CCRN REVIEW Practice Test 1 — Questions and Answers

Question 1: Which of the following is an isotonic solution that can be given to a hypovolemic patient to replace fluid volume without causing significant fluid shifts across cell membranes or vessels?

D5 0.5 NS (5% Dextrose and 0.45% Normal Saline)
(0.9%) Normal Saline (Correct answer)
D5W (5% Dextrose in Water)
5% Normal saline

Correct answer: (0.9%) Normal Saline

Isotonic solutions have an osmolality similar to that of blood plasma, which prevents significant fluid shifts across cell membranes. 0.9% Normal Saline (NS) is an isotonic solution commonly used to expand intravascular volume in hypovolemic patients because it remains primarily within the extracellular space, effectively replacing fluid without causing cells to swell or shrink. D5W becomes hypotonic in the body, and D5 0.5 NS is hypotonic.

Question 2: A typical bacterial pathogens associated with community-acquired pneumonia (CAP) include:

Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenza
Chlamydia pneumoniae (Correct answer)

Correct answer: Chlamydia pneumoniae

Community-acquired pneumonia (CAP) can be caused by a variety of bacterial pathogens. While Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae are common 'typical' bacterial causes, Chlamydia pneumoniae is a well-recognized 'atypical' bacterial pathogen frequently implicated in CAP. Atypical pathogens often present with different clinical features and require specific antibiotic coverage.

Question 3: The two guideline biochemical operators that are discharged from the endothelium of blood vessels and work to diminish blood flow to destinations of harm and preserve blood volume are:

Serotonin and collagen
Thromboxane A2 and endothelin (Correct answer)
Fibrogenin and prothrombin
Thrombin and prothrombin

Correct answer: Thromboxane A2 and endothelin

Thromboxane A2 (TXA2) is a potent vasoconstrictor and platelet aggregator released by activated platelets, contributing to clot formation and local vasoconstriction. Endothelin is a powerful vasoconstrictor released by endothelial cells in response to injury. Both substances work synergistically to diminish blood flow to sites of harm, thereby helping to preserve blood volume and promote hemostasis.

Question 4: A patient in the intensive care unit has symptoms of delirium. Drug treatment for delirium often includes: I. Antipsychotics II. Benzodiazepines III. Antidepressants

I and II (Correct answer)
I and III
I, II, and III
I

Correct answer: I and II

Pharmacological treatment for delirium often involves antipsychotics (e.g., haloperidol) to manage agitation, hallucinations, or delusions, especially in hyperactive delirium. Benzodiazepines are typically reserved for delirium caused by alcohol or benzodiazepine withdrawal, or when antipsychotics are contraindicated, but they can be used cautiously for severe agitation. Antidepressants are not a primary treatment for acute delirium.

Question 5: Regarding the Synergy Model for Patient care, which of the following refers to the nurse's ability to use her knowledge and a set of skills for understanding how one decision can affect the system as a whole?

Systems thinking (Correct answer)
Clinical practices
Advocacy/moral agency
Caring practices

Correct answer: Systems thinking

In the Synergy Model for Patient Care, 'systems thinking' describes the nurse's ability to comprehend how individual actions and decisions impact the broader healthcare system and patient outcomes. This competency involves recognizing interconnectedness, anticipating consequences, and making choices that optimize care across various components of the system. It goes beyond individual clinical tasks to encompass a holistic view of care delivery.

Question 6: Damage to the developing brain's motor control areas causes which of the following developmental conditions?

Fragile X syndrome
Prader-Willi syndrome
Cerebral palsy (Correct answer)
Williams syndrome

Correct answer: Cerebral palsy

Cerebral palsy (CP) is a group of permanent movement disorders that emerge in early childhood, resulting from non-progressive disturbances in the developing fetal or infant brain. These disturbances specifically affect the motor control areas of the brain, leading to challenges with muscle tone, movement, and posture. The other listed syndromes are genetic conditions with distinct etiologies.

Question 7: Blood flows back into the ____ in mitral valve regurgitation:

Right ventricle
Right atrium
Left atrium (Correct answer)
Left ventricle

Correct answer: Left atrium

Mitral valve regurgitation occurs when the mitral valve, situated between the left atrium and left ventricle, fails to close completely during the left ventricle's contraction (systole). This malfunction allows blood to flow backward from the left ventricle into the left atrium, leading to increased pressure and volume within the left atrium.

Question 8: The number of vertebrae in each section of the vertebral column is appropriately identified by which of the following?

7 cervical, 12 thoracic, 7 lumbar, 6 sacral, 2 coccygeal
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal (Correct answer)
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3 coccygeal
7 cervical, 11 thoracic, 5 lumbar, 4 sacral, 5 coccygeal

Correct answer: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal

The human vertebral column is typically composed of 33 vertebrae, divided into five distinct regions. This arrangement includes 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused sacral vertebrae, and typically 4 fused coccygeal vertebrae. This specific count for each section provides the structural support and flexibility of the spine.

Question 9: Which of the following organizes the four layers of the gastrointestinal wall from most superficial to most interior correctly?

Serosa, mucosa, submucosa, muscularis
Mucosa, submucosa, serosa, muscularis
Muscularis, serosa, mucosa, submucosa
Serosa, muscularis, submucosa, mucosa (Correct answer)

Correct answer: Serosa, muscularis, submucosa, mucosa

The gastrointestinal (GI) tract wall is organized into four distinct layers, arranged from the outermost to the innermost lumen. The most superficial layer is the serosa, followed by the muscularis externa, which is responsible for peristalsis. Beneath that is the submucosa, containing blood vessels and nerves, and finally, the innermost layer lining the lumen is the mucosa, involved in absorption and secretion.

Question 10: HIPPA laws require which of the following ethical principles?

Patient fidelity
Patient confidentiality (Correct answer)
Patient justice
Patient veracity

Correct answer: Patient confidentiality

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law primarily enacted to protect the privacy and security of individuals' protected health information (PHI). A core ethical and legal principle mandated by HIPAA is patient confidentiality, ensuring that sensitive medical information is handled securely and disclosed only with proper authorization or under specific legal circumstances.

Question 11: Which of the following granulocytes contributes to the inflammatory response by releasing histamine?

Basophils (Correct answer)
Neutrophils
Monocytes
Macrophages

Correct answer: Basophils

Basophils are a type of granulocyte that plays a critical role in allergic reactions and inflammatory responses. They contain granules rich in histamine, heparin, and other inflammatory mediators. Upon activation, basophils release these substances, leading to vasodilation, increased vascular permeability, and other characteristic symptoms of inflammation and allergic reactions.

Question 12: Which of the following statements accurately describes encephalitis?

Inflammation of the protective membranes that cover the brain and spinal cord comes from a CNS infection caused by bacteria, viruses, or fungus.
Parasitic infection of the CNS causes demyelination of axons in the cerebellum.
Inflammation of brain tissue as a result of a CNS infection (most usually caused by viruses). (Correct answer)
As a result of bloodborne bacteria infiltrating the cranium, a localized infection of brain tissue occurs.

Correct answer: Inflammation of brain tissue as a result of a CNS infection (most usually caused by viruses).

Encephalitis is precisely defined as inflammation of the brain tissue itself, most commonly resulting from a central nervous system (CNS) infection, predominantly caused by viruses. This condition directly affects the brain parenchyma, leading to neurological dysfunction. It is distinct from meningitis, which is inflammation of the protective membranes surrounding the brain and spinal cord.

Question 13: Damage to or illness of the adrenal cortex's zona glomerulosa is likely to cause electrolyte imbalance due to dysfunction of:

Aldosterone (Correct answer)
Vasopressin
Calcitonin
Cortisol

Correct answer: Aldosterone

The zona glomerulosa is the outermost layer of the adrenal cortex, responsible for producing mineralocorticoids, primarily aldosterone. Aldosterone's main function is to regulate electrolyte balance by promoting sodium reabsorption and potassium excretion in the kidneys. Therefore, damage to this zone directly impairs aldosterone production, leading to significant electrolyte imbalances.

Question 14: When assessing renal function, a normal BUN-to-creatinine ratio is as:

> 20:1
> 5:1
< 20:1 (Correct answer)
< 5:1

Correct answer: < 20:1

The BUN-to-creatinine ratio is a diagnostic tool used to assess renal function and differentiate causes of kidney injury. A normal ratio typically falls below 20:1, often ranging from 10:1 to 15:1. Ratios significantly higher than this can indicate prerenal causes like dehydration, while a normal ratio with elevated BUN and creatinine suggests intrinsic kidney damage.

Question 15: Osmotic diuretics include which of the following medications? I. Mannitol II. Furosemide III. Ethacrynic acid

I and II
I and III
III
I (Correct answer)

Correct answer: I

Osmotic diuretics work by increasing the osmolality of the glomerular filtrate, which in turn inhibits water reabsorption in the renal tubules, leading to increased urine output. Mannitol is the classic example of an osmotic diuretic, commonly used to reduce intracranial or intraocular pressure. Furosemide and ethacrynic acid, on the other hand, are loop diuretics with a different mechanism of action.

Question 16: You're using a pulmonary artery catheter to monitor a patient. You are unable to determine the pulmonary artery wedge pressure of the patient. You check the ___________ to get a value that matches to the pulmonary artery wedge pressure.

Pulmonary artery mean pressure
Pulmonary artery diastolic pressure (Correct answer)
Right ventricular pressure
Right atrial pressure

Correct answer: Pulmonary artery diastolic pressure

The pulmonary artery wedge pressure (PAWP) is a critical measurement reflecting left ventricular preload and left atrial pressure. When a PAWP cannot be obtained, the pulmonary artery diastolic pressure (PADP) can serve as a reliable substitute. This is because, in the absence of pulmonary hypertension, the pulmonary valve opens during diastole, allowing the pressures in the pulmonary artery to equilibrate with the left atrial pressure, which the PAWP estimates.

Question 17: A normal wedge pressure, elevated pulmonary artery pressures, and indications of right ventricular failure are all assessed by the nurse. Which condition is this most likely to indicate?

Left ventricular failure
Pulmonary embolism (Correct answer)
Cardiac-tamponade'
Myocardial infarction

Correct answer: Pulmonary embolism

This clinical scenario strongly suggests a pulmonary embolism (PE). A PE obstructs pulmonary blood flow, leading to increased pulmonary vascular resistance and elevated pulmonary artery pressures. This increased workload can cause acute right ventricular failure, while a normal wedge pressure indicates that the left side of the heart is not the primary source of the problem.

Question 18: An alcohol abuser's spontaneous and painless GI tract bleeding could indicate which of the following patient conditions?

Peptic ulcer disease
Duodenal ulcer
Mallory-Weiss tear (Correct answer)
Gastric ulcer perforation

Correct answer: Mallory-Weiss tear

A Mallory-Weiss tear is a laceration of the esophageal mucosa, typically at the gastroesophageal junction, often caused by forceful vomiting or retching. This condition is frequently associated with alcohol abuse and can cause GI bleeding that is often described as spontaneous and painless, differentiating it from the severe pain typically associated with peptic ulcers or gastric perforations.

Question 19: The nurse examines Mr. David., a 45-year-old sportsman. His heart rate speeds up and slows down. In Lead II, he has upright P and R waves at 70 beats per minute. Most likely, his rhythm is an example of:

normal variation in EKG (Correct answer)
Digoxin toxicity
Inferior wall MI
Increased intracranial pressure

Correct answer: normal variation in EKG

The description of a heart rate that speeds up and slows down, upright P and R waves in Lead II, and a rate of 70 bpm is characteristic of sinus arrhythmia. Sinus arrhythmia is a normal physiological variation where the heart rate fluctuates with respiration, commonly observed in healthy individuals, especially athletes. It is a benign finding and not indicative of a pathological condition.

Question 20: What does the "spine sign" shown on Daniel's chest x-ray mean?

Pneumonia (Correct answer)
Pre-existing spinal injury
Scoliosis
Kyphosis

Correct answer: Pneumonia

The 'spine sign' on a chest x-ray refers to the abnormal visibility of the thoracic vertebral bodies below the diaphragm. Normally, these vertebrae become progressively less visible due to overlying lung tissue. In pneumonia, particularly in the lower lobes, lung consolidation increases tissue density, making the vertebral bodies appear abnormally bright or more distinct, thus indicating the presence of pneumonia.

Question 21: Which of the following is NOT the most appropriate first intervention if a patient is suspected of having an episode of acute hypoglycemia?

Give the patient a ½ glass of orange juice.
Draw a STAT blood glucose level. (Correct answer)
Check the blood glucose with a glucometer.
Give the patient IV dextrose or IM glucagon.

Correct answer: Draw a STAT blood glucose level.

In a suspected acute hypoglycemic episode, the immediate priority is to rapidly raise the patient's blood glucose level to prevent neurological damage. Administering oral glucose (like orange juice) or IV/IM glucose is the first therapeutic intervention. While checking blood glucose with a glucometer is important for rapid confirmation, drawing a STAT lab blood glucose delays critical treatment and is not the most appropriate first intervention.

Question 22: The nurse expects that the foremost life-threatening occasion of adrenal crisis is:

Vascular collapse (Correct answer)
Hypernatremia
Hypokalemia
Hypoglycemia

Correct answer: Vascular collapse

Adrenal crisis, or Addisonian crisis, is a life-threatening emergency resulting from severe acute adrenal insufficiency, leading to profound deficiencies of cortisol and aldosterone. The lack of cortisol causes severe hypotension and shock, while aldosterone deficiency leads to critical electrolyte imbalances and hypovolemia. These combined effects culminate in severe vascular collapse, which is the most immediate and life-threatening complication.

Question 23: Of the following, which is included within the etiology of idiopathic thrombocytopenic purpura (ITP)?

IgG autoantibodies (Correct answer)
Splenomegaly
Bone marrow depression
Hepatomegaly

Correct answer: IgG autoantibodies

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by the destruction of platelets. The primary etiology involves the production of IgG autoantibodies that target and bind to platelet surface antigens. These antibody-coated platelets are then recognized and rapidly destroyed by macrophages, predominantly in the spleen, leading to a low platelet count.

Question 24: What is the most common location for a brain aneurysm to burst and cause a subarachnoid hemorrhage (SAH)?

Posterior communicating artery
Anterior communicating artery (Correct answer)
Anterior cerebral artery
Middle cerebral artery

Correct answer: Anterior communicating artery

The anterior communicating artery (AComm) is the most frequent site for saccular (berry) aneurysms in the brain. Consequently, it is the most common location for an aneurysm to rupture and cause a subarachnoid hemorrhage (SAH). This artery is part of the Circle of Willis, an area prone to hemodynamic stress that contributes to aneurysm formation.

Question 25: Janice is a Type I diabetic who was admitted to the unit after losing consciousness due to a severe hypoglycemia episode. She claims to have experienced numerous episodes of hypoglycemia, but she no longer seems to be able to predict when they will occur. What do you call this phenomenon?

Hypoglycemia unawareness (Correct answer)
Hypoglycemia latency
Hypoglycemia neurosis
Hypoglycemia tolerance

Correct answer: Hypoglycemia unawareness

Hypoglycemia unawareness is a condition where individuals with diabetes, especially Type 1, lose the ability to recognize the typical warning signs of low blood sugar. This phenomenon occurs due to repeated episodes of hypoglycemia, which can blunt the body's counter-regulatory responses, leading to a lack of symptoms like shakiness or sweating. This makes it difficult for patients to intervene before severe hypoglycemia develops.

CCRN REVIEW Practice Test 1

Which of the following is an isotonic solution that can be given to a hypovolemic patient to replace fluid volume without
causing significant fluid shifts across cell membranes or vessels?