(Solved with Rationales) Pass CCRN test bank.
Which of the following would be the earliest auscultatory finding in left ventricular failure
(LVF)?
A. Crackles
B. S3
C. Murmur of mitral regurgitation
D. Pericardial friction rub
B. S3
LVF would be the most subtle because early changes are usually subtle changes.
Choose "S3."
A patient with a triple-lumen subclavian catheter has been receiving total parenteral
nutrition, maintenance fluids, and antibiotics by the catheter. He has been slightly
confused. Suddenly he grasps the catheter and pulls it out. He then complains of
shortness of breath, and his pulse oximetry indicates an SpO2 of 84%. How should this
patient be positioned?
A. Head down, left side
B. Head down, right side
C. Head of bed elevated, left side
D. Head of bed elevated, right side
A. Head down, left side
Envision a big air bubble in the patient's heart. Think: what position would decrease the
movement of the air embolism out of the right side of the heart. Chose "Head down, left
side."
Oxygen delivery (DO2) is the product of which of the following?
A.
PaO2, hemoglobin, mean arterial pressure
B.
SaO2, hemoglobin, cardiac output
C.
SvO2, cardiac index, SaO2
D.
PaO2, mean arterial pressure, SvO2
B. SaO2, hemoglobin, cardiac output
Oxygen is delivered from the arterial end, so choose an option that has SaO2
Which of the following is the most significant complication of status asthmaticus?
,A.
Pulmonary embolism
B.
Acute respiratory failure
C.
Hypertension
D.
Anaphylaxis
B. Acute respiratory failure
A 22-year-old man is admitted to the critical care unit after a motor vehicle collision. The
emergency department nurse reports that he was unconscious at the scene of the
accident, but he is now alert and oriented. Skull films show a linear fracture of the right
temporal bone. He is at significant risk for:
A.
scalp hematoma.
B.
subdural hematoma.
C.
epidural hematoma.
D.
intracerebral hematoma.
C. epidural hematoma.
Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and
cause epidural hematoma. Patients with an epidural hematoma classically present with
a short period of unconsciousness followed by a lucid interval and then rapid
deterioration. An epidural hematoma is usually caused by arterial bleeding.
A patient is admitted to the ICU after sustaining a concussion and blunt abdominal
trauma to the right upper quadrant in a domestic dispute. The patient's vital signs are
BP 145/86 mm Hg, pulse 86 beats/min, respiration 15 breaths/min, and temperature
98.8° F. The nurse is monitoring the patient's bowel sounds, abdominal tenderness, and
abdominal girth frequently. Which of the following laboratory parameters is especially
important for the nurse to closely monitor for bleeding in this patient?
A.
Platelet count
B.
Protime
C.
Hematocrit
D.
Mean corpuscular volume
C. Hematocrit
Common injuries resulting from blunt abdominal trauma can include injury to the liver,
,spleen, mesenteric vessels, pancreas, or kidneys. In a nonoperative approach to blunt
abdominal trauma, observation and monitoring include serial hematocrits to evaluate for
intra-abdominal bleeding. The platelet count does not fluctuate unless there is a disease
process (e.g. cirrhosis, leukemia) or significant blood loss. Protime is a monitor of
coagulation status and can be prolonged without active bleeding. Mean corpuscular
volume measures the average volume or size of a single RBC and is used in classifying
anemias.
Which of the following is associated with chest pain, confusion, and petechiae?
A.
Dissecting aneurysm
B.
Fat embolism
C.
Pneumothorax
D.
Myocardial infarction
B. Fat embolism
Chest pain, confusion, and petechiae are suggestive of a fat embolism, especially within
the first 48 to 72 hours after a long-bone fracture.
The clincher is the petechiae. None of the other choices would cause petechiae.
Which type of shock is most likely to be iatrogenic?
A.
Hypovolemic
B.
Cardiogenic
C.
Septic
D.
Neurogenic
C. Septic
Iatrogenic means caused by treatment or diagnostic procedures or medically induced.
Septic shock is the type of shock most likely to be iatrogenic. Significant contributors
include immunosuppressive medications and therapies and invasive procedures.
A patient had a craniotomy 2 days ago for removal of a tumor. He is awake and talking
to the nurse and demonstrates no neurologic deficit. Blood pressure is 110/80 mm Hg,
pulse is 92 beats/min, and respiratory rate is 22 breaths/min. Urine outputs have been
approximately 60 ml/hr over the last 2 days, but he has had a recent change. He has
had 300 to 400 ml/hr of urine output over the last several hours. The urine has a specific
gravity of 1.002. The nurse checks his serum glucose and finds that it is 100 mg/dl. The
cause of hypernatremia in this patient is:
, A.
sodium retention.
B.
water loss.
C.
water gain.
D.
aldosterone excess.
B. water loss
This case is an example of diabetes insipidus, which is caused by a lack of antidiuretic
hormone (ADH). ADH causes water retention in the renal tubules but not sodium
retention, so eliminate sodium retention. A lack of ADH causes water loss not water
gain, so eliminate water gain. Diabetes insipidus does not have anything to do with
aldosterone. The hypernatremia is a concentration effect caused by water loss. This
sometimes is called hypovolemic hypernatremia.
A patient is admitted with unstable angina. He has a long history of hypertension and
coronary artery disease. The nurse notes a split S2on expiration and a single S2 on
inspiration during cardiac auscultation. Blood pressure is 150/88 mm Hg, and heart rate
is 88 beats/min. On the electrocardiogram, there is a normal-appearing P wave in front
of each QRS complex, the PR interval measures 0.2 second consistently, and the QRS
complexes measure 0.14 second. They are positive in V5 and V6 and negative in V1
and V2. These findings most likely indicate which of the following?
A.
Left bundle branch block (LBBB)
B.
Right bundle branch block (RBBB)
C.
Third-degree atrioventricular block
D.
Ventricular tachycardia
A. Left bundle branch block (LBBB)
Features of LBBB described here are a QRS complex greater than 0.12 second in
duration and a QRS complex that is positive in leads V5 and V6 (consider these left
ventricular leads) and negative in leads V1 and V2 (consider these right ventricular
leads). LBBB causes a paradoxical splitting of S2. This means that it is split on
expiration but not on inspiration. This is paradoxical because it is opposite of a normal
physiologic split of S2, which is split on inspiration but not split on expiration
Which of the following is not an indication for mechanical ventilation in patients with
asthma?
A.
Respiratory alkalosis
Which of the following would be the earliest auscultatory finding in left ventricular failure
(LVF)?
A. Crackles
B. S3
C. Murmur of mitral regurgitation
D. Pericardial friction rub
B. S3
LVF would be the most subtle because early changes are usually subtle changes.
Choose "S3."
A patient with a triple-lumen subclavian catheter has been receiving total parenteral
nutrition, maintenance fluids, and antibiotics by the catheter. He has been slightly
confused. Suddenly he grasps the catheter and pulls it out. He then complains of
shortness of breath, and his pulse oximetry indicates an SpO2 of 84%. How should this
patient be positioned?
A. Head down, left side
B. Head down, right side
C. Head of bed elevated, left side
D. Head of bed elevated, right side
A. Head down, left side
Envision a big air bubble in the patient's heart. Think: what position would decrease the
movement of the air embolism out of the right side of the heart. Chose "Head down, left
side."
Oxygen delivery (DO2) is the product of which of the following?
A.
PaO2, hemoglobin, mean arterial pressure
B.
SaO2, hemoglobin, cardiac output
C.
SvO2, cardiac index, SaO2
D.
PaO2, mean arterial pressure, SvO2
B. SaO2, hemoglobin, cardiac output
Oxygen is delivered from the arterial end, so choose an option that has SaO2
Which of the following is the most significant complication of status asthmaticus?
,A.
Pulmonary embolism
B.
Acute respiratory failure
C.
Hypertension
D.
Anaphylaxis
B. Acute respiratory failure
A 22-year-old man is admitted to the critical care unit after a motor vehicle collision. The
emergency department nurse reports that he was unconscious at the scene of the
accident, but he is now alert and oriented. Skull films show a linear fracture of the right
temporal bone. He is at significant risk for:
A.
scalp hematoma.
B.
subdural hematoma.
C.
epidural hematoma.
D.
intracerebral hematoma.
C. epidural hematoma.
Linear fractures of the temporal bone frequently disrupt the middle meningeal artery and
cause epidural hematoma. Patients with an epidural hematoma classically present with
a short period of unconsciousness followed by a lucid interval and then rapid
deterioration. An epidural hematoma is usually caused by arterial bleeding.
A patient is admitted to the ICU after sustaining a concussion and blunt abdominal
trauma to the right upper quadrant in a domestic dispute. The patient's vital signs are
BP 145/86 mm Hg, pulse 86 beats/min, respiration 15 breaths/min, and temperature
98.8° F. The nurse is monitoring the patient's bowel sounds, abdominal tenderness, and
abdominal girth frequently. Which of the following laboratory parameters is especially
important for the nurse to closely monitor for bleeding in this patient?
A.
Platelet count
B.
Protime
C.
Hematocrit
D.
Mean corpuscular volume
C. Hematocrit
Common injuries resulting from blunt abdominal trauma can include injury to the liver,
,spleen, mesenteric vessels, pancreas, or kidneys. In a nonoperative approach to blunt
abdominal trauma, observation and monitoring include serial hematocrits to evaluate for
intra-abdominal bleeding. The platelet count does not fluctuate unless there is a disease
process (e.g. cirrhosis, leukemia) or significant blood loss. Protime is a monitor of
coagulation status and can be prolonged without active bleeding. Mean corpuscular
volume measures the average volume or size of a single RBC and is used in classifying
anemias.
Which of the following is associated with chest pain, confusion, and petechiae?
A.
Dissecting aneurysm
B.
Fat embolism
C.
Pneumothorax
D.
Myocardial infarction
B. Fat embolism
Chest pain, confusion, and petechiae are suggestive of a fat embolism, especially within
the first 48 to 72 hours after a long-bone fracture.
The clincher is the petechiae. None of the other choices would cause petechiae.
Which type of shock is most likely to be iatrogenic?
A.
Hypovolemic
B.
Cardiogenic
C.
Septic
D.
Neurogenic
C. Septic
Iatrogenic means caused by treatment or diagnostic procedures or medically induced.
Septic shock is the type of shock most likely to be iatrogenic. Significant contributors
include immunosuppressive medications and therapies and invasive procedures.
A patient had a craniotomy 2 days ago for removal of a tumor. He is awake and talking
to the nurse and demonstrates no neurologic deficit. Blood pressure is 110/80 mm Hg,
pulse is 92 beats/min, and respiratory rate is 22 breaths/min. Urine outputs have been
approximately 60 ml/hr over the last 2 days, but he has had a recent change. He has
had 300 to 400 ml/hr of urine output over the last several hours. The urine has a specific
gravity of 1.002. The nurse checks his serum glucose and finds that it is 100 mg/dl. The
cause of hypernatremia in this patient is:
, A.
sodium retention.
B.
water loss.
C.
water gain.
D.
aldosterone excess.
B. water loss
This case is an example of diabetes insipidus, which is caused by a lack of antidiuretic
hormone (ADH). ADH causes water retention in the renal tubules but not sodium
retention, so eliminate sodium retention. A lack of ADH causes water loss not water
gain, so eliminate water gain. Diabetes insipidus does not have anything to do with
aldosterone. The hypernatremia is a concentration effect caused by water loss. This
sometimes is called hypovolemic hypernatremia.
A patient is admitted with unstable angina. He has a long history of hypertension and
coronary artery disease. The nurse notes a split S2on expiration and a single S2 on
inspiration during cardiac auscultation. Blood pressure is 150/88 mm Hg, and heart rate
is 88 beats/min. On the electrocardiogram, there is a normal-appearing P wave in front
of each QRS complex, the PR interval measures 0.2 second consistently, and the QRS
complexes measure 0.14 second. They are positive in V5 and V6 and negative in V1
and V2. These findings most likely indicate which of the following?
A.
Left bundle branch block (LBBB)
B.
Right bundle branch block (RBBB)
C.
Third-degree atrioventricular block
D.
Ventricular tachycardia
A. Left bundle branch block (LBBB)
Features of LBBB described here are a QRS complex greater than 0.12 second in
duration and a QRS complex that is positive in leads V5 and V6 (consider these left
ventricular leads) and negative in leads V1 and V2 (consider these right ventricular
leads). LBBB causes a paradoxical splitting of S2. This means that it is split on
expiration but not on inspiration. This is paradoxical because it is opposite of a normal
physiologic split of S2, which is split on inspiration but not split on expiration
Which of the following is not an indication for mechanical ventilation in patients with
asthma?
A.
Respiratory alkalosis
