CCRN Questions
A 22-year-old man is admitted to the intensive care unit after a motor vehicle collision. There are
lacerations on his face and head. The nurse observes a steady drip of clear fluid coming from his left ear.
Which of the following is an appropriate action to contain the drainage of cerebrospinal fluid (CSF)?
A.
Applying sterile ear packing
B.
Connecting low suction to the ear
C.
Applying loose sterile dressing
D.
Leaving ear uncovered - ANSWER-It is important not to obstruct CSF flow because this could increase
intracranial pressure. Introducing suction could cause bleeding, infection, or further structural damage.
A 23-year-old man is admitted via the emergency department after a motorcycle collision. His Glasgow
Coma Scale score was 12 in the emergency department, and it is still 12 upon his admission to the
neurologic intensive care unit. Both eyes are ecchymotic and swollen shut, and he has multiple
abrasions on his face. Which of the following is the most likely diagnosis?
A.
Linear skull fracture
B.
Basal skull fracture
C.
Orbital fracture
,CCRN Questions
D.
Mandibular fracture - ANSWER-Basal skull fracture
A 24-year-old woman is admitted with a closed head injury after a fall from a cliff. She is less responsive
and has a nonreactive dilated right pupil. These signs suggest pressure in which area of the brain?
A.
Right hemisphere
B.
Left hemisphere
C.
Cerebellum
D.
Hypothalamus - ANSWER-Right hemisphere
CN III controls pupil constriction. Hemispheric pressure on this nerve will result in a dilated pupil on the
same side as the pressure.
A 28-year-old woman is admitted to the critical care unit from the emergency department with a
diagnosis of asthma. Her initial arterial blood gases on a 28% Venturi mask are as follows:
pH 7.48
PaCO2 30 mm Hg
HCO3 24 mEq/L
PaO2 64 mm Hg
,CCRN Questions
Which of the following repeat arterial blood gases on 40% oxygen indicate that the patient's condition is
worsening?
A.
pH 7.48, PaCO2 30 mm Hg, PaO2 68 mm Hg
B.
pH 7.46, PaCO2 32 mm Hg, PaO2 61 mm Hg
C.
pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg
D.
pH 7.39, PaCO2 30 mm Hg, PaO2 60 mm Hg - ANSWER-C.
pH 7.40, PaCO2 40 mm Hg, PaO2 62 mm Hg
The case study shows stage II asthma. Option c shows stage III asthma. The patient is still breathing at a
fast rate, but carbon dioxide is starting to be retained as evidenced by the increase of the PaCO2 into
normal range. Options a and b are still stage II. Option d shows a respiratory alkalosis with a metabolic
acidosis because you would have expected the pH to be in an alkalotic range with the PaCO2 of 30.
A 29-year-old woman has been a patient in the critical care unit for 2 weeks with acute tubular necrosis
(ATN) as a result of crush injuries experienced in a motor vehicle collision. She was normotensive on
admission. Which electrolyte imbalances are likely to result from ATN?
Hypermagnesemia and hyperkalemia result from the inability of the kidneys to excrete these
electrolytes. Hypocalcemia is the result of the inability of the kidneys to produce the active component
of vitamin D, 1,25-dihydroxycholecalciferol and the change in calcium as a result of the
hyperphosphatemia that is seen in ATN.
A 30-year-old man is in the surgical intensive care unit after exploratory laparotomy performed after he
sustained a gunshot wound to the abdomen. He now has developed a pancreatic fistula. Which acid-
base imbalance is this patient at risk for developing?
A.
Respiratory acidosis
B.
Metabolic acidosis
C.
Respiratory alkalosis
D.
Metabolic alkalosis - ANSWER-Metabolic acidosis
The stomach is acidic, but the gastrointestinal tract below the stomach is alkaline. Pancreatic secretions
are rich in bicarbonate, and these losses would cause metabolic acidosis.
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