(Solved) BARRONS CCRN EXAM LATEST 2022/2023 Questions and Answers Test Bank with Rationale

(Solved) BARRONS CCRN EXAM LATEST 2022/2023 Questions and Answers Test Bank -Which of the following ventilator settings is most likely to decrease the work of breathing? A assist-control B pressure support C tidal volume D CPAP {{Ans- Answer: B Pressure support senses the beginning of the patient's spontaneous inspiration and provides a set pressure to assist the inspiratory effort. The primary purpose of the ventilator settings listed in choices (A), (C), and (D) is not to decrease the work of breathing. -A nurse is caring for a patient with an acute inferior wall MI, post coronary artery stent deployment. For optimal care of this patient, the nurse should: Select single answer choice. A administer an analgesic for acute back You selected. B apply a pressure dressing to the You did not select. C continuously monitor the patient in lead II. D maintain the patient in a supine position. {{Ans- Answer: C It is best practice to continuously monitor a patient, who is post coronary artery stent deployment, in the lead that was most abnormal during the acute occlusion. Lead II would most likely meet this criterion for a patient with an inferior wall MI. The remaining interventions are NOT indicated for a patient who is post coronary artery stent deployment. -A patient with aortic regurgitation will have which of the following upon auscultation? Select single answer choice. A a diastolic murmur, loudest at the fifth intercostal space, midclavicular a systolic murmur, loudest at the apex of the heart C a diastolic murmur, loudest at the second intercostal space, right sternal border D a systolic murmur, loudest at the base of the heart {{Ans- Answer: C Aortic insufficiency (regurgitation) is the backflow of blood during the time when the aortic valve should be closed. The aortic valve is closed during diastole; therefore, this patient has a diastolic murmur. The aortic area of auscultation is at the base of the heart: the second intercostal space, right sternal border. -A patient has acute kidney injury with fluid overload, and continuous renal replacement therapy (CRRT) has been ordered. Which of the following would indicate the need for CRRT rather than intermittent hemodialysis? Select single answer choice. A hyperkalemia B. a MAP of 45 mmHg C acidosis D severe hypoxemia {{Ans- Answer: B Hemodynamic instability, such as hypotension, is the indication for CRRT since it does not cause the rapid fluid shifts that are seen with intermittent hemodialysis. The remaining choices are not indications for CRRT. -Which of the following patients, who are all receiving mechanical ventilation, is most likely a candidate for a spontaneous awakening trial? Select single answer choice. A a patient who is receiving PRN morphine B a patient who is receiving a propofol infusion C a patient who is receiving 100% oxygen and 20 cm H2O pressure of PEEP D a patient who is receiving a vecuronium (Norcuron) infusion {{Ans- Answer: B A spontaneous awakening trial should be considered for a patient who is receiving a continuous infusion of a sedating drug and/or an analgesic drug and who meets the hemodynamic criteria. A patient who is receiving a propofol infusion is a potential candidate for a spontaneous awakening trial as long as the hemodynamic criteria are met. A patient who is receiving PRN morphine may be a candidate for a spontaneous breathing trial, but that patient does not require an infusion to be stopped in order to be awakened. The remaining 2 choices do not meet the criteria for performing either a spontaneous awakening trial or a spontaneous breathing trial. -While the code team is performing resuscitative efforts, many of the patient's family members start to cry and pray, while other family members lie down on the floor in the corner of the room. Which of the following demonstrates the best action for the nurse to take at this time? Select single answer choice. A Ensure that a member of the code team serves as a family presence facilitator and clearly communicates the treatment strategies to the family. B Call security to escort the family members to the waiting room due to their disruptive behavior. C Encourage the family members to leave the patient care area because they are extremely distressed. D Ask the family members to leave the patient care area because they may suffer anxiety from remaining in the room. {{Ans- Answer: A It is important to offer families the opportunity to witness the efforts of the health care team during a patient's cardiopulmonary resuscitation. Research suggests that allowing family members to stay with a patient during this time may decrease their rates of post-traumatic stress disorder, depression, and anxiety related to the event. If the family interferes with the code team's ability to provide care to the patient, it may be necessary to have security remove the family; however, this scenario does not state that the family members are interfering with the code team's efforts, so choice (B) is incorrect. The remaining 2 choices do not allow the family to grieve in a way that may be natural to them. -Cardiogenic shock secondary to left ventricular failure will generally result in: Select single answer choice. A decreased afterload. B a narrow pulse pressure. C decreased preload. D a widening pulse pressure. {{Ans- Answer: B The systolic pressure decreases due to a drop in the cardiac output; however, the diastolic pressure either stays the same or increases due to a compensatory increase in the systemic vascular resistance. The remaining choices are not found in the presence of cardiogenic shock. -Massive atelectasis occurs in the presence of acute respiratory distress syndrome (ARDS). What are the 2 causes of the atelectasis that is typical of ARDS? Select single answer choice. A a surfactant deficiency and pulmonary edema B increased pulmonary vascular resistance and increased pulmonary compliance C increased pulmonary compliance and pulmonary edema D mucus plugs and bronchospasm {{Ans- Answer: A ARDS destroys Type II alveolar cells, which results in decreased surfactant production. ARDS also results in capillary leak at normal left-sided heart pressures, which results in pulmonary edema. Both a surfactant deficiency and pulmonary edema lead to atelectasis. The remaining choices are not correct because increased pulmonary compliance and mucus plugs are not features of ARDS. -A patient was admitted with an acute inferior wall STEMI. The physician advises the nurse to monitor the patient for signs of right ventricular (RV) infarction. Which of the following are signs of RV infarction? Select single answer choice. A S4 heart sound, lung crackles B hypotension, flat neck veins C hypertension, a systolic murmur D distended neck veins, clear lungs {{Ans- Answer: D If the RV contractility decreases, the pressure that is proximal to the right ventricle (which is the right atrial pressure) increases, resulting in distended neck veins. As the right heart fails, the left heart preload decreases, and the lungs are clear. -Which of the following is an effect of hypothermia? Select single answer choice. A a decrease in the SaO2 B a decrease in the blood pressure C an increase in the heart rate D a shift of the oxyhemoglobin dissociation curve to the left {{Ans- Answer: D Hypothermia shifts the oxyhemoglobin dissociation curve to the left, which inhibits the release of oxygen from hemoglobin, thereby resulting in a higher SaO2 than usual at the same PaO2. The remaining choices are not related to hypothermia. -It is important for a nurse to identify the signs of respiratory depression during procedural sedation. Which of the following is a LATE sign of respiratory depression? Select single answer choice. A a cough B SpO2 88% C ETCO2 of 50 mmHg per waveform capnography D sedation {{Ans- Answer: B A pulse oximetry decrease is a late sign of respiratory depression. A cough is not indicative of respiratory depression. An elevated ETCO2 per waveform capnography is an early sign of respiratory depression. Sedation precedes respiratory depression. -The most common cause of acute hepatic failure is: Select single answer choice. A alcohol abuse. B a salicylate overdose. C biliary obstruction. D an acetaminophen overdose. {{Ans- Answer: D Alcohol abuse results in chronic, not acute, hepatic failure. A salicylate overdose results in renal failure. Biliary obstruction may lead to pancreatitis or gallbladder disease. -Which of the following is most likely to lead to cardiopulmonary arrest for a patient with status asthmaticus? Select single answer choice. A bronchospasm. B thick, tenacious secretions. C hypoxemia. D air trapping. {{Ans- Answer: D Air trapping, due to the inability to effectively exhale, leads to chest hyperinflation, which in turn leads to decreased venous return and a precipitous drop in cardiac output. The remaining choices are seen with status asthmaticus but are not direct causes of cardiopulmonary arrest. -The ECG demonstrates ST elevation in leads II, III, and aVF. The nurse needs to monitor the patient closely for which of the following? Select single answer choice. A tachycardia, lung crackles B sinus bradycardia, an acute systolic murmur in the fifth intercostal space, midclavicular C second-degree AV block (Type II), hypotension. D hypoxemia, an acute systolic murmur in the fifth intercostal space, left sternal border. {{Ans- Answer: B Complications that are likely to occur after an acute inferior wall MI include bradycardia secondary to ischemia to the SA node and/or the AV node and papillary muscle rupture or dysfunction due to the anatomical distance between the right coronary artery and the papillary muscle. The remaining choices are not common complications of an inferior wall MI.