Free CCRN Practice Test (2024)

Cardiovascular

1. A 47-year-old male has been admitted to the CCU from the emergency room with a history of sudden diaphoresis, nausea, vomiting and radiating pain down his left arm. He reports no significant medical history, and has been a two PPD smoker since his early twenties. His admitting diagnosis is UA/NSTEMI and he is being prepped for cardiac catheterization for possible angioplasty with stent placement. What type of medication orders might the nurse see prior to his procedure?
2. A 62-year-old male presents to the emergency department with complaints of sudden onset chest pain, shortness of breath, and dizziness. The nurse places the client on a cardiac monitor and notes the attached rhythm. Which intervention is most appropriate for this client?
Free CCRN Practice Test (1)
3. A 43-year-old female with a past medical history of coronary artery disease is admitted to the CCU for concerns of acute onset dyspnea and chest pain. The client's troponin level is 0.02 ng/mL and CK-MB is 2%. The client's oxygen saturation is 95% and blood pressure is 200/120 mm Hg. Which medication would the nurse expect the provider to order?
4. A 75-year-old male with a past medical history of chronic hypertension and ischemic heart disease presents to the CCU on 3L of oxygen therapy with abnormal laboratory results. Which assessment finding would be associated with left-sided heart failure?
5. Agnes is a 65-year-old white female who has a history of pulmonary fibrosis with steroid use for the past two years with concomitant hypertension. She has been on oxygen therapy at 4L per nasal cannula for the past 3 years. Recently, her first great-grandchild was born, and she decided to quit smoking. Three days ago, she experienced nausea and dizziness and was admitted to the CCU with a diagnosis of acute myocardial infarction. During shift change, Agnes' low blood pressure alarm sounds. Upon assessment, she is diaphoretic and has severe dyspnea. What is the most likely cause of her symptoms?

Respiratory

Refer to the following for questions 6 and 7:

Norman is a 65 year old paraplegic who resides in a nursing home. He presents with a 3-day history of increased temperature, productive cough, and increased weakness. His caregiver states that he had developed a decubitis ulcer, and has not been able to tolerate sitting in his wheelchair, so has been in bed for the past week. Bibasilar crackles are audible on auscultation, with overall diminished breath sounds bilaterally. Obvious respiratory distress is apparent with tachypnea, suprasternal retractions and use of accessory muscles. Vitals: T-100.2F, HR-120, RR-28, BP 104/50, O2 Sat on RA - 88%. An initial chest x-ray reveals the "spine sign" and a normal cardiac silhouette.

6. What is the most likely cause of Norman's condition?
7. What does the finding of "spine sign" on Norman's chest x-ray indicate?
8. A client who has a history of COPD and is admitted for pneumonia and hypoxia. An arterial blood gas is drawn and results indicate the following: pH 7.12, pCO2 61 mm Hg, and HCO3- of 28 mEq/L. The results indicate which condition?
9. A 36-year-old client is admitted to the ICU for acute respiratory distress syndrome and is intubated on admission. The client is agitated and is requiring 60% FiO2 to maintain oxygen saturations greater than 93%. The provider has placed an order to increase the client's PEEP from 10 to 15 cm H2O. The nurse would monitor for which complication?
10. A 40-year-old client was admitted with dyspnea, unilateral breath sounds, tracheal deviation and a chest tube was inserted. Upon assessment, the nurse notes there is no tidaling in the water-seal chamber of the chest tube. Which order would the nurse anticipate the provider place given the client's findings?

Endocrine

11. If a patient is suspected of having an episode of acute hypoglycemia, which of the following is NOT the most appropriate first intervention?
12. The nurse is conducting an assessment on a 19-year-old client in the emergency department. The client's respiratory rate is 25 breaths per minute, heart rate 128 beats per minute, blood pressure 102/60 mm Hg, and oxygen saturation 87% on room air. The client briefly awakens to vigorous stimulation. Labs include a glucose of 630 mg/dL, pH 7.1, serum bicarb 12 mEq/L, potassium 7.1 mEq/L and sodium 130 mEq/L. Which fluid would the nurse expect the provider to order for this client?
13. A 45-year-old client underwent a craniotomy for tumor resection and is now 48 hours postop. The client's urine output in the last 24 hours was 20 liters. Labs include a urine osmolality of 200 mmol/L, urine specific gravity of 1.000 and sodium of 145. Which medication is appropriate for this client's diagnosis?
14. Which lab findings would be seen in a client who presents with syndrome of inappropriate antidiuretic hormone secretion?
15. Marilyn is a Type I diabetic who has been admitted to the unit after a severe hypoglycemic episode in which she lost consciousness. She states that she has had many episode of hypoglycemia, but just does not seem to know when they are coming on anymore. What is the term for this phenomenon?

Hematology / Immunology

16. Of the following, which is included in the etiology of idiopathic thrombocytopenic purpura (ITP)?

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17. A 45-year-old client is admitted for severe anemia secondary to chemotherapy. The nurse started the client's blood transfusion approximately 1 hour ago. The nurse is assessing vital signs and notes a heart rate of 162 beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 84/58 mm Hg, and temperature of 101.5 degrees F. The client is vomiting and has severe agitation. Which type of transfusion reaction is this client most likely experiencing?
18. A 55-year-old male has a history of lymphoma and has been receiving chemotherapy treatment for the past 3 months. The client presents to the emergency department with concerns for weakness, nausea, and decreased urine output. Labs include a potassium of 6.9 mmol/L, phosphate of 8.9 mg/dL, uric acid of 12.4 mg/dL, creatinine of 2.3 mg/dL, and calcium of 7.7 mg/dL. Which intervention is priority given the client's assessment and lab results?
19. Which lab findings would be seen in a client who presents with disseminated intravascular coagulation?
20. Of the following, which is NOT a consideration when administering IVIg therapy?

Neurology

21. What is the most common site of rupture of a cerebral aneurysm with resulting subarachnoid hemorrhage (SAH)?
22. A client was in a motor vehicle accident and underwent a craniotomy yesterday. The client has an external ventricular drain set at 15 mm Hg which has drained 50 cc of cerebral spinal fluid the past hour. The client's current intracranial pressure is 32. Which intervention is appropriate?
23. A client presents to the emergency room after getting hit in the head from a baseball. The client has clear leakage from the right ear, hemotympanum and a positive battle sign. Which type of skull fracture is the client most likely presenting with?
24. Which lab findings in cerebral spinal fluid would be most suggestive of a client presenting with bacterial meningitis?
25. Donna is a 43-year-old teacher who was admitted 6 days ago with a ruptured middle cerebral artery (MCA) aneurysm with subarachnoid hemorrhage (SAH). She underwent surgery for aneurysm clipping 12 hours after admission, and has had an excellent post-operative course. However, this morning, she complained of a severe headache, became acutely confused and quickly progressed to unresponsiveness. What is the likely cause for Donna's change of status?

Gastrointestinal

26. Matthew is a 26-year-old who has been admitted to the ICU following a motor vehicle accident. Upon assessment, it is noted that he has a positive Cullen sign. What does this indicate?
27. A 60-year-old client reports to emergency room with concerns for severe abdominal pain and distention, nausea and vomiting for 24 hours. On assessment, the client has hyperactive bowel sounds and 10 out of 10 abdominal pain. An abdominal x-ray reveals multiple air-fluid levels. Which intervention is appropriate for this client?
28. A client presents to the emergency department with complaints of hematemesis and melena. The client has a history of esophageal varices. Where is the most likely origin of the bleeding?
29. The nurse is assessing a client in the emergency department and notes the client has a grey turner's sign and Cullen sign. The client's heart rate is 142 beats per minute, respiratory rate is 22 breaths per minute, and blood pressure is 92/68 mm Hg. Which diagnosis is most likely given the client's findings?
30. If bowel sounds are audible when auscultating Matthew's lungs, what injury may he have sustained?

Renal

31. If a patient sustains acute renal failure (ARF) secondary to cardiogenic shock, what type of renal failure is this considered?

Refer to the following for questions 32 and 33:

A 62-year-old male with a past medical history of hypertension and type 2 diabetes mellitus presents to the emergency department with concerns for decreased urine output, fatigue, and edema in lower extremities for the past week. Vital signs include a heart rate of 92 beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 160/90 mmHg and temperature of 98.7 degrees F. Labs include a serum creatinine of 4.6 mg/dL, potassium of 6.5 mmol/L, sodium 136 mmol/L, and blood urea nitrogen of 52 mg/dL. Urinalysis shows 3+ proteinuria, 1+ hematuria, and elevated specific gravity.

32. Which type of renal failure is this client presenting with?
33. Which intervention is most appropriate for the client?
34. Which order would the nurse question for a client who is in severe kidney failure?
35. The RIFLE classification system provides a definition and classification system for acute renal failure (ARF). What does the "R" in the RIFLE acronym refer to?

Behavior / Psychological

36. A 22-year-old client presents to the emergency department with concerns for tremors, confusion and agitation. The client has a history of major depressive syndrome and was recently started on a new antidepressant medications. Vital signs include a heart rate of 120 beats per minute, respiratory rate of 24 breaths per minute, blood pressure of 150/90 mmHg, and temperature of 103.2 degrees F. On examination, client has 4+ reflexes and muscle rigidity. Labs include a normal basic metabolic panel, normal electrolytes, and an elevated serum creatinine kinase. Which intervention is most appropriate for this client?
37. A 6-month-old infant presents to the emergency department with concerns for poor feedings, emesis, and a seizure-like episode. Vital signs include a heart rate of 162 beats per minute, respiratory rate of 30 breaths per minute, blood pressure of 90/60 mmHg, and temperature of 100.8 degrees F. The infant is lethargic with poor muscle tone. Which assessment finding is diagnostic for a child who presents with shaken baby syndrome?
38. A client is admitted following a motor vehicle accident and has severe anxiety and nightmares. The client reports intrusive thoughts and flashbacks related to the incident. The client has a history of post-traumatic stress disorder. Which intervention would the nurse prioritize in the management of this client?

Multisystem

39. Andrew is a 47-year-old with advanced amyotrophic lateralizing sclerosis (ALS). He requires total assistance for positioning, bathing and mobility. His swallowing is impaired, so he takes nothing by mouth and receives nutrition through tube feedings via a gastrostomy tube. Based on his current condition, what type of asphyxia may Andrew be most susceptible to?

Refer to the following for questions 40 and 41:

A 30-year-old underwent an emergency cesarean section secondary to placental abruption. The client is now in the postpartum unit. Upon assessment, the nurse notes the client has an altered mental status, dyspnea, and cyanosis. Vital signs include a respiratory rate of 45 breaths per minute, heart rate of 138 beats per minute, and blood pressure of 64/40 mm Hg.

40. Which diagnosis is most likely given the client's findings?
41. Which intervention is most appropriate for the client?
42. A client presents to the emergency department after falling off a ladder and is diagnosed with a spinal cord injury in the lower cervical area. Upon assessment, the client is awake and alert and their skin is warm and dry. The client reports severe headache, neck pain, and weakness in extremities. Vital signs include a heart rate of 118 beats per minute, respiratory rate of 27 breaths per minute, oxygen saturation of 87% on room air, and blood pressure of 78/42 mm Hg. Which assessment finding is most suggestive of neurogenic shock?
43. Ramona is a 21-year-old who has been admitted to the ICU after suffering an anaphylactic reaction during dinner due to peanut sauce in a dish that the host didn't tell her about. She was stabilized in the emergency room with IV epinephrine and IV diphenhydramine. However, 4 hours after being admitted to the ICU she becomes anxious, develops hives and begins to have difficulty breathing. What is the most likely cause for Ramona's symptoms?

Behavior / Psychological

44. Madge is a 91-year-old nursing home resident with a history of dementia and atrial fibrillation who has been admitted to the ICU for treatment of pneumonia. As you are performing her bed bath, you note bruising around her breasts and genital area. What potential issue should be of major concern in Madge's situation?
45. Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper" for no reason, starts "ranting" and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence which includes irritability, agitation, and violent behavior during manic or psychotic episodes?

Professional Caring and Ethical Practice

46. Emily has been admitted to the ICU after being found unconscious on the street. She was found to be in diabetic ketoacidosis (DKA) with a blood sugar of 785. Emily is homeless, has had multiple admissions for DKA, and could benefit from use of an insulin pump, but says she has been repeatedly told, "Those are for rich people." What ethical principle supports Emily's right to have an insulin pump?
47. Tonya is a 44-year-old with a history of substance abuse who has been admitted to the ICU status-post left lateral thoracotomy. She has been clean and sober for 14 years, and discussed her status with her physician prior to her surgery. When she arrives from the operating room, she is in a great deal of pain. Post-operative pain management orders are for acetaminophen only. When you ask the surgeon for an opioid for pain management, he states, "She's an addict. She doesn't need anything for pain." What should your first response be?
48. The emergency room nurse is caring for a client who is admitted to the trauma bay after a motor vehicle accident. The nurse notes that the healthcare provider is rushing through the assessment and is not paying close attention to the client's neurological status or vital signs. The healthcare provider has ordered fentanyl to be administered. Which action would the nurse take to prioritize proper ethical care of the client?
49. The nurse is caring for a pediatric oncology client that has been withdrawn during this admission. The nurse sits with the client each day to play arts and crafts to help engage the client. Which ethical principle is the nurse demonstrating?
50. Which ethical principle should the nurse uphold when a client reports past sexual abuse but asks that the nurse not repeat this information?
Free CCRN Practice Test (2024)

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