CCRN EXAM 2025 WITH 100% 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: - Precise 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? - Precise 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 - Precise 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 - Precise 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? -
Precise 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: - Precise 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? - Precise
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? - Precise 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? - Precise 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? - Precise 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? - Precise
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. Hypotermia
B. Fever
C. Severe sepsis - Precise Answer ✔✔Fever
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? - Precise Answer ✔✔Perform 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? - Precise Answer ✔✔Warm blood products and crystalloids
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? - Precise
Answer ✔✔high dose vasopressors
, 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? - Precise Answer ✔✔Nimodipine (Nimotop)
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? - Precise Answer ✔✔Powell
perforation; provide fluids, prepare for surgery.
The clinical signs are those of bowel perforation.
Which is the priority treatment for the pt with DKA who presents with hyperglycemia, ketosis, and
normal serum potassium? - Precise Answer ✔✔replace potassium
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? -
Precise Answer ✔✔Hyperglycemia secondary to insulin resistance.
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: - Precise Answer ✔✔CCB and anticoagulation
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: - Precise 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? - Precise 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 - Precise 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 - Precise 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? -
Precise 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: - Precise 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? - Precise
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? - Precise 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? - Precise 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? - Precise 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? - Precise
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. Hypotermia
B. Fever
C. Severe sepsis - Precise Answer ✔✔Fever
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? - Precise Answer ✔✔Perform 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? - Precise Answer ✔✔Warm blood products and crystalloids
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? - Precise
Answer ✔✔high dose vasopressors
, 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? - Precise Answer ✔✔Nimodipine (Nimotop)
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? - Precise Answer ✔✔Powell
perforation; provide fluids, prepare for surgery.
The clinical signs are those of bowel perforation.
Which is the priority treatment for the pt with DKA who presents with hyperglycemia, ketosis, and
normal serum potassium? - Precise Answer ✔✔replace potassium
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? -
Precise Answer ✔✔Hyperglycemia secondary to insulin resistance.
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: - Precise Answer ✔✔CCB and anticoagulation
