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(CCRN) CRITICAL CARE REGISTERED NURSE EXAM
NEWEST 2025 ACTUAL EXAM TEST BANK| COMPLETE 450
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A patient experiencing alcohol withdrawal syndrome describes the swirls in the wallpaper as being worms. This is an example of which of the following?
- Delusion
- Hallucination
- Illusion
- Visual impairment - Correct Answer - C. Illusion
An illusion is a misperception or misinterpretation of an actual external stimulus. Illusions and hallucinations (a perception that has no actual external stimulus) are common during alcohol withdrawal syndrome.
A patient arrives in the emergency department with multiple gunshot wounds. He requires massive transfusion for blood loss from chest and abdominal wounds. The electrocardiogram should be observed closely for changes indicative of which of the following?
- Atrioventricular block
- Hyperkalemia
- Hypercalcemia
- Hypomagnesemia - Correct Answer - Hyperkalemia
Banked blood is high in potassium because of hemolysis. Look for tall, peaked T waves and widening of the QRS complex. Other 1 / 4
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pg. 2 considerations with massive transfusion of banked blood are hypocalcemia, hypothermia, and decreased tissue oxygen delivery caused by decreased levels of 2,3-diphosphoglycerate.
A 65-year-old woman reports severe dyspnea 2 days after abdominal surgery. She is transferred to the critical care unit. On 5 L of oxygen by
nasal cannula, her arterial blood gases are as follows:
pH 7.39 PaCO2 35 mm Hg HCO3 19 mEq/L PaO2 40 mm Hg Arterial oxygen saturation 75%
Why does this patient have hypoxemia without hypercapnia?
- Because carbon dioxide is more diffusible than oxygen
- Because carbon dioxide has more driving pressure
- Because carbon dioxide is less diffusible than oxygen
- Because carbon dioxide excretion by the kidney is increased -
Correct Answer - Because carbon dioxide is more diffusible than oxygen Carbon dioxide is 20 times more diffusible than oxygen. In conditions that affect diffusion but do not affect ventilation, expect the PaO2 to be decreased and the PaCO2 to be normal (or decreased in hyperventilation, as in this patient). If ventilation were affected, such as if this patient were fatiguing, the PaCO2 then would increase. Driving pressure is the fraction of the gas in inspired air multiplied by the barometric pressure.Because carbon dioxide is ~0.5% of inspired air, the driving pressure 2 / 4
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pg. 3 would be very low. The kidney eliminates bicarbonate and hydrogen ions, but the lungs eliminate carbon dioxide.
A 55-year-old patient has headache, nuchal rigidity, photophobia, and positive Kernig's and Brudzinski's signs. These are consistent with which of the following?
- Intracranial hemorrhage
- Subarachnoid hemorrhage
- Epidural hemorrhage
- Subdural hemorrhage - Correct Answer - Subarachnoid hemorrhage
When there is bleeding from an aneurysm, that blood irritates the meninges. The clinical presentation is very similar to meningitis. This clinical presentation is not consistent with intracranial, epidural, or subdural bleeding because the blood is not in contact with the meninges in those situations.
A 58-year-old man is admitted to the critical care unit with upper gastrointestinal bleeding. He has a history of chronic renal failure. When
one is administering antacids, it is important to remember to avoid:
- magnesium-containing antacids.
- phosphate-binding antacids.
- calcium-containing antacids.
- histamine2 receptor antagonists. - Correct Answer - magnesium-
containing antacids.Magnesium-containing antacids can lead to magnesium intoxication in the patient with renal failure. 3 / 4
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pg. 4 A patient is complaining of dull, diffuse abdominal pain. Of the following possible causes, which is most likely to be the cause?
- Appendicitis
- Cholecystitis
- Ulcerative colitis
- Large intestinal obstruction - Correct Answer - Large intestinal
obstruction The rest are sharp pain Vt for extubation - Correct Answer - 5ml/kg
A 30-year-old man is in the surgical intensive care unit after exploratory laparotomy performed after he sustained a gunshot wound to the abdomen. He now has developed a pancreatic fistula. Which acid-base imbalance is this patient at risk for developing?
- Respiratory acidosis
- Metabolic acidosis
- Respiratory alkalosis
- Metabolic alkalosis - Correct Answer - Metabolic acidosis
The stomach is acidic, but the gastrointestinal tract below the stomach is alkaline. Pancreatic secretions are rich in bicarbonate, and these losses would cause metabolic acidosis.
A 65-year-old man was admitted 2 hours ago after coronary artery
bypass grafting. He has had the following vital sign changes:
Admission 2 Hours Later
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