CCRN-ADULT sample questions

Question 1

A 28-year-old female with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Following 4 hours of intravenous 0.9% normal saline resuscitation and continuous regular insulin infusion, laboratory values reveal: serum glucose 218 mg/dL, potassium 4.2 mEq/L, sodium 138 mEq/L, serum bicarbonate 14 mEq/L, and calculated anion gap 19 mEq/L. Which intravenous fluid and insulin titration order should the critical care nurse implement next?

Accepted Answer

Change intravenous fluids to 5% dextrose in 0.45% normal saline with potassium while maintaining the continuous insulin infusion until the anion gap normalizes.

Answer

Double the continuous insulin infusion rate to resolve the acidosis rapidly while continuing 0.9% normal saline boluses.

Answer

Discontinue the intravenous insulin infusion and transition the patient immediately to subcutaneous glargine and lispro.

Answer

Administer an ampule of 8.4% sodium bicarbonate intravenously and hold all potassium supplementation until urine output exceeds 100 mL/hr.

Question 2

In a post-craniotomy patient who develops acute central diabetes insipidus (DI), the characteristic diagnostic findings include a urine specific gravity _____ and a serum osmolality _____.

Accepted Answer

295 mOsm/kg

Answer

< 1.005; < 280 mOsm/kg

Answer

> 1.030; > 310 mOsm/kg

Answer

> 1.030; < 275 mOsm/kg

Question 3

A critically ill patient with septic shock and oliguric acute kidney injury is receiving continuous venovenous hemodiafiltration (CVVHDF). The CRRT circuit experiences repeated clotting within 6 hours of setup despite systemic unfractionated heparin. The nurse notes progressively rising transmembrane pressure (TMP) with high pre-filter pressures. Which evidence-based adjustment should the nurse recommend to optimize circuit patency while minimizing systemic bleeding risk?

Accepted Answer

Transition to regional citrate anticoagulation (RCA) with pre-filter citrate and post-filter calcium infusion, monitoring post-filter and systemic ionized calcium levels.

Answer

Decrease blood flow rate (Qb) to less than 80 mL/min to reduce turbulent sheer stress on the hemofilter membrane.

Answer

Switch replacement solution from post-dilution to pre-dilution without adding anticoagulation.

Answer

Double the systemic unfractionated heparin bolus and increase the target partial thromboplastin time (aPTT) to > 100 seconds.

Question 4

A 58-year-old postoperative patient receiving subcutaneous unfractionated heparin for venous thromboembolism prophylaxis is noted to have a platelet count drop from 310,000/mcL on postoperative day 1 to 96,000/mcL on postoperative day 6. Ultrasound confirms a new, extensive left lower extremity deep vein thrombosis. What is the immediate priority nursing action?

Accepted Answer

Discontinue all heparin products immediately (including vascular flushes) and initiate an alternative non-heparin anticoagulant such as argatroban or bivalirudin.

Answer

Switch the patient from unfractionated heparin to therapeutic-dose low-molecular-weight heparin (enoxaparin).

Answer

Administer 2 units of pooled platelets immediately to prevent acute hemorrhagic transformation of the thrombus.

Answer

Initiate continuous warfarin loading doses while continuing low-dose subcutaneous heparin.

Question 5

A 52-year-old male with decompensated alcoholic cirrhosis is admitted to the intensive care unit with acute, massive upper gastrointestinal hemorrhage manifesting as torrential hematemesis and frank melena.

Upon arrival, the patient is obtunded, responding only to noxious stimuli. Vital signs reveal blood pressure 76/42 mmHg, heart rate 136 beats/min, respiratory rate 28 breaths/min, and oxygen saturation 89% on ambient air. Physical assessment demonstrates spider angiomas, prominent ascites, and active oral bleeding threatening the airway.

Which comprehensive initial resuscitation strategy should the critical care team implement prior to emergent esophagogastroduodenoscopy (EGD)?

Accepted Answer

Perform endotracheal intubation for airway protection, initiate continuous octreotide and prophylactic intravenous ceftriaxone, and transfuse packed red blood cells to maintain target hemoglobin between 7 and 8 g/dL.

Answer

Rapidly infuse 4 liters of 0.9% normal saline through large-bore peripheral lines, administer high-dose propranolol, and place a nasogastric tube to continuous high wall suction.

Answer

Administer intravenous vasopressin without concomitant nitroglycerin, initiate therapeutic total parenteral nutrition, and transfuse whole blood to target hemoglobin > 12 g/dL.

Answer

Insert a Sengstaken-Blakemore tube immediately without intubation, inflate the gastric balloon to 60 mmHg, and place the patient on high-flow nasal cannula.

Question 6

Ninety minutes after the initiation of a transfusion of fresh frozen plasma, a patient with acute coagulopathy develops acute respiratory distress, hypoxemia (SpO2 86%), bilateral crackles, and jugular venous distention. Hemodynamic monitoring demonstrates central venous pressure (CVP) of 18 mmHg and pulmonary artery occlusion pressure (PAOP) of 22 mmHg. Blood pressure has risen from 124/76 to 178/98 mmHg, and serum B-type natriuretic peptide (BNP) is markedly elevated. Which transfusion reaction is the patient experiencing?

Accepted Answer

Transfusion-associated circulatory overload (TACO)

Answer

Anaphylactic transfusion reaction

Answer

Acute hemolytic transfusion reaction (AHTR)

Answer

Transfusion-related acute lung injury (TRALI)

Top vendors

Top exams

Free CCRN-ADULT sample questions

In a post-craniotomy patient who develops acute central diabetes insipidus (DI), the characteristic diagnostic findings include a urine specific gravity _ and a serum osmolality _.

6 more free samples are waiting