AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 111:

  A patient is recovering from CABG surgery. On postoperative day 3, the patient's laboratory values indicate thrombocytopenia and elevated liver function tests. The patient is scheduled for hemodialysis today. A nurse notifies the physician of the abnormal laboratory values. The nurse should next anticipate an order to

  A. administer heparin to prevent clot formation.
  B. complete hemodialysis without heparin.
  C. transfuse platelets during hemodialysis.
  D. reschedule hemodialysis.
  B. complete hemodialysis without heparin.

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  Explanation

  The patient has thrombocytopenia, which is a low platelet count that increases the risk of bleeding. Heparin is an anticoagulant that prevents clotting, but also increases the risk of bleeding. Therefore, heparin should be avoided in patients

  with thrombocytopenia. Hemodialysis can be performed without heparin by using alternative methods such as saline flushes, blood predilution, or specialized dialyzers that reduce clotting. Transfusing platelets during hemodialysis is not

  recommended, as platelets may be damaged by the extracorporeal circuit. Rescheduling hemodialysis may not be feasible, as the patient may have fluid overload, electrolyte imbalance, or uremia that require urgent dialysis.

  References:

  Use and safety of heparin-free maintenance hemodialysis in the USA Anticoagulation for the hemodialysis procedure

  Dialysis without anticoagulation (Heparin Free Dialysis)

• Question 112:

  The dysrhythmia most commonly associated with mitral stenosis is

  A. second-degree AV heart block, Mobitz Type II.
  B. idioventricular rhythm.
  C. sinus bradycardia.
  D. atrial fibrillation.
  D. atrial fibrillation.

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  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.

• Question 113:

  A patient is admitted with hypotension, tachycardia, and intermittent confusion. Upon arrival, the patient asks to walk to the bathroom. Which of the

  following is a nurse's best action?

  A. Assess the patient's vital signs and ask the physician for an order for activity.
  B. Conduct a fall risk assessment and institute appropriate interventions.
  C. Encourage the patient to walk independently to the bathroom to enhance early mobility.
  D. Situate the patient in bed and provide a bed pan.
  D. Situate the patient in bed and provide a bed pan.

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  Explanation

  Given the patient's symptoms of hypotension, tachycardia, and intermittent confusion, the safest course of action is to keep the patient in bed to prevent falls and further injury. The patient is at high risk for falls due to their hemodynamic instability and altered mental status. Using a bed pan minimizes the risk of injury compared to allowing the patient to walk, which could lead to falls and worsen their condition.

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

• Question 114:

  A patient with a C5 spinal cord injury calls the nurse every 15 minutes with requests for juice, water, and repositioning. Which of the following is the nurse's best response?

  A. "You need to be repositioned only every 2 hours."
  B. "You are safe. Nothing will happen to you."
  C. "I will check on you every 30 minutes."
  D. "I will get someone to sit with you."
  D. "I will get someone to sit with you."

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  Explanation

  

  Spinal cord injury

  

  The patient with a C5 spinal cord injury may have anxiety, fear, or depression due to the loss of function and independence. The patient may also have difficulty breathing, swallowing, or regulating body temperature. The patient may call the nurse frequently to seek reassurance, attention, or comfort. The nurse should respond with empathy and compassion, and provide the patient with emotional support and psychological counseling. The nurse should also assess the patient's physical needs and provide adequate hydration, nutrition, and skin care. The nurse should not dismiss the patient's requests, ignore the patient's feelings, or limit the patient's contact with the nurse. The nurse should also not give false reassurance or minimize the patient's concerns. Therefore, the best response is to get someone to sit with the patient, such as a family member, a friend, or a volunteer. This will help the patient feel less isolated, anxious, or depressed, and provide the patient with a sense of security and companionship.

• Question 115:

  For a patient with suspected pulmonary embolism, which of the following is the most definitive diagnostic test?

  A. pulmonary angiography
  B. ABG analysis
  C. ventilation scan
  D. chest x-ray
  A. pulmonary angiography

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  Explanation

  

  Pulmonary embolism

  Pulmonary angiography is the most definitive diagnostic test for pulmonary embolism, as it provides a clear picture of the blood flow in the arteries of the lungs. It can detect even small clots and determine the location and extent of the

  obstruction. However, because it requires a high degree of skill to perform and has potentially serious risks, it is usually done when other tests fail to provide a definite diagnosis1. Other tests that can be used to diagnose pulmonary embolism

  include CT pulmonary angiography, ventilation-perfusion scan, D-dimer test, chest X-ray, ultrasound, and MRI23. However, these tests may have limitations such as low sensitivity, low specificity, radiation exposure, contrast allergy, or

  availability4.

  References:

  Pulmonary embolism - Diagnosis and treatment - Mayo Clinic, under "Pulmonary angiogram".

  Pulmonary Embolism (PE): Symptoms, Signs and Treatment - Cleveland Clinic, under "How is a pulmonary embolism diagnosed?".

  Diagnosis of Pulmonary embolism and what are its different treatment options?, under "Diagnosis for Pulmonary embolism".

  Diagnosis of pulmonary embolism - UpToDate, under "Overview".

• Question 116:

  Which of the following should the nurse expect in a patient with papillary muscle dysfunction?

  A. mitral insufficiency
  B. aortic stenosis
  C. mitral stenosis
  D. aortic insufficiency
  A. mitral insufficiency

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  Explanation

  Papillary muscle dysfunction, often resulting from myocardial infarction, can lead to mitral insufficiency (mitral regurgitation). The papillary muscles support the mitral valve, and if they are damaged, the valve may not close properly, causing blood to flow backward into the left atrium during systole. This condition is not associated with aortic stenosis, mitral stenosis, or aortic insufficiency.

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

• Question 117:

  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. obtain an order for a muscle relaxer.
  C. recognize that contractures are an expected response after a head injury.
  D. consult a physical therapist regarding appropriate positioning.
  D. consult a physical therapist regarding appropriate positioning.

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  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.

• Question 118:

  A nurse is caring for a patient with pulmonary fibrosis who is exhibiting shortness of breath, tachypnea, and feels a sense of impending doom. In order to relieve these symptoms, the nurse should anticipate an order for

  A. morphine.
  B. hydromorphone.
  C. lorazepam.
  D. diazepam.
  A. morphine.

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  Explanation

  Morphine is often used to relieve symptoms such as shortness of breath and anxiety in patients with pulmonary fibrosis. It works by reducing the sensation of dyspnea and the sense of impending doom by decreasing the respiratory drive and alleviating anxiety through its sedative effects. Additionally, morphine can help reduce tachypnea by slowing down the respiratory rate.

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

• Question 119:

  A patient admits to a nurse that he has struggled with depression and feelings of isolation and abandonment since moving into a nursing home last year,

  but he has recently started taking an anti-depressant. The patient states, "Sometimes it takes everything I've got just to go on each day." Which of the

  following is the nurse's best initial response?

  A. "You sound like you've been really unhappy. Have you thought about harming yourself?"
  B. "Those feelings should resolve when the medication you've started has a chance to take effect."
  C. "I understand how you feel. We all get that way when we're depressed."
  D. "Have you talked to anyone about what is bothering you?"
  A. "You sound like you've been really unhappy. Have you thought about harming yourself?"

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  Explanation

  This is the nurse's best initial response, as it expresses empathy, validates the patient's feelings, and assesses the patient's risk of suicide. Depression is a common and serious mental health condition that affects older adults, especially those living in nursing homes. Depression can cause persistent sadness, hopelessness, loss of interest, and suicidal thoughts or behaviors. The nurse should screen the patient for depression using a validated tool, such as the Patient Health Questionnaire (PHQ-9) 1, and ask about any suicidal ideation or plans. The nurse should also provide emotional support, education, and referral to appropriate resources for the patient.

  B. "Those feelings should resolve when the medication you've started has a chance to take effect." This is not the nurse's best initial response, as it dismisses the patient's feelings, implies that the patient just needs to wait for the medication to work, and does not address the patient's psychosocial needs. Antidepressants are one of the treatment options for depression, but they may take several weeks to show their full effect, and they may not work for everyone. The nurse should also explore other factors that may contribute to the patient's depression, such as social isolation, loss of autonomy, chronic illness, or grief, and offer interventions that may help the patient cope, such as counseling, psychotherapy, cognitive-behavioral therapy, or social activities.

  C. "I understand how you feel. We all get that way when we're depressed." This is not the nurse's best initial response, as it assumes that the nurse knows how the patient feels, minimizes the patient's experience, and generalizes the patient's condition. Depression is not a normal or inevitable part of aging, and it affects each person differently. The nurse should not compare the patient's feelings to their own or to others, but rather acknowledge and respect the patient's unique perspective and situation. The nurse should also avoid using words like "we" or "you" that may create a sense of distance or judgment, and instead use words like "I" or "me" that may convey a sense of empathy or rapport.

  D. "Have you talked to anyone about what is bothering you?" This is not the nurse's best initial response, as it may sound like the nurse is trying to avoid listening to the patient, or that the patient is bothering the nurse with their problems. The nurse should not imply that the patient should talk to someone else, but rather show interest and willingness to listen to the patient. The nurse should also use open-ended questions that invite the patient to share more, such as "How are you feeling today?" or "What has been on your mind lately?" The nurse should also use active listening skills, such as nodding, paraphrasing, reflecting, or summarizing, to demonstrate understanding and engagement.

• Question 120:

  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. PLT 150,000/mm3
  C. WBC less than 500/mm3
  D. Hct 39%
  A. positive blood cultures

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  Explanation

  

  Splenomegaly

  

  An x-ray of a person's body 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