DEH 2300 : CCRN-PCCN Review Study Guide. Questions and Answers. Rationales Provided.

DEH 2300 : CCRN-PCCN Review Study Guide. Questions and Answers. Rationales Provided. CCRN-PCCN Review: Questions, Answers, Rationale & Strategies Synergy 1. After cardiac surgery, a patient who is a Jehovah’s Witness had an HCT of 18% and accumulated chest-tube drainage of 1800cc in the first 3 hours. The most appropriate action would be to: A. Begin continuous-circuit autotransfusion B. Administer donated directed PRBCs C. Administer donated autologous whole blood D. Administer 500cc of albumin 2. An alert patient is emergently intubated during an episode of pulmonary edema. When family members come to visit the patient, they cry out, “Talk to me; talk to me!” The nurse should tell the family that: A. They must not excite the patient while visiting B. Communication is not a priority at this time C. The patient is too exhausted to converse with them D. The breathing tube temporarily prevents the patient from speaking Cardiac 3. The heart sound most often associated with heart failure is: A. An S3 B. A pericardial friction rub C. An S4 D. A systolic ejection murmur 4. A patient is admitted with acute decompensated heart failure. The physician orders that the patient receive nesiritide (Natrecor) for volume overload refractory to loop diuretics. The nurse would closely monitor the patient for which side effect of nesiritide? A. Hypokalemia B. Hypotension C. Ventricular dysrhythmia D. Nausea/vomiting 5. The nurse should be alert for complications associated with embolic phenomena in which group of patients regardless of their disease stage? A. Patients with dilated cardiomyopathy B. Patients with hypertrophic cardiomyopathy C. Patients with restrictive cardiomyopathy D. Patients with myocarditis 6. Which of the following physiologic changes occurs as direct result of cardiogenic shock? A. Increase in capacitance B. Increase in afterload C. Decrease in preload D. Decrease in SVR Pulmonary 7. A young patient is admitted to the ICU after a motorcycle accident involving the center median of the freeway in which she sustained blunt head and chest trauma. Within minutes of arrival on the unit, the patient complains of dysphasia and is coughing. She develops upper airway obstruction unrelieved by oxygen, becomes cyanotic, and has palpable subcutaneous emphysema near the sternal notch. For which of the following interventions should the nurse prepare? A. Intubation and mechanical ventilation B. Fiberoptic bronchoscopy C. Emergent tracheostomy D. Initiation of cardiac compressions for CPR 8. The nurse maintains an adequate water level in the water-seal chamber of a chest tube drainage system because the waterseal: A. Controls the suction level of the chest tube system B. Controls the rate of drainage from the pleural cavity C. Prevents air and pleural fluid from reentering the pleural cavity D. Determines the amount of drainage from the pleural cavity Neuro 9. Anna is an ICU patient with new-onset grand mal seizures. While at her bedside, you witness a seizure. What should your first action be? A. Hit the Code Blue Button B. Hold the patient down to prevent injury C. Insert an oral airway and call for help D. Roll Anna to her right side and protect the airway 10. Jason M., an 80 year old African American male, as had a left temporal cerebral vascular accident due to uncontrolled hypertension. As the critical care nurse you know Jason is likely to have which of the following deficits? A. Receptive Aphasia B. Motor Deficits C. Balance deficits D. Expressive Aphasia GI 11. Mr. Smith, is a 46 year old male who is frequently admitted to your ICU and step down for alcohol withdrawal syndrome. Most recently he spent the last week in the ICU for alcoholinduced coma and was transferred to Medical Step Down 2 days ago. Just prior to being transferred to GMF, Mr. Smith begins projectile vomiting bright red blood. As the critical care step down nurse you should: A. Position the patient flat to facilitate intubation, call RRT and get a set of vital signs B. Obtain and insert a Linton-NachlasTube for balloon tamponade and call RRT. C. Start dopamine at 5mcg/kg/min in anticipation of hypotension secondary to the bleeding and call RRT D. Protect Airway with Aspiration Precautions/HOB 30 degrees, verify IV access, get vital signs and call RRT. 12. Liam, a 45 year old alcoholic with chronic pancreatitis, develops respiratory distress with dyspnea and pulmonary edema. These symptoms are due to which of the following? A. Bronchospasm related to stress B. Aspiration C. Pulmonary capillary endothelial damage related to release of phospholipase A2, a digestive enzyme D. Atelectasis . Renal 13. You, the critical care RN, are preparing Laura for her first peritoneal dialysis session. It is important to tell her which of the following findings is normal?l A. During the instillation phase, the insertion site may leak B. During the dwell phase, you may feel abdominal fullness and shortness of breath C. During the dwell phase, subcutaneous fluid may be seen in the groin D. During the drain phase, you may feel dizzy and have palpitations 14. Eve is undergoing hemodialysis for renal failure as a result of uncontrolled Type I Juvenile Diabetes. Her mother asks you, the critical care RN, how do you know that the dialysis is effective. Adequacy of hemodialysis is measured by which of the following? A. Urine Creatinine clearance B. Sodium, Chloride and potassium levels C. Blood Pressure D. Urea Clearance Endocrine 15. Mr. Johnny Appleseed has been admitted to your critical care unit with DKA. His serum glucose was initially 675 and his K+ = 6.0. His insulin drip is currently at 5 units/hour and NSS is at 200 ml/hr. Mr. A’s most recent FSBG = 275 and his anion gap = 25. Which changes in his care you would anticipate? A. Change the IV fluids to D5NS, continue the insulin drip, and continue FSBG every one hour and recheck BMP every 4 hours B. Change the IV fluids to D5W, continue the insulin drip, continue FSBG every one hour and give Kayexylate to lower the K+ C. Discontinue the insulin drip and change FSBG to every 4 hours D. No changes in therapy; continue as is 16.