CCRN General Review — Questions and Answers
Question 1: A patient with acute decompensated heart failure has a pulmonary artery wedge pressure of 24 mmHg. What does this elevated value indicate?
- Increased left atrial/left ventricular filling pressure (Correct answer)
- Right ventricular failure
- Hypovolemia
- Pulmonary embolism
Correct answer: Increased left atrial/left ventricular filling pressure
An elevated PAWP reflects increased left-sided filling pressures, typical of left heart failure.
Question 2: Which arterial blood gas result indicates uncompensated respiratory acidosis?
- pH 7.30, PaCO2 55, HCO3 24 (Correct answer)
- pH 7.50, PaCO2 30, HCO3 24
- pH 7.34, PaCO2 60, HCO3 32
- pH 7.40, PaCO2 40, HCO3 24
Correct answer: pH 7.30, PaCO2 55, HCO3 24
Low pH with high PaCO2 and normal HCO3 indicates uncompensated respiratory acidosis.
Question 3: A patient develops sudden hypotension, jugular venous distension, and muffled heart sounds after cardiac surgery. What is the most likely diagnosis?
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
- Septic shock
- Myocardial infarction
Correct answer: Cardiac tamponade
Beck's triad—hypotension, JVD, and muffled heart sounds—is classic for cardiac tamponade.
Question 4: What is the priority intervention for a patient in pulseless ventricular tachycardia?
- Immediate defibrillation (Correct answer)
- Synchronized cardioversion
- Administer adenosine
- Vagal maneuvers
Correct answer: Immediate defibrillation
Pulseless VT is a shockable rhythm requiring immediate defibrillation.
Question 5: A patient receiving heparin develops a platelet count drop from 250,000 to 80,000. What condition should be suspected?
- Heparin-induced thrombocytopenia (Correct answer)
- Disseminated intravascular coagulation
- Idiopathic thrombocytopenic purpura
- Aplastic anemia
Correct answer: Heparin-induced thrombocytopenia
A significant platelet drop after heparin exposure suggests HIT, requiring heparin discontinuation.
Question 6: Which finding best indicates effective fluid resuscitation in a patient with septic shock?
- Urine output greater than 0.5 mL/kg/hr (Correct answer)
- Heart rate of 120 bpm
- Mean arterial pressure of 55 mmHg
- Decreasing level of consciousness
Correct answer: Urine output greater than 0.5 mL/kg/hr
Adequate urine output indicates restored perfusion to the kidneys and effective resuscitation.
Question 7: A mechanically ventilated patient suddenly desaturates with high peak pressures and absent breath sounds on the right. What is the most likely cause?
- Tension pneumothorax (Correct answer)
- Endotracheal tube migration into the esophagus
- Atelectasis
- Pulmonary edema
Correct answer: Tension pneumothorax
Sudden desaturation with high pressures and unilateral absent breath sounds suggests tension pneumothorax.
Question 8: A patient with diabetic ketoacidosis has a serum potassium of 5.8 mEq/L. Why must potassium be monitored closely during insulin therapy?
- Insulin drives potassium into cells, causing rapid hypokalemia (Correct answer)
- Insulin raises serum potassium
- Potassium does not change with insulin
- Insulin causes potassium retention by the kidneys
Correct answer: Insulin drives potassium into cells, causing rapid hypokalemia
Insulin shifts potassium intracellularly, so serum levels can fall quickly during DKA treatment.
Question 9: Which ECG change is the earliest sign of hyperkalemia?
- Peaked T waves (Correct answer)
- ST elevation
- Prolonged QT interval
- U waves
Correct answer: Peaked T waves
Tall, peaked T waves are the earliest ECG manifestation of hyperkalemia.
Question 10: A patient with increased intracranial pressure shows Cushing's triad. Which set of vital signs reflects this?
- Hypertension, bradycardia, irregular respirations (Correct answer)
- Hypotension, tachycardia, rapid respirations
- Hypertension, tachycardia, apnea
- Hypotension, bradycardia, deep respirations
Correct answer: Hypertension, bradycardia, irregular respirations
Cushing's triad is hypertension with widened pulse pressure, bradycardia, and irregular respirations.
Question 11: What is the primary goal when managing a patient with acute respiratory distress syndrome on the ventilator?
- Low tidal volume lung-protective ventilation (Correct answer)
- High tidal volumes to maximize oxygenation
- Minimizing PEEP
- Permissive hyperoxia
Correct answer: Low tidal volume lung-protective ventilation
Low tidal volume (6 mL/kg) ventilation reduces ventilator-induced lung injury in ARDS.
Question 12: A post-operative patient has a sudden drop in blood pressure, tachycardia, and cool clammy skin. Which type of shock is most likely?
- Hypovolemic shock (Correct answer)
- Neurogenic shock
- Anaphylactic shock
- Cardiogenic shock from tamponade
Correct answer: Hypovolemic shock
Hemorrhage causing hypovolemia presents with hypotension, tachycardia, and cool clammy skin.
Question 13: Which lab value is most specific for myocardial cell injury?
- Troponin I (Correct answer)
- Myoglobin
- CK total
- LDH
Correct answer: Troponin I
Troponin I is the most cardiac-specific and sensitive marker of myocardial injury.
Question 14: A patient with severe sepsis has a lactate of 4.5 mmol/L. What does this elevated lactate indicate?
- Tissue hypoperfusion and anaerobic metabolism (Correct answer)
- Adequate oxygen delivery
- Metabolic alkalosis
- Improving organ perfusion
Correct answer: Tissue hypoperfusion and anaerobic metabolism
Elevated lactate reflects anaerobic metabolism from tissue hypoperfusion in sepsis.
Question 15: A patient with a chest tube has continuous bubbling in the water-seal chamber. What does this most likely indicate?
- An air leak in the system or patient (Correct answer)
- Normal lung re-expansion
- Tube obstruction
- Complete lung healing
Correct answer: An air leak in the system or patient
Continuous bubbling in the water-seal chamber indicates an air leak that must be investigated.
Question 16: Which intervention is most appropriate for a patient with symptomatic bradycardia unresponsive to atropine?
- Transcutaneous pacing (Correct answer)
- Synchronized cardioversion
- Administer beta-blocker
- Vagal maneuvers
Correct answer: Transcutaneous pacing
Transcutaneous pacing is the next step when atropine fails to treat symptomatic bradycardia.
Question 17: A patient on a continuous insulin infusion has a glucose of 65 mg/dL. What is the priority nursing action?
- Treat hypoglycemia and recheck glucose (Correct answer)
- Increase the insulin rate
- Continue the infusion unchanged
- Administer additional insulin bolus
Correct answer: Treat hypoglycemia and recheck glucose
A glucose of 65 mg/dL requires treating hypoglycemia and rechecking before continuing insulin.
Question 18: Which clinical sign is most consistent with right ventricular failure?
- Jugular venous distension and peripheral edema (Correct answer)
- Pulmonary edema and crackles
- Orthopnea
- Pink frothy sputum
Correct answer: Jugular venous distension and peripheral edema
Right-sided failure causes systemic venous congestion, leading to JVD and peripheral edema.
Question 19: A patient with acute kidney injury has a rising creatinine and a urine output of 15 mL/hr. Which electrolyte imbalance poses the greatest immediate threat?
- Hyperkalemia (Correct answer)
- Hypocalcemia
- Hyponatremia
- Hypomagnesemia
Correct answer: Hyperkalemia
Hyperkalemia in oliguric AKI can cause life-threatening cardiac dysrhythmias.
Question 20: What is the most reliable indicator of correct endotracheal tube placement after intubation?
- Waveform capnography confirming end-tidal CO2 (Correct answer)
- Auscultation of breath sounds alone
- Chest rise
- Pulse oximetry reading
Correct answer: Waveform capnography confirming end-tidal CO2
Continuous waveform capnography is the most reliable method to confirm ET tube placement.
Question 21: A patient develops flushing, hypotension, and wheezing minutes after starting a blood transfusion. What is the priority action?
- Stop the transfusion immediately (Correct answer)
- Slow the transfusion rate
- Administer acetaminophen
- Continue and monitor closely
Correct answer: Stop the transfusion immediately
These signs indicate a transfusion reaction, and the transfusion must be stopped immediately.
