CCRN PRACTICE QUESTIONS WITH 100% PRECISE ANSWERS AND RATIONALES GRADED A+ 2024 UPDATED( A, Exams of Nursing

Download CCRN PRACTICE QUESTIONS WITH 100% PRECISE ANSWERS AND RATIONALES GRADED A+ 2024 UPDATED( A and more Exams Nursing in PDF only on Docsity! CCRN PRACTICE QUESTIONS WITH 100% PRECISE ANSWERS AND RATIONALES GRADED A+ 2024 UPDATED( ACTUAL EXAM). A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and complains of a headache and nausea. He reports he ran out of blood pressure meds three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach? - Precise answer Rapidly lower the diastolic pressure to 100 with IV antihypertensive meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive meds. The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure. A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this intervention is having it's intended effect? - Precise answer ScvO2 of 72% Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%, and urine output greater than 0.5 kg/hr 72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet count decreased significantly to 43,000 and was found to have new DVT on his right upper extremity. What do you suspect is the most likely cause of these findings? - Precise answer HIT The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period (>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new development of DVT despite being on VTE prophylaxis. TRALI: - Precise answer is a complication from a blood transfusion reaction, which causes acute lung injury typically within 6 hours of a blood transfusion. 2 Hallmark signs of HIT: - Precise answer Decrease in platelet count over a 24 hr period. New development of DVT despite being on VTE prophylaxis. Values in Early compensated Hypovolemic shock? - Precise answer CO 4.0 L/min, HR 135, SV 65, SVR 1700, MAP 65 In hypovolemic states, circulating volume is depleted therefore preload and contractility are decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure to preserve CO, MAP and cerebral perfusion. Post-renal failure values: - Precise answer Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1.010 BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is typically 1-40 mEq/L. What to do in the event of HIT: - Precise answer Stop Heparin and administer an alternative direct thrombin inhibitor. Warfarin is contraindicated in HIT? T/F - Precise answer True - there is also no evidence that shows protamine, corticosteroids, and benadryl are effective treatments for HIT Patients with right ventricular infarctions become preload dependent. Meds that decrease preload should be avoided - which meds are these? - Precise answer Morphine, Nitro, Beta blockers and diuretics. Polymorphic ventricular tachycardia aka Torsades is treated by? - Precise answer Magnesium A person with disecting AAA would receive what drug? - Precise answer PRN IV narcotic analgesia - BP management is a priority in the care of a patient with a dissecting AAA. Pain is the primary driver of HTN. Autonomic hyperreflexia is what? - Precise answer This disorder is seen with spinal injuries occurring above the T6 spine. Cause of autonomic hyperreflexia? - Precise answer Bladder obstruction, constipation, pressure ulcers, and pain. Usually when the noxious stimulus is identified and removed, the symptoms resolve. Checking urinary catheter for obstruction is the most appropriate next action. MEDS for asymptomatic left ventricular systolic dysfunction? - Precise answer ACE or (ARB), beta-blockers and statins for all patients with a history of MI and for all patients with a reduced ejection fraction. What is the Z point technique? - Precise answer is a method used to estimate ventricular end diastolic pressure. It is taken just before the closure of the mitral valve and is especially useful when an A wave does not exist on the PAOP tracing such as in atrial fib. Ascites position for relief? - Precise answer Place pt on left side. DIC lab values? - Precise answer Fibrinogen decreased FSP elevated Platelets decreased D-dimer elevated Decreased Albumin is an indicator of what? - Precise answer Protein deficiency and poor nutrition, which are major contributors to poor wound healing. A continous infusion of Lorazepam for greater than 3 days can lead to an accumulation of? - Precise answer Propylene glycol. Inability to communicate in full sentences may be a sign of what? - Precise answer Severity of asthma (high risk) Management of high ICP includes? - Precise answer Osmotic diuretics, hypertonic saline & antihypertensives. Causes increased left atrial pressure during atrial contraction - results in a larger than normal A wave on the PAOP tracing? - Precise answer Mitral Stenosis Pulmonary htn will result in elevated PA pressures but have no impact on? - Precise answer PAOP Elevated urine osmolality; decreased serum osmolality; decreased serum sodium? - Precise answer SIADH Absolute contraindication for thrombolytic therapy? - Precise answer Aortic dissection Crackles in bilateral lower lobes and a s3 heart sounds are indicative of what? Tx? - Precise answer Fluid overload Furosemide 40 mg IV x 1 now Narrow pulse pressure - CO 3L/min, HR 135, SV 30, SVR 2100 are all signs of what? - Precise answer Cardiogenic shock HUS is marked by what? - Precise answer Renal failure Thrombocytopenia & hemolytic anemia DIC lab values? - Precise answer Decreased Fibrinogen FSP elevated Platelets decreased D-dimer elevated HOB position for ICP? Other tx? - Precise answer 45 degrees Increase sedation or mannitol as prescribed. Opening the Ventriculostomy drain requires specific orders? - Precise answer True Brain death criteria? - Precise answer Positive Apnea test Absent Oculovestibular and Oculocephalic reflex Respiratory acidosis ST elevation is indicative of what? - Precise answer Cardiac ischemia and should be treated as myocardial infarction CDC indications for urinary catheter include: - Precise answer end-of-life care, strict I&O, immobility, select surgical procedures, sacral wounds, urinary retention/obstruction A saddle embolus is life threatening and requires which immediate intervention? - Precise answer IV thrombolytic for clot lysis. Subcutaneous and IV heparin inhibit thrombus growth and promote resolution of the formed clot, but will treat the a saddle pulmonary embolus. Indiscrimate pacing spikes indicate that the pacer is not what? - Precise answer Not sensing or seeing the cardiac activity present. Sensitivity should be decreased. A sudden increase in left atrial diastolic pressure will result in? - Precise answer Mitral regurgitation Late stages of shock results in what lab values? - Precise answer Increased Potassium Decreased Bicarbonate Increased Lactic acid Ominous sign of acute asthma exacerbation: - Precise answer Hypercapnia or elevated PaCO2 indicates patient is becoming fatigued and going into acute respiratory failure. Nephrogenic DI would cause what? - Precise answer the kidneys not respond to ADH Lactated ringers at 100ml hr before and after procedure is often prescribed to prevent what? - Precise answer Contrast induced nephropathy Keeping the TV (tidal volume) low is the best way to decrease pressures and avoid what? - Precise answer Barometric trauma in ARDS Which of the following parameters most accurately estimates end-organ perfusion? - Precise answer Urinary output, lactate, ScvO2 Aortic stenosis cause increased noise during systole and impaired outflow, leading to: - Precise answer Pulmonary edema and crackles. Tx for neurogenic shock? - Precise answer Vasoconstrictor (phenylephrine) over large volume of fluid resuscitation Liver failure labs: - Precise answer Elevated bilirubin Decreased albumin elevated PTT, PT & INR When the liver fails: - Precise answer ammonia levels build causing encephalopathy. Bilirubin levels rise causing jaundice and coagulation times often prolong putting patient at risk for bleeding. Patients with HIT may develop: - Precise answer Thrombosis, DVT, PE, STROKE, MI, Renal impairment Vancomycin has a risk of nephrotoxicity and RN should monitor which lab value: - Precise answer Elevated serum creatinine Cerebral insults include: - Precise answer ipsilateral pupil changes and contralateral motor extremity changes. Diuretic phase of ATN would include which lab value: - Precise answer Decreased urine osmolality Kernig's sign is indicative of: - Precise answer Meningitis - pt cannot extend the knee when the hip is flexed. DKA patients have a profound decrease in what: - Precise answer Fluids Pancreatitis leads to what? - Precise answer ARDS, DIC, hypovolemic shock Glycopyrrolate is part of medical mgmnt for: - Precise answer Respiratory failure in patient with chronic pulmonary dz. Thrombolytic therapy using rtPA is most common tx for: - Precise answer ischemic stroke Inclusion criteria for thrombolytic therapy: - Precise answer over the age of 18 less than 3 hours of onset CT scan verifying ischemic stroke Exclusion criteria for thrombolytic therapy: - Precise answer Seizure activity with onset stroke symptoms major surgery or trauma past 3months Adverse effects of Increasing PEEP causes: - Precise answer Hypotension Inattention, alterations in perception, disorganized thinking and memory impairment: - Precise answer Delirium An elevated Lactate level would include which tx: - Precise answer Central line and additional IV fluids ARDS defined as: - Precise answer PaO2/FiO2 less than or equal to 300 with bilateral infiltrates on chest X-ray and refractory hypoxemia. P/F ratio less than 100: - Precise answer Severe ARDS a STAT CT is first priority to dx what: - Precise answer Hemorrhagic or ischemic event When P2 component is greater than the P1 indicates: - Precise answer Poor brain compliance Venous Pulmonary HTN results from: - Precise answer Left - sided heart fx and ineffective pumping of blood. Pulmonary arterial HTN results from: - Precise answer Vasoconstriction of vasculature leading to and within the lungs Management of Pancreatitis: - Precise answer Preventing hypoxemia, resting pancreas, pain mgmnt, volume resuscitation. Inner layer of the heart muscle, between the endocardium? - Precise answer Myocardium Higher cognitive functions (Impulsivity) and personality are controlled by what part of the brain: - Precise answer Frontal lobe tachycardia, tachypnea, and left shoulder pain indicates possible what: - Precise answer Anastomotic leak Intubation: FiO2 < 60% Maintain plateau pressures <30 Maintain Tidal volume < 8 - Precise answer Goals for ventilated pts. Position with the HOB 30 degrees with midline neck alignment: - Precise answer First line therapy for optimizing cerebral perfusion. Is Serum osmolality elevated or decreased in DI? - Precise answer Elevated due to volume loss - the urine will be dilute (decreased urine osmo) and hemoconcentration with increased sodium levels. Beta Blockers, ACE, & Aldosterone antagonists are used for: - Precise answer Heart failure pts. evaluates the effectiveness of this intervention? - Precise answer Decreased PAP Which of following is recommended to prevent shivering during induction and the maintenance phase in therapeutic hypothermia? - Precise answer Blow warm air across the face or body The pt is placed on CRRT - The nurse know which is a priority when receiving CRRT? - Precise answer Frequent electrolyte monitoring to minimize electrolyte shifts 78 yr old female fell at home 1 wk ago. She has been on Coumadin for A- fib for over 1 year. She presents with a complaint of headache. Her family states: "Mom has been acting weird for the past couple days." Scenario is consistent with? - Precise answer Subdural hematoma A subdural bleed is usually a slow accumulating, venous bleed. Abnormal neuro changes may not be seen for days or weeks. Epidural hematoma? - Precise answer May bleed and accumulate rapidly since they result from arterial bleeding. Cerebral Aneurysm rupture? - Precise answer Is associated with patient complaining of "worst HA in their life." During a pt's admission to the ICU, the RN notes Hgb 9g/dl and Hct 27 ml/dl. Which meds should be confirmed with the provider prior to administration? - Precise answer Sulfa-trimethoprim (Bactrim) Anemia can be caused or exacerbated by some meds, including sulfa, antibiotics and ACE. A 56 yr male presents in heart block with a ventricular rate of 38 caused from an intentional overdose from CCB. What is appropriate antidote? - Precise answer Calcium Which is the earliest sign of Supratentorial (Uncal) herniation? - Precise answer Ipsilateral pupil dilation. Pt post-operative day 2 after a right hemicolectomy for ischemic bowel. The post-operative course has been complicated with pain control concerns. As the patient is getting out of bed for the first time the patient complains of sudden wet sounding cough. The assesses new onset tachycardia - Precise answer Pulmonary embolism - clinical signs of sudden SOB, anxiety points to PE Glucagon is an antidote for? - Precise answer Beta blockers Which port do you get to measure mixed venous blood? - Precise answer Distal port DIC - which medication does the nurse anticipate to be ordered and started urgently? - Precise answer Heparin continous infusion 4 units/kg/hr Other tx would be to eliminate the cause. Which lab value would expect to see in a patient with pancreatitis? - Precise answer Decreased Albumin, elevated amylase and lipase Reversal for warfarin overdose? - Precise answer Vit K A pt with 3 vessel CABG with PA catheter in place. Pt has crackles in bilateral bases, s3,s4 heart sounds are audible, in addition to holosystolic murmur. The nurse suspects mitral valve insufficiency. Which set of data confirms this suspicion? - Precise answer CVP elevated PA pressure elevated PAOP elevated As mitral regurgitation develops blood moves back into the right atrium from the left ventricle. This in turn causes an increase in left atrial pressure, pulmonary artery pressure, and cvp pressure. Pt with traumatic brain injury, what intervention should you include to prevent an increase in ICP? - Precise answer Keep patient's head in a neutral midline position. You are caring for a patient with an acute episode of asthma exacerbation. The first line of treatment is: - Precise answer beta 2 agonist - immediate tx of asthma exacerbation is to bronchodilate the airways to facilitate ventilation. Beta 2 agonists such as albuterol are a mainstay in the management of asthma and can be administered via nebulizer if needed. Which of the following would be expected in a patient experiencing herniation & Cushing's triad? - Precise answer Wide pulse pressure, bradycardia, increased systolic pressure Medication to treat hyperactive delirium? - Precise answer Haloperidol An increase in PEEP complication? - Precise answer A decrease in the RAP Patient is at risk for decreased right atrial filling and decreased cardiac output due to an increased intrathoracic pressure. Any time PEEP is increased, watch for signs of decreased cardiac output resulting from decreased venous return. Elevated P2 waves in an ICP waveform are a sign of: - Precise answer Increased intracranial pressure The P2 wave of an ICP occurs just after systole and indicates the compliance of the brain, or it's ability to respond to pressure. P2 should be lower than P1; elevation indicates decreased compliance due to increased ICP The benefit of the TIPS procedure is: - Precise answer Relieve portal venous pressure Which of the following heart block complications would you monitor for in the setting of an anterior wall MI? - Precise answer 2nd degree Type II Which of the following is indicated during the embolization of an AV malformation? - Precise answer Heparin - anticoagulation will prevent clot formation. A patient was 48-hours post aortic valve replacement. Which of following would be a major goal for this patient? - Precise answer Prevent thrombus - clot formation on the valve is a major complication of valvular replacement, especially a mechanical valve.