Pass CCRN EXAM
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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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. - CORRECT ANSWER 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 - CORRECT ANSWER 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.
Which of the following is associated with chest pain, confusion, and petechiae?
A.
Dissecting aneurysm
B.
Fat embolism
C.
Pneumothorax
, D.
Myocardial infarction - CORRECT ANSWER B. Fat embolism
Chest pain, confusion, and petechiae are suggestive of a fat embolism, especially within the first 48
to 72 hours after a long-bone fracture.
The clincher is the petechiae. None of the other choices would cause petechiae.
Which type of shock is most likely to be iatrogenic?
A.
Hypovolemic
B.
Cardiogenic
C.
Septic
D.
Neurogenic - CORRECT ANSWER C. Septic
Iatrogenic meCORRECT ANSWER caused by treatment or diagnostic procedures or medically induced.
Septic shock is the type of shock most likely to be iatrogenic. Significant contributors include
immunosuppressive medications and therapies and invasive procedures.
A patient had a craniotomy 2 days ago for removal of a tumor. He is awake and talking to the nurse
and demonstrates no neurologic deficit. Blood pressure is 110/80 mm Hg, pulse is 92 beats/min, and
respiratory rate is 22 breaths/min. Urine outputs have been approximately 60 ml/hr over the last 2
days, but he has had a recent change. He has had 300 to 400 ml/hr of urine output over the last
several hours. The urine has a specific gravity of 1.002. The nurse checks his serum glucose and finds
that it is 100 mg/dl. The cause of hypernatremia in this patient is:
A.
sodium retention.
B.
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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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. - CORRECT ANSWER 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 - CORRECT ANSWER 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.
Which of the following is associated with chest pain, confusion, and petechiae?
A.
Dissecting aneurysm
B.
Fat embolism
C.
Pneumothorax
, D.
Myocardial infarction - CORRECT ANSWER B. Fat embolism
Chest pain, confusion, and petechiae are suggestive of a fat embolism, especially within the first 48
to 72 hours after a long-bone fracture.
The clincher is the petechiae. None of the other choices would cause petechiae.
Which type of shock is most likely to be iatrogenic?
A.
Hypovolemic
B.
Cardiogenic
C.
Septic
D.
Neurogenic - CORRECT ANSWER C. Septic
Iatrogenic meCORRECT ANSWER caused by treatment or diagnostic procedures or medically induced.
Septic shock is the type of shock most likely to be iatrogenic. Significant contributors include
immunosuppressive medications and therapies and invasive procedures.
A patient had a craniotomy 2 days ago for removal of a tumor. He is awake and talking to the nurse
and demonstrates no neurologic deficit. Blood pressure is 110/80 mm Hg, pulse is 92 beats/min, and
respiratory rate is 22 breaths/min. Urine outputs have been approximately 60 ml/hr over the last 2
days, but he has had a recent change. He has had 300 to 400 ml/hr of urine output over the last
several hours. The urine has a specific gravity of 1.002. The nurse checks his serum glucose and finds
that it is 100 mg/dl. The cause of hypernatremia in this patient is:
A.
sodium retention.
B.
