CCRN EXAM LATEST 2023-2024 ACTUAL EXAM
300 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES|ALREADY
GRADED A+
The patient with oat cell carcinoma has the following clinical findings: low urine
output, low serum osmolality, hyponatremia, and elevated urine sodium. The nurse
anticipates which of the following as part of the treatment plan? – ANSWERPhenytoin (Dilantin), 3% saline.
RATIONALE:The patient has signs of SIADH which results in production of
excessive ADH. Dilantin will inhibit ADH secretion and 3% saline will increase
serum sodium.
Peep therapy and mechanical ventilation are ordered for the patient with acute
respiratory failure. Which of the following is a possible complication? –
ANSWER- Barotrauma
RATIONALE:The addition of positive end-expiratory pressure will increase
alveolar recruitment, prevent atelectasis and improve oxygenation. However, the
increase in intrathoracic pressure may lead to pneumothorax or subcutaneous
emphysema.
The postoperative thoracic surgery patient has bubbling in the water seal drainage
chamber of the chest tube. Which of the following interventions is indicated? –
ANSWER- avoid high airway pressures
RATIONALE:Bubbling in the water seal chamber is due to a pleural air leak, and
high airway pressure will either prevent resolution of the current air leak or make it
worse.
Which clinical sign might patients with both systolic and diastolic heart failure
have in common? – ANSWER- Lung crackles
RATIONALE:Both a problem with systolic (ejection problem) and diastolic
(filling problem) will increase left heart pressure and cause cardiogenic pulmonary
edema (lung crackles).<\/p>\n\n\n\n
Which of the following is most likely to result in a low Sv02?
A. Hypotermia
B. Fever
C. Severe sepsis – ANSWER- Fever
RATIONALE:Fever increases metabolic rate and consumption, which may lead
to a drop in mixed venous oxygen saturation.
The nurse needs to assess adequacy of the tubing\/catheter system for the arterial
line. Which of the following interventions will best assess this? – ANSWERPerform a square wave test
The patient requires fluid resuscitation and 8 units of PRBC’s status post traumatic
injury. Which of the following interventions is most appropriate? – ANSWERWarm blood products and crystalloids
RATIONALE:Warming fluids and blood needed for traumatic injury will prevent
hypothermia and its related adverse effects.
Which of the following therapies should be avoided for the patient with
cardiogenic shock? – ANSWER- high dose vasopressors
RATIONALE:Vasopressors increase left ventricular after load, which would
increase myocardial work of a failing heart.
The patient is status post repair of an aneurysm for subarachnoid hemorrhage.
Which of the following interventions is indicated to prevent vasospasm? –
ANSWER- Nimodipine (Nimotop)
RATIONALE:is a calcium channel blocker that is started immediately post-op to
prevent arterial spasm of the brain.
The patient presents with a rigid abdomen, rebound tenderness, and a free air in the
peritoneum seen on KUB x-ray. Which of the following should the nurse
anticipate? – ANSWER- Powell perforation; provide fluids, prepare for surgery.
RATIONALE:The clinical signs are those of bowel perforation.<\/p>\n\n\n\n
Which is the priority treatment for the pt with DKA who presents with
hyperglycemia, ketosis, and normal serum potassium? – ANSWER- replace
potassium
RATIONALE:The patient with DKA will have a low pH and metabolic acidosis.
In a state of metabolic acidosis, hydrogen ions move into the intracellular space. In
exchange, potassium leaves the intracellular space. The movement of K into the
extracellular space results in hyperkalemia.
Which of the following is a systemic effect of the therapeutic hypothermia during
the cooling phase? – ANSWER- Hyperglycemia secondary to insulin resistance.
RATIONALE:During the cooling phase of clinical hypothermia there is typically
insulin resistance. Additionally, during the phase there is vasoconstriction,
decreased neutrophil production and during rewarming, rebound hyperkalemia
may occur (not during the cooling phase).
The patient presented to the ED with a history of palpitations and dyspnea,
persisting on and off for one week. The heart monitor shows trail fibrillation with
rapid ventricular response, blood pressure 112\/70. Treatment will most likely
include: – ANSWER- CCB and anticoagulation
RATIONALE:The patient history seems to be one of intermittent atrail fibrillation
over the past week. Controlling rate and addressing potential left atrial clot
formation are priority treatments.
Which of the following clinical findings would you expect to find in the patient
with septic shock? – ANSWER- Lactate 8, SvO2 85
RATIONALE:Elevated lactate is evidence of anaerobic metabolism and elevated
Sv02 is evidence of decreased oxygen utilization at the cellular level – both
definitive for septic shock.
The patient has a massive pulmonary embolism. Which of the following would be
expected? – ANSWER- Hypotension, increased alveolar dead space.
RATIONALE:Massive pulmonary embolism results in sudden extremely elevated
pulmonary pressures with resultant right ventricular failure and decreased left
ventricular pressure. The drop in CO results in hypotension. The clot obstructs
pulmonary perfusion which results in increase headspace ventilation.<\/p>\n\n\n\n
The patient presents with left leg pain; ankle-brachial index (ABI) is 0.7. The
patient would benefit from which of the following interventions? – ANSWERdependent position of legs
RATIONALE:The clinical signs are indicative of peripheral arterial occlusive
disease. Dependent leg position will aid perfusion.
Which of the following are clinical signs of variant (Prinzmetal’s) angina? –
ANSWER- ST-elevation, resolves with nitrate therapy.
RATIONALE:This type of angina is thought to be due to arterial spasm at the
point of coronary artery plaque, not due to plaque rupture. The ST elevation is
transient because the spasm is relieved with nitrates; therefore infarction does not
occur.
The most specific clinical sign for the presence of brain death would include which
of the following? – ANSWER- Absent oculocephalic reflex
RATIONALE:If eyes remain midline or turn to the side of head rotation, it is a
sign of cranial nerve VIII damage and possible brain death. The apnea test is
positive in the presence of brain death; while coma is present during brain death,
most patients with coma do not have brain death.
The physician determines the patient has ARDS. The patient has developed
refractory hypoxemia, bilateral infiltrates, and pulmonary edema on chest x-ray.
What findings would be expected?
a. increased lung compliance
b. PAOP normal or low
c. decreased cardiac output – ANSWER- b.
RATIONALE:The pulmonary edema of ARDS is due to lung capillary leak at
normal or even low left heart pressure, unlike cariogenic pulmonary edema, which
results in pulmonary edema at higher than normal left heart pressure.
The patient presents one month status post gastric bypass bariatric surgery with
vomiting, headache, diplopia, and memory loss. These are clinical signs of which
of the following? – ANSWER- Malabsorption
<\/p>\n","protected":false},"excerpt":{"rendered":"
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