CCRN QUESTIONS V1
1. A 30-year-old man is in the surgical intensive care unit after exploratory laparotomy
performed after he sustained a gunshot wound to the abdomen. He now has developed a
pancreatic fistula. Which acid-base imbalance is thispatient at risk for developing?
A.
Respiratory acidosis
B.
Metabolic acidosis
C.
Respiratory alkalosis
D.
Metabolic alkalosis: Metabolic acidosis
The stomach is acidic, but the gastrointestinal tract below the stomach is alkaline. Pancreatic
secretions are rich in bicarbonate, and these losses would cause metabolic acidosis.
2. A 65-year-old man was admitted 2 hours ago after coronary artery bypassgrafting. He has
had the following vital sign changes:
Admission 2 Hours Later
Blood pressure (mm Hg) 110/80 96/76Heart rate (per minute) 85 100
Right atrial pressure (RAP; mm Hg) 6 2
Pulmonary artery pressure (PAP; mm Hg) 24/12 18/6 Pulmonary artery occlusive pressure
(PAOP; mm Hg) 10 5Cardiac output (L/min) 6 4
Cardiac index (L/min/m2) 3.5 2.5
Systemic vascular resistance index (SVRI; dynes/sec/cm5) 1920 2590What is the most likely
cause of these changes?
A.
Stunned myocardium
B.
Blood loss
C.
Cardiac tamponadeD.
,Intraoperative myocardial infarction: Blood loss
Note that all of the volume indicators (RAP, PAP, PAOP) have decreased. The increase in SVRI
is compensatory and is caused by sympathetic nervous system stimulation. Stunned
myocardium and intraoperative myocardial infarction more likely would cause an increase in
PAOP because of heart failure. Cardiac tamponadewould cause an increase in RAP, PAP, and
PAOP.
3. Provision of adequate nutrition in a malnourished patient may cause se-vere deficiency of
which of the following electrolytes?
A.
Potassium
B.
Magnesium
C.
Calcium
D.
Phosphate: Phosphate
This often is called refeeding syndrome. Nutritional support allows the cells to beginmaking
more adenosine triphosphate (ATP), and phosphate supplies are depleted.The same thing
happens in diabetic ketoacidosis with treatment when insulin allowsglucose to move into the
cell increasing production of ATP and depletion of phosphate.
4. Which of the following would be a contraindication to the use of fibrinolyticdrugs, such as
recombinant tissue plasminogen activator?
A.
Hypotension
B.
Heart block
C.
Uncontrolled hypertension
D.
,Pain lasting more than 6 hours: Uncontrolled hypertension
Pain of more than 6 hours duration is no longer a contraindication to the use of fibrinolytic
drugs, although we certainly want to give fibrinolytic drugs as early as possible. Consider that
pain indicates the presence of lactic acid and anaerobic metabolism. If the myocardial
infarction is completed, there is no pain because dead myocardium does not metabolize
aerobically or anaerobically. As long as thereis pain, there is salvageable myocardium.
Hypotension and heart block are not contraindications to fibrinolytic drugs, and they may
improve with reperfusion of themyocardium. Uncontrolled hypertension increases the risk of
hemorrhagic stroke.
5. A 72-year-old woman arrives at the emergency department after becomingunresponsive
while watching television with her husband.The nurse observesparalysis of her right
extremities, aphasia, and lethargy. The patient receivesfibrinolytic therapy. After the patient is
stabilized, a diet is offered. The nurseknows that before the patient eats, it is crucial to check
which of the followingcranial nerves?
A.
IX, X
B.
I, II
C.
III, VI
D.
VIII, XI: IX, X
Cranial nerves IX and X control the gag and swallow response. These must be intactbilaterally to
protect the patient's airway.
glossopharngeal and vagus
6. A 23-year-old man is admitted via the emergency department after a mo-torcycle
collision. His Glasgow Coma Scale score was 12 in the emergencydepartment, and it is still
12 upon his admission to the neurologic intensivecare unit. Both eyes are ecchymotic and
swollen shut, and he has multiple abrasions on his face. Which of the following is the most
likely diagnosis?
A.
Linear skull fracture
, B.
Basal skull fracture
C.
Orbital fracture
D.
Mandibular fracture: Basal skull fracture
7. Which leads are most helpful in differentiating ventricular tachycardia froma
supraventricular tachycardia with aberrancy?
A.
Leads II and III
B.
Leads V1 and V6
C.
Leads I and aVL
D.
Leads V3 and V4: Leads V1 and V6
Looking at the heart from either side helps to identify whether the impulse originatedin one
ventricle or the other. Inferior, lateral, and anterior leads have a predominantlypositive QRS
complex because the wave of depolarization through the heart is downward and to the left.
Lead V1 is the single most helpful lead to differentiate ventricular ectopy from aberrancy.
Leads V1 and V6 together are the two most helpfulleads.
8. Which of the following describes the primary role of a case manager?
A.
Educator
B.
Evaluator
C.
Facilitator
1. A 30-year-old man is in the surgical intensive care unit after exploratory laparotomy
performed after he sustained a gunshot wound to the abdomen. He now has developed a
pancreatic fistula. Which acid-base imbalance is thispatient at risk for developing?
A.
Respiratory acidosis
B.
Metabolic acidosis
C.
Respiratory alkalosis
D.
Metabolic alkalosis: Metabolic acidosis
The stomach is acidic, but the gastrointestinal tract below the stomach is alkaline. Pancreatic
secretions are rich in bicarbonate, and these losses would cause metabolic acidosis.
2. A 65-year-old man was admitted 2 hours ago after coronary artery bypassgrafting. He has
had the following vital sign changes:
Admission 2 Hours Later
Blood pressure (mm Hg) 110/80 96/76Heart rate (per minute) 85 100
Right atrial pressure (RAP; mm Hg) 6 2
Pulmonary artery pressure (PAP; mm Hg) 24/12 18/6 Pulmonary artery occlusive pressure
(PAOP; mm Hg) 10 5Cardiac output (L/min) 6 4
Cardiac index (L/min/m2) 3.5 2.5
Systemic vascular resistance index (SVRI; dynes/sec/cm5) 1920 2590What is the most likely
cause of these changes?
A.
Stunned myocardium
B.
Blood loss
C.
Cardiac tamponadeD.
,Intraoperative myocardial infarction: Blood loss
Note that all of the volume indicators (RAP, PAP, PAOP) have decreased. The increase in SVRI
is compensatory and is caused by sympathetic nervous system stimulation. Stunned
myocardium and intraoperative myocardial infarction more likely would cause an increase in
PAOP because of heart failure. Cardiac tamponadewould cause an increase in RAP, PAP, and
PAOP.
3. Provision of adequate nutrition in a malnourished patient may cause se-vere deficiency of
which of the following electrolytes?
A.
Potassium
B.
Magnesium
C.
Calcium
D.
Phosphate: Phosphate
This often is called refeeding syndrome. Nutritional support allows the cells to beginmaking
more adenosine triphosphate (ATP), and phosphate supplies are depleted.The same thing
happens in diabetic ketoacidosis with treatment when insulin allowsglucose to move into the
cell increasing production of ATP and depletion of phosphate.
4. Which of the following would be a contraindication to the use of fibrinolyticdrugs, such as
recombinant tissue plasminogen activator?
A.
Hypotension
B.
Heart block
C.
Uncontrolled hypertension
D.
,Pain lasting more than 6 hours: Uncontrolled hypertension
Pain of more than 6 hours duration is no longer a contraindication to the use of fibrinolytic
drugs, although we certainly want to give fibrinolytic drugs as early as possible. Consider that
pain indicates the presence of lactic acid and anaerobic metabolism. If the myocardial
infarction is completed, there is no pain because dead myocardium does not metabolize
aerobically or anaerobically. As long as thereis pain, there is salvageable myocardium.
Hypotension and heart block are not contraindications to fibrinolytic drugs, and they may
improve with reperfusion of themyocardium. Uncontrolled hypertension increases the risk of
hemorrhagic stroke.
5. A 72-year-old woman arrives at the emergency department after becomingunresponsive
while watching television with her husband.The nurse observesparalysis of her right
extremities, aphasia, and lethargy. The patient receivesfibrinolytic therapy. After the patient is
stabilized, a diet is offered. The nurseknows that before the patient eats, it is crucial to check
which of the followingcranial nerves?
A.
IX, X
B.
I, II
C.
III, VI
D.
VIII, XI: IX, X
Cranial nerves IX and X control the gag and swallow response. These must be intactbilaterally to
protect the patient's airway.
glossopharngeal and vagus
6. A 23-year-old man is admitted via the emergency department after a mo-torcycle
collision. His Glasgow Coma Scale score was 12 in the emergencydepartment, and it is still
12 upon his admission to the neurologic intensivecare unit. Both eyes are ecchymotic and
swollen shut, and he has multiple abrasions on his face. Which of the following is the most
likely diagnosis?
A.
Linear skull fracture
, B.
Basal skull fracture
C.
Orbital fracture
D.
Mandibular fracture: Basal skull fracture
7. Which leads are most helpful in differentiating ventricular tachycardia froma
supraventricular tachycardia with aberrancy?
A.
Leads II and III
B.
Leads V1 and V6
C.
Leads I and aVL
D.
Leads V3 and V4: Leads V1 and V6
Looking at the heart from either side helps to identify whether the impulse originatedin one
ventricle or the other. Inferior, lateral, and anterior leads have a predominantlypositive QRS
complex because the wave of depolarization through the heart is downward and to the left.
Lead V1 is the single most helpful lead to differentiate ventricular ectopy from aberrancy.
Leads V1 and V6 together are the two most helpfulleads.
8. Which of the following describes the primary role of a case manager?
A.
Educator
B.
Evaluator
C.
Facilitator
