Nov 10, 2024 Updated CCRN-Adult Dumps Questions For AACN Exam
Best Value Available Preparation Guide for CCRN-Adult Exam
NEW QUESTION # 56
A patient is admitted for hypertensive crisis. As a nurse is starting a peripheral IV, the patient appears increasingly anxious as the catheter is about to be inserted. The patient threatens to harm the nurse if the catheter insertion causes pain. Which of the following is the nurse's best action?
- A. Tell the patient to remain still in a stern, authoritative voice.
- B. Engage the patient in a conversation and encourage him to verbalize his feelings.
- C. Physically restrain the patient during the performance of the procedure.
- D. Ask another staff member to distract the patient during insertion.
Answer: B
NEW QUESTION # 57
A nurse who is providing care to a patient with a hemorrhagic stroke receives an order to administer 3% Normal Saline IV. The nurse should recognize the goal of therapy is to create an
- A. oncotic gradient which pulls fluid from the vascular system into the brain tissue.
- B. osmotic gradient which pulls fluid from the vascular system into the brain tissue.
- C. osmotic gradient which pulls fluid from the brain tissue into the vascular system.
- D. oncotic gradient which pulls fluid from the brain tissue into the vascular system.
Answer: C
Explanation:
The administration of hypertonic saline (3% Normal Saline) creates an osmotic gradient that pulls water out of the swollen brain tissue into the vascular system, helping to reduce cerebral edema. This is a critical intervention in managing increased intracranial pressure in patients with hemorrhagic stroke. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 58
A patient with a hemorrhaging renal laceration has received two units of PRBCs and 500 mL of NS via IV bolus. Assessment reveals: BP 78/42; HR 148; UO 15 mL/hr; skin is cool and diaphoretic. While preparing the patient for emergency surgery, a nurse should administer
- A. mannitol (Osmitrol), 25 g IV.
- B. dopamine (Intropin), 3 mcg/kg/min.
- C. an additional 500-mL bolus of NS.
- D. norepinephrine (Levophed), 10 mcg/min.
Answer: D
Explanation:
In a patient with a hemorrhaging renal laceration who remains hypotensive despite fluid resuscitation with two units of PRBCs and 500 mL of NS, administering norepinephrine (Levophed) is appropriate. Norepinephrine is a potent vasopressor that helps to increase blood pressure by vasoconstriction and improving cardiac output, which is critical in stabilizing a patient with severe hemorrhagic shock prior to surgery.References: = CCRN Exam Handbook, page 38
NEW QUESTION # 59
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. administering prescribed acetaminophen
- D. requesting an ABG
Answer: C
NEW QUESTION # 60
Assessment of a patient with a head injury reveals increased muscle tone and contractured positioning of the upper extremities. A nurse should
- A. use wrist restraints to maintain upper extremity extension.
- B. recognize that contractures are an expected response after a head injury.
- C. consult a physical therapist regarding appropriate positioning.
- D. obtain an order for a muscle relaxer.
Answer: C
Explanation:
In patients with head injuries, increased muscle tone and contractured positioning (such as decorticate or decerebrate posturing) are signs of significant neurological impairment. It is essential to manage these symptoms to prevent further complications. Consulting a physical therapist is the best course of action to ensure appropriate positioning, prevent contractures, and manage spasticity effectively. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
NEW QUESTION # 61
A patient is admitted with a traumatic brain injury. During assessment, a nurse notes increased urinary output from the catheter. Which of the following should the nurse suspect?
- A. nephrogenic diabetes insipidus
- B. central diabetes insipidus
- C. syndrome of inappropriate antidiuretic hormone (SIADH)
- D. cerebral salt wasting
Answer: B
Explanation:
brain injury (TBI) is most suggestive of central diabetes insipidus (DI). This condition is caused by damage to the hypothalamus or pituitary gland, leading to insufficient secretion of antidiuretic hormone (ADH). The result is an inability to concentrate urine, leading to polyuria (excessive urine output) and potentially significant dehydration and electrolyte imbalances if not managed appropriately. References: =
* CCRN (Adult) Certification Review Course Online: Neurological Disorders and Endocrine Emergencies.
* 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 # 62
Which of the following are most indicative of acute pancreatitis?
- A. severe mid-epigastric pain, leukocytosis, hypocalcemia
- B. hypotension, jaundice, hyperalbuminuria
- C. Grey Turner's sign, hyperkalemia, right shoulder pain
- D. abdominal distention, decreased lipase level, hypertension
Answer: A
Explanation:
Acute pancreatitis is most commonly indicated by severe mid-epigastric pain, which often radiates to the back, leukocytosis (an elevated white blood cell count indicating inflammation), and hypocalcemia (low calcium levels in the blood). The inflammation of the pancreas leads to the release of digestive enzymes and inflammatory mediators that can cause widespread effects, including alterations in calcium metabolism.References: = CCRN Exam Handbook, page 47
NEW QUESTION # 63
In a patient with a chest tube, an air leak in the pleural space is indicated by which of the following conditions in the water-seal chamber?
- A. bubbling increases
- B. bubbling stops
- C. fluctuation increases
- D. fluctuation is absent
Answer: A
Explanation:
In a patient with a chest tube, an air leak in the pleural space is indicated by an increase in bubbling in the water-seal chamber. Bubbling in this chamber occurs when air escapes from the pleural space into the chest drainage system. An increase in bubbling signifies an ongoing air leak, indicating that air is still entering the pleural space, often due to a bronchopleural fistula or lung injury.References: = CCRN Exam Handbook, page
36
NEW QUESTION # 64
Which of the following is a late finding in hypovolemic shock?
- A. cool, dry skin
- B. tachycardia
- C. hypotension
- D. UO greater than 30 mL/hr
Answer: C
Explanation:
Hypovolemic shock
Hypotension, or low blood pressure, is a late finding in hypovolemic shock, which means that it occurs when the condition has progressed to a severe stage. Hypotension indicates that the body's compensatory mechanisms, such as vasoconstriction, tachycardia, and increased cardiac output, have failed to maintain adequate perfusion and oxygen delivery to the vital organs. Hypotension is a sign of impending circulatory collapse and organ failure, and requires immediate intervention to restore blood volume and blood pressure.
Hypotension is usually defined as a systolic blood pressure below 90 mmHg or a mean arterial pressure below
65 mmHg1.
References:
* Hypovolemic Shock: Causes, Symptoms and Treatment - Cleveland Clinic: This article states that "As you keep losing blood or fluids, your systolic (top or first number) blood pressure comes down." and
"Your blood pressure drops very low and your heart rate and breathing get faster."
NEW QUESTION # 65
A patient is admitted with anaphylactic shock secondary to a blood transfusion. The patient's spouse asks the nurse to explain how blood can cause a low blood pressure. The nurse responds that with anaphylactic shock the
- A. kidneys excrete large amounts of urine dropping the blood pressure.
- B. peripheral blood vessels dilate, and this creates a maldistribution of volume.
- C. heart muscle weakens and is unable to pump effectively.
- D. autonomic nervous system is disrupted dropping blood pressure.
Answer: B
Explanation:
Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 66
A patient has experienced significant brain damage from an anoxic episode and has been unable to be weaned from ventilator support. The patient's spouse expresses ambivalence about stopping the ventilator now that it has been started. Which of the following statements is the nurse's most appropriate response?
- A. "We can look at the hospital's policies regarding discontinuing therapy."
- B. "Perhaps you should talk with the rest of your family before making any decisions."
- C. "Maybe we shouldn't have been so quick to start the ventilator."
- D. "When the patient no longer responds to treatment, it can be discontinued."
Answer: A
Explanation:
The nurse's role in this situation is to provide clear and compassionate guidance regarding the complex decision about continuing or discontinuing ventilator support. Referring to the hospital's policies provides a structured approach to making such decisions and ensures that the decision aligns with ethical and legal standards. This approach also supports the spouse by providing concrete information and a framework within which to make an informed decision. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 67
For a patient with unstable angina, the major goal of treatment is to
- A. decrease myocardial contractility.
- B. increase afterload.
- C. increase preload.
- D. decrease myocardial O2 consumption.
Answer: D
Explanation:
For a patient with unstable angina, the major goal of treatment is to decrease myocardial oxygen consumption.
This can be achieved by reducing heart rate, blood pressure, and myocardial contractility to lessen the workload on the heart and reduce the demand for oxygen. This helps in preventing further ischemia and potential myocardial infarction. Treatment strategies may include the use of medications such as beta-blockers, nitrates, and calcium channel blockers, which all help in decreasing the oxygen demand of the heart.References: = CCRN Exam Handbook, page 10
NEW QUESTION # 68
The dysrhythmia most commonly associated with mitral stenosis is
- A. sinus bradycardia.
- B. atrial fibrillation.
- C. second-degree AV heart block, Mobitz Type II.
- D. idioventricular rhythm.
Answer: B
Explanation:
Mitral stenosis leads to increased pressure in the left atrium, which can cause atrial enlargement and predispose patients to atrial fibrillation. Atrial fibrillation is the most common arrhythmia associated with mitral stenosis due to the structural changes in the atrium. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
NEW QUESTION # 69
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. Introduce the new nurse to staff and team members on the unit.
- B. Explain patient care policies and procedures to the new nurse.
- C. Determine the knowledge and skills the new nurse needs to learn.
- D. Teach the new nurse about unit routines and practices.
Answer: C
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 # 70
A patient reported to have smoked crack cocaine is brought to the hospital by paramedics and admitted in an agitated state. On the way to the hospital, the patient had a generalized seizure. The toxicology screen is positive for cocaine. Which of the following is most appropriate to administer?
- A. naloxone (Narcan)
- B. ipecac
- C. lorazepam (Ativan)
- D. activated charcoal
Answer: C
Explanation:
Lorazepam (Ativan) is most appropriate to administer in a patient who has smoked crack cocaine and is agitated, particularly after a generalized seizure. Benzodiazepines like lorazepam help to manage agitation and seizure activity associated with cocaine toxicity by providing sedative and anticonvulsant effects.References: = CCRN Exam Handbook, page 53
NEW QUESTION # 71
A patient develops the dysrhythmia shown below:
Blood pressure is 83/40. The patient is pale, diaphoretic, lethargic, and disoriented. The most appropriate treatment is
- A. lidocaine (Xylocaine), 1.5 mg/kg IV.
- B. defibrillation at 200 J.
- C. cardioversion at 100 J.
- D. adenosine (Adenocard), 6 mg rapid IV bolus.
Answer: C
Explanation:
The dysrhythmia shown in the image is likely a rapid ventricular tachycardia (VT), given the hemodynamic instability (BP 83/40, patient pale, diaphoretic, lethargic, and disoriented). Synchronized cardioversion at 100 joules is the appropriate treatment for unstable VT, as it can effectively terminate the arrhythmia and restore normal sinus rhythm, addressing both the dysrhythmia and the patient's symptoms.References: = CCRN Exam Handbook, page 33
NEW QUESTION # 72
After consultation with the interdisciplinary team, a nurse implements progressive mobility by having the patient sit at the side of the bed. The patient's HR increases by 10, RR increases by 6, SpO2 remains at 94%, and BP remains stable. The patient states he is tired. Which of the following should be the nurse's next action?
- A. Progress to sitting in a chair during the next activity.
- B. Return the patient to a supine position and notify the physician.
- C. Discontinue the attempts to mobilize the patient.
- D. Wait for assistance from physical therapy to resume mobility.
Answer: B
Explanation:
The patient's increased heart rate and respiratory rate, along with the patient's statement of feeling tired, may indicate that the activity was too strenuous123. It's important to ensure patient safety and comfort, so the nurse should return the patient to a supine position123. The physician should be notified about the patient's response to the activity for further evaluation and to adjust the care plan if necessary123.
NEW QUESTION # 73
A patient is admitted with a traumatic brain injury after being thrown from a horse. Despite numerous interventions, the patient is declared brain dead.
The parents have consented for organ donation, and the patient's mother requests to lay next to her daughter before being taken to the operating room.
Which of the following is the nurse's most appropriate response?
- A. "I will need a few minutes to prepare and organize this for you."
- B. "It would be too risky to move all of the machines and wires."
- C. "We must obtain permission from the organ donation team first."
- D. "Please sit at the side of the bed, hold her hand, and talk to her."
Answer: A
Explanation:
The nurse should respect the mother's request and facilitate the family's emotional needs during the end-of-life care. The nurse should also ensure the patient's safety and dignity by preparing and organizing the necessary equipment and monitoring before moving the mother next to the patient. The other options are not appropriate because they either deny the mother's request, imply that the patient is no longer alive, or delay the organ donation process.
References:
* Donor Family Care Service - NHS Blood and Transplant
* Family-Centered Care to Improve Family Consent for Organ Donation
NEW QUESTION # 74
A patient presents with fever and chills, is diaphoretic, and reports experiencing abdominal and intermittent left shoulder pain for the past week. An ultrasound shows an enlarged spleen. Vital signs are:
BP 106/59
HR 118
RR 23
T101.2° F (38.4° C)
When reviewing the lab report, which of the following findings is most significant to this presentation?
- A. positive blood cultures
- B. Hct 39%
- C. WBC less than 500/mm3
- D. PLT 150,000/mm3
Answer: A
Explanation:
Splenomegaly
An x-ray of a person's body Description automatically generated
The patient's presentation is suggestive of splenic abscess, which is a rare but serious complication of splenomegaly. Splenic abscess is caused by bacterial or fungal infection of the spleen, usually from hematogenous spread or contiguous spread from adjacent organs. The most common symptoms are fever, chills, abdominal pain, and left shoulder pain (Kehr sign). The most significant laboratory finding is positive blood cultures, which indicate systemic infection and sepsis. Other laboratory findings may include leukocytosis, anemia, thrombocytopenia, elevated inflammatory markers, and abnormal liver function tests.
However, these are nonspecific and may vary depending on the underlying cause of splenomegaly and the type of microorganism involved.
References:
* Splenic Abscess - Infectious Disease Advisor
* Cross-sectional imaging findings of splenic infections: is ... - Springer
NEW QUESTION # 75
Following a splenectomy, a patient is most at risk for
- A. sepsis.
- B. pulmonary embolism.
- C. wound dehiscence.
- D. hypertension.
Answer: A
Explanation:
The spleen plays a crucial role in filtering bacteria and old or damaged blood cells, as well as mounting an immune response. After a splenectomy, the patient is at increased risk for infections, particularly from encapsulated organisms like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
This heightened susceptibility to infection can lead to sepsis, a life-threatening condition. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 76
A patient with cardiogenic shock for several days has been managed aggressively with vasopressor and inotrope therapies. Which of the following indicates organ dysfunction from hypoperfusion?
- A. elevated creatinine and fever
- B. decreased insulin requirements and abdominal pain
- C. fever and decreased insulin requirements
- D. abdominal pain and elevated creatinine
Answer: D
Explanation:
In the context of cardiogenic shock managed with vasopressor and inotrope therapies, organ dysfunction from hypoperfusion can manifest as elevated creatinine and abdominal pain. Elevated creatinine indicates renal impairment, a common result of poor perfusion to the kidneys. Abdominal pain can indicate hypoperfusion to the gastrointestinal tract, leading to ischemic bowel or other GI complications. These symptoms are direct indicators of hypoperfusion and organ dysfunction. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 77
A patient with unilateral facial droop and slurred speech has a history of hyperlipidemia and hypertension. The nurse should anticipate an order for a
- A. head MRI.
- B. triglyceride panel.
- C. coagulation panel.
- D. head and neck CT scan.
Answer: D
Explanation:
Given the symptoms of unilateral facial droop and slurred speech, a stroke is highly suspected. A head and neck CT scan is the most appropriate initial imaging to quickly evaluate for the presence of an ischemic or hemorrhagic stroke, which is critical for determining the appropriate treatment plan. An MRI may provide more detailed information later but is not the initial test of choice in the acute setting. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 78
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