CCRN EXAM QUESTIONS WITH
COMPLETE AND ACCURATE
SOLUTIONS.
The nurse is caring for a patient with acute inferior wall MI, post-
coronary artery stent deployment, For optimal care of the patient, the
nurse should: -- Answer ✔✔ Continuously monitor the patient in lead II
It is best practice to monitor the patient status post PCI with stent, in
the lead that was most abnormal during the acute occlusion.
The ECG demonstrates ST elevation in leads II, III and aVF. The nurse
needs to monitor the patient closely for which of the following? --
Answer ✔✔ Complication likely to occur after an acute inferior wall MI
include bradycardia secondary to ischemia to the SA and/or AV node,
and papillary muscle rupture or dysfunction due to the anatomical
distance between the RCA and the papillary muscle.
Which of the following hemodynamic profiles would benefit from the
aggressive fluid administration, pressers and antibiotics therapy?
a. RAP: 1mm Hg; PAOP: 4 mmHg; SVR: 1800 dynes/sec; CO: 2L/min
b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L -- Answer ✔✔ B. the
hemodynamic profile of RAP 5, PAOP 7, SVR 400 is typical of septic
shock, and choice B would be the best approach.
Which of the following is indicative of a mixed acid-base disorder?
A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11
,B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 -- Answer ✔✔ The decrease
in PaCO2 is evidence of respiratory alkalosis and the decreased HCO3
is evidenced of a metabolic acidosis. The pt with severe sepsis or
septic shock may present with this mixed acid-base disorder.
The patient with a temporary pacemaker develops pacemaker
malfunction. The oriented is instructed to reposition the patient to try
and correct the problem. The cardiac monitor most likely
demonstrates? -- Answer ✔✔ Failure to capture (pacemaker without a
QRS) may be corrected by repositioning the patient to the side.
The patient with diastolic heart develops SVT, heart rate 220/min. The
most dangerous hemodynamic effect is a decrease in: -- Answer ✔✔
coronary artery perfusion.
Diastolic heart failure results in a problem with left ventricular FILLING
secondary to ventricular thickening, and contractility and ejection are
maintained in diastolic failure. The rapid heart rate will decrease filling
time, worsen left ventricular filling and because coronary artery
perfusion occurs during diastole, this arrhythmia may be life-
threatening.
The patient is receiving heparin infusion for the treatment of
pulmonary embolism. There has been a 60% decrease in the platelet
count and no clinical change. Which of the following is indicated? --
Answer ✔✔ Discontinue heparin and being argatroban.
The patient most likely has HIT. Exposure to heparin needs to
discontinued and a direct thrombin inhibitor started for continued
anticoagulation.
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? -- Answer ✔✔ Phenytoin (Dilantin), 3% saline.
, 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
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
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
Both a problem with systolic (ejection problem) and diastolic (filling
problem) will increase left heart pressure and cause cardiogenic
pulmonary edema (lung crackles).
Which of the following is most likely to result in a low Sv02?
A. Hypothermia
B. Fever
C. Severe sepsis -- Answer ✔✔ Fever
Fever increases metabolic rate and consumption, which may lead to a
drop in mixed venous oxygen saturation.
COMPLETE AND ACCURATE
SOLUTIONS.
The nurse is caring for a patient with acute inferior wall MI, post-
coronary artery stent deployment, For optimal care of the patient, the
nurse should: -- Answer ✔✔ Continuously monitor the patient in lead II
It is best practice to monitor the patient status post PCI with stent, in
the lead that was most abnormal during the acute occlusion.
The ECG demonstrates ST elevation in leads II, III and aVF. The nurse
needs to monitor the patient closely for which of the following? --
Answer ✔✔ Complication likely to occur after an acute inferior wall MI
include bradycardia secondary to ischemia to the SA and/or AV node,
and papillary muscle rupture or dysfunction due to the anatomical
distance between the RCA and the papillary muscle.
Which of the following hemodynamic profiles would benefit from the
aggressive fluid administration, pressers and antibiotics therapy?
a. RAP: 1mm Hg; PAOP: 4 mmHg; SVR: 1800 dynes/sec; CO: 2L/min
b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L -- Answer ✔✔ B. the
hemodynamic profile of RAP 5, PAOP 7, SVR 400 is typical of septic
shock, and choice B would be the best approach.
Which of the following is indicative of a mixed acid-base disorder?
A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11
,B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 -- Answer ✔✔ The decrease
in PaCO2 is evidence of respiratory alkalosis and the decreased HCO3
is evidenced of a metabolic acidosis. The pt with severe sepsis or
septic shock may present with this mixed acid-base disorder.
The patient with a temporary pacemaker develops pacemaker
malfunction. The oriented is instructed to reposition the patient to try
and correct the problem. The cardiac monitor most likely
demonstrates? -- Answer ✔✔ Failure to capture (pacemaker without a
QRS) may be corrected by repositioning the patient to the side.
The patient with diastolic heart develops SVT, heart rate 220/min. The
most dangerous hemodynamic effect is a decrease in: -- Answer ✔✔
coronary artery perfusion.
Diastolic heart failure results in a problem with left ventricular FILLING
secondary to ventricular thickening, and contractility and ejection are
maintained in diastolic failure. The rapid heart rate will decrease filling
time, worsen left ventricular filling and because coronary artery
perfusion occurs during diastole, this arrhythmia may be life-
threatening.
The patient is receiving heparin infusion for the treatment of
pulmonary embolism. There has been a 60% decrease in the platelet
count and no clinical change. Which of the following is indicated? --
Answer ✔✔ Discontinue heparin and being argatroban.
The patient most likely has HIT. Exposure to heparin needs to
discontinued and a direct thrombin inhibitor started for continued
anticoagulation.
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? -- Answer ✔✔ Phenytoin (Dilantin), 3% saline.
, 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
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
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
Both a problem with systolic (ejection problem) and diastolic (filling
problem) will increase left heart pressure and cause cardiogenic
pulmonary edema (lung crackles).
Which of the following is most likely to result in a low Sv02?
A. Hypothermia
B. Fever
C. Severe sepsis -- Answer ✔✔ Fever
Fever increases metabolic rate and consumption, which may lead to a
drop in mixed venous oxygen saturation.
