LATEST PASS CCRN 2025
ACTUAL EXAM WITH UPDATED
QUESTIONS & ACCURATE
ANSWERS GRADED A+
,A patient is started on nitroprusside, and his oxygen saturation by pulse oximetry decreases to
90%. Arterial blood gases are drawn, which show a PaO2 of 60 mm Hg and an arterial oxygen
saturation (SaO2) of 90%. What is the mechanism for this change?
A.
Methemoglobinemia
B.
Intrapulmonary shunt
C.
Thiocyanate toxicity
D.
Coronary artery steal - ANSWER✔✔: B. Intrapulmonary shunt
Intrapulmonary shunt occurs when perfusion exceeds ventilation. This can be due to decreased
ventilation relative to normal perfusion (e.g., acute respiratory distress syndrome) or normal
ventilation relative to increased perfusion (e.g., nitroprusside- induced intrapulmonary shunt).
A patient received Humulin NPH insulin at 7 am. He was nauseated and vomiting at lunchtime
and cannot tolerate PO. If this patient develops manifestations of hypoglycemia, treatment
would include:
A.
25 ml of 50% dextrose in water (D50W).
B.
glucagon subcutaneously.
C.
4 oz of apple juice.
D.
100 ml of 5% dextrose in water (D5W). - ANSWER✔✔: A. 25 ml of 50% dextrose in water
(D50W).
A volume of 25 ml of D50W would provide 12.5 g of carbohydrate and 50 calories.
A patient received one unit of packed cells. Which of the following would be the expected effects
of the transfusion?
A.
Increase in hemoglobin by 0.5 g/dl and increase in hematocrit by 2%
B.
Increase in hemoglobin by 0.5 g/dl and increase in platelets by 50,000/mm3
C.
Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3%
D.
Increase in hemoglobin by 1 g/dl and increase in platelets by 50,000/mm3 - ANSWER✔✔: C.
Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3%
One unit of packed red blood cells should increase the hemoglobin by 1 g/dl and hematocrit by
3% within approximately 4 to 6 hours. Red blood cells do not provide platelets.
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 - ANSWER✔✔: 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."
,A patient with acute kidney injury has the following arterial blood gas results: 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. - ANSWER✔✔: A. excrete acid by-products of metabolism.
The patient has a metabolic acidosis because the kidneys are unable to excrete the acid by-
products of cellular metabolism.
A patient with myasthenia gravis develops hypoxemia with hypercapnia. What is the cause of
hypoxemia in this patient?
A.
Alveolar hypoventilation
B.
Alveolar hyperventilation
C.
Diffusion defect
D.
Shunt - ANSWER✔✔: A. Alveolar hypoventilation
Alveolar hypoventilation causes hypoxemia and hypercapnia. Alveolar hyperventilation would
cause hypocapnia. Diffusion defect or shunt would cause hypoxemia with normal or decreased
PaCO2, depending on ventilation.
A sound occurring in early diastole caused by a rapid opening of a stenotic mitral valve is
which of the following?
A.
An S4
B.
A pansystolic murmur
C.
An ejection click
D.
An opening snap - ANSWER✔✔: D. An opening snap
A.
Decreased urine specific gravity
B.
Increased hematocrit
C.
Central venous pressure greater than 8 mm Hg
D.
Decreased systemic vascular resistance (SVR) - ANSWER✔✔: B. Increased hematocrit
The patient lost fluid, so the hematocrit would be increased because the blood is
hemoconcentrated. If the patient had lost blood, the hematocrit would be decreased.
According to the volume-pressure curve, initial small increases in intracranial volume in a
patient with no brain pathology would have which of the following effects on intracranial
pressure (ICP)?
, A.
No effect
B.
Small increase in ICP
C.
Moderate increase in ICP
D.
Profound increase in ICP - ANSWER✔✔: A. No effect
The brain is normally compliant and small increases in intracranial volume have no effect on
ICP. However, when the brain is injured and noncompliant, increases in volume result in
increases in pressure. As the end of the volume pressure-curve is approached, even small
increases in volume result in profound increase in ICP and resultant herniation.
Altering the pH of the gastric secretions through the use of H2 receptor antagonists, antacids,
and proton pump inhibitors contributes to which potential complication?
A.
Pulmonary embolism
B. Pneumonia
C.
Stress ulcer
D.
Acid-base imbalance - ANSWER✔✔: B. Pneumonia
Gastric colonization is likely with a gastric pH of greater than 4. Pneumonia rates of patients
receiving mechanical ventilation correlate directly with increased gastric pH levels. This is one
of the risks of the use of H2 receptor antagonists, antacids, and proton pump inhibitors to
prevent stress ulcers in intubated patients.
An elderly man is admitted after several days of nausea, vomiting, and diarrhea. Which of the
following would be most indicative of dehydration in this patient?
A.
Thirst, hypotension, bradycardia
B.
Hypotension, tachycardia, oliguria
C.
Thirst, tachycardia, dry mucous membranes
D.
Bradycardia, dry mucous membranes, oliguria - ANSWER✔✔: B. Hypotension, tachycardia,
oliguria
Tachycardia, hypotension, oliguria, dry mucous membranes, and poor skin turgor would all be
indications of dehydration. Even though thirst may be an indication of dehydration, it is
frequently not seen in elderly patients, which makes hypotension, tachycardia, oliguria
preferred over thirst, tachycardia, dry mucous membranes.
An elderly patient is admitted with pneumonia. This morning he is febrile, tachycardic,
tachypneic, and confused. He is started on norepinephrin. You would monitor him closely for
which of the following?
A.
Hypotension
B. Bradycardia
C. Bronchospasm
D.
Abdominal pain - ANSWER✔✔: D. Abdominal pain
Norepinephrine stimulates predominantly α receptors but also stimulates β receptors. Monitor
ACTUAL EXAM WITH UPDATED
QUESTIONS & ACCURATE
ANSWERS GRADED A+
,A patient is started on nitroprusside, and his oxygen saturation by pulse oximetry decreases to
90%. Arterial blood gases are drawn, which show a PaO2 of 60 mm Hg and an arterial oxygen
saturation (SaO2) of 90%. What is the mechanism for this change?
A.
Methemoglobinemia
B.
Intrapulmonary shunt
C.
Thiocyanate toxicity
D.
Coronary artery steal - ANSWER✔✔: B. Intrapulmonary shunt
Intrapulmonary shunt occurs when perfusion exceeds ventilation. This can be due to decreased
ventilation relative to normal perfusion (e.g., acute respiratory distress syndrome) or normal
ventilation relative to increased perfusion (e.g., nitroprusside- induced intrapulmonary shunt).
A patient received Humulin NPH insulin at 7 am. He was nauseated and vomiting at lunchtime
and cannot tolerate PO. If this patient develops manifestations of hypoglycemia, treatment
would include:
A.
25 ml of 50% dextrose in water (D50W).
B.
glucagon subcutaneously.
C.
4 oz of apple juice.
D.
100 ml of 5% dextrose in water (D5W). - ANSWER✔✔: A. 25 ml of 50% dextrose in water
(D50W).
A volume of 25 ml of D50W would provide 12.5 g of carbohydrate and 50 calories.
A patient received one unit of packed cells. Which of the following would be the expected effects
of the transfusion?
A.
Increase in hemoglobin by 0.5 g/dl and increase in hematocrit by 2%
B.
Increase in hemoglobin by 0.5 g/dl and increase in platelets by 50,000/mm3
C.
Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3%
D.
Increase in hemoglobin by 1 g/dl and increase in platelets by 50,000/mm3 - ANSWER✔✔: C.
Increase in hemoglobin by 1 g/dl and increase in hematocrit by 3%
One unit of packed red blood cells should increase the hemoglobin by 1 g/dl and hematocrit by
3% within approximately 4 to 6 hours. Red blood cells do not provide platelets.
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 - ANSWER✔✔: 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."
,A patient with acute kidney injury has the following arterial blood gas results: 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. - ANSWER✔✔: A. excrete acid by-products of metabolism.
The patient has a metabolic acidosis because the kidneys are unable to excrete the acid by-
products of cellular metabolism.
A patient with myasthenia gravis develops hypoxemia with hypercapnia. What is the cause of
hypoxemia in this patient?
A.
Alveolar hypoventilation
B.
Alveolar hyperventilation
C.
Diffusion defect
D.
Shunt - ANSWER✔✔: A. Alveolar hypoventilation
Alveolar hypoventilation causes hypoxemia and hypercapnia. Alveolar hyperventilation would
cause hypocapnia. Diffusion defect or shunt would cause hypoxemia with normal or decreased
PaCO2, depending on ventilation.
A sound occurring in early diastole caused by a rapid opening of a stenotic mitral valve is
which of the following?
A.
An S4
B.
A pansystolic murmur
C.
An ejection click
D.
An opening snap - ANSWER✔✔: D. An opening snap
A.
Decreased urine specific gravity
B.
Increased hematocrit
C.
Central venous pressure greater than 8 mm Hg
D.
Decreased systemic vascular resistance (SVR) - ANSWER✔✔: B. Increased hematocrit
The patient lost fluid, so the hematocrit would be increased because the blood is
hemoconcentrated. If the patient had lost blood, the hematocrit would be decreased.
According to the volume-pressure curve, initial small increases in intracranial volume in a
patient with no brain pathology would have which of the following effects on intracranial
pressure (ICP)?
, A.
No effect
B.
Small increase in ICP
C.
Moderate increase in ICP
D.
Profound increase in ICP - ANSWER✔✔: A. No effect
The brain is normally compliant and small increases in intracranial volume have no effect on
ICP. However, when the brain is injured and noncompliant, increases in volume result in
increases in pressure. As the end of the volume pressure-curve is approached, even small
increases in volume result in profound increase in ICP and resultant herniation.
Altering the pH of the gastric secretions through the use of H2 receptor antagonists, antacids,
and proton pump inhibitors contributes to which potential complication?
A.
Pulmonary embolism
B. Pneumonia
C.
Stress ulcer
D.
Acid-base imbalance - ANSWER✔✔: B. Pneumonia
Gastric colonization is likely with a gastric pH of greater than 4. Pneumonia rates of patients
receiving mechanical ventilation correlate directly with increased gastric pH levels. This is one
of the risks of the use of H2 receptor antagonists, antacids, and proton pump inhibitors to
prevent stress ulcers in intubated patients.
An elderly man is admitted after several days of nausea, vomiting, and diarrhea. Which of the
following would be most indicative of dehydration in this patient?
A.
Thirst, hypotension, bradycardia
B.
Hypotension, tachycardia, oliguria
C.
Thirst, tachycardia, dry mucous membranes
D.
Bradycardia, dry mucous membranes, oliguria - ANSWER✔✔: B. Hypotension, tachycardia,
oliguria
Tachycardia, hypotension, oliguria, dry mucous membranes, and poor skin turgor would all be
indications of dehydration. Even though thirst may be an indication of dehydration, it is
frequently not seen in elderly patients, which makes hypotension, tachycardia, oliguria
preferred over thirst, tachycardia, dry mucous membranes.
An elderly patient is admitted with pneumonia. This morning he is febrile, tachycardic,
tachypneic, and confused. He is started on norepinephrin. You would monitor him closely for
which of the following?
A.
Hypotension
B. Bradycardia
C. Bronchospasm
D.
Abdominal pain - ANSWER✔✔: D. Abdominal pain
Norepinephrine stimulates predominantly α receptors but also stimulates β receptors. Monitor
