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CCRN CRITICAL CARE REGISTERED NURSE EXAM LATEST
2023/2024 QUESTIONS AND 100% CORRECT ANSWERS TEST
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-Which of the following ventilator settings is most likely to decrease the work of breathing? A assist- control B pressure support C tidal volume D CPAP {{Ans- Answer: B Pressure support senses the beginning of the patient's spontaneous inspiration and provides a set pressure to assist the inspiratory effort. The primary purpose of the ventilator settings listed in choices (A), (C), and (D) is not to decrease the work of breathing. -A nurse is caring for a patient with an acute inferior wall MI, post coronary artery stent deployment. For optimal care of this patient, the nurse should: Select single answer choice. A administer an analgesic for acute back pain. clearYou selected. B apply a pressure dressing to the groin. ClearYou did not select. C continuously monitor the patient in lead II. D maintain the patient in a supine position. {{Ans- Answer: C It is best practice to continuously monitor a patient, who is post coronary artery stent deployment, in the lead that was most abnormal during the acute occlusion. Lead II would most likely meet this criterion for a patient with an inferior wall MI. The remaining interventions are NOT indicated for a patient who is post coronary artery stent deployment. -A patient with aortic regurgitation will have which of the following upon auscultation? Select single answer choice.
A
a diastolic murmur, loudest at the fifth intercostal space, midclavicular a systolic murmur, loudest at the apex of the heart C a diastolic murmur, loudest at the second intercostal space, right sternal border
as long as the hemodynamic criteria are met. A patient who is receiving PRN morphine may be a candidate for a spontaneous breathing trial, but that patient does not require an infusion to be stopped in order to be awakened. The remaining 2 choices do not meet the criteria for performing either a spontaneous awakening trial or a spontaneous breathing trial. -While the code team is performing resuscitative efforts, many of the patient's family members start to cry and pray, while other family members lie down on the floor in the corner of the room. Which of the following demonstrates the best action for the nurse to take at this time? Select single answer choice. A Ensure that a member of the code team serves as a family presence facilitator and clearly communicates the treatment strategies to the family. B Call security to escort the family members to the waiting room due to their disruptive behavior. C Encourage the family members to leave the patient care area because they are extremely distressed. D Ask the family members to leave the patient care area because they may suffer anxiety from remaining in the room. {{Ans- Answer: A It is important to offer families the opportunity to witness the efforts of the health care team during a patient's cardiopulmonary resuscitation. Research suggests that allowing family members to stay with a patient during this time may decrease their rates of post- traumatic stress disorder, depression, and anxiety related to the event. If the family interferes with the code team's ability to provide care to the patient, it may be necessary to have security remove the family; however, this scenario does not state that the family members are interfering with the code team's efforts, so choice (B) is incorrect. The remaining 2 choices do not allow the family to grieve in a way that may be natural to them. -Cardiogenic shock secondary to left ventricular failure will generally result in: Select single answer choice. A decreased afterload. B a narrow pulse pressure. C decreased preload. D a widening pulse pressure. {{Ans- Answer: B
The systolic pressure decreases due to a drop in the cardiac output; however, the diastolic pressure either stays the same or increases due to a compensatory increase in the systemic vascular resistance. The remaining choices are not found in the presence of cardiogenic shock. -Massive atelectasis occurs in the presence of acute respiratory distress syndrome (ARDS). What are the 2 causes of the atelectasis that is typical of ARDS? Select single answer choice. A a surfactant deficiency and pulmonary edema B increased pulmonary vascular resistance and increased pulmonary compliance C increased pulmonary compliance and pulmonary edema D mucus plugs and bronchospasm {{Ans- Answer: A ARDS destroys Type II alveolar cells, which results in decreased surfactant production. ARDS also results in capillary leak at normal left-sided heart pressures, which results in pulmonary edema. Both a surfactant deficiency and pulmonary edema lead to atelectasis. The remaining choices are not correct because increased pulmonary compliance and mucus plugs are not features of ARDS. -A patient was admitted with an acute inferior wall STEMI. The physician advises the nurse to monitor the patient for signs of right ventricular (RV) infarction. Which of the following are signs of RV infarction? Select single answer choice. A S4 heart sound, lung crackles B hypotension, flat neck veins C hypertension, a systolic murmur D distended neck veins, clear lungs {{Ans- Answer: D If the RV contractility decreases, the pressure that is proximal to the right ventricle (which is the right atrial pressure) increases, resulting in distended neck veins. As the right heart fails, the left heart preload decreases, and the lungs are clear. -Which of the following is an effect of hypothermia?
{{Ans- Answer: D Alcohol abuse results in chronic, not acute, hepatic failure. A salicylate overdose results in renal failure. Biliary obstruction may lead to pancreatitis or gallbladder disease. -Which of the following is most likely to lead to cardiopulmonary arrest for a patient with status asthmaticus? Select single answer choice. A bronchospasm
. B thick, tenacious secretions. C hypoxemi a. D air trapping. {{Ans- Answer: D Air trapping, due to the inability to effectively exhale, leads to chest hyperinflation, which in turn leads to decreased venous return and a precipitous drop in cardiac output. The remaining choices are seen with status asthmaticus but are not direct causes of cardiopulmonary arrest. -The ECG demonstrates ST elevation in leads II, III, and aVF. The nurse needs to monitor the patient closely for which of the following? Select single answer choice. A tachycardia, lung crackles B sinus bradycardia, an acute systolic murmur in the fifth intercostal space, midclavicular C second-degree AV block (Type II), hypotension. D hypoxemia, an acute systolic murmur in the fifth intercostal space, left sternal border. {{Ans- Answer: B Complications that are likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA node and/or the AV node and papillary muscle rupture or dysfunction due to the anatomical distance between the right coronary artery and the papillary muscle. The remaining choices are not common complications of an inferior wall MI. -Which of the following statements about delirium is accurate? Select single answer choice.
A
Hypoactive delirium is easier to identify than hyperactive delirium or mixed delirium. B Haloperidol is an effective treatment for delirium. C The severity of a patient's illness upon admission puts the patient at a greater risk for delirium. D Deep sedation will prevent delirium. {{Ans- Answer: C Studies have shown the severity of a patient's illness upon admission puts the patient at a greater risk for delirium during his or her time in critical care. The remaining choices are not true statements. -Which of the following is an early indication of adequate fluid resuscitation? Select single answer choice. A a decreased heart rate B a narrowing pulse pressure. C an S3 heart sound. D increased hematocrit. {{Ans- Answer: A As fluid resuscitation progresses and hypovolemia is addressed, there is less need for heart rate compensation to maintain the cardiac output. The remaining choices are not seen as evidence of adequate fluid resuscitation. -Which of the following hemodynamic profiles would benefit from aggressive fluid administration, pressors, and antibiotic therapy? Select single answer choice. A right atrial pressure (RAP) 1 mmHg; pulmonary artery occlusion pressure (PAOP) 4 mmHg; systemic vascular resistance (SVR) 1,800 dynes/sec/cm-5; cardiac output (CO) 2 L/min. B right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 7 mmHg; systemic vascular resistance (SVR) 400 dynes/sec/cm-5; cardiac output (CO) 8 L/min. C right atrial pressure (RAP) 5 mmHg; pulmonary artery occlusion pressure (PAOP) 17 mmHg; systemic vascular resistance (SVR) 1,900 dynes/sec/cm-5; cardiac output (CO) 2 L/min. D
This patient requires titration of FiO2 to maintain an SpO2greater than 0.90. Short-term mechanical ventilation may be needed for select patients who are in a similar situation. There is no indication of fluid overload, which may occur with transfusion-associated circulatory overload (TACO). Therefore, a diuretic, such as furosemide (Lasix), is not needed. Diphenhydramine (Benadryl) and subcutaneous epinephrine are not treatments for TRALI. -A patient with a history of chronic alcohol abuse was admitted in a stuporous state with an extremely elevated serum alcohol level. Which of the following will most likely be a part of the treatment plan for this patient? Select single answer choice. A naloxone, activated charcoal, sodium bicarbonate B flumazenil (Romazicon), lactulose, calcium gluconate. C dialysis, cooling, potassium. D fluids, thiamine, phosphate. {{Ans- Answer: D This patient has signs of acute alcohol poisoning with a history of chronic alcohol abuse. Fluids are needed to prevent hypovolemia. Chronic alcohol abuse leads to a thiamine deficiency. Therefore, thiamine is needed to prevent Wernicke encephalopathy. Hypophosphatemia is commonly seen in patients with chronic alcohol abuse. Therefore, the administration of phosphate is also indicated. The remaining 3 choices are not interventions for alcohol poisoning. -Which of the following is indicative of a mixed acid-base disorder? Select single answer choice. A pH 7.18; PaCO2 25; PaO2 64; HCO3 11. B pH 7.33; PaCO2 29; PaO2 72; HCO3 15. C pH 7.35; PaCO2 61; PaO2 62; HCO3 41. D pH 7.25; PaCO2 36; PaO2 68; HCO3 18. {{Ans- Answer: B The decreased PaCO2 is evidence of respiratory alkalosis, and the decreased HCO3 is evidence of metabolic acidosis. A patient with sepsis or septic shock may present with this type of mixed acid-base disorder. Choice (A) is reflective of a patient who has metabolic acidosis with partial compensation.
Choice (C) is reflective of a patient who has respiratory acidosis with full compensation. Choice (D) is reflective of a patient who has uncompensated metabolic acidosis. -A patient has an 18-gauge intravenous catheter in his right wrist. The nurse assessed the insertion site prior to administering an IV medication, and the nurse noticed that there was a red line up the arm above the insertion site, there was no swelling, the catheter blood return was brisk, and the site up the arm with the red line was tender to touch. Which assessment and intervention is appropriate at this time? Select single answer choice. A The patient has an extravasation; apply warm compresses over the insertion site. B The patient has a grade 2 infiltration; restart the IV, and apply cool compresses over the insertion site. C The patient has phlebitis; restart the IV with a 20-gauge catheter in the left arm. D The IV catheter is functional; give the IV medication, and reassess the catheter for blood return in an hour. {{Ans- Answer: C A red line above the insertion site, with tenderness, is a sign that the wall of the vein is inflamed, and the catheter needs to be removed. Reinsertion with a smaller gauge catheter is a strategy that can be used to prevent vein irritation. There is no evidence provided that this patient received a vesicant nor are there signs of an extravasation. Therefore, choice (A) is incorrect. The nurse's findings do not support an infiltration. Therefore, choice (B) is incorrect. The nurse should not administer the IV medication into a vein with phlebitis. Therefore, choice (D) is also incorrect. -Which of the following treatments is appropriate for the corresponding overdose? Select single answer choice. A dialysis for a salicylate overdose B Romazicon for an opiate overdose. C a beta blocker for a cocaine overdose. D warming for a phencyclidine (PCP) overdose. {{Ans- Answer: A Dialysis may be initiated even before abnormal creatinine or GFR develop. The remaining choices are incorrect treatments for the associated overdoses.
D
vasopressors. {{Ans- Answer: A The rhythm described is sinus arrest. Since the patient is having serious signs and symptoms, the immediate treatment is transcutaneous pacing. Transvenous pacing may be done once the patient is stabilized. The remaining 2 choices are not indicated for sinus arrest. -A patient is receiving a heparin infusion for the treatment of a pulmonary embolism. There has been a 60% decrease in the platelet count and no clinical changes. Which of the following is indicated? Select single answer choice. A Administer vitamin K, and begin a direct thrombin inhibitor. B Discontinue heparin, and begin argatroban. C Order an enzyme-linked immunosorbent assay (ELISA), and infuse platelets. D Administer protamine sulfate, and decrease heparin. {{Ans- Answer: B This patient most likely has heparin-induced thrombocytopenia (HIT). Exposure to heparin needs to be immediately discontinued, and a direct thrombin inhibitor (such as argatroban) needs to be started for continued anticoagulation. Vitamin K does not address thrombocytopenia, so choice (A) is incorrect. The ELISA test will definitively confirm HIT, but the results generally take longer than 24 hours to return, whereas action needs to be taken immediately in this situation. Also, the administration of platelets is not indicated unless bleeding occurs or the platelet count is reduced to ~ 10,000. For those reasons, choice (C) is incorrect. Protamine sulfate is not useful for the treatment of HIT. Therefore, choice (D) is also incorrect. -Lab tests show urine sodium less than 20, urine osmolality greater than the serum osmolality, BUN 70, and creatinine 3.1. This is a sign of what type of renal failure? Select single answer choice. A renal hypoperfusion without tubular basement membrane involvement. B nephrotoxic acute tubular necrosis, intrarenal failure. C ischemic acute tubular necrosis, intrarenal failure. D cortical renal failure with tubular basement membrane involvement. {{Ans- Answer: A
A urine sodium less than 20, the renal tubules' ability to concentrate urine, and a BUN/creatinine ratio of ~ 20:1 indicate that the renal tubular basement membrane remains intact. The remaining 3 choices involve an injury to the renal tubular basement membrane and would not produce the lab results described in the question. -Which of the following statements about the provision of enteral nutrition for a critically ill patient is accurate? Select single answer choice. A It is preferred over the parenteral nutrition route. B It should be initiated 48 to 72 hours after the first day of mechanical ventilation. C It should be initiated after the patient has bowel sounds and passing flatus. D Enteral nutrition should be withheld if the gastric residual volume is greater than 100 mL. {{Ans- Answer: A If the gut can be used, that is the preferred nutrition route because it is more natural and has fewer complications than the parenteral nutrition route. The remaining choices are not accurate in regard to enteral nutritional support. -A patient with Type 1 diabetes has been started on metoprolol for heart disease. The nurse needs to inform the patient that the first sign of hypoglycemia might be which of the following? Select single answer choice. A mental status change. B palpitations
. C diaphoresis . D irritability. {{Ans- Answer: A The beta blocker (metoprolol) will mask the early signs of hypoglycemia that are due to sympathetic stimulation (tachycardia, palpitations, irritability, headache, shakiness, and diaphoresis). The presenting signs will be the later signs of hypoglycemia (mental status change, slurred speech, seizure, and coma). -Which of the following are appropriate interventions for the treatment of anaphylaxis? Select single answer choice.
Balloon deflation in the descending aortic arch right before systole creates a drop in afterload. When the balloon inflates during diastole, blood is displaced into the coronary arteries, increasing coronary artery perfusion. -Which of the following patient diagnoses has the greatest degree of predictability? Select single answer choice. A an acute inferior wall MI B septic shock. C heart failure. D acute leukemia. {{Ans- Answer: A Of the diagnoses listed, the diagnosis of an acute inferior wall MI has the greatest degree of predictability. Predictability is a patient characteristic that considers the degree to which the patient outcome is expected. The remaining 3 choices are more likely to involve unforeseen complications and are therefore are less predictable. -A patient presents with hypotension refractory to initial treatment, and a pulmonary artery catheter is placed. The hemodynamic profile demonstrates right atrial (RA) pressure 1 mmHg, pulmonary artery pressure (PAP) 19/6 mmHg, pulmonary artery occlusion pressure (PAOP) 4 mmHg, systemic vascular resistance (SVR) 1,500 dynes/sec/cm-5, and SvO255%. What is most likely the cause of this patient's hypotension, and what is the appropriate treatment? Select single answer choice. A hypovolemic shock; fluids B septic shock; vasopressors. C cardiogenic shock; IABP. D anaphylactic shock; epinephrine IM. {{Ans- Answer: A Volume depletion results in decreased preload. A compensatory response to volume depletion results in an increase in the SVR in an attempt to maintain pressure. Fluids will restore the filling pressure (preload), and the SVR will return to normal as compensatory mechanisms will no longer be needed.
-A patient has right middle and lower lobe pneumonia. Which of the following is an appropriate intervention for this patient? Select single answer choice. A Provide fluids and expectorants. B Maintain the patient in a supine position. C Withhold enteral nutrition. D Avoid turning the patient to his right side. {{Ans- Answer: D Gravity will increase perfusion to the dependent lung tissue. The "good" lung in this case is the left side. Turning the patient to his right side may precipitate hypoxemia by increasing perfusion to the side with greater disease. -A patient was admitted post motor vehicle accident with hypotension and an INR of 8. Which of the following needs to be administered to this patient? Select single answer choice. A protamine sulfate. B vitamin K. C heparin
. D platelets. {{Ans- Answer: B This patient was most likely taking warfarin (Coumadin) prior to admission, which caused an elevated INR. Warfarin works by inhibiting the effects of vitamin K, thereby preventing the conversion of prothrombin to thrombin. A rapid reversal of warfarin with vitamin K is indicated since this patient is hypotensive post MVA and may have internal bleeding. The remaining choices will not decrease the INR. -A patient with a history of thyroid disease was admitted with elevated TSH and decreased T and T4. Based on these lab results and the patient history, which of the following assessments would be expected for this patient? Select single answer choice. A tremor, fever, respiratory alkalosis
-A patient with oat cell carcinoma has the following clinical findings: low urine output, low serum osmolality, hyponatremia, and elevated urine sodium. The nurse anticipates which of the following as part of the treatment plan? Select single answer choice. A vasopressin, free water B vasopressin, hypertonic saline. C phenytoin (Dilantin), 3% saline. D phenytoin (Dilantin), 0.45 normal saline. {{Ans- Answer: C This patient has signs of SIADH, which results in the production of excessive ADH. Phenytoin (Dilantin) will inhibit ADH secretion, and 3% saline will increase the serum sodium. The remaining choices (vasopressin, free water, 0.45 normal saline) will worsen the problem. -What is an indication for which a patient, who is receiving mechanical ventilation, is placed in the prone position? Select single answer choice. A tachypnea
. B hypoventilatio n. C pulmonary hypertension. D refractory hypoxemia. {{Ans- Answer: D The prone position helps alleviate refractory hypoxemia (e.g., ARDS) by allowing for the perfusion of lung units that were not able to be perfused while the patient was in the supine position. P lacing the patient in the prone position is not an intervention that is used for the remaining 3 problems. -Which of the following is NOT needed to calculate the creatinine clearance? Select single answer choice. A serum BUN B
the patient's age. C the patient's sex. D ideal body weight. {{Ans- Answer: A The serum BUN is not needed to calculate the creatinine clearance. The remaining 3 values (as well as the serum creatinine) are used for this calculation. The creatinine clearance is the best clinical indicator of the glomerular filtration rate (GFR). -A 70 kg patient required intubation for status asthmaticus. A propofol infusion was started at 40 mcg/kg/min, and the patient appears calm. The ventilator settings are: FiO20.30, assist-control mode 12 breaths/minute, tidal volume 400 mL, and an increased peak flow rate. The patient's respiratory rate is 28 breaths/minute, and the SpO2 is 0.98. Which of the following interventions should the nurse anticipate? Select single answer choice. A Administer vecuronium (Norcuron) PRN. B Decrease the tidal volume. C Increase the assist-control rate. D Increase the FiO2. {{Ans- Answer: A The elevated respiratory rate needs to be immediately addressed since it puts the patient at risk for auto-PEEP. The goal of ventilation for a patient with status asthmaticus is to provide low breath rates, a short inspiratory time, and a longer expiratory time, as well as to prevent auto- PEEP. Although neuromuscular blocking agents should be avoided, if possible, the benefit of administering Norcuron PRN outweighs the risk in this particular situation. The tidal volume is already low, so choice (B) is incorrect. An increase in the assist-control rate would not be beneficial, so choice (C) is incorrect. This patient does not have hypoxemia. Therefore, an increase in the FiO2 is not indicated, which means that choice (D) is also incorrect. -A patient has a flattened diaphragm, as confirmed on a chest X-ray, and a decreased expiratory flow rate. This patient most likely has which of the following? Select single answer choice. A pulmonary embolism. B
