Pass CCRN test bank Questions &
Answers with rationale(2023)
Which of the following would be the earliest auscultators finding in left ventricular failure
(LVF)?
A. Crackles
B. S3
C. Murmur of mitral regurgitation
D. Pericardial friction rub - 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 - 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 - 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 - 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. - 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 - 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 - 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 - Answer - C. Septic
Iatrogenic means 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.
water loss.
C.
water gain.
D.
aldosterone excess. - Answer - B. water loss
This case is an example of diabetes insipidus, which is caused by a lack of antidiuretic hormone
(ADH). ADH causes water retention in the renal tubules but not sodium retention, so eliminate
sodium retention. A lack of ADH causes water loss not water gain, so eliminate water gain.
Diabetes insipidus does not have anything to do with aldosterone. The hypernatremia is a
concentration effect caused by water loss. This sometimes is called hypovolemic hypernatremia.
A patient is admitted with unstable angina. He has a long history of hypertension and coronary
artery disease. The nurse notes a split S2on expiration and a single S2 on inspiration during
cardiac auscultation. Blood pressure is 150/88 mm Hg, and heart rate is 88 beats/min. On the
electrocardiogram, there is a normal-appearing P wave in front of each QRS complex, the PR
interval measures 0.2 second consistently, and the QRS complexes measure 0.14 second. They
are positive in V5 and V6 and negative in V1 and V2. These findings most likely indicate which
of the following?
A.
Left bundle branch block (LBBB)
B.
Right bundle branch block (RBBB)
C.
Third-degree atrioventricular block
D.
Ventricular tachycardia - Answer - A. Left bundle branch block (LBBB)
Features of LBBB described here are a QRS complex greater than 0.12 second in duration and a
QRS complex that is positive in leads V5 and V6 (consider these left ventricular leads) and
negative in leads V1 and V2 (consider these right ventricular leads). LBBB causes a paradoxical
splitting of S2. This means that it is split on expiration but not on inspiration. This is paradoxical
because it is opposite of a normal physiologic split of S2, which is split on inspiration but not
split on expiration
Which of the following is not an indication for mechanical ventilation in patients with asthma?
A.
Respiratory alkalosis
B.
Cardiopulmonary arrest
Answers with rationale(2023)
Which of the following would be the earliest auscultators finding in left ventricular failure
(LVF)?
A. Crackles
B. S3
C. Murmur of mitral regurgitation
D. Pericardial friction rub - 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 - 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 - 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 - 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. - 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 - 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 - 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 - Answer - C. Septic
Iatrogenic means 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.
water loss.
C.
water gain.
D.
aldosterone excess. - Answer - B. water loss
This case is an example of diabetes insipidus, which is caused by a lack of antidiuretic hormone
(ADH). ADH causes water retention in the renal tubules but not sodium retention, so eliminate
sodium retention. A lack of ADH causes water loss not water gain, so eliminate water gain.
Diabetes insipidus does not have anything to do with aldosterone. The hypernatremia is a
concentration effect caused by water loss. This sometimes is called hypovolemic hypernatremia.
A patient is admitted with unstable angina. He has a long history of hypertension and coronary
artery disease. The nurse notes a split S2on expiration and a single S2 on inspiration during
cardiac auscultation. Blood pressure is 150/88 mm Hg, and heart rate is 88 beats/min. On the
electrocardiogram, there is a normal-appearing P wave in front of each QRS complex, the PR
interval measures 0.2 second consistently, and the QRS complexes measure 0.14 second. They
are positive in V5 and V6 and negative in V1 and V2. These findings most likely indicate which
of the following?
A.
Left bundle branch block (LBBB)
B.
Right bundle branch block (RBBB)
C.
Third-degree atrioventricular block
D.
Ventricular tachycardia - Answer - A. Left bundle branch block (LBBB)
Features of LBBB described here are a QRS complex greater than 0.12 second in duration and a
QRS complex that is positive in leads V5 and V6 (consider these left ventricular leads) and
negative in leads V1 and V2 (consider these right ventricular leads). LBBB causes a paradoxical
splitting of S2. This means that it is split on expiration but not on inspiration. This is paradoxical
because it is opposite of a normal physiologic split of S2, which is split on inspiration but not
split on expiration
Which of the following is not an indication for mechanical ventilation in patients with asthma?
A.
Respiratory alkalosis
B.
Cardiopulmonary arrest
