AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 1:

  The family member of a patient who is receiving mechanical ventilation is to be taught suctioning. When developing a teaching plan, the nurse should first

  A. obtain written information about the procedure.
  B. determine a schedule for demonstrating the technique.
  C. identify the areas in which the family member needs information and skills.
  D. encourage the family member to observe the procedure on other patients.
  C. identify the areas in which the family member needs information and skills.

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  explanation:

  Explanation

  The first step in developing a teaching plan is to assess the learner's needs, knowledge, and readiness to learn. This will help the nurse tailor the teaching plan to the individual's learning style, preferences, and goals. Obtaining written

  information, determining a schedule, and encouraging observation are all strategies that can be used later in the teaching plan, but they are not the first step.

  References:

  AACN Essentials of Critical Care Nursing, Fourth Edition, page 18.

  Patient Education and Counseling, page 3.

• Question 2:

  A patient has a linear skull fracture with multisystem trauma. The patient's vital signs are as follows:

  BP 80/50

  HR120

  CVP2 mm Hg

  Which of the following is the most appropriate explanation for this patient's condition?

  A. The patient has lost a significant amount of blood because of intracranial hemorrhage.
  B. Fluid regulation by the neurohypophysis is impaired because of increased intracranial pressure.
  C. Parasympathetic stimulation is causing significant vasodilatation and pooling of blood.
  D. Blood loss is occurring from a noncerebral injury.
  D. Blood loss is occurring from a noncerebral injury.

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  explanation:

  Explanation

  The patient's vital signs (BP 80/50, HR 120, CVP 2 mm Hg) indicate hypovolemic shock, likely due to significant blood loss. Given the presence of multisystem trauma, it is reasonable to suspect that the blood loss is from a noncerebral source, such as abdominal or thoracic injuries, rather than intracranial hemorrhage. Intracranial hemorrhage typically does not result in such profound hypovolemia without other sources of blood loss.

  References: CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

• Question 3:

  A patient has been declared brain dead. A nurse would like the family to consider organ donation but has never requested this from a family before. The best initial action by the nurse is to

  A. consult the organ donation liaison.
  B. directly ask the patient's family members if they would consider organ donation.
  C. find out if the patient has an organ donor card.
  D. request that the physician discuss the issue with the family.
  A. consult the organ donation liaison.

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  explanation:

  Explanation

  When a patient has been declared brain dead, the appropriate initial action for a nurse who has not previously discussed organ donation with a family is to consult the organ donation liaison. These professionals are trained to handle sensitive

  conversations about organ donation and can provide the necessary support and information to the family, ensuring that the process is handled respectfully and in accordance with legal and ethical guidelines.

  References: =

  CCRN (Adult) Certification Review Course Online: Professional Caring and Ethical Practice.

  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

• Question 4:

  A patient is admitted for sepsis secondary to pneumonia. The patient has received 2000 mL of plasmalyte and their BP remains 80/50. What should the nurse anticipate next for the patient?

  A. dopamine
  B. norepinephrine
  C. 1L of plasmalyte
  D. vasopressin
  B. norepinephrine

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  explanation:

  Explanation

• Question 5:

  In a patient with status asthmaticus, which of the following indicate a deteriorating condition?

  A. increased compliance and respiratory acidosis
  B. increased PaCO2 and decreased expiratory flow
  C. respiratory alkalosis and increased expiratory flow
  D. decreased PaCO2 and increased minute ventilation
  B. increased PaCO2 and decreased expiratory flow

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  explanation:

  Explanation

  In status asthmaticus, a worsening condition is indicated by increased PaCO2 and decreased expiratory flow. This reflects severe airway obstruction and ventilatory failure, leading to hypercapnia (elevated PaCO2) and a decrease in the ability to exhale effectively.

  References: CCRN Exam Handbook and AACN's Certification Review Course materials.

• Question 6:

  A ventilator-associated event (VAE) is best prevented by

  A. tracheal instillation of normal saline.
  B. changing ventilator tubing daily.
  C. minimizing tube feedings.
  D. subglottic suctioning.
  D. subglottic suctioning.

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  explanation:

  Explanation

  Ventilator-associated events (VAEs) can be prevented by reducing the risk of aspiration and maintaining airway hygiene. Subglottic suctioning is an effective measure to remove secretions that accumulate above the endotracheal tube cuff, which can harbor bacteria and lead to infection. This intervention helps prevent the development of pneumonia and other VAEs.

  References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

• Question 7:

  A patient underwent a successful percutaneous coronary intervention to the left anterior descending coronary artery. The patient suddenly begins to complain of dyspnea, jaw pain, and chest tightness. The bedside monitor displays sinus tachycardia and ST segment elevation in lead V2. The patient's neck veins are flat and BP is 152/98. Which of the following is the most likely cause of the patient's symptoms?

  A. pulmonary hypertension
  B. coronary artery occlusion
  C. vasovagal reaction
  D. cardiac tamponade
  B. coronary artery occlusion

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  explanation:

  Explanation

  The patient presents with dyspnea, jaw pain, chest tightness, and sinus tachycardia with ST segment elevation in lead V2 after a percutaneous coronary intervention (PCI). These symptoms are indicative of myocardial ischemia or infarction, likely due to a re-occlusion of the treated coronary artery. Coronary artery occlusion is a common cause of these acute symptoms post-PCI. Other options like pulmonary hypertension, vasovagal reaction, and cardiac tamponade are less consistent with the clinical presentation.

  References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

• Question 8:

  The rationale for initiating early enteral feeding in a patient with sepsis is to

  A. minimize translocation of GI bacteria.
  B. minimize electrolyte imbalances and fluid shifts.
  C. prevent pulmonary aspiration.
  D. increase GI motility.
  A. minimize translocation of GI bacteria.

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  explanation:

  Explanation

  Early enteral feeding in patients with sepsis is crucial as it helps maintain gut integrity, thereby minimizing the translocation of gastrointestinal (GI) bacteria. The presence of nutrients in the gut lumen supports the mucosal barrier function and reduces bacterial translocation, which can lead to secondary infections and further complications in septic patients.

  References: CCRN Exam Handbook and AACN's Certification Review Course materials.

• Question 9:

  An older adult patient reports an inability to sleep due to staff waking the patient for frequent neurological assessments. In order to minimize sleep disruptions, the nurse should

  A. encourage the patient to sleep between assessments.
  B. discontinue neurologic assessments.
  C. establish a schedule with the provider.
  D. move the patient to the quieter part of the unit.
  C. establish a schedule with the provider.

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  explanation:

  Explanation

  Verified Answer:

  C. establish a schedule with the provider. Neurological assessments are important for monitoring the patient's neurological status and detecting any changes that may indicate a complication or improvement. However, frequent interruptions of sleep can have negative effects on the patient's health and well-being, such as impaired cognition, mood, immune function, and wound healing. Therefore, the nurse should collaborate with the provider to establish a schedule for neurologic assessments that balances the need for monitoring and the need for rest. This may involve reducing the frequency of assessments during the night, clustering other interventions to minimize disruptions, and using noninvasive methods of assessment when possible. Discontinuing neurologic assessments, encouraging the patient to sleep between assessments, or moving the patient to a quieter part of the unit are not appropriate actions as they do not address the root cause of the problem or ensure adequate monitoring of the patient's condition.

• Question 10:

  Patients in end-stage cardiomyopathy often exhibit which of the following symptoms of right-sided heart failure?

  A. hypotension and oliguria
  B. JVD and hepatomegaly
  C. hypertension and polyuria
  D. pulmonary edema and restlessness
  B. JVD and hepatomegaly

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  explanation:

  Explanation

  JVD stands for jugular venous distension, which is a sign of increased pressure in the right atrium and the superior vena cava. Hepatomegaly means enlargement of the liver, which can occur due to congestion of blood in the portal vein and the hepatic vein. Both JVD and hepatomegaly are common symptoms of right-sided heart failure, as they indicate fluid retention and backup in the systemic circulation12. Hypotension and oliguria are not specific to right-sided heart failure, as they can also occur in left-sided heart failure or other conditions that affect the cardiac output and renal perfusion. Hypertension and polyuria are unlikely to be seen in right-sided heart failure, as they indicate increased blood pressure and urine output, which are opposite to the effects of reduced cardiac function and fluid overload. Pulmonary edema and restlessness are more characteristic of left-sided heart failure, as they indicate fluid accumulation and impaired gas exchange in the lungs12.