CCRN EXAM LATEST 2023-2024 ACTUAL
EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED
A+|BRAND NEW!!
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.
RATIONALE: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.
RATIONALE: 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
RATIONALE :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
,RATIONALE :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
RATIONALE 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 - ANSWER- Fever
RATIONALE :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? - 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? - ANSWER- Warm
blood products and crystalloids
RATIONALE 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? - ANSWER- high dose vasopressors
RATIONALE : 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? - ANSWER- Nimodipine
(Nimotop)
RATIONALE :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? -
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? - ANSWER- replace potassium
RATIONALE :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? - ANSWER- Hyperglycemia secondary to insulin resistance.
RATIONALE :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: - ANSWER- CCB
and anticoagulation
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
RATIONALE :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.
RATIONALE: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 history seems to be one of intermittent atrail fibrillation over the past week.
Controlling rate and addressing potential left atrial clot formation are priority treatments.
Which of the following clinical findings would you expect to find in the patient with septic
shock? - ANSWER- Lactate 8, SvO2 85
RATIONALE :Elevated lactate is evidence of anaerobic metabolism and elevated Sv02
is evidence of decreased oxygen utilization at the cellular level - both definitive for septic
shock.
The patient has a massive pulmonary embolism. Which of the following would be
expected? - ANSWER- Hypotension, increased alveolar dead space.
RATIONALE :Massive pulmonary embolism results in sudden extremely elevated
pulmonary pressures with resultant right ventricular failure and decreased left
ventricular pressure. The drop in CO results in hypotension. The clot obstructs
pulmonary perfusion which results in increase headspace ventilation.
The patient presents with left leg pain; ankle-brachial index (ABI) is 0.7. The patient
would benefit from which of the following interventions? - ANSWER- dependent position
of legs
EXAM 300 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED
A+|BRAND NEW!!
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.
RATIONALE: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.
RATIONALE: 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
RATIONALE :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
,RATIONALE :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
RATIONALE 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 - ANSWER- Fever
RATIONALE :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? - 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? - ANSWER- Warm
blood products and crystalloids
RATIONALE 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? - ANSWER- high dose vasopressors
RATIONALE : 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? - ANSWER- Nimodipine
(Nimotop)
RATIONALE :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? -
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? - ANSWER- replace potassium
RATIONALE :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? - ANSWER- Hyperglycemia secondary to insulin resistance.
RATIONALE :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: - ANSWER- CCB
and anticoagulation
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
RATIONALE :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.
RATIONALE: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 history seems to be one of intermittent atrail fibrillation over the past week.
Controlling rate and addressing potential left atrial clot formation are priority treatments.
Which of the following clinical findings would you expect to find in the patient with septic
shock? - ANSWER- Lactate 8, SvO2 85
RATIONALE :Elevated lactate is evidence of anaerobic metabolism and elevated Sv02
is evidence of decreased oxygen utilization at the cellular level - both definitive for septic
shock.
The patient has a massive pulmonary embolism. Which of the following would be
expected? - ANSWER- Hypotension, increased alveolar dead space.
RATIONALE :Massive pulmonary embolism results in sudden extremely elevated
pulmonary pressures with resultant right ventricular failure and decreased left
ventricular pressure. The drop in CO results in hypotension. The clot obstructs
pulmonary perfusion which results in increase headspace ventilation.
The patient presents with left leg pain; ankle-brachial index (ABI) is 0.7. The patient
would benefit from which of the following interventions? - ANSWER- dependent position
of legs
