Adult CCRN® Q & A 2nd Edition

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Sample Questions

Cardiovascular Questions

1. A patient presents with heaviness in the chest and radiation to left arm. A 12-Lead ECG and cardiac enzymes are obtained. The 12-Lead EKG demonstrates ST segment elevation in leads II, III and avF. These changes would correspond to injury in which area of the heart?
a. Anterior MI
b. Lateral MI
c. Inferior MI
d. Posterior MI

Answer: C

Rationale: The EKG leads, II, III and avF view the inferior portion of the left ventricle. Leads V2-V4 reflect an anterior wall infarct of the LV. Leads I, avL, V5 and V6 view the lateral wall MI. Posterior wall MI is diagnosed with the reciprocal changes (large R waves) in leads V1 and V2.

2. A 64-year-old male, with a history of CHF, presents with a worsening of his pulmonary congestion. He has a history of hypertension and has been diagnosed with hypertrophy. The echocardiogram showed an ejection fraction of 60%. Which of the following is the most probable underlying abnormality?
a. systolic dysfunction
b. diastolic dysfunction
c. biventricular failure
d. mitral regurgitation

Answer: B

Rationale: Diastolic dysfunction is frequently a result of ventricular hypertrophy. The enlarged ventricular wall limits the cavity volume (decreased ventricular compliance), thus limited filling during diastole. The hallmark is a reduced stroke volume with a normal ejection fraction. A systolic dysfunction, abnormalities with contractility, demonstrates a reduced stroke volume and ejection fraction. This may also involve a biventricular failure but there is not enough information provided in the scenario to determine this. Mitral regurgitation results in diminished stroke volume.

Pulmonary Questions

3. Your patient has been intubated and is on a mechanical ventilator for respiratory failure. She has a history of CHF. The pulmonologist has requested weaning parameters to be obtained. Which of the following weaning parameters would indicate a criteria for extubation?
a. tidal volume of 3 ml/kg, vital capacity of 10 ml/kg, respiratory rate less than 14
b. tidal volume at least 5 ml/kg, vital capacity 15 ml/kg, negative inspiratory force greater than -25 cm H2O
c. vital capacity of 10 ml/kg, negative inspiratory force of at least -10 cm H20, no excessive secretions
d. vital capacity of 15 ml/kg, respiratory rate less than 20, ability to breathe spontaneously on flow-by for 6 hours

Answer: B

Rationale: Criteria for extubation include the following weaning parameters: tidal volume at least 5 ml/kg, vital capacity of 10–15 ml/kg, negative inspiratory force greater than -20 to -25 cm H2O, respiratory rate greater than 10 and less than 30, adequate oxygenation on inspired oxygen concentration of 40% or less, ability to protect airway and no excessive secretions.

4. Your patient is in the ICU following a motorcycle crash. He has sustained multiple rib fractures. He is complaining of increased pain with deep breathing and coughing. Which of the following pain management techniques would best control his pain and allow him to take deep breaths and cough?
a. morphine continuous infusion
b. distraction and imagery
c. propofol (Diprivan) infusion
d. thoracic epidural opioids

Answer: D

Rationale: A continual epidural is one of the most efficient routes of analgesia. Epidurals provide excellent pain management with either or both opioid and local anesthetics but does not interfere with the ability to breathe deep and cough. A continuous morphine infusion can cause a greater sleepiness and clouding of mentation, which can interfere with deep breathing and coughing. Distraction and imagery can be used with an opioid but would not be recommended to use instead of an opioid in this patient. Propofol (Diprivan) is used as a sedative in the ICU but it does not have any analgesic properties and should not be used in place of an analgesic. Also, Propofol (Diprivan) should be used on an intubated patient only.

5. Which of the following conditions will cause a greater discrepancy between SpO2 obtained from pulse oximetry and SaO2 obtained from arterial ABG?
a. primary pulmonary hypertension
b. carbon monoxide poisoning
c. chemical pneumonitis
d. aspiration pneumonia

Answer: B

Rationale: Carbon monoxide has a greater affinity for Hgb than oxygen. In carbon monoxide poisoning, large amounts of Hgb are carrying the carbon monoxide. The pulse oximetry will measure the amount of saturated Hgb but does not distinguish between whether the Hgb is saturated with oxygen or other substances such as carbon monoxide. However the laboratory ABG can distinguish between oxygen and carbon monoxide bound Hgb. Primary pulmonary hypertension causes dead space and will increase discrepancies between end-tidal CO2 and PaCO2 from an ABG but does not alter correlation of the oxygen saturations. Chemical pneumonitis and aspiration pneumonia both cause a shunt and do not alter the correlation between the SpO2 and SaO2.

Neurological Questions

6. Your patient is admitted following a severe traumatic brain injury. He has bilateral periorbital ecchymosis. Which of the following is the most likely cause?
a. epidural hematoma
b. subdural hematoma
c. depressed skull fracture
d. basilar skull fracture

Answer: D

Rationale: A basilar skull fracture will present with either bilateral periorbital ecchymosis (raccoon eyes) or bruising on the mastoid processes bilateral (battle signs). A basilar skull fracture is frequently associated with CSF leak from either the nose (rhinorrhea) or from the ears (otorrhea). An epidural hematoma (EDH) or subdural hematoma (SDH) will result in acute neurological deficits and can result in a herniation syndrome. A depressed skull fracture can increase the risk of CNS infection but does not cause the bilateral periorbital ecchymosis.