CCRN-ADULT CCRN (Adult) - Direct Care Eligibility Pathway Practice Questions

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?

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)?

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?

A critically ill patient with cardiogenic shock refractory to inotropic support has an intra-aortic balloon pump (IABP) placed. While assessing the arterial waveform, the critical care nurse observes that balloon inflation occurs immediately prior to the dicrotic notch. Which hemodynamic consequence occurs as a result of this timing abnormality, and what corrective action is required?

A 64-year-old male is admitted to the intensive care unit following an emergent endovascular repair of an infrarenal abdominal aortic aneurysm (EVAR). Postoperative orders include continuous nicardipine infusion to maintain systolic blood pressure between 100 and 120 mmHg.

Four hours after admission, the patient suddenly reports excruciating lumbar back pain and dizziness. On assessment, the nurse notes heart rate 124 beats/min (sinus tachycardia), blood pressure 78/48 mmHg, respiratory rate 24 breaths/min, and urinary output declining to 10 mL over the last hour. Physical examination reveals cool extremities, diaphoresis, and a faint, non-palpable left dorsalis pedis pulse that was previously +2.

Which immediate set of nursing interventions must the critical care nurse prioritize?

A patient with an extensive acute anterior wall ST-elevation myocardial infarction suddenly develops a new second-degree Mobitz Type II AV block with a ventricular rate of 38 beats/min and blood pressure of 78/46 mmHg. Which TWO emergency interventions should the critical care nurse execute immediately? (Select TWO)