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Quiz Session - Attempts With Random Questions

AACN CCRN (Adult) Exam Questions

Page 4 of 50

61.

All of the following laboratory values indicate a diagnosis of Acute Myocardial Infarction (AMI) EXCEPT:

  • Creatine Kinase (CK): 135 mcg/L

  • Troponin T: 0.5 ng/mL

  • Troponin I: 0.9 ng/mL

  • Myoglobin: 85 ng/mL

Correct answer: Creatine Kinase (CK) 135 mcg/L

Creatine Kinase (CK) of greater than 150 to 180 mcg/L is an indicator of a heart attack; therefore, CK of 135 mcg/L does not indicate AMI.

The three other labs are elevated; therefore, indicative of Myocardial Infarction (MI). MI is indicated with lab results showing:

  • Troponin T: > 0.1 to 0.2 ng/mL
  • Troponin I: > 0.4 ng/mL
  • Myoglobin: 17.4 to 105.7 ng/mL

62.

Of the following, the MOST common cause of Disseminated Intravascular Coagulation (DIC) is:

  • sepsis

  • surgery

  • carcinoma

  • obstetric complications

Correct answer: sepsis

Disseminated Intravascular Coagulation (DIC) is a complex, diffuse response to systemic activation of the coagulation system. It is triggered by disease states or conditions systemically activating the coagulation system, resulting in the formation of micro-clots. These micro-clots obstruct the capillaries of organs and tissues, which initiates a series of events which result in both bleeding and thrombosis. It most commonly occurs in critically ill patients acutely due to sepsis, but can also occur in chronic forms with cancer. It can additionally be seen with traumatic injury and extensive surgery, and in obstetrical states such as eclampsia and preeclampsia, amniotic fluid embolism, and abortion.

63.

An absolute neutrophil count that is less than which of the following values indicates a severely compromised immune system response:

  • 1,000 cells/mm3

  • 10,000 cells/mm3

  • 5,000 cells/mm3

  • 20,000 cells/mm3

Correct answer: 1000 cells/mm3

An absolute neutrophil count of less than 1000 cells/mm3 severely compromises immune system response, particularly to bacterial infections.

64.

Which of the following BEST describes the function of the papillary muscles?

  • The papillary muscles control the opening and closure of heart valves.

  • The papillary muscles plan an important role in the letdown reflex during lactation.

  • The papillary muscles maintain vascular tone in the smallest blood vessels throughout the body.

  • The papillary muscles assist the ventricles to fully contract during systole.

Correct answer: The papillary muscles control the opening and closure of heart valves.

The papillary muscles sit within the ventricles and control the opening and closure of heart valves. These muscles account for about 10% of heart mass. They do not assist the ventricles in fully contracting during systole and are not connected with any non-cardiac functions.

65.

Flumazenil is often given as an antidote to the patient who overdoses on which of the following drugs? 

  • Chlordiazepoxide

  • Propranolol 

  • Amitriptyline 

  • Morphine

Correct answer: Chlordiazepoxide

Flumazenil is a specific benzodiazepine antagonist indicated for the reversal of benzodiazepine-induced moderate sedation, recurrent sedation, and benzodiazepine overdose. Chlordiazepoxide (Librium) is a benzodiazepine. 

Naloxone is used for opiate (morphine) overdose. In the case of a patient overdosing on tricyclic antidepressants (amitriptyline), sodium bicarbonate should be used. Glucagon and calcium are antidotes for beta-blockers (propranolol) or calcium channel blockers.

66.

All of the following clinical situations may affect the accuracy of POC blood glucose measurements EXCEPT:

  • ibuprofen use

  • blood glucose levels that exceed 500 mg/dL

  • a patient in hypovolemic shock

  • high blood triglycerides

Correct answer: ibuprofen use 

Several clinical conditions may influence POC glucose measurements. Shock or hypotensive states can lead to inadequate tissue perfusion in fingers, thus increasing inaccuracies of fingerstick glucometer analysis. Naturally occurring blood substances, such as hematocrit and high triglycerides, can also interfere with glucose measurement accuracy and are associated with higher glucose levels. Acetaminophen use, not ibuprofen, can cause falsely low readings. Blood glucose levels that exceed 500 mg/dL may result in a variable error.

67.

Of the distributive shock syndromes, which of the following is MOST commonly seen in critically ill patients?

  • Septic shock

  • Neurogenic shock

  • Anaphylactic shock

  • Hypovolemic shock

Correct answer: Septic shock

There are three types of shock: 

  • Hypovolemic
  • Cardiogenic
  • Distributive

Distributive shock is an abnormal placement or distribution of vascular volume, occurring in three situations:

  1. Septic shock
  2. Neurologic damage
  3. Anaphylaxis

In the critical care setting, septic shock (one of the types of distributive shock syndromes) is most commonly seen. In the field or emergency department settings, anaphylaxis and neurogenic shock are common and typically result from allergic reactions and trauma-related spinal cord injury.

68.

Which of the following is MOST LIKELY to precipitated Diabetic Ketoacidosis (DKA)?

  • Underlying infection

  • Missed insulin

  • Newly diagnosed, previously unknown diabetes 

  • Stroke

Correct answer: Underlying infection

Underlying infection is the precipitating cause of DKA in about 40% of cases. Missed insulin accounts for about 25% of situations while newly diagnosed, previously unknown diabetes is a precipitating factor in about 15% of cases. While stroke may be a precipitating factor, this less common.

69.

A patient with traumatic brain injury is suspected to be going into DIC. Laboratory results consistent with this diagnosis would be:

  • low platelet count, low fibrinogen, high INR, high aPTT

  • low PT, low aPTT, high platelet count, high fibrinogen

  • low bleeding time (BT), low hemoglobin, high PT, high aPTT

  • low fibrinogen, low D-dimer, high platelet count, high hemoglobin

Correct answer: low platelet count, low fibrinogen, high INR, high aPTT

In a patient suspected to be in DIC (Disseminated Intravascular Coagulation), platelets, fibrinogen, and clotting factors have been used to make clots. Thus, the patient will have decreased platelet counts and decreased fibrinogen levels. INR (international Normalized Ratio) and aPTT (Activated Partial Thromboplastin Clotting Time) will be prolonged (or elevated) because bleeding is present and coagulation factors are abnormal. Hemoglobin will be low due to active bleeding.

70.

For patients with acute respiratory failure, which ventilator mode is MOST likely to be used initially?

  • Assist-control ventilation

  • Pressure support ventilation

  • Synchronized intermittent mandatory ventilation

  • High-frequency oscillatory ventilation

Correct answer: Assist-control ventilation

Assist-Control (AC) ventilation is most commonly initially used for patients with acute respiratory failure because it guarantees a set number of breaths per minute while still allowing the patient to initiate breaths. Pressure support ventilation and synchronized intermittent mandatory ventilation allow more patient control and are often used in weaning. High-frequency oscillatory ventilation is typically used only for patients with severe ARDS (Acute Respiratory Distress Syndrome) who are not responding to other ventilation modes.

71.

A critical patient's condition worsens, and quick decisions need to be made by the healthcare team. What is the BEST way for the team to approach this situation?

  • Each team member should collaboratively discuss the situation and decide on the best course of action

  • The senior-most doctor should make all decisions

  • The team member most familiar with the patient should make all decisions

  • Each team member should make decisions on the areas they are most qualified in

Correct answer: Each team member should collaboratively discuss the situation and decide on the best course of action

The best way for a healthcare team to approach a critical situation is to collaborate and make decisions together. While it may be tempting to have one person make all decisions, this negates the value of the diverse expertise present in the team. Making decisions independently can lead to disjointed care and potential conflicts, disrupting holistic care.

72.

Of the following, which is MOST involved in the pathology of Immune Thrombocytopenia Purpura (ITP)?

  • IgG autoantibodies

  • Hepatomegaly

  • Splenomegaly

  • Bone marrow suppression

Correct answer: IgG autoantibodies

Immune Thrombocytopenia Purpura (ITP) is an autoimmune disorder caused by the presence of IgG (Immunoglobulin G) autoantibodies on the surface of the platelets and results in the destruction of platelets in the spleen and a platelet count of less than 20,000. It is defined as isolated thrombocytopenia with normal bone marrow function and the absence of other causes of thrombocytopenia. Clinically, there are two syndromes which manifest; acute in children and chronic in adults. Depending on the patient's status, treatment may or may not be indicated. If indicated, steroids (glucocorticoids) and IV immunoglobulin infusion are the typical mainstays of medical therapy, and surgical options may include splenectomy in adults.

73.

Which of the following medications is LEAST LIKELY to be used to treat a patient who has shortness of breath related to pulmonary fibrosis?

  • Sildenafil

  • Oxygen

  • Nintedanib

  • Dexamethasone

Correct answer: Sildenafil

Sildenafil is a phosphodiesterase inhibitor and is used to treat both pulmonary hypertension and erectile dysfunction. While sildenafil can improve pulmonary hypertension in patients who have this condition, it is not used to treat pulmonary fibrosis. Oxygen therapy is often used to treat pulmonary fibrosis. Corticosteroids, such as dexamethasone, are used to treat airway inflammation. Nintedanib and pirfenidone are both used to promote pulmonary vascular growth, helping to improve diffusion of gasses across the alveolar membrane by increasing the vasculature to the alveoli.

74.

Of the following drug classes, which is NOT indicated for the management of heart failure (HF)?

  • Calcium channel-blocking (CCBs) agents 

  • Selective beta-blocking agents 

  • Nitrates

  • Angiotensin-converting enzyme (ACE) inhibitors 

Correct answer: Calcium channel-blocking (CCBs) agents 

CCBs should generally be avoided in patients with HF plus reduced ejection fraction since they provide no functional or mortality benefit, and some first generation agents may worsen outcomes. They have negative inotropic activity, and therefore, weaken the force of myocardial contractility. 

First line drugs in the management of acute heart failure include:

  • Nitrates: reduce oxygen consumption, dilate venous system, and relax arterial smooth muscle
  • ACE inhibitors: decrease afterload, inhibit the renin-angiotensin-aldosterone system (RAAS), reducing fluid volume overload and remodeling of the left ventricle
  • Beta-blockers: reduce the frequency of ventricular tachycardia and ventricular fibrillation, which are the most prevalent cause of death in heart failure patients

75.

Initial treatment for a pulmonary contusion includes all of the following EXCEPT:

  • immediate thoracotomy and pneumonectomy

  • humidified oxygenation

  • pain control

  • pulmonary hygiene

Correct answer: immediate thoracotomy and pneumonectomy

A pulmonary contusion is defined as an injury to the lung parenchyma, which commonly occurs after a blunt injury to the chest. It generally involves pulmonary infiltrates with hemorrhage in the lung tissue. Initial treatment typically includes humidified oxygenation, pulmonary hygiene to keep the airway clear of mucous and secretions, fluid resuscitation, and pain control. 

Depending on the severity of the lung contusion, a thoracotomy to obtain surgical control of bleeding vessels and/or a pneumonectomy may be necessary but is not generally part of initial management. 

76.

The nurse is caring for a 57-year-old male who is one-day post Abdominal Aortic Aneurysm (AAA) repair. This morning he developed atrial fibrillation with subjective dyspnea. His heart rate is 121, but otherwise, his vital signs are normal. 

From what pulmonary complication is this patient MOST LIKELY suffering?

  • Pulmonary Embolism (PE)

  • Pneumonia

  • Severe asthma

  • Acute Respiratory Distress Syndrome (ARDS)

Correct answer: Pulmonary Embolism (PE)

A PE is an obstruction of blood flow to one or more of the arteries of the lung and is a complication of Deep Vein Thrombosis (DVT), long bone fracture, or air entering the circulatory system. The critically ill patient is especially susceptible to PE due to the presence of central venous and PA catheters, immobility, and (in this scenario) heart failure. Circulatory impairment is the major contributor to this condition's mortality rate; the physical obstruction of the pulmonary capillary bed increases right ventricular afterload, dilates the right ventricle, and impedes coronary perfusion.

Signs and symptoms of PE include dyspnea, chest pain, cough, rales, tachycardia and tachypnea, hypoxia, and hypotension. ECG findings include tall peaked P waves, atrial dysrhythmias, and sinus tachycardia.

77.

A 23-year-old male is admitted to the emergency department after a motor vehicle accident (MVA). A lung contusion with a possible pneumothorax is suspected, as the patient sustained a blunt injury to the chest. 

Upon auscultation, what finding suggests a left pneumothorax?

  • Decreased chest excursion on the affected side 

  • Bibasilar crackles on the affected side

  • Wheezes upon inspiration on the affected side 

  • Stridor upon inspiration on the affected side 

Correct answer: Decreased chest excursion on the affected side 

A pulmonary contusion is an injury to the lung parenchyma, which commonly occurs after blunt trauma to the chest. This injury to the lung parenchyma may cause a pneumothorax, in which the alveoli are deflated, and no air exchange occurs in the lungs. With pneumothorax, breath sounds in the affected lung field are diminished or absent with decreased chest excursion. 

Evidence of labored breathing or accessory muscle use suggests a sizeable pneumothorax. Tracheal deviation away from the affected side is a late sign, but is not always indicative of tension pneumothorax. Hemodynamic compromise (eg, tachycardia, hypotension) is an ominous sign, and suggests a tension pneumothorax and/or impending cardiopulmonary collapse.

None of the other options are associated with pneumothorax. Bibasilar crackles may result from pulmonary congestion, inspiratory wheezes may signal asthma, and stridor is a physical sign which is caused by a narrowed or obstructed airway that usually occurs in children with croup.

78.

What is the MOST common cause of ascites?

  • Cirrhosis

  • Hepatitis

  • Electrolyte imbalances 

  • Jaundice

Correct answer: Cirrhosis

Cirrhosis is the most common cause of ascites, an abnormal accumulation of protein-containing (ascitic) fluid within the peritoneal cavity. Many disorders can cause ascites, but the most common is high blood pressure in the veins that bring blood to the liver (portal hypertension), which is usually due to cirrhosis.

Portal hypertension occurs when the hydrostatic pressure is greater than ten mmHg within the portal venous system. This is a result of the disruption of the normal liver lobular system, which impedes blood flow into, through, or out of the liver.

Electrolyte imbalances and jaundice are clinical manifestations directly related to failure of the liver to perform important metabolic processes. Hepatitis is an inflammation of the liver.

79.

Which of the following is the MOST LIKELY early symptom to occur with an aortic aneurysm?

  • Early symptoms are not likely to occur with aortic aneurysms

  • Dyspnea

  • Tachycardia

  • Tearing pain in the chest, back, or abdomen

Correct answer: Early symptoms are not likely to occur with aortic aneurysms

Aortic aneurysms are normally asymptomatic in their early stages. Pain only occurs as an expanding aneurysm begins to create pressure on the internal tissues and nerves. Tachycardia and dyspnea are both late signs that occur when the aneurysm places pressure on blood vessels, airways, or begins to dissect or rupture.

80.

A patient who is admitted to the intensive care unit (ICU) has a medical history of underlying depression for 3 years that has been well managed. Throughout her hospitalization, she begins to experience more profound symptoms of depression. Her husband asks the ICU nurse why his wife's depression is getting worse, as it had been well managed prior to her being in the hospital.

Which of the following responses by the nurse is BEST?

  • Her worsening depression is likely to be temporary, but we will continue to monitor it and intervene if necessary.

  • Critical illness often causes chronic worsening of depression. We will schedule a consultation with a psychiatrist.

  • This worsening depression is not likely due to her hospitalization and will require separate treatment.

  • This worsening depression is due to the medications she is on and will stop when she stops those medications.

Correct answer: Her worsening depression is likely to be temporary, but we will continue to monitor it and intervene if necessary.

Depression occurring with a medical illness affects the long-term recovery outcomes by lengthening the course of the illness and increasing morbidity and mortality. Many patients arrive in the ICU with a history of treatment for depression that can be exacerbated by the critical illness crisis. It is important that the healthcare providers maintain the patient's psychiatric medication regimen if at all possible, in order to avoid worsening of the patient's psychological status.

Educating the patient and family about the temporary nature of most depressions during critical illness assists in providing reassurance that this is not an unusual phenomenon. The depressive symptoms generally resolve as the patient's condition improves. This exacerbation is unlikely to be chronic; a psychiatric consultation would only be warranted if pharmacologic intervention needs to be changed from the patient's original medication regimen, or if the patient is suicidal.

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