CCRN Questions And 100% Correct Answers
A patient has had a large anterior myocardial infarction last month and developed a
ventricular aneurysm. He now has episodes of ventricular tachycardia that are not
prevented or converted with antidysrhythmic agents. An ICD is implanted. Four days
after surgery he develops VT. The ICD has delivered three shocks but has not converted
the rhythm. He is pulseless and apneic. Cardiopulmonary resuscitation is in progress.
What is the priority action now?
A.
IV epinephrine
Administration of
B.
amiodarone
C.
Defibrillate
D.
ICD reactivation - Answer Defibrillate
A 28-year-old female is brought to the critical care unit from the emergency department
with a diagnosis of asthma. Initial arterial blood gases on a 28% Venturi mask are as
follows:
pH 7.48
PaCO2 30 mm Hg
HCO3 24 mEq/L
PaO2 64 mm Hg
Which of the following repeated arterial blood gases on 40% oxygen indicate the
patient's condition is deteriorating?
,A.
pH 7.48, PaCO2 30 mm Hg, PaO2 68 mm Hg
B.
pH 7.46, PaCO2 32 mm Hg, PaO2 61 mm Hg
C.
pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg
D.
pH 7.39, PaCO2 30 mm Hg, PaO2 60 mm Hg Answer C.
pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg
This case represents stage II asthma. Option c is now in stage III asthma. The patient is
still tachypneic, but CO2 is beginning to be retained as evidenced by the elevation of the
PaCO2 into normal range. Options a and b remain in stage II. Option d shows a
respiratory alkalosis with a metabolic acidosis because you would have expected the
pH to be in an alkalotic range with the PaCO2 of 30.
A patient who is in alcohol withdrawal syndrome describes the swirls in the wallpaper as
being worms. This is an example of which of the following?
A.
Delusion
B.
Hallucination
C.
,Illusion
D.
Visual impairment - Answer C.
Illusion
An illusion is a misperception or misinterpretation of an actual external stimulus.
Illusions and hallucinations (a perception that has no actual actual external stimulus)
are common during alcohol withdrawal syndrome.
A patient comes to the emergency department with multiple gunshot wounds. He
requires massive transfusion for blood loss from chest and abdominal wounds. The
electrocardiogram should be observed closely for changes indicative of which of the
following?
A.
Atrioventricular block
B.
Hyperkalemia
C.
Hypercalcemia
D.
Hypomagnesemia - Answer Hyperkalemia
Banked blood is high in potassium due to hemolysis. Look for tall peaked T waves and
widening of the QRS complex. Other considerations with massive transfusion of banked
blood are hypocalcemia, hypothermia and decreased tissue oxygen delivery due to
, decreased levels of 2,3-diphosphoglycerate.
A 65-year-old woman presents with severe dyspnea 2 days after abdominal surgery. She
is admitted to the critical care unit. On 5 L of oxygen by nasal cannula, her arterial blood
gases are as follows:
pH 7.39
PaCO2 35 mm Hg
HCO3 19 mEq/L
PaO2 40 mm Hg
Arterial oxygen saturation 75%
Why does this patient have hypoxemia without hypercapnia?
A.
Because carbon dioxide is more diffusible than oxygen
B.
Because carbon dioxide has more driving pressure
C.
Because carbon dioxide is less diffusible than oxygen
D.
Because carbon dioxide excretion by the kidney is increased - Answer Because carbon
dioxide is more diffusible than oxygen
Carbon dioxide is 20 times more diffusible than oxygen. In conditions that affect
diffusion but not ventilation, one would expect the PaO2 to be low and the PaCO2 to be
A patient has had a large anterior myocardial infarction last month and developed a
ventricular aneurysm. He now has episodes of ventricular tachycardia that are not
prevented or converted with antidysrhythmic agents. An ICD is implanted. Four days
after surgery he develops VT. The ICD has delivered three shocks but has not converted
the rhythm. He is pulseless and apneic. Cardiopulmonary resuscitation is in progress.
What is the priority action now?
A.
IV epinephrine
Administration of
B.
amiodarone
C.
Defibrillate
D.
ICD reactivation - Answer Defibrillate
A 28-year-old female is brought to the critical care unit from the emergency department
with a diagnosis of asthma. Initial arterial blood gases on a 28% Venturi mask are as
follows:
pH 7.48
PaCO2 30 mm Hg
HCO3 24 mEq/L
PaO2 64 mm Hg
Which of the following repeated arterial blood gases on 40% oxygen indicate the
patient's condition is deteriorating?
,A.
pH 7.48, PaCO2 30 mm Hg, PaO2 68 mm Hg
B.
pH 7.46, PaCO2 32 mm Hg, PaO2 61 mm Hg
C.
pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg
D.
pH 7.39, PaCO2 30 mm Hg, PaO2 60 mm Hg Answer C.
pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg
This case represents stage II asthma. Option c is now in stage III asthma. The patient is
still tachypneic, but CO2 is beginning to be retained as evidenced by the elevation of the
PaCO2 into normal range. Options a and b remain in stage II. Option d shows a
respiratory alkalosis with a metabolic acidosis because you would have expected the
pH to be in an alkalotic range with the PaCO2 of 30.
A patient who is in alcohol withdrawal syndrome describes the swirls in the wallpaper as
being worms. This is an example of which of the following?
A.
Delusion
B.
Hallucination
C.
,Illusion
D.
Visual impairment - Answer C.
Illusion
An illusion is a misperception or misinterpretation of an actual external stimulus.
Illusions and hallucinations (a perception that has no actual actual external stimulus)
are common during alcohol withdrawal syndrome.
A patient comes to the emergency department with multiple gunshot wounds. He
requires massive transfusion for blood loss from chest and abdominal wounds. The
electrocardiogram should be observed closely for changes indicative of which of the
following?
A.
Atrioventricular block
B.
Hyperkalemia
C.
Hypercalcemia
D.
Hypomagnesemia - Answer Hyperkalemia
Banked blood is high in potassium due to hemolysis. Look for tall peaked T waves and
widening of the QRS complex. Other considerations with massive transfusion of banked
blood are hypocalcemia, hypothermia and decreased tissue oxygen delivery due to
, decreased levels of 2,3-diphosphoglycerate.
A 65-year-old woman presents with severe dyspnea 2 days after abdominal surgery. She
is admitted to the critical care unit. On 5 L of oxygen by nasal cannula, her arterial blood
gases are as follows:
pH 7.39
PaCO2 35 mm Hg
HCO3 19 mEq/L
PaO2 40 mm Hg
Arterial oxygen saturation 75%
Why does this patient have hypoxemia without hypercapnia?
A.
Because carbon dioxide is more diffusible than oxygen
B.
Because carbon dioxide has more driving pressure
C.
Because carbon dioxide is less diffusible than oxygen
D.
Because carbon dioxide excretion by the kidney is increased - Answer Because carbon
dioxide is more diffusible than oxygen
Carbon dioxide is 20 times more diffusible than oxygen. In conditions that affect
diffusion but not ventilation, one would expect the PaO2 to be low and the PaCO2 to be
