CCRN TEST BANK QUESTIONS AND ANSWERS
Which of the following would be the earliest auscultatory finding in left ventricular failure
(LVF)?
A. Crackles
B. S3
C. Murmur of mitral regurgitation
D. Pericardial friction rub - Answers -B. S3
LVF would be the most subtle because early changes are usually subtle changes.
Choose "S3."
A patient with a triple-lumen subclavian catheter has been receiving total parenteral
nutrition, maintenance fluids, and antibiotics by the catheter. He has been slightly
confused. Suddenly he grasps the catheter and pulls it out. He then complains of
shortness of breath, and his pulse oximetry indicates an SpO2 of 84%. How should this
patient be positioned?
A. Head down, left side
B. Head down, right side
C. Head of bed elevated, left side
D. Head of bed elevated, right side - Answers -A. Head down, left side
Envision a big air bubble in the patient's heart. Think: what position would decrease the
movement of the air embolism out of the right side of the heart. Chose "Head down, left
side."
Oxygen delivery (DO2) is the product of which of the following?
A.
PaO2, hemoglobin, mean arterial pressure
B.
SaO2, hemoglobin, cardiac output
C.
SvO2, cardiac index, SaO2
D.
PaO2, mean arterial pressure, SvO2 - Answers -B. SaO2, hemoglobin, cardiac output
Oxygen is delivered from the arterial end, so choose an option that has SaO2
Which of the following is the most significant complication of status asthmaticus?
A.
Pulmonary embolism
,B.
Acute respiratory failure
C.
Hypertension
D.
Anaphylaxis - Answers -B. Acute respiratory failure
A 22-year-old man is admitted to the critical care unit after a motor vehicle collision. The
emergency department nurse reports that he was unconscious at the scene of the
accident, but he is now alert and oriented. Skull films show a linear fracture of the right
temporal bone. He is at significant risk for:
A.
scalp hematoma.
B.
subdural hematoma.
C.
epidural hematoma.
D.
intracerebral hematoma. - Answers -C. epidural hematoma.
Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and
cause epidural hematoma. Patients with an epidural hematoma classically present with
a short period of unconsciousness followed by a lucid interval and then rapid
deterioration. An epidural hematoma is usually caused by arterial bleeding.
A patient is admitted to the ICU after sustaining a concussion and blunt abdominal
trauma to the right upper quadrant in a domestic dispute. The patient's vital signs are
BP 145/86 mm Hg, pulse 86 beats/min, respiration 15 breaths/min, and temperature
98.8° F. The nurse is monitoring the patient's bowel sounds, abdominal tenderness, and
abdominal girth frequently. Which of the following laboratory parameters is especially
important for the nurse to closely monitor for bleeding in this patient?
A.
Platelet count
B.
Protime
C.
Hematocrit
D.
Mean corpuscular volume - Answers -C. Hematocrit
Common injuries resulting from blunt abdominal trauma can include injury to the liver,
spleen, mesenteric vessels, pancreas, or kidneys. In a nonoperative approach to blunt
abdominal trauma, observation and monitoring include serial hematocrits to evaluate for
intra-abdominal bleeding. The platelet count does not fluctuate unless there is a disease
,process (e.g. cirrhosis, leukemia) or significant blood loss. Protime is a monitor of
coagulation status and can be prolonged without active bleeding. Mean corpuscular
volume measures the average volume or size of a single RBC and is used in classifying
anemias.
The most rapid administration of fluids is achieved through a large-gauge, short
catheter. Central venous catheters are long and, if multiple-lumen, each lumen may be
smaller gauge than large-gauge peripheral catheters. Large-gauge, long peripheral
catheters, including peripherally inserted central catheters, would be slower than a short
peripheral catheter.
A patient received Humulin NPH insulin at 7 am. He was nauseated and vomiting at
lunchtime and cannot tolerate PO. If this patient develops manifestations of
hypoglycemia, treatment would include:
A.
25 ml of 50% dextrose in water (D50W).
B.
glucagon subcutaneously.
C.
4 oz of apple juice.
D.
100 ml of 5% dextrose in water (D5W). - Answers -A. 25 ml of 50% dextrose in water
(D50W).
A volume of 25 ml of D50W would provide 12.5 g of carbohydrate and 50 calories.
A patient is being treated for hypertrophic cardiomyopathy. Which of the following drugs
would be contraindicated for this patient?
A.
Nitroprusside
B.
Propranolol
C.
Verapamil
D.
Digoxin - Answers -D. Digoxin
Remember that with hypertrophic cardiomyopathy, it is desirable to decrease
contractility and afterload; it is not desirable to increase contractility or decrease
preload.
How would a pneumothorax appear on chest x-ray film?
, A.
Less radiolucent than normal lung
B.
Less radiopaque than normal lung
C.
More radiopaque than normal lung
D.
More radiolucent than normal lung - Answers -D. More radiolucent than normal lung
The pleura is not visible on a normal chest radiograph, but in a pneumothorax, the
visceral pleura is displaced from the parietal pleura by air in the pleural space. No lung
markings can be seen in this area, and it is darker than the lung.
A 55-year-old man is admitted to the critical care unit with upper gastrointestinal
bleeding. Endoscopy identifies esophageal varices, but bleeding continues despite
sclerosing. The physician inserts a Sengstaken-Blakemore tube. The family tells you
that the patient has a long history of alcohol use, drinking about one half of a fifth of
Jack Daniels every day. Which of the following are early indications of alcohol
withdrawal syndrome for which the nurse should monitor?
A.
Diaphoresis, pruritus
B.
Marked tachycardia, marked hypertension
C.
Hyperthermia, dehydration
D.
Delirium, hallucinations - Answers -A. Diaphoresis, pruritus
Because the question says "early," look for the mildest symptoms.
Diaphoresis, pruritus, mild tachycardia, mild hypertension, nausea, vomiting, visual
disturbances, tremors, anxiety, agitation, and sleep disturbances are signs of early
alcohol withdrawal syndrome.
Options "Marked tachycardia, marked hypertension," "Hyperthermia, dehydration," and
"Delirium, hallucinations" describe late signs.
Altering the pH of the gastric secretions through the use of H2 receptor antagonists,
antacids, and proton pump inhibitors contributes to which potential complication?
A.
Pulmonary embolism
B.
Pneumonia
C.
Which of the following would be the earliest auscultatory finding in left ventricular failure
(LVF)?
A. Crackles
B. S3
C. Murmur of mitral regurgitation
D. Pericardial friction rub - Answers -B. S3
LVF would be the most subtle because early changes are usually subtle changes.
Choose "S3."
A patient with a triple-lumen subclavian catheter has been receiving total parenteral
nutrition, maintenance fluids, and antibiotics by the catheter. He has been slightly
confused. Suddenly he grasps the catheter and pulls it out. He then complains of
shortness of breath, and his pulse oximetry indicates an SpO2 of 84%. How should this
patient be positioned?
A. Head down, left side
B. Head down, right side
C. Head of bed elevated, left side
D. Head of bed elevated, right side - Answers -A. Head down, left side
Envision a big air bubble in the patient's heart. Think: what position would decrease the
movement of the air embolism out of the right side of the heart. Chose "Head down, left
side."
Oxygen delivery (DO2) is the product of which of the following?
A.
PaO2, hemoglobin, mean arterial pressure
B.
SaO2, hemoglobin, cardiac output
C.
SvO2, cardiac index, SaO2
D.
PaO2, mean arterial pressure, SvO2 - Answers -B. SaO2, hemoglobin, cardiac output
Oxygen is delivered from the arterial end, so choose an option that has SaO2
Which of the following is the most significant complication of status asthmaticus?
A.
Pulmonary embolism
,B.
Acute respiratory failure
C.
Hypertension
D.
Anaphylaxis - Answers -B. Acute respiratory failure
A 22-year-old man is admitted to the critical care unit after a motor vehicle collision. The
emergency department nurse reports that he was unconscious at the scene of the
accident, but he is now alert and oriented. Skull films show a linear fracture of the right
temporal bone. He is at significant risk for:
A.
scalp hematoma.
B.
subdural hematoma.
C.
epidural hematoma.
D.
intracerebral hematoma. - Answers -C. epidural hematoma.
Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and
cause epidural hematoma. Patients with an epidural hematoma classically present with
a short period of unconsciousness followed by a lucid interval and then rapid
deterioration. An epidural hematoma is usually caused by arterial bleeding.
A patient is admitted to the ICU after sustaining a concussion and blunt abdominal
trauma to the right upper quadrant in a domestic dispute. The patient's vital signs are
BP 145/86 mm Hg, pulse 86 beats/min, respiration 15 breaths/min, and temperature
98.8° F. The nurse is monitoring the patient's bowel sounds, abdominal tenderness, and
abdominal girth frequently. Which of the following laboratory parameters is especially
important for the nurse to closely monitor for bleeding in this patient?
A.
Platelet count
B.
Protime
C.
Hematocrit
D.
Mean corpuscular volume - Answers -C. Hematocrit
Common injuries resulting from blunt abdominal trauma can include injury to the liver,
spleen, mesenteric vessels, pancreas, or kidneys. In a nonoperative approach to blunt
abdominal trauma, observation and monitoring include serial hematocrits to evaluate for
intra-abdominal bleeding. The platelet count does not fluctuate unless there is a disease
,process (e.g. cirrhosis, leukemia) or significant blood loss. Protime is a monitor of
coagulation status and can be prolonged without active bleeding. Mean corpuscular
volume measures the average volume or size of a single RBC and is used in classifying
anemias.
The most rapid administration of fluids is achieved through a large-gauge, short
catheter. Central venous catheters are long and, if multiple-lumen, each lumen may be
smaller gauge than large-gauge peripheral catheters. Large-gauge, long peripheral
catheters, including peripherally inserted central catheters, would be slower than a short
peripheral catheter.
A patient received Humulin NPH insulin at 7 am. He was nauseated and vomiting at
lunchtime and cannot tolerate PO. If this patient develops manifestations of
hypoglycemia, treatment would include:
A.
25 ml of 50% dextrose in water (D50W).
B.
glucagon subcutaneously.
C.
4 oz of apple juice.
D.
100 ml of 5% dextrose in water (D5W). - Answers -A. 25 ml of 50% dextrose in water
(D50W).
A volume of 25 ml of D50W would provide 12.5 g of carbohydrate and 50 calories.
A patient is being treated for hypertrophic cardiomyopathy. Which of the following drugs
would be contraindicated for this patient?
A.
Nitroprusside
B.
Propranolol
C.
Verapamil
D.
Digoxin - Answers -D. Digoxin
Remember that with hypertrophic cardiomyopathy, it is desirable to decrease
contractility and afterload; it is not desirable to increase contractility or decrease
preload.
How would a pneumothorax appear on chest x-ray film?
, A.
Less radiolucent than normal lung
B.
Less radiopaque than normal lung
C.
More radiopaque than normal lung
D.
More radiolucent than normal lung - Answers -D. More radiolucent than normal lung
The pleura is not visible on a normal chest radiograph, but in a pneumothorax, the
visceral pleura is displaced from the parietal pleura by air in the pleural space. No lung
markings can be seen in this area, and it is darker than the lung.
A 55-year-old man is admitted to the critical care unit with upper gastrointestinal
bleeding. Endoscopy identifies esophageal varices, but bleeding continues despite
sclerosing. The physician inserts a Sengstaken-Blakemore tube. The family tells you
that the patient has a long history of alcohol use, drinking about one half of a fifth of
Jack Daniels every day. Which of the following are early indications of alcohol
withdrawal syndrome for which the nurse should monitor?
A.
Diaphoresis, pruritus
B.
Marked tachycardia, marked hypertension
C.
Hyperthermia, dehydration
D.
Delirium, hallucinations - Answers -A. Diaphoresis, pruritus
Because the question says "early," look for the mildest symptoms.
Diaphoresis, pruritus, mild tachycardia, mild hypertension, nausea, vomiting, visual
disturbances, tremors, anxiety, agitation, and sleep disturbances are signs of early
alcohol withdrawal syndrome.
Options "Marked tachycardia, marked hypertension," "Hyperthermia, dehydration," and
"Delirium, hallucinations" describe late signs.
Altering the pH of the gastric secretions through the use of H2 receptor antagonists,
antacids, and proton pump inhibitors contributes to which potential complication?
A.
Pulmonary embolism
B.
Pneumonia
C.
