Pass CCRN Test Bank – AACN Critical Care Nursing
Certification – Comprehensive Practice Questions with
Verified Answers and Rationales
Which of the following would be the earliest auscultator 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 a 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.
1
,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 asthmatics?
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.
Proteome
C.
2
,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 cooperative 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. Proteome 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 petechial?
A.
Dissecting aneurysm
B.
Fat embolism
C.
Pneumothorax
D.
Myocardial infarction - Correct Answer -B. Fat embolism
Chest pain, confusion, and petechial are suggestive of a fat embolism, especially within the
first 48 to 72 hours after a long-bone fracture.
The clincher is the petechial. None of the other choices would cause petechial.
Which type of shock is most likely to be iatrogenic?
A.
Hypovolemic
B.
Cardiogenic
C.
Septic
D.
Neurogenic - Correct 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.
3
, 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. - Correct 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 - Correct 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?
4
Certification – Comprehensive Practice Questions with
Verified Answers and Rationales
Which of the following would be the earliest auscultator 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 a 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.
1
,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 asthmatics?
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.
Proteome
C.
2
,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 cooperative 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. Proteome 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 petechial?
A.
Dissecting aneurysm
B.
Fat embolism
C.
Pneumothorax
D.
Myocardial infarction - Correct Answer -B. Fat embolism
Chest pain, confusion, and petechial are suggestive of a fat embolism, especially within the
first 48 to 72 hours after a long-bone fracture.
The clincher is the petechial. None of the other choices would cause petechial.
Which type of shock is most likely to be iatrogenic?
A.
Hypovolemic
B.
Cardiogenic
C.
Septic
D.
Neurogenic - Correct 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.
3
, 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. - Correct 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 - Correct 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?
4
