CCRN TEST BANK QUESTIONS
1. You have a 76-year-old patient that is on a norepinephrine gtt. You noticethe patient is
complaining of severe pain and that the area around her IV is becoming translucent, cool to
touch, and discolored. What stage is this andwhat medication should you administer to
prevent extravasation?
A.
Stage 1, phentolamine
B.
Stage 4, hyaluronidase
C.
Stage 4, phentolamine
D.
Stage 3, dexrazoxane: C. Stage 4, phentolamine
The patient is experiencing Stage 4 infiltration and is on a vasopressor gtt; therefore,
phentolamine is the drug of choice to counteracts the effects of infiltration/extravasation.
2. Which of the following solutions would be most appropriate for initial fluid resuscitation of
a patient with severe hypovolemia caused by several days ofdiarrhea and vomiting?
A.
An isotonic crystalloid
B.
A hypotonic crystalloid
C.
A hypertonic crystalloid
D.
A colloid: A. An isotonic crystalloid
In this situation, the intravascular and the interstitial spaces would be depleted. The priority is
the intravascular space, which would be replaced best with isotonic solution. Because isotonic
fluids equilibrate across all spaces, the interstitial spacealso would be replaced.
Consider: What did the patient lose? Crystalloid and electrolyte. Then ask: Which crystalloid
would replace the intravascular and interstitial spaces? An isotonic crystalloid. Electrolytes
would be added.
3. A 28-year-old man is admitted with bowel perforation. His blood pressureis 92/64 mm
Hg, heart rate is 116 beats/min and regular, respiratory rate is 22breaths/min and regular, and
urine output has only been 20 ml since being admitted 3 hours ago. Mucous membranes are
dry, and there is poor skin turgor. Based on this information, you would expect his pulmonary
artery occlusive pressure to be:
,A.
4 mm Hg.
B.
8 mm Hg.
C.
12 mm Hg.
D.
16 mm Hg.: A. 4 mm Hg.
This assessment reveals dehydration (hypotension, tachycardia, oliguria, dry mu- cous
membranes, and poor skin turgor). A pulmonary artery occlusive pressure (PAOP) of 4 mm
Hg would correlate with the physical assessment. Normal PAOP is12 to 15 mm Hg.
Clinical indications of dehydration are present in the case study. Choose the valuebelow
normal. Choose 4 mm Hg.
4. A patient with acute kidney injury has the following arterial blood gasresults:
pH7.32Paco235 mm HgHCO318 mEq/L
This acid-base imbalance is the result of the inability of the kidney to:
A.
excrete acid by-products of metabolism.
B.
excrete carbon dioxide.
C.
excrete bicarbonate ions.
D.
excrete calcium ions.: A. excrete acid by-products of metabolism.
The patient has a metabolic acidosis because the kidneys are unable to excrete theacid by-
products of cellular metabolism.
5. A 42-year-old woman is admitted with myasthenic crisis after a viral illness.Which of the
following are characteristics of myasthenia gravis?
A.
It causes muscle weakness and fatigability.
B.
It is associated with demyelination of peripheral nerve fibers.
C.
It affects the nerve roots.D.
,It may result in adrenergic crisis.: A. It causes muscle weakness and fatigability.
Myasthenia gravis is a disorder of voluntary muscles caused by a defect in nerve impulse
transmission at the neuromuscular junction. It causes muscle weaknessand fatigability.
6. A 42-year-old man is admitted to the critical care unit with smoke inhalationand acute
respiratory distress syndrome (ARDS). He is intubated, and the following mechanical
ventilation is initiated: fraction of inspired oxygen, 0.6;intermittent mandatory ventilation, 10
breaths/min; tidal volume, 450 ml; pos-itive end-expiratory pressure (PEEP), 15 cm H2O.
Arterial blood gases are pH,7.39; PaCO2, 42 mm Hg; HCO3, 24 mEq/L; and PaO2, 70 mm
Hg. The purposeof using PEEP in the treatment of this patient is which of the following?
A.
Increase pulmonary compliance.
B.
Decrease the chance of barotrauma.
C.
Increase alveolar surface tension.
D.
Decrease intrapulmonary shunt.: D. Decrease intrapulmonary shunt.
PEEP has three primary purposes: to increase the driving pressure of oxygen, to decrease
surface tension and the work of breathing, and to decrease shunt by reopening collapsed
alveoli. In ARDS, the purpose of PEEP is to open alveoli thathave collapsed (called alveolar
recruitment) and to keep alveoli open that are stillopen. The effect of this action is to decrease
intrapulmonary shunt.
7. Which ventilator mode requires close monitoring for auto-PEEP (positiveend-expiratory
pressure)?
A.
Intermittent mandatory ventilation
B.
Pressure support ventilation
C.
Pressure-controlled inverse ratio ventilation
D.
Pressure-regulated, volume-controlled ventilation: C. Pressure-controlled in-verse ratio
ventilation
Pressure-controlled inverse ratio ventilation, which flips the normal 2:1 inspira-
tion/expiration ratio to make inspiration longer than expiration, allows trapping of airin the
lungs. This inadvertent PEEP is called auto-PEEP.
8. Which of the following best differentiates hypovolemic from cardiogenicshock?
, A.
Increased systemic vascular resistance
B.
Decreased cardiac index
C.
Decreased urine output
D.
Decreased pulmonary artery occlusive pressure: D. Decreased pulmonaryartery occlusive
pressure
The cardiac index is decreased, the systemic vascular resistance is increased, and the urine
output is decreased in hypovolemic and cardiogenic shock. The pulmonary artery occlusive
pressure (PAOP) is decreased in hypovolemic shock but increasedin cardiogenic shock.
9. A patient develops carpopedal spasm and neuromuscular irritability manifested by
Chvostek and Trousseau signs. Which electrolyte imbalance shouldyou suspect?
A.
Hyperkalemia
B.
Hypercalcemia
C.
Hypermagnesemia
D.
Hyperphosphatemia: D. Hyperphosphatemia
The patient's signs/symptoms are associated with hypocalcemia and its reciprocal condition,
hyperphosphatemia. The same signs/symptoms also are seen in hypo-
magnesemia.
You probably immediately looked for hypocalcemia but could not find it among theoptions. To
answer this question correctly, you need to remember the reciprocal relationship between
calcium and phosphorus.
10. Which mode of mechanical ventilation requires the nurse to monitor close-ly for auto-PEEP
(positive end-expiratory pressure)?
A.
Inverse ratio ventilation
B.
Pressure support ventilation
C.
Intermittent mandatory ventilation
1. You have a 76-year-old patient that is on a norepinephrine gtt. You noticethe patient is
complaining of severe pain and that the area around her IV is becoming translucent, cool to
touch, and discolored. What stage is this andwhat medication should you administer to
prevent extravasation?
A.
Stage 1, phentolamine
B.
Stage 4, hyaluronidase
C.
Stage 4, phentolamine
D.
Stage 3, dexrazoxane: C. Stage 4, phentolamine
The patient is experiencing Stage 4 infiltration and is on a vasopressor gtt; therefore,
phentolamine is the drug of choice to counteracts the effects of infiltration/extravasation.
2. Which of the following solutions would be most appropriate for initial fluid resuscitation of
a patient with severe hypovolemia caused by several days ofdiarrhea and vomiting?
A.
An isotonic crystalloid
B.
A hypotonic crystalloid
C.
A hypertonic crystalloid
D.
A colloid: A. An isotonic crystalloid
In this situation, the intravascular and the interstitial spaces would be depleted. The priority is
the intravascular space, which would be replaced best with isotonic solution. Because isotonic
fluids equilibrate across all spaces, the interstitial spacealso would be replaced.
Consider: What did the patient lose? Crystalloid and electrolyte. Then ask: Which crystalloid
would replace the intravascular and interstitial spaces? An isotonic crystalloid. Electrolytes
would be added.
3. A 28-year-old man is admitted with bowel perforation. His blood pressureis 92/64 mm
Hg, heart rate is 116 beats/min and regular, respiratory rate is 22breaths/min and regular, and
urine output has only been 20 ml since being admitted 3 hours ago. Mucous membranes are
dry, and there is poor skin turgor. Based on this information, you would expect his pulmonary
artery occlusive pressure to be:
,A.
4 mm Hg.
B.
8 mm Hg.
C.
12 mm Hg.
D.
16 mm Hg.: A. 4 mm Hg.
This assessment reveals dehydration (hypotension, tachycardia, oliguria, dry mu- cous
membranes, and poor skin turgor). A pulmonary artery occlusive pressure (PAOP) of 4 mm
Hg would correlate with the physical assessment. Normal PAOP is12 to 15 mm Hg.
Clinical indications of dehydration are present in the case study. Choose the valuebelow
normal. Choose 4 mm Hg.
4. A patient with acute kidney injury has the following arterial blood gasresults:
pH7.32Paco235 mm HgHCO318 mEq/L
This acid-base imbalance is the result of the inability of the kidney to:
A.
excrete acid by-products of metabolism.
B.
excrete carbon dioxide.
C.
excrete bicarbonate ions.
D.
excrete calcium ions.: A. excrete acid by-products of metabolism.
The patient has a metabolic acidosis because the kidneys are unable to excrete theacid by-
products of cellular metabolism.
5. A 42-year-old woman is admitted with myasthenic crisis after a viral illness.Which of the
following are characteristics of myasthenia gravis?
A.
It causes muscle weakness and fatigability.
B.
It is associated with demyelination of peripheral nerve fibers.
C.
It affects the nerve roots.D.
,It may result in adrenergic crisis.: A. It causes muscle weakness and fatigability.
Myasthenia gravis is a disorder of voluntary muscles caused by a defect in nerve impulse
transmission at the neuromuscular junction. It causes muscle weaknessand fatigability.
6. A 42-year-old man is admitted to the critical care unit with smoke inhalationand acute
respiratory distress syndrome (ARDS). He is intubated, and the following mechanical
ventilation is initiated: fraction of inspired oxygen, 0.6;intermittent mandatory ventilation, 10
breaths/min; tidal volume, 450 ml; pos-itive end-expiratory pressure (PEEP), 15 cm H2O.
Arterial blood gases are pH,7.39; PaCO2, 42 mm Hg; HCO3, 24 mEq/L; and PaO2, 70 mm
Hg. The purposeof using PEEP in the treatment of this patient is which of the following?
A.
Increase pulmonary compliance.
B.
Decrease the chance of barotrauma.
C.
Increase alveolar surface tension.
D.
Decrease intrapulmonary shunt.: D. Decrease intrapulmonary shunt.
PEEP has three primary purposes: to increase the driving pressure of oxygen, to decrease
surface tension and the work of breathing, and to decrease shunt by reopening collapsed
alveoli. In ARDS, the purpose of PEEP is to open alveoli thathave collapsed (called alveolar
recruitment) and to keep alveoli open that are stillopen. The effect of this action is to decrease
intrapulmonary shunt.
7. Which ventilator mode requires close monitoring for auto-PEEP (positiveend-expiratory
pressure)?
A.
Intermittent mandatory ventilation
B.
Pressure support ventilation
C.
Pressure-controlled inverse ratio ventilation
D.
Pressure-regulated, volume-controlled ventilation: C. Pressure-controlled in-verse ratio
ventilation
Pressure-controlled inverse ratio ventilation, which flips the normal 2:1 inspira-
tion/expiration ratio to make inspiration longer than expiration, allows trapping of airin the
lungs. This inadvertent PEEP is called auto-PEEP.
8. Which of the following best differentiates hypovolemic from cardiogenicshock?
, A.
Increased systemic vascular resistance
B.
Decreased cardiac index
C.
Decreased urine output
D.
Decreased pulmonary artery occlusive pressure: D. Decreased pulmonaryartery occlusive
pressure
The cardiac index is decreased, the systemic vascular resistance is increased, and the urine
output is decreased in hypovolemic and cardiogenic shock. The pulmonary artery occlusive
pressure (PAOP) is decreased in hypovolemic shock but increasedin cardiogenic shock.
9. A patient develops carpopedal spasm and neuromuscular irritability manifested by
Chvostek and Trousseau signs. Which electrolyte imbalance shouldyou suspect?
A.
Hyperkalemia
B.
Hypercalcemia
C.
Hypermagnesemia
D.
Hyperphosphatemia: D. Hyperphosphatemia
The patient's signs/symptoms are associated with hypocalcemia and its reciprocal condition,
hyperphosphatemia. The same signs/symptoms also are seen in hypo-
magnesemia.
You probably immediately looked for hypocalcemia but could not find it among theoptions. To
answer this question correctly, you need to remember the reciprocal relationship between
calcium and phosphorus.
10. Which mode of mechanical ventilation requires the nurse to monitor close-ly for auto-PEEP
(positive end-expiratory pressure)?
A.
Inverse ratio ventilation
B.
Pressure support ventilation
C.
Intermittent mandatory ventilation
