II (increased ___ causing ___ & ____ response causing increased what?) - correct answer>>Hypoxemia causing
- Hypercapnia (headache, CNS changes, confusion, decreased LOC)
- SNS response = (Increased HR, RR, BP) PP calculation - correct answer>>PP = SBP-DBP Prevention of intubation complications 5 - correct answer>>-ready oral suction at bedside
- lift HOB after procedure
- assess for gastric distension
- assess for bilateral lung sounds
- can cause atelectatic left and RUL lungs Proper spot for end of ETT tube - correct answer>>2 cm above carina QRS complex: what is the normal range? - correct answer>><.10 secs QRS complex:what does it represent? - correct answer>>Ventricular depolarization QT interval: what is the normal range? - correct answer>>< 1/2 R to R S/s of air embolism 5 - correct answer>>Dyspnea, tachypnea, coughing, cyanosis, hypotension Short term complications of intubation 3 - correct answer>>-vomit/aspiration
- gastric intubation
- right mainstem broncos infection SV calculation - correct answer>>(CO/HR) x 1000ml SVR Calculation - correct answer>>((MAP-CVP)/CO )x T wave; what does it represent? - correct answer>>Ventricular repolarization The right side of the heart pumps blood to the ____ and the left side of the heart pumps blood to the _____ - correct answer>>1. Lungs
- Rest of the body The upper chambers of the heart are called ______ & the lower chambers are called ______ - correct answer>>1. L&R atrium'
- L&R ventricles Tx for sinus bradycardia - correct answer>>No treatment unless symptomatic!! O2, Atropine, Pacemaker Tx goals for ARDS 7 (Tx what?, Reverse what?. Open what?, Ph?, Tv?,
- Ensure the seal is complete
- Watch for nasal pressure ulcers
- make sure to perform mouth care because they get dry real quick What are the 2 reasons that a ETT cuff would be deflated? - correct answer>>1. Reposition
- Suction on top of cuff What are the 3 major components of oxygen supply/delivery? (SvO2) - correct answer>>CO SaO Hgb What are the 3 resistances to blood flow? - correct answer>>Diameter of vessels Viscosity of blood Elastic recoil of vessels What are the 4 most common unstable hemodynamic symptoms? - correct answer>>1. LOC
- Hypotension
- Chest pain
- SOB What are the interventions for decreased contractility and what are the medications to treat it? - correct answer>>Positive inotropes Dobutamine & Dopamine What are the interventions for increased contractility? - correct answer>>Beta blockers - Lopressor What are the normal values for CVP and RAP? - correct answer>>-Central Venous Pressure 2-6mmHg
- Right atrial pressure 2-8mmHg What are the normal values of PAS, PAD, PAM? - correct answer>>Pulm artery systolic: 20-30mmHg Pulm artery diastolic: 5-10mmHg Pulmonary artery mean: 10 - 15mmHg What are the spontaneous resp parameters? (3) - correct answer>>-TV around 5 - 8ml/kg
- VC of 3xTV
- NIF of - 20 to - 30cm H2O What are the top 4 causes of ARDS - correct answer>>Indirect --> Sepsis (#1) & Trauma Direct --> Aspiration & Pneumonia What are the two back up pacemakers of the heart called and what are their intrinsic rates? - correct answer>>AV junction (40-60bpm) & Purknje fibers (ventricles) (30-40bpm) What are the two common insertion sites for a PA catheter? - correct answer>>Subclavin & jugular What are the V/Q mismatches and what are they? - correct answer>>1. Shunt unit - Decreased ventilation but ok perfusion
- Dead space - Decreased perfusion but ok ventilation
- Silent unit - Neither perfusion or ventilation What body chemicals decrease the heart rate? - correct answer>>parasympathetic acetylcholine What body chemicals increase the heart rate? - correct answer>>Sympathetic epi/norepi What causes decreased contractility? 4 - correct answer>>Decreased SV, LVEF,
What generates electrical impulses spontaneously & generate an action potential with pacemaker heart cells? - correct answer>>Automaticity What happens during diastole and what two valves are open? - correct answer>>Atriums fill w/ blood Mitral & tricuspid What happens during systole and what two valves are open? - correct answer>>Ventricles contract & empty contents Pulmonic & aortic What happens if the tissues are not receiving adequate oxygen? - correct answer>>Cells switch to anaerobic metabolism and produce lactic acid What happens if you over inflate a ETT cuff - correct answer>>Possible esophagotracheal fistula What is a bite block? - correct answer>>Prevents pt from biting down on the tube What is a CVP and how can you assess it with a central line? - correct answer>>Central venous pressure, directly monitors pressure of superior vena cava. Can be assessed by attaching monitor to brown port on triple lumen central line What is a CVP catheter measuring? - correct answer>>Right sided preload(filling pressures) CVP & RAP what is a high dose dopamine use for? - correct answer>>-A1 stimulation
- artery constriction to increase BP/SVR What is a low dose dopamine used for? - correct answer>>-increases renal and mesenteric perfusion What is a mid dose dopamine used for? - correct answer>>-B1 stimulation to
increase contractility What is a mixed disorder and what type of failure usually causes it? - correct answer>>Mixed metabolic and respiratory acidosis due to resp/renal failure. Causes excessive pH drop, increased PCO2 and decreased HCO What is a modified allen test? - correct answer>>Assesses the collateral circulation to hand via ulnar artery. Done by holding pressure on ulnar artery and the fingers should turn pink, also done before checking ABGs from art line What is a normal lactic acid level and what does it test for? - correct answer>><2 normal value Showing perfusion at capillary membranes What is a normal LVEF/EF - correct answer>>Left ventricular ejection 50-70% What is a normal SV - correct answer>>-Stroke Volume 60-100ml/beat What is a occlusion test? - correct answer>>Done if airway swelling is suspected, does the air flow around the cuff when deflated? If not the pt airway wont support extubation What is a RSBI and how do you calc it? - correct answer>>Rapid shallow breathing index RR/TV What is a sub-glottic suction? - correct answer>>A special tube that has the ability to suction secretions that lay on top of the inflated cuff What is a swan-ganz catheter and what does it measure? - correct answer>>Pulmonary artery catheter Can measure both R & L sided heart pressures What is a tidal volume and the normal levels? - correct answer>>The normal breath that you breath in & out.
