Pass CCRN test bank
A 20-mm S wave in lead V1 and a 25-mm R wave in lead V6 are mentioned on a affected
person's 12-lead electrocardiogram. This might indicate which of the following?
A.
Right package department block (RBBB)
B.
Left ventricular hypertrophy
C.
Posterior wall myocardial infarction (MI)
D.
Right ventricular hypertrophy - ANS-B. Left ventricular hypertrophy
When the intensity of the S wave in lead V1 or V2 plus the peak of the R wave in lead V5 or
V6 is 35 mm or more, this constitutes voltage criteria for left ventricular hypertrophy.
A 22-12 months-old man is admitted after a bicycle collision with a tree. He has a contusion
on the right side of his head. An intraventricular catheter has been inserted via a burr hole to
screen his intracranial strain (ICP). He develops respiration despair and is intubated and
mechanically ventilated. Which of the subsequent is the maximum in all likelihood motive of
an increase in ICP at the moment?
A.
Positive strain air flow
B.
Hypocapnia because of hyperventilation
C.
Sedation
D.
Cerebral dehydration due to osmotic diuretics - ANS-A. Positive pressure ventilation
Positive strain air flow increases intrathoracic stress, which leads to accelerated ICP.
A 22-12 months-vintage man is admitted to the essential care unit after a motor automobile
collision. The emergency department nurse reports that he changed into unconscious on the
scene of the coincidence, but he is now alert and orientated. Skull movies show a linear
fracture of the proper temporal bone. He is at giant chance for:
A.
Scalp hematoma.
B.
Subdural hematoma.
C.
Epidural hematoma.
D.
,Intracerebral hematoma. - ANS-C. Epidural hematoma.
Linear fractures of the temporal bone frequently disrupt the center meningeal artery and
cause epidural hematoma. Patients with an epidural hematoma classically present with a
short period of unconsciousness observed by way of a lucid c language and then speedy
deterioration. An epidural hematoma is normally caused by arterial bleeding.
A 22-12 months-vintage man is admitted with spontaneous pneumothorax. He is
extraordinarily dyspneic and demanding. He also is complaining of tingling around his mouth
and his fingertips and feeling mild-headed. Blood stress is one hundred twenty/eighty two
mm Hg, heart rate is a hundred and ten beats/min, respiration rate is 36 breaths/min and
deep, and temperature is 37° C (98.6° F). Which of the subsequent could now not be used to
deal with this situation?
A.
Calcium
B.
Chest tube
C.
Analgesia
D.
Calming the affected person - ANS-A. Calcium
Remember that breathing alkalosis, because of hyperventilation, increases the binding
between albumin and calcium and, therefore, reduces the serum ionized calcium level. This
is why the patient is having the symptoms of tetany. However, he does now not need
calcium. He wishes a discount in minute air flow, as a way to lower his pH and correct the
binding among calcium and albumin, increasing the ionized calcium stage. Chest tube to
re-make bigger the lung, analgesia to deal with the chest pain, and calming of the affected
person (such as using sedatives) could be appropriate components of the treatment plan for
this patient.
A 24-year-antique man has been diagnosed with acute kidney harm as a result of intense
hemorrhaging after a motor automobile collision. Which of the following would be expected
laboratory values for this affected person?
A.
Low urinary osmolality, high urinary sodium concentration
B.
High urinary osmolality, high urinary sodium concentration
C.
Low urinary osmolality, low urinary sodium concentration
D.
High urinary osmolality, low urinary sodium awareness - ANS-D. High urinary osmolality, low
urinary sodium attention
Consider that the kidney would want to preserve sodium and water with blood loss. If the
kidney is conserving onto sodium, little is excreted into the urine, so urinary sodium is low. If
the kidney is retaining onto water, little is excreted into the urine, so it is concentrated and
osmolality is increased.
,A 24-yr-vintage man is admitted to the important care unit after maintaining a pulmonary
contusion in a motor vehicle collision. He has no history of cardiac or pulmonary ailment.
During the first 24 hours after admission, he has been complaining of increasing dyspnea,
his breathing price has been growing, and his oxygen saturation via pulse oximetry has been
reducing regardless of supplemental oxygen. Breath sound evaluation well-knownshows
excellent crackles bilaterally. Arterial blood gases monitor respiratory alkalosis and
hypoxemia. Chest x-ray movie reveals patchy infiltrates. Acute respiratory misery syndrome
is identified. Oxygen remedy is initiated, and arterial blood gases are monitored closely,
however SaO2 continues to fall. Which of those oxygen transport systems will offer the
highest attention of oxygen and indicated in this situation?
A.
Face tent
B.
Nonrebreathing masks
C.
Nasal cannula
D.
Venturi mask - ANS-B. Nonrebreathing mask
The nonrebreathing mask shops oxygen in nostril, pharynx, masks, and reservoir bag
among breaths. This permits a concentration of near 100%.
A 24-yr-antique man is admitted to the essential care unit after maintaining a pulmonary
contusion in a motor car collision. He has no records of cardiac or pulmonary sickness. Over
the previous few hours, he has been complaining of growing dyspnea, his respiratory price
has been increasing, and his oxygen saturation thru pulse oximetry has been lowering.
Breath sound evaluation well-knownshows great crackles bilaterally. Arterial blood gases
reveal breathing alkalosis and hypoxemia. Chest x-ray film famous patchy infiltrates. Acute
respiratory misery syndrome (ARDS) is diagnosed. Oxygen remedy is initiated, and arterial
blood gases are monitored carefully. The big atelectasis that happens in acute respiratory
distress syndrome is a conventional instance of intrapulmonary shunt. Intrapulmonary
shunting is nice described as which of the subsequent?
A.
Ventilated alveoli having blocked perfusion.
B.
Perfused alveoli having bloc - ANS-B. Perfused alveoli having blocked ventilation.
A 27-yr-antique lady arrives in the emergency branch 3 weeks after the vaginal shipping of
her first infant. She is transferred to the important care unit after an acute onset of dyspnea
and chest pain. Vital symptoms are blood stress, one hundred twenty/88 mm Hg; coronary
heart price, 122 beats/min; and respiration fee, 32 breaths/min. Arterial blood gases reveal a
pH of seven.Forty eight, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of fifty five
mm Hg, and an arterial oxygen saturation of 89% on 100% oxygen by means of
nonrebreathing masks. Jugular venous distention is obvious, and cardiac auscultation
exhibits an accentuated P2 and a proper-sided S3 and S4. A air flow/perfusion test indicates
excessive possibility of a pulmonary embolism. Which of the subsequent isn't always glaring
by using the heart sound adjustments?
, A.
Pulmonary high blood pressure
B.
Right ventricular strain and noncompliance
C.
Right ventricular failure
D.
Pulmonary edema - ANS-D. Pulmonary edema
A 27-year-vintage woman arrives within the emergency branch three weeks after the vaginal
delivery of her first child. She is transferred to the vital care unit after an acute onset of
dyspnea and chest ache. Vital signs are blood stress, a hundred and twenty/88 mm Hg;
heart charge, 122 beats/min; and respiration rate, 32 breaths/min. Arterial blood gases
display a pH of 7.48, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of fifty five mm
Hg, and an arterial oxygen saturation of 89% on one hundred% oxygen by means of
nonrebreathing masks. Jugular venous distention is clear, and cardiac auscultation reveals
an accentuated P2 and an S3 and S4 of the right aspect. A ventilation/perfusion test
suggests high opportunity of a pulmonary embolism. What remedy is indicated at this time?
A.
Intubation and mechanical air flow
B.
Heparin
C.
Fibrinolytic dealers
D.
Pulmonary embolectomy - ANS-C. Fibrinolytic agents
Remember that fibrinolytic marketers aren't contraindicated by means of surgical operation
or trauma after approximately 2 weeks due to the fact the everyday fibrinolytic method
already might have damaged down the clot. The exception could be brain or spinal twine
trauma or surgery because the outcomes of bleeding into the pinnacle or backbone would be
specifically dire.
A 28-12 months-vintage man is admitted with bowel perforation. His blood strain is ninety
two/sixty four mm Hg, heart rate is 116 beats/min and normal, breathing price is 22
breaths/min and normal, and urine output has simplest been 20 ml because being admitted
three hours ago. Mucous membranes are dry, and there may be negative skin turgor. Based
on this statistics, you would anticipate his pulmonary artery occlusive pressure to be:
A.
Four mm Hg.
B.
8 mm Hg.
C.
12 mm Hg.
D.
16 mm Hg. - ANS-A. 4 mm Hg.
A 20-mm S wave in lead V1 and a 25-mm R wave in lead V6 are mentioned on a affected
person's 12-lead electrocardiogram. This might indicate which of the following?
A.
Right package department block (RBBB)
B.
Left ventricular hypertrophy
C.
Posterior wall myocardial infarction (MI)
D.
Right ventricular hypertrophy - ANS-B. Left ventricular hypertrophy
When the intensity of the S wave in lead V1 or V2 plus the peak of the R wave in lead V5 or
V6 is 35 mm or more, this constitutes voltage criteria for left ventricular hypertrophy.
A 22-12 months-old man is admitted after a bicycle collision with a tree. He has a contusion
on the right side of his head. An intraventricular catheter has been inserted via a burr hole to
screen his intracranial strain (ICP). He develops respiration despair and is intubated and
mechanically ventilated. Which of the subsequent is the maximum in all likelihood motive of
an increase in ICP at the moment?
A.
Positive strain air flow
B.
Hypocapnia because of hyperventilation
C.
Sedation
D.
Cerebral dehydration due to osmotic diuretics - ANS-A. Positive pressure ventilation
Positive strain air flow increases intrathoracic stress, which leads to accelerated ICP.
A 22-12 months-vintage man is admitted to the essential care unit after a motor automobile
collision. The emergency department nurse reports that he changed into unconscious on the
scene of the coincidence, but he is now alert and orientated. Skull movies show a linear
fracture of the proper temporal bone. He is at giant chance for:
A.
Scalp hematoma.
B.
Subdural hematoma.
C.
Epidural hematoma.
D.
,Intracerebral hematoma. - ANS-C. Epidural hematoma.
Linear fractures of the temporal bone frequently disrupt the center meningeal artery and
cause epidural hematoma. Patients with an epidural hematoma classically present with a
short period of unconsciousness observed by way of a lucid c language and then speedy
deterioration. An epidural hematoma is normally caused by arterial bleeding.
A 22-12 months-vintage man is admitted with spontaneous pneumothorax. He is
extraordinarily dyspneic and demanding. He also is complaining of tingling around his mouth
and his fingertips and feeling mild-headed. Blood stress is one hundred twenty/eighty two
mm Hg, heart rate is a hundred and ten beats/min, respiration rate is 36 breaths/min and
deep, and temperature is 37° C (98.6° F). Which of the subsequent could now not be used to
deal with this situation?
A.
Calcium
B.
Chest tube
C.
Analgesia
D.
Calming the affected person - ANS-A. Calcium
Remember that breathing alkalosis, because of hyperventilation, increases the binding
between albumin and calcium and, therefore, reduces the serum ionized calcium level. This
is why the patient is having the symptoms of tetany. However, he does now not need
calcium. He wishes a discount in minute air flow, as a way to lower his pH and correct the
binding among calcium and albumin, increasing the ionized calcium stage. Chest tube to
re-make bigger the lung, analgesia to deal with the chest pain, and calming of the affected
person (such as using sedatives) could be appropriate components of the treatment plan for
this patient.
A 24-year-antique man has been diagnosed with acute kidney harm as a result of intense
hemorrhaging after a motor automobile collision. Which of the following would be expected
laboratory values for this affected person?
A.
Low urinary osmolality, high urinary sodium concentration
B.
High urinary osmolality, high urinary sodium concentration
C.
Low urinary osmolality, low urinary sodium concentration
D.
High urinary osmolality, low urinary sodium awareness - ANS-D. High urinary osmolality, low
urinary sodium attention
Consider that the kidney would want to preserve sodium and water with blood loss. If the
kidney is conserving onto sodium, little is excreted into the urine, so urinary sodium is low. If
the kidney is retaining onto water, little is excreted into the urine, so it is concentrated and
osmolality is increased.
,A 24-yr-vintage man is admitted to the important care unit after maintaining a pulmonary
contusion in a motor vehicle collision. He has no history of cardiac or pulmonary ailment.
During the first 24 hours after admission, he has been complaining of increasing dyspnea,
his breathing price has been growing, and his oxygen saturation via pulse oximetry has been
reducing regardless of supplemental oxygen. Breath sound evaluation well-knownshows
excellent crackles bilaterally. Arterial blood gases monitor respiratory alkalosis and
hypoxemia. Chest x-ray movie reveals patchy infiltrates. Acute respiratory misery syndrome
is identified. Oxygen remedy is initiated, and arterial blood gases are monitored closely,
however SaO2 continues to fall. Which of those oxygen transport systems will offer the
highest attention of oxygen and indicated in this situation?
A.
Face tent
B.
Nonrebreathing masks
C.
Nasal cannula
D.
Venturi mask - ANS-B. Nonrebreathing mask
The nonrebreathing mask shops oxygen in nostril, pharynx, masks, and reservoir bag
among breaths. This permits a concentration of near 100%.
A 24-yr-antique man is admitted to the essential care unit after maintaining a pulmonary
contusion in a motor car collision. He has no records of cardiac or pulmonary sickness. Over
the previous few hours, he has been complaining of growing dyspnea, his respiratory price
has been increasing, and his oxygen saturation thru pulse oximetry has been lowering.
Breath sound evaluation well-knownshows great crackles bilaterally. Arterial blood gases
reveal breathing alkalosis and hypoxemia. Chest x-ray film famous patchy infiltrates. Acute
respiratory misery syndrome (ARDS) is diagnosed. Oxygen remedy is initiated, and arterial
blood gases are monitored carefully. The big atelectasis that happens in acute respiratory
distress syndrome is a conventional instance of intrapulmonary shunt. Intrapulmonary
shunting is nice described as which of the subsequent?
A.
Ventilated alveoli having blocked perfusion.
B.
Perfused alveoli having bloc - ANS-B. Perfused alveoli having blocked ventilation.
A 27-yr-antique lady arrives in the emergency branch 3 weeks after the vaginal shipping of
her first infant. She is transferred to the important care unit after an acute onset of dyspnea
and chest pain. Vital symptoms are blood stress, one hundred twenty/88 mm Hg; coronary
heart price, 122 beats/min; and respiration fee, 32 breaths/min. Arterial blood gases reveal a
pH of seven.Forty eight, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of fifty five
mm Hg, and an arterial oxygen saturation of 89% on 100% oxygen by means of
nonrebreathing masks. Jugular venous distention is obvious, and cardiac auscultation
exhibits an accentuated P2 and a proper-sided S3 and S4. A air flow/perfusion test indicates
excessive possibility of a pulmonary embolism. Which of the subsequent isn't always glaring
by using the heart sound adjustments?
, A.
Pulmonary high blood pressure
B.
Right ventricular strain and noncompliance
C.
Right ventricular failure
D.
Pulmonary edema - ANS-D. Pulmonary edema
A 27-year-vintage woman arrives within the emergency branch three weeks after the vaginal
delivery of her first child. She is transferred to the vital care unit after an acute onset of
dyspnea and chest ache. Vital signs are blood stress, a hundred and twenty/88 mm Hg;
heart charge, 122 beats/min; and respiration rate, 32 breaths/min. Arterial blood gases
display a pH of 7.48, a PaCO2 of 30 mm Hg, an HCO3 of 24 mEq/L, a PaO2 of fifty five mm
Hg, and an arterial oxygen saturation of 89% on one hundred% oxygen by means of
nonrebreathing masks. Jugular venous distention is clear, and cardiac auscultation reveals
an accentuated P2 and an S3 and S4 of the right aspect. A ventilation/perfusion test
suggests high opportunity of a pulmonary embolism. What remedy is indicated at this time?
A.
Intubation and mechanical air flow
B.
Heparin
C.
Fibrinolytic dealers
D.
Pulmonary embolectomy - ANS-C. Fibrinolytic agents
Remember that fibrinolytic marketers aren't contraindicated by means of surgical operation
or trauma after approximately 2 weeks due to the fact the everyday fibrinolytic method
already might have damaged down the clot. The exception could be brain or spinal twine
trauma or surgery because the outcomes of bleeding into the pinnacle or backbone would be
specifically dire.
A 28-12 months-vintage man is admitted with bowel perforation. His blood strain is ninety
two/sixty four mm Hg, heart rate is 116 beats/min and normal, breathing price is 22
breaths/min and normal, and urine output has simplest been 20 ml because being admitted
three hours ago. Mucous membranes are dry, and there may be negative skin turgor. Based
on this statistics, you would anticipate his pulmonary artery occlusive pressure to be:
A.
Four mm Hg.
B.
8 mm Hg.
C.
12 mm Hg.
D.
16 mm Hg. - ANS-A. 4 mm Hg.
