CCRN PRACTICE QUESTIONS,
ANSWERS AND RATIONALES 100 %
PASS GRADED 2024 UPDATED( ACTUAL
EXAM).
A 52-year-old accountant is admitted to the critical care unit with frank
gastrointestinal bleeding for more than 18 hours. He has had a blood loss
of more than 1000 mL. Which of the following sets of vital signs would be
consistent with the patient's blood loss?
A.
Blood pressure (BP) 100/84 mm Hg, heart rate 124 beats/min
B.
BP 86/40 mm Hg, heart rate 92 beats/min
C.
BP 124/66 mm Hg, heart rate 124 beats/min
D.
BP 112/60 mm Hg, heart rate 92 beats/min - Precise answer A!
With a loss of 750 to 1500 mL of blood, an increase in heart rate greater
than 100 beats/min and a narrowing of the pulse pressure is expected.
These changes are due to sympathetic nervous system innervation. Option
a shows a narrow pulse pressure and tachycardia.
Which is the most critical concern during the acute phase of care for a
patient with an intestinal obstruction?
A.
Aspiration
B.
Hyperkalemia
,C.
Hypovolemia
D.
Metabolic alkalosis - Precise answer C - hypovolemia
In intestinal obstruction, hypovolemia is the result of vomiting and
sequestration of fluids in the lumen of the intestine. Intravascular volume
decreases which can cause hypovolemic shock. Aspiration is a potential
risk if the patient is vomiting. Hypokalemia and metabolic acidosis occur as
a result of trapping of fluid within the lumen of the intestine.
A patient is brought to the hospital after inadvertent consumption of
shellfish. He says he knew he was allergic to shellfish but did not know that
the casserole that he was eating had shellfish in it. His face is edematous
and his tongue is swollen. His voice is hoarse and he has inspiratory
stridor. His medical history includes a myocardial infarction last year, and
he has been taking metoprolol (Lopressor) since that time. Symptoms of
anaphylaxis would have occurred how long after exposure to the antigen?
A.
5 to 20 minutes
B.
20 to 60 minutes
C.
48 hours
D.
3 days - Precise answer A
Symptoms of anaphylaxis occur within 5 to 20 minutes. These immediate
hypersensitivity reactions are life threatening. Later reactions, including
cytotoxic hypersensitivity, cause urticaria but rarely are life threatening.
Which of the following would not occur during a stressful situation?
A.
,Hypersalivation
B.
Hyperventilation
C.
Increased muscle tension
D.
Palpitations - Precise answer A
Oral and gastrointestinal secretions are reduced with sympathetic nervous
system stimulation.
A patient arrives with multisystem trauma after falling out of a second-floor
window. She is lethargic and has peripheral cyanosis. Her vital signs are
blood pressure 80/60 mm Hg, heart rate 145 beats/min, and respiratory
rate 40 breaths/min. Which class of hemorrhagic shock is she in?
A.
I
B.
II
C.
III
D.
IV - Precise answer D. IV
She is hypotensive with a narrowed pulse pressure, significantly
tachycardic and tachypneic, and cyanotic. This clinical presentation is
consistent with Class IV hemorrhagic shock and a loss of more than 40% of
blood volume, or greater than 2000 mL.
A patient arrives in the emergency department at 10:30 am with severe
chest pain. He has ST segment elevation in leads V3 to V6. He has been
given morphine for pain and is being evaluated for fibrinolytic therapy. The
, family arrives in the waiting room. Which of the following would be the best
action?
A.
Ask the unit secretary to tell the family that the patient has had a cardiac
arrest and that the nursing staff will talk to the family as soon as possible.
B.
Ask the unit secretary to take family members to a private area and tell
them that the physician will be there to talk to them soon.
C.
Take the family to a private area yourself and briefly explain what has
happened.
D.
Take family members to a private area yourself and tell them that the
physician will be there to talk to them soon. - Precise answer C
Family members need privacy as they begin to deal with this crisis. They
should be briefly told what has happened as soon as possible, and then the
physician can talk to them as soon as he or she is available.
A nurse is asked to lead a project team to develop a new protocol for
suctioning endotracheal tubes. The nurse conducts a literature search for
clinical practice guidelines that have been developed already and revises
the protocol for the hospital according to the recommendations of the
clinical practice guidelines and the findings from research that has been
conducted since the development of the clinical practice guidelines. A
clinical practice guideline is an example of:
A.
discovery of knowledge.
B.
summary of evidence.
C.
translation of evidence.
ANSWERS AND RATIONALES 100 %
PASS GRADED 2024 UPDATED( ACTUAL
EXAM).
A 52-year-old accountant is admitted to the critical care unit with frank
gastrointestinal bleeding for more than 18 hours. He has had a blood loss
of more than 1000 mL. Which of the following sets of vital signs would be
consistent with the patient's blood loss?
A.
Blood pressure (BP) 100/84 mm Hg, heart rate 124 beats/min
B.
BP 86/40 mm Hg, heart rate 92 beats/min
C.
BP 124/66 mm Hg, heart rate 124 beats/min
D.
BP 112/60 mm Hg, heart rate 92 beats/min - Precise answer A!
With a loss of 750 to 1500 mL of blood, an increase in heart rate greater
than 100 beats/min and a narrowing of the pulse pressure is expected.
These changes are due to sympathetic nervous system innervation. Option
a shows a narrow pulse pressure and tachycardia.
Which is the most critical concern during the acute phase of care for a
patient with an intestinal obstruction?
A.
Aspiration
B.
Hyperkalemia
,C.
Hypovolemia
D.
Metabolic alkalosis - Precise answer C - hypovolemia
In intestinal obstruction, hypovolemia is the result of vomiting and
sequestration of fluids in the lumen of the intestine. Intravascular volume
decreases which can cause hypovolemic shock. Aspiration is a potential
risk if the patient is vomiting. Hypokalemia and metabolic acidosis occur as
a result of trapping of fluid within the lumen of the intestine.
A patient is brought to the hospital after inadvertent consumption of
shellfish. He says he knew he was allergic to shellfish but did not know that
the casserole that he was eating had shellfish in it. His face is edematous
and his tongue is swollen. His voice is hoarse and he has inspiratory
stridor. His medical history includes a myocardial infarction last year, and
he has been taking metoprolol (Lopressor) since that time. Symptoms of
anaphylaxis would have occurred how long after exposure to the antigen?
A.
5 to 20 minutes
B.
20 to 60 minutes
C.
48 hours
D.
3 days - Precise answer A
Symptoms of anaphylaxis occur within 5 to 20 minutes. These immediate
hypersensitivity reactions are life threatening. Later reactions, including
cytotoxic hypersensitivity, cause urticaria but rarely are life threatening.
Which of the following would not occur during a stressful situation?
A.
,Hypersalivation
B.
Hyperventilation
C.
Increased muscle tension
D.
Palpitations - Precise answer A
Oral and gastrointestinal secretions are reduced with sympathetic nervous
system stimulation.
A patient arrives with multisystem trauma after falling out of a second-floor
window. She is lethargic and has peripheral cyanosis. Her vital signs are
blood pressure 80/60 mm Hg, heart rate 145 beats/min, and respiratory
rate 40 breaths/min. Which class of hemorrhagic shock is she in?
A.
I
B.
II
C.
III
D.
IV - Precise answer D. IV
She is hypotensive with a narrowed pulse pressure, significantly
tachycardic and tachypneic, and cyanotic. This clinical presentation is
consistent with Class IV hemorrhagic shock and a loss of more than 40% of
blood volume, or greater than 2000 mL.
A patient arrives in the emergency department at 10:30 am with severe
chest pain. He has ST segment elevation in leads V3 to V6. He has been
given morphine for pain and is being evaluated for fibrinolytic therapy. The
, family arrives in the waiting room. Which of the following would be the best
action?
A.
Ask the unit secretary to tell the family that the patient has had a cardiac
arrest and that the nursing staff will talk to the family as soon as possible.
B.
Ask the unit secretary to take family members to a private area and tell
them that the physician will be there to talk to them soon.
C.
Take the family to a private area yourself and briefly explain what has
happened.
D.
Take family members to a private area yourself and tell them that the
physician will be there to talk to them soon. - Precise answer C
Family members need privacy as they begin to deal with this crisis. They
should be briefly told what has happened as soon as possible, and then the
physician can talk to them as soon as he or she is available.
A nurse is asked to lead a project team to develop a new protocol for
suctioning endotracheal tubes. The nurse conducts a literature search for
clinical practice guidelines that have been developed already and revises
the protocol for the hospital according to the recommendations of the
clinical practice guidelines and the findings from research that has been
conducted since the development of the clinical practice guidelines. A
clinical practice guideline is an example of:
A.
discovery of knowledge.
B.
summary of evidence.
C.
translation of evidence.
