AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 131:

  During the monthly code team review, it is noted that regulators have been consistently missing from the O2 tanks. Which of the following is a nurse's best action?

  A. Document on the daily flow sheets when the regulators are missing.
  B. Inform the nurse manager of the need for more regulators.
  C. Form a task force to try to find a solution.
  D. Report the missing regulators to the shift supervisor.
  B. Inform the nurse manager of the need for more regulators.

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  Explanation

  The absence of regulators from O2 tanks is a serious issue that can affect patient care. The nurse manager is in a position to address this problem effectively by ensuring the availability of necessary equipment. Therefore, the best action would be to inform the nurse manager of the need for more regulators. While documenting the issue and reporting to the shift supervisor are important, they do not directly address the problem. Forming a task force could be helpful, but it might take more time to implement solutions.

• Question 132:

  A nurse is precepting an experienced critical care nurse who is new to the facility. To develop the orientation plan, which of the following should the preceptor do first?

  A. Determine the knowledge and skills the new nurse needs to learn.
  B. Teach the new nurse about unit routines and practices.
  C. Explain patient care policies and procedures to the new nurse.
  D. Introduce the new nurse to staff and team members on the unit.
  A. Determine the knowledge and skills the new nurse needs to learn.

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  Explanation

  The first step in developing an orientation plan is to assess the new nurse's current knowledge and skills. This helps tailor the orientation to address any gaps and build on existing competencies. Understanding the new nurse's background ensures that the training is efficient and effective, focusing on areas that need improvement rather than repeating familiar information.

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

• Question 133:

  Which of the following is most indicative of successful treatment for salicylate poisoning?

  A. osmotic diuresis
  B. decrease in gastric pH
  C. decrease in CPK
  D. alkalinization of urine
  D. alkalinization of urine

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  Explanation

  

  Salicylate poisoning Alkalinization of urine is one of the main goals of treatment for salicylate poisoning, as it enhances the renal excretion of salicylate and reduces its reabsorption. Alkalinization of urine can be achieved by administering intravenous sodium bicarbonate and maintaining adequate hydration and urine output. Alkalinization of urine can be monitored by measuring the urine pH, which should be above 7.5. Osmotic diuresis, decrease in gastric pH, and decrease in CPK are not indicative of successful treatment for salicylate poisoning. Osmotic diuresis may occur as a result of salicylate toxicity, but it does not improve the elimination of salicylate. Decrease in gastric pH may impair the absorption of salicylate, but it does not affect the elimination of salicylate. Decrease in CPK may reflect the resolution of rhabdomyolysis, which is a possible complication of salicylate poisoning, but it does not reflect the clearance of salicylate.

  References: Salicylate (aspirin) poisoning: Management - UpToDate1, p. 1-2. Salicylate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice US2, p. 4-5.

• Question 134:

  Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include

  A. decreases in PT and thrombin time.
  B. increases in PT, PTT, and FSP (FDP).
  C. increases in platelet count and fibrinogen.
  D. decreases in platelet count, thrombin time, and FSP (FDP).
  B. increases in PT, PTT, and FSP (FDP).

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  Explanation

  Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include increased prothrombin time (PT), partial thromboplastin time (PTT), and fibrin split products (FSP), also known as fibrin degradation products (FDP). These increases indicate widespread clotting and subsequent fibrinolysis, which are characteristic of DIC. The consumption of clotting factors and platelets in DIC leads to prolonged clotting times and elevated levels of fibrin degradation products.

  References: CCRN Exam Handbook, page 42

• Question 135:

  For a patient with unstable angina, the major goal of treatment is to

  A. increase afterload.
  B. decrease myocardial contractility.
  C. increase preload.
  D. decrease myocardial O2 consumption.
  D. decrease myocardial O2 consumption.

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  Explanation

  For a patient with unstable angina, the major goal of treatment is to decrease myocardial oxygen consumption. This can be achieved by reducing heart rate, blood pressure, and myocardial contractility to lessen the workload on the heart and reduce the demand for oxygen. This helps in preventing further ischemia and potential myocardial infarction. Treatment strategies may include the use of medications such as beta-blockers, nitrates, and calcium channel blockers, which all help in decreasing the oxygen demand of the heart.

  References: CCRN Exam Handbook, page 10

• Question 136:

  After consultation with the interdisciplinary team, a nurse implements progressive mobility by having the patient sit at the side of the bed. The patient's HR increases by 10, RR increases by 6, SpO2 remains at 94%, and BP remains stable. The patient states he is tired. Which of the following should be the nurse's next action?

  A. Return the patient to a supine position and notify the physician.
  B. Discontinue the attempts to mobilize the patient.
  C. Progress to sitting in a chair during the next activity.
  D. Wait for assistance from physical therapy to resume mobility.
  A. Return the patient to a supine position and notify the physician.

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  Explanation

  The patient's increased heart rate and respiratory rate, along with the patient's statement of feeling tired, may indicate that the activity was too strenuous123. It's important to ensure patient safety and comfort, so the nurse should return the patient to a supine position123. The physician should be notified about the patient's response to the activity for further evaluation and to adjust the care plan if necessary123.

• Question 137:

  In septic shock, a mixed venous O2 saturation (SO2) of 84% indicates that

  A. O2 delivery to tissues is inadequate due to shunting.
  B. the mixed venous pO2 is low.
  C. venous pO2 and saturation are irrelevant to tissue perfusion.
  D. the tissue cells are being well oxygenated.
  D. the tissue cells are being well oxygenated.

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  Explanation

  A high mixed venous O2 saturation (SO2) indicates that the tissue cells are not extracting enough oxygen from the blood, which can be due to impaired cellular metabolism or increased oxygen delivery. In septic shock, there is often a

  mismatch between oxygen delivery and consumption, resulting in a high SO2 despite tissue hypoxia. Therefore, SO2 alone is not a reliable indicator of tissue perfusion in septic shock.

  References:

  Mixed venous oxygen saturation (SvO2) monitoring ?LITFL °CCC SvO2 to monitor resuscitation of septic patients: let's just understand the basic physiology | Critical Care | Full Text

  Reference Guide for CCRN (Adult), page 14.

• Question 138:

  The most appropriate therapy for carboxyhemoglobinemia is

  A. 100% O2 administration.
  B. inhaled corticosteroids.
  C. hyperventilation.
  D. aerosolized beta-agonists.
  A. 100% O2 administration.

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  Explanation

  The most appropriate therapy for carboxyhemoglobinemia, which is carbon monoxide poisoning, is the administration of 100% oxygen. This treatment helps to displace carbon monoxide from hemoglobin, allowing oxygen to bind to hemoglobin and be transported to tissues more effectively. High-flow oxygen can significantly reduce the half- life of carboxyhemoglobin, facilitating faster recovery.

  References: CCRN Exam Handbook, page 30

• Question 139:

  A patient who survives near-drowning develops hypoxia-induced cerebral edema. Interventions should include

  A. administration of osmotic diuretics.
  B. maintaining a MAP of 60-70 mm Hg.
  C. keeping the patient flat, in a supine position.
  D. hyperventilation to maintain PaCO2 of 40-45 mm Hg.
  A. administration of osmotic diuretics.

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  Explanation

  Hypoxia-induced cerebral edema after a near-drowning incident can be managed by administering osmotic diuretics like mannitol. These medications help reduce intracranial pressure by drawing fluid out of the brain tissue and into the bloodstream, thereby alleviating cerebral edema. Maintaining a MAP of 60-70 mm Hg may not be sufficient to address the elevated intracranial pressure, keeping the patient flat could worsen cerebral edema, and hyperventilation with a PaCO2 of 40-45 mm Hg is not typically recommended for managing increased intracranial pressure as it can lead to vasoconstriction and decreased cerebral perfusion.

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

• Question 140:

  A terminally ill patient is deteriorating. The patient's family states, "We don't want him to suffer any more." The most appropriate response is

  A. "I have given him the medication that was ordered."
  B. "Do you feel he is suffering now?"
  C. "He probably isn't feeling anything right now."
  D. "I will make a referral to the chaplain."
  B. "Do you feel he is suffering now?"

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  Explanation

  This response is the most appropriate because it acknowledges the family's concern, invites them to share their perspective, and opens up a dialogue about the patient's condition and comfort. Communication with patients and families about illness progression and end of life requires sensitivity, empathy, and respect. The nurse should avoid making assumptions, giving false reassurance, or dismissing the family's emotions. Instead, the nurse should explore the family's understanding, expectations, and needs, and provide information and support accordingly12. Answer A is not appropriate because it does not address the family's emotional distress or their perception of the patient's suffering. Answer C is not appropriate because it may contradict the family's observation or belief, and it may imply that the patient is not aware of their presence or care. Answer D is not appropriate because it may seem like the nurse is avoiding the issue or imposing a religious intervention that the family may not want or need.