CCRN 124 test Questions
A 72-year-old man arrived in the emergency department after 4 hours of
substernal pain radiating to the left arm. He has a 100 pack-year history
of cigarette smoking, chronic obstructive pulmonary disease, and
intermittent claudication. His electrocardiogram on admission shows
sinus tachycardia with a rate of 120 beats/min and ST segment elevation
in leads I, AVL, and V3 to V6. Vital signs include blood pressure,
150/84 mm Hg; respiratory rate, 15 breaths/min; functional oxygen
saturation (SpO2), 95%; and temperature, 38.3° C (100.9° F). Which of
the following treatments would not be indicated for this patient at this
time?
A.
Morphine and nitroglycerin
B.
Aspirin and fibrinolytic drugs
C.
β-blockers
D.
Lidocaine - ✔ ✔ D. Lidocaine
Lidocaine is used for symptomatic ventricular dysrhythmias.
A 72-year-old woman has been complaining of chest pain for 30 min.
Her medical history includes vaginal hysterectomy and angina. She was
initially alert but is now drowsy. Her skin is cool and moist. Vital signs
are blood pressure, 84/60 mm Hg; heart rate, 42 beats/min and regular;
and respiratory rate, 28 breaths/min. Electrocardiogram monitor shows
sinus bradycardia. Which of the following treatments is indicated?
A.
Epinephrine 1 mg IV
B.
,Atropine 0.5 mg IV
C.
Isoproterenol IV infusion at 2 mcg/min
D.
Transcutaneous pacemaker - ✔ ✔ D. Transcutaneous pacemaker
A 76-year-old man is admitted with complaints of sudden, sharp,
"tearing" chest pain radiating to the shoulders, neck, and back. He has
been in apparent good health except for a history of hypertension. Vital
signs are blood pressure, 180/96 mm Hg; heart rate, 90 beats/min; and
respiratory rate, 26 breaths/min. He is dyspneic, and his
electrocardiogram shows nonspecific ST-T wave changes. Which of the
following would not be an important aspect of care for this patient?
A.
Control his blood pressure.
B.
Provide adequate analgesia.
C.
Initiate fibrinolytic therapy.
D.
Prepare the patient for surgery. - ✔ ✔ C. Initiate fibrinolytic therapy.
Fibrinolytic therapy is contraindicated if dissecting thoracic aortic
aneurysm is suspected. All of the other interventions are appropriate.
A 22-year-old man is admitted after a bicycle collision with a tree. He
has a contusion on the right side of his head. An intraventricular catheter
has been inserted via a burr hole to monitor his intracranial pressure
(ICP). He develops respiratory depression and is intubated and
mechanically ventilated. Which of the following is the most likely cause
of an increase in ICP at this time?
A.
Positive pressure ventilation
B.
,Hypocapnia caused by hyperventilation
C.
Sedation
D.
Cerebral dehydration caused by osmotic diuretics - ✔ ✔ A. Positive
pressure ventilation
Positive pressure ventilation increases intrathoracic pressure, which
leads to increased ICP.
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. - ✔ ✔ 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 22-year-old man is admitted with spontaneous pneumothorax. He is
extremely dyspneic and anxious. He also is complaining of tingling
around his mouth and his fingertips and feeling light-headed. Blood
pressure is 120/82 mm Hg, heart rate is 110 beats/min, respiratory rate is
, 36 breaths/min and deep, and temperature is 37° C (98.6° F). Which of
the following would not be used to treat this condition?
A.
Calcium
B.
Chest tube
C.
Analgesia
D.
Calming the patient - ✔ ✔ A. Calcium
Remember that respiratory alkalosis, caused by hyperventilation,
increases the binding between albumin and calcium and, therefore,
reduces the serum ionized calcium level. This is why the patient is
having the symptoms of tetany. However, he does not need calcium. He
needs a reduction in minute ventilation, which will decrease his pH and
correct the binding between calcium and albumin, increasing the ionized
calcium level. Chest tube to re-expand the lung, analgesia to treat the
chest discomfort, and calming of the patient (including the use of
sedatives) would be appropriate components of the treatment plan for
this patient.
A 24-year-old man has been diagnosed with acute kidney injury as a
result of severe hemorrhaging after a motor vehicle collision. Which of
the following would be expected laboratory values for this patient?
A.
Low urinary osmolality, high urinary sodium concentration
B.
High urinary osmolality, high urinary sodium concentration
C.
Low urinary osmolality, low urinary sodium concentration
D.
A 72-year-old man arrived in the emergency department after 4 hours of
substernal pain radiating to the left arm. He has a 100 pack-year history
of cigarette smoking, chronic obstructive pulmonary disease, and
intermittent claudication. His electrocardiogram on admission shows
sinus tachycardia with a rate of 120 beats/min and ST segment elevation
in leads I, AVL, and V3 to V6. Vital signs include blood pressure,
150/84 mm Hg; respiratory rate, 15 breaths/min; functional oxygen
saturation (SpO2), 95%; and temperature, 38.3° C (100.9° F). Which of
the following treatments would not be indicated for this patient at this
time?
A.
Morphine and nitroglycerin
B.
Aspirin and fibrinolytic drugs
C.
β-blockers
D.
Lidocaine - ✔ ✔ D. Lidocaine
Lidocaine is used for symptomatic ventricular dysrhythmias.
A 72-year-old woman has been complaining of chest pain for 30 min.
Her medical history includes vaginal hysterectomy and angina. She was
initially alert but is now drowsy. Her skin is cool and moist. Vital signs
are blood pressure, 84/60 mm Hg; heart rate, 42 beats/min and regular;
and respiratory rate, 28 breaths/min. Electrocardiogram monitor shows
sinus bradycardia. Which of the following treatments is indicated?
A.
Epinephrine 1 mg IV
B.
,Atropine 0.5 mg IV
C.
Isoproterenol IV infusion at 2 mcg/min
D.
Transcutaneous pacemaker - ✔ ✔ D. Transcutaneous pacemaker
A 76-year-old man is admitted with complaints of sudden, sharp,
"tearing" chest pain radiating to the shoulders, neck, and back. He has
been in apparent good health except for a history of hypertension. Vital
signs are blood pressure, 180/96 mm Hg; heart rate, 90 beats/min; and
respiratory rate, 26 breaths/min. He is dyspneic, and his
electrocardiogram shows nonspecific ST-T wave changes. Which of the
following would not be an important aspect of care for this patient?
A.
Control his blood pressure.
B.
Provide adequate analgesia.
C.
Initiate fibrinolytic therapy.
D.
Prepare the patient for surgery. - ✔ ✔ C. Initiate fibrinolytic therapy.
Fibrinolytic therapy is contraindicated if dissecting thoracic aortic
aneurysm is suspected. All of the other interventions are appropriate.
A 22-year-old man is admitted after a bicycle collision with a tree. He
has a contusion on the right side of his head. An intraventricular catheter
has been inserted via a burr hole to monitor his intracranial pressure
(ICP). He develops respiratory depression and is intubated and
mechanically ventilated. Which of the following is the most likely cause
of an increase in ICP at this time?
A.
Positive pressure ventilation
B.
,Hypocapnia caused by hyperventilation
C.
Sedation
D.
Cerebral dehydration caused by osmotic diuretics - ✔ ✔ A. Positive
pressure ventilation
Positive pressure ventilation increases intrathoracic pressure, which
leads to increased ICP.
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. - ✔ ✔ 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 22-year-old man is admitted with spontaneous pneumothorax. He is
extremely dyspneic and anxious. He also is complaining of tingling
around his mouth and his fingertips and feeling light-headed. Blood
pressure is 120/82 mm Hg, heart rate is 110 beats/min, respiratory rate is
, 36 breaths/min and deep, and temperature is 37° C (98.6° F). Which of
the following would not be used to treat this condition?
A.
Calcium
B.
Chest tube
C.
Analgesia
D.
Calming the patient - ✔ ✔ A. Calcium
Remember that respiratory alkalosis, caused by hyperventilation,
increases the binding between albumin and calcium and, therefore,
reduces the serum ionized calcium level. This is why the patient is
having the symptoms of tetany. However, he does not need calcium. He
needs a reduction in minute ventilation, which will decrease his pH and
correct the binding between calcium and albumin, increasing the ionized
calcium level. Chest tube to re-expand the lung, analgesia to treat the
chest discomfort, and calming of the patient (including the use of
sedatives) would be appropriate components of the treatment plan for
this patient.
A 24-year-old man has been diagnosed with acute kidney injury as a
result of severe hemorrhaging after a motor vehicle collision. Which of
the following would be expected laboratory values for this patient?
A.
Low urinary osmolality, high urinary sodium concentration
B.
High urinary osmolality, high urinary sodium concentration
C.
Low urinary osmolality, low urinary sodium concentration
D.
