CCRN EXAM 2 REAL 2024 -2025 ACTUAL EXAM QUESTIONS EXPERT VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+ 2023/2024 1. A patient presents with a productive cough, hypoxemia, a fever, hypotension, tachycardia, and tachypnea. Hypoxemia was corrected with the administration of oxygen. Which of the following should be done next? A. Administer antibiotics. B. Start a vasopressor. C. Collect a sputum culture. D. Initiate 0.9 normal saline. - CORRECT ANSWER ✔✔ (D) Correcting the hypotension (with isotonic fluid resuscitation in order to maintain organ perfusion) is the priority at this time. Antibiotics (choic e (A)) will need to be started after blood cultures are obtained. A vasopressor (choice (B)) may not be needed if the MAP is restored with fluids. Although a sputum culture (choice (C)) may be indicated, blood cultures need to be drawn first so that antibi otics can be given (within the first hour, if possible). 2. A patient has a history of chronic respiratory failure secondary to COPD and now has acute respiratory failure secondary to pneumonia. Upon arrival at the critical care unit, his ABGs were a pH of 7.29, a PaCO 2 of 77, a PaO 2 of 51, and an HCO 3 of 31. He is receiving noninvasive ventilation with settings that read as follows: FiO 2 0.40, IPAP 12 cm, and EPAP 5 cm. After 1 hour of therapy, the patient's ABG results are a pH of 7.20, a PaCO 2 of 89, a PaO 2 of 48, and an HCO 3 of 32. What is the correct evaluation of this data? A) Alveolar hyperventilation is getting worse; the BiPAP settings need adjustment. B) Metabolic acidosis is worse; the FiO 2 needs to be increased. C) Alveolar hypoventi lation is getting worse; the patient needs to be intubated. D) The pH is acceptable for a patient with COPD; continue the current therapy. - CORRECT ANSWER ✔✔ C. The patient did not CCRN EXAM 2 REAL 2024 -2025 ACTUAL EXAM QUESTIONS EXPERT VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+ 2023/2024 respond to noninvasive ventilation since the PaCO 2 increased, respiratory acidosis is worse, and severe hypoxemia was not corrected. BiPAP should not be continued. The issue is not metabolic acidosis. The pH is not acceptable. 3. A patient is alert and is receiving mechanical ventilation with the following settings: assist -control mode at 10 breaths/minute, FiO 2 0.40, and PEEP 5 cm H 2 O pressure. Vital signs include a 18 breaths/minute, with norepinephrine at 7 mcg/min for the past 4 hours. The patient has tolerated repositioning in bed and a head of bed elevation up to 90°. Which of the following would be an appropriate next step in terms of mobility for this patient? A) Allow the patient to sit on the edge of the bed, with assistance. B) Reduce the head of bed elevation to 45°. C) Maintain the patient's current level of m obility. D) Help the patient stand and pivot to a chair. - CORRECT ANSWER ✔✔ A. This patient tolerated the current activity with head of bed elevation in high Fowler's position and is now ready to progress to sitting without back support with his legs dangl ing. This patient does not have contraindications to mobility progression; therefore, reducing the patient's mobility (choice (B)) or maintaining the patient's current level of mobility (choice (C)) would not provide progress. Although the patient might be able to progress to weight -bearing and sitting in a chair, it is best to go step -by-step and then reassess, not to proceed directly to weight -
bearing (as choice (D) suggests). CCRN EXAM 2 REAL 2024 -2025 ACTUAL EXAM QUESTIONS EXPERT VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+ 2023/2024 4. A 70 kg patient with ARDS is mechanically ventilated with the following settings: FiO 2 70%, tidal volume 450 mL, assist -control mode 10 breaths/minute, and PEEP 20 cm H 2 O pressure. On these settings, the patient's PaO 2 is 76 mmHg and the PaCO 2 is 58 mmHg. The patient's core temperature is 37°C, his heart rate is 116 beats/minute, and his B/P is 78/58. Which of the following interventions should the nurse now anticipate? A) Decrease PEEP to decrease the intrathoracic pressure. B) Administer a 500 mL fluid bolus of normal saline. C) Initiate a norepinephrine drip to maintain a SBP of 80 mmHg. D) Increase the tidal volume to 750 mL. - CORRECT ANSWER ✔✔ B. The primary problem is hypotension, and it should be treated with fluids. Although a reduction o f PEEP would most likely increase the B/P, it would result in derecruitment of alveoli and hypoxemia. A norepinephrine drip should be initiated only if fluids alone do not correct the hypotension. An increase in the tidal volume would not increase the B/P and would cause volutrauma in a patient with ARDS. 5. A 70 kg patient with ARDS is intubated and mechanically ventilated. The patient is on continuous infusions of an opiate, a sedative, and neuromuscular blocking drugs. The plateau pressure is 45 cm H 2 O. The PaO 2 is 60 mmHg. The physician orders the following ventilator settings: SIMV mode, tidal volume 700 mL, rate 12 breaths/minute, FiO 2 1.00, and PEEP 15 cm H 2 O pressure. Which of the following needs to be discussed with the physician? A) the ve ntilator mode B) the tidal volume C) the PEEP D) the FiO 2 - CORRECT ANSWER ✔✔ B. This patient with ARDS CCRN EXAM 2 REAL 2024 -2025 ACTUAL EXAM QUESTIONS EXPERT VERIFIED SOLUTIONS WITH RATIONALES ALREADY GRADED A+ 2023/2024 needs to receive 4 -5 mL/kg tidal volume in order to prevent volutrauma. This patient is receiving 10 mL/kg tidal volume, and this level needs to be re duced. The mode of ventilation and both the PEEP and the FiO 2 settings are acceptable. 6. Which of the following nursing behaviors is usually most helpful to patients and families regarding end -of-life decisions? A) avoiding the use of words such as "d eath," "dying," and "suffering" B) consulting the clergy for support C) acting as an arbitrator between family members D) requesting that only 1 person be the spokesperson - CORRECT ANSWER ✔✔ C. When end -of-life decisions are required, a certain amount of family conflict usually occurs. An experienced nurse knows how to arbitrate in these matters. Choice (A) is not an effective strategy. The clergy may be consulted but only if this is the family's wish. A request that only 1 person be the spokesperson is an effective strategy for routine communication with a large family. However, when end -of-life decisions are necessary, all stakeholders need to have a voice. 7. A patient presented with sepsis secondary to a urinary tract infection. After the initial admi nistration of 30 mL/kg of isotonic crystalloid, the B/P is 88/46 (the MAP is 60 mmHg), the heart rate is 102 beats/minute, the respiratory rate is 22 breaths/minute, and the lungs are clear. What intervention is indicated at this time? A) Decrease the ra te of fluid administration. B) Start a dobutamine (Dobutrex) infusion.
