CCRN Multisystem Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Medium

   Which precautions are required for a patient admitted with suspected pulmonary tuberculosis?

   1. AA. Droplet precautions in a private room, with surgical masks for staff
   2. BB. Airborne precautions in a negative-pressure room, with fit-tested N95s
   3. CC. Contact precautions with a gown and gloves, with the door left open
   4. DD. Standard precautions until a sputum culture confirms the diagnosis
   Show answer to question 1

   Answer: B. Airborne precautions in a negative-pressure room, with fit-tested N95s

   Tuberculosis spreads by airborne droplet nuclei, so the patient is placed in an airborne infection isolation room with negative pressure and the door closed, and staff wear fit-tested N95 or higher-level respirators. When the patient must leave the room, the patient wears a surgical mask.

   Why the other options are wrong

   • ASurgical masks and droplet precautions do not protect against droplet nuclei that stay suspended and travel on air currents.
   • CContact precautions do not address airborne spread, and an open door lets contaminated air escape.
   • DCultures take weeks, so airborne precautions begin on suspicion rather than confirmation.

2. Question 2 of 25Hard

   A 71-year-old woman with cancer pain who has taken high-dose oral opioids for months is receiving a hydromorphone infusion in the ICU. The infusion has been stopped because she is now difficult to arouse, with a respiratory rate of 6/min and pinpoint pupils. The provider orders naloxone. How should the nurse give it?

   1. AA. Give a full 2 mg dose, undiluted, by rapid IV push at once
   2. BB. Give it intramuscularly and reassess in 15 minutes
   3. CC. Give one dose and end close monitoring once she wakes
   4. DD. Dilute it and give small doses until breathing improves
   Show answer to question 2

   Answer: D. Dilute it and give small doses until breathing improves

   In a patient with long-term opioid use, small diluted doses of naloxone titrated to adequate breathing reverse respiratory depression while limiting abrupt withdrawal, severe pain and complications such as pulmonary edema. Monitoring continues because naloxone can wear off before the opioid does.

   Why the other options are wrong

   • AA large undiluted dose in an opioid-tolerant patient can cause acute withdrawal, a severe pain crisis and complications such as pulmonary edema.
   • BIntramuscular absorption is slower and less predictable, and IV titration is preferred when IV access is available.
   • CNaloxone can wear off before the opioid does, so respiratory depression may return and close monitoring must continue.

3. Question 3 of 25Medium

   A 70-year-old man on mechanical ventilation after abdominal surgery cannot self-report. During turning, he grimaces, keeps his arms rigid, pulls at the endotracheal tube and coughs against the ventilator. His heart rate and blood pressure stay at his baseline. How should the nurse interpret these findings?

   1. AA. He has pain, and stable vital signs do not rule it out
   2. BB. He has no pain, because his vital signs did not change
   3. CC. He has delirium, which explains the behaviors during turning
   4. DD. He needs more sedation, not analgesia, for ventilator synchrony
   Show answer to question 3

   Answer: A. He has pain, and stable vital signs do not rule it out

   Grimacing, muscle rigidity, pulling at devices and fighting the ventilator during a painful procedure are validated behavioral indicators of pain. Vital signs are not valid indicators of pain on their own, so unchanged vital signs do not rule pain out.

   Why the other options are wrong

   • BHeart rate and blood pressure can stay unchanged despite pain, especially with medications or illness, so they cannot rule pain out.
   • CThese behaviors occurred during turning, a known painful procedure, and match validated pain indicators; delirium is assessed separately with its own tool.
   • DSedating a patient who shows pain behaviors without treating the pain is not appropriate; analgesia comes first.

4. Question 4 of 25Hard

   A 44-year-old man on ECMO for severe ARDS is also receiving CRRT with net fluid removal. Over the past hour the drainage tubing has begun to shake rhythmically, the drainage pressure has become more negative, the ECMO blood flow has dropped intermittently, and his SpO2 has fallen from 90% to 82%. His CVP is 3 mm Hg. Which cause is most likely?

   1. AA. A blood clot forming in the oxygenator membrane
   2. BB. Too little venous blood reaching the circuit
   3. CC. Failure of the sweep gas supply to the oxygenator
   4. DD. Air entering the return limb of the circuit
   Show answer to question 4

   Answer: B. Too little venous blood reaching the circuit

   Shaking or chattering of the drainage line, more negative drainage pressure and falling flow with a low CVP mean too little blood is reaching the drainage cannula, often from hypovolemia after fluid removal. The team typically pauses fluid removal, gives volume and checks cannula position rather than increasing pump speed.

   Why the other options are wrong

   • AOxygenator clotting widens the pressure drop across the membrane and lowers post-oxygenator oxygen levels, but it does not make the drainage line shake.
   • CLoss of sweep gas lowers oxygenation and raises carbon dioxide, but blood flow and drainage pressure would not change.
   • DAir in the return limb shows as bubbles in the tubing and is a different emergency; it does not cause chattering with more negative drainage pressure.

5. Question 5 of 25Medium

   An unresponsive 84-year-old man who is expected to die within hours has loud, gurgling respirations from secretions pooled in his throat. His daughter at the bedside is distressed by the sound. Which nursing action is most appropriate?

   1. AA. Suction deep in his airway every hour and tell her this will stop the sound
   2. BB. Ask for IV fluids to loosen the secretions and reassure her
   3. CC. Request IV furosemide to dry his lungs and explain this to her
   4. DD. Turn him onto his side and explain to her what the sound means
   Show answer to question 5

   Answer: D. Turn him onto his side and explain to her what the sound means

   Turning him to the side helps pooled secretions drain, and explaining that the noise comes from secretions moving with breathing, which is not thought to distress the patient, supports his daughter. An anticholinergic such as glycopyrrolate may be added to reduce new secretions.

   Why the other options are wrong

   • ADeep suctioning is uncomfortable, stimulates more secretions and gives only brief relief, so it is avoided in actively dying patients.
   • BIV fluids can increase secretions and edema in an actively dying patient, making the noisy breathing worse.
   • CThese secretions are pooled saliva and airway mucus, not pulmonary edema, so a diuretic would not help.

6. Question 6 of 25Easy

   A patient has a serum potassium of 3.0 mEq/L. Which of these potassium chloride orders should the nurse question?

   1. AA. 10 mEq in 100 mL IV by pump over 1 hour
   2. BB. 20 mEq by mouth twice today
   3. CC. 10 mEq IV push over 2 minutes
   4. DD. 20 mEq in 1,000 mL IV by pump at 100 mL/hr
   Show answer to question 6

   Answer: C. 10 mEq IV push over 2 minutes

   Concentrated potassium must never be given by IV push or bolus, because a rapid rise in serum potassium can cause fatal dysrhythmias and cardiac arrest. IV potassium is always diluted and infused by pump at a controlled rate.

   Why the other options are wrong

   • AA diluted 10 mEq dose infused by pump over 1 hour is a common, safe peripheral replacement rate.
   • BOral replacement is safe and appropriate when the patient can take medications by mouth.
   • DA dilute solution infused by pump at a controlled rate is a safe approach.

7. Question 7 of 25Hard

   A 31-year-old man was declared dead by neurologic criteria, and his family has authorized organ donation. While organ recovery is being arranged, his urine output is 650 mL/h of dilute urine, his serum sodium has risen from 142 to 156 mEq/L, and his blood pressure is 80/46 mm Hg despite fluid replacement. Which medication should the nurse anticipate to treat both problems?

   1. AA. Desmopressin IV
   2. BB. Norepinephrine infusion
   3. CC. Vasopressin infusion
   4. DD. Dopamine infusion
   Show answer to question 7

   Answer: C. Vasopressin infusion

   Brain death often causes central diabetes insipidus and vasodilation, and vasopressin replaces antidiuretic hormone while also constricting blood vessels to raise blood pressure. Desmopressin treats the polyuria alone, and catecholamines raise pressure without stopping the water loss.

   Why the other options are wrong

   • ADesmopressin controls diabetes insipidus but has almost no vasopressor effect, so it would not correct his hypotension.
   • BNorepinephrine raises blood pressure but does not reduce the dilute polyuria that is driving his hypernatremia and volume loss.
   • DDopamine raises blood pressure through adrenergic effects but does not replace antidiuretic hormone, so the polyuria continues.

8. Question 8 of 25Medium

   A 57-year-old man is resuscitated from a witnessed ventricular fibrillation arrest and remains comatose after return of spontaneous circulation. His 12-lead ECG shows ST elevation in leads V1 to V4. The hospital has a cardiac catheterization laboratory available. Which plan should the nurse anticipate?

   1. AA. Angiography after he wakes and follows commands
   2. BB. Emergency coronary angiography with possible PCI
   3. CC. Temperature control for 72 hours before angiography
   4. DD. A repeat 12-lead ECG in 24 hours to confirm the changes
   Show answer to question 8

   Answer: B. Emergency coronary angiography with possible PCI

   Emergency coronary angiography is recommended after resuscitation when the ECG shows ST elevation and a cardiac cause of arrest is suspected, whether or not the patient is awake. Temperature control can be started and continued during the procedure.

   Why the other options are wrong

   • AComa after arrest is not a reason to delay reperfusion of an acute coronary occlusion, and early neurologic prognosis is unreliable.
   • CTemperature control does not require delaying angiography; both can proceed at the same time.
   • DST elevation after a ventricular fibrillation arrest suggests an acute coronary occlusion that needs reperfusion now, not repeat testing a day later.

9. Question 9 of 25Medium

   The family of a 45-year-old woman with a devastating brain injury has decided to withdraw life support and has authorized donation after circulatory death. The organ procurement organization (OPO) is coordinating organ recovery in the operating room. Which practice must be followed?

   1. AA. Her ICU team manages withdrawal and declares death, not the recovery team
   2. BB. The organ recovery surgeon decides when the ventilator is withdrawn
   3. CC. The OPO coordinator declares death as soon as circulation stops
   4. DD. Comfort medications are withheld so that they do not harm the organs
   Show answer to question 9

   Answer: A. Her ICU team manages withdrawal and declares death, not the recovery team

   To avoid any conflict of interest, the patient's own care team handles the withdrawal of support, comfort care and the declaration of death, and the organ recovery team takes no part in those steps. This separation protects the patient and the family's trust in the donation process.

   Why the other options are wrong

   • BOrgan recovery staff may not take part in decisions about withdrawal or its timing, which belong to the patient's own care team.
   • CDeath is declared by an authorized clinician from the patient's care team, not by OPO staff, after the required observation period.
   • DComfort-focused care continues during withdrawal, and medications needed for comfort are not withheld because of donation.

10. Question 10 of 25Medium

    A 58-year-old woman receiving chemotherapy develops a vesicular rash that began on one side of her chest and has now spread to her face, arms and legs. Disseminated herpes zoster is suspected. Which precautions should the nurse implement?

    1. AA. Standard precautions, with the lesions covered by dressings
    2. BB. Droplet precautions until 24 hours of antiviral therapy
    3. CC. Contact precautions with a gown and gloves until lesions crust
    4. DD. Airborne and contact precautions until all lesions are crusted
    Show answer to question 10

    Answer: D. Airborne and contact precautions until all lesions are crusted

    Disseminated zoster requires both airborne and contact precautions, because the virus spreads through the air and from lesion fluid. Precautions continue until all lesions are dry and crusted, and caregivers should be immune to varicella whenever possible.

    Why the other options are wrong

    • ACovering lesions under standard precautions is acceptable for localized zoster in a patient with an intact immune system, not for this patient.
    • BDroplet precautions do not stop airborne spread, and antiviral therapy does not end the need for isolation.
    • CContact precautions without airborne precautions do not prevent airborne transmission of the virus.

11. Question 11 of 25Medium

    A 46-year-old man is admitted with acute pancreatitis after heavy alcohol use. His temperature is 38.5°C (101.3°F), heart rate 114/min, respiratory rate 26/min and WBC count 15,800/mm3. His blood pressure is 128/76 mm Hg, and his creatinine, platelet count and bilirubin are normal. Blood, urine and sputum cultures are negative, and imaging shows no abscess or other infection. Which term best describes his condition?

    1. AA. Sepsis from an occult bacterial infection
    2. BB. Septic shock with negative blood cultures
    3. CC. Systemic inflammatory response syndrome
    4. DD. Multiple organ dysfunction syndrome
    Show answer to question 11

    Answer: C. Systemic inflammatory response syndrome

    He meets the SIRS criteria for temperature, heart rate, respiratory rate and WBC count, and pancreatitis is a common noninfectious trigger of this systemic inflammatory response. Sepsis requires a suspected or proven infection with organ dysfunction, which he does not have.

    Why the other options are wrong

    • ANo source of infection has been found, and pancreatitis itself explains the inflammatory findings.
    • BSeptic shock requires infection with vasopressor-dependent hypotension and an elevated lactate, none of which is present.
    • DHis blood pressure, kidney, liver and platelet values are normal, so no organ dysfunction is present.

12. Question 12 of 25Easy

    Before giving an IV medication through the needleless connector of a central venous catheter, what should the nurse do to reduce the risk of a bloodstream infection?

    1. AA. Flush the connector with saline before cleaning it
    2. BB. Replace the connector before every medication dose
    3. CC. Wipe the connector when it looks visibly soiled
    4. DD. Scrub the connector with an antiseptic and let it dry
    Show answer to question 12

    Answer: D. Scrub the connector with an antiseptic and let it dry

    Scrubbing the connector with an appropriate antiseptic such as alcohol or chlorhexidine-alcohol and allowing it to dry removes microorganisms before each access. Antiseptic-containing caps that stay on between accesses are an alternative in many units.

    Why the other options are wrong

    • AFlushing through an unclean connector pushes microorganisms into the catheter.
    • BFrequent connector changes add manipulations and have not been shown to reduce infection.
    • CMicroorganisms are invisible, so every access needs disinfection whether or not soil is seen.

13. Question 13 of 25Easy

    A 54-year-old male with a height of 5 feet 8 inches (173 cm) and an actual body weight of 145 kg (BMI 48.5 kg/m²) is admitted to the ICU with acute respiratory distress syndrome. When setting initial volume-controlled mechanical ventilation parameters, which weight metric should guide the calculation of the target tidal volume of 6 mL/kg?

    1. AA. Adjusted body weight
    2. BB. Lean body weight plus 20%
    3. CC. Predicted ideal body weight
    4. DD. Actual body weight
    Show answer to question 13

    Answer: C. Predicted ideal body weight

    Mechanical ventilation tidal volumes must be calculated using predicted ideal body weight because lung volume is determined by biological sex and height rather than total body mass. Calculating tidal volume based on actual or adjusted body weight in patients with severe obesity delivers excessively large volumes, causing volutrauma and barotrauma. Using predicted ideal body weight ensures lung-protective ventilation and minimizes the risk of ventilator-induced lung injury.

14. Question 14 of 25Hard

    A 63-year-old man with septic shock from cholangitis has a MAP of 66 mm Hg on a vasopressor. His lactate of 5.6 mmol/L has not fallen in 4 hours, his urine output is 10 mL/hr, and his knees are mottled. His central venous oxygen saturation (ScvO2) is 84%. How should the nurse interpret the ScvO2?

    1. AA. Tissue perfusion is adequate, so the high lactate is not a concern
    2. BB. Oxygen extraction is impaired, so hypoperfusion is still possible
    3. CC. Oxygen consumption is high, so his sedation needs to be deepened
    4. DD. The sample must have been drawn incorrectly, so it should be ignored
    Show answer to question 14

    Answer: B. Oxygen extraction is impaired, so hypoperfusion is still possible

    In septic shock, microcirculatory dysfunction and impaired cellular use of oxygen can keep venous saturation normal or high while tissues are hypoperfused. The persistent high lactate, oliguria and mottling show ongoing hypoperfusion, so a high ScvO2 is not reassuring.

    Why the other options are wrong

    • AThe unchanged lactate, oliguria and mottling show that perfusion is inadequate despite the ScvO2.
    • CHigh oxygen consumption would lower the ScvO2, not raise it.
    • DNothing suggests a sampling error, and a high ScvO2 is a recognized finding in septic shock.

15. Question 15 of 25Easy

    Which nighttime plan best promotes sleep for an older ICU patient who is at risk for delirium?

    1. AA. Give a benzodiazepine at bedtime to help sleep onset
    2. BB. Keep the room lights on so staff can observe closely
    3. CC. Group care into blocks, dim the lights and limit noise
    4. DD. Schedule the bath and daily weight for 0300, when it is quiet
    Show answer to question 15

    Answer: C. Group care into blocks, dim the lights and limit noise

    Clustering care to allow uninterrupted periods of sleep, reducing light and noise and offering earplugs or eye masks are recommended parts of ICU sleep-promotion protocols. Better sleep and a normal day-night rhythm may also help lower the risk of delirium.

    Why the other options are wrong

    • ABenzodiazepines disturb normal sleep architecture and increase the risk of delirium in older ICU patients.
    • BBright light at night disrupts the circadian rhythm and makes sleep harder.
    • DNighttime baths and weights interrupt sleep and should be moved to daytime hours when possible.

16. Question 16 of 25Medium

    A patient who underwent open colorectal resection is receiving an intravenous lidocaine infusion as an adjunct for postoperative pain. Two hours into the infusion, the patient reports a metallic taste, perioral numbness, and ringing in the ears. What is the priority nursing intervention?

    1. AA. Administer a prescribed bolus of normal saline
    2. BB. Reassure the patient that these are expected transient sensations
    3. CC. Slow the infusion rate by half and recheck symptoms in one hour
    4. DD. Stop the infusion immediately and evaluate vital signs
    Show answer to question 16

    Answer: D. Stop the infusion immediately and evaluate vital signs

    Perioral numbness, metallic taste, and tinnitus are classic early central nervous system manifestations of local anesthetic systemic toxicity (LAST). The immediate priority is to stop the lidocaine infusion to prevent progression to seizures, cardiovascular collapse, and arrhythmias, followed by assessing airway, breathing, circulation, and notifying the team to prepare 20% lipid emulsion. Reassuring the patient or simply slowing the infusion allows toxic plasma concentrations to rise, risking life-threatening toxicity.

17. Question 17 of 25Medium

    A 63-year-old woman says she cannot rest because her bedside monitor alarms several times an hour. Most alarms are leads-off or artifact alerts, and her ECG electrodes were placed 3 days ago on skin that is now moist with sweat. Her rhythm has been stable sinus rhythm. Which action is most appropriate?

    1. AA. Clean and dry the sites and apply new ECG electrodes
    2. BB. Turn off the ECG alarms at night so that she can rest
    3. CC. Lower the alarm volume at the bedside and central station
    4. DD. Keep the current electrodes and widen the alarm limits
    Show answer to question 17

    Answer: A. Clean and dry the sites and apply new ECG electrodes

    Old electrodes on moist skin are a common cause of nonactionable alarms, and replacing them daily after proper skin preparation reduces false alarms, alarm fatigue and sensory overload. Alarms should stay on and be customized to the patient rather than silenced.

    Why the other options are wrong

    • BTurning off ECG alarms leaves her unprotected if a true dysrhythmia occurs.
    • CLowering alarm volumes risks missing true alarms and does not fix the cause of the false ones.
    • DWider limits do not stop leads-off and artifact alarms from old electrodes and may delay recognition of true changes.

18. Question 18 of 25Hard

    A 45-year-old woman being treated for pneumonia has a potassium of 6.9 mEq/L on a routine morning sample, which the laboratory reports as moderately hemolyzed. Yesterday her potassium was 4.1 mEq/L. Her creatinine is 0.8 mg/dL, she takes no drugs that raise potassium, and her cardiac monitor shows normal T waves and a narrow QRS. Which action should the nurse take first?

    1. AA. Give IV insulin with dextrose to shift potassium into cells
    2. BB. Give oral sodium polystyrene sulfonate to remove potassium
    3. CC. Arrange urgent placement of a hemodialysis catheter
    4. DD. Arrange a prompt repeat on a carefully drawn specimen
    Show answer to question 18

    Answer: D. Arrange a prompt repeat on a carefully drawn specimen

    Hemolysis releases potassium from red cells into the sample, so this result is likely falsely high, especially with a normal ECG, normal kidney function and no cause for hyperkalemia. A prompt repeat sample drawn without prolonged tourniquet time or fist clenching confirms the true level before any treatment.

    Why the other options are wrong

    • ATreating a probably spurious value exposes her to hypoglycemia and other harm without benefit.
    • BA potassium binder treats true hyperkalemia, and this value must first be confirmed.
    • CDialysis is for severe, confirmed hyperkalemia that does not respond to therapy, not for a hemolyzed sample.

19. Question 19 of 25Easy

    After emergency repair of a ruptured abdominal aortic aneurysm, a patient has a MAP of 68 mm Hg and an intra-abdominal pressure of 22 mm Hg. What is the abdominal perfusion pressure?

    1. AA. 22 mm Hg
    2. BB. 46 mm Hg
    3. CC. 68 mm Hg
    4. DD. 90 mm Hg
    Show answer to question 19

    Answer: B. 46 mm Hg

    Abdominal perfusion pressure equals the MAP minus the intra-abdominal pressure, so 68 minus 22 gives 46 mm Hg. It estimates the pressure driving blood flow to the abdominal organs, and a falling value signals a risk of organ ischemia.

    Why the other options are wrong

    • AThis is the intra-abdominal pressure itself, not the perfusion pressure, which subtracts it from the MAP.
    • CThis is the MAP alone, which ignores the opposing pressure inside the abdomen.
    • DThis adds the two pressures; the intra-abdominal pressure must be subtracted from the MAP.

20. Question 20 of 25Hard

    An older adult who lives in an unventilated apartment during a severe summer heat wave is admitted with non-exertional (classic) heatstroke. Which laboratory profile most strongly indicates the development of disseminated intravascular coagulation (DIC) from widespread thermal endothelial injury?

    1. AA. Elevated D-dimer, prolonged prothrombin time, and decreased fibrinogen
    2. BB. Normal prothrombin time, decreased D-dimer, and marked reticulocytosis
    3. CC. Elevated antithrombin III, prolonged thrombin time, and elevated fibrinogen
    4. DD. Decreased D-dimer, shortened activated partial thromboplastin time, and elevated platelet count
    Show answer to question 20

    Answer: A. Elevated D-dimer, prolonged prothrombin time, and decreased fibrinogen

    Severe thermal injury causes systemic endothelial damage, release of tissue factor, and widespread microvascular thrombosis leading to consumptive coagulopathy (DIC). This state is confirmed by elevated fibrin degradation products and D-dimer, prolonged prothrombin and activated partial thromboplastin times, and rapid depletion of platelets and fibrinogen. Shortened clotting times, elevated fibrinogen, or normal D-dimer levels reflect acute-phase reactivity or early compensated states rather than consumptive coagulopathy.

21. Question 21 of 25Medium

    An 86-year-old woman who lives alone is admitted with weakness and dehydration. Her daughter reports that she has lost 7 kg over 3 months, eats very little, rarely leaves her chair and has seemed withdrawn since her husband died. Which nursing action addresses the most likely reversible contributors?

    1. AA. Start parenteral nutrition because her oral intake is poor
    2. BB. Reassure the daughter that these changes are part of normal aging
    3. CC. Screen for depression and review her medicines for appetite effects
    4. DD. Track her serum albumin daily to guide nutrition therapy
    Show answer to question 21

    Answer: C. Screen for depression and review her medicines for appetite effects

    Adult failure to thrive combines weight loss, poor intake, inactivity and functional decline, and depression and medication side effects are common reversible causes. Screening for them, along with assessing cognition, dentition and swallowing, guides treatment.

    Why the other options are wrong

    • AParenteral nutrition is reserved for patients who cannot use the gut, and the cause of her poor intake needs evaluation first.
    • BWeight loss, withdrawal and functional decline are not normal aging and often have treatable causes.
    • DAlbumin falls with inflammation and illness and changes slowly, so it is a poor daily marker of nutrition.

22. Question 22 of 25Easy

    Which medication is used to increase heart rate and contractility in beta-blocker overdose when atropine and IV fluids have not corrected the bradycardia and hypotension?

    1. AA. IV glucagon
    2. BB. IV flumazenil
    3. CC. IV physostigmine
    4. DD. IV adenosine
    Show answer to question 22

    Answer: A. IV glucagon

    Glucagon raises intracellular cyclic AMP through its own receptors, bypassing the blocked beta receptors, so it can increase heart rate and contractility. Vomiting is common after a bolus, so airway protection and positioning matter.

    Why the other options are wrong

    • BFlumazenil reverses benzodiazepines and has no effect on beta-receptor blockade.
    • CPhysostigmine treats anticholinergic toxicity and can worsen bradycardia.
    • DAdenosine slows conduction through the AV node and would worsen the bradycardia.

23. Question 23 of 25Hard

    A comatose patient is being actively rewarmed following 24 hours of targeted temperature management. The rewarming rate is unintentionally accelerated to 0.8°C per hour. Which complication is most directly associated with an excessively rapid rewarming rate?

    1. AA. Paradoxical peripheral vasoconstriction and severe hypertensive emergency
    2. BB. Acute decrease in intracranial pressure and cerebral metabolic rate
    3. CC. Severe peripheral vasodilation and systemic hypotension
    4. DD. Marked intracellular potassium shifting leading to refractory hypokalemia
    Show answer to question 23

    Answer: C. Severe peripheral vasodilation and systemic hypotension

    A slow, controlled rewarming rate of 0.25°C to 0.5°C per hour is recommended because rapid rewarming causes brisk peripheral vasodilation, sudden intravascular volume depletion, and profound hypotension. Rapid rewarming also accelerates cerebral metabolic demand and can worsen cerebral edema, while causing extracellular potassium release rather than hypokalemia.

24. Question 24 of 25Easy

    A patient with severe obesity has noninvasive blood pressure readings taken with a standard adult cuff whose bladder wraps only about halfway around the upper arm. How will this affect the readings?

    1. AA. Both pressures will read falsely low
    2. BB. Both pressures will read falsely high
    3. CC. Readings will be accurate if the bladder is centered
    4. DD. The systolic will read high and the diastolic low
    Show answer to question 24

    Answer: B. Both pressures will read falsely high

    A cuff bladder that is too small must be inflated to a higher pressure to compress the artery, so it overestimates blood pressure. The bladder should encircle about 80% of the arm, and a large adult or thigh cuff, or an arterial line, may be needed.

    Why the other options are wrong

    • AFalsely low readings come from a cuff that is too large, not one that is too small.
    • CCentering the bladder does not correct the error caused by a bladder that is too small for the arm.
    • DAn undersized cuff raises both the systolic and the diastolic readings rather than moving them in opposite directions.

25. Question 25 of 25Medium

    When caring for a patient with diarrhea from Clostridioides difficile infection, which practice should the nurse follow?

    1. AA. Wear a gown and gloves, and wash with soap and water after care
    2. BB. Wear a surgical mask within 6 feet and use alcohol rub after care
    3. CC. Use alcohol hand rub after care, as it reliably kills the spores
    4. DD. Clean the room daily with a quaternary ammonium disinfectant
    Show answer to question 25

    Answer: A. Wear a gown and gloves, and wash with soap and water after care

    C. difficile requires contact precautions with a gown and gloves. Alcohol does not kill its spores, so washing with soap and water removes them mechanically, and rooms and equipment are cleaned with a sporicidal agent such as a bleach-based product.

    Why the other options are wrong

    • BC. difficile spreads by contact with stool and contaminated surfaces, not droplets, and alcohol does not kill the spores.
    • CAlcohol-based hand rubs do not kill C. difficile spores, so they are not reliable for this organism.
    • DStandard quaternary ammonium products are not sporicidal and leave spores on surfaces.

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