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CCRN Exam Review Chapter 8 Questions With Correct Answers 2024
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CCRN Exam Review Chapter 8 Questions With Correct Answers 2024
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CCRN Exam Review Chapter 8 QuestionsWith Correct Answers 2024
A .patient .with .complete .spinal .cord .injury .at .the .C4 .level .has .bladder .atony .and .requires
.catheterization. .Which .of .the .following .bladder .catheterizations .is .the .recommended .goal
.in .the .acute .care .of .a .spinal .cord-injured .patient?
A. .Indwelling .catheter
B. .Intermittent .catheterization .
C. .External .catheters
D. .Stents .placed .in .the .urethra .- .correct .answer.B
A .spinal .cord-injured .patient .develops .an .atonic .bladder .early .after .injury .during .the
.period .of .spinal .shock. .Initially, .due .to .fluid .resuscitation, .the .patient .may .require .an
.indwelling .catheter .but .the .goal .is .intermittent .catheterization. .An .indwelling .catheter
.increases .the .risk .of .catheter-related .urinary .tract .infection .and .urosepsis. .This .com-
.plication .can .increase .length .of .stay .in .the .acute .care .facility .and .the .risk .of .mortal- .ity.
.Spinal .cord-injured .patients .will .typically .have .an .inability .to .empty .the .bladder
.completely .so .an .external .catheter .is .not .effective .in .these .patients. .Urethral .stents .are
.being .used .in .some .patients .with .bladder .outlet .obstruction.
Ms. .J .has .been .in .the .ICU .for .3 .days .following .a .motor .vehicle .collision. .She .is .now .febrile
.(temperature .38.5°C) .with .an .elevated .WBC .count .(20,000). .The .following .are .her .vital
.signs:
BP .124/64 .HR .112 .RR .24 .Lactate .2 .mmol/L
Which .of .the .following .best .describes .the .complication .Ms. .J .is .experiencing?
A. .Sepsis/SIRS
B. .Severe .sepsis
C. .Septic .shock
D. .Multisystem .organ .dysfunction .- .correct .answer.A
Sepsis .is .an .inflammatory .response .to .a .known .infection .and .SIRS .is .an .inflammatory
.response .to .a .clinical .insult. .Both .sepsis .and .SIRS .use .the .same .criteria .to .diagnose; .the
.dif- .ference .is .that .sepsis .has .a .known .infection .(including .positive .blood .cultures),
.whereas .in .SIRS .it .is .not .possible .to .locate .an .infection .(negative .blood .culture). .At .this
.time, .Ms. .J .meets .the .criteria .for .an .inflammatory .response .but .no .culture .results .or
.potential .loca- .tions .are .provided .in .the .scenario. .It .could .be .either .sepsis .or .SIRS
.because .of .the .elevated .WBC .count, .fever, .tachycardia, .and .tachypnea. .To .meet .the
.criteria .for .severe .sepsis, .her .systolic .BP .would .have .been .less .than .90 .mmHg .and/or
.lactate .levels .elevated .greater .than .4 .mmol/L. .Septic .shock .is .hypotension .and
, .hypoperfusion .despite .adequate .resus- .citation. .The .scenario .for .Ms. .J .does .not .indicate
.the .presence .of .organ .dysfunction.
Mr. .M .is .in .the .ICU .for .management .of .exacerbation .of .his .congestive .heart .failure. .He
.develops .fever .and .his .WBC .count .has .elevated .to .14,000. .What .is .the .recommended
.time .frame .to .initiate .antibiotics?
A. .Within .1 .hour
B. .2 .to .3 .hours
C. .Within .6 .hours
D. .Antibiotics .are .not .indicated .at .this .time .- .correct .answer.A
It .is .recommended .by .the .Sepsis .Campaign .that .antibiotics .be .initiated .within .1 .hour .of
.recognition .of .sepsis. .This .patient .meets .the .criteria .for .sepsis. .The .recommenda- .tion .to
.resuscitate .and .correct .hypotension .and .hypoperfusion .is .within .6 .hours. .This .patient
.does .have .indicators .for .antibiotics .because .he .meets .the .criteria .for .sepsis.
A .physician .orders .an .initial .bolus .of .fluids .to .be .administered .in .a .sepsis-induced
.hypoperfused .patient. .Which .of .the .following .fluids .would .be .recommended .for .an .initial
.bolus?
A. .Albumin
B. .Normal .saline
C. .Hetastarch
D. .Packed .red .blood .cells .- .correct .answer.B
Initial .fluid .bolus .for .severe .sepsis .or .sepsis-induced .hypoperfusion .should .be .a
.crystalloid .(normal .saline .[NS] .or .lactated .Ringer's). .There .is .no .known .benefit .of .albumin
.over .crystalloids .in .the .initial .fluid .bolus .and .albumin .is .more .expensive. .If .the .patient
.requires .substantial .fluid .to .maintain .hemodynamic .parameters, .it .is .recommended .to
.administer .albumin .in .addition .to .NS. .Hetastarch .is .not .recommended .and .may .actually
.increase .mortality. .PRBCs .may .be .given .at .some .point .in .the .resuscitation .to .maintain
.oxygen .delivery .but .are .not .recommended .as .the .initial .fluid.
Which .of .the .following .is .recommended .before .initiating .a .hydrocortisone .infusion .in
.septic .shock .patients?
A. .Low .cortisol .levels
B. .ACTH .test
C. .Hypotension .despite .vasopressors .
D. .Presence .of .three .organs .in .failure .- .correct .answer.C
Corticosteroid .therapy .is .recommended .in .septic .shock .patients .who .are .hypoten- .sive
.despite .adequate .fluid .resuscitation .and .vasopressor .therapy. .Administration .of .200
.mg/24 .hours .of .hydrocortisone .is .recommended .to .improve .BP .and .perfusion .to .the
.tissues. .Cortisol .levels .and .ACTH .test .are .not .recommended .to .guide .steroid .therapy .in
.septic .shock .patients. .The .lack .of .responsiveness .to .treatments .is .thought .to .be .due .to .a
.cortisol .resistance, .not .an .actual .adrenal .insufficiency. .Organ .dysfunction .or .failure .is .not
.required .before .the .initiation .of .steroids.
Which .of .the .following .electrolytes .need .to .be .monitored .closely .during .infusion .of
.hydrocortisone?
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