CCRN General Review 2 — Questions and Answers
Question 1: A patient with acute decompensated heart failure has a pulmonary artery wedge pressure of 24 mmHg. What does this elevated value indicate?
- Increased left atrial/left ventricular filling pressure (Correct answer)
- Right ventricular failure
- Hypovolemia
- Pulmonary embolism
Correct answer: Increased left atrial/left ventricular filling pressure
An elevated PAWP reflects increased left-sided filling pressures, typical of left heart failure.
Question 2: Which arterial blood gas result indicates uncompensated respiratory acidosis?
- pH 7.30, PaCO2 55, HCO3 24 (Correct answer)
- pH 7.50, PaCO2 30, HCO3 24
- pH 7.34, PaCO2 60, HCO3 32
- pH 7.40, PaCO2 40, HCO3 24
Correct answer: pH 7.30, PaCO2 55, HCO3 24
Low pH with high PaCO2 and normal HCO3 indicates uncompensated respiratory acidosis.
Question 3: A patient develops sudden hypotension, jugular venous distension, and muffled heart sounds after cardiac surgery. What is the most likely diagnosis?
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
- Septic shock
- Myocardial infarction
Correct answer: Cardiac tamponade
Beck's triad—hypotension, JVD, and muffled heart sounds—is classic for cardiac tamponade.
Question 4: What is the priority intervention for a patient in pulseless ventricular tachycardia?
- Immediate defibrillation (Correct answer)
- Synchronized cardioversion
- Administer adenosine
- Vagal maneuvers
Correct answer: Immediate defibrillation
Pulseless VT is a shockable rhythm requiring immediate defibrillation.
Question 5: A patient receiving heparin develops a platelet count drop from 250,000 to 80,000. What condition should be suspected?
- Heparin-induced thrombocytopenia (Correct answer)
- Disseminated intravascular coagulation
- Idiopathic thrombocytopenic purpura
- Aplastic anemia
Correct answer: Heparin-induced thrombocytopenia
A significant platelet drop after heparin exposure suggests HIT, requiring heparin discontinuation.
Question 6: Which finding best indicates effective fluid resuscitation in a patient with septic shock?
- Urine output greater than 0.5 mL/kg/hr (Correct answer)
- Heart rate of 120 bpm
- Mean arterial pressure of 55 mmHg
- Decreasing level of consciousness
Correct answer: Urine output greater than 0.5 mL/kg/hr
Adequate urine output indicates restored perfusion to the kidneys and effective resuscitation.
Question 7: A mechanically ventilated patient suddenly desaturates with high peak pressures and absent breath sounds on the right. What is the most likely cause?
- Tension pneumothorax (Correct answer)
- Endotracheal tube migration into the esophagus
- Atelectasis
- Pulmonary edema
Correct answer: Tension pneumothorax
Sudden desaturation with high pressures and unilateral absent breath sounds suggests tension pneumothorax.
CCRN General Review 2
A patient with acute decompensated heart failure has a pulmonary artery wedge pressure of 24 mmHg.
What does this elevated value indicate?