AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 101:

  A 22-year-old trauma patient sustained multiple fractures after a fall. The patient fell 50 feet from a cliff while rock climbing without a harness. The patient is intubated and sedated with casts to bilateral lower extremities. The nurse should recognize that young adults are

  A. more likely to engage in risk-taking behaviors.
  B. developmentally vulnerable to peer pressure in extreme sports.
  C. working through trust issues that cause them to test limits.
  D. influenced by long-time intervals spent in virtual reality.
  A. more likely to engage in risk-taking behaviors.

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  Explanation

• Question 102:

  A patient is receiving therapeutic hypothermia post-cardiac arrest. Which of the following orders should a nurse clarify?

  A. chemistry labs every day
  B. ABGs every 4 hours and with any ventilator changes
  C. hourly intake and output
  D. sequential compression devices
  D. sequential compression devices

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  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."

• Question 103:

  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. head and neck CT scan.
  D. coagulation panel.
  C. head and neck CT scan.

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  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

• Question 104:

  A patient is admitted for acute benzodiazepine overdose. Nursing interventions should include administration of

  A. sodium bicarbonate.
  B. flumazenil (Romazicon).
  C. naloxone (Narcan).
  D. osmotic diuretics.
  B. flumazenil (Romazicon).

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  Explanation

  Flumazenil is a benzodiazepine antagonist that can reverse the effects of benzodiazepine overdose. It acts by competitively inhibiting the activity at the benzodiazepine receptor, thus reversing sedation and other effects caused by benzodiazepines. Sodium bicarbonate, naloxone, and osmotic diuretics are not appropriate treatments for benzodiazepine overdose.

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

• Question 105:

  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

  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 106:

  Postoperatively, symptoms that may indicate hemothorax or internal bleeding in a video- assisted thoracic surgery (VATS) patient include

  A. diminished breath sounds.
  B. pain with deep inspiration.
  C. bradycardia.
  D. hypertension.
  A. diminished breath sounds.

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  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 and 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

• Question 107:

  A physician tries three times to insert a central line, then says, "I think I can get it this time." A nurse should

  A. suggest that another physician insert the line.
  B. administer an analgesic.
  C. allow the physician to try again.
  D. start a peripheral line.
  A. suggest that another physician insert the line.

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  Explanation

  When a physician has attempted to insert a central line multiple times without success, the nurse's responsibility includes ensuring patient safety and advocating for the patient. Continued attempts by the same physician may increase the risk of complications, such as infection or trauma. Therefore, the nurse should suggest that another physician, possibly one with more experience or skill in central line insertion, perform the procedure.

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

• Question 108:

  The family of a patient with trauma believes that the patient is in pain and requests that a neighbor, a therapeutic touch practitioner, be allowed to see the patient. Unit policy allows visits by immediate family only. Which of the following is the most important consideration in a nurse's decision about facilitating the visit?

  A. Alternative modalities have been associated with enhancements in pharmacologic effects.
  B. Research does not support the value of therapeutic touch in pain management.
  C. Alternative therapies are not generally acceptable in an ICU setting.
  D. The family needs an explanation of the rationale for unit visitation policies.
  D. The family needs an explanation of the rationale for unit visitation policies.

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  Explanation

  The primary consideration is to ensure that the family understands the unit's visitation policies. While alternative modalities like therapeutic touch can be beneficial, the nurse must adhere to established policies and explain the rationale to the family. This helps maintain the integrity of unit operations and ensures that all patients receive equitable care. Explaining the policies also provides an opportunity to discuss alternative ways to support the patient within the existing framework.

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

• Question 109:

  A patient was admitted 3 days ago for an overdose of acetaminophen (Tylenol). The patient is developing a decreasing level of consciousness. Which the following is the most likely finding?

  A. Cheyne-Stokes respirations
  B. splenomegaly
  C. decreased GFR
  D. increased INR
  D. increased INR

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  Explanation

  A patient with acetaminophen overdose is at risk for acute liver failure, which can lead to coagulopathy. This condition is often marked by an increased International Normalized Ratio (INR) due to impaired synthesis of clotting factors in the liver. Decreasing level of consciousness can also result from hepatic encephalopathy, a complication of liver failure.

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

• Question 110:

  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. "When the patient no longer responds to treatment, it can be discontinued."
  B. "We can look at the hospital's policies regarding discontinuing therapy."
  C. "Perhaps you should talk with the rest of your family before making any decisions."
  D. "Maybe we shouldn't have been so quick to start the ventilator."
  B. "We can look at the hospital's policies regarding discontinuing therapy."

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  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