AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 121:

  A patient is 2 days post MI. The patient was stable until this morning, when severe chest discomfort developed. Assessment reveals:

  BP70/palpable

  HR122

  RR38

  PAOP28 mm Hg, with large V waves

  CI1.6 L/min/m2

  Cool, clammy skin

  Inspiratory crackles throughout the lung field

  Loud blowing holosystolic murmur at the apex

  The patient's present clinical status is most likely a result of

  A. papillary muscle rupture.
  B. cardiac tamponade.
  C. acute aortic insufficiency.
  D. ventricular septal defect.
  D. ventricular septal defect.

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  Explanation

  The patient's present clinical status is most likely a result of a ventricular septal defect (VSD), which is a hole in the wall between the left and right ventricles. A VSD can occur as a mechanical complication of MI, usually within the first week,

  due to necrosis and rupture of the ventricular septum. A VSD causes a left-to-right shunt of blood, which leads to increased pulmonary pressure, pulmonary edema, and reduced cardiac output. The patient's symptoms and signs are

  consistent with a VSD, such as severe chest pain, hypotension, tachycardia, respiratory distress, high PAOP with large V waves, low CI, cool and clammy skin, inspiratory crackles, and a loud blowing holosystolic murmur at the apex. A

  papillary muscle rupture, a cardiac tamponade, and an acute aortic insufficiency are other possible mechanical complications of MI, but they have different clinical manifestations. A papillary muscle rupture causes acute mitral regurgitation,

  which presents with a soft systolic murmur at the apex and pulmonary congestion1. A cardiac tamponade causes compression of the heart by pericardial fluid, which presents with hypotension, muffled heart sounds, and jugular venous

  distension2. An acute aortic insufficiency causes backflow of blood from the aorta to the left ventricle, which presents with a diastolic decrescendo murmur at the left sternal border and a wide pulse pressure3.

  References:

  1: Mechanical complications of acute myocardial infarction - UpToDate4, p. 2-3. 2: Cardiac tamponade - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2. 3: Acute aortic regurgitation - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.

• Question 122:

  A patient in septic shock is treated with a dopamine (Intropin) infusion of 10 mcg/kg/min. Which of the following indicates that this intervention has been effective?

  A. decreased systemic vascular resistance and decreased MAP
  B. increased systemic vascular resistance and decreased MAP
  C. decreased systemic vascular resistance and increased MAP
  D. increased systemic vascular resistance and increased MAP
  D. increased systemic vascular resistance and increased MAP

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  Explanation

  Dopamine, when administered at a dose of 10 mcg/kg/min, acts primarily as an alpha-adrenergic agonist, leading to vasoconstriction. This results in increased systemic vascular resistance (SVR) and increased mean arterial pressure (MAP),

  which are desired outcomes in the treatment of septic shock. This effect helps improve perfusion to vital organs and stabilize hemodynamics in patients with septic shock.

  References: CCRN (Adult) Certification Review Course Online:

  Cardiovascular and Hemodynamics.

  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 123:

  A patient with a history of COPD is admitted with increasing dyspnea and fatigue. O2 is initiated via nasal cannula at 4 L/min with an O2 saturation of 99%. One hour later, the patient becomes lethargic. Which of the following is the most likely cause for the change in the patient's mental status?

  A. O2 toxicity
  B. absorption atelectasis
  C. depressed hypoxic drive
  D. decreased end-tidal CO2
  C. depressed hypoxic drive

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  Explanation

  A patient with COPD may have a chronically elevated PaCO2 and rely on hypoxia as the main stimulus for breathing. If the patient receives too much oxygen, this may reduce the hypoxic drive and cause respiratory depression, leading to

  lethargy and hypercapnia. O2 toxicity, absorption atelectasis, and decreased end-tidal CO2 are unlikely to occur with 4 L/min of O2 via nasal cannula in a short period of time.

  References:

  Reference Guide for CCRN (Adult), page 14. Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

• Question 124:

  Which of the following is a cause of cardiogenic pulmonary edema?

  A. elevated PAOP reading
  B. RV chamber enlargement
  C. pulmonary hypertension
  D. LV noncompliance
  D. LV noncompliance

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  Explanation

  Cardiogenic pulmonary edema is primarily caused by left ventricular (LV) noncompliance. When the left ventricle is unable to properly fill or eject blood, pressure increases in the left atrium and pulmonary veins, leading to fluid leakage into the pulmonary interstitium and alveoli, causing pulmonary edema. Elevated PAOP readings, RV chamber enlargement, and pulmonary hypertension are not primary causes of cardiogenic pulmonary edema but can be related to other cardiac conditions.

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

• Question 125:

  A patient who had a liver resection now has a copious amount of serous drainage from the surgical incision. Which of the following should a nurse anticipate when caring for this patient?

  A. preparing for an incision and debridement of the wound
  B. applying several abdominal dressings
  C. administering antibiotics
  D. applying a drainage pouch to the site
  B. applying several abdominal dressings

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  Explanation

  A copious amount of serous drainage from a liver resection incision may indicate a bile leak, which can cause pain, infection, and delayed healing. The nurse should anticipate applying several abdominal dressings to absorb the fluid and protect the wound. The nurse should also monitor the patient for signs of infection, such as fever, increased white blood cell count, and foul-smelling drainage. The nurse should notify the surgeon of the excessive drainage and follow the orders for further interventions, such as imaging studies, drainage catheter placement, or surgical repair. Antibiotics may be prescribed, but they are not the first-line treatment for a bile leak. Incision and debridement of the wound may be necessary if there is necrotic tissue or infection, but it is not the initial action. Applying a drainage pouch to the site may not be sufficient to contain the large amount of fluid and may increase the risk of skin breakdown.

  References: Problems after cancer surgery to remove part of your liver: This article states that "The bile ducts connect the liver and gallbladder to the small bowel. There is a risk of bile leaking from the ducts on the cut surface of the liver. This may cause pain, sickness and a high temperature. Rarely, you might need another operation to repair the leak." Understanding Liver Abscess Treatment - Saint Luke's Health System: This article states that "The provider uses CT scan or ultrasound to help place the wire in the right spot. A thin, flexible tube (catheter) is then placed over the wire and into the abscess. The tube is left in place for 5 to 7 days to drain the fluid. In some cases, surgery may be done to cut into the liver abscess and drain it." How Much Time Does it Take to Recover from Liver Surgery?: This article states that "If you have any drainage from your incision or if the area around your incision is puffy or red, visit your surgeon. Take a shower every day with warm water. When you are ready to take solid foods, make sure to eat 4 to 6 small meals every day. Do not lift heavy weights for 8 weeks after your surgery."

• Question 126:

  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

  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 127:

  The goal of PEEP therapy in acute lung injury (ALI) is to

  A. decrease PAP.
  B. decrease airway resistance.
  C. increase cardiac output.
  D. reduce physiologic shunting.
  D. reduce physiologic shunting.

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  Explanation

  The goal of PEEP therapy in acute lung injury (ALI) is to reduce physiologic shunting, which is the perfusion of blood through unventilated or collapsed alveoli. This results in hypoxemia and impaired gas exchange. PEEP therapy increases

  the end- expiratory pressure and prevents alveolar collapse, thus improving ventilation and oxygenation. PEEP therapy does not necessarily decrease PAP (pulmonary artery pressure), decrease airway resistance, or increase cardiac output.

  In fact, PEEP therapy may have adverse effects on these parameters, such as increasing intrathoracic pressure, reducing venous return, and decreasing cardiac output.

  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. AACN. (2020). Practice Alert: Acute Lung Injury/Acute Respiratory Distress Syndrome. Retrieved from [Practice Alert], p. 1-2. Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., and Roberts,

  D. (2017). Medical-surgical

  nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier. Retrieved from [Textbook], p. 1908- 1910.

• Question 128:

  A patient is intubated, is unable to follow simple commands, and has no history of alcohol abuse. The patient has become increasingly disoriented and confused over the past 24 hours. After assessment and treatment of pain, the best medication intervention for management is

  A. lorazepam (Ativan).
  B. cisatracurium (Nimbex).
  C. midazolam (Versed).
  D. dexmedetomidine (Precedex).
  D. dexmedetomidine (Precedex).

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  Explanation

  Dexmedetomidine (Precedex) is the most appropriate medication for managing agitation and delirium in a critically ill intubated patient. It provides sedation without significant respiratory depression and has analgesic properties, which makes

  it suitable for patients who are disoriented and confused. Unlike benzodiazepines (lorazepam and midazolam) or neuromuscular blockers (cisatracurium), dexmedetomidine can improve delirium outcomes and facilitates easier weaning from

  mechanical ventilation.

  References:

  = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 57-60.

• Question 129:

  After observing an increase in the occurrence of oral pressure injuries in intubated patients on the unit, the nurse should

  A. discuss concerns at the next unit based practice meeting.
  B. report the issue to the respiratory therapy manager.
  C. continue to provide oral care to intubated patients.
  D. recommend removal endotracheal tube holders from the unit.
  A. discuss concerns at the next unit based practice meeting.

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  Explanation

  When noticing an increase in the occurrence of oral pressure injuries in intubated patients, it is essential to address this issue in a structured and collaborative manner. Discussing concerns at the next unit-based practice meeting allows for a multidisciplinary approach to identify possible causes, review current practices, and implement evidence-based interventions to prevent further occurrences. This approach fosters a culture of continuous improvement and ensures that the issue is addressed comprehensively.

  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 130:

  Which of the following are physiologic effects of pulmonary contusion?

  A. increased dead space and decreased airway resistance
  B. increased gas diffusion and decreased lung compliance
  C. increased airway resistance and decreased gas diffusion
  D. increased lung compliance and decreased dead space
  C. increased airway resistance and decreased gas diffusion

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  Explanation

  Pulmonary contusion leads to damage to lung parenchyma, resulting in alveolar hemorrhage and edema. This causes increased airway resistance and decreased gas diffusion due to the inflammatory response and accumulation of fluid within the alveoli, impairing effective gas exchange and reducing lung compliance.

  References: CCRN Exam Handbook, page 40