AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 1:

  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

  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 2:

  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. hypovolemia.
  B. hypervolemia.
  C. pulmonary dysfunction.
  D. left ventricular failure.
  C. pulmonary dysfunction.

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  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.

• Question 3:

  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. fluctuation increases
  B. bubbling increases
  C. fluctuation is absent
  D. bubbling stops
  B. bubbling increases

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  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

• Question 4:

  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. osmotic gradient which pulls fluid from the brain tissue into the vascular system.
  B. osmotic gradient which pulls fluid from the vascular system into the brain tissue.
  C. oncotic gradient which pulls fluid from the brain tissue into the vascular system.
  D. oncotic gradient which pulls fluid from the vascular system into the brain tissue.
  A. osmotic gradient which pulls fluid from the brain tissue into the vascular system.

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  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

• Question 5:

  Which of the following assessment findings would be found in a patient with pulmonary hypertension?

  A. crackles in the bases bilaterally
  B. rhonchi in the apices bilaterally
  C. pink frothy sputum
  D. distended neck veins
  D. distended neck veins

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  Explanation

  Pulmonary hypertension leads to increased pressure in the pulmonary circulation, which can cause right ventricular hypertrophy and failure. This results in systemic venous congestion, presenting as distended neck veins. Crackles, rhonchi, and pink frothy sputum are more indicative of pulmonary edema or other respiratory conditions rather than pulmonary hypertension.

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

• Question 6:

  A patient is admitted following a motor vehicle crash. A fluid challenge is initiated immediately after assessing a BP of 80/palpable. Fifteen minutes later, vital signs are as follows:

  BP 86/50

  HR 150

  RR 36

  The most appropriate action should be to

  A. administer a vasopressor.
  B. administer a second fluid challenge.
  C. request a CT scan of the chest.
  D. request an abdominal ultrasound.
  B. administer a second fluid challenge.

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  Explanation

• Question 7:

  While recording hourly ventilator checks on a patient who is being mechanically ventilated, the nurse notes that the PIP has gradually increased by 5 cm H2O over the past 4 hours. This increase indicates

  A. an improvement in pulmonary function.
  B. a leak in the ET tube cuff.
  C. a decrease in airway resistance.
  D. a decrease in lung compliance.
  D. a decrease in lung compliance.

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  Explanation

  An increase in peak inspiratory pressure (PIP) over time in a mechanically ventilated patient indicates a decrease in lung compliance. This means the lungs are becoming stiffer and less able to expand, which can be caused by conditions such as pulmonary edema, ARDS, or pneumothorax. It is important to address the underlying cause of decreased lung compliance to prevent further respiratory complications.

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

• Question 8:

  A patient presents with the following hemodynamics:

  MAP 40 mm Hg

  PAD6 mm Hg

  PAOP5 mm Hg

  CI1.8 L/min/m2

  SVR875 dynes/sec/cm-5

  Which of the following is essential in the plan of care?

  A. loop diuretic
  B. fluid resuscitation
  C. vasopressors
  D. whole blood
  B. fluid resuscitation

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  Explanation

  The patient has signs of hypovolemic shock, which is characterized by low MAP, low PAOP, low CI, and high SVR. The patient needs fluid resuscitation to restore intravascular volume and improve tissue perfusion. Loop diuretic,

  vasopressors, and whole blood are not indicated in this case.

  References:

  Reference Guide for CCRN (Adult), page 14. Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online - Individual Purchase, Module 1: Cardiovascular, Part 1: Shock.

• Question 9:

  A patient's blood culture report notes the presence of vancomycin resistant enterococcus. The nurse should place the patient in which type of isolation?

  A. droplet
  B. airborne
  C. contact
  D. protective
  C. contact

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  Explanation

  The nurse should place the patient in contact isolation, which is a type of precaution used to prevent the transmission of microorganisms that are spread by direct or indirect contact with the patient or the patient's environment. Contact

  isolation requires the use of gloves and gowns when entering the patient's room, as well as dedicated patient- care equipment and proper hand hygiene. Vancomycin resistant enterococcus (VRE) is a type of bacteria that is resistant to the

  antibiotic vancomycin and can cause infections in various sites, such as the urinary tract, bloodstream, or wounds. VRE can be spread by contact with contaminated surfaces, equipment, or hands.

  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. CDC. (2019). Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved from [CDC Guidelines], p. 69- 70.

  CDC. (2019). Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory. Retrieved from [CDC Fact Sheet], p. 1-2.

• Question 10:

  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. 3% NS infusion.

  B. Kayexalate in sorbitol.

  C. hemodialysis.

  D. 50% dextrose and insulin.

  Correct Answer. D
  D

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  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