CCRN EXAM LATEST 2023-2024 ACTUAL
EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
The elderly patient was admitted with a history of having had diarrhea and progressive shock for the
past three days. Based on this history, the patient's assessment would most likely include which of the
following?
a. MAP 60 mmHg, narrowing pulse pressure, elevated serum Na+
b. MAP 66 mmHG, widening pulse pressure, elevated serum lactate
The patient was admitted with severe sepsis/septic shock 90 minutes ago with the following conditions;
BP 78/42; MAP 52 mmHg; HR 112/min; RR 22/min and lungs clear bilaterally; lactate 5 mmol/L; and
urine output 0.1 mL/hr/hr. The patient was given 30 mL/kg of 0.9 NS. The latest assessment reveals the
following conditions: BP 98/46; MAP 63 mmHg; HR 98/min; RR 20/min and lungs clear; lactate 6
mmol/L; UOP 0.5 mL/kg/hr. Which of the following interventions will best address the patient's current
status?
a. reduce normal saline to 150 mL/hr
b. discontinue NS, and begin LR at 125 mL/hr
c. continue the infusion of NS at 30 mL/kg
d. initiate a norepinephrine (Levophed) infusion - ANSWER-c. continue the infusion of NS at 30 mL/kg
The patient sustained a traumatic injury while driving. Prior to arrival, the patient's spine was stabilized
with a cervical collar. He was also receiving bag/mask ventilation via an advanced airway, and two large
bore IVs were in place. What is a priority assessment at this time?
a. assess the patient's vital signs
b. perform a neuro assessment
c. auscultate the patient's breath sounds bilaterally
d. remove the patient's clothes - ANSWER-b. perform a neuro assessment
,Important interventions for the treatment of severe sepsis/septic shock include administering 30 mL/kg
of isotonic fluid and initiating a vasopressor if the patient is not responsive to fluids. What is the
pathology of sepsis that is addressed by administering fluids and initiating a vasopressor?
a. pulmonary dysfunction and impaired oxygen utilization
b. myocardial dysfunction and maldistribution of blood flow
c. impaired carbon dioxide elimination and hypoxemia
d. vasodilation and increased capillary leak - ANSWER-d. vasodilation and increased capillary leak
The patient required transfusion of 12U of PRBCs over 24-hour period. The nurse will need to monitor
the patient for which of the following complications related to multiple transfusions of PRBCs?
a. coagulopathy
b. deep vein thrombosis
c. alkalosis
d. hyperthermia - ANSWER-a. coagulopathy
The patient is transferred to the ICU with hypotension, tachycardia, oliguria, and a pressure injury with
foul smelling drainage on her coccyx. Fluids are started at 30 mL/kg, blood cultures are drawn, ad a
broad-spectrum antibiotic is administered. What additional evidence-based intervention for the
treatment of this patient's problem is inicated as soon as possible for this patient?
a. measure the electrolytes
b. measure the serum lactate
c. administer oxygen
d. begin a norepinephrine (Levophed) infusion - ANSWER-b. measure the serum lactate
What are the priority nursing interventions for a patient with an acetaminophen overdose?
a. administer N-acetylcysteine, and monitor hepatic function
b. administer activated charcoal, and perform cooling for hyperthermia
c. administer activated charcoal, and perform cooling for hyperthermia
d. administer flumazenil (Romazicon), and support the patient's airway - ANSWER-a. administer N-
acetylcysteine, and monitor hepatic function
,The patient is receiving epidural analgesia status post thoracotomy for a lung tumor. The patient's blood
pressure is 124/78, his heart rate is 72/min, and his RR is 10/min, snoring in quality. When asked about
his pain, the patient arouses to a loud voice and to touch, but he does not answer the question. What is
the priority intervention for the patient at this time?
a. continue current plan of care
b. decrease the epidural analgesia
c. administer naloxone (Narcan)
d. call a code - ANSWER-c. administer naloxone (Narcan)
The patient is agitated. He is attempting to pull at his enteral feeding tube and IV line. Which of the
following nursing interventions is indicated in this situation?
a. attempt to verbally calm the patient
b. administer a sedation agent
c. administer an analgesic
d. assess for hemodynamic instability - ANSWER-d. assess for hemodynamic instability
The SIRS criteria assess for a systemic inflammatory response, and the qSOFA score is a bedside
assessment for possible organ dysfunction. A qSOFA score of 2 or 3 positive criteria indicates suspicion
of organ dysfunction. Which of the following criteria is NOT an element of the qSOFA score?
a. altered mentation as evidenced by a GCS < 15
b. temperature > 38 C or < 36 C
c. low blood pressure as evidenced by a systolic pressure < 100 mmHg
d. high respiratory rate as evidenced by a RR ? 22 breaths per min - ANSWER-b. temperature > 38 C or <
36 C
A patient with septic shock is likely to have which of the following measurements of oxygenation?
, The patient is status post abdominal aortic aneurysm (AAA) repair with a blood pressure of 82/62 and a
heart rate of 112/min. The patient has received fluid resuscitation and required implementation of the
massive transfusion protocol. Which of the following interventions will be included in this patient's post-
operative plan of care?
a. ongoing infusion of 0.45 NS
b. initiation of a vasopressor for sustained MAP < 65 mmHg
c. administration of a diuretic for generalized edema
d. monitoring for and treatment of hypocalcemia - ANSWER-d. monitoring for and treatment of
hypocalcemia
The patient has been receiving targeted temperature management (TTM) following resuscitation for a
ventricular fibrillation. Rewarming is now scheduled to begin. The nurse anticipates that which of the
following interventions will be needed during this phase of TTM?
a. administering a vasodilator
b. increasing the insulin drip dose
c. discontinuing the potassium supplementation
d. assessing for/controlling the onset of shivering - ANSWER-c. discontinuing the potassium
supplementation
During rewarming, rebound hyperkalemia is likely. Therefore, the potassium supplementation that was
required during the cooling phase needs to be discontinued
The patient develops severe respiratory distress and bronchospasm with complaints of not being able to
breathe after the initiation of a scheduled antibiotic. Which of the following interventions is indicated
first?
a. administer fluids
b. administer 1:1000 epinephrine
c. administer inhaled albuterol
d. administer a steroid IV - ANSWER-b. administer 1:1000 epinephrine
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