CCRN Questions
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 implantable cardioverter-defibrillator (ICD) is implanted. Four days after
surgery he develops ventricular tachycardia. 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.
Administer epinephrine IV.
B.
Administer amiodarone.
C.
Defibrillate.
D.
Reset the ICD. - Answer-Defibrillate
A 28-year-old woman is admitted to the critical care unit from the emergency department with a
diagnosis of asthma. Her 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 repeat arterial blood gases on 40% oxygen indicate that the patient's condition is
worsening?
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
The case study shows stage II asthma. Option c shows stage III asthma. The patient is still breathing at a
fast rate, but carbon dioxide is starting to be retained as evidenced by the increase of the PaCO2 into
normal range. Options a and b are still 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 experiencing 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 external stimulus) are common during alcohol withdrawal
syndrome.
A patient arrives in 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 because of 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 caused by decreased levels of 2,3-
diphosphoglycerate.
A 65-year-old woman reports severe dyspnea 2 days after abdominal surgery. She is transferred 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
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 implantable cardioverter-defibrillator (ICD) is implanted. Four days after
surgery he develops ventricular tachycardia. 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.
Administer epinephrine IV.
B.
Administer amiodarone.
C.
Defibrillate.
D.
Reset the ICD. - Answer-Defibrillate
A 28-year-old woman is admitted to the critical care unit from the emergency department with a
diagnosis of asthma. Her 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 repeat arterial blood gases on 40% oxygen indicate that the patient's condition is
worsening?
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
The case study shows stage II asthma. Option c shows stage III asthma. The patient is still breathing at a
fast rate, but carbon dioxide is starting to be retained as evidenced by the increase of the PaCO2 into
normal range. Options a and b are still 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 experiencing 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 external stimulus) are common during alcohol withdrawal
syndrome.
A patient arrives in 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 because of 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 caused by decreased levels of 2,3-
diphosphoglycerate.
A 65-year-old woman reports severe dyspnea 2 days after abdominal surgery. She is transferred 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
