CCRN-ADULT sample questions

Question 1

A 64-year-old male is admitted to the intensive care unit following an emergent endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR). Postoperative orders include continuous nicardipine infusion to maintain systolic blood pressure between 100 and 120 mmHg.

Four hours after admission, the patient suddenly reports excruciating lumbar back pain and dizziness. On assessment, the nurse notes heart rate 124 beats/min (sinus tachycardia), blood pressure 78/48 mmHg, respiratory rate 24 breaths/min, and urinary output declining to 10 mL over the last hour. Physical examination reveals cool extremities, diaphoresis, and a faint, non-palpable left dorsalis pedis pulse that was previously +2.

Which immediate set of nursing interventions must the critical care nurse prioritize?

Accepted Answer

Discontinue the nicardipine infusion, initiate rapid resuscitation with intravenous fluids and blood products, and urgently notify the vascular surgical team.

Answer

Titrate nicardipine upward to maintain end-organ perfusion and administer intravenous hydromorphone for operative pain control.

Answer

Place the patient in reverse Trendelenburg position, administer an intravenous furosemide bolus, and obtain a stat non-contrast abdominal radiograph.

Answer

Maintain current nicardipine rate, draw serum cardiac biomarkers, and apply bilateral lower extremity sequential compression devices.

Question 2

A patient with an extensive acute anterior wall ST-elevation myocardial infarction suddenly develops a new second-degree Mobitz Type II AV block with a ventricular rate of 38 beats/min and blood pressure of 78/46 mmHg. Which TWO emergency interventions should the critical care nurse execute immediately? (Select TWO)

Accepted Answer

Prepare for immediate transvenous pacemaker placement.

Accepted Answer

Initiate emergent transcutaneous pacing.

Answer

Administer adenosine 6 mg rapid intravenous push.

Answer

Perform synchronized electrical cardioversion at 100 Joules.

Answer

Administer atropine 1 mg intravenous push every 3 to 5 minutes.

Question 3

A mechanically ventilated patient with severe acute respiratory distress syndrome (ARDS) secondary to viral pneumonia has a PaO2/FiO2 ratio of 88 mmHg despite optimal PEEP titration and neuromuscular blockade. The critical care team decides to implement prone positioning. Which physiological mechanism explains the therapeutic improvement in oxygenation achieved by prone positioning?

Accepted Answer

Decreased compressive forces of the heart and abdomen on dorsal lung segments, promoting alveolar recruitment and more homogeneous ventilation-perfusion matching.

Answer

Direct stimulation of endogenous surfactant production by the chest wall contact pressures.

Answer

Shifting of pulmonary blood flow exclusively into ventral alveoli while suppressing dorsal perfusion.

Answer

Marked increase in total lung compliance by stiffening the ventral rib cage and diaphragm.

Question 4

A critically ill patient who is volume-controlled mechanically ventilated triggers a high peak inspiratory pressure alarm. The critical care nurse performs an inspiratory hold maneuver and observes that the peak inspiratory pressure (PIP) has increased from 24 cmH2O to 46 cmH2O, while the plateau pressure (Pplat) remains stable at 18 cmH2O. What is the primary clinical etiology of this pressure discrepancy?

```mermaid
flowchart TD
Alarm[High Peak Pressure Alarm]
Alarm --> Assess{Inspiratory Hold: Check Pplat}
Assess -->|Pplat Normal, PIP Elevated| HighResist[Increased Airway Resistance]
Assess -->|Both PIP and Pplat Elevated| LowComp[Decreased Lung Compliance]
```

Accepted Answer

Increased airway resistance, such as endotracheal tube kinking, biting, or bronchospasm.

Answer

Severe acute pulmonary edema with alveolar fluid flooding.

Answer

Worsening abdominal compartment syndrome compressing lung parenchyma.

Answer

Development of a tension pneumothorax causing decreased thoracic compliance.

Question 5

True or False: In a mechanically ventilated patient with a chest tube placed for a pneumothorax, continuous, vigorous bubbling across both inspiration and expiration in the water-seal chamber indicates a leak within the drainage system or chest tube connection rather than a simple resolving pleural air leak.

Accepted Answer

True

Answer

False

Question 6

A 28-year-old female with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Following 4 hours of intravenous 0.9% normal saline resuscitation and continuous regular insulin infusion, laboratory values reveal: serum glucose 218 mg/dL, potassium 4.2 mEq/L, sodium 138 mEq/L, serum bicarbonate 14 mEq/L, and calculated anion gap 19 mEq/L. Which intravenous fluid and insulin titration order should the critical care nurse implement next?

Accepted Answer

Change intravenous fluids to 5% dextrose in 0.45% normal saline with potassium while maintaining the continuous insulin infusion until the anion gap normalizes.

Answer

Double the continuous insulin infusion rate to resolve the acidosis rapidly while continuing 0.9% normal saline boluses.

Answer

Discontinue the intravenous insulin infusion and transition the patient immediately to subcutaneous glargine and lispro.

Answer

Administer an ampule of 8.4% sodium bicarbonate intravenously and hold all potassium supplementation until urine output exceeds 100 mL/hr.

Free CCRN-ADULT sample questions

6 more free samples are waiting