CCRN-Adult Practice AACN Verified Answers - Pass Your Exams For Sure! [2024]
Valid Way To Pass AACN CCRN's CCRN-Adult Exam
NEW QUESTION # 40
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
- A. a CT scan.
- B. chest tube insertion.
- C. gastric decompression.
- D. IV antibiotics.
Answer: A
Explanation:
Subcutaneous emphysema (SE) is a condition where gas or air accumulates in the subcutaneous tissue layer of the skin, causing swelling and a crackling sensation when touched. SE can occur after esophagectomy, a surgical procedure to remove part or all of the esophagus, due to air leakage from the anastomosis site or the lung. SE can also be a sign of a more serious complication, such as anastomotic leakage, mediastinitis, or tracheal injury12. Therefore, the nurse should expect an order for a CT scan, which is a diagnostic imaging test that can detect the source and extent of the air leakage and any associated complications. A CT scan can also guide the appropriate management of SE, which may include conservative measures, such as increasing the suction of the chest tube, or more invasive interventions, such as surgical repair or drainage123. Chest tube insertion, IV antibiotics, and gastric decompression are not likely to be ordered for SE after esophagectomy, as they do not address the underlying cause of the air leakage or the potential complications. Chest tube insertion may be indicated for pneumothorax, but not for SE alone. IV antibiotics may be indicated for infection, but not for SE alone. Gastric decompression may be indicated for gastric distension, but not for SE alone.
NEW QUESTION # 41
To maintain adequate pain control in a post-surgical patient addicted to heroin, a nurse should plan to
- A. avoid administering any intravenous pain medication.
- B. administer oral opioids only as needed.
- C. administer PCA with continuous and on-demand opioid delivery.
- D. administer PCA opioids with on-demand dosing only.
Answer: C
Explanation:
For a post-surgical patient with a history of heroin addiction, a PCA (patient-controlled analgesia) with both continuous and on-demand opioid delivery ensures consistent pain control and addresses both baseline pain and breakthrough pain. This approach helps manage pain more effectively and can prevent withdrawal symptoms in patients with opioid tolerance. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 88-90.
NEW QUESTION # 42
A patient is recovering from CABG surgery. On postoperative day 3, the patient's laboratory values indicate thrombocytopenia and elevated liver function tests. The patient is scheduled for hemodialysis today. A nurse notifies the physician of the abnormal laboratory values. The nurse should next anticipate an order to
- A. complete hemodialysis without heparin.
- B. transfuse platelets during hemodialysis.
- C. reschedule hemodialysis.
- D. administer heparin to prevent clot formation.
Answer: A
Explanation:
The patient has thrombocytopenia, which is a low platelet count that increases the risk of bleeding. Heparin is an anticoagulant that prevents clotting, but also increases the risk of bleeding. Therefore, heparin should be avoided in patients with thrombocytopenia. Hemodialysis can be performed without heparin by using alternative methods such as saline flushes, blood predilution, or specialized dialyzers that reduce clotting.
Transfusing platelets during hemodialysis is not recommended, as platelets may be damaged by the extracorporeal circuit. Rescheduling hemodialysis may not be feasible, as the patient may have fluid overload, electrolyte imbalance, or uremia that require urgent dialysis.
References:
* Use and safety of heparin-free maintenance hemodialysis in the USA
* Anticoagulation for the hemodialysis procedure
* Dialysis without anticoagulation (Heparin Free Dialysis)
NEW QUESTION # 43
A patient with a history of asthma presents with acute onset of dyspnea, a non-productive cough, and tachypnea. He is very anxious, restless, and tachycardic. Which of the following is a first-line drug for these symptoms?
- A. anticholinergic
- B. mast cell stabilizer
- C. leukotriene inhibitor
- D. beta-agonist
Answer: D
Explanation:
Beta-agonists are the first-line drugs for acute asthma exacerbations because they rapidly reverse bronchoconstriction and improve airflow. They act by stimulating beta-2 receptors in the smooth muscle of the airways, causing relaxation and dilation. Beta-agonists can be administered by inhalation, nebulization, or injection. Examples of beta-agonists include albuterol, levalbuterol, and terbutaline.
References:
* Management of Acute Asthma Exacerbations | AAFP: This article states that "Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."
* Asthma attack - Diagnosis and treatment - Mayo Clinic: This article states that "If you're in the yellow zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you can repeat the dose. Young children or people who have difficulty with an inhaler use a device called a nebulizer to inhale the medicine in a mist. Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."
NEW QUESTION # 44
A patient is intubated and receiving assist control mechanical ventilation and is on a norepinephrine drip following a head injury. Patient data are:
Which of the following interventions will improve cerebral perfusion?
- A. increasing the norepinephrine rate
- B. suctioning the airway
- C. requesting an ABG
- D. administering prescribed acetaminophen
Answer: D
NEW QUESTION # 45
A patient who sustained acute head trauma exhibited intermittent unconsciousness prior to admission. The patient is disoriented initially and exhibits rapid deterioration in neurological status shortly after admission.
X-rays reveal a right temporal bone fracture, and a diagnosis of epidural hematoma is made. The deterioration in the patient's condition is most likely associated with
- A. arterial bleeding.
- B. intracranial aneurysm.
- C. clot formation.
- D. venous bleeding.
Answer: A
Explanation:
Epidural hematoma
An epidural hematoma is a collection of blood that forms between the skull and the dura mater, the outermost layer of the meninges that cover the brain. The most common cause of an epidural hematoma is a head injury that fractures the temporal bone and tears the middle meningeal artery, which runs along the inner surface of the skull. Arterial bleeding is under high pressure and can rapidly expand the hematoma, compressing the brain and causing neurological deterioration. A typical symptom of an epidural hematoma is a brief loss of consciousness followed by a lucid interval and then a rapid decline in consciousness and brain function. This condition requires urgent surgical evacuation of the hematoma to prevent brain damage or death12. Venous bleeding, clot formation, and intracranial aneurysm are not the main factors associated with the deterioration of the patient's condition in this case.
NEW QUESTION # 46
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?
- A. Consult with the pharmacist on the effects of the specific herbs.
- B. Inform the family that herbal therapy is not appropriate in the hospital.
- C. Obtain an order for the herbs.
- D. Allow the patient to take the herbs because they are natural.
Answer: A
Explanation:
Verified answer: B. Consult with the pharmacist on the effects of the specific herbs. Herbal therapy is a type of complementary and alternative medicine (CAM) that uses plants or plant extracts to treat various health conditions. Many patients use herbal therapy for various reasons, such as cultural beliefs, personal preferences, or dissatisfaction with conventional medicine. However, herbal therapy is not without risks and challenges, especially in the hospital setting. Some of the potential problems include lack of standardization, quality control, and regulation of herbal products; adverse effects and interactions with other medications; and ethical and legal issues regarding informed consent, documentation, and liability12. Therefore, the nurse's first action should be to consult with the pharmacist on the effects of the specific herbs that the family wants to administer to the patient. The pharmacist can provide information on the safety, efficacy, dosage, and compatibility of the herbs with the patient's condition and current medications. The nurse should also inform the patient's primary provider and obtain an order for the herbs before allowing the patient to take them. The nurse should document the use of herbal therapy in the patient's medical record and monitor the patient for any adverse effects or changes in response to other treatments. Informing the family that herbal therapy is not appropriate in the hospital is not respectful of the patient's autonomy and cultural values. Allowing the patient to take the herbs without consulting the pharmacist and obtaining an order is not safe and may violate the hospital's policies and standards of care.
NEW QUESTION # 47
A family member asks permission to visit a patient after work at 12:30 AM. On previous visits, the family member has been disruptive. To address the situation, a nurse should
- A. allow the family member to visit after setting behavioral limits.
- B. not allow the visit, as the patient will be sleeping.
- C. ask the family member to visit before work.
- D. ask the family member to visit during scheduled visiting hours.
Answer: A
Explanation:
While it is important to support family involvement, previous disruptive behavior necessitates setting clear behavioral limits to ensure a safe and therapeutic environment for the patient. Allowing the visit with established guidelines helps balance the need for patient support with maintaining unit order. This approach also respects the patient's rest and recovery needs. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 48
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
- A. hypervolemia.
- B. hypovolemia.
- C. pulmonary dysfunction.
- D. left ventricular failure.
Answer: C
Explanation:
The patient's ABG values show hypoxemia, which is a low level of oxygen in the blood. This can be caused by various pulmonary disorders that impair gas exchange, such as pneumonia, pulmonary edema, pulmonary embolism, or acute respiratory distress syndrome (ARDS). The patient's PAP (pulmonary artery pressure) is elevated, indicating increased resistance in the pulmonary circulation. This can also result from pulmonary dysfunction, as the lungs become stiff and inflamed, or from pulmonary hypertension, which is a chronic condition that affects the small arteries in the lungs. The patient's PAOP (pulmonary artery occlusion pressure) is normal, suggesting that the left ventricle is not failing and that the patient is not hypovolemic or hypervolemic. The patient's CI (cardiac index) is also normal, indicating adequate cardiac output. Therefore, the most likely cause of the patient's hypoxemia and dyspnea is pulmonary dysfunction.
References:
* AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
* AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
NEW QUESTION # 49
Which of the following suggests acute peripheral arterial insufficiency?
- A. positive Homans' sign
- B. weak equal bilateral pedal pulses
- C. capillary refill time less than 2 sec
- D. sudden, severe pain at rest
Answer: D
Explanation:
Acute peripheral arterial insufficiency typically presents with sudden, severe pain at rest, which may be accompanied by other signs such as pallor, paresthesia, paralysis, pulselessness, and poikilothermia (the six P's). This condition indicates a critical reduction in blood flow to the affected extremity, requiring immediate medical attention. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 50
Postoperatively, symptoms that may indicate hemothorax or internal bleeding in a video-assisted thoracic surgery (VATS) patient include
- A. pain with deep inspiration.
- B. bradycardia.
- C. hypertension.
- D. diminished breath sounds.
Answer: D
Explanation:
Hemothorax
Diminished breath sounds are one of the symptoms that may indicate hemothorax or internal bleeding in a video-assisted thoracic surgery (VATS) patient. VATS is a minimally invasive surgical technique that uses a small video camera (thoracoscope) and special instruments to access the chest cavity through small incisions1.
Hemothorax is a condition where blood accumulates in the pleural space, the area between the lungs and the chest wall2. Hemothorax can occur as a complication of VATS due to injury to the lung, blood vessels, or chest wall during the procedure3. Hemothorax can cause compression of the lung and reduce its expansion, leading to diminished breath sounds on the affected side2. Other symptoms of hemothorax may include chest pain, shortness of breath, low blood pressure, rapid heart rate, and pale or clammy skin2.
Internal bleeding is another possible complication of VATS that can cause similar symptoms as hemothorax.
Internal bleeding can occur due to damage to the major vessels, such as the aorta, pulmonary artery, or vena cava, during VATS. Internal bleeding can cause hypovolemia, which is a decrease in the volume of blood in the body, and hypoxemia, which is a low level of oxygen in the blood. These conditions can impair the delivery of oxygen to the tissues and organs, including the lungs, and cause diminished breath sounds, as well as other signs of shock, such as confusion, weakness, dizziness, and loss of consciousness.
Pain with deep inspiration, bradycardia, and hypertension are not typical symptoms of hemothorax or internal bleeding in a VATS patient. Pain with deep inspiration may be a normal postoperative finding after VATS, as the incisions and the chest tube may cause discomfort. Bradycardia and hypertension may be caused by other factors, such as medications, cardiac disorders, or neurological conditions, but they are not directly related to hemothorax or internal bleeding .
References:
* 1: Video-Assisted Thoracoscopic Surgery (VATS) | Johns Hopkins Medicine
* 2: Hemothorax: Causes, Symptoms, Diagnosis & Treatment - Cleveland Clinic2
* 3: Complications of video-assisted thoracoscopic surgery: a retrospective analysis of 3000 cases - PubMed
* : Major vascular complications after video-assisted thoracoscopic surgery: a case report and literature review - PubMed
* : Video-Assisted Thoracoscopic Surgery (VATS) | Michigan Medicine
* : Bradycardia - Symptoms and causes - Mayo Clinic
* : High blood pressure (hypertension) - Symptoms and causes - Mayo Clinic
NEW QUESTION # 51
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?
- A. Explain patient care policies and procedures to the new nurse.
- B. Determine the knowledge and skills the new nurse needs to learn.
- C. Introduce the new nurse to staff and team members on the unit.
- D. Teach the new nurse about unit routines and practices.
Answer: B
Explanation:
The first step in developing an orientation plan is to assess the new nurse's current knowledge and skills. This helps tailor the orientation to address any gaps and build on existing competencies. Understanding the new nurse's background ensures that the training is efficient and effective, focusing on areas that need improvement rather than repeating familiar information. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 52
A patient with acute renal failure has a serum potassium level of 7.2 mEq/L. The most appropriate immediate intervention for this patient is
- A. hemodialysis.
- B. Kayexalate in sorbitol.
- C. 3% NS infusion.
- D. 50% dextrose and insulin.
Answer: D
Explanation:
A serum potassium level of 7.2 mEq/L is critically high and can lead to life-threatening cardiac arrhythmias.
The most immediate intervention is the administration of 50% dextrose followed by insulin, which helps drive potassium back into the cells, thereby rapidly lowering the serum potassium level. Hemodialysis and Kayexalate are also effective but may not act as quickly as the dextrose-insulin combination. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 53
A nurse is caring for a patient who had a gastric bypass procedure 2 days ago. A physician has ordered a gastric tube to be placed due to increased abdominal distention. The nurse realizes that this procedure will most likely need to be done
- A. with a guide wire.
- B. under fluoroscopy.
- C. using ultrasound.
- D. by two nurses.
Answer: B
Explanation:
After gastric bypass surgery, the altered anatomy of the gastrointestinal tract makes it challenging to place a gastric tube. Performing the procedure under fluoroscopy provides real-time imaging guidance, ensuring correct placement and reducing the risk of complications, such as perforation or misplacement.References: = CCRN Exam Handbook, page 45
NEW QUESTION # 54
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
- A. normal response.
- B. third cranial nerve palsy.
- C. brain-stem infarction.
- D. persistent vegetative state.
Answer: A
Explanation:
The caloric irrigation test, also known as the oculovestibular reflex test, is used to assess brainstem function in patients, especially those who are comatose. In this test, cold water is introduced into the ear canal, which should induce a predictable response if the brainstem is intact. The normal response to cold water irrigation is nystagmus with slow deviation of the eyes toward the side of the cold water (in this case, the left) and a fast phase of eye movement (nystagmus) away from the side of the cold water (to the right). This indicates that the brainstem pathways are functioning properly. References: =
* American Association of Critical-Care Nurses (AACN). (2024). CCRN Exam Handbook. Retrieved from AACN CCRN Exam Handbook
* Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online. AACN
NEW QUESTION # 55
Which of the following are physiologic effects of pulmonary contusion?
- A. increased dead space and decreased airway resistance
- B. increased lung compliance and decreased dead space
- C. increased airway resistance and decreased gas diffusion
- D. increased gas diffusion and decreased lung compliance
Answer: C
Explanation:
Pulmonary contusion leads to damage to lung parenchyma, resulting in alveolar hemorrhage and edema. This causes increased airway resistance and decreased gas diffusion due to the inflammatory response and accumulation of fluid within the alveoli, impairing effective gas exchange and reducing lung compliance.References: = CCRN Exam Handbook, page 40
NEW QUESTION # 56
A patient is receiving therapeutic hypothermia post-cardiac arrest. Which of the following orders should a nurse clarify?
- A. hourly intake and output
- B. ABGs every 4 hours and with any ventilator changes
- C. sequential compression devices
- D. chemistry labs every day
Answer: C
Explanation:
Sequential compression devices (SCDs) are not recommended for patients receiving therapeutic hypothermia (TH) post-cardiac arrest, because they may interfere with the cooling process and increase the risk of skin injury. SCDs are used to prevent deep vein thrombosis (DVT) by applying intermittent pneumatic pressure to the lower extremities, but they may also increase peripheral blood flow and heat exchange, which can counteract the effects of TH. SCDs may also cause skin breakdown, blisters, or burns in patients with impaired sensation and reduced perfusion due to TH. Therefore, a nurse should clarify the order for SCDs and consider alternative methods of DVT prophylaxis, such as pharmacological agents or early mobilization.
References:
* Therapeutic Hypothermia (TH) Education Components: This document states that "Avoid use of sequential compression devices (SCDs) during cooling phase as they may interfere with cooling process and increase risk of skin injury."
* Sequential Compression Devices: Clinical Effectiveness, Cost- Effectiveness and Guidelines: This document states that "One evidence-based guideline from the American Heart Association (AHA) and the American Stroke Association (ASA) recommended against the use of SCDs in patients undergoing therapeutic hypothermia after cardiac arrest, as they may interfere with the cooling process and increase the risk of skin injury."
NEW QUESTION # 57
Which of the following is most indicative of successful treatment for salicylate poisoning?
- A. alkalinization of urine
- B. osmotic diuresis
- C. decrease in CPK
- D. decrease in gastric pH
Answer: A
Explanation:
Salicylate poisoning
Alkalinization of urine is one of the main goals of treatment for salicylate poisoning, as it enhances the renal excretion of salicylate and reduces its reabsorption. Alkalinization of urine can be achieved by administering intravenous sodium bicarbonate and maintaining adequate hydration and urine output. Alkalinization of urine can be monitored by measuring the urine pH, which should be above 7.5. Osmotic diuresis, decrease in gastric pH, and decrease in CPK are not indicative of successful treatment for salicylate poisoning. Osmotic diuresis may occur as a result of salicylate toxicity, but it does not improve the elimination of salicylate. Decrease in gastric pH may impair the absorption of salicylate, but it does not affect the elimination of salicylate. Decrease in CPK may reflect the resolution of rhabdomyolysis, which is a possible complication of salicylate poisoning, but it does not reflect the clearance of salicylate.
References:
* Salicylate (aspirin) poisoning: Management - UpToDate1, p. 1-2.
* Salicylate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice US2, p. 4-5.
NEW QUESTION # 58
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