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CCRN (Adult) - Direct Care Eligibility Pathway Question and Answers

CCRN (Adult) - Direct Care Eligibility Pathway

Last Update Nov 30, 2025
Total Questions : 150

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Questions 1

A patient lying on the left side in Trendelenburg position is in the correct position for postural drainage of which of the following lobes of the lungs?

Options:

A.  

left upper

B.  

left lower

C.  

right lower

D.  

right upper

Discussion 0
Questions 2

The water retention associated with SIADH is characterized by

Options:

A.  

fluid intake greater than UO, weight gain, and increased urine osmolality and sodium.

B.  

UO greater than fluid intake, extreme weight gain, and mild (2+) pitting edema.

C.  

UO greater than fluid intake and severe (4+) pitting edema.

D.  

fluid intake greater than UO, increased serum osmolality and sodium, and severe (4+) pitting edema.

Discussion 0
Questions 3

A patient's IV with norepinephrine (Levophed) infusing is red, swollen, and the IV pump is alarming. A nurse should anticipate

Options:

A.  

administering phentolamine (Regitine).

B.  

providing a warm compress.

C.  

lowering the extremity below heart level.

D.  

removing the IV immediately.

Discussion 0
Questions 4

For a patient with unstable angina, the major goal of treatment is to

Options:

A.  

increase afterload.

B.  

decrease myocardial contractility.

C.  

increase preload.

D.  

decrease myocardial O2 consumption.

Discussion 0
Questions 5

A patient is admitted with a femoral shaft fracture and an oblique fracture of three ribs on the right side. The patient suddenly reports shortness of breath. Assessment reveals new-onset headache, central and peripheral cyanosis, and petechiae of the neck and anterior chest wall. Available data are:

The nurse should suspect the development of

Options:

A.  

a pulmonary embolus.

B.  

sepsis.

C.  

acute pulmonary edema.

D.  

a fat embolus

Discussion 0
Questions 6

In a patient with status asthmaticus, which of the following indicate a deteriorating condition?

Options:

A.  

increased compliance and respiratory acidosis

B.  

increased PaCO2 and decreased expiratory flow

C.  

respiratory alkalosis and increased expiratory flow

D.  

decreased PaCO2 and increased minute ventilation

Discussion 0
Questions 7

A nurse should expect which of the following plans of care for a patient with a complicated RV infarction?

Options:

A.  

dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix)

B.  

nitroprusside (Nipride), fluid restrictions, and transvenous pacing

C.  

nitroglycerin, fluid infusions, and morphine

D.  

dobutamine (Dobutrex), fluid infusions, and transvenous pacing

Discussion 0
Questions 8

Postoperatively, symptoms that may indicate hemothorax or internal bleeding in a video-assisted thoracic surgery (VATS) patient include

Options:

A.  

diminished breath sounds.

B.  

pain with deep inspiration.

C.  

bradycardia.

D.  

hypertension.

Discussion 0
Questions 9

The family of a patient requests permission to administer traditional herbs to the patient. Which of the following should be the nurse's first action?

Options:

A.  

Inform the family that herbal therapy is not appropriate in the hospital.

B.  

Consult with the pharmacist on the effects of the specific herbs.

C.  

Allow the patient to take the herbs because they are natural.

D.  

Obtain an order for the herbs.

Discussion 0
Questions 10

Which of the following diagnostic procedures best pinpoints the location, size, and origin of a cerebral aneurysm?

Options:

A.  

MRI

B.  

cerebral angiography

C.  

positron emission tomography (PET) scanning

D.  

CT scanning

Discussion 0
Questions 11

A unit council is requesting to change a documentation screen of the electronic health record (EHR) at a large health system. The change was not discussed with the department prior to the request and was denied by the EHR committee. Which of the following strategies will most likely lead to accomplishing the team's goals?

Options:

A.  

Have nursing leadership evaluate the proposal before resubmitting the request.

B.  

Discuss the proposed solution with stakeholders to determine buy in.

C.  

Work with key staff members to rewrite the request to present at the next meeting.

D.  

Attempt to change the process through another format.

Discussion 0
Questions 12

A caloric irrigation test of the oculovestibular reflex is performed on a patient who is comatose following a hypoxic brain injury. When cold water is introduced into the left ear, nystagmus occurs with slow deviation of the eyes toward the left, followed by faster eye deviation to the right. This pattern is indicative of a

Options:

A.  

persistent vegetative state.

B.  

brain-stem infarction.

C.  

normal response.

D.  

third cranial nerve palsy.

Discussion 0
Questions 13

A patient is intubated, is unable to follow simple commands, and has no history of alcohol abuse. The patient has become increasingly disoriented and confused over the past 24 hours. After assessment and treatment of pain, the best medication intervention for management is

Options:

A.  

lorazepam (Ativan).

B.  

cisatracurium (Nimbex).

C.  

midazolam (Versed).

D.  

dexmedetomidine (Precedex).

Discussion 0
Questions 14

A patient who experienced a blunt chest trauma in an automobile crash is admitted with multiple rib fractures. The patient is dyspneic and hypotensive and is reporting left shoulder pain. On auscultation, a nurse notes that bowel sounds can be heard over the lower left thorax. These findings are consistent with

Options:

A.  

ruptured abdominal viscus.

B.  

ruptured diaphragm.

C.  

flail chest.

D.  

mediastinal shift.

Discussion 0
Questions 15

A patient who had a liver resection now has a copious amount of serous drainage from the surgical incision. Which of the following should a nurse anticipate when caring for this patient?

Options:

A.  

preparing for an incision and debridement of the wound

B.  

applying several abdominal dressings

C.  

administering antibiotics

D.  

applying a drainage pouch to the site

Discussion 0
Questions 16

An experienced nurse new to a unit believes the literature does not support current unit practice of a fixed-dose nitroglycerin IV (Tridil) infusion in all postoperative cardiac surgery patients for 24 hours. The nurse develops a proposal referencing peer-reviewed articles. Based on the proposal, unit leaders agree to remove the nitroglycerin IV (Tridil) infusion from the standard order set. The actions taken by the nurse are best described as

Options:

A.  

collaboration with a team.

B.  

a clinical research study.

C.  

a performance improvement project.

D.  

evidence-based practice.

Discussion 0
Questions 17

A patient develops the dysrhythmia shown below:

Blood pressure is 83/40. The patient is pale, diaphoretic, lethargic, and disoriented. The most appropriate treatment is

Options:

A.  

defibrillation at 200 J.

B.  

adenosine (Adenocard), 6 mg rapid IV bolus.

C.  

lidocaine (Xylocaine), 1.5 mg/kg IV.

D.  

cardioversion at 100 J.

Discussion 0
Questions 18

A patient is admitted with a traumatic brain injury after being thrown from a horse. Despite numerous interventions, the patient is declared brain dead.

The parents have consented for organ donation, and the patient's mother requests to lay next to her daughter before being taken to the operating room.

Which of the following is the nurse's most appropriate response?

Options:

A.  

"I will need a few minutes to prepare and organize this for you."

B.  

"It would be too risky to move all of the machines and wires."

C.  

"We must obtain permission from the organ donation team first."

D.  

"Please sit at the side of the bed, hold her hand, and talk to her."

Discussion 0
Questions 19

A patient with end-stage COPD who has failed multiple mechanical ventilation weaning trials communicates a desire to discontinue mechanical ventilation and be extubated. Which of the following is a nurse's best response?

Options:

A.  

Advocate with the care team for a withdrawal of treatment plan.

B.  

Encourage the patient to continue with current medications and attempts to wean.

C.  

Explore the patient's reasons for the request and understanding of potential consequences.

D.  

Refer the patient's request to the healthcare facility's ethics committee for review.

Discussion 0
Questions 20

A nurse is precepting an experienced critical care nurse who is new to the facility. To develop the orientation plan, which of the following should the preceptor do first?

Options:

A.  

Determine the knowledge and skills the new nurse needs to learn.

B.  

Teach the new nurse about unit routines and practices.

C.  

Explain patient care policies and procedures to the new nurse.

D.  

Introduce the new nurse to staff and team members on the unit.

Discussion 0
Questions 21

Which of the following is a sign of brain death?

Options:

A.  

positive vestibulo-ocular reflex

B.  

negative apnea test

C.  

positive cough reflex

D.  

negative cold caloric test

Discussion 0
Questions 22

Which of the following intubated patients is most at risk for developing ventilator-associated pneumonia (VAP)?

Options:

A.  

68-year-old patient, 142 kg, from an assisted living facility with COPD and dialysis-dependent renal disease

B.  

84-year-old patient, 38 kg, from a skilled nursing facility receiving chemotherapy for colorectal cancer

C.  

91-year-old patient, 54 kg, from home with osteoporosis and hypothyroidism

D.  

72-year-old patient, 81 kg, from a nursing home with heart failure and chronic bronchitis

Discussion 0
Questions 23

A patient with a history of six cardiac catheterizations relates that he has received differing instructions about the duration of required bedrest after the procedure. To further investigate this issue, which of the following is a nurse's most appropriate action?

Options:

A.  

Ask about obtaining an independent evaluation of unit outcomes.

B.  

Conduct an informal chart review and outcome evaluation of patients treated with different bedrest protocols.

C.  

Review recent published research about bedrest protocols.

D.  

Ask the nursing supervisor to request standardized physician orders for patients who have undergone catheterization.

Discussion 0
Questions 24

A patient admitted with a diagnosis of pneumonia has a temperature of 103.2° F (39.5° C) and copious pulmonary secretions. ABG results drawn on room air are:

The nurse should expect that hemoglobin's affinity for oxygen in this patient to be

Options:

A.  

unchanged.

B.  

unpredictable.

C.  

increased.

D.  

decreased.

Discussion 0
Questions 25

A patient has been declared brain dead. A nurse would like the family to consider organ donation but has never requested this from a family before. The best initial action by the nurse is to

Options:

A.  

consult the organ donation liaison.

B.  

directly ask the patient's family members if they would consider organ donation.

C.  

find out if the patient has an organ donor card.

D.  

request that the physician discuss the issue with the family.

Discussion 0
Questions 26

An older adult patient reports an inability to sleep due to staff waking the patient for frequent neurological assessments. In order to minimize sleep disruptions, the nurse should

Options:

A.  

encourage the patient to sleep between assessments.

B.  

discontinue neurologic assessments.

C.  

establish a schedule with the provider.

D.  

move the patient to the quieter part of the unit.

Discussion 0
Questions 27

Which of the following suggests acute peripheral arterial insufficiency?

Options:

A.  

positive Homans' sign

B.  

capillary refill time less than 2 sec

C.  

weak equal bilateral pedal pulses

D.  

sudden, severe pain at rest

Discussion 0
Questions 28

Which of the following serum laboratory results is most concerning to a nurse who is caring for a patient with a Stage Ill pressure ulcer on the coccyx?

Options:

A.  

albumin 2.1 mg/dL

B.  

hemoglobin 10.2 mg/dL

C.  

WBC 6,000/mm3

D.  

glucose 125 mg/dL

Discussion 0
Questions 29

A patient's blood culture report notes the presence of vancomycin resistant enterococcus. The nurse should place the patient in which type of isolation?

Options:

A.  

droplet

B.  

airborne

C.  

contact

D.  

protective

Discussion 0
Questions 30

A nurse admits a patient awaiting surgery for an unstable pelvic fracture following a fall in which no other injuries were sustained. The nurse should prioritize

Options:

A.  

transportation to radiology for an MRI.

B.  

type and crossmatch PRBC prior to surgery.

C.  

placement of a binder across the patient's hips.

D.  

administration of a sedative to reduce movement.

Discussion 0
Questions 31

A patient is admitted with a traumatic brain injury. During assessment, a nurse notes increased urinary output from the catheter. Which of the following should the nurse suspect?

Options:

A.  

syndrome of inappropriate antidiuretic hormone (SIADH)

B.  

central diabetes insipidus

C.  

cerebral salt wasting

D.  

nephrogenic diabetes insipidus

Discussion 0
Questions 32

A patient who was admitted after an open aortofemoral bypass for claudication at rest has a hemoglobin A1C of 8.9. The patient admits having poor control of blood glucose levels and is scared to use insulin as directed because of a few episodes of hypoglycemia. Which of the following should the nurse initially request to be consulted?

Options:

A.  

endocrinology

B.  

diabetes educator

C.  

hospital pharmacist

D.  

vascular surgeon

Discussion 0
Questions 33

Which of the following is a late finding in hypovolemic shock?

Options:

A.  

tachycardia

B.  

UO greater than 30 mL/hr

C.  

cool, dry skin

D.  

hypotension

Discussion 0
Questions 34

A patient is admitted with hypotension, tachycardia, and intermittent confusion. Upon arrival, the patient asks to walk to the bathroom. Which of the

following is a nurse's best action?

Options:

A.  

Assess the patient's vital signs and ask the physician for an order for activity.

B.  

Conduct a fall risk assessment and institute appropriate interventions.

C.  

Encourage the patient to walk independently to the bathroom to enhance early mobility.

D.  

Situate the patient in bed and provide a bed pan.

Discussion 0
Questions 35

A patient is admitted for hypertensive crisis. As a nurse is starting a peripheral IV, the patient appears increasingly anxious as the catheter is about to be inserted. The patient threatens to harm the nurse if the catheter insertion causes pain. Which of the following is the nurse's best action?

Options:

A.  

Engage the patient in a conversation and encourage him to verbalize his feelings.

B.  

Physically restrain the patient during the performance of the procedure.

C.  

Ask another staff member to distract the patient during insertion.

D.  

Tell the patient to remain still in a stern, authoritative voice.

Discussion 0
Questions 36

Which of the following assessment findings would be found in a patient with pulmonary hypertension?

Options:

A.  

crackles in the bases bilaterally

B.  

rhonchi in the apices bilaterally

C.  

pink frothy sputum

D.  

distended neck veins

Discussion 0
Questions 37

A consistent prolongation of the P-R interval beyond 0.20 sec indicates which of the following types of AV block?

Options:

A.  

second-degree, Mobitz Type II

B.  

first-degree

C.  

second-degree, Mobitz Type I (Wenckebach)

D.  

third-degree (complete)

Discussion 0
Questions 38

The nurse who is caring for a patient following an esophagectomy notes new subcutaneous emphysema in the upper chest and neck. The nurse should expect an order for

Options:

A.  

chest tube insertion.

B.  

a CT scan.

C.  

IV antibiotics.

D.  

gastric decompression.

Discussion 0
Questions 39

An older adult patient is admitted with acute exacerbation of congestive heart failure. An echocardiogram indicates that EF is unchanged at 50%. The patient is most likely experiencing

Options:

A.  

heart failure with reduced EF.

B.  

heart failure with preserved EF.

C.  

left ventricular failure.

D.  

advanced heart failure.

Discussion 0
Questions 40

A patient who is confused and dyspneic is admitted with ABG values that reveal hypoxemia. Results from insertion of a pulmonary artery catheter are:

PAP 38/18 mm Hg

PAOP10 mm Hg

CI 3.5 L/min/m2

These values are most indicative of

Options:

A.  

hypovolemia.

B.  

hypervolemia.

C.  

pulmonary dysfunction.

D.  

left ventricular failure.

Discussion 0
Questions 41

Which of the following is most often associated with damage to the alveolar capillary membrane secondary to aspiration?

Options:

A.  

reabsorption atelectasis

B.  

lung cavitation

C.  

bronchopleural fistulas

D.  

noncardiogenic pulmonary edema

Discussion 0
Questions 42

Assessment of a patient admitted with excruciating back pain reveals:

Appropriate therapy should include

Options:

A.  

nitroglycerin.

B.  

diltiazem (Cardizem).

C.  

digoxin (Lanoxin).

D.  

nitroprusside (Nipride).

Discussion 0
Questions 43

A patient with a history of alcohol abuse has been admitted for progressive dyspnea and leg swelling. Assessment findings include:

BP155/90

HR85

CVP12 mm Hg

Which of the following tests will provide the most definitive diagnosis?

Options:

A.  

echocardiogram

B.  

pro-BNP

C.  

chest x-ray

D.  

liver function panel

Discussion 0
Questions 44

The spouse of a critically ill patient is indecisive, withdrawn, and tells the nurse, "I feel so helpless." Appropriate nursing interventions include

Options:

A.  

offering solutions to problems identified by the spouse.

B.  

encouraging other family members to make necessary decisions.

C.  

providing reassurance that visiting is not always necessary.

D.  

identifying and reinforcing the spouse's support systems.

Discussion 0
Questions 45

Examination of a patient exhibiting Kernig's and Brudzinski's signs indicates which of the following?

Options:

A.  

autonomic hyperreflexia

B.  

adrenal insufficiency

C.  

meningeal irritation

D.  

increased intracranial pressure

Discussion 0