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Quiz Session - Attempts With Random Questions

AACN CCRN (Adult) Exam Questions

Page 6 of 50

101.

Which of the following strategies is BEST for optimizing ventilation in a patient with ARDS? 

  • Permissive hypercapnia

  • High tidal volume ventilation

  • Hyperventilation

  • Ventilating in the supine position 

Correct answer: Permissive hypercapnia

Permissive hypercapnia is a lung-protective ventilation strategy commonly used in ARDS (Acute Respiratory Distress Syndrome) to allow for lower tidal volumes, thus preventing lung injury. High tidal volume ventilation is contraindicated as it could lead to ventilator-induced lung injury due to the fact that some lung volume is occupied by fluid. Hyperventilation could lead to alkalosis. Ventilating in the prone position can optimize ventilation for a patient with ARDS; however, ventilating in the supine position is not advantageous. 

102.

All of the following are common signs/symptoms of Acute Renal Failure (ARF) EXCEPT:

  • bradycardia

  • oliguria

  • dry mucous membranes

  • nausea and vomiting

Correct answer: bradycardia

Signs and symptoms of acute renal failure include:

  • Oliguria < 400 mL/d or anuria < 100 mL/d
  • Tachycardia
  • Hypotension (prerenal)
  • Hypertension (intrarenal)
  • Flat neck veins (prerenal)
  • Distended neck veins (intrarenal)
  • Dry mucous membranes
  • Cool, clammy skin
  • Lethargy
  • Deep, rapid respirations
  • Vomiting
  • Nausea
  • Confusion

103.

The nurse is caring for a patient and auscultates a diastolic heart murmur. In which of the following valvular disorders would the nurse anticipate with this finding?

  • Mitral stenosis

  • Tricuspid insufficiency

  • Aortic stenosis

  • Mitral insufficiency

Correct answer: Mitral stenosis

Heart murmurs are the result of abnormal blood flow and are produced by two murmurs: mitral stenosis and mitral insufficiency. Mitral stenosis is a narrowing of the mitral valve opening that blocks (obstructs) blood flow from the left atrium to the left ventricle. Mitral insufficiency is a backflow of blood caused by the failure of the heart's mitral valve to close tightly. Both of these can cause heart murmurs.

  • Systolic murmurs: Produced by mitral and tricuspid insufficiency
  • Diastolic murmurs: Produced by mitral and tricuspid stenosis; pulmonic and aortic insufficiency

104.

The nurse is caring for a patient diagnosed with a hemorrhagic stroke located by a CT scan in the frontal lobe. 

All the following would be appropriate nursing interventions, EXCEPT:

  • Administration of fibrinolytic therapy 

  • Administration of IV antihypertensives 

  • Administration of fresh frozen plasma (FFP) 

  • Administration of antiepileptic drugs (AEDs)

Correct answer: Administration of fibrinolytic therapy 

Approximately 15% of all strokes are hemorrhagic, presenting as a subarachnoid or intracranial hemorrhage (ICH). Hypertension is the most common cause of ICH. 

Initial priorities of care for the patient with ICH include blood pressure control and correction of coagulopathy, based on the underlying cause of abnormal clotting. IV medications are often required to treat elevated blood pressure and may be administered intermittently or continuously. Generally, the goal is to keep the systolic blood pressure between 140 and 160 mm Hg. Fresh frozen plasma (FFP), platelets, vitamin K, or prothrombin complex concentrate may be ordered. AEDs are recommended for patients who experience a seizure, or to prevent seizures if the hemorrhage is in a part of the brain associated with seizure risk (temporal or frontal lobe). 

Since this patient's CT scan showed bleeding, fibrinolytic therapy would not be administered.

105.

Immunosuppressive agents, such as cyclosporine and tacrolimus, are often indicated after organ transplantation to prevent rejection. What is the MOST COMMON adverse effect of these medications?

  • Nephrotoxicity

  • Hyperkalemia

  • Tremors

  • Hypertension

Correct answer: Nephrotoxicity 

Nephrotoxicity is the major adverse effect of these medications and occurs in up to 40% of transplant patients receiving tacrolimus. Hyperkalemia can develop secondary to the nephrotoxic effects of the drugs. Other side effects observed include tremors and hypertension.

106.

Which of the following statements regarding Hyperosmolar Hyperglycemic State (HHS) is FASLE?

  • Hyperglycemia develops because of decreased gluconeogenesis

  • Continued osmotic diuresis causes hypovolemia

  • There is an accelerated conversion of glycogen to glucose

  • As glucose concentration increases, water is drawn out of the cells

Correct answer: Hyperglycemia develops because of decreased gluconeogenesis

Hyperglycemia develops because of an increased gluconeogenesis and accelerated conversion of glycogen to glucose (glycogenolysis) and by inadequate use of glucose by peripheral tissues, primarily muscle. As the glucose concentration and osmolality of extracellular fluid increase, an osmolar gradient is created that draws water out of the cells. Glomerular filtration is initially increased, which leads to glucosuria and osmotic diuresis. The initial glucosuria prevents the development of severe hyperglycemia as long as the glomerular filtration rate is normal. However, with continued osmotic diuresis, hypovolemia eventually occurs, which leads to a progressive decline in glomerular filtration rate and worsening hyperglycemia.

107.

When assessing a non-alert patient's Level of Consciousness (LOC), the nurse should begin with which of the following forms of stimulation?

  • Auditory stimuli

  • Painful stimuli

  • Tactile stimuli

  • Observation

Correct answer: Auditory stimuli

Observation of the patient's behavior, appearance, and ability to communicate is the first step in assessing level of consciousness, but is not a form of stimuli. If the patient responds to the examiner without the need for stimulation, the patient is described as alert. If stimulation is required, auditory stimuli are used first. Auditory stimuli is followed by tactile stimuli (i.e., shake or gentle touch) and then painful stimuli (i.e., squeezing a large muscle group).

108.

Which of the following patients would be at HIGHEST risk of developing diabetes insipidus (DI)?

  • A 61-year-old male with bipolar disorder on chronic lithium therapy 

  • A 52-year-old male with prolonged use of positive pressure ventilation secondary to a pulmonary disorder 

  • An 84-year-old male with a gastrointestinal malignancy 

  • A 49-year-old male with a history of smoking and chronic narcotic use for back pain

Correct answer: A 61-year-old male with bipolar disorder on chronic lithium therapy 

DI results from a group of disorders in which there is an absolute or relative deficiency of ADH (called central DI) or an insensitivity to its effects on the kidney tubules (called nephrogenic DI). 

There are many causes that can contribute to the development of DI. Central DI (also called neurogenic DI) results from damage to the hypothalamic/pituitary system, while an absolute deficiency of antidiuretic hormone (ADH) results in an impaired ability to concentrate urine, polyuria, and a risk for dehydration. 

Medication-induced etiologies of DI include chronic use of lithium. This is a type of nephrogenic DI, or ADH insensitivity. 

Nicotine, narcotic use (opioids), GI malignancies, and prolonged use of positive pressure ventilation (PPV) can predispose the patient to the development of SIADH (The syndrome of inappropriate antidiuretic hormone), not DI.

109.

In a patient with low Systemic Vascular Resistance (SVR) due to sepsis and fever, which of the following medications would be BEST to raise SVR?

  • Norepinephrine and dopamine

  • Epinephrine and dobutamine

  • Nitropursside and dobutamine

  • Vasopressin and nitroprusside

Correct answer: Norepinephrine and dopamine

If Systemic Vascular Resistance (SVR) is low, the left ventricle faces a lower resistance to the ejection of blood. Generally, the SVR decreases as a pathologic response to inflammatory conditions such as sepsis and fever, or in hepatic disease due to increased collateral circulation. If SVR is low, fluid administration and/or vasopressor drugs such as norepinephrine and dopamine are indicated.

Dobutamine and nitroprusside decrease SVR.

110.

A lethal dysrhythmia often found in chest trauma patients, often from cardiac tamponade, is known as:

  • Pulseless Electrical Activity (PEA)

  • sinus tachycardia

  • atrial fibrillation

  • Premature Ventricular Tachycardia (PVT)

Correct answer: Pulseless Electrical Activity (PEA)

Pulseless Electrical Activity (PEA), also known as electromechanical dissociation, refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse but does not.

Cardiac tamponade is a potentially life-threatening complication of both blunt and penetrating chest trauma; bleeding (from trauma) into the pericardial sac causes compression on the heart, compromising cardiac function and output. A rapid accumulation of blood does not allow the pericardial sac to stretch, and the tamponade may lead to PEA and/or cardiogenic shock.

The other answer choices are common in patients experiencing blunt cardiac injury but are not necessarily lethal complications.

111.

Which of the following factors would MOST LIKELY predispose the patient to develop renal failure?

  • Hypertension

  • Hypercalcemia

  • Hypophosphatemia

  • Anemia

Correct answer: Hypertension

Prolonged high blood pressure can place a patient at risk for developing renal failure. Other diseases that increase a patient's chance of developing renal failure include heart failure, diabetes, and chronic renal insufficiency. Anemia may be caused by renal failure, but does not cause renal failure itself.

Hypercalcemia may be a symptom of renal failure but is not an etiology. Hypophosphatemia is not generally associated with renal failure.

112.

The nurse is caring for a newly admitted patient with worsening chronic heart failure. The nurse notes on the patient's EKG strip that the P wave in lead II is > 0.13 seconds and > 3.2 mm.

The nurse knows that these findings MOST LIKELY indicate:

  • Atrial hypertrophy

  • Atrial hypotrophy

  • Ventricular hypertrophy

  • Ventricular hypotrophy

Correct answer: Atrial hypertrophy

The P wave represents atrial muscle depolarization. It is normally 2.5 mm or less in height and 0.11 seconds or less in duration. The P wave morphology, which is smooth and rounded, can reveal right or left atrial hypertrophy or atrial arrhythmias and is best determined in leads II and V1 during sinus rhythm.

Patient's EKG FindingsNormal EKG Findings
> 3.2 mm≤ 2.5 mm
> 0.13 seconds≤ 0.11 seconds

113.

A 71-year-old patient comes in after falling and complaining of hip pain. The X-ray shows a displaced femoral neck fracture. What is the MOST appropriate intervention?

  • Open reduction and internal fixation

  • Immobilization with a cast

  • Traction

  • Physical therapy

Correct answer: Open reduction and internal fixation

Femoral neck fractures in older patients are generally treated with surgical intervention like an Open Reduction and Internal Fixation (ORIF) because of the high risk of non-union and avascular necrosis. Immobilization with a cast or traction is unlikely to be effective in healing femoral neck fractures. Physical therapy is a vital intervention to promote recovery, but is only likely to facilitate healing after initial surgical management.

114.

Which of the following diagnostic or laboratory abnormalities would BEST indicate that septic shock is present in a critically ill patient? 

  • Serum lactate > 2 mmol/L after fluid resuscitation

  • Decreased serum creatinine levels 

  • Hypotension

  • White blood cell (WBC) count >10,000 or <4,000 cells/mm3

Correct answer: Serum lactate > 2 mmol/L after fluid resuscitation

Early recognition and treatment of sepsis and septic shock is extremely important, and there is no one single biomarker that confirms a diagnosis. Tissues that are poorly perfused resort to anaerobic metabolism, leading to an accumulation of lactic acid. Thus, a rise in serum lactate indicates poor perfusion. Patients with a serum lactate over 4 mmol/L and evidence of infection should undergo urgent treatment for sepsis, because lactic acidosis is present. In addition, a lactate greater than 2 mmol/L after fluid resuscitation indicates septic shock. 

In response to infection, the WBC count may rise to greater than 12,000 cells/mm3, or fall below 4000 cells/mm3. A rise in the percent of bands (white blood cells released from the marrow before reaching maturity) to greater than 10%, indicates acute infection. The over-activation of platelets induced by the dysregulated response of sepsis can also lead to thrombocytopenia. 

Elevated (not decreased) serum creatinine and transaminitis are other signs of organ hypoperfusion. Hypotension alone is not a good indicator of septic shock.

115.

A patient with a past diagnosis of schizoaffective disorder is admitted to the critical care unit with diabetes insipidus. As the admission nurse, priorities would include all of the following EXCEPT:

  • hold all psychiatric medications until the patient's blood glucose is under control

  • ask the patient if he knows why he is in the hospital

  • contact the patient's psychiatrist with permission from the patient or the patient's guardian

  • review all preadmission medications

Correct answer: hold all psychiatric medications until the patient's blood glucose is under control 

Medications should only be held when there is a clear benefit to doing so. Many of the psych meds have a long half‐life, and holding them can affect the steady state of the drug within the body. 

Asking the patient if he knows why he is in the hospital, and reviewing all preadmission medications should be done with all admitted patients. Continuity of care (contacting the patient's psychiatrist to ensure adequate care while inpatient) is important with every admission, and of particular importance with behavioral health issues.

116.

A patient with Wolff-Parkinson-White syndrome asks the critical care nurse about treatment of this condition. Which of the following answers is CORRECT?

  • The specific therapy depends on the mechanism of the tachyarrhythmia caused.

  • There is no cure for Wolff-Parkinson-White syndrome.

  • Wolff-Parkinson-White syndrome should be treated as soon as possible once it is diagnosed.

  • Treatment for Wolff-Parkinson-White syndrome focuses on treating a malfunctioning AV node.

Correct answer: The specific therapy depends on the mechanism of the tachyarrhythmia caused.

There are multiple potential therapies that can be used to treat Wolff-Parkinson-White syndrome, but the specific therapy does depend on the mechanism causing the tachyarrhythmia. Wolff-Parkinson-White syndrome can be cured by radioablation that destroys the aberrant conduction pathway. Wolff-Parkinson-White syndrome is only treated if it causes symptomatic tachyarrhythmias. In Wolff-Parkinson-White syndrome electrical signals in the heart bypass the AV node. The AV node functions normally, but is circumnavigated by aberrant conduction pathways. Treating the AV node is not a component of treating Wolff-Parkinson-White syndrome.

117.

The critical care nurse is preparing to care for a patient who is being admitted with Hyperosmolar Hyperglycemic Syndrome (HHS). Which of the following interventions is NOT correct?

  • Preparing to administer rapid acting IV insulin

  • Preparing to administer IV crystalloids

  • Preparing to routinely check potassium levels

  • Preparing to frequently check blood glucose levels

Correct answer: Preparing to administer rapid acting IV insulin

IV regular insulin, not rapid acting insulin, should be used to treat HHS. Preparing to administer IV crystalloids, routinely check potassium levels, and frequently check blood glucose levels are all correct interventions for treating HHS.

118.

In which of the following clinical scenarios is intra-aortic balloon pump (IABP) therapy contraindicated? 

  • Aortic aneurysm 

  • Angina refractory to medical therapy

  • Cardiogenic shock

  • Failure to wean from cardiopulmonary bypass after cardiac surgery

Correct answer: Aortic aneurysm 

The IABP provides cardiac assistance by improving myocardial oxygen supply and reducing cardiac workload. The IABP works on the principle of counterpulsation. Gas (helium or CO2) moves back and forth from the IABP console to the IABP catheter, causing inflation and deflation of the balloon. Inflation occurs during ventricular diastole, increasing intra-aortic pressure and blood flow to coronary arteries. Deflation occurs immediately before ventricular systole, decreasing intra-aortic pressure. This pressure reduces the resistance to left ventricular ejection, or afterload. 

IABP therapy may be used to treat: 

  • Angina refractory to medical therapy
  • Left ventricular failure
  • Cardiogenic shock
  • Failure to wean from cardiopulmonary bypass after cardiac surgery

Symptoms necessitating the need for IABP therapy include symptoms of cardiogenic shock (tachycardia, systolic BP > 90 mmHg, MAP < 70 mmHg, CI < 2.2–2.5 L/min/square meter, PAOP pressure < 18 mmHg), decreased oxygenation, unstable angina, inadequate peripheral perfusion, and decreased urine output. 

Contraindications to IABP therapy include moderate to severe aortic insufficiency and aortic aneurysms.

119.

A hematoma of brain tissue in which capillaries (and sometimes venules) are damaged by trauma that occurs at the site of impact is known as a(n):

  • Coup contusion

  • Contrecoup contusion

  • Subarachnoid hemorrhage (SAH)

  • Epidural hematoma (EDH)

Correct answer: Coup contusion

A brain contusion (bruise) is a type of hematoma of tissue in which capillaries (and sometimes venules) are damaged by trauma, allowing blood to seep, hemorrhage, or extravasate into the surrounding interstitial tissues. 

Contusions are caused by the brain impacting the inside of the skull, and may be described as:

  1. Coup: occurring at the site of impact, or
  2. Contrecoup: occurring opposite the site of impact

Common sites of contusions include the frontal and temporal lobes. Clinical presentation depends on the site and extent of brain injury, 

An EDH is bleeding located above the dura. It occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain. 

A SAH refers to bleeding within the subarachnoid space (the space between the brain and the tissue covering the brain) and can result from trauma, aneurysm, or other vascular malformation.

120.

In a healthy adult female, what are the normal values for hemoglobin (Hgb) and hematocrit (Hct)?

  • Hgb 12–16 g/dL, Hct 36%–48%

  • Hgb 14–18 g/dL, Hct 42%–52%

  • Hgb 8–12 g/dL, Hct 32%–36%

  • Hgb 18–22 g/dL, Hct 39%–49%

Correct answer: Hgb 12–16 g/dL, Hct 36%–48%

Hemoglobin is the primary carrier of oxygen to body tissues. Hematocrit measures the RBC mass in relationship to a volume of blood, expressed as the percentage of cells per 100 mL of blood. Normal values in healthy adult women (Hgb 12–16 g/dL, Hct 36%–48%) are slightly less than those of healthy adult men (Hgb 14–18 g/dL, Hct 42%–52%). A lower Hgb and Hct is suggestive of anemia from blood loss, post-surgical values, or chronic disease.

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