CCRN QUESTIONS & UPDATED
ANSWERS PASSED ALREADY
GRADED A+ NEWEST VERSION
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. - Correct 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 - Correct 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 - Correct 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 - Correct 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
C.
Because carbon dioxide is less diffusible than oxygen
D.
Because carbon dioxide excretion by the kidney is increased - Correct Answer ✔✔
Because carbon dioxide is more diffusible than oxygen
Carbon dioxide is 20 times more diffusible than oxygen. In conditions that affect
diffusion but do not affect ventilation, expect the PaO2 to be decreased and the PaCO2
to be normal (or decreased in hyperventilation, as in this patient). If ventilation were
affected, such as if this patient were fatiguing, the PaCO2 then would increase. Driving
pressure is the fraction of the gas in inspired air multiplied by the barometric pressure.
Because carbon dioxide is ~0.5% of inspired air, the driving pressure would be very low.
The kidney eliminates bicarbonate and hydrogen ions, but the lungs eliminate carbon
dioxide.
A 55-year-old patient has headache, nuchal rigidity, photophobia, and positive Kernig's
and Brudzinski's signs. These are consistent with which of the following?
, A.
Intracranial hemorrhage
B.
Subarachnoid hemorrhage
C.
Epidural hemorrhage
D.
Subdural hemorrhage - Correct Answer ✔✔ Subarachnoid hemorrhage
When there is bleeding from an aneurysm, that blood irritates the meninges. The clinical
presentation is very similar to meningitis. This clinical presentation is not consistent with
intracranial, epidural, or subdural bleeding because the blood is not in contact with the
meninges in those situations.
An extra heart sound preceding S1 is most likely an S4 if the stethoscope's:
A.
diaphragm is over the apex.
B.
bell is over the aortic area.
C.
diaphragm is over the aortic area.
D.
bell is over the apex. - Correct Answer ✔✔ bell is over the apex.
S3 and S4 are low pitched, so choose options with the bell being used. S3 and S4 are
heard at the mitral area (i.e., apex) unless the right ventricular is affected, and then they
are heard in the tricuspid area.
Low-Pitched is best heard with Bell
The charge nurse on the 7 pm to 7 am shift was asked to assist a group of nurses to
resolve their conflict so that their two opposing goals are discarded and new goals are
adopted. This is an example of which of the following?
A.
Smoothing of conflict
B.
Facilitating collaboration
ANSWERS PASSED ALREADY
GRADED A+ NEWEST VERSION
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. - Correct 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 - Correct 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 - Correct 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 - Correct 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
C.
Because carbon dioxide is less diffusible than oxygen
D.
Because carbon dioxide excretion by the kidney is increased - Correct Answer ✔✔
Because carbon dioxide is more diffusible than oxygen
Carbon dioxide is 20 times more diffusible than oxygen. In conditions that affect
diffusion but do not affect ventilation, expect the PaO2 to be decreased and the PaCO2
to be normal (or decreased in hyperventilation, as in this patient). If ventilation were
affected, such as if this patient were fatiguing, the PaCO2 then would increase. Driving
pressure is the fraction of the gas in inspired air multiplied by the barometric pressure.
Because carbon dioxide is ~0.5% of inspired air, the driving pressure would be very low.
The kidney eliminates bicarbonate and hydrogen ions, but the lungs eliminate carbon
dioxide.
A 55-year-old patient has headache, nuchal rigidity, photophobia, and positive Kernig's
and Brudzinski's signs. These are consistent with which of the following?
, A.
Intracranial hemorrhage
B.
Subarachnoid hemorrhage
C.
Epidural hemorrhage
D.
Subdural hemorrhage - Correct Answer ✔✔ Subarachnoid hemorrhage
When there is bleeding from an aneurysm, that blood irritates the meninges. The clinical
presentation is very similar to meningitis. This clinical presentation is not consistent with
intracranial, epidural, or subdural bleeding because the blood is not in contact with the
meninges in those situations.
An extra heart sound preceding S1 is most likely an S4 if the stethoscope's:
A.
diaphragm is over the apex.
B.
bell is over the aortic area.
C.
diaphragm is over the aortic area.
D.
bell is over the apex. - Correct Answer ✔✔ bell is over the apex.
S3 and S4 are low pitched, so choose options with the bell being used. S3 and S4 are
heard at the mitral area (i.e., apex) unless the right ventricular is affected, and then they
are heard in the tricuspid area.
Low-Pitched is best heard with Bell
The charge nurse on the 7 pm to 7 am shift was asked to assist a group of nurses to
resolve their conflict so that their two opposing goals are discarded and new goals are
adopted. This is an example of which of the following?
A.
Smoothing of conflict
B.
Facilitating collaboration
