CCRN EXAM LATEST 2023-2024 ACTUAL EXAM 300 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+

CCRN EXAM LATEST 2023-2024 ACTUAL EXAM

300 QUESTIONS AND CORRECT DETAILED

ANSWERS WITH RATIONALES|ALREADY

GRADED A+

The patient with oat cell carcinoma has the following clinical findings: low urine

output, low serum osmolality, hyponatremia, and elevated urine sodium. The nurse

anticipates which of the following as part of the treatment plan? - ANSWERPhenytoin (Dilantin), 3% saline.

RATIONALE:The patient has signs of SIADH which results in production of

excessive ADH. Dilantin will inhibit ADH secretion and 3% saline will increase

serum sodium.

Peep therapy and mechanical ventilation are ordered for the patient with acute

respiratory failure. Which of the following is a possible complication? -

ANSWER- Barotrauma

RATIONALE:The addition of positive end-expiratory pressure will increase

alveolar recruitment, prevent atelectasis and improve oxygenation. However, the

increase in intrathoracic pressure may lead to pneumothorax or subcutaneous

emphysema.

The postoperative thoracic surgery patient has bubbling in the water seal drainage

chamber of the chest tube. Which of the following interventions is indicated? -

ANSWER- avoid high airway pressures

RATIONALE:Bubbling in the water seal chamber is due to a pleural air leak, and

high airway pressure will either prevent resolution of the current air leak or make it

worse.

Which clinical sign might patients with both systolic and diastolic heart failure

have in common? - ANSWER- Lung crackles

RATIONALE:Both a problem with systolic (ejection problem) and diastolic

(filling problem) will increase left heart pressure and cause cardiogenic pulmonary

edema (lung crackles).

Which of the following is most likely to result in a low Sv02?

A. Hypotermia

B. Fever

C. Severe sepsis - ANSWER- Fever

RATIONALE:Fever increases metabolic rate and consumption, which may lead

to a drop in mixed venous oxygen saturation.

The nurse needs to assess adequacy of the tubing/catheter system for the arterial

line. Which of the following interventions will best assess this? - ANSWERPerform a square wave test

The patient requires fluid resuscitation and 8 units of PRBC's status post traumatic

injury. Which of the following interventions is most appropriate? - ANSWERWarm blood products and crystalloids

RATIONALE:Warming fluids and blood needed for traumatic injury will prevent

hypothermia and its related adverse effects.

Which of the following therapies should be avoided for the patient with

cardiogenic shock? - ANSWER- high dose vasopressors

RATIONALE:Vasopressors increase left ventricular after load, which would

increase myocardial work of a failing heart.

The patient is status post repair of an aneurysm for subarachnoid hemorrhage.

Which of the following interventions is indicated to prevent vasospasm? -

ANSWER- Nimodipine (Nimotop)

RATIONALE:is a calcium channel blocker that is started immediately post-op to

prevent arterial spasm of the brain.

The patient presents with a rigid abdomen, rebound tenderness, and a free air in the

peritoneum seen on KUB x-ray. Which of the following should the nurse

anticipate? - ANSWER- Powell perforation; provide fluids, prepare for surgery.

RATIONALE:The clinical signs are those of bowel perforation.

Which is the priority treatment for the pt with DKA who presents with

hyperglycemia, ketosis, and normal serum potassium? - ANSWER- replace

potassium

RATIONALE:The patient with DKA will have a low pH and metabolic acidosis.

In a state of metabolic acidosis, hydrogen ions move into the intracellular space. In

exchange, potassium leaves the intracellular space. The movement of K into the

extracellular space results in hyperkalemia.

Which of the following is a systemic effect of the therapeutic hypothermia during

the cooling phase? - ANSWER- Hyperglycemia secondary to insulin resistance.

RATIONALE:During the cooling phase of clinical hypothermia there is typically

insulin resistance. Additionally, during the phase there is vasoconstriction,

decreased neutrophil production and during rewarming, rebound hyperkalemia

may occur (not during the cooling phase).

The patient presented to the ED with a history of palpitations and dyspnea,

persisting on and off for one week. The heart monitor shows trail fibrillation with

rapid ventricular response, blood pressure 112/70. Treatment will most likely

include: - ANSWER- CCB and anticoagulation

RATIONALE:The patient history seems to be one of intermittent atrail fibrillation

over the past week. Controlling rate and addressing potential left atrial clot

formation are priority treatments.

Which of the following clinical findings would you expect to find in the patient

with septic shock? - ANSWER- Lactate 8, SvO2 85

RATIONALE:Elevated lactate is evidence of anaerobic metabolism and elevated

Sv02 is evidence of decreased oxygen utilization at the cellular level - both

definitive for septic shock.

The patient has a massive pulmonary embolism. Which of the following would be

expected? - ANSWER- Hypotension, increased alveolar dead space.

RATIONALE:Massive pulmonary embolism results in sudden extremely elevated

pulmonary pressures with resultant right ventricular failure and decreased left

ventricular pressure. The drop in CO results in hypotension. The clot obstructs

pulmonary perfusion which results in increase headspace ventilation.

The patient presents with left leg pain; ankle-brachial index (ABI) is 0.7. The

patient would benefit from which of the following interventions? - ANSWERdependent position of legs

RATIONALE:The clinical signs are indicative of peripheral arterial occlusive

disease. Dependent leg position will aid perfusion.

Which of the following are clinical signs of variant (Prinzmetal's) angina? -

ANSWER- ST-elevation, resolves with nitrate therapy.

RATIONALE:This type of angina is thought to be due to arterial spasm at the

point of coronary artery plaque, not due to plaque rupture. The ST elevation is

transient because the spasm is relieved with nitrates; therefore infarction does not

occur.

The most specific clinical sign for the presence of brain death would include which

of the following? - ANSWER- Absent oculocephalic reflex

RATIONALE:If eyes remain midline or turn to the side of head rotation, it is a

sign of cranial nerve VIII damage and possible brain death. The apnea test is

positive in the presence of brain death; while coma is present during brain death,

most patients with coma do not have brain death.

The physician determines the patient has ARDS. The patient has developed

refractory hypoxemia, bilateral infiltrates, and pulmonary edema on chest x-ray.

What findings would be expected?

a. increased lung compliance

b. PAOP normal or low

c. decreased cardiac output - ANSWER- b.

RATIONALE:The pulmonary edema of ARDS is due to lung capillary leak at

normal or even low left heart pressure, unlike cariogenic pulmonary edema, which

results in pulmonary edema at higher than normal left heart pressure.

The patient presents one month status post gastric bypass bariatric surgery with

vomiting, headache, diplopia, and memory loss. These are clinical signs of which

of the following? - ANSWER- Malabsorption