ADULT CCRN LEAKED MULTISYSTEM TEST
QUESTIONS 2024 UPDATED AND REVISED IN 2024-
2025
A patient has attempted suicide by ingesting a mixture of
alcohol and
acetaminophen. A nurse should monitor for
A) elevated ammonia and decreased lactate.
B) elevated AST and elevated ALT levels.
c) elevated BUN and decreased creatinine.
D) decreased PT and decreased FSP.
elevated AST and elevated ALT levels.
The combination of acetaminophen and alcohol is toxic to the
liver. Rising AST and ALT levels are indicative of acute liver
damage. Liver failure causes the PT to rise. FSP will rise if the
patient develops DIC. Acute liver failure will cause the ammonia
and lactate to increase as the liver is unable to manage the
byproducts of cellular metabolism. Acute liver failure may also
lead to renal failure with both BUN and creatinine rising.
A patient receiving long-term IV therapy via a peripherally
inserted central
catheter (PICC) line has the following vital signs BP 110/72
HR 128 RR 28 T 101
degrees F (38.3 degrees C) The nurse should anticipate
A) drawing a culture from the PICC.
B) dwelling antibiotic solution in the PICC.
,C) preparing for guidewire exchange.
D) establishing peripheral IV access.
establishing peripheral IV access.
This patient meets systemic inflammatory response syndrome
(SIRS) criteria. If a central line-associated bloodstream infection is
suspected, the catheter should be removed if possible. The nurse
should establish alternate access, anticipating the removal of the
PICC.
For a patient in sepsis, adequate fluid therapy and oxygen
are essential to
A) mobilize secretions.
B) maintain adequate cardiac output.
c) ensure tissue perfusion.
D) support ventilation.
ensure tissue prefusion
Adequate fluid therapy will enhance tissue perfusion, carrying the
supplemental oxygen to the hypoxic tissues. While supporting
ventilation is important, it does not meet the primary treatment
goal of sepsis. Mobilizing secretions is not impacted by either fluid
therapy or oxygen and will not affect sepsis. While fluid therapy
will assist in maintaining cardiac output and increasing tissue
perfusion, oxygen will have no appreciable effect on cardiac
output.
A nurse is conducting a focused exam on a patient with
sepsis who just
received a fluid bolus for hypotension one-hour prior. What
should the nurse assess?
,A) SV and Cl
B) CI and SVR
c) CVP and cardiac output
D) BP after passive leg raise and Scv02
BP after passive leg raise and Scv02
The 6-hour bundle of care for sepsis includes that a patient must
be reassessed with two of the following: CVP, ScvO2, bedside
cardiac ultrasound, or passive leg raise. Cardiac output, Cl, stroke
volume and SVR are not included in the sepsis bundle
assessment.
Primary pharmacological management of the patient with
sepsis includes
administration of
A) diuretics.
B) antibiotics.
c) analgesics.
D) vasodilators.
antibiotics.
Immediately upon presentation after obtaining blood cultures,
treatment with antibiotics is essential. The agent(s) selected
should be based on the insulting organism(s) and subsequently
modified based on culture and sensitivity reports. The inability to
obtain blood cultures for more than one hour must not delay the
initiation of antibiotic therapy, as the mortality rate increases for
each hour that antibiotics are not started. A vasodilator would
lower the patient's BP even more. Fluid resuscitation should begin
, as soon as possible to combat the hypotension that occurs as a
result of cytokine release; cytokines cause vasodilation and
capillary leak. Volume repletion is essential. A diuretic will volume
deplete the patient further. Primary pharmacologic management
for sepsis includes treating the suspected infection, restoring
intravascular volume, maintaining adequate cardiac output and
maintaining adequate oxygenation and ventilation. If the patient is
having pain, analgesics are indicated. However, analgesic
therapy is not part of the mainstay of sepsis management.
A 70kg patient with ARDS is receiving sedation,
neuromuscular blockade, and is on mechanical ventilation
with the following settings: Assist/Control, FiO2 .50, TV 420
mL, Rate 14, PEEP 6 cm H2O. ABG results are:
pH 7.30
pC02 50 mm Hg
pO2 73 mm Hg
HCO3 24 mEg/L
Sa02 94%
Which intervention is indicated?
A) increase the tidal volume
B) increase the Fi02
C) increase the rate
D) increase the PEEP
increase the rate
The patient has a respiratory acidosis, meaning there is CO2
retention. An increase in the rate is indicated. Since the patient is
QUESTIONS 2024 UPDATED AND REVISED IN 2024-
2025
A patient has attempted suicide by ingesting a mixture of
alcohol and
acetaminophen. A nurse should monitor for
A) elevated ammonia and decreased lactate.
B) elevated AST and elevated ALT levels.
c) elevated BUN and decreased creatinine.
D) decreased PT and decreased FSP.
elevated AST and elevated ALT levels.
The combination of acetaminophen and alcohol is toxic to the
liver. Rising AST and ALT levels are indicative of acute liver
damage. Liver failure causes the PT to rise. FSP will rise if the
patient develops DIC. Acute liver failure will cause the ammonia
and lactate to increase as the liver is unable to manage the
byproducts of cellular metabolism. Acute liver failure may also
lead to renal failure with both BUN and creatinine rising.
A patient receiving long-term IV therapy via a peripherally
inserted central
catheter (PICC) line has the following vital signs BP 110/72
HR 128 RR 28 T 101
degrees F (38.3 degrees C) The nurse should anticipate
A) drawing a culture from the PICC.
B) dwelling antibiotic solution in the PICC.
,C) preparing for guidewire exchange.
D) establishing peripheral IV access.
establishing peripheral IV access.
This patient meets systemic inflammatory response syndrome
(SIRS) criteria. If a central line-associated bloodstream infection is
suspected, the catheter should be removed if possible. The nurse
should establish alternate access, anticipating the removal of the
PICC.
For a patient in sepsis, adequate fluid therapy and oxygen
are essential to
A) mobilize secretions.
B) maintain adequate cardiac output.
c) ensure tissue perfusion.
D) support ventilation.
ensure tissue prefusion
Adequate fluid therapy will enhance tissue perfusion, carrying the
supplemental oxygen to the hypoxic tissues. While supporting
ventilation is important, it does not meet the primary treatment
goal of sepsis. Mobilizing secretions is not impacted by either fluid
therapy or oxygen and will not affect sepsis. While fluid therapy
will assist in maintaining cardiac output and increasing tissue
perfusion, oxygen will have no appreciable effect on cardiac
output.
A nurse is conducting a focused exam on a patient with
sepsis who just
received a fluid bolus for hypotension one-hour prior. What
should the nurse assess?
,A) SV and Cl
B) CI and SVR
c) CVP and cardiac output
D) BP after passive leg raise and Scv02
BP after passive leg raise and Scv02
The 6-hour bundle of care for sepsis includes that a patient must
be reassessed with two of the following: CVP, ScvO2, bedside
cardiac ultrasound, or passive leg raise. Cardiac output, Cl, stroke
volume and SVR are not included in the sepsis bundle
assessment.
Primary pharmacological management of the patient with
sepsis includes
administration of
A) diuretics.
B) antibiotics.
c) analgesics.
D) vasodilators.
antibiotics.
Immediately upon presentation after obtaining blood cultures,
treatment with antibiotics is essential. The agent(s) selected
should be based on the insulting organism(s) and subsequently
modified based on culture and sensitivity reports. The inability to
obtain blood cultures for more than one hour must not delay the
initiation of antibiotic therapy, as the mortality rate increases for
each hour that antibiotics are not started. A vasodilator would
lower the patient's BP even more. Fluid resuscitation should begin
, as soon as possible to combat the hypotension that occurs as a
result of cytokine release; cytokines cause vasodilation and
capillary leak. Volume repletion is essential. A diuretic will volume
deplete the patient further. Primary pharmacologic management
for sepsis includes treating the suspected infection, restoring
intravascular volume, maintaining adequate cardiac output and
maintaining adequate oxygenation and ventilation. If the patient is
having pain, analgesics are indicated. However, analgesic
therapy is not part of the mainstay of sepsis management.
A 70kg patient with ARDS is receiving sedation,
neuromuscular blockade, and is on mechanical ventilation
with the following settings: Assist/Control, FiO2 .50, TV 420
mL, Rate 14, PEEP 6 cm H2O. ABG results are:
pH 7.30
pC02 50 mm Hg
pO2 73 mm Hg
HCO3 24 mEg/L
Sa02 94%
Which intervention is indicated?
A) increase the tidal volume
B) increase the Fi02
C) increase the rate
D) increase the PEEP
increase the rate
The patient has a respiratory acidosis, meaning there is CO2
retention. An increase in the rate is indicated. Since the patient is
