AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 91:

  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
  C. lorazepam (Ativan)

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  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

• Question 92:

  Which of the following signs is most frequently associated with meningitis?

  A. positive Trousseau's
  B. positive Cullen's
  C. positive Kernig's
  D. positive Babinski's
  C. positive Kernig's

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  Explanation

  

  Meningitis

  A positive Kernig's sign is a clinical test for meningitis that involves flexing the hip and knee of the patient and then extending the knee. If the patient feels pain or resistance in the lower back or hamstring, the test is positive. A positive Kernig's sign indicates irritation of the meninges, the membranes that cover the brain and spinal cord. A positive Trousseau's sign is a sign of hypocalcemia that involves carpal spasm after inflating a blood pressure cuff. A positive Cullen's sign is a sign of retroperitoneal bleeding that involves bruising around the umbilicus. A positive Babinski's sign is a sign of upper motor neuron lesion that involves fanning of the toes when the sole of the foot is stroked.

  References: Kernig's sign - Wikipedia Trousseau's sign - Wikipedia Cullen's sign - Wikipedia Babinski sign - Wikipedia

• Question 93:

  Which of the following diagnostic procedures best pinpoints the location, size, and origin of a cerebral aneurysm?

  A. MRI
  B. cerebral angiography
  C. positron emission tomography (PET) scanning
  D. CT scanning
  B. cerebral angiography

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  Explanation

  Cerebral angiography is considered the gold standard for diagnosing and pinpointing the location, size, and origin of cerebral aneurysms. It involves the use of contrast material injected into the cerebral arteries and imaging to provide detailed visualization of the blood vessels in the brain, which is essential for accurate diagnosis and planning treatment strategies.

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

  

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• Question 94:

  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. leukotriene inhibitor
  B. anticholinergic
  C. mast cell stabilizer
  D. beta-agonist
  D. beta-agonist

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  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)."

• Question 95:

  A nurse is performing medication reconciliation during a patient's admission. To determine the patient's current understanding of the medication furosemide (Lasix), which of the following is the best statement by the nurse?

  A. "Can you explain to me what furosemide (Lasix) does for you?"
  B. "Do you take the furosemide (Lasix) for your hypertension?"
  C. "Which of your medications help to remove extra fluid?"
  D. "When is the best time of day to take furosemide (Lasix)?"
  A. "Can you explain to me what furosemide (Lasix) does for you?"

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  Explanation

  Asking the patient to explain what furosemide (Lasix) does for them assesses their understanding and allows the nurse to gauge their knowledge and correct any misconceptions. This method is more effective than asking yes/no questions, as it provides a comprehensive insight into the patient's medication literacy.

  References: AACN Handbook for CCRN Certification, pp. 102-105.

• Question 96:

  A patient's IV with norepinephrine (Levophed) infusing is red, swollen, and the IV pump is alarming. A nurse should anticipate

  A. administering phentolamine (Regitine).
  B. providing a warm compress.
  C. lowering the extremity below heart level.
  D. removing the IV immediately.
  A. administering phentolamine (Regitine).

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  Explanation

  Phentolamine (Regitine) is the antidote for norepinephrine extravasation, which is the leakage of the vasopressor from the vein into the surrounding tissue. Phentolamine reverses the vasoconstriction and ischemia caused by norepinephrine by blocking the alpha-adrenergic receptors. Phentolamine should be administered intradermally around the site of extravasation as soon as possible, and the infusion should be stopped but the IV catheter should not be removed until some of the norepinephrine is aspirated. A warm compress may worsen the tissue damage by increasing the absorption of norepinephrine, and lowering the extremity may increase the edema and pain. Removing the IV immediately may prevent the aspiration of norepinephrine and the administration of phentolamine.

  References: Episode 240: What to do with norepinephrine extravasation: This article explains the steps to take when norepinephrine extravasates, including the use of phentolamine, and the reasons to avoid cold compress, lowering the extremity, and removing the IV. What are current recommendations for treatment of drug extravasation?: This article summarizes the latest recommendations for treatment of extravasation, and lists phentolamine as the immediate topical therapy for norepinephrine extravasation.

• Question 97:

  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."
  A. "I will need a few minutes to prepare and organize this for you."

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  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

• Question 98:

  A nurse should expect which of the following plans of care for a patient with a complicated RV infarction?

  A. dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix)
  B. nitroprusside (Nipride), fluid restrictions, and transvenous pacing
  C. nitroglycerin, fluid infusions, and morphine
  D. dobutamine (Dobutrex), fluid infusions, and transvenous pacing
  D. dobutamine (Dobutrex), fluid infusions, and transvenous pacing

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  Explanation

  A nurse should expect a plan of care that includes dobutamine (Dobutrex), fluid infusions, and transvenous pacing for a patient with a complicated RV infarction, as these interventions aim to improve RV function, increase cardiac output, and correct bradyarrhythmias. Dobutamine is an inotropic agent that increases myocardial contractility and reduces RV afterload1. Fluid infusions are used to optimize RV preload and maintain adequate systemic perfusion12. Transvenous pacing is indicated for patients with symptomatic bradycardia or high-grade AV block that compromise hemodynamics13. Dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix) are not appropriate for a patient with a complicated RV infarction, as they may worsen RV preload and cardiac output. Nitroprusside (Nipride), fluid restrictions, and transvenous pacing are not suitable for a patient with a complicated RV infarction, as they may cause excessive vasodilation and hypotension. Nitroglycerin, fluid infusions, and morphine are not optimal for a patient with a complicated RV infarction, as they may reduce RV preload and increase RV ischemia.

• Question 99:

  Treatment of cerebral vasospasm includes administration of

  A. lorazepam (Ativan).
  B. propranolol (Inderal).
  C. nimodipine (Nimotop).
  D. pentobarbital (Nembutal).
  C. nimodipine (Nimotop).

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  Explanation

  Nimodipine is a calcium channel blocker that is used to prevent or treat cerebral vasospasm after subarachnoid hemorrhage. It works by relaxing the smooth muscle of the cerebral arteries and improving blood flow to the brain. Nimodipine is the only FDA- approved agent for vasospasm and has been shown to reduce the risk of ischemic complications and improve neurological outcomes12. Lorazepam, propranolol, and pentobarbital are not effective for treating cerebral vasospasm and may have adverse effects on the patient's blood pressure, heart rate, and level of consciousness.

• Question 100:

  A patient with an acute anterior wall MI presents with an S3 gallop and the following values:

  

  Which drug therapy would be most appropriate for this patient?

  A. vasodilators and positive inotropes
  B. vasopressors and beta-blockers
  C. vasodilators and diuretics
  D. vasopressors and calcium-channel blockers
  C. vasodilators and diuretics

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  Explanation

  In the setting of an acute anterior wall myocardial infarction (MI) with an S3 gallop, the patient is likely experiencing heart failure and possibly acute pulmonary edema. The appropriate treatment includes vasodilators to reduce afterload and diuretics to decrease preload and pulmonary congestion. This combination helps to improve cardiac output and reduce the workload on the heart.

  References: CCRN Exam Handbook, AACN, page 20, section on Cardiovascular.