CCRN GI, Renal/GU & Integumentary Practice Questions
GI, Renal/GU & Integumentary makes up 5 of every 50 questions on a Tigertest CCRN practice test. Here are 10 of the 20 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Based on the AACN Adult CCRN test plan. Original questions; 50 per test, weighted like the real exam. Not affiliated with AACN or AACN Certification Corporation.
1. Measuring intra-abdominal pressure (IAP) in mm Hg, which finding defines abdominal compartment syndrome?
- A.IAP of 12 on a single reading
- B.IAP over 20 with organ failure
- C.IAP of 8 with distension
- D.IAP of 5 with abdominal pain
Answer: B. Abdominal compartment syndrome is a sustained intra-abdominal pressure above 20 mm Hg with new organ dysfunction, such as falling urine output or rising airway pressures. A pressure of 12 mm Hg or more is intra-abdominal hypertension.
2. How is intra-abdominal pressure usually measured at the bedside?
- A.Through an arterial line
- B.Through a central venous line
- C.Through a rectal probe
- D.Through the urinary bladder
Answer: D. A small volume of saline is instilled into the bladder through the urinary catheter and the pressure is read with the transducer zeroed at the iliac crest in the midaxillary line, with the patient supine at end-expiration.
3. A patient with cirrhosis is vomiting bright red blood and esophageal varices are suspected. Which drug infusion should the nurse expect?
- A.Octreotide
- B.Labetalol
- C.Nitroprusside
- D.Heparin
Answer: A. Octreotide lowers portal pressure by reducing splanchnic blood flow and is started before endoscopic band ligation. A nonselective beta blocker such as propranolol is used later to prevent rebleeding, not in the acute bleed.
4. Besides vasoactive drugs and endoscopy, which therapy lowers mortality in a patient with cirrhosis and a GI bleed?
- A.A lactulose retention enema
- B.An albumin 25% bolus
- C.Prophylactic antibiotics
- D.A platelet transfusion
Answer: C. Patients with cirrhosis who bleed are at high risk of bacterial infection, and short-course prophylactic antibiotics such as ceftriaxone reduce infection, rebleeding and death.
5. A patient with cirrhosis is confused with asterixis. Which drug is first-line?
- A.Loperamide
- B.Lorazepam
- C.Lactulose
- D.Morphine
Answer: C. Lactulose traps ammonia in the colon and speeds its removal; it is titrated to two or three soft stools a day, often with rifaximin. Benzodiazepines and opioids worsen hepatic encephalopathy, and loperamide works against lactulose.
6. Which sign suggests hypocalcemia in a patient with acute pancreatitis?
- A.Trousseau sign
- B.Cullen sign
- C.Murphy sign
- D.Grey Turner sign
Answer: A. Carpal spasm when a BP cuff is inflated (Trousseau) or facial twitching when the facial nerve is tapped (Chvostek) suggest low calcium, which occurs in pancreatitis as calcium binds to fat necrosis. Cullen and Grey Turner signs are bruising from retroperitoneal bleeding.
7. A patient with moderately severe acute pancreatitis cannot eat. Which nutrition plan is preferred?
- A.NPO for seven days
- B.Parenteral nutrition
- C.Clear liquids for weeks
- D.Early enteral feeding
Answer: D. Enteral feeding started early protects the gut barrier and lowers infection and organ failure compared with parenteral nutrition, which is kept for patients who cannot be fed enterally.
8. An older patient with atrial fibrillation has severe abdominal pain, but the abdomen is soft with little tenderness. Lactate is 5.2 mmol/L. What should the nurse suspect?
- A.Early appendicitis
- B.Mesenteric ischemia
- C.Viral gastroenteritis
- D.A peptic ulcer
Answer: B. Pain out of proportion to the examination, especially with atrial fibrillation as an embolic source, is the classic picture of acute mesenteric ischemia. A rising lactate suggests bowel infarction and needs urgent imaging and surgery.
9. After blunt abdominal trauma, a patient reports pain in the left shoulder. Which organ is most likely injured?
- A.The appendix
- B.The spleen
- C.The liver
- D.The right kidney
Answer: B. Kehr sign is left shoulder pain from blood irritating the diaphragm, referred along the phrenic nerve, and it is classic for splenic injury. Liver injury more often refers pain to the right shoulder.
10. After an esophagectomy, the patient's nasogastric tube comes partly out. What should the nurse do?
- A.Push it back to the original mark
- B.Flush it firmly with normal saline
- C.Remove the tube completely now
- D.Notify the surgeon, do not reinsert
Answer: D. The tube lies across a fresh anastomosis, and blind repositioning can perforate it. The surgeon decides on replacement, usually under fluoroscopy or endoscopy.
Practice all 20 gi, renal/gu & integumentary questions, and the rest of the 200-question bank, in the free CCRN training sets. Questions you miss come back until you have mastered them.
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