Free CCRN Practice Questions

Question 1

A recent spinal cord injury presents with a mean arterial pressure of 52 mmHg, a central venous pressure of 2 mmHg, and a heart rate of 46 beats per minute. The systemic vascular resistance is 550 dynes per second per cm5. The clinical team immediately initiated a norepinephrine infusion. Which intervention was bypassed in this sequence?

Accepted Answer

Administering rapid intravenous crystalloid boluses to optimize preload

Answer

Evaluating central venous oxygen saturation to assess tissue perfusion

Answer

Weaning the vasopressor based on improving serum lactate clearance

Answer

Transitioning to oral midodrine therapy to maintain vascular tone

Question 2

Scheduled for a CT angiogram, an alert individual has clear lungs and a heart rate of 82 beats per minute. Which intervention is most appropriate to protect the kidneys prior to the procedure?

Accepted Answer

Initiate a continuous intravenous infusion of 0.9 percent sodium chloride

Answer

Administer a dose of intravenous furosemide to increase urine output

Answer

Prepare the patient for continuous renal replacement therapy

Answer

Draw a serum creatinine level to evaluate kidney injury after the procedure

Question 3

During the removal of a femoral arterial sheath after a percutaneous coronary intervention, a patient experiences a sudden blood pressure drop from 124/78 to 70/38 mmHg. The heart rate drops from 88 to 34 beats per minute. The cardiac index falls to 1.6 L per minute per m2, and systemic vascular resistance decreases to 600 dynes per second per cm5. The patient suddenly reports severe nausea. What is the best initial response?

Accepted Answer

Administer intravenous atropine and elevate the lower extremities

Answer

Administer intravenous norepinephrine and prepare for intubation

Answer

Apply a mechanical compression device and administer packed red blood cells

Answer

Defibrillate at 200 joules and initiate cardiopulmonary resuscitation

Question 4

You are reviewing the morning arterial blood gas results and clinical assessments for four assigned cardiovascular intensive care patients. Which targeted intervention must you perform FIRST to address the highest risk physiological derangement?

Accepted Answer

Increase the dobutamine infusion for a cardiogenic shock patient with a pH of 7.21, PaCO2 of 29 mm Hg, and HCO3 of 11 mEq per L

Answer

Administer prescribed intravenous morphine to a postoperative patient with a pH of 7.48, PaCO2 of 30 mm Hg, and HCO3 of 23 mEq per L

Answer

Perform immediate airway clearance for an extubated patient with a pH of 7.31, PaCO2 of 52 mm Hg, and HCO3 of 25 mEq per L

Answer

Administer prescribed acetazolamide to a diuresing heart failure patient with a pH of 7.46, PaCO2 of 48 mm Hg, and HCO3 of 33 mEq per L

Question 5

During recovery from an open abdominal aortic aneurysm repair, the radial arterial waveform suddenly loses the dicrotic notch and narrows in pulse pressure from 140/70 to 105/90 mmHg. A noninvasive cuff pressure reading shows 138/72 mmHg. What is the most appropriate initial nursing action?

Accepted Answer

Aspirate the line and flush to clear potential blood clots

Answer

Remove excess extension tubing from the transducer system

Answer

Administer a prescribed fluid bolus for apparent hypotension

Answer

Level and zero the transducer to the phlebostatic axis

Question 6

Volume control ventilation with a set tidal volume of 400 mL and a respiratory rate of 14 breaths per minute is in progress. High pressure alarms begin to sound as the patient awakens and their right-sided hemiplegia resolves following a recent seizure. Which action is the most appropriate next step?

Accepted Answer

Transition the ventilator to a spontaneous pressure support mode

Answer

Administer an intravenous propofol bolus to restore ventilator synchrony

Answer

Transport the patient for an emergent noncontrast computed tomography scan

Answer

Prepare for immediate administration of intravenous alteplase

Question 7

Thirty minutes after a 1000 mL fluid bolus, vital signs reveal a respiratory rate of 34 and SpO2 of 86 percent. The nurse observes new bilateral crackles and frothy sputum. ABG shows pH 7.28, PaCO2 55, PaO2 58. Which intervention is indicated?

Accepted Answer

Initiate noninvasive positive pressure ventilation and administer furosemide

Answer

Administer intravenous metoprolol to decrease myocardial oxygen demand

Answer

Position the patient supine and increase the nasal cannula flow rate

Answer

Administer an albuterol nebulizer treatment to resolve acute bronchospasm

Question 8

A patient recently experienced a cardiac arrest secondary to severe dynamic hyperinflation. After successful resuscitation, you evaluate the current mechanical ventilation waveforms to prevent another event. Which finding requires your immediate intervention?

Accepted Answer

AC Volume setup displaying an expiratory flow time scalar failing to reach zero

Answer

SIMV setup demonstrating spontaneous breaths triggering without pressure support

Answer

PRVC setup indicating variable peak inspiratory pressures to maintain tidal volume

Answer

APRV setup showing expiratory flow termination at 75 percent of peak expiratory flow

Question 9

A mechanically ventilated post-CABG patient with aspiration pneumonia exhibits bilateral opacities, a PAOP of 12 mmHg, and a PaO2 of 54 mmHg on an FiO2 of 0.60 with a PEEP of 10 cmH2O. The resident decides to continue current management without changes. What is the BEST action for the nurse?

Accepted Answer

Escalate the request for prone positioning based on a calculated P/F ratio of 90

Answer

Advocate for transitioning to noninvasive positive pressure ventilation to reduce ventilator-induced lung injury

Answer

Initiate the unit spontaneous awakening and breathing trial protocol to assess for early liberation

Answer

Request an immediate evaluation for venovenous extracorporeal membrane oxygenation

Question 10

Ordering a 30 mL per kg crystalloid bolus for a hypotensive individual with an ejection fraction of 15 percent and a lactate of 4.2 mmol per L, a resident prompts concern from the nurse regarding the risk of volume overload. What is the best action the nurse should take to fulfill the Synergy role of clinical advocacy?

Accepted Answer

Escalate concerns to the attending physician to advocate for smaller fluid aliquots with frequent reassessment

Answer

Refuse all crystalloid administration and insist on immediately initiating a norepinephrine infusion

Answer

Administer the ordered volume over a prolonged 12-hour period to satisfy metrics while preventing overload

Answer

Document the order exactly as written and file a safety report after completing the infusion

Question 11

Despite aggressive fluid resuscitation and a norepinephrine infusion, an individual in the intensive care unit remains hypotensive with a blood pressure of 70/40 mm Hg. Assessment reveals distended neck veins and muffled heart sounds. Which intervention should be anticipated next?

Accepted Answer

Preparing for an emergent pericardiocentesis

Answer

Increasing the norepinephrine infusion rate

Answer

Administering a stress dose of hydrocortisone

Answer

Initiating a continuous dobutamine infusion

Question 12

A mechanically ventilated individual suddenly develops profound hypotension with a blood pressure of 68/38 mm Hg and an oxygen saturation of 81 percent. The ventilator alarms for a peak inspiratory pressure of 60 cm H2O, and right-sided lung sounds are absent. Which intervention is required immediately?

Accepted Answer

Prepare for immediate needle thoracostomy

Answer

Obtain a stat portable chest radiograph

Answer

Administer a rapid intravenous fluid bolus

Answer

Instill an inline bronchodilator treatment

Question 13

Hemodynamic monitoring reveals a mean arterial pressure of 52 mmHg despite norepinephrine at 0.5 mcg/kg/min and vasopressin at 0.04 units/min. Laboratory results demonstrate serum sodium 131 mEq/L, potassium 5.4 mEq/L, and glucose 62 mg/dL. Review of the medical history indicates chronic prednisone therapy prior to recent coronary artery bypass grafting. Which intervention is indicated next?

Accepted Answer

Administer intravenous hydrocortisone

Answer

Initiate an epinephrine infusion at 0.05 mcg/kg/min

Answer

Administer 50 percent dextrose and regular insulin

Answer

Administer fludrocortisone via gastric tube

Question 14

Intracranial pressure waveforms consistently display a P2 wave taller than the P1 wave for an individual with a traumatic brain injury. An external ventricular drain is in place, correctly leveled to the tragus, and the tubing has no kinks. The monitor displays a continuous pressure of 16 mmHg. Which action is the priority for this patient?

Accepted Answer

Space out routine nursing interventions to minimize stimulation

Answer

Flush the transducer tubing with preservative-free normal saline

Answer

Administer the prescribed as-needed dose of intravenous mannitol

Answer

Lower the head of the bed to a flat position to promote drainage

Question 15

New peaked T waves and widened QRS complexes appear on the cardiac monitor one day after induction chemotherapy. Recent laboratory results show a potassium level of 6.8 mEq/L, a uric acid level of 12.5 mg/dL, and a calcium level of 6.2 mg/dL. These findings are most consistent with which pathophysiological process?

Accepted Answer

Rapid destruction of malignant cells resulting in the massive release of intracellular contents

Answer

Systemic inflammatory response leading to widespread endothelial damage and capillary leak

Answer

Direct nephrotoxic injury from chemotherapy causing acute tubular necrosis and retention

Answer

Paraneoplastic syndrome causing ectopic hormone production and electrolyte wasting

Question 16

Pain out of proportion to injury is present in the right lower extremity 12 hours after a crush injury. The extremity is tense and pale. Vital signs include blood pressure 110/60 mm Hg, heart rate 115 beats per minute, and respiratory rate 22 breaths per minute. An intracompartmental pressure monitor displays a reading of 35 mm Hg. What is the priority intervention based on these findings?

Accepted Answer

Prepare for immediate surgical fasciotomy

Answer

Elevate the right lower extremity above heart level

Answer

Apply cold compresses to the affected extremity

Answer

Administer additional intravenous opioid analgesia

Question 17

Severe hepatic encephalopathy prompts admission for an individual with a history of cirrhosis. The patient is lethargic and exhibits asterixis. The nurse administers lactulose via a nasogastric tube, which produces three soft bowel movements over the past 12 hours. Despite this, the patient remains highly confused, and the serum ammonia level is 125 mcmol/L. Which intervention is indicated next?

Accepted Answer

Administer enteral rifaximin

Answer

Initiate continuous venovenous hemofiltration

Answer

Administer intravenous flumazenil

Answer

Increase lactulose to induce six bowel movements daily

Question 18

Ten minutes after protamine administration, a patient develops a blood pressure of 68/34 mmHg and peak airway pressures rise from 18 to 42 cm H2O. Hemodynamic monitoring reveals a CVP of 2 mmHg, a PAOP of 4 mmHg, a CI of 4.2 L/min/m2, and an SVR of 450 dynes sec/cm5. Which intervention is indicated immediately?

Accepted Answer

Administer intramuscular epinephrine 0.3 mg

Answer

Administer intravenous diphenhydramine 50 mg

Answer

Administer intravenous norepinephrine 4 mcg/min

Answer

Administer intravenous methylprednisolone 125 mg

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