Adult CCRN® Ultimate Exam Prep 2025–2026 | Practice Questions,
Answers & Rationales
1. One day following posterior spinal fusion surgery a 35-year-old female
suddenly exhibits restlessness, labored breathing and acute chest pain. Her
heart rate is 122/min., she is afebrile, and exhibits slightly diminished breath
sounds on the right side. Which of the following will most likely confirm the
patient's diagnosis?
Answer: A. Pulmonary radioisotope scan
Rationale: A pulmonary radioisotope scan (V/Q scan) or a CT pulmonary
angiography (CTPA) is the standard diagnostic test to confirm a pulmonary
embolus. While chest x-ray and ABGs are useful, they are non-specific. A V/Q
scan directly evaluates ventilation and perfusion mismatch, which is the hallmark
of a PE.
2. The nursing staff does not wish to be assigned a difficult patient who
continues to demonstrate disorderly behavior. Which of the following is an
acceptable solution?
Answer: D. Alternate the patient assignment among the nursing staff.
Rationale: This is the most fair and ethical solution. It distributes the burden of
care among all staff members, preventing burnout and ensuring the patient still
receives consistent care. Transferring the patient is inappropriate unless clinically
,indicated, and assigning based on charge nurse decision alone doesn't address the
underlying staff concern.
3. One day following posterior spinal fusion surgery a 35-year-old female
suddenly exhibits restlessness, labored breathing and acute chest pain. Her
heart rate is 122/min., she is afebrile, and exhibits slightly diminished breath
sounds on the right side. The findings described above should lead the nurse
to suspect that the patient has developed:
Answer: B. A pulmonary embolus
Rationale: This patient is post-operative (a major risk factor for venous
thromboembolism) and presents with the classic, acute triad of pleuritic chest pain,
dyspnea, and tachycardia. The absence of fever and the sudden onset make a
pulmonary embolus (PE) much more likely than pneumonia or a spontaneous
pneumothorax, which is less common in this age group without underlying lung
disease.
4. A patient who is 72 hours postoperative repair of a bowel obstruction
suddenly demonstrates shortness of breath and his respiratory rate increases
from 22 to 45/min. His SpO2 went from 95% to 88% acutely. An arterial
blood gas sample obtained while the patient is receiving oxygen via a nasal
cannula at 6L/min reveals the following results: pH 7.40, pCO2 27, pO2 50. A
chest x-ray is obtained and a "ground-glass-like appearance" is reported.
Auscultation of the lungs reveals diffuse crackles that were not present
previously. The findings described above should lead the nurse to believe that
the patient has:
, Answer: A. Acute respiratory distress syndrome
Rationale: This patient has severe hypoxemia (PaO2 of 50 on 6L O2), bilateral
infiltrates ("ground-glass" appearance on CXR), and respiratory distress. This
occurs in the setting of a systemic inflammatory response (72 hours post-op bowel
repair), which is classic for ARDS. A PE typically shows a wedge-shaped infarct
on CXR, and pneumothorax would show absent breath sounds unilaterally.
5. On admission, your patient's arterial blood gas on room air is: pH 7.23,
PaCO2 55, PaO2 90, HCO3 30. The correct arterial blood gas interpretation
is:
Answer: C. Uncompensated respiratory acidosis
Rationale: The pH is low (7.23 < 7.35), indicating acidosis. The PaCO2 is high
(55 > 45), indicating a respiratory cause. The HCO3 is slightly elevated (30 > 26),
which would be an expected metabolic compensation, however, because the pH is
still abnormal, it is not fully compensated. Therefore, it is an uncompensated
respiratory acidosis.
6. Your patient just received 10 units of banked blood for a GI bleed. You
know this will affect the oxyhemoglobin dissociation curve by:
Answer: C. Shifting it to the left
Rationale: Banked blood has depleted levels of 2,3-DPG (2,3-diphosphoglycerate)
due to storage. A decrease in 2,3-DPG increases hemoglobin's affinity for oxygen,
Answers & Rationales
1. One day following posterior spinal fusion surgery a 35-year-old female
suddenly exhibits restlessness, labored breathing and acute chest pain. Her
heart rate is 122/min., she is afebrile, and exhibits slightly diminished breath
sounds on the right side. Which of the following will most likely confirm the
patient's diagnosis?
Answer: A. Pulmonary radioisotope scan
Rationale: A pulmonary radioisotope scan (V/Q scan) or a CT pulmonary
angiography (CTPA) is the standard diagnostic test to confirm a pulmonary
embolus. While chest x-ray and ABGs are useful, they are non-specific. A V/Q
scan directly evaluates ventilation and perfusion mismatch, which is the hallmark
of a PE.
2. The nursing staff does not wish to be assigned a difficult patient who
continues to demonstrate disorderly behavior. Which of the following is an
acceptable solution?
Answer: D. Alternate the patient assignment among the nursing staff.
Rationale: This is the most fair and ethical solution. It distributes the burden of
care among all staff members, preventing burnout and ensuring the patient still
receives consistent care. Transferring the patient is inappropriate unless clinically
,indicated, and assigning based on charge nurse decision alone doesn't address the
underlying staff concern.
3. One day following posterior spinal fusion surgery a 35-year-old female
suddenly exhibits restlessness, labored breathing and acute chest pain. Her
heart rate is 122/min., she is afebrile, and exhibits slightly diminished breath
sounds on the right side. The findings described above should lead the nurse
to suspect that the patient has developed:
Answer: B. A pulmonary embolus
Rationale: This patient is post-operative (a major risk factor for venous
thromboembolism) and presents with the classic, acute triad of pleuritic chest pain,
dyspnea, and tachycardia. The absence of fever and the sudden onset make a
pulmonary embolus (PE) much more likely than pneumonia or a spontaneous
pneumothorax, which is less common in this age group without underlying lung
disease.
4. A patient who is 72 hours postoperative repair of a bowel obstruction
suddenly demonstrates shortness of breath and his respiratory rate increases
from 22 to 45/min. His SpO2 went from 95% to 88% acutely. An arterial
blood gas sample obtained while the patient is receiving oxygen via a nasal
cannula at 6L/min reveals the following results: pH 7.40, pCO2 27, pO2 50. A
chest x-ray is obtained and a "ground-glass-like appearance" is reported.
Auscultation of the lungs reveals diffuse crackles that were not present
previously. The findings described above should lead the nurse to believe that
the patient has:
, Answer: A. Acute respiratory distress syndrome
Rationale: This patient has severe hypoxemia (PaO2 of 50 on 6L O2), bilateral
infiltrates ("ground-glass" appearance on CXR), and respiratory distress. This
occurs in the setting of a systemic inflammatory response (72 hours post-op bowel
repair), which is classic for ARDS. A PE typically shows a wedge-shaped infarct
on CXR, and pneumothorax would show absent breath sounds unilaterally.
5. On admission, your patient's arterial blood gas on room air is: pH 7.23,
PaCO2 55, PaO2 90, HCO3 30. The correct arterial blood gas interpretation
is:
Answer: C. Uncompensated respiratory acidosis
Rationale: The pH is low (7.23 < 7.35), indicating acidosis. The PaCO2 is high
(55 > 45), indicating a respiratory cause. The HCO3 is slightly elevated (30 > 26),
which would be an expected metabolic compensation, however, because the pH is
still abnormal, it is not fully compensated. Therefore, it is an uncompensated
respiratory acidosis.
6. Your patient just received 10 units of banked blood for a GI bleed. You
know this will affect the oxyhemoglobin dissociation curve by:
Answer: C. Shifting it to the left
Rationale: Banked blood has depleted levels of 2,3-DPG (2,3-diphosphoglycerate)
due to storage. A decrease in 2,3-DPG increases hemoglobin's affinity for oxygen,
