CCRN QUESTIONS
The nurse is caring for a patient with acute inferior wall MI, post-coronary artery stent
deployment, For optimal care of the patient, the nurse should: - ANSContinuously monitor
the patient in lead II
It is best practice to monitor the patient status post PCI with stent, in the lead that was most
abnormal during the acute occlusion.
The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the
patient closely for which of the following? - ANSComplication likely to occur after an acute
inferior wall MI include bradycardia secondary to ischemia to the SA and/or AV node, and
papillary muscle rupture or dysfunction due to the anatomical distance between the RCA and
the papillary muscle.
Which of the following hemodynamic profiles would benefit from the aggressive fluid
administration, pressers and antibiotics therapy?
a. RAP: 1mm Hg; PAOP: 4 mmHg; SVR: 1800 dynes/sec; CO: 2L/min
b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L - ANSB. the hemodynamic profile of RAP 5, PAOP
7, SVR 400 is typical of septic shock, and choice B would be the best approach.
Which of the following is indicative of a mixed acid-base disorder?
A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11
B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 - ANSThe decrease in PaCO2 is evidence of
respiratory alkalosis and the decreased HCO3 is evidenced of a metabolic acidosis. The pt
with severe sepsis or septic shock may present with this mixed acid-base disorder.
The patient with a temporary pacemaker develops pacemaker malfunction. The oriented is
instructed to reposition the patient to try and correct the problem. The cardiac monitor most
likely demonstrates? - ANSFailure to capture (pacemaker without a QRS) may be corrected
by repositioning the patient to the side.
The patient with diastolic heart develops SVT, heart rate 220/min. The most dangerous
hemodynamic effect is a decrease in: - ANScoronary artery perfusion.
Diastolic heart failure results in a problem with left ventricular FILLING secondary to
ventricular thickening, and contractility and ejection are maintained in diastolic failure. The
rapid heart rate will decrease filling time, worsen left ventricular filling and because coronary
artery perfusion occurs during diastole, this arrhythmia may be life-threatening.
The patient is receiving heparin infusion for the treatment of pulmonary embolism. There has
been a 60% decrease in the platelet count and no clinical change. Which of the following is
indicated? - ANSDiscontinue heparin and being argatroban.
,The patient most likely has HIT. Exposure to heparin needs to discontinued and a direct
thrombin inhibitor started for continued anticoagulation.
The patient with oat cell carcinoma has the following clinical findings: low urine output, low
serum osmolality, hyponatremia, and elevated urine sodium. The nurse anticipates which of
the following as part of the treatment plan? - ANSPhenytoin (Dilantin), 3% saline.
The patient has signs of SIADH which results in production of excessive ADH. Dilantin will
inhibit ADH secretion and 3% saline will increase serum sodium.
Peep therapy and mechanical ventilation are ordered for the patient with acute respiratory
failure. Which of the following is a possible complication? - ANSBarotrauma
The addition of positive end-expiratory pressure will increase alveolar recruitment, prevent
atelectasis and improve oxygenation. However, the increase in intrathoracic pressure may
lead to pneumothorax or subcutaneous emphysema.
The postoperative thoracic surgery patient has bubbling in the water seal drainage chamber of
the chest tube. Which of the following interventions is indicated? - ANSavoid high airway
pressures
Bubbling in the water seal chamber is due to a pleural air leak, and high airway pressure will
either prevent resolution of the current air leak or make it worse.
Which clinical sign might patients with both systolic and diastolic heart failure have in
common? - ANSLung crackles
Both a problem with systolic (ejection problem) and diastolic (filling problem) will increase
left heart pressure and cause cardiogenic pulmonary edema (lung crackles).
Which of the following is most likely to result in a low Sv02?
A. Hypotermia
B. Fever
C. Severe sepsis - ANSFever
Fever increases metabolic rate and consumption, which may lead to a drop in mixed venous
oxygen saturation.
The nurse needs to assess adequacy of the tubing/catheter system for the arterial line. Which
of the following interventions will best assess this? - ANSPerform a square wave test
The patient requires fluid resuscitation and 8 units of PRBC's status post traumatic injury.
Which of the following interventions is most appropriate? - ANSWarm blood products and
crystalloids
Warming fluids and blood needed for traumatic injury will prevent hypothermia and its
related adverse effects.
, Which of the following therapies should be avoided for the patient with cardiogenic shock? -
ANShigh dose vasopressors
Vasopressors increase left ventricular after load, which would increase myocardial work of a
failing heart.
The patient is status post repair of an aneurysm for subarachnoid hemorrhage. Which of the
following interventions is indicated to prevent vasospasm? - ANSNimodipine (Nimotop)
is a calcium channel blocker that is started immediately post-op to prevent arterial spasm of
the brain.
The patient presents with a rigid abdomen, rebound tenderness, and a free air in the
peritoneum seen on KUB x-ray. Which of the following should the nurse anticipate? -
ANSPowell perforation; provide fluids, prepare for surgery.
The clinical signs are those of bowel perforation.
Which is the priority treatment for the pt with DKA who presents with hyperglycemia,
ketosis, and normal serum potassium? - ANSreplace potassium
The patient with DKA will have a low pH and metabolic acidosis. In a state of metabolic
acidosis, hydrogen ions move into the intracellular space. In exchange, potassium leaves the
intracellular space. The movement of K into the extracellular space results in hyperkalemia.
Which of the following is a systemic effect of the therapeutic hypothermia during the cooling
phase? - ANSHyperglycemia secondary to insulin resistance.
During the cooling phase of clinical hypothermia there is typically insulin resistance.
Additionally, during the phase there is vasoconstriction, decreased neutrophil production and
during rewarming, rebound hyperkalemia may occur (not during the cooling phase).
The patient presented to the ED with a history of palpitations and dyspnea, persisting on and
off for one week. The heart monitor shows trail fibrillation with rapid ventricular response,
blood pressure 112/70. Treatment will most likely include: - ANSCCB and anticoagulation
The patient history seems to be one of intermittent atrail fibrillation over the past week.
Controlling rate and addressing potential left atrial clot formation are priority treatments.
Which of the following clinical findings would you expect to find in the patient with septic
shock? - ANSLactate 8, SvO2 85
Elevated lactate is evidence of anaerobic metabolism and elevated Sv02 is evidence of
decreased oxygen utilization at the cellular level - both definitive for septic shock.
The patient has a massive pulmonary embolism. Which of the following would be expected?
- ANSHypotension, increased alveolar dead space.
Massive pulmonary embolism results in sudden extremely elevated pulmonary pressures with
resultant right ventricular failure and decreased left ventricular pressure. The drop in CO
The nurse is caring for a patient with acute inferior wall MI, post-coronary artery stent
deployment, For optimal care of the patient, the nurse should: - ANSContinuously monitor
the patient in lead II
It is best practice to monitor the patient status post PCI with stent, in the lead that was most
abnormal during the acute occlusion.
The ECG demonstrates ST elevation in leads II, III and aVF. The nurse needs to monitor the
patient closely for which of the following? - ANSComplication likely to occur after an acute
inferior wall MI include bradycardia secondary to ischemia to the SA and/or AV node, and
papillary muscle rupture or dysfunction due to the anatomical distance between the RCA and
the papillary muscle.
Which of the following hemodynamic profiles would benefit from the aggressive fluid
administration, pressers and antibiotics therapy?
a. RAP: 1mm Hg; PAOP: 4 mmHg; SVR: 1800 dynes/sec; CO: 2L/min
b. RAP: 5; PAOP: 7; SVR: 400; CO; 8L - ANSB. the hemodynamic profile of RAP 5, PAOP
7, SVR 400 is typical of septic shock, and choice B would be the best approach.
Which of the following is indicative of a mixed acid-base disorder?
A. pH 7.18; PaCO2 25; PaO2 64; HCO3 11
B. pH 7.33; PaCO2 29; PaO2 72; HCO3 15 - ANSThe decrease in PaCO2 is evidence of
respiratory alkalosis and the decreased HCO3 is evidenced of a metabolic acidosis. The pt
with severe sepsis or septic shock may present with this mixed acid-base disorder.
The patient with a temporary pacemaker develops pacemaker malfunction. The oriented is
instructed to reposition the patient to try and correct the problem. The cardiac monitor most
likely demonstrates? - ANSFailure to capture (pacemaker without a QRS) may be corrected
by repositioning the patient to the side.
The patient with diastolic heart develops SVT, heart rate 220/min. The most dangerous
hemodynamic effect is a decrease in: - ANScoronary artery perfusion.
Diastolic heart failure results in a problem with left ventricular FILLING secondary to
ventricular thickening, and contractility and ejection are maintained in diastolic failure. The
rapid heart rate will decrease filling time, worsen left ventricular filling and because coronary
artery perfusion occurs during diastole, this arrhythmia may be life-threatening.
The patient is receiving heparin infusion for the treatment of pulmonary embolism. There has
been a 60% decrease in the platelet count and no clinical change. Which of the following is
indicated? - ANSDiscontinue heparin and being argatroban.
,The patient most likely has HIT. Exposure to heparin needs to discontinued and a direct
thrombin inhibitor started for continued anticoagulation.
The patient with oat cell carcinoma has the following clinical findings: low urine output, low
serum osmolality, hyponatremia, and elevated urine sodium. The nurse anticipates which of
the following as part of the treatment plan? - ANSPhenytoin (Dilantin), 3% saline.
The patient has signs of SIADH which results in production of excessive ADH. Dilantin will
inhibit ADH secretion and 3% saline will increase serum sodium.
Peep therapy and mechanical ventilation are ordered for the patient with acute respiratory
failure. Which of the following is a possible complication? - ANSBarotrauma
The addition of positive end-expiratory pressure will increase alveolar recruitment, prevent
atelectasis and improve oxygenation. However, the increase in intrathoracic pressure may
lead to pneumothorax or subcutaneous emphysema.
The postoperative thoracic surgery patient has bubbling in the water seal drainage chamber of
the chest tube. Which of the following interventions is indicated? - ANSavoid high airway
pressures
Bubbling in the water seal chamber is due to a pleural air leak, and high airway pressure will
either prevent resolution of the current air leak or make it worse.
Which clinical sign might patients with both systolic and diastolic heart failure have in
common? - ANSLung crackles
Both a problem with systolic (ejection problem) and diastolic (filling problem) will increase
left heart pressure and cause cardiogenic pulmonary edema (lung crackles).
Which of the following is most likely to result in a low Sv02?
A. Hypotermia
B. Fever
C. Severe sepsis - ANSFever
Fever increases metabolic rate and consumption, which may lead to a drop in mixed venous
oxygen saturation.
The nurse needs to assess adequacy of the tubing/catheter system for the arterial line. Which
of the following interventions will best assess this? - ANSPerform a square wave test
The patient requires fluid resuscitation and 8 units of PRBC's status post traumatic injury.
Which of the following interventions is most appropriate? - ANSWarm blood products and
crystalloids
Warming fluids and blood needed for traumatic injury will prevent hypothermia and its
related adverse effects.
, Which of the following therapies should be avoided for the patient with cardiogenic shock? -
ANShigh dose vasopressors
Vasopressors increase left ventricular after load, which would increase myocardial work of a
failing heart.
The patient is status post repair of an aneurysm for subarachnoid hemorrhage. Which of the
following interventions is indicated to prevent vasospasm? - ANSNimodipine (Nimotop)
is a calcium channel blocker that is started immediately post-op to prevent arterial spasm of
the brain.
The patient presents with a rigid abdomen, rebound tenderness, and a free air in the
peritoneum seen on KUB x-ray. Which of the following should the nurse anticipate? -
ANSPowell perforation; provide fluids, prepare for surgery.
The clinical signs are those of bowel perforation.
Which is the priority treatment for the pt with DKA who presents with hyperglycemia,
ketosis, and normal serum potassium? - ANSreplace potassium
The patient with DKA will have a low pH and metabolic acidosis. In a state of metabolic
acidosis, hydrogen ions move into the intracellular space. In exchange, potassium leaves the
intracellular space. The movement of K into the extracellular space results in hyperkalemia.
Which of the following is a systemic effect of the therapeutic hypothermia during the cooling
phase? - ANSHyperglycemia secondary to insulin resistance.
During the cooling phase of clinical hypothermia there is typically insulin resistance.
Additionally, during the phase there is vasoconstriction, decreased neutrophil production and
during rewarming, rebound hyperkalemia may occur (not during the cooling phase).
The patient presented to the ED with a history of palpitations and dyspnea, persisting on and
off for one week. The heart monitor shows trail fibrillation with rapid ventricular response,
blood pressure 112/70. Treatment will most likely include: - ANSCCB and anticoagulation
The patient history seems to be one of intermittent atrail fibrillation over the past week.
Controlling rate and addressing potential left atrial clot formation are priority treatments.
Which of the following clinical findings would you expect to find in the patient with septic
shock? - ANSLactate 8, SvO2 85
Elevated lactate is evidence of anaerobic metabolism and elevated Sv02 is evidence of
decreased oxygen utilization at the cellular level - both definitive for septic shock.
The patient has a massive pulmonary embolism. Which of the following would be expected?
- ANSHypotension, increased alveolar dead space.
Massive pulmonary embolism results in sudden extremely elevated pulmonary pressures with
resultant right ventricular failure and decreased left ventricular pressure. The drop in CO
