Free CCRN: Critical Care Registered Nurse Exam Questions and Answers

A patient with advanced heart failure secondary to ischemic cardiomyopathy is admitted with increasing orthopnea, bilateral crackles, dyspnea, and 3+ pitting edema in the lower bilateral extremities. The echocardiogram shows an ejection fraction of 20%. The nurse anticipates which medication combination would be MOST beneficial to improve cardiac remodeling and reduce symptoms of fluid overload?

• AA. carvedilol and lisinopril
• BB. captopril and spironolactone
• CC. cdigoxin and diltiazem
• DD. flecainide and hydralazine

An elderly patient with a history of diabetes and hepatic insufficiency is recovering from hip replacement surgery. Twelve hours postoperatively, the nurse notes: BP 88/54 HR 118 RR 24 T 101.8° F (38.7° C) Surgical site: erythema, swelling, and urulent drainage WBC 18,500/mm3 Cultures grow Staphylococcus species. Which intervention should the nurse anticipate as the highest PRIORITY?

• AA. Administer antipyretics and monitor temperature trends.
• BB. Intiate broad-spectrum IV antibiotics while monitoring hemodynamics.
• CC. Prepare for urgent surgical debridement and possible return to the operating room.
• DD. Initiate agressive wound dressing changes at the bedside.

A patient with a four-year history of type I diabetes is admitted with influenza. The patient is lethargic, responds only to name, and follows simple commands. Skin is dry with poor turgor and dry oral mucous membranes. Which condition is the MOST LIKELY cause of the patient's presentation?

• AA. hyponatremia
• BB. hypovolemia
• CC. hypoglycemia
• DD. ketosis

A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with increasing oxygen requirements. The nurse notes decreasing breath sounds in both lower lobes and diminished chest expansion. Which pathophysiologic change is MOST likely contributing to these findings?

• AA. loss of surfactant and interstitial fluid accumulation
• BB. decreased pulmonary vascular resistance and hypoxemia
• CC. increased pulmonary compliance and hypoxemia
• DD. mucosal edema and mucus plugging

A patient with a history of angina underwent surgical repair of an AAA. The patient is receiving a sodium nitroprusside drip for severe postoperative hypertension. Twelve hours later, the patient reports new-onset back pain. Current assessment findings are: BP 80/60 HR 120 UO 20 mL/hr +1 left dorsalis pedis pulse +1 right dorsalis pedis pulse After notifying the provider, which intervention should the nurse anticipate as the IMMEDIATE intervention?

• AA. Prepare for insertion of an intra-aortic balloon pump.
• BB. Administer isotonic fluid at 200 mL/hr and prepare for Doppler studies.
• CC. Obtain a computed tomography scan and prepare for pericardiocentesis.
• DD. Discontue the nitroprusside infusion and prepare for surgical intervention.

A toddler with a history of unrepaired Tetralogy of Fallot (TOF) is undergoing IV insertion. During the procedure, the child begins to cry and becomes cyanotic and diaphoretic. Vital signs are: BP 82/54 HR 160 RR 38 SpO2 72% Which intervention is the most appropriate IMMEDIATE nursing action?

• AA. prepare for a red blood cell transfusion
• BB. apply a face mask with supllemental oxygen
• CC. place the child in a knee-chest position
• DD. administer a premedication for IV insertion

An adolescent with a history of recurrent admissions for chronic status asthmaticus is being prepared for discharge. During discharge teaching, the nurse determines that the patient has not been compliant with prescribed medications, stating they make them feel "too different" from their peers. Which nursing action is the most appropriate NEXT step?

• AA. Explore the patient’s feelings about peer acceptance and collaboratively plan strategies to improve adherence.
• BB. Review the risks of nonadherence and collaboratively develop a written action plan.
• CC. Encourage the patient to demonstrate proper inhaler technique and reinforce daily usage.
• DD. Contact the provider to review the regimen and discuss possible medication adjustments.

A child is admitted with colitis develops increased respiratory distress, progressive abdominal distention, and delayed capillary refill greater than 4 seconds, eight hours after admission. The nurse should suspect

• AA. splenic rupture.
• BB. intussusception.
• CC. malrotation with volvulus.
• DD. bowel perforation.

An infant admitted with encephalitis becomes increasingly lethargic, exhibits irregular respirations with brief periods of apnea, and has a weak cry. Vital signs are: BP 82/48 HR 158 RR 22, irregular T 102.6° F (38.6° C) SpO2 93% on room air Which assessment should the nurse perform FIRST?

• AA. Evaluate pupillary size and reactivity.
• BB. Assess Glasgow Coma Scale and document level of consciousness.
• CC. Check capillary blood glucose level.
• DD. Assess airway patency and prepare for possible ventilatory support.

A 15-year-old is admitted with hypovolemic shock following three days of severe vomiting and poor oral intake. The patient is pale, anxious, and has cool, clammy skin. Vital signs are: BP 85/54 HR 128 RR 26 SpO2 91% on room air Which action should the nurse perform FIRST?

• AA. Administer oxygen via nonrebreather mask.
• BB. Prepare for endotracheal intubation.
• CC. Anticipate placement of a central venous catheter.
• DD. Prepare for rapid infusion of isotonic fluids.