CCRN Practice Questions with guaranteed pass answers

A 52-year-old accountant is admitted to the critical care unit with frank gastrointestinal bleeding for more than 18 hours. He has had a blood loss of more than 1000 mL. Which of the following sets of vital signs would be consistent with the patient's blood loss? A. Blood pressure (BP) 100/84 mm Hg, heart rate 124 beats/min B. BP 86/40 mm Hg, heart rate 92 beats/min C. BP 124/66 mm Hg, heart rate 124 beats/min D. BP 112/60 mm Hg, heart rate 92 beats/min A! With a loss of 750 to 1500 mL of blood, an increase in heart rate greater than 100 beats/min and a narrowing of the pulse pressure is expected. These changes are due to sympathetic nervous system innervation. Option a shows a narrow pulse pressure and tachycardia. Which is the most critical concern during the acute phase of care for a patient with an intestinal obstruction? A. Aspiration B. Hyperkalemia C. Hypovolemia D. Metabolic alkalosis C - hypovolemia In intestinal obstruction, hypovolemia is the result of vomiting and sequestration of fluids in the lumen of the intestine. Intravascular volume decreases which can cause hypovolemic shock. Aspiration is a potential risk if the patient is vomiting. Hypokalemia and metabolic acidosis occur as a result of trapping of fluid within the lumen of the intestine. 00:19 01:14 A patient is brought to the hospital after inadvertent consumption of shellfish. He says he knew he was allergic to shellfish but did not know that the casserole that he was eating had shellfish in it. His face is edematous and his tongue is swollen. His voice is hoarse and he has inspiratory stridor. His medical history includes a myocardial infarction last year, and he has been taking metoprolol (Lopressor) since that time. Symptoms of anaphylaxis would have occurred how long after exposure to the antigen? A. 5 to 20 minutes B. 20 to 60 minutes C. 48 hours D. 3 days A Symptoms of anaphylaxis occur within 5 to 20 minutes. These immediate hypersensitivity reactions are life threatening. Later reactions, including cytotoxic hypersensitivity, cause urticaria but rarely are life threatening. Which of the following would not occur during a stressful situation? A. Hypersalivation B. Hyperventilation C. Increased muscle tension D. Palpitations A Oral and gastrointestinal secretions are reduced with sympathetic nervous system stimulation. A patient arrives with multisystem trauma after falling out of a second-floor window. She is lethargic and has peripheral cyanosis. Her vital signs are blood pressure 80/60 mm Hg, heart rate 145 beats/min, and respiratory rate 40 breaths/min. Which class of hemorrhagic shock is she in? A. I B. II C. III D. IV D. IV She is hypotensive with a narrowed pulse pressure, significantly tachycardic and tachypneic, and cyanotic. This clinical presentation is consistent with Class IV hemorrhagic shock and a loss of more than 40% of blood volume, or greater than 2000 mL. A patient arrives in the emergency department at 10:30 am with severe chest pain. He has ST segment elevation in leads V3 to V6. He has been given morphine for pain and is being evaluated for fibrinolytic therapy. The family arrives in the waiting room. Which of the following would be the best action? A. Ask the unit secretary to tell the family that the patient has had a cardiac arrest and that the nursing staff will talk to the family as soon as possible. B. Ask the unit secretary to take family members to a private area and tell them that the physician will be there to talk to them soon. C. Take the family to a private area yourself and briefly explain what has happened. D. Take family members to a private area yourself and tell them that the physician will be there to talk to them soon. C Family members need privacy as they begin to deal with this crisis. They should be briefly told what has happened as soon as possible, and then the physician can talk to them as soon as he or she is available. A nurse is asked to lead a project team to develop a new protocol for suctioning endotracheal tubes. The nurse conducts a literature search for clinical practice guidelines that have been developed already and revises the protocol for the hospital according to the recommendations of the clinical practice guidelines and the findings from research that has been conducted since the development of the clinical practice guidelines. A clinical practice guideline is an example of: A. discovery of knowledge. B. summary of evidence. C. translation of evidence. D. implementation of evidence. C Using the ACE Star Model, original research is an example of discovery of knowledge. Systematic review of the research related to a specific clinical question is an example of summary of the evidence. A clinical practice guideline is an example of translation of evidence. A pilot test would be an example of implementation of evidence. Which of the following is the underlying cause of multiple organ dysfunction syndrome (MODS) in the majority of cases? A. Anergy B. Sepsis C. Multisystem trauma D. Major surgery B Sepsis is the underlying cause of MODS in about 90% of cases A 23-year-old woman is beginning her second hemodialysis treatment for acute kidney injury. Suddenly she complains of headache and nausea. She is agitated and confused, and you notice twitching in her right hand. Which of the following is causing these findings? A. Uremia B. Dialysis disequilibrium syndrome C. Intracerebral hemorrhage D. Fluid overload B Dialysis disequilibrium syndrome occurs when urea is removed from the blood at a rate faster than it is removed from the brain tissue. The greater amount of urea in the brain causes a fluid shift resulting in cerebral edema. A 45-year-old man is admitted with acute epigastric pain that radiates to his back. He says that he has been vomiting continuously for 12 hours and that the pain has been worsening. His social history includes the information that he drinks about two six-packs of beer each night. He has dry, cracked lips and poor skin turgor. His abdomen is distended and tender. He is restless and agitated. Vital signs are blood pressure of 90/60 mm Hg, heart rate of 135 beats/min, and respiratory rate of 28 breaths/min. Acute pancreatitis is suspected. Which of the following diagnostic study results are consistent with a diagnosis of acute pancreatitis? A. Elevated serum amylase, elevated serum lipase, decreased serum albumin B. Decreased serum amylase, decreased serum lipase, elevated serum calcium C. Elevated serum bilirubin, decreased serum albumin, elevated serum calcium D. Elevated serum amylase, elevated serum lipase, elevated serum calcium A Acute pancreatitis causes elevations in serum amylase, serum lipase, and possibly bilirubin, whereas calcium and albumin are decreased. A 67-year-old man is in the critical care unit after repair of an abdominal aortic aneurysm. His nasogastric tube has been removed, and he is eating a soft diet. He is now 4 days postoperative and is complaining of excruciating abdominal pain. After a meal he urgently asks for the bedpan and has a large, dark reddish stool. The most likely cause of these recent events is: A. stress ulcer. B. mesenteric infarction. C. hemorrhoids. D. bowel perforation. B Mesenteric ischemia and infarction are not uncommon after abdominal aortic aneurysm repair. They may be due to embolization or cross-clamping of the aorta above the mesenteric arteries. The primary clinical indications of mesenteric ischemia are abdominal pain and bloody diarrhea (i.e., currant-jelly diarrhea). Stress ulcer most likely would be located in the stomach or duodenum, and the stool would appear black. Hemorrhoids cause stool to be streaked with blood and/or toilet paper to be bloody. Bowel perforation causes the signs/symptoms of an acute abdomen: abdominal distention; rigid, boardlike abdomen; decreased bowel sounds; and rebound tenderness. A 16-year-old girl with a history of type 1 diabetes mellitus (DM) is admitted to the critical care unit. Her friend states that she has had a cold for the last few days. She is now lethargic. Diabetic ketoacidosis causes dehydration by: A. ketones causing diarrhea. B. ketones causing Kussmaul's respirations. C. glucose causing a diffusion diuresis. D. glucose causing an osmotic diuresis. D Remember that osmolality and osmotic pull are increased by the addition of solutes such as sodium or glucose. The high serum glucose in diabetic ketoacidosis causes an increase in osmotic pull in the renal tubules and an osmotic diuresis.