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CCRN Practice Test 1 Questions With
Accurate Answers
a 29 year old female has been in the critical care unit for 2 days after a motor vehicle crash, and she has developed acute tubular necrosis (ATN). she was normotensive upon admission. what would be the most likely cause of her ATN? A) hemorrhage B) rhabdomyolysis C) creatinine release D) cardiac dysrhythmias correct answer B) rhabdomyolysis. the motor vehicle crash most likely resulted in a crush injury with destruction of skeletal muscle cells (rhabdomyolysis). this results in the release of massive amounts of creatine kinase (CK) that, in turn, may "clog" renal tubules and lead to acute tubular necrosis (ATN). choice A is not correct, as there is no history of bleeding. choice C is too vague, could be minor, and doesn't cause ATN. cardiac dysrhythmias are not included in this scenario. a nurse knows that research supports a patient having unrestricted access to his or her designated support person (according to the patient's wishes). however, the nurse's unit restricts all patient visitors to set times. the nurse's best response would be to: A) gather the facts and propose a policy change to the manager for the unit B) tell patients/visitors that the unit's policy is outdated but there is nothing that can be done about it C) continue to follow the unit policy D) complain to colleagues about the outdated policy. correct answer A) gather the facts and propose a policy change to the manager for the unit.
the AACN synergy model supports patient advocacy. unrestricted access to a designated support person (according to the patient's wishes) is an evidence based practice that is included in the family presence: visitation in the adult ICU AACN practice alert. a patient has been receiving mechanical ventilation for 2 days but the nurse notices that there is no order for nutrition. the nurse's best response would be to: a) insert a feeding tube and begin enteral nutritional therapy b) complain about the physician's practice patterns to her colleagues c) ask the physician for an order for enteral feeding for the patient d) assume it is the physician's responsibility for the nutritional plan of care correct answer c) early nutritional therapy for a patient who is receiving mechanical ventilation improves the patient's outcome. knowledge of evidence-based practices, however, is not enough. a critical care nurse needs to advocate for the patient using strategies that work. collaboration with the physician would be most likely to provide the patient with what he needs. a patient has just consented to a bedside chest tube insertion and requests that his wife be allowed to be present during the procedure. the nurse should: D) prepare the wife for what to expect and allow her to be present correct answer the AACN synergy model supports caring practices and family presence. an AACN practice alert indicates that family presence may improve patient outcome. a patient is admitted with a respiratory infection. the patient has shortness of breath with a frequent productive cough and is expectorating light green sputum. vital signs are stable, except for the temp, which is 39C, and an increased respiratory rate. the nurse should anticipate which of the following abg results? a) respiratory acidosis b) respiratory alkalosis
PAP=pulmonary artery pressure, PAOP=pulmonary artery occlusion pressure and CVP=central venous pressure. A) elevated PAP; elevated PAOP; elevated CVP, ST elevation in II, III, and aVF; crackles bilaterally b) elevated PAP; elevated PAOP; elevated CVP, ST elevation in V2-V6; clear lungs c) normal PAP; normal PAOP; elevated CVP; ST elevation in II, III, and aVF; clear lungs d) normal PAP, elevated PAOP; elevated CVP, ST elevation in V2-V6; crackles bilaterally correct answer C) when the right ventricle (RV) fails, the pressure that is proximal to the RV (CVP) increases, whereas pressures that are distal to the RV (pulmonary artery pressure and pulmonary artery occlusion pressure) are normal or even low. this results in clear lungs. ecg changes that are indicative of an inferior wall MI are found in leads II, III, and aVF. a patient post op CABG had a sudden decrease in mediastinal chest tube drainage with hypotension, narrowing pulse pressure, and respiratory variation on the arterial waveform (pulsus paradoxus). what other signs or symptoms would the nurse anticipate that this patient might exhibit? A) muffled heart sounds B) decreased central venous pressure and increased pulmonary artery occlusion pressure C) flat neck veins D) ripping mid scapular back pain correct answer A) muffled heart sounds the patient history and signs and symptoms are indicative of cardiac tamponade and muffled heart sounds are another sign. cardiac tamponade is not characterized by a decrease in CVP and an increase in PAOP or flat neck veins, nor does it cause back pain.
a patient status post head trauma has an ICP of 32mmHg. which of the following interventions is contraindicated for this patient? A) provide enteral feeding via a nasal tube B) elevate the head of bed 30-45 degrees C) maintain a MAP of 50- D) avoid hypotonic IV solitons correct answer C) maintain a MAP of 50- the patient has an elevated ICP, and the patient requires a MAP greater than 50- 60 in order to maintain cerebral perfusion pressure and prevent brain ischemia. the remaining interventions listed in choices A B and D are indicated for a patient with elevated ICP. a patient with a history of hyperlipidemia and alcohol abuse reports left upper quadrant abdominal pain. the patients vital signs are as follows: temp 101F, BP 85/50, HR 110, RR 24. which of the following labs should the nurse anticipate? a) decreased serum amylase level and increased wbc count b) decrease hematocrit and increased lipase level c) decreased sedimentation rate and elevated calcium level d) increased LDH and increased SGOT (AST) correct answer b) decreased hematocrit and increased lipase level. this scenario describes acute pancreatitis, which may be hemorrhagic and could cause the hematocrit to drop. serum lipase increases with acute pancreatitis. a patient with a history of opioid and alcohol abuse is admitted for treatment of cellulitis. the patient has flushed, slightly moist skin and is slow to respond to verbal stimuli. the affected arm is edematous and hard to touch, with yellow exudates noted from puncture wounds on the skin. the patients vital signs are as follows: temp 102F, bp 88/50, hr 120, RR 26. the nurse should anticipate orders for: A) antibiotic and crystalloid administration
d) pinpoint pupils correct answer d) pinpoint pupils are associated with pontine infarcts. the other 3 choices are features of an acute subarachnoid hemorrhage ECG changes associated with ST elevation myocardial infarction (STEMI) that affect the lateral wall would include changes in which of the following leads? A) II, III, aVF B) V1, V2, V C) V2, V3, V D) V5, V6, I, aVL correct answer D) V5 and V6 represent the lower lateral wall of the left ventricle and I and aVL represent the high lateral wall of the left ventricle, supplied by the left circumflex artery in most of the population in a patient with acute lung injury (ALI), which of the following contributes to the development of atelectasis? a) loss of surfactant and interstitial fluid accumulation b) increased pulmonary vascular resistance and hypoxemia c) increased pulmonary compliance and hypoxemia d) mucosal edema and mucus plugging correct answer a) the pathophysiology of acute lung injury includes damage to the type II alveolar cells (which results in alveolar collapse)and capillary leak (which results in interstitial fluid accumulation). both alveolar collapse and interstitial fluid lead to atelectasis. although mucosal edema and mucus plugging may lead to atelectasis; these problems aren't associated with acute lung injury. nitrate therapy is indicated for the treatment of unstable angina and acute heart failure because it: A) decrease preload and increases myocardial O2 demand B) increases preload and increases myocardial O2 demand
C) increases preload and decreased myocardial O2 demand D) decreases preload and decreases myocardial O2 demand correct answer D) decreases preload and decreases myocardial O2 demand nitrates cause venodilation which results in a decrease in venous return to the heart (left ventricular preload reduction). the decrease in preload decreases the work of the left ventricle and the myocardial oxygen demand. what is the recommended initial position to improve oxygenation for a patient with unilateral pneumonia? a) trendelenburg position b) supine position c) side lying on affected side d) side lying on unaffected side correct answer d) side lying on unaffected side it is near to place the "good" lung down and have the patient on the side that doesn't have the problem. this is because more blood perfusion is greater to the down side due to gravity. if more blood goes to the bad side, hypoxemia may occur. Which of the following are symptoms of hypoglycemia? A) tachycardia and trembling B) bradycardia and diaphoresis C) anxiety and flushed, dry skin D) flushed, dry skin and tachycardia correct answer A) tachycardia and trembling When the blood glucose drops, sympathetic stimulation occurs. Symptoms are masked for a patient who is receiving beta-adrenergic blocker drugs. Flushed, dry skin is a sign of hyperglycemia.
D) diastolic murmur, complete heart block correct answer C) systolic murmur, interior wall myocardial infarction inferior wall MI may result in ischemia and dysfunction (regurgitation) of the mitral valve. the mitral valve is closed during systole (left ventricular ejection). a murmur is produced when the mitral valve is not fully closed during systole. Which of the following is TRUE for a patient who has had a right sided stroke and develops increased ICP? A) the pupils will change before the level of consciousness does, there will be right sided paralysis, the eyes will be deviated to the left, and there will be a left pupil change. B) the pupils will change before the level of consciousness does, there will be left- sided paralysis, the eyes will be deviated to the right, and there will be a right pupil change C) The level of consciousness will change before there will be pupil changes, there will be right sided paralysis, the eyes will be deviated to the left, and there will be a left pupil change D) The level of consciousness will change before there will be pupil changes, there will be left sided paralysis, the eyes will be deviated to the right, and there will be a right pupil change correct answer D) The level of consciousness will change before there will be pupil changes, there will be left sided paralysis, the eyes will be deviated to the right, and there will be a right pupil change Higher brain centers (cerebral cortex) are the first to be affected by increased ICP. therefore, the level of consciousness is the first sign (the one exception to that rule is epidural hematoma). pupil changes are ipsilateral (same side as the injury) due to compression of cranial nerve III against the transtentorial notch. motor changes are contra lateral (opposite side of the injury) due to motor fiber crossing in the brain stem
which of the following lab findings are most specifically indicative of disseminated intravascular coagulation (DIC) as the cause of bleeding? a) elevated fibrin split products and D-dimer b) prolonged PT, PTT, and bleeding time c) decreased platelet count d) decreased hemoglobin and hematocrit correct answer a) elevated fibrin split products and d-dimer DIC is a clotting problem, with massive coagulation. as clots break down, fibrin split products are produced. therefore with DIC FSPs will be high. in fact this is the most specific test result for DIC. D dimer is present due to the presence of clots. while not specific for DIC it is a good rule out test. which of the following patients is least likely to return to a normal level of functioning after discharge? a) the 70 year old who was admitted with septic shock and is receiving chemo b) the 75 year old who was admitted for a scheduled coronary artery bypass graft procedure c) the 21 year old trauma patient who was admitted with a pneumothorax and a fractured pelvis d) the 65 year old who was admitted with an acute MI and a history of diabetes correct answer A) the AACN believes that a critical care nurse should assess not only the pt's physiological status but also the patient's resiliency, which has been shown to affect the outcome. in addition to acute problems, extremes of age and chronic conditions also need to be considered. which of the following statements is true? a) delirium is a permanent condition b) a patient who develops delirium has an increased risk of mortality
