Thinking of taking the critical care nursing certification exam? This self-test can help you prepare by reviewing key concepts in the CCRN exam offered by the American Association of Critical-Care Nurses.
1. A pregnant woman, 30, comes to the emergency department (ED) with a history of sudden onset of severe headaches followed by seizures. You hear bruits over her carotid arteries and eyeballs and notice nuchal rigidity. What do you suspect, and which test would confirm it?
a. Guillain-Barre syndrome and electromyography
b. meningitis and lumbar puncture
c. autonomic dysreflexia and spinal series
d. arteriovenous malformation and computed tomography (CT) scan
Answer: d. The presence of bruits over the eyes with nuchal rigidity suggests a leaking arteriovenous malformation, which can be confirmed with a CT scan. Most arteriovenous malformations are present at birth but don't cause symptoms until the third decade of life. The likelihood of hemorrhage is increased during pregnancy. Seizures and headaches are common presenting symptoms. Guillain-Barre syndrome is a neuromuscular demyelination disease characterized by progressive ascending paralysis. Although nuchal rigidity, headache, and seizures are signs and symptoms of meningitis, this disease doesn't cause bruits. Autonomic dysreflexia is a syndrome associated with spinal cord injuries below the level of T6 and is characterized by loss of sympathetic inhibition.
2. A patient with chronic bronchitis requires tracheobronchial suctioning. Which nursing action would best help prevent complications from this procedure?
a. hyperoxygenating the patient with 100% oxygen
b. keeping the patient in a supine position
c. inserting the suction catheter no more than 4 3/4 inches (12 cm)
d. giving an I.V. bolus dose of lidocaine to prevent ventricular ectopic beats
Answer: a. Hypoxia, one of the most common complications of tracheobronchial suctioning, can cause arrhythmias and changes in heart rate. An upright position is best for suctioning. The catheter must be inserted about 7 1/2 inches (19 cm). Ventricular ectopic beats that occur during suctioning are best treated by reoxygenating the patient.
3. A patient in the ED has a pH of 7.36; PaO2, 88 mm Hg; PaCO2, 62 mm Hg; and HCO3-, 35 mEq/liter. Which condition does he have?
a. respiratory acidosis
b. compensated respiratory acidosis
c. metabolic alkalosis
d. compensated metabolic alkalosis
Answer: b. The pH is in the normal range, but the PaCO2 value indicates acidosis.
4. After starting an insulin infusion, you notice on serial finger-stick blood glucose tests that the patient's serum glucose level is progressively falling. At what plasma glucose level should you start adding dextrose to the maintenance I.V. infusion?
a. 100 mg/dl
b. 150 mg/dl
c. 200 mg/dl
d. 250 mg/dl
Answer: d. Dextrose is added to the I.V. infusion when the patient's plasma glucose level reaches 250 mg/dl in diabetic ketoacidosis (DKA) or 300 mg/dl in hyperketotic hyperosmolar syndrome (HHS). You may be able to decrease the insulin infusion rate and add dextrose (5% or 10%) to the I.V. fluids; the insulin infusion rate and dextrose concentration may need to be adjusted later to maintain the above glucose values until acidosis (in DKA) or mental obtundation and hyperosmolarity (in HHS) resolve.
5. A patient with disseminated intravascular coagulation is receiving I.V. albumin, which
a. is isotonic.
b. decreases intravascular volume.
c. increases interstitial volume.
d. increases intravascular volume.
Answer: d. Albumin consists of large protein molecules that help draw and hold fluid in blood vessels. A hypertonic fluid, albumin also helps to decrease interstitial fluid volume. *
6. An 18-year-old motor-vehicle crash victim is confused and having problems reasoning. He most likely has a closed-head injury involving the
a. parietal lobe.
b. frontal lobe.
c. occipital lobe.
d. temporal lobe.
Answer: b. The frontal lobe is responsible for high-level functioning, such as reasoning and abstract thinking.
7. For evaluating a patient with traumatic brain injury, the diagnostic study of choice is
a. computed tomography.
b. magnetic resonance imaging.
d. single photon emission computed tomography.
Answer: a. Computed tomography is the diagnostic study of choice for evaluating traumatic brain injury because it's widely available, easy to interpret, reliable, and quick.
8. A patient suddenly becomes unresponsive as you're speaking to him and develops generalized tonic-clonic seizures. Your priority is to
a. notify the primary care provider immediately.
b. administer intravenous diazepam.
c. establish an airway.
d. perform a rapid neurologic exam.
Answer: c. Initially, the patient's airway, breathing, and circulation are priorities, followed by seizure assessment and treatment.
9. For patients with major burns, when should you start enteral feedings?
a. after the emergent phase of the injury
b. a few hours after the injury has occurred
c. 2 to 3 days after the injury
d. not until bowel sounds have returned
Answer: d. Start enteral feedings when bowel sounds return. Until then, give total parenteral nutrition to meet the patient's nutritional needs.
Source: Critical Care Nursing Certification: An Indispensable Study Guide for the CCRN Exam, Springhouse Corp., 2002.