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CCRN-Adult CCRN (Adult) - Direct Care Eligibility Pathway Questions and Answers

Questions 4

Which of the following is most often associated with damage to the alveolar capillary membrane secondary to aspiration?

Options:

A.

reabsorption atelectasis

B.

lung cavitation

C.

bronchopleural fistulas

D.

noncardiogenic pulmonary edema

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Questions 5

A nurse who is providing care to a patient with a hemorrhagic stroke receives an order to administer 3% Normal Saline IV. The nurse should recognize the goal of therapy is to create an

Options:

A.

osmotic gradient which pulls fluid from the brain tissue into the vascular system.

B.

osmotic gradient which pulls fluid from the vascular system into the brain tissue.

C.

oncotic gradient which pulls fluid from the brain tissue into the vascular system.

D.

oncotic gradient which pulls fluid from the vascular system into the brain tissue.

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Questions 6

For a patient who sustained blunt renal trauma and a crush injury to the leg, monitoring should include observing for

Options:

A.

a shortened PR interval.

B.

tall peaked T waves.

C.

ST segment depression.

D.

a prolonged PR interval.

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Questions 7

A patient who survives near-drowning develops hypoxia-induced cerebral edema. Interventions should include

Options:

A.

administration of osmotic diuretics.

B.

maintaining a MAP of 60-70 mm Hg.

C.

keeping the patient flat, in a supine position.

D.

hyperventilation to maintain PaCO2 of 40-45 mm Hg.

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Questions 8

An older adult patient reports an inability to sleep due to staff waking the patient for frequent neurological assessments. In order to minimize sleep disruptions, the nurse should

Options:

A.

encourage the patient to sleep between assessments.

B.

discontinue neurologic assessments.

C.

establish a schedule with the provider.

D.

move the patient to the quieter part of the unit.

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Questions 9

A patient with a left ventricular assist device has been hospitalized for 5 days. A nurse notes anasarca and skin breakdown over multiple pressure points. When addressing the patient's nutritional needs, which of the following should the nurse consider?

Options:

A.

Edema may mask physical signs of protein calorie malnutrition.

B.

Initial signs may include low hemoglobin and hematocrit.

C.

Parenteral administration of amino acids is the first-line treatment.

D.

Lipids are needed for the utilization of protein calorie replacements.

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Questions 10

A patient with a history of alcohol abuse has been admitted for progressive dyspnea and leg swelling. Assessment findings include:

BP155/90

HR85

CVP12 mm Hg

Which of the following tests will provide the most definitive diagnosis?

Options:

A.

echocardiogram

B.

pro-BNP

C.

chest x-ray

D.

liver function panel

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Questions 11

Which of the following diagnostic procedures best pinpoints the location, size, and origin of a cerebral aneurysm?

Options:

A.

MRI

B.

cerebral angiography

C.

positron emission tomography (PET) scanning

D.

CT scanning

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Questions 12

An unconscious patient presents with the following laboratory values:

CCRN-Adult Question 12

Appropriate management of this patient should include

Options:

A.

IV hydration.

B.

hemodialysis.

C.

intubation.

D.

osmotic diuresis.

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Questions 13

Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include

Options:

A.

decreases in PT and thrombin time.

B.

increases in PT, PTT, and FSP (FDP).

C.

increases in platelet count and fibrinogen.

D.

decreases in platelet count, thrombin time, and FSP (FDP).

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Questions 14

A patient is intubated, is unable to follow simple commands, and has no history of alcohol abuse. The patient has become increasingly disoriented and confused over the past 24 hours. After assessment and treatment of pain, the best medication intervention for management is

Options:

A.

lorazepam (Ativan).

B.

cisatracurium (Nimbex).

C.

midazolam (Versed).

D.

dexmedetomidine (Precedex).

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Questions 15

A patient who sustained acute head trauma exhibited intermittent unconsciousness prior to admission. The patient is disoriented initially and exhibits rapid deterioration in neurological status shortly after admission. X-rays reveal a right temporal bone fracture, and a diagnosis of epidural hematoma is made. The deterioration in the patient's condition is most likely associated with

Options:

A.

arterial bleeding.

B.

venous bleeding.

C.

clot formation.

D.

intracranial aneurysm.

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Questions 16

In a patient with a chest tube, an air leak in the pleural space is indicated by which of the following conditions in the water-seal chamber?

Options:

A.

fluctuation increases

B.

bubbling increases

C.

fluctuation is absent

D.

bubbling stops

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Questions 17

A patient who underwent bowel resection surgery due to small bowel rupture is tachycardic and hypotensive. A nurse calls the on-call surgical resident and reports the findings. No new orders are received. The nurse should continue to monitor the patient and

Options:

A.

notify the charge nurse during nightly rounds.

B.

inform the clinical manager in the morning.

C.

initiate the rapid response team.

D.

consult the nearest nursing colleague.

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Questions 18

A patient is admitted for acute benzodiazepine overdose. Nursing interventions should include administration of

Options:

A.

sodium bicarbonate.

B.

flumazenil (Romazicon).

C.

naloxone (Narcan).

D.

osmotic diuretics.

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Questions 19

A nurse is precepting an experienced critical care nurse who is new to the facility. To develop the orientation plan, which of the following should the preceptor do first?

Options:

A.

Determine the knowledge and skills the new nurse needs to learn.

B.

Teach the new nurse about unit routines and practices.

C.

Explain patient care policies and procedures to the new nurse.

D.

Introduce the new nurse to staff and team members on the unit.

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Questions 20

Assessment of a patient with a head injury reveals increased muscle tone and contractured positioning of the upper extremities. A nurse should

Options:

A.

use wrist restraints to maintain upper extremity extension.

B.

obtain an order for a muscle relaxer.

C.

recognize that contractures are an expected response after a head injury.

D.

consult a physical therapist regarding appropriate positioning.

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Questions 21

A patient is admitted with a femoral shaft fracture and an oblique fracture of three ribs on the right side. The patient suddenly reports shortness of breath. Assessment reveals new-onset headache, central and peripheral cyanosis, and petechiae of the neck and anterior chest wall. Available data are:

CCRN-Adult Question 21

The nurse should suspect the development of

Options:

A.

a pulmonary embolus.

B.

sepsis.

C.

acute pulmonary edema.

D.

a fat embolus

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Questions 22

A patient is receiving continuous enteral feedings via jejunostomy tube. The patient develops mild, intermittent diarrhea. Which of the following actions is most appropriate?

Options:

A.

Obtain an abdominal x-ray.

B.

Review the patient's formula with nutrition services.

C.

Contact the physician for an order to hold feedings.

D.

Consider PICC line placement.

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Questions 23

A patient is admitted for sepsis secondary to pneumonia. The patient has received 2000 mL of plasmalyte and their BP remains 80/50. What should the nurse anticipate next for the patient?

Options:

A.

dopamine

B.

norepinephrine

C.

1L of plasmalyte

D.

vasopressin

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Questions 24

A patient who is post repair of an abdominal aortic aneurysm should be monitored for which of the following complications?

Options:

A.

acute renal failure

B.

acute hepatic dysfunction

C.

acute CVA

D.

atrial fibrillation

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Questions 25

Following a splenectomy, a patient is most at risk for

Options:

A.

sepsis.

B.

pulmonary embolism.

C.

hypertension.

D.

wound dehiscence.

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Questions 26

The family of a patient with trauma believes that the patient is in pain and requests that a neighbor, a therapeutic touch practitioner, be allowed to see the patient. Unit policy allows visits by immediate family only. Which of the following is the most important consideration in a nurse's decision about facilitating the visit?

Options:

A.

Alternative modalities have been associated with enhancements in pharmacologic effects.

B.

Research does not support the value of therapeutic touch in pain management.

C.

Alternative therapies are not generally acceptable in an ICU setting.

D.

The family needs an explanation of the rationale for unit visitation policies.

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Questions 27

A patient with a hemorrhaging renal laceration has received two units of PRBCs and 500 mL of NS via IV bolus. Assessment reveals: BP 78/42; HR 148; UO 15 mL/hr; skin is cool and diaphoretic. While preparing the patient for emergency surgery, a nurse should administer

Options:

A.

norepinephrine (Levophed), 10 mcg/min.

B.

an additional 500-mL bolus of NS.

C.

mannitol (Osmitrol), 25 g IV.

D.

dopamine (Intropin), 3 mcg/kg/min.

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Questions 28

Which of the following is most indicative of successful treatment for salicylate poisoning?

Options:

A.

osmotic diuresis

B.

decrease in gastric pH

C.

decrease in CPK

D.

alkalinization of urine

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Questions 29

An oncology patient presents with hematuria and bleeding from previous injection sites. Which diagnostic test result should the nurse review first?

Options:

A.

complete blood count

B.

arterial blood gas

C.

complete metabolic panel

D.

coagulation panel

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Questions 30

A patient with a C5 spinal cord injury calls the nurse every 15 minutes with requests for juice, water, and repositioning. Which of the following is the nurse's best response?

Options:

A.

"You need to be repositioned only every 2 hours."

B.

"You are safe. Nothing will happen to you."

C.

"I will check on you every 30 minutes."

D.

"I will get someone to sit with you."

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Questions 31

Which of the following serum laboratory results is most concerning to a nurse who is caring for a patient with a Stage Ill pressure ulcer on the coccyx?

Options:

A.

albumin 2.1 mg/dL

B.

hemoglobin 10.2 mg/dL

C.

WBC 6,000/mm3

D.

glucose 125 mg/dL

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Questions 32

An older adult patient is admitted with acute exacerbation of congestive heart failure. An echocardiogram indicates that EF is unchanged at 50%. The patient is most likely experiencing

Options:

A.

heart failure with reduced EF.

B.

heart failure with preserved EF.

C.

left ventricular failure.

D.

advanced heart failure.

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Questions 33

In septic shock, a mixed venous O2 saturation (SO2) of 84% indicates that

Options:

A.

O2 delivery to tissues is inadequate due to shunting.

B.

the mixed venous pO2 is low.

C.

venous pO2 and saturation are irrelevant to tissue perfusion.

D.

the tissue cells are being well oxygenated.

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Questions 34

In order to meet the spiritual needs of critically ill patients and their families, which of the following should the nurse understand regarding chaplain services?

Options:

A.

The chaplain may be of a specific denomination, but the chaplain provides resources to patients of many faiths and beliefs.

B.

The service should be provided only when specifically requested by the patient or family.

C.

A chaplain's visit will not benefit a patient who is comatose or non-communicative.

D.

It would be inappropriate for the hospital chaplain to document in the medical record.

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Questions 35

Which of the following are physiologic effects of pulmonary contusion?

Options:

A.

increased dead space and decreased airway resistance

B.

increased gas diffusion and decreased lung compliance

C.

increased airway resistance and decreased gas diffusion

D.

increased lung compliance and decreased dead space

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Questions 36

A patient has a linear skull fracture with multisystem trauma. The patient's vital signs are as follows:

BP 80/50

HR120

CVP2 mm Hg

Which of the following is the most appropriate explanation for this patient's condition?

Options:

A.

The patient has lost a significant amount of blood because of intracranial hemorrhage.

B.

Fluid regulation by the neurohypophysis is impaired because of increased intracranial pressure.

C.

Parasympathetic stimulation is causing significant vasodilatation and pooling of blood.

D.

Blood loss is occurring from a noncerebral injury.

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Questions 37

Which of the following are most indicative of acute pancreatitis?

Options:

A.

abdominal distention, decreased lipase level, hypertension

B.

Grey Turner's sign, hyperkalemia, right shoulder pain

C.

hypotension, jaundice, hyperalbuminuria

D.

severe mid-epigastric pain, leukocytosis, hypocalcemia

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Questions 38

A patient is admitted following a motor vehicle crash. A fluid challenge is initiated immediately after assessing a BP of 80/palpable. Fifteen minutes later,

vital signs are as follows:

BP 86/50

HR 150

RR 36

The most appropriate action should be to

Options:

A.

administer a vasopressor.

B.

administer a second fluid challenge.

C.

request a CT scan of the chest.

D.

request an abdominal ultrasound.

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Questions 39

Treatment of cerebral vasospasm includes administration of

Options:

A.

lorazepam (Ativan).

B.

propranolol (Inderal).

C.

nimodipine (Nimotop).

D.

pentobarbital (Nembutal).

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Questions 40

A physician tries three times to insert a central line, then says, "I think I can get it this time." A nurse should

Options:

A.

suggest that another physician insert the line.

B.

administer an analgesic.

C.

allow the physician to try again.

D.

start a peripheral line.

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Questions 41

Which of the following should the nurse expect in a patient with papillary muscle dysfunction?

Options:

A.

mitral insufficiency

B.

aortic stenosis

C.

mitral stenosis

D.

aortic insufficiency

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Questions 42

A ventilator-associated event (VAE) is best prevented by

Options:

A.

tracheal instillation of normal saline.

B.

changing ventilator tubing daily.

C.

minimizing tube feedings.

D.

subglottic suctioning.

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Questions 43

The water retention associated with SIADH is characterized by

Options:

A.

fluid intake greater than UO, weight gain, and increased urine osmolality and sodium.

B.

UO greater than fluid intake, extreme weight gain, and mild (2+) pitting edema.

C.

UO greater than fluid intake and severe (4+) pitting edema.

D.

fluid intake greater than UO, increased serum osmolality and sodium, and severe (4+) pitting edema.

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Questions 44

A nurse is caring for a patient with pulmonary fibrosis who is exhibiting shortness of breath, tachypnea, and feels a sense of impending doom. In order to relieve these symptoms, the nurse should anticipate an order for

Options:

A.

morphine.

B.

hydromorphone.

C.

lorazepam.

D.

diazepam.

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Questions 45

A patient is receiving therapeutic hypothermia post-cardiac arrest. Which of the following orders should a nurse clarify?

Options:

A.

chemistry labs every day

B.

ABGs every 4 hours and with any ventilator changes

C.

hourly intake and output

D.

sequential compression devices

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Exam Code: CCRN-Adult
Exam Name: CCRN (Adult) - Direct Care Eligibility Pathway
Last Update: Dec 4, 2024
Questions: 150

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