2024 CCRN PRACTICE TEST 1
EXAM WITH CORRECT ANSWERS
What activities increase myocardial ischemia? - CORRECT-ANSWERSUsing
the bedpan, having the bed changed, having painful procedures (such as the
insertion of an intravenous catheter), and being weighed on an overbed
scale increase myocardial oxygen consumption and may cause myocardial
ischemia. Eating a meal also may shunt blood to the gastrointestinal tract
and cause myocardial ischemia
What is the primary role of the case manager? - CORRECT-
ANSWERSAdvocate- informing and supporting in decision making, informing
about available resources and negotiating access to resources
What are the current guidelines on providing oxygen to COPD patients -
CORRECT-ANSWERSMaintain hypoxemia (lower than normal O2 in blood) but
prevent hypoxia (low O2 to tissues). This is achieved by maintain SaO2/SpO2
around 90%. Therefore some patients may need more than 2L of oxygen.
What electrolytes may be involved in a patient with prolonged QT -
CORRECT-ANSWERSPotassium, calcium, and magnesium. Low levels of any
of these would result in prolonged repolarization, which would be seen as a
prolonged QT segment
If the ventricles are depolarized before the atria in a junctional rhythm you
would expect to find the P wave where? - CORRECT-ANSWERSAfter the QRS
A patient has CSF leaking from their nose after a transsphenoidal
hypophysectomy, what do you do? - CORRECT-ANSWERSIt is normal to have
a CSF leak for 48 hrs after surgery. Cover with a sterile "moustache" 2x2
tapes under their nose to form a barrier.
If your dura is not intact that you would expect a leak, but it does increase
your risk of infection
What is Wernicke's syndrome and what is it associated with? - CORRECT-
ANSWERSThiamine is necessary for use of glucose. Administration of glucose
in patients with thiamine deficiency may cause Wernicke's syndrome (also
called Wernicke's encephalopathy). The syndrome is characterized by
diplopia, nystagmus, lack of coordination, and decreased metal function
, Diastolic murmurs are always pathologic. Systolic murmurs can be
pathologic (related to valve disease or septal defects) or they can be
functional related to turbulence of blood flow - CORRECT-ANSWERS
What causes a dampened pulmonary artery pressure and how do you correct
it? - CORRECT-ANSWERSA damped pulmonary artery waveform may be
caused by air or blood in the pressure monitoring system, a clot in the
catheter, or the catheter being advanced distally enough that the catheter
diameter occludes the pulmonary arteriole in which the catheter is located
(referred to as a spontaneous wedge). First, make sure that air has not been
left in the balloon inadvertently by making sure that the balloon lumen is
open with the empty syringe attached. Next, search the system for air or
blood. Then reposition the patient or ask the patient to cough. If there is no
change in the waveform, try to aspirate a clot from the catheter. If there is
still no change, have the patient assume a spontaneous wedge position, and
the catheter should be repositioned (withdrawn slightly) by the physician as
soon as possible to prevent a pulmonary infarction. If the catheter is fast-
flushed and a clot is present, it will be embolized with 300 mm Hg pressure
(the pressure bag is maintained at this pressure). If the catheter is in a
wedge position and the catheter is fast-flushed, it may result in pulmonary
arteriole rupture and potentially massive hemoptysis and even
exsanguination
Pt with multiple traumas has a temp of 39, is restless/agitated, has warm/dry
skin and his hemodynamics are as follows...
BP- 88/48 HR-124 CO-10.5 CI-5.35 RAP-4 PAOP-3 SVR-452 VSat-90
What does this represent and what med would treat it? - CORRECT-
ANSWERSDistributive shock (septic shock- temp). Most specific characteristic
of distributive shocks is low SVR (afterload). Goal is to restore afterload and
perfusion gradient- which is done by the use of pressors (restore vascular
tone caused by massive vasodilation)
What is Wolff-Parkinson-White syndrome and how is it treated? - CORRECT-
ANSWERSThere is an extra pathway between your hearts upper and lower
chambers causing a rapid heartbeat. Lidocain and amiodarone may be used
in treatment, as well as adenosine if experiencing SVT. DON't give verapamil
because it slows conduction through the AV node which could lead to severe
tachycardias
If you got a whole bunch of banked blood you also need to get platelets and
plasma, why? - CORRECT-ANSWERSRBCs do not contain platelets; therefore
patients receiving multiple transfusions also will need to receive platelets.
Clotting abnormalities in these patients result from hypocalcemia,
EXAM WITH CORRECT ANSWERS
What activities increase myocardial ischemia? - CORRECT-ANSWERSUsing
the bedpan, having the bed changed, having painful procedures (such as the
insertion of an intravenous catheter), and being weighed on an overbed
scale increase myocardial oxygen consumption and may cause myocardial
ischemia. Eating a meal also may shunt blood to the gastrointestinal tract
and cause myocardial ischemia
What is the primary role of the case manager? - CORRECT-
ANSWERSAdvocate- informing and supporting in decision making, informing
about available resources and negotiating access to resources
What are the current guidelines on providing oxygen to COPD patients -
CORRECT-ANSWERSMaintain hypoxemia (lower than normal O2 in blood) but
prevent hypoxia (low O2 to tissues). This is achieved by maintain SaO2/SpO2
around 90%. Therefore some patients may need more than 2L of oxygen.
What electrolytes may be involved in a patient with prolonged QT -
CORRECT-ANSWERSPotassium, calcium, and magnesium. Low levels of any
of these would result in prolonged repolarization, which would be seen as a
prolonged QT segment
If the ventricles are depolarized before the atria in a junctional rhythm you
would expect to find the P wave where? - CORRECT-ANSWERSAfter the QRS
A patient has CSF leaking from their nose after a transsphenoidal
hypophysectomy, what do you do? - CORRECT-ANSWERSIt is normal to have
a CSF leak for 48 hrs after surgery. Cover with a sterile "moustache" 2x2
tapes under their nose to form a barrier.
If your dura is not intact that you would expect a leak, but it does increase
your risk of infection
What is Wernicke's syndrome and what is it associated with? - CORRECT-
ANSWERSThiamine is necessary for use of glucose. Administration of glucose
in patients with thiamine deficiency may cause Wernicke's syndrome (also
called Wernicke's encephalopathy). The syndrome is characterized by
diplopia, nystagmus, lack of coordination, and decreased metal function
, Diastolic murmurs are always pathologic. Systolic murmurs can be
pathologic (related to valve disease or septal defects) or they can be
functional related to turbulence of blood flow - CORRECT-ANSWERS
What causes a dampened pulmonary artery pressure and how do you correct
it? - CORRECT-ANSWERSA damped pulmonary artery waveform may be
caused by air or blood in the pressure monitoring system, a clot in the
catheter, or the catheter being advanced distally enough that the catheter
diameter occludes the pulmonary arteriole in which the catheter is located
(referred to as a spontaneous wedge). First, make sure that air has not been
left in the balloon inadvertently by making sure that the balloon lumen is
open with the empty syringe attached. Next, search the system for air or
blood. Then reposition the patient or ask the patient to cough. If there is no
change in the waveform, try to aspirate a clot from the catheter. If there is
still no change, have the patient assume a spontaneous wedge position, and
the catheter should be repositioned (withdrawn slightly) by the physician as
soon as possible to prevent a pulmonary infarction. If the catheter is fast-
flushed and a clot is present, it will be embolized with 300 mm Hg pressure
(the pressure bag is maintained at this pressure). If the catheter is in a
wedge position and the catheter is fast-flushed, it may result in pulmonary
arteriole rupture and potentially massive hemoptysis and even
exsanguination
Pt with multiple traumas has a temp of 39, is restless/agitated, has warm/dry
skin and his hemodynamics are as follows...
BP- 88/48 HR-124 CO-10.5 CI-5.35 RAP-4 PAOP-3 SVR-452 VSat-90
What does this represent and what med would treat it? - CORRECT-
ANSWERSDistributive shock (septic shock- temp). Most specific characteristic
of distributive shocks is low SVR (afterload). Goal is to restore afterload and
perfusion gradient- which is done by the use of pressors (restore vascular
tone caused by massive vasodilation)
What is Wolff-Parkinson-White syndrome and how is it treated? - CORRECT-
ANSWERSThere is an extra pathway between your hearts upper and lower
chambers causing a rapid heartbeat. Lidocain and amiodarone may be used
in treatment, as well as adenosine if experiencing SVT. DON't give verapamil
because it slows conduction through the AV node which could lead to severe
tachycardias
If you got a whole bunch of banked blood you also need to get platelets and
plasma, why? - CORRECT-ANSWERSRBCs do not contain platelets; therefore
patients receiving multiple transfusions also will need to receive platelets.
Clotting abnormalities in these patients result from hypocalcemia,
