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Quiz Session - Attempts With Random Questions

AACN CCRN (Adult) Exam Questions

Page 7 of 50

121.

An ICU nurse who is off-shift finds a 26-year-old male in public with a suspected opioid overdose. He is unresponsive and has shallow, slow respirations. His pulse is weak but regular. Circumoral cyanosis is noted. The ICU nurse understands that which of the following is the MOST important priority for this individual?

  • Initiate ventilatory support 

  • Administer naloxone

  • Activated charcoal

  • Gastric lavage

Correct answer: Initiate ventilatory support 

In the setting of opioid overdose, the most immediate threat to life is respiratory depression, hence ensuring a patent airway and providing ventilatory support should be the first step. Naloxone is used to reverse opioid toxicity, but it should be administered after securing the airway. While naloxone may quickly reverse the side effects of an opioid overdose, if the substance is not known with certainty, valuable time can be wasted administering naloxone instead of securing the airway. Gastric lavage and activated charcoal are not the first-line interventions for opioid overdose, and their use depends on multiple factors, including the type of substance ingested, the method of administration, and time since ingestion.

122.

The critical care nurse understands that the primary etiology of hyperphosphatemia in all patients, including the critically ill, is:

  • renal failure

  • Addison disease

  • bone tumors

  • excessive intake of vitamin D

Correct answer: renal failure 

Renal failure is the most common cause of excessive phosphate levels in all patients, including the critically ill. The regulation of phosphate in the body is performed by the kidneys. Other causes of hyperphosphatemia include hypoparathyroidism, excessive intake of alkali or vitamin D, Addison disease, and with bone tumors or fractures. It is often associated with hypocalcemia and presents most commonly with muscle cramps, joint pain, and seizures.

123.

Which of the following diagnostic tests would be indicative of Diabetes Insipidus (DI)?

  • Serum sodium level of 165 mEq/L

  • Serum osmolality of 250 mOsm/L

  • Oliguria

  • Decreased BUN and creatinine

Correct answer: Serum sodium level of 165 mEq/L

Diabetes Insipidus (DI) results from a group of disorders in which there is an absolute or relative deficiency of ADH (Antidiuretic Hormone) or insensitivity to its effects on the renal tubules; it is characterized by excessive and diluted urine output and subsequent dehydration. Without ADH, the renal tubules cannot reabsorb water which produces polyuria (excessive or abnormally large production or passage of urine) of 5–20 L in 24 hours. The urine remains diluted with a decreased specific gravity. As the body loses water, the serum sodium level increases, causing an increased serum osmolality of greater than 295 mOsm/kg/L. In addition, BUN (Blood Urea Nitrogen) and creatinine are increased (hemoconcentration). 

The normal range for serum sodium levels is 135–145 mEq/L. Typically, symptoms manifest when serum sodium levels exceed 155 mEq/L.

124.

The nurse is helping care for a patient who is suspected of having pulmonary fibrosis. Which of the following is LEAST LIKELY to help in the diagnosis of pulmonary fibrosis?

  • Sweat chloride test

  • CT scan

  • Lung biopsy

  • Pulmonary function tests

Correct answer: Sweat chloride test

Pulmonary fibrosis is a condition in which the lungs gradually develop scar tissue that decreases lung compliance and inhibits diffusion of gasses across the alveolar membranes. A sweat chloride test is used to diagnose cystic fibrosis, not pulmonary fibrosis. High-resolution CT scan of the chest, lung biopsy, and pulmonary function tests can all be used as part of the diagnosis of pulmonary fibrosis.

125.

A patient currently taking heparin and furosemide presents with thrombocytopenia, an elevated PT, and signs of deep vein thrombosis. The nurse FIRST suspects which of the following?

  • Heparin-induced thrombocytopenia

  • Idiopathic thrombocytopenic purpura

  • Hemolytic uremic syndrome

  • Disseminated intravascular coagulation

Correct answer: Heparin-induced thrombocytopenia

In Heparin-Induced Thrombocytopenia (HIT), exposure to heparin leads to the development of antibodies that activate platelets, causing thrombocytopenia and increased clotting. Hemolytic uremic syndrome and idiopathic thrombocytopenic purpura are not related to heparin use. Disseminated intravascular coagulation typically presents with both bleeding and clotting, not just clotting.

126.

Which of the following is a goal of intra-aortic balloon pump therapy?

  • Maximize aortic diastolic augmentation pressure

  • Increase systolic blood pressure

  • Decrease MAP

  • Increase end-diastolic blood pressure

Correct answer: Maximized aortic diastolic augmentation pressure

The IABP (Intra-Aortic Balloon Pump) provides cardiac assistance by improving myocardial oxygen supply and reducing cardiac workload. The IAPB works on the principle of counterpulsation. Gas (helium or CO2) moves back and forth from the IABP console to the IABP catheter, causing the balloon to inflate (during ventricular diastole, increasing intra-aortic pressure and blood flow to the coronary arteries) and deflate (just prior to ventricular systole, decreasing intra-aortic pressure). This counterpulsation increases the Mean Arterial Pressure (MAP), improves coronary artery blood flow and perfusion during diastole, and decreases systolic blood pressure and end-diastolic blood pressure.

127.

 A 54-year old female is admitted after being found unconscious in a nearby park. She has remained unconscious and, upon assessment, the critical care nurse notes respiratory depression, hypotension, and miosis. The nurse anticipates which of the following drugs will be administered?

  • Naloxone

  • Flumazenil 

  • Epinephrine

  • Sodium bicarbonate 

Correct answer: Naloxone 

The most likely cause of this patient's symptomology is an opioid overdose, and naloxone should be the initial drug administered.

Clinically significant respiratory depression with accompanying hypotension and miosis resulting from opiate use is generally treated with IV naloxone, an opioid antagonist, in very small doses. It is titrated up to the desired level of alertness since the abrupt, complete withdrawal of all opiate effects can cause an acute, severe, and frightening pain response for a patient.

Flumazenil is the antidote to counteract a benzodiazepine overdose. Signs indicative of a benzodiazepine overdose include altered mental status, respiratory depression, and weakness or tremors. 

Sodium bicarbonate is the antidote for a tricyclic antidepressant (TCA) overdose, evidenced by seizures, coma, cardiac dysrhythmias, heart failure and shock. 

Epinephrine is warranted only if the patient does not respond to IV naloxone. 

128.

In which of the following patients would use of jejunal placement for a feeding tube over the gastric route be LEAST important when preparing to administer enteral feedings?

  • A patient who has severely limited movement due to rheumatoid arthritis

  • A patient who had esophageal cancer that has undergone an esophagectomy

  • A patient who has scleroderma

  • A patient with severe gastroparesis

Correct answer: A patient who has severely limited movement due to rheumatoid arthritis

Use of the gastric route to administer enteral feedings is generally safe when with low rates of aspiration, and when appropriate protocols are developed and followed. A patient with limited mobility due to rheumatoid arthritis would not require jejunal placement of a feeding tube. Jejunal placement is indicated in conditions where anatomical considerations, such as an esophagectomy, contraindicate the use of the gastric route. Diseases affecting gastric motility, such as scleroderma or severe gastroparesis, may also require jejunal feeding tube placement.

129.

The critical care nurse suspects a patient exhibiting which of the following signs and symptoms to be in hypovolemic shock?

  • Hypotension, oliguria, tachycardia

  • Hypotension, polyuria, hypoglycemia

  • Hypotension, tachycardia, hypoglycemia

  • Hypotension, bradycardia, oliguria

Correct answer: Hypotension, oliguria, tachycardia

In hypovolemic shock, the patient would most likely exhibit hypotension due to dehydration and blood and/or fluid loss, scant urine output (oliguria) due to decreased function of the kidneys and release of ADH to compensate for the low BP, and tachycardia, due to stimulation of compensatory response from low perfusion.

In addition, the patient would likely have an increased respiratory rate (tachypnea), increased serum glucose levels (hyperglycemia), and have cool, clammy, cyanotic skin and/or hypothermia.

130.

The RIFLE classification system provides a definition and classification system for Acute Renal Failure (ARF). To what does the "R" in the RIFLE acronym refer?

  • Risk of renal dysfunction

  • Role of renal perfusion

  • Recurrence of intrinsic injury

  • Response to renal injury

Correct answer: Risk of renal dysfunction

A classification system for the ARF spectrum is RIFLE; this system allows patients to be classified by changes in serum creatinine, urine output, or both. The "R" in RIFLE stands for risk of renal dysfunction. The remainder of the acronym represents the following: "I" for injury to the kidney, "F" for failure or loss of kidney function, and "E" for End-Stage Kidney Disease (ESKD).

131.

A nurse is caring for a Korean patient who refuses to make eye contact. What of the following responses by the nurse is BEST?

  • "Do you have any cultural preferences regarding making eye contact?"

  • "I notice that you're avoiding me. Do you feel uncomfortable with me as your nurse?"

  • "Has anyone at home been physically abusive towards you?"

  • "Would you please look at me while I am speaking so that I know you're paying attention?"

Correct answer: "Do you have any cultural preferences regarding making eye contact?"

In some cultures, including many Asian cultures, avoiding direct eye contact is considered respectful, especially with authority figures like healthcare providers. The nurse should directly ask the patient about their cultural practices to avoid any misunderstandings. The nurse should not assume that a lack of eye contact is an indicator of abuse. The nurse should not address the behavior until they understand if there is any cultural significance to the behavior.

132.

Which of the following statements is TRUE regarding epinephrine and norepinephrine?

  • Epinephrine is normally reserved for when other vasoconstrictive agents are inadequate

  • Norepinephrine is a stronger inotropic agent than epinephrine

  • Epinephrine possesses only alpha-adrenergic effects

  • Norepinephrine possesses only beta-adrenergic agonist properties and is a direct-acting vasoactive agent 

Correct answer: Epinephrine is normally reserved for when other vasoconstrictive agents are inadequate

Epinephrine and norepinephrine are hormones of the adrenal medulla, neurotransmitters, and medications (vasopressor agents). Both epinephrine and norepinephrine possess alpha- and beta-adrenergic agonist properties, and therefore influence both alpha- and beta-receptors, producing an increase in heart rate, contractility, and vasoconstriction at higher doses. 

Epinephrine produces pronounced effects on heart rate and contractility. It is a stronger inotropic agent than norepinephrine, and its use is reserved for when other vasoconstrictive agents are inadequate (the desired response has not been achieved). Epinephrine (not norepinephrine) is associated with tachyarrhythmias: myocardial, mesenteric, renal, and extremity ischemia, as well as hyperglycemia. 

133.

Analyze and interpret the following ABG results:

  • pH: 7.28
  • PaCO2: 47 mmHg
  • HCO3: 21 mEq/L

  • Acute (uncompensated) combined acidosis

  • Normal ABG

  • Partially compensated respiratory acidosis

  • Acute (uncompensated) metabolic acidosis

Correct answer: Acute (uncompensated) combined acidosis

Normal pH ranges from 7.35–7.45. Since this patient's pH is below 7.45, the patient is experiencing acidosis. Normal CO2 (carbon dioxide) levels range from 35–45 mmHg, and normal HCO3 (bicarbonate) levels range from 22–26 mEq/L. CO2 is the respiratory component and HCO3 is the metabolic component. The component that matches the pH is the system controlling the ABG (Arterial Blood Gas).

In this scenario, all levels are acidotic, so both the metabolic and respiratory systems are contributing to the acidosis. There is no compensation present here.

134.

The MOST common cause of upper Gastrointestinal (GI) bleeding is:

  • peptic ulcer disease

  • Crohn's disease

  • colitis

  • duodenal ulcer

Correct answer: peptic ulcer disease

The most common cause of upper GI bleeding is peptic ulcer disease, which accounts for 31%–67% of all cases. This is followed by erosive disease, variceal bleeding, esophagitis, cancer, and Mallory-Weis tears.

Peptic ulcers occur in the stomach and the duodenum and are characterized by a break in the mucosal layer that penetrates the muscularis mucosa (innermost muscular layer), resulting in bleeding. Infection of the mucosa by Helicobacter pylori has also been implicated in the pathogenesis of peptic ulcer disease.

Crohn's disease causes lower (not upper) GI bleeding, which results from radiation, chemotherapy, or ischemia. Duodenal ulcers result from an over-secretion of acid. Colitis is also a cause of lower GI bleeding.

135.

Which of the following is MOST LIKELY to be the cause of a hemorrhagic stroke?

  • Hypertension

  • Arteriovenous malformations

  • Use of illicit stimulants

  • Head trauma

Correct answer: Hypertension

A hemorrhagic stroke is most likely to be caused by hypertension, especially from hypertensive crises. Arteriovenous malformations, use of illicit drugs (especially stimulants) and head trauma may all cause a hemorrhagic stroke; however, hypertension is the most common cause of this condition.

136.

The ICU nurse is part of a healthcare team that includes physicians, other nurses, respiratory therapists, and dietitians. What BEST describes the nurse's role in this interdisciplinary team?

  • Collaborating and contributing to care planning

  • Performing physician-ordered procedures

  • Being the end decision maker on issues relating to the coordination of care

  • Being the center of communication for the team 

Correct answer: Collaborating and contributing to care planning

In an interdisciplinary team, all members have a role to play in patient care. The nurse's role centers around collaborating and contributing to care planning. While it is necessary for the nurse to carry out physician-ordered procedures, this is not the primary responsibility of the nurse relating to being part of an interdisciplinary team. The nurse is a key decision-maker on issues relating to the coordination of care. However, they should collaborate with others and understand that they will not be the end decision-maker. The nurse may help enhance communication for the team, but is not the center of communication for the team. Members of the team are responsible for communicating with all other members of the team directly, not through the nurse.

137.

An ICU patient requests to use acupuncture to manage their pain instead of medication after an appendectomy they are about to undergo. What response by the nurse is BEST?

  • "Can you arrange to have an acupuncturist here after your procedure?"

  • "Acupuncture won't provide adequate pain management after this procedure; you will need opioids initially."

  • "I will consult with an anesthetist who is trained in acupuncture to see you after the surgery."

  • "You should consider combining opioids and acupuncture for pain management."

Correct answer: "Can you arrange to have an acupuncturist here after your procedure?"

The patient's desire to rely on nonpharmacological pain management should be supported if possible. The nurse should assess if an acupuncturist can be available to provide care when it will be necessary. Acupuncture may not provide adequate pain management after this procedure; however, the patient's care plan can be altered to use pharmacological pain management combined with acupuncture or by itself if necessary. Acupuncture will need to be provided by an acupuncturist, not by an anesthetist, and the patient will likely need to make arrangements for an acupuncturist independently.

138.

Which of the following is LEAST LIKELY to be an indicator of infiltration?

  • Generalized edema

  • Coolness at the IV site

  • Pain

  • IV pump alarms

Correct answer: Generalized edema

Infiltration occurs when the distal end of an IV catheter slips from the vein into the surrounding tissues, infusing the IV medication or solution into tissues instead of into the vein. Localized, not generalized edema may occur as fluid accumulates into the tissues. Coolness at the IV site may be noted as the IV solution that is below body temperature accumulates in the tissues. Pain occurs due to stretching as localized edema develops. IV pump alarms may occur as resistance increases due to the slow absorption rate of the tissues.

139.

Which of the following BEST describes the risk of infection for trauma wounds?

  • Trauma wound infections can be due to both the initial trauma and to hospital acquired sources

  • Trauma wound infections are unlikely if the wounds are treated correctly

  • Prophylactic antibiotics are indicated for all trauma wounds to prevent infection

  • Treatment for all trauma wounds should follow the same course to optimize infection risks

Correct answer: Trauma wound infections can be due to both the initial trauma and to hospital acquired sources

While trauma wound infection may develop due to the initial trauma, it may also be due to hospital interventions associated with the wound. Infection of trauma related wounds may still be likely even if the wounds are treated correctly. Prophylactic antibiotics may be indicated for some trauma wounds, but are not always necessary. Treatment for trauma wounds should be tailored for the needs of the specific patient's condition to optimize infection risks.

140.

Of the following medications given in the critical care setting, which has the LEAST potential for the development of tolerance or dependence?

  • Haloperidol (Haldol)

  • Midazolam (Versed)

  • Meperidine (Demerol)

  • Fentanyl

Correct answer: Haloperidol (Haldol)

Haloperidol is a major tranquilizer that has been commonly used for the management of agitated or delirious patients who are unresponsive to nonpharmacologic interventions or other sedatives. Haloperidol has the advantage of limited respiratory depression and little potential for the development of tolerance or dependence.

Midazolam is a benzodiazepine and meperidine and fentanyl are both opioids. These drugs all have potential for tolerance and/or dependence

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