CCNS Sample Questions

General - CORE

Please Note: There are 150 questions in the general category for all CNSs and 25 additional questions in each specific category: adult, neonatal, pediatric.

The critical care department is considering purchasing new ET tube holders. An appropriate program of evaluation would include testing the new device:
- using a specified protocol for care compared with care routinely provided.
- in the post-cardiac surgery unit, and compare with current care being provided in the medical-surgical ICU.
- on a randomly assigned group of patients using a standard care protocol for patients in both the routine care and test groups.
- for a 6-month test period, followed by a comparison period of 6 months.
The CNS identifies a learning need for the staff regarding the utilization of research. Which of the following interventions would allow the CNS to address this need?
- Assist the staff in performing a review of the literature.
- Develop and present an inservice on the benefits of research.
- Establish a hospital-wide research committee.
- Encourage the staff to conduct an independent research study.

There are only 25 questions on the exam in the age-specific categories:

NEONATAL
PEDIATRIC
ADULT

NEONATAL

For questions 3 & 4
A 24-week, 600 gram neonate developed surgical NEC on day 8 of life. The exploratory laparotomy revealed massive bowel necrosis. After discussion with the medical team the family specifies "Do Not Resuscitate". The patient remains vented in the NICU to receive a Fentanyl drip and to be provided comfort care. The patient's nurse has requested that the mother postpone visiting until change of shift is completed and she performs a complete assessment. The CNS finds the mother in the waiting room behaving in an agitated manner.

The CNS's most appropriate immediate action is to:
- Sit with the mother and allow her to express her feelings regarding the situation.
- Explain the rationale for the visiting policy to the family.
- Take the mother immediately to the infant's bedside.
- Discuss with the bedside nurse the need for the mother to be with the baby during this terminal life phase.
The CNS would guide the staff nurse in making which of the following recommendations to the inter-disciplinary team to provide ongoing pain relief for this neonate post-operatively:
- Monitor for episodes of tachycardia.
- Increase the Fentanyl infusion to 3 mcg/kg/hr.
- Initiate a paralytic agent such as Pavulon.
- Provide music therapy as a non-pharmacologic intervention.

ANSWERS

PEDIATRIC

For question 5
A 4-year-old 20-kg female with a closed head injury sustained in a motor vehicle accident arrives in the PICU intubated and sedated. During transport, her Glasgow Coma Scale score was 8. A CT scan of the head reveals a contralateral contusion. A CT scan of the abdomen is normal, and X-rays have ruled out spinal injuries. Breath sounds are clear with a respiratory rate of 30 assisted by the ventilator. Other vital signs are:

BP 90/52
HR 130
T 99.1F (37.3C)

Mannitol (Osmitrol), steroids, and ranitidine (Zantac) are begun.

The CNS should ensure that which of the following steps are taken to support the patient's status, given the patient's diagnosis?
- Suctioning when crackles (rales) are heard, chest physical therapy q4h, and use of a rotating mattress.
- Trendelenburg position for pulmonary toilet, instillation of NaCl to aid suctioning, and chest physical therapy q2h.
- Suctioning q2h, turning of the patient on a regular schedule, and aggressive pulmonary toilet.
- Elevating the head of the bed at 30 degrees, frequent assessment of breath sounds, and suctioning as indicated by the PIP.

For question 6
A 15-year-old patient sustains a left temporal fracture and multiple facial fractures in a motor vehicle accident. Surgical evacuation of an epidural hematoma is performed following a CT scan. Physical assessment of the patient reveals stable vital signs, Glasgow Coma Scale score = 7, ICP = 15 mm Hg. The CNS is working with an ICU orientee who has limited neurotrauma experience.

To assist the orientee in making sound clinical decisions related to the potential for development of vasogenic cerebral edema, the CNS would initially:
- allow the orientee to care for the patient, then critique the orientee's response to any patient alterations from normal.
- ask the orientee to define personal learning needs and goals related to neurotrauma patient care.
- provide the orientee with several pertinent recent journal articles on neurotrauma.
- facilitate expansion of the orientee's existing knowledge base of hemodynamics.

ANSWERS

ADULT

For questions 7 and 8
A 63-year-old male is in the ICU with cardiogenic shock secondary to severe mitral regurgitation. He is currently receiving phenylephrine (Neo-Synephrine), 33 mcg/min; dopamine (Intropin), 6 mcg/kg/min; dobutamine (Dobutrex), 8 mcg/kg/min; dilatiazem (Cardizem) infusion; and bumetanide (Bumex), 1 mg/min. As the CNS is making the bedside rounds, the bedside nurse states, "We need a class on managing patients with multiple drips. The physician has not specified what all of these drips are for, and I don't know what to turn up or down if the patient's blood pressure drops."

The CNS would most appropriately respond by:
- reviewing with the nurse the actions and side effects of all of the patient's current infusions, then role-playing examples of patient changes and nursing responses.
- calling the physician to determine exactly what indices should be used to manipulate the vasoactive infusions.
- providing the nurse with an article to read on the vasoactive drugs and assessing the nurse's learning afterward.
- agreeing with the nurse about the class and soliciting input from staff members as to what they would like covered in such a class

For question 8
The CNS returns 4 hours later and notes that the nurse has decreased the dopamine to 5 mcg/kg/min for renal perfusion, but the other vasoactive drips are unchanged. The following hemodynamic data are obtained:

BP 84/58
CVP 8
MAP 67
SVR 1242
CO 3.8
CI 1.7

The CNS would expect the nurse to adjust the drips by:
- decreasing the diltiazem (Cardizem)
- increasing the dobutamine (Dobutrex)
- increasing the Neo-Synephrine
- increasing the bumtanide (Bumex)

ANSWERS