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NEW QUESTION # 219
A patient who is confused and dyspneic is admitted with ABG values that reveal hypoxemia. Results from insertion of a pulmonary artery catheter are:
PAP 38/18 mm Hg
PAOP10 mm Hg
CI 3.5 L/min/m2
These values are most indicative of
- A. hypervolemia.
- B. hypovolemia.
- C. pulmonary dysfunction.
- D. left ventricular failure.
Answer: C
Explanation:
The patient's ABG values show hypoxemia, which is a low level of oxygen in the blood. This can be caused by various pulmonary disorders that impair gas exchange, such as pneumonia, pulmonary edema, pulmonary embolism, or acute respiratory distress syndrome (ARDS). The patient's PAP (pulmonary artery pressure) is elevated, indicating increased resistance in the pulmonary circulation. This can also result from pulmonary dysfunction, as the lungs become stiff and inflamed, or from pulmonary hypertension, which is a chronic condition that affects the small arteries in the lungs. The patient's PAOP (pulmonary artery occlusion pressure) is normal, suggesting that the left ventricle is not failing and that the patient is not hypovolemic or hypervolemic. The patient's CI (cardiac index) is also normal, indicating adequate cardiac output. Therefore, the most likely cause of the patient's hypoxemia and dyspnea is pulmonary dysfunction.
References:
* AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
* AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
NEW QUESTION # 220
Which of the following is NOT a primary ethical principle?
- A. Veracity
- B. Beneficence
- C. Nonmaleficence
- D. Autonomy
Answer: A
Explanation:
Ethical principles consist of four primary ethical principles and derivative principles that are derived from the four primary principles. The four primary ethical principles are autonomy, justice, beneficence, and nonmaleficence. Veracity is a derivative principle that is derived from both beneficence and nonmaleficence.
NEW QUESTION # 221
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?
- A. Administer naloxone
- B. Gastric lavage
- C. Initiate ventilatory support
- D. Activated charcoal
Answer: C
Explanation:
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.
NEW QUESTION # 222
All of the following factors increase the risk for the development of Ventilator-Associated Pneumonia (VAP) in the critically ill patient EXCEPT:
- A. use of medications that neutralize acidic gastric contents such as antacids, H2 blockers, and proton- pump inhibitors
- B. aspiration of increased gastric secretions in the presence of endotracheal tubes
- C. tube feedings
- D. use of chlorhexidine gluconate when performing oral care
Answer: D
Explanation:
Using an oral chlorhexidine gluconate rinse when performing oral care on a critically ill, ventilated patient decreases the risk of developing VAP.
Use of medications that neutralize acidic gastric contents and tube feedings allow increased growth of gram-negative bacteria in gastric contents, thus increasing the risk of developing VAP. In addition, aspirating gastric secretions can greatly increase the risk of VAP development, even in the presence of an ET tube.
NEW QUESTION # 223
What is the nonsurgical intervention for the treatment of Peripheral Artery Disease (PAD)?
- A. Angioplasty
- B. Cardiac catheterization
- C. Angiography
- D. Endarterectomy
Answer: A
Explanation:
Angioplasty is a minimally invasive, endovascular procedure to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. Angioplasty, with and without stent placement, is recommended in patients with severe PAD that is amendable by the nonsurgical route. A deflated balloon attached to a catheter is passed over a guide-wire into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing improved blood flow. A stent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn. Stents may keep the arteries open with a lower restenosis rate over angioplasty alone.
Angiography is a diagnostic test, not an intervention, in the treatment of PAD. Endarterectomy is a surgical intervention to remove or bypass the fatty deposits, or blockage, in an artery narrowed by the buildup of fatty tissue (atherosclerosis). Cardiac catheterization is used for evaluation of valvular heart disease, not PAD.
NEW QUESTION # 224
Which of the following electrolyte imbalances would the nurse expect to see in the patient diagnosed with acute pancreatitis?
- A. Hyperkalemia
- B. Hypophosphatemia
- C. Hypernatremia
- D. Hypocalcemia
Answer: D
Explanation:
Hypocalcemia is most often associated with pancreatitis. The patient with acute pancreatitis would most likely have the following electrolyte abnormalities:
* Hypocalcemia (serum calcium < 8.5 mg/dL)
* Hyponatremia (serum sodium < 135 mEq/L)
* Hypokalemia (serum potassium < 3.5 mEq/L)
* Hypomagnesemia (serum magnesium < 1.5 mg/dL)
NEW QUESTION # 225
The critical care nurse just received report on a female patient with new-onset generalized tonic-clonic (grand mal) seizures. While at her bedside, the nurse witnesses a seizure.
What should the nurse's FIRST action be?
- A. Position the patient on her side and provide supplemental oxygen
- B. Position the patient on her side and place pillows and blankets around the bed rails for padding
- C. Position the patient on her side and call a rapid response team (RRT)
- D. Position the patient on her side and insert an oral airway
Answer: A
Explanation:
From a nursing perspective, the first priority is to protect the patient from injury. Ensure a safe environment during the seizure by clearing objects out of the area. Position the patient on her side to decrease aspiration risk, and provide supplemental oxygen to assist with maintaining adequate cerebral oxygenation.
Padded side rails are no longer considered routine care and are indicated only for patients at high risk.
Because the seizure has already started, it is impossible to insert an oral airway safely. Never try to restrain a seizing patient; movement is strong and involuntary, and you and the patient could be harmed. Hitting the code button or calling an RRT can be done, but will not immediately help the patient.
The nurse should also assess for precipitating events, aura, onset, duration, medication or interventions that stopped the seizure, if any, and postictal state. All should be documented in the nursing note after the seizure has ended.
NEW QUESTION # 226
A patient who was admitted after an open aortofemoral bypass for claudication at rest has a hemoglobin A1C of 8.9. The patient admits having poor control of blood glucose levels and is scared to use insulin as directed because of a few episodes of hypoglycemia. Which of the following should the nurse initially request to be consulted?
- A. diabetes educator
- B. hospital pharmacist
- C. vascular surgeon
- D. endocrinology
Answer: A
NEW QUESTION # 227
A family of a critically ill patient has a meeting with the healthcare team. The family is struggling to understand the patient's prognosis and asks the nurse to simplify the medical jargon used by the physicians. How should the nurse respond?
- A. The nurse should inform the patient that doing so is not within their scope of practice
- B. The nurse should advise the family to research the medical terms themselves and provide them with resources where they can do this
- C. The nurse should ask the physicians to reexplain the information, simplifying their language
- D. The nurse should attempt to explain the situation in simpler terms
Answer: D
Explanation:
The nurse's responsibility of collaboration involves cooperation with patients and their families. The nurse, in their role as patient advocate, should attempt to explain the medical terms in simpler language. Asking the physicians to simplify their language may also be helpful, but it is within the nurse's scope to clarify terminology used in information that has already been provided..Asking the family to do their own research is not patient-centered and refusing to explain is based on the nurse's scope of practice is incorrect.
NEW QUESTION # 228
The MOST common type of cardiomyopathy is:
- A. Dilated
- B. Hypertrophic
- C. Restrictive
- D. Obstructive
Answer: A
Explanation:
Cardiomyopathy, a disease involving the destruction of the cardiac muscle fibers, causes impairment of myocardial function and decreased cardiac output. Cardiomyopathies are commonly classified into three types:
1. Dilated (most common): Commonly caused by CAD (Coronary Artery Disease_ and associated with impaired myocardial contractility and increased ventricular filling pressures
2. Hypertrophic: Categorized as obstructive and nonobstructive
3. Restrictive (least common): A classic finding is ventricular fibrosis, often caused by infiltration of the cardiac myocytes with abnormal tissue (i.e., sarcoid or amyloid disease)
NEW QUESTION # 229
A ventilator-associated event (VAE) is best prevented by
- A. minimizing tube feedings.
- B. changing ventilator tubing daily.
- C. subglottic suctioning.
- D. tracheal instillation of normal saline.
Answer: C
Explanation:
Ventilator-associated events (VAEs) can be prevented by reducing the risk of aspiration and maintaining airway hygiene. Subglottic suctioning is an effective measure to remove secretions that accumulate above the endotracheal tube cuff, which can harbor bacteria and lead to infection. This intervention helps prevent the development of pneumonia and other VAEs. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 230
An unconscious patient just had an endotracheal tube inserted orally for intubation. The critical care nurse knows which of the following interventions should be performed INITIALLY to confirm proper tube placement?
- A. Ensure proper cuff inflation
- B. Use an end-tidal CO2 with waveform verification monitor
- C. Auscultate the chest for bilateral breath sounds
- D. Obtain a chest x-ray
Answer: C
Explanation:
Once an endotracheal tube (ETT) has been placed, the nurse should initially listen for bilateral breath sounds, along with equal chest excursion during inspiration. The nurse should confirm the presence of bilateral breath sounds over the chest and the absence of breath sounds over the stomach, as this preliminarily confirms proper tube placement.
Next, an end-tidal CO2 with waveform verification monitor is used as an immediate assessment for determining tracheal placement. If not available, a colorimetric CO2 detector may be used.
A portable chest x-ray verifies proper tube placement. Once proper placement is confirmed, the tube is anchored to prevent movement with tape or a special ET fixation device, and the centimeter lip-line marking is documented and checked each shift. Finally, the cuff of the tube is inflated with just enough air to create an effective seal.
NEW QUESTION # 231
A patient presents with fever and chills, is diaphoretic, and reports experiencing abdominal and intermittent left shoulder pain for the past week. An ultrasound shows an enlarged spleen. Vital signs are:
BP 106/59
HR 118
RR 23
T101.2° F (38.4° C)
When reviewing the lab report, which of the following findings is most significant to this presentation?
- A. PLT 150,000/mm3
- B. positive blood cultures
- C. Hct 39%
- D. WBC less than 500/mm3
Answer: B
Explanation:
Splenomegaly
An x-ray of a person's body Description automatically generated
The patient's presentation is suggestive of splenic abscess, which is a rare but serious complication of splenomegaly. Splenic abscess is caused by bacterial or fungal infection of the spleen, usually from hematogenous spread or contiguous spread from adjacent organs. The most common symptoms are fever, chills, abdominal pain, and left shoulder pain (Kehr sign). The most significant laboratory finding is positive blood cultures, which indicate systemic infection and sepsis. Other laboratory findings may include leukocytosis, anemia, thrombocytopenia, elevated inflammatory markers, and abnormal liver function tests.
However, these are nonspecific and may vary depending on the underlying cause of splenomegaly and the type of microorganism involved.
References:
* Splenic Abscess - Infectious Disease Advisor
* Cross-sectional imaging findings of splenic infections: is ... - Springer
NEW QUESTION # 232
A 69-year-old female with a history of hearing-impairment was admitted to the medical-surgical unit for syncope four days ago. The nurse notes that the patient has been intermittently confused over the past
12 hours, appears more withdrawn, and is not interacting with her visitors as much today as usual.
What is the MOST appropriate nursing action?
- A. Keep the lights on in the room so the patient can see where she is at all times
- B. Place the patient on the unit sleep protocol and review their medication list
- C. Discuss with the physician the need for an antidepressant
- D. Move the patient to a private room and limit visitors
Answer: B
Explanation:
Delirium, an alteration in mental status, is of particular importance in critically ill patients because the development of this condition is associated with worseclinical outcomes. It is characterized by acute changes in mental status, inattention, and cognitive changes or perceptual disturbances. The hospital environment and change in routine are the first things to consider as causes of delirium.
Lighting can help with safety concerns, but this might disrupt sleep even more, making the delirium worse. The patient should not be moved to a private room, as the lack of stimulation might make the delirium worse. Before prescribing medications, medications should be reviewed, and a diagnosis should be made.
NEW QUESTION # 233
Many ventilators have a mode that allows the patient to breathe spontaneously without ventilator support. This mode of ventilation is often identified as:
- A. Assist-control (A/C)
- B. Synchronized intermittent mandatory ventilation (SIMV)
- C. Continuous positive airway pressure (CPAP)
- D. Volume-control (VC)
Answer: C
Explanation:
CPAP is a form of positive airway pressure ventilation, which applies mild air pressure on a continuous basis to keep the airways continuously open in patients who are able to breathe spontaneously on their own.
SIMV, A/C, and VC modes of ventilation deliver a predetermined number and volume of breaths each minute, and are indicated for the patient who is not breathing spontaneously.
NEW QUESTION # 234
The underlying pathophysiology of disseminated intravascular coagulation (DIC) is best explained as
- A. depression of platelet aggregation.
- B. depletion of clotting factors.
- C. inactivation of tissue thromboplastin.
- D. fragmentation of erythrocytes.
Answer: B
Explanation:
Disseminated intravascular coagulation (DIC) is a condition where blood clots form excessively and block blood vessels, leading to organ damage and bleeding. The pathophysiology of DIC involves excess and unregulated thrombin generation, which consumes coagulation factors and platelets, and activates fibrinolysis1. Thus, in severe DIC there is paradoxically simultaneous thrombosis and spontaneous bleeding2.
This is due to the depletion of clotting factors, which is a key aspect of the underlying pathophysiology of DIC12.
NEW QUESTION # 235
A patient reported to have smoked crack cocaine is brought to the hospital by paramedics and admitted in an agitated state. On the way to the hospital, the patient had a generalized seizure. The toxicology screen is positive for cocaine. Which of the following is most appropriate to administer?
- A. activated charcoal
- B. naloxone (Narcan)
- C. ipecac
- D. lorazepam (Ativan)
Answer: D
Explanation:
Lorazepam (Ativan) is most appropriate to administer in a patient who has smoked crack cocaine and is agitated, particularly after a generalized seizure. Benzodiazepines like lorazepam help to manage agitation and seizure activity associated with cocaine toxicity by providing sedative and anticonvulsant effects.References: = CCRN Exam Handbook, page 53
NEW QUESTION # 236
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