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CCRN Questions And 100% Correct Answers
A patient has had a large anterior myocardial infarction last month and developed a ventricular aneurysm. He now has episodes of ventricular tachycardia that are not prevented or converted with antidysrhythmic agents. An ICD is implanted. Four days after surgery he develops VT. The ICD has delivered three shocks but has not converted the rhythm. He is pulseless and apneic. Cardiopulmonary resuscitation is in progress.What is the priority action now?
A. IV epinephrine Administration of B. amiodarone C. Defibrillate D. ICD reactivation - Answer Defibrillate A 28-year-old female is brought to the critical care unit from the emergency department with a diagnosis of asthma. Initial arterial blood gases on a 28% Venturi mask are as follows: pH 7. PaCO2 30 mm Hg HCO3 24 mEq/LPaO2 64 mm Hg
Which of the following repeated arterial blood gases on 40% oxygen indicate the patient's condition is deteriorating?
A.
pH 7.48, PaCO2 30 mm Hg, PaO2 68 mm Hg B. pH 7.46, PaCO2 32 mm Hg, PaO2 61 mm Hg C. pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg D. pH 7.39, PaCO2 30 mm Hg, PaO2 60 mm Hg Answer C. pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg
This case represents stage II asthma. Option c is now in stage III asthma. The patient is still tachypneic, but CO2 is beginning to be retained as evidenced by the elevation of the PaCO2 into normal range. Options a and b remain in stage II. Option d shows a respiratory alkalosis with a metabolic acidosis because you would have expected the pH to be in an alkalotic range with the PaCO2 of 30. A patient who is in alcohol withdrawal syndrome describes the swirls in the wallpaper as being worms. This is an example of which of the following?
A. Delusion B. Hallucination C.
decreased levels of 2,3-diphosphoglycerate. A 65-year-old woman presents with severe dyspnea 2 days after abdominal surgery. She is admitted to the critical care unit. On 5 L of oxygen by nasal cannula, her arterial blood gases are as follows: pH 7. PaCO2 35 mm Hg HCO3 19 mEq/L PaO2 40 mm Hg Arterial oxygen saturation 75% Why does this patient have hypoxemia without hypercapnia? A. Because carbon dioxide is more diffusible than oxygen B. Because carbon dioxide has more driving pressure C. Because carbon dioxide is less diffusible than oxygen D. Because carbon dioxide excretion by the kidney is increased - Answer Because carbon dioxide is more diffusible than oxygen
Carbon dioxide is 20 times more diffusible than oxygen. In conditions that affect diffusion but not ventilation, one would expect the PaO2 to be low and the PaCO2 to be
normal (or low in hyperventilation, as in this patient). If ventilation were impaired, as might occur if this patient were fatiguing, the PaCO2 then would rise. Driving pressure is the fraction of the gas in inspired air multiplied by the barometric pressure. Because carbon dioxide is ~0.5% of inspired air, the driving pressure would be very low. The kidney eliminates bicarbonate and hydrogen ions, but the lungs eliminate carbon dioxide.
A 55-year-old patient has headache, nuchal rigidity, photophobia, and positive Kernig's and Brudzinski's signs. These are consistent with which of the following?
Intracranial hemorrhageA.
Subarachnoid hemorrhage^ B.
Epidural hemorrhage^ C. D. Subdural hemorrhage - Answer Subarachnoid hemorrhage When there is bleeding from an aneurysm, that blood will irritate the meninges. The clinical presentation is very similar to meningitis. This clinical presentation is not consistent with intracranial, epidural, or subdural bleeding because in those situations, the blood is not in contact with the meninges.
An extra heart sound preceding S1 is most likely an S4 if the stethoscope's:
diaphragm is over the apex.^ A.
D.
Democratic approach - Answer Facilitating collaboration This is a sample of facilitating collaboration. The nurse is, in effect serving as mediator to help these two groups work toward shared goals. In smoothing, you would attempt to decrease the emotional tension of the conflict, but the conflict really wouldn't be resolved. In compromising, each group would lose something it desires. In a democratic approach, majority rules. Which of the following ICP waveforms are of the most clinical significance and require immediate intervention?
A. A waves
B waves^ B.
C waves^ C.
D waves - Answer A waves, or plateau waves, are spontaneous, rapid increases in^ D. pressure between 50 and 200 mm Hg that last 5 minutes or more. A waves cause cerebral ischemia and are the most clinically significant ICP waveforms. Immediate intervention is necessary to prevent further brain injury and herniation. A waves are Awful Name Which of the following diagnostic tests would provide definitive evidence of a pneumothorax? A.
Arterial blood gases B.Chest x-ray film
Pulmonary function studies^ C. D. Spiral computed tomography - Answer Chest x-ray film (Which is not really true. but the test says so. Which of the following does not shift the oxyhemoglobin dissociation curve to the left or the right?
A. Blood pH B. 2,3-diphosphoglycerate (2,3-DPG) levels C. Body temperature
Cardiac output - Answer Cardiac output^ D.
right axis deviation or indeterminate axis.
right axis deviation or left axis deviation.^ C.
left axis deviation or indeterminate axis. - Answer left axis deviation or indeterminate^ D. axis. Ventricular tachycardia is most likely to be left axis deviation of indeterminate axis, whereas aberrancy is more likely to be normal axis or right axisdeviation. −30 or greater or
A 58-year-old man is admitted to the critical care unit with upper gastrointestinal bleeding. He has a history of chronic renal failure. When one is administering antacids, it is important to remember to avoid: A. magnesium-containing antacids.
phosphate-binding antacids.^ B.
calcium-containing antacids.^ C.
histamine2 receptor antagonists. - Answer magnesium-containing antacids.^ D.
Magnesium-containing antacids can lead to magnesium intoxication in the patient with renal failure.
A patient has been complaining of dull diffuse abdominal pain. Of the following etiology listed, which one is most likely to be the cause?
A. Appendicitis B. Cholecystitis C. Ulcerative colitis D. Large intestinal obstruction - Answer Large intestinal obstruction The rest are sharp pain Vt for extubation - Answer 5ml/kg A 30-year-old male is in the surgical intensive care unit after exploratory laparotomy performed after he sustained a gunshot wound to the abdomen. He now has developed a pancreatic fistula. Which acid-base imbalance is this patient at risk for developing? A. Respiratory acidosis
Metabolic acidosis^ B.
Blood loss C. Cardiac tamponade D. Intraoperative myocardial infarction - Answer Blood loss Note that all of the volume indicators (RAP, PAP, PAOP) have decreased. The increase in SVRI is compensatory and is caused by sympathetic nervous system stimulation. Stunned myocardium and intraoperative myocardial infarction more likely would cause an increase in PAOP because of heart failure. Cardiac tamponade would cause an increase in RAP, PAP, and PAOP. Which electrolyte is likely to develop a severe deficiency when an adequately nourished patient becomes malnourished?
A. Potassium B. Magnesium
Calcium^ C.
Phosphate - Answer Phosphate^ D. This is often termed refeeding syndrome. Nutritional support enables the cells to start producing more adenosine triphosphate, and phosphate stores are depleted. The same occurs in diabetic ketoacidosis with treatment when insulin enables glucose to enter the
cell, increasing production of ATP and depletion of phosphate. Which of the following would be a contraindication to the use of fibrinolytic drugs, such as recombinant tissue plasminogen activator?
A. Hypotension
B Heart block CUncontrolled hypertension DPain lasting more than 6 hours - Answer Uncontrolled hypertension Pain of more than 6 hours duration is no longer a contraindication to the use of fibrinolytic drugs, although we certainly want to give fibrinolytic drugs as early as possible. Consider that pain indicates the presence of lactic acid and anaerobic metabolism. The presence or absence of pain is related to the transmural nature and the extent of myocardial necrosis. If the myocardial infarction is completed, there is no pain because dead myocardium does not metabolize aerobically or anaerobically. As long as there is pain, there is salvageable myocardium. Hypotension and heart block are not contraindications to fibrinolytic drugs, and they may improve with reperfusion of the myocardium. Uncontrolled hypertension increases the risk of hemorrhagic stroke. A 72-year-old female is admitted to the emergency department following an episode of unresponsiveness while watching television with her husband. The nurse notes right-sided paralysis, aphasia, and lethargy. The patient was treated with fibrinolytic therapy. After the patient is stable, a diet is provided. The nurse knows that prior to allowing the patient to eat, it is important to assess which of the following cranial nerves?
A. IX, X
D.
Mandible fracture - Answer Fracture of the base of the skull Which of the following leads are most useful in distinguishing between ventricular tachycardia and a supraventricular tachycardia with aberrancy?
A. Leads II and III B. Leads V1 and V C. Leads I and aVL D. Leads V3 and V4 - Answer Leads V1 and V Looking at the heart from either side helps to identify whether the impulse originated in one ventricle or the other. Inferior, lateral, and anterior leads have a predominantly positive QRS complex because the wave of depolarization through the heart is downward and to the left. Lead V1 is the single most helpful lead to differentiate ventricular ectopy from aberrancy. Leads V1 and V6 together are the two most helpful leads.
Which of the following describes the main role of a case manager?
Educator^ A.
B.
Evaluator
Facilitator^ C.
Advocate - Answer Advocate^ D. A patient develops carpopedal spasm and neuromuscular irritability manifested by Chvostek's and Trousseau's signs. Which electrolyte imbalance should you suspect?
A. Hyperkalemia
Hypercalcemia^ B. C. Hypermagnesemia D. Hyperphosphatemia - Answer Hyperphosphatemia The patient's signs/symptoms are associated with hypocalcemia and its reciprocal condition, hyperphosphatemia. The same signs/symptoms also are seen in hypomagnesemia.
Hypercapnia C. Substernal chest pain
D. Moist, productive cough - Answer Substernal chest pain
Early manifestations of oxygen toxicity include substernal distress, paresthesias of the extremities, and gastrointestinal symptoms such as anorexia, nausea, vomiting, fatigue, malaise, dyspnea, and restlessness. Late manifestations include hypercapnia, cyanosis, decreasing compliance, increasing A:a gradient, and pulmonary edema.
Hyperventilation therapy, which was used routinely in the past for patients with neurological injury, is now restricted to indications of acute herniation. What is the physiologic rationale for this restriction? A. A. volume and pressure. The resultant vasodilation increases cerebral blood flow but increases intracranial
B. volume and pressure. The resultant hypervolemia increases cerebral blood flow but increases intracranial
C. cerebral ischemia. The resultant hypovolemia decreases intracranial volume and pressure but causes
D. causes cerebral ischemia. - Answer The resultant vasoconstriction decreases The resultant vasoconstriction decreases intracranial volume and pressure but intracranial volume and pressure but causes cerebral ischemia.
Hyperventilation causes respiratory alkalosis, which causes vasoconstriction, which decreases intracranial volume and pressure. However, this vasoconstriction potentially causes cerebral ischemia. A decrease in static compliance would occur in which of the following? A. Pneumothorax B. Flail chest C. Bronchospasm D. Mucous plug - Answer Pneumothorax Static compliance is the compliance of the lung when no air is moving, so it reflects the compliance of the lung and the chest wall. Dynamic compliance reflects the compliance of the lung when air is moving; therefore, it reflects compliance of the lung and chest wall plus airway resistance. The conditions causing an acute drop in static compliance include pneumothorax, while acute respiratory syndrome causes a gradual drop in static compliance. Bronchospasm or mucous plug results in a drop in dynamic compliance due to its relation to airway resistance. Flail chest actually would increase the static compliance because of the loss of intactness of the bony thorax.
A 46-year-old woman is admitted to the critical care unit with acute respiratory failure as a consequence of pneumonia.
Vital Signs
