CCRN PRACTICE TEST QUESTIONS AND ANSWERS
A patient in hyperosolar hyperglycemic state (HHS) is being admitted with dehydration
and a serum glucose level of 836 mg/dL. Which of the following additional laboratory
findings should the nurse anticipate?
A. decreased BUN, decreased creatinine, and elevated serum osmolality
B. decreased BUN, decreased creatinine and decreased serum osmolality
C. decreased BUN, elevated creatinine and decreased serum osmolality
D. elevated BUN, elevated creatinine and elevated serum osmolality - Answers -D.
elevated BUN, elevated creatinine and elevated serum osmolality
Serum osmolality > 320 mOsm/kg distinguishes HHS from DKA
On the fifth day post-admission, a patient with Q waves in V1, V2, and V3 develops
hypotension, tachycardia, and a pan-systolic murmur that is loudest at the lower left
sternal border. This patient most likely developed
A. idiopathic hypertrophic cardiomyopathy
B. inferior wall infarction
C. cardiac tamponade
D. a ruptured inter-ventricular septum - Answers -D. a ruptured inter-ventricular septum
(septal wall MI)
When providing care to a patient with status epilepticus, the nurse should recognize that
usually
A. it is a state of continuous seizures lasting more than two minutes
B. the patient comes out of the post ictal state between seizures
C. it results from abrupt discontinuation of anti-seizure meds
D. the cause of death is due to cerebral hemorrhage - Answers -C. it results from abrupt
discontinuation of anti-seizure meds
A patient with a history of angina is admitted to the units after surgical repair of an AAA.
The patient is receiving a sodium nitroprusside (Nipride) gtt for severe postop
hypertension. Twelve hours later, the pattient complains of back pain.
BP 80/60
HR 120
UO 20 mL/hr
+1 left and right dorsalis pedis pulse
A. Admin of NS 200 ml/hr and prepare for doppler studies
B. spiral chest CT and emergent pericardiocentesis
C. procedural sedation and IABP insertion
,D. discontinuation of Nipride and prepare for surgery - Answers -D. discontinuation of
Nipride and prepare for surgery (because the patient is hypotensive-DUH! w/ s/s of
postop bleeding and hypovolemic shock)
A patient with head trauma is experiencing increased ICP. The ideal level at which to
maintain arterial pCO2
A. below 20
B. between 35 and 45
C. between 25 and 30
D. above 45 - Answers -B. between 35 and 45 (normocapnia is essential for maintaining
stable intracranial pressure, because CO2 directly affects the degree of vasodilation in
cerebral blood vessels)
Which of the following is an endpoint of volume resuscitation?
A. CVP 3 mm Hg
B. CI 2.4 L/min/m2
C. oxygen consumption 250 ml/min
D. BE 4 mmol/L - Answers -C. oxygen consumption 250 ml/min (the amount of oxygen
used by the body)
Which of the following life-threatening dysrhythmias is most frequently associated with
HF?
A. bigeminy PACs
B. ventricular tachycardia
C. second-degree AV Block Type II (anterior wall MI)
D. junctional tachycardia (digoxin toxicity) - Answers -B. ventricular tachycardia (Low Ef
leads to stretch and excitability of ventricles. Can lead to electrolyte shifts from diuretic
therapy which can exacerbate VTACH)
Which of the following hemodynamic profiles is most consistent with distributive shock?
A. BP 88/45, CI 1.5, CVP 15, PAOP 24, SVR 1200, svO2 47%
B. BP 85/40, CI 2.0, CVP 12, PAOP 20, SVR 1445, svO2 50%
C. BP 84/42, CI 2.5, CVP 3, PAOP 8, SVR 475, svO2 52%
D. BP 75/50, CI 2.5, CVP 8, PAOP 8, SVR 1500, svO2 68% - Answers -C. BP 84/42, CI
2.5, CVP 3, PAOP 8, SVR 475, svO2 52%
(in distributive shock types: anaphylactic or neurogenic there is a decrease in venous
return causing a low CVP. Loss of vessel tone results in decreased SVR)
Which of the following is an advantage of pressure support ventilation?
A. decreased work of breathing
B. decreased inspiratory flow
,C. decreased muscular endurance
D. decreased fiO2. - Answers -A. decreased work of breathing (assists spontaneous
breathing efforts by delivering a high flow of gas early in inspiration and maintaining the
level through the inspiratory phase)
A patient with a four-year history of type 1 diabetes is admitted with influenza. The
patient is lethargic, responds to name and follows simple commands. Skin is dry, with
poor turgor. Which of the follow is the most likely cause of the patient's condition?
A. hyponatremia
B. hypoglycemia
C. ketosis
D. hypovolemia - Answers -D. hypovolemia
A patient is admitted after a PCI to the RCA. four hours later, the patient complains of
flank pain, and vital sings are:
BP 84/50, HR 120, RR 32
A. PE
B. retroperitoneal bleed
C. coronary artery dissection
D. restenosis of the RCA - Answers -B. retroperitoneal bleed (caused by an arterial tear
with bleeding int the flank area)
The most important indicator to be used in monitoring respiratory status of a patient with
Guillain Barre syndrome is
A. vital capacity
B. O2 sat
C. negative inspiratory force
D. A-a gradient (degree of shunt) - Answers -A. vital capacity
A patient is admitted complaining of crushing chest pain, which began two hours ago.
An ECG shows ST elevation in leads V2-V4, which is treated with a PCI procedure to
the LAD. Post procedure the patient develops oliguria and bilateral, diffuse crackles.
Which of the following hemodynamic findings should be expected at the point?
A. CO 3.8, BP 80/50, SVR 2200, PAP 40/24
B. CO 5.0, BP 86/50, SVR 1000, PAP 30/10
C. CO 2.9, BP 85/56, SVR 660, PAP 20/14
D. CO 6.8, BP 90/60, SVR 500, PAP 18/4 - Answers -A. CO 3.8, BP 80/50, SVR 2200,
PAP 40/24 (anterior infarction predisposes him to develop LV failure and cardiogenic
shock)
A patient with a history of chronic pain, asthma, diabetes, and heavy alcohol intake is
now experiencing cognitive impairment from medications. Assessment: awake but
, confused, BP 155/82, HR 84, RR 16 and SpO2 95% on RA. This patient is at high risk
for
A. Intubation
B. needing long-term psychiatric care
C. attempting suicide
D. over-sedation by staff - Answers -C. attempting suicide (chronic medical illness,
heavy alcohol intake, and chronic pain)
Which of the following 12-lead ECG changes should be expected in a patient with acute
coronary syndrome involving the inferior wall?
A. ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL
B. ST segment elevation in leads II, III, and all precordial leads
C. ST segment elevation and deeply inverted T waves in leads II, III, aVF
D. ST segment depression and T wave elevation in leads II, III, aVL - Answers -C. ST
segment elevation and deeply inverted T waves in leads II, III, aVF
The major effect of acute lung injury (ALI) on the lung tissue is
A. decreased capillary permeability
B. increased function residual capacity (FRC)
C. decreased compliance
D. decreased alveolar surface tension - Answers -C. decreased compliance (related to
the alteration of lung endothelium and vascular tissue. Results in stiffness and fluid filled
non-aerated airways)
A patient with mitral regurgitation suddenly develops atrial fibrillation with a rate of 156.
BP is 118/74. The nurse should anticipate medication orders for
A. beta-blockers and vasopressors
B. warfarin (Coumadin) and alpha-agonists
C. beta-agonists and calcium-channel blockers
D. cardiac glycosides and calcium channel blockers - Answers -D. cardiac glycosides
(digoxin) and calcium channel blockers
Which of the following pulmonary artery catheter findings would be anticipated in a
patient with chronic emphysema?
A. increased CVP
B. decreased CI
C. increased SV
D. decreased PAOP - Answers -A. increased CVP (emphysema can cause cor
pulmonale secondary to increased pressure)
A patient in hyperosolar hyperglycemic state (HHS) is being admitted with dehydration
and a serum glucose level of 836 mg/dL. Which of the following additional laboratory
findings should the nurse anticipate?
A. decreased BUN, decreased creatinine, and elevated serum osmolality
B. decreased BUN, decreased creatinine and decreased serum osmolality
C. decreased BUN, elevated creatinine and decreased serum osmolality
D. elevated BUN, elevated creatinine and elevated serum osmolality - Answers -D.
elevated BUN, elevated creatinine and elevated serum osmolality
Serum osmolality > 320 mOsm/kg distinguishes HHS from DKA
On the fifth day post-admission, a patient with Q waves in V1, V2, and V3 develops
hypotension, tachycardia, and a pan-systolic murmur that is loudest at the lower left
sternal border. This patient most likely developed
A. idiopathic hypertrophic cardiomyopathy
B. inferior wall infarction
C. cardiac tamponade
D. a ruptured inter-ventricular septum - Answers -D. a ruptured inter-ventricular septum
(septal wall MI)
When providing care to a patient with status epilepticus, the nurse should recognize that
usually
A. it is a state of continuous seizures lasting more than two minutes
B. the patient comes out of the post ictal state between seizures
C. it results from abrupt discontinuation of anti-seizure meds
D. the cause of death is due to cerebral hemorrhage - Answers -C. it results from abrupt
discontinuation of anti-seizure meds
A patient with a history of angina is admitted to the units after surgical repair of an AAA.
The patient is receiving a sodium nitroprusside (Nipride) gtt for severe postop
hypertension. Twelve hours later, the pattient complains of back pain.
BP 80/60
HR 120
UO 20 mL/hr
+1 left and right dorsalis pedis pulse
A. Admin of NS 200 ml/hr and prepare for doppler studies
B. spiral chest CT and emergent pericardiocentesis
C. procedural sedation and IABP insertion
,D. discontinuation of Nipride and prepare for surgery - Answers -D. discontinuation of
Nipride and prepare for surgery (because the patient is hypotensive-DUH! w/ s/s of
postop bleeding and hypovolemic shock)
A patient with head trauma is experiencing increased ICP. The ideal level at which to
maintain arterial pCO2
A. below 20
B. between 35 and 45
C. between 25 and 30
D. above 45 - Answers -B. between 35 and 45 (normocapnia is essential for maintaining
stable intracranial pressure, because CO2 directly affects the degree of vasodilation in
cerebral blood vessels)
Which of the following is an endpoint of volume resuscitation?
A. CVP 3 mm Hg
B. CI 2.4 L/min/m2
C. oxygen consumption 250 ml/min
D. BE 4 mmol/L - Answers -C. oxygen consumption 250 ml/min (the amount of oxygen
used by the body)
Which of the following life-threatening dysrhythmias is most frequently associated with
HF?
A. bigeminy PACs
B. ventricular tachycardia
C. second-degree AV Block Type II (anterior wall MI)
D. junctional tachycardia (digoxin toxicity) - Answers -B. ventricular tachycardia (Low Ef
leads to stretch and excitability of ventricles. Can lead to electrolyte shifts from diuretic
therapy which can exacerbate VTACH)
Which of the following hemodynamic profiles is most consistent with distributive shock?
A. BP 88/45, CI 1.5, CVP 15, PAOP 24, SVR 1200, svO2 47%
B. BP 85/40, CI 2.0, CVP 12, PAOP 20, SVR 1445, svO2 50%
C. BP 84/42, CI 2.5, CVP 3, PAOP 8, SVR 475, svO2 52%
D. BP 75/50, CI 2.5, CVP 8, PAOP 8, SVR 1500, svO2 68% - Answers -C. BP 84/42, CI
2.5, CVP 3, PAOP 8, SVR 475, svO2 52%
(in distributive shock types: anaphylactic or neurogenic there is a decrease in venous
return causing a low CVP. Loss of vessel tone results in decreased SVR)
Which of the following is an advantage of pressure support ventilation?
A. decreased work of breathing
B. decreased inspiratory flow
,C. decreased muscular endurance
D. decreased fiO2. - Answers -A. decreased work of breathing (assists spontaneous
breathing efforts by delivering a high flow of gas early in inspiration and maintaining the
level through the inspiratory phase)
A patient with a four-year history of type 1 diabetes is admitted with influenza. The
patient is lethargic, responds to name and follows simple commands. Skin is dry, with
poor turgor. Which of the follow is the most likely cause of the patient's condition?
A. hyponatremia
B. hypoglycemia
C. ketosis
D. hypovolemia - Answers -D. hypovolemia
A patient is admitted after a PCI to the RCA. four hours later, the patient complains of
flank pain, and vital sings are:
BP 84/50, HR 120, RR 32
A. PE
B. retroperitoneal bleed
C. coronary artery dissection
D. restenosis of the RCA - Answers -B. retroperitoneal bleed (caused by an arterial tear
with bleeding int the flank area)
The most important indicator to be used in monitoring respiratory status of a patient with
Guillain Barre syndrome is
A. vital capacity
B. O2 sat
C. negative inspiratory force
D. A-a gradient (degree of shunt) - Answers -A. vital capacity
A patient is admitted complaining of crushing chest pain, which began two hours ago.
An ECG shows ST elevation in leads V2-V4, which is treated with a PCI procedure to
the LAD. Post procedure the patient develops oliguria and bilateral, diffuse crackles.
Which of the following hemodynamic findings should be expected at the point?
A. CO 3.8, BP 80/50, SVR 2200, PAP 40/24
B. CO 5.0, BP 86/50, SVR 1000, PAP 30/10
C. CO 2.9, BP 85/56, SVR 660, PAP 20/14
D. CO 6.8, BP 90/60, SVR 500, PAP 18/4 - Answers -A. CO 3.8, BP 80/50, SVR 2200,
PAP 40/24 (anterior infarction predisposes him to develop LV failure and cardiogenic
shock)
A patient with a history of chronic pain, asthma, diabetes, and heavy alcohol intake is
now experiencing cognitive impairment from medications. Assessment: awake but
, confused, BP 155/82, HR 84, RR 16 and SpO2 95% on RA. This patient is at high risk
for
A. Intubation
B. needing long-term psychiatric care
C. attempting suicide
D. over-sedation by staff - Answers -C. attempting suicide (chronic medical illness,
heavy alcohol intake, and chronic pain)
Which of the following 12-lead ECG changes should be expected in a patient with acute
coronary syndrome involving the inferior wall?
A. ST segment elevation and deeply inverted T waves in leads V4-V6, I and aVL
B. ST segment elevation in leads II, III, and all precordial leads
C. ST segment elevation and deeply inverted T waves in leads II, III, aVF
D. ST segment depression and T wave elevation in leads II, III, aVL - Answers -C. ST
segment elevation and deeply inverted T waves in leads II, III, aVF
The major effect of acute lung injury (ALI) on the lung tissue is
A. decreased capillary permeability
B. increased function residual capacity (FRC)
C. decreased compliance
D. decreased alveolar surface tension - Answers -C. decreased compliance (related to
the alteration of lung endothelium and vascular tissue. Results in stiffness and fluid filled
non-aerated airways)
A patient with mitral regurgitation suddenly develops atrial fibrillation with a rate of 156.
BP is 118/74. The nurse should anticipate medication orders for
A. beta-blockers and vasopressors
B. warfarin (Coumadin) and alpha-agonists
C. beta-agonists and calcium-channel blockers
D. cardiac glycosides and calcium channel blockers - Answers -D. cardiac glycosides
(digoxin) and calcium channel blockers
Which of the following pulmonary artery catheter findings would be anticipated in a
patient with chronic emphysema?
A. increased CVP
B. decreased CI
C. increased SV
D. decreased PAOP - Answers -A. increased CVP (emphysema can cause cor
pulmonale secondary to increased pressure)
