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CCRN Nicole Kupchik Practice Exam
Questions with Accurate Answers
30yo female who is experiencing sustained tonic-clonic convulsions while sitting in a chair. A family states: "She was talking to us and suddenly she let out a shriek and started flopping around like a fish out of water." What is your initial priority of care? A. Call for help and safely guide pt to the floor B. Call for help and administer prescribed anticonvulsant medication C. Call for help and administer a prescribed benzodiazepine D. Call for help and monitor the course of the seizure correct answer A. Call for help and safely guide pt to the floor Pt safety is the first priority. Once pt is safe from immediate harm/injury, seizure activity must be terminated (by benzo aministration). Anticonvulsant is useful in seizure prevention. 38yo F w/ 1wk hx of productive cough, progressive SOB and fever is admitted w/ diagnosis of PNA. Her vitals: HR 108, RR 24, BP 106/54 (62), T 38.9. What are top priorities in her care? A. Administer heparin, IV fluids, and SCDs B. Administer IV fluids, antibiotics, and assess lactate lvl C. Administer IV fluids and dopamine D. Administer IC fluids, Dobutamine and Acetaminophen correct answer B. Administer IV fluids, antibiotics, and assess lactate lvl
Pt meets criteria for severe sepsis d/t elevated HR and fever. Early therapy includes Abx and obtaining a lactate lvl to help guide fluid resuscitation. Vasopressors should be utilized as needed after fluid replacement has been optimized 46yo presents w/ PNA and sepsis. Treated w/ 4 days of Abx and fluids. He is increasingly SOB and is not on 100% fio2 via NRB. You obtain an ABG w/ the following results: pH 7.2, PaCO2 68, PaO2 102, HCO3 28. A CXR reveals bil pulm infiltrates. The pt is developing: A. Worsening PNA B. ARDS C. Pulmonary embolus D. Atelectasis correct answer B. ARDS Criteria for ARDS include bil pulm infiltrates on CXR and P/F ratio < or = 300. To calculate P/F ratio, 102 (PaO2) / 1.0 (100% Fio2) = 102. Other criteria are decreased vent compliance, high peep requirements and low expired minute volume 54yo M admitted 4 days ago w/ a PE. Pt receiving low-molecular-weight heparin for tx. During assessment, you notice ecchymosis and necrotic areas at injection sites. Pt also has plt count drop from 189k to 65k. HIT is diagnosed. Which intervention should you anticipate first? A. Stop heparin and administer an alternate direct thrombin inhibitor B. Administer protamine, corticosteroids and diphenhydramine
A. Dobutamine B. Norepinephrine C. Amiodarone D. Phenylephrine correct answer A. Dobutamine Positive inotrope used to improve MI on pts w/ low cardiac index and elevated SVR. It will improve contractility and reduce after load. Milrinone could be used as an alternative in the setting of decompensated heart failure. Milrinone used cautiously in pts in cardiogenic shock because it can cause hotn. Half-life of Milrinone is 6hrs. Levo and Neo cause vasoconstriction, which would increase SVR and may further compromise CO. Amio is an anti-arrhythmic not indicated in this scenario A 15 y/o female is admitted to the ICU with nausea/vomiting, and Kussmaul's respirations at a rate of 30. Serum blood glucose is 620 mg/dL. What is the priority management? A. Administration of antiemetic medication B. Oxygen via nasal cannula at 4 L/min C. IV insulin administration D. Volume resuscitation correct answer A 22yo female complains of palpitations. You see the following rhythm at the monitor: You interpret the rhythm as:
A. A fib B. A flutter C. Atrial tachycardia D. V tachycardia correct answer C. Atrial tachycardia Caused by a singular ectopic focus in the atria that paces the heart at a rate
100bpm. Because of the fast rate, diastolic time is reduced, and the ectopic P- wave merges w/ the preceding T-wave. If rate is >150bpm, it may be called SVT. A fib and A flutter have no identifiable P-waves. Vent rhythm of a fib is irregularly irregular. Vtach has a widened QRS complex A 25 y/o female patient is mechanically ventilated in association with an acute asthma exacerbation. Which of the following interventions will reduce the risk of ventilator-associated events? A. Hand hygiene of all providers B. Head of bed elevated at 15° C. Prophylactic antibiotics D. Routine tracheal suctioning correct answer A 25 y/o male patient was admitted to the ICU yesterday with a diagnosis of closed head injury. During bedside handoff, the off-going nurse reported the patient was awake, alert, and oriented to person, place, time, and situation. During visiting time, the family reports the patient "seems sleepier than yesterday". What is the appropriate next nursing action? A. Ask the family members not to overstimulate the patient B. Notify the physician of the neurologic change C. Perform a focused neurologic exam
A 33 y/o female, who just delivered twins, is transferred to the ICU with hemorrhagic shock and has received 6 units of packed red blood cells via massive transfusion. You should anticipate which of the following interventions next? A. Calcium gluconate and potassium chloride administration B. Acetaminophen and diphenhydramine administration C. Furosemide 20 mg IV D. Fresh frozen plasma and platelet transfusions correct answer D. FFP and Plts PRBCs are beneficial for oxygenating bld, but do not contain all the clotting factors of whole blood. When transfusing lots of red, FFP and plts are also required, otherwise hemorrhage will continue w/o adequate clotting factors. Calcium will need to be replaced, as banked prbcs use citrate to prevent bld from clotting. Potassium lvls should not become depleted. Tylenol and benedryl would only be administered if there were a transfusion rxn. Lasix typicall given w/ the massive transfusion, unless pulm edema was of serious concern A 34-year-old patient with bacterial meningitis is sedated and intubated. A Ventriculostomy is in place, but currently clamped. Intermittent ICP measurements are being monitored. The ICP has been trending up form 6 to 17 mm Hg over the last 4 hours. The best initial intervention is to : A. Assess sedation and bolus as needed B. Open the ventriculostomy to allow drainage C. Elevate the head of the bed to 45 degrees D. Administer 1g/kg of 20 % Mannitol correct answer C. Elevate HOB to 45 degrees
Among other things, increase in ICP can be caused by venous outflow obstruction. Repositioning and elevating HOB to ensure proper alignment should be first intervention. If ICP remains elevated, increased sedation or mannitol may be indicated. Opening ventriculostomy requires specific orders A 35 y/o patient has a splenic laceration, pulmonary contusion, multiple rib fractures and a left femur fracture after motor vehicle collision. Vital signs: HR 110, BP 94/56 (68), SpO2 93% on 40% venturi mask, RR 26, pain 4/10 with movement. What is the next intervention? A. Medicate for pain B. Teach incentive spirometer use C. Increase O2 to 50% D. Bolus 500 ml isotonic fluid correct answer A 39 y/o female is being assessed in the ED for an acute asthma exacerbation. Which of the following presentations would most likely warrant an ICU admission for close monitoring and treatment? A. Presence of inspiratory wheezes B. Presence of expiratory wheezes C. Dyspnea that interferes with activities of daily living D. Inability to communicate in full sentences correct answer D. Inability to communicate in full sentences Severity of asthma is determined by degree of dyspnea. Dyspnea w/ ADLs is moderate severity likely to be treated in ED and sent home. Pt unable to speak in full sentences is higher severity and warrants an ICU admission for closer monitoring
A 45yo male admitted to ICU w/ sepsis. You are administering LR 500 mL IV boluses. Which of the findings below indicate that this intervention is having its intended effect? A. MAP of 55mmHg B. ScvO2 of 72% C. CVP of 4mmHg D. UOP of 15ml/hr correct answer B. ScvO2 of 72% Early therapy for sepsis includes fluid resuscitation at 30mL/kg to maintain a CVP of 8-12 or 12-15 in ventilated pts, MAP >65, ScvO2 > 70%, and UOP > 0. mL/kg/hr Scv02 = central venous O2 sat (less invasive alternative to mixed-venous or SvO2). Indicates how much O2 remains after delivery to tissues A 48 y/o male is admitted with the diagnosis of acute anterior wall MI. He is on Dopamine & Dobutamine and is mechanically ventilated. His family is visibly upset. What would be your best action to assist them? A. Teach them about cardiac risk factors B. Counsel the family about diet changes C. Listen to their concerns & answer questions in a way that is easy to understand D. Discuss cause of a myocardial infarction correct answer C. Listen to their concerns and answer questions in a way that is easy to understand During an emotional response, people need to feel heard and have their feelings validated. They need to receive info in a simple manner that is easy for them to
process. Over time, they may have more complex questions and be open to teaching, but immediate need is for them to be heard and updated A 48-year-old male suffered a right-sided epidural hemorrhage after a skiing accident. The patient is mechanically ventilated and unresponsive. GCS: 3. The provider approaches the nurse and asks to gather the family to the private consultation room to discuss the prognosis and possible organ donation. What is the most appropriate response from the nurse? A " we're not supposed to talk to the family about organ donation" B. " I will call the family now. They should be here within the hour" C. " I will call the family now. I'll also notify the organ procurement organization for referral and further direction" D. " I will call the family. A representative from Pastoral Services is available to participate in the discussion" correct answer C. I'll call fam now, but also notify organ procurement for referral and further direction Organ procurement should be notified ASAP. Policies may differ from state to state about who may approach fam regarding donation, so make sure to follow your facility policy. Best to confer w/ organ procurement organization on how to best approach fam A 49yo male was recently admitted w/ an inferior wall MI resulting from 100% occlusion of the R coronary artery (RCA). The 12 lead ECG reveals ST elevation in leads II, III, and aVF. You would expect to see reciprocal changes in which leads? A. I, aVR B. V1, V C. V3, V
C. Correction of coagulopathy D. Endoscopic intervention correct answer B. Intravascular volume replacement Rapid correction is needed to prevent organ hypoperfusion. Initial resuscitation should be w/ crystalloids, then depending on clinical status and lab values, a bld transfusion may be necessary. Efforts to treat coagulopathy occur after initial fluid resuscitation. Vasopressors or endoscopy may be used to treat underlying esophageal varices, but not initially A 52 y/o female was started on heparin 6 hours ago for suspicion of NSTE-ACS. Her troponin is 3.8 and VSS. She suddenly is having trouble moving her leg. Past history reveals previous heparin therapy for suspected MI. Ultrasound reveals a large DVT of the femoral vein. Which of the following do you anticipate? A. Immediately stop the heparin infusion & draw a heparin antibody panel B. Prepare for the administration of TPA C. Continue the Heparin & draw a Heparin antibody panel D. Prepare for stat Coumadin correct answer A. Immediately stop heparin and draw hep antibody panel 2 types of HIT: one is mild and temporary drop in plts for several days after exposure, and the other can cause life-threatening thrombosis, particularly w/ repeated exposure to heparin. If the second type is suspected, the pt should receive no further heparin for any purpose. A hep antibody panel can confirm source of the pt's clot A 53yo male was admitted to the trauma ICU in hypovolemic shock after a MCC. He sustained multiple injuries including pelvis fx and splenic lac. Which of the following hemodynamic profiles would be consistent with the diagnosis of hypovolemic shock?
a. dec CO, dec preload, inc afterload b. dec CO, inc preload, dec afterload c. inc CO, dec preload, inc afterload d. inc CO, inc preload, dec afterload correct answer a. dec CO, dec preload, inc afterload In hypovolemic states circulating volume is depleted, therefore the preload will decrease. In response, the SNS and RAAS are activated resulting in an increase in heart rate to compensate. In addition, those systems cause vasoconstriction leading to an increase in the SVR in hopes of increasing the BP A 55-year-old female presents to the ED anxious and SOB. Her 12 lead ECG reveals a STEMI. Which of the following findings suggests an absolute contraindication for thrombolytic therapy? A. Dull chest pain, ST elevation in V4, V5, V6, new left bundle branch block B. History of cholecystectomy 2 weeks ago, ST elevation V3, V4, V C. Sudden onset severe chest and back pain, uncontrolled BP 195/115, ST elevation II, III, aVF, and a new diastolic murmur over the left sternal border D. Left arm pain, BP 180/100 easily controlled on antihypertensive meds, ST elevation in V1, V2, V3 correct answer C. Sudden onset severe chest and back pain, uncontrolled BP 195/115, ST elevation II, IIIm aVF, and a new diastolic murmur over the left sternal border These S/S raise suspicion for aortic dissection and should be ruled out prior to thrombolytic therapy. Aortic dissection is an ABSOLUTE CONTRAINDICATION
B. Single IV bolus of units of insulin C. Fluid replacement with dextrose 5% in half normal saline solution D. Fluid replacement with an isotonic solution correct answer D. Fluid replacement w/ an isotonic solution HHNS leads to large fluid deficits and may require multiple liters of fluid. Amount needed is determined by pt's lvl of dehydration and hyperosmolality. Hydration and insulin will cause serum K to drive back into cells, causing serum lvls to fall. However, K should not be ordered as a standard dose, but should be based on serum lvl and UOP. Insulin admin should be targeted to decreased by no more than 15% per hour. Initial resuscitation should not include dextrose as the pt is already hyperglycemic A 58 y/o African American male is being discharged from the hospital status post hypertensive crisis. What is the highest priority in his discharge education? A. Lifestyle modification B. Medication side effects C. Signs and symptoms of stroke D. Smoking cessation correct answer C. S/S of stroke The pt already has non-modifiable risk factors (age, race, hx of HTN). Priority is given to education of early recognition of stroke and activation of EMS should signs occur. Early stoke identification and tx at a stroke center will provide best outcomes A 58 y/o female experienced an anterior wall MI 2 days ago. She is now complaining of chest pain and dizziness. Upon auscultation you note a new, loud systolic murmur. What do you suspect may be the issue?
A. Acute mitral stenosis B. Acute aortic stenosis C. Left ventricular outflow obstruction D. Acute papillary muscle dysfunction correct answer A 58 y/o female is admitted with GI bleed. The patient has been stooling bright red blood for the past 6 hours. Patient data as follows: HR 114 BP 90/64 (72) RR 22 O2 94% 2L NC Hct 20% Hgb 6. INR 1. CVP 2 mmHg ScvO2 56% What intervention foes the nurse anticipate an order for? A. Transfuse 2 units of PRBCs B. Transfuse 2 units of fresh frozen plasma (FFP) C. 1 liter normal saline bolus D. 40 % FiO2 with CPAP + 8 correct answer A. Transfuse 2u PRBCs In general, the goal for ScvO2 is >70% in the care of a bleeding pt giving a SIRS response. It is important to meet oxygen tissue demands. Since the pt is bleeding,
A. Alpha blockers B. Calcium channel blockers C. ACE inhibitors D. Digoxin correct answer C. ACE inhibitors ('pril' family) prevent conversion of Angiotensin I to Angiotensin II, resulting in lower aldosterone secretion. This results in the increase in secretion of water and sodium thereby decreasing circulating volume, intra-cardiac pressures and venous pressures. ACE inhibitors, in general, are used post-MI when the EF is less than 40% Significant evidence shows it reduces mortality in pts w/ L vent systolic dysfunction and HF secondary to STEMI. Alpha-blockers used to treat HTN as they cause bld vessels to dilate which leads to a decrease in blood pressure. CCBs are not used in HF w/ a reduced EF bc of their negative inotropic effects. Dig may reduce symptoms but has no impact on mortality A 65-year-old male is admitted to the ICU with syndrome of inappropriate antidiuretic hormone (SIADH) resultant from a brain tumor in his frontal lobe. Serum sodium is 115 mEq/L. What is the priority of nursing care for the patient? A. Fluid restriction B. Sodium replacement to 140 mEq/L C. Administration of diuretics D. Maintaining a safe environment correct answer D. Maintaining a safe environment Frontal lobe tumors often impair judgement and hypoNA+ can lead to confusion. Ensuring pt's safety is of the utmost importance.
Na+ would probably occur, however, it usually stops when sodium reaches 130 to prevent over correction of sodium lvls A 67 y/o patient with history of COPD and atrial fibrillation is admitted for acute respiratory failure. Treatment strategies should include which of the following: A. Theophylline (Theo-24) B. Subcutaneous epinephrine (EpiPen) C. Alprazolam (Xanax) D. Glycopyrrolate (Robinul) correct answer A 68 y/o female is admitted with a diagnosis of acute ischemic stroke. While performing a dysphagia screen, the nurse notices the patient clears his throat immediately afterward. There is no hacking cough or hoarseness to her voice. The nurse has oral medications to administer. What is the next appropriate action? A. Administer the medications and tell the patient to place them on her unaffected side to facilitate swallowing B. Insert a nasogastric tube for medication administration C. Notify the physician to change the medication administration route to IV instead of by mouth D. Request a swallow evaluation and do not administer anything by mouth correct answer A 68 y/o patient has a history of type II diabetes, hypertension and heart failure with an ejection fraction of 28%. She is admitted with chest pain, rule out MI and suddenly goes into atrial fibrillation at a rate of 164 per minute. Her blood pressure is 96/54. She denies chest pain or shortness of breath, but says she feels
