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Question 1: A 56-year-old woman with chronic renal failure is status post a left carotid endarterectomy. She is admitted to the ICU with severe hypertension. The surgeon would like the systolic blood pressure <140mm Hg.fter 24 hours of treatment with nitroprusside, the patient develops confusion and metabolic acidosis. Her symptoms are best prevented/treated with administration of which one of the following agents?

  1. Cyanocobalamin

  2. Thiosulfate (correct)

  3. Glucagon

  4. Sodium bicarbonate

Answer: Thiosulfate (B)

References: Curry, SC (2005) Sodium nitroprusside. In: Brent J, Wallace K, Burkhart K et al. (2005) Critical Care Toxicology, Mosby Philadelphia, PA. Schulz V, Gross R, Pasch T, et al. (1982) Cyanide toxicity of sodium nitroprusside in therapeutic use with and without sodium thiosulfate. Klinische Wochenschrift 60, 1393–400. Varon J, Marik PE (2000) The diagnosis and management of hypertensive crises. Chest 118, 214–27.

Question 2: A 56-year-old man undergoes an urgent sigmoid colectomy and Hartmann’s prouch for perforated diverticulitis eight hours prior. Due to a history of coronary disease he is monitored using telemetry. The patient has the acute onset of tachycardia to 146 beats/minute and an ECG strip demonstrates p waves with three different morphologies. His respiratory rate is 34 breaths/minute, BP is 146/88mm Hg with a SaO2 of 94% on 40% O2 by FM. The most appropriate and effective therapy for this condition is:

  1. Furosemide 40mg IVP and KVO IVF

  2. 100% oxygen via non-rebreather mask

  3. BiPAP at 15/7cm H2O and FIO2 100%

  4. Intubation and mechanical ventilation (D)

Answer: Intubation and mechanical ventilation (correct)

Explanation: An ECG trace with tachycardia demonstrating p waves of three different morphologies is termed multifocal atrial tachycardia (MAT). MAT is unique among atrial dysrhythmias in that is it strongly associated with impending acute respiratory failure and as such represents a stress rhythm. Therapy hinges on addressing the patient’s elevated work of breathing by providing immediate endotracheal intubation and mechanical ventilation. None of the other therapies provides deļ¬nitive management and do not address the underlying cause of MAT. BiPAP does provide some ventilatory support but is in general inadequate at relieving the patient of all of the work of breathing.References: Biggs FD, Lefrak SS, Kleiger RE, et al. (1977) Disturbances of rhythm in chronic lung disease. Heart and Lung 6 (2), 256–61.


Critical Care Nursing Question Bank

Prepare for the CCRN exam by reviewing over 400 CCRN study guide questions. Each question includes an answer, rationale, and explanation for important concepts. Questions are written exclusively by experienced Critical Care Advance Practice Nurses who are active at the bedside and are modeled after the case structure found on the exam.

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This is a great source of CCRN questions to prepare for the exam. Questions are challenging, but the rationales are great. Everything had references too! Thanks for a good qbank.” - Anita Fetzick, UPMC