CCRN EXAM 2 REAL 2024-2025 ACTUAL EXAM QUESTIONS EXPERT
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
1. A patient presents with a productive cough, hypoxemia, a fever, hypotension,
tachycardia, and tachypnea. Hypoxemia was corrected with the administration of
oxygen. Which of the following should be done next?
A. Administer antibiotics.
B. Start a vasopressor.
C. Collect a sputum culture.
D. Initiate 0.9 normal saline. - CORRECT ANSWER✔✔(D) Correcting the
hypotension (with isotonic fluid resuscitation in order to maintain
organ perfusion) is the priority at this time. Antibiotics (choice
(A)) will need to be started after blood cultures are obtained. A
vasopressor (choice (B)) may not be needed if the MAP is restored
with fluids. Although a sputum culture (choice (C)) may be
indicated, blood cultures need to be drawn first so that antibiotics
can be given (within the first hour, if possible).
2. A patient has a history of chronic respiratory failure secondary to COPD and
now has acute respiratory failure secondary to pneumonia. Upon arrival at the
critical care unit, his ABGs were a pH of 7.29, a PaCO 2 of 77, a PaO 2 of 51, and an
HCO 3 of 31. He is receiving noninvasive ventilation with settings that read as
follows: FiO 2 0.40, IPAP 12 cm, and EPAP 5 cm. After 1 hour of therapy, the
patient's ABG results are a pH of 7.20, a PaCO 2 of 89, a PaO 2 of 48, and an HCO 3
of 32. What is the correct evaluation of this data?
A) Alveolar hyperventilation is getting worse; the BiPAP settings need adjustment.
B) Metabolic acidosis is worse; the FiO 2 needs to be increased.
C) Alveolar hypoventilation is getting worse; the patient needs to be intubated.
D) The pH is acceptable for a patient with COPD; continue the current therapy. -
CORRECT ANSWER✔✔C. The patient did not
, CCRN EXAM 2 REAL 2024-2025 ACTUAL EXAM QUESTIONS EXPERT
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
respond to noninvasive ventilation since the PaCO 2 increased, respiratory
acidosis is worse, and severe hypoxemia was
not corrected. BiPAP should not be continued. The issue is not metabolic acidosis.
The pH is not acceptable.
3. A patient is alert and is receiving mechanical ventilation with the following
settings: assist-control mode at 10 breaths/minute, FiO 2 0.40, and PEEP 5 cm H 2
O pressure. Vital signs include a 18 breaths/minute, with norepinephrine at 7
mcg/min for the past 4 hours. The patient has tolerated repositioning in bed and a
head of bed elevation up to 90°. Which of the following would be an appropriate
next step in terms of mobility for this patient?
A) Allow the patient to sit on the edge of the bed, with assistance.
B) Reduce the head of bed elevation to 45°.
C) Maintain the patient's current level of mobility.
D) Help the patient stand and pivot to a chair. - CORRECT ANSWER✔✔A. This
patient tolerated
the current activity with head of bed elevation in high
Fowler's position and is now ready to progress to sitting without back support
with his legs dangling. This patient does not have contraindications to mobility
progression; therefore, reducing the patient's mobility (choice (B)) or maintaining
the patient's current level of mobility (choice (C)) would not provide progress.
Although
the patient might be able to progress to weight-bearing and sitting in a chair, it is
best to go step-by-step and then reassess, not to proceed directly to weight-
bearing (as choice (D) suggests).
, CCRN EXAM 2 REAL 2024-2025 ACTUAL EXAM QUESTIONS EXPERT
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
4. A 70 kg patient with ARDS is mechanically ventilated with the following settings:
FiO 2 70%, tidal volume 450 mL, assist-control mode 10 breaths/minute, and PEEP
20 cm H 2 O pressure. On these settings, the patient's PaO 2 is 76 mmHg and the
PaCO 2 is 58 mmHg. The patient's core temperature is 37°C, his heart rate is 116
beats/minute, and his B/P is 78/58. Which of the following interventions should
the nurse now anticipate?
A) Decrease PEEP to decrease the intrathoracic pressure.
B) Administer a 500 mL fluid bolus of normal saline.
C) Initiate a norepinephrine drip to maintain a SBP of 80 mmHg.
D) Increase the tidal volume to 750 mL. - CORRECT ANSWER✔✔B. The primary
problem is
hypotension, and it should be treated with fluids. Although a reduction of PEEP
would most likely increase the B/P, it would result in derecruitment of alveoli and
hypoxemia. A norepinephrine drip should be initiated only if fluids alone do not
correct the hypotension. An increase in the tidal volume would not increase the
B/P and would cause volutrauma in a patient with ARDS.
5. A 70 kg patient with ARDS is intubated and mechanically ventilated. The patient
is on continuous infusions of an opiate, a sedative, and neuromuscular blocking
drugs. The plateau pressure is 45 cm H 2 O. The PaO 2 is 60 mmHg. The physician
orders the following ventilator settings: SIMV mode, tidal volume 700 mL, rate 12
breaths/minute, FiO 2 1.00, and PEEP 15 cm H 2 O pressure. Which of the following
needs to be discussed with the physician?
A) the ventilator mode
B) the tidal volume
C) the PEEP
D) the FiO 2 - CORRECT ANSWER✔✔B. This patient with ARDS
, CCRN EXAM 2 REAL 2024-2025 ACTUAL EXAM QUESTIONS EXPERT
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
needs to receive 4-5 mL/kg tidal volume in order to prevent volutrauma. This
patient is receiving 10 mL/kg tidal volume, and
this level needs to be reduced. The mode of ventilation and both the
PEEP and the FiO 2 settings are acceptable.
6. Which of the following nursing behaviors is usually most helpful to patients and
families regarding end-of-life decisions?
A) avoiding the use of words such as "death," "dying," and "suffering" B)
consulting the clergy for support
C) acting as an arbitrator between family members
D) requesting that only 1 person be the spokesperson - CORRECT ANSWER✔✔C.
When end-of-life
decisions are required, a certain amount of family conflict usually occurs. An
experienced nurse knows how to arbitrate in these
matters. Choice (A) is not an effective strategy. The clergy may be consulted but
only if this is the family's wish. A request that only 1 person be the spokesperson
is an effective strategy for routine
communication with a large family. However, when end-of-life decisions are
necessary, all stakeholders need to have a voice.
7. A patient presented with sepsis secondary to a urinary tract infection. After the
initial administration of 30 mL/kg of isotonic crystalloid, the B/P is 88/46 (the
MAP is 60 mmHg), the heart
rate is 102 beats/minute, the respiratory rate is 22 breaths/minute, and the
lungs are clear. What intervention is indicated at this time?
A) Decrease the rate of fluid administration.
B) Start a dobutamine (Dobutrex) infusion.
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
1. A patient presents with a productive cough, hypoxemia, a fever, hypotension,
tachycardia, and tachypnea. Hypoxemia was corrected with the administration of
oxygen. Which of the following should be done next?
A. Administer antibiotics.
B. Start a vasopressor.
C. Collect a sputum culture.
D. Initiate 0.9 normal saline. - CORRECT ANSWER✔✔(D) Correcting the
hypotension (with isotonic fluid resuscitation in order to maintain
organ perfusion) is the priority at this time. Antibiotics (choice
(A)) will need to be started after blood cultures are obtained. A
vasopressor (choice (B)) may not be needed if the MAP is restored
with fluids. Although a sputum culture (choice (C)) may be
indicated, blood cultures need to be drawn first so that antibiotics
can be given (within the first hour, if possible).
2. A patient has a history of chronic respiratory failure secondary to COPD and
now has acute respiratory failure secondary to pneumonia. Upon arrival at the
critical care unit, his ABGs were a pH of 7.29, a PaCO 2 of 77, a PaO 2 of 51, and an
HCO 3 of 31. He is receiving noninvasive ventilation with settings that read as
follows: FiO 2 0.40, IPAP 12 cm, and EPAP 5 cm. After 1 hour of therapy, the
patient's ABG results are a pH of 7.20, a PaCO 2 of 89, a PaO 2 of 48, and an HCO 3
of 32. What is the correct evaluation of this data?
A) Alveolar hyperventilation is getting worse; the BiPAP settings need adjustment.
B) Metabolic acidosis is worse; the FiO 2 needs to be increased.
C) Alveolar hypoventilation is getting worse; the patient needs to be intubated.
D) The pH is acceptable for a patient with COPD; continue the current therapy. -
CORRECT ANSWER✔✔C. The patient did not
, CCRN EXAM 2 REAL 2024-2025 ACTUAL EXAM QUESTIONS EXPERT
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
respond to noninvasive ventilation since the PaCO 2 increased, respiratory
acidosis is worse, and severe hypoxemia was
not corrected. BiPAP should not be continued. The issue is not metabolic acidosis.
The pH is not acceptable.
3. A patient is alert and is receiving mechanical ventilation with the following
settings: assist-control mode at 10 breaths/minute, FiO 2 0.40, and PEEP 5 cm H 2
O pressure. Vital signs include a 18 breaths/minute, with norepinephrine at 7
mcg/min for the past 4 hours. The patient has tolerated repositioning in bed and a
head of bed elevation up to 90°. Which of the following would be an appropriate
next step in terms of mobility for this patient?
A) Allow the patient to sit on the edge of the bed, with assistance.
B) Reduce the head of bed elevation to 45°.
C) Maintain the patient's current level of mobility.
D) Help the patient stand and pivot to a chair. - CORRECT ANSWER✔✔A. This
patient tolerated
the current activity with head of bed elevation in high
Fowler's position and is now ready to progress to sitting without back support
with his legs dangling. This patient does not have contraindications to mobility
progression; therefore, reducing the patient's mobility (choice (B)) or maintaining
the patient's current level of mobility (choice (C)) would not provide progress.
Although
the patient might be able to progress to weight-bearing and sitting in a chair, it is
best to go step-by-step and then reassess, not to proceed directly to weight-
bearing (as choice (D) suggests).
, CCRN EXAM 2 REAL 2024-2025 ACTUAL EXAM QUESTIONS EXPERT
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
4. A 70 kg patient with ARDS is mechanically ventilated with the following settings:
FiO 2 70%, tidal volume 450 mL, assist-control mode 10 breaths/minute, and PEEP
20 cm H 2 O pressure. On these settings, the patient's PaO 2 is 76 mmHg and the
PaCO 2 is 58 mmHg. The patient's core temperature is 37°C, his heart rate is 116
beats/minute, and his B/P is 78/58. Which of the following interventions should
the nurse now anticipate?
A) Decrease PEEP to decrease the intrathoracic pressure.
B) Administer a 500 mL fluid bolus of normal saline.
C) Initiate a norepinephrine drip to maintain a SBP of 80 mmHg.
D) Increase the tidal volume to 750 mL. - CORRECT ANSWER✔✔B. The primary
problem is
hypotension, and it should be treated with fluids. Although a reduction of PEEP
would most likely increase the B/P, it would result in derecruitment of alveoli and
hypoxemia. A norepinephrine drip should be initiated only if fluids alone do not
correct the hypotension. An increase in the tidal volume would not increase the
B/P and would cause volutrauma in a patient with ARDS.
5. A 70 kg patient with ARDS is intubated and mechanically ventilated. The patient
is on continuous infusions of an opiate, a sedative, and neuromuscular blocking
drugs. The plateau pressure is 45 cm H 2 O. The PaO 2 is 60 mmHg. The physician
orders the following ventilator settings: SIMV mode, tidal volume 700 mL, rate 12
breaths/minute, FiO 2 1.00, and PEEP 15 cm H 2 O pressure. Which of the following
needs to be discussed with the physician?
A) the ventilator mode
B) the tidal volume
C) the PEEP
D) the FiO 2 - CORRECT ANSWER✔✔B. This patient with ARDS
, CCRN EXAM 2 REAL 2024-2025 ACTUAL EXAM QUESTIONS EXPERT
VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+
2023/2024
needs to receive 4-5 mL/kg tidal volume in order to prevent volutrauma. This
patient is receiving 10 mL/kg tidal volume, and
this level needs to be reduced. The mode of ventilation and both the
PEEP and the FiO 2 settings are acceptable.
6. Which of the following nursing behaviors is usually most helpful to patients and
families regarding end-of-life decisions?
A) avoiding the use of words such as "death," "dying," and "suffering" B)
consulting the clergy for support
C) acting as an arbitrator between family members
D) requesting that only 1 person be the spokesperson - CORRECT ANSWER✔✔C.
When end-of-life
decisions are required, a certain amount of family conflict usually occurs. An
experienced nurse knows how to arbitrate in these
matters. Choice (A) is not an effective strategy. The clergy may be consulted but
only if this is the family's wish. A request that only 1 person be the spokesperson
is an effective strategy for routine
communication with a large family. However, when end-of-life decisions are
necessary, all stakeholders need to have a voice.
7. A patient presented with sepsis secondary to a urinary tract infection. After the
initial administration of 30 mL/kg of isotonic crystalloid, the B/P is 88/46 (the
MAP is 60 mmHg), the heart
rate is 102 beats/minute, the respiratory rate is 22 breaths/minute, and the
lungs are clear. What intervention is indicated at this time?
A) Decrease the rate of fluid administration.
B) Start a dobutamine (Dobutrex) infusion.
