CCRN ADULT BOARD PRACTICE
QUESTIONS AND ANSWERS 2022/2023
UPDATE
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 - Answer 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 - Answer 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.
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 - Answer 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 - Answer 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 - Answer 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. - Answer 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. - Answer 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 - Answer 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?
QUESTIONS AND ANSWERS 2022/2023
UPDATE
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 - Answer 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 - Answer 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.
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 - Answer 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 - Answer 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 - Answer 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. - Answer 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. - Answer 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 - Answer 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?
