AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 141:

  A patient has gained 8 kg in the past week. Serum sodium is 115 mEq/L, CVP is 20 mm Hg, and serum osmolality is decreased. The patient has just experienced a generalized tonic-clonic seizure. In this situation, which of the following IV solutions should a nurse be prepared to administer?

  A. 3% sodium chloride
  B. 0.45% sodium chloride
  C. 0.9% sodium chloride
  D. 5% dextrose with 0.25% sodium chloride
  A. 3% sodium chloride

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  Explanation

  The patient has signs of severe hyponatremia, which is a low level of sodium in the blood. Hyponatremia can cause cerebral edema, which can lead to seizures, confusion, coma, and death. The patient needs a hypertonic solution, which is a

  fluid that has a higher concentration of solutes than the blood, to draw water out of the brain cells and restore the normal sodium level. 3% sodium chloride is a hypertonic solution that can be used to treat severe hyponatremia. 0.45% sodium

  chloride, 0.9% sodium chloride, and 5% dextrose with 0.25% sodium chloride are all hypotonic solutions, which are fluids that have a lower concentration of solutes than the blood, and would worsen the patient's condition by adding more

  water to the blood and the brain.

  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: Hyponatremia. 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. 303

  304.

• Question 142:

  A patient is admitted with an acute anterior wall MI. Initial hemodynamic readings are:

  

  The nurse anticipates initiating a plan of care for

  A. pulmonary hypertension.
  B. cardiogenic shock.
  C. volume overload.
  D. right ventricular infarct.
  B. cardiogenic shock.

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  Explanation

  The hemodynamic readings provided (BP 80/60, HR 110, CVP 20 mm Hg, PAOP 26 mm Hg, CO 2.1 L/min, CI 1.3 L/min/m? PAP 42/32 mm Hg, SVR 1762 dynes/sec/cm) suggest cardiogenic shock. This condition is characterized by low cardiac output and index, elevated filling pressures (CVP and PAOP), and systemic vascular resistance. Cardiogenic shock often occurs following an acute anterior wall myocardial infarction (MI) due to extensive damage to the myocardium, leading to impaired contractility and inadequate tissue perfusion.

  References: CCRN Exam Handbook, page 12

• Question 143:

  A consistent prolongation of the P-R interval beyond 0.20 sec indicates which of the following types of AV block?

  A. second-degree, Mobitz Type II
  B. first-degree
  C. second-degree, Mobitz Type I (Wenckebach)
  D. third-degree (complete)
  B. first-degree

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  Explanation

  A consistent prolongation of the P-R interval beyond 0.20 seconds indicates a first-degree atrioventricular (AV) block. This type of block is characterized by a delay in the conduction of electrical impulses through the AV node, resulting in a prolonged P-R interval. However, every P wave is still followed by a QRS complex, distinguishing it from higher-degree AV blocks where some P waves are not followed by QRS complexes.

  References: CCRN Exam Handbook, page 35

• Question 144:

  The nurse is caring for a patient with neutropenia secondary to chemotherapy. When communicating dietary needs to the provider, the nurse should request which of the following to improve the patient's immune function?

  A. low protein diet
  B. total parental nutrition
  C. high carbohydrate diet
  D. nutritional supplements
  D. nutritional supplements

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  Explanation

  Nutritional supplements are beneficial for patients with neutropenia secondary to chemotherapy, as they can help provide adequate calories, protein, vitamins, and minerals that are essential for immune function and tissue repair.

  Chemotherapy can cause side effects such as nausea, vomiting, loss of appetite, taste changes, and mouth sores, which can make it difficult for patients to eat enough food and meet their nutritional needs. Nutritional supplements can be in

  the form of oral drinks, shakes, bars, or powders, or they can be administered through a feeding tube or intravenously. The nurse should request nutritional supplements that are appropriate for the patient's condition, preferences, and

  tolerance, and that are compatible with the neutropenic diet and food safety guidelines. The nurse should also monitor the patient's weight, hydration, and laboratory values, and report any signs of malnutrition, infection, or intolerance to the

  provider.

  References:

  Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families: This article states that "Nutritional supplements are products that can be used to add nutrients to your diet or to lower your risk of health problems.

  They can be in pill, capsule, tablet, or liquid form. They might have vitamins, minerals, amino acids, herbs, or other substances. Some examples of common supplements are calcium, iron, omega-3 fatty acids, vitamin C, and vitamin

  D. You

  might need supplements if you cannot get enough nutrients from foods or if you have certain health conditions that might cause a deficiency, such as cancer, diabetes, or chronic diarrhea."

  Nutrition in Cancer Care (PDQ?璓atient Version: This article states that "Nutritional support is therapy for people who do not get enough nourishment by eating or drinking. You may need nutritional support if you have trouble swallowing, have

  lost your appetite, or are losing weight. Nutritional support can be given in different ways: Enteral nutrition is liquid food given through a tube (called a feeding tube) into the stomach or small intestine. Parenteral nutrition is a liquid mixture of

  nutrients given through a vein (intravenous or IV). Oral nutrition is food or liquid taken by mouth. This includes nutritional supplements, such as drinks, shakes, bars, or powders that have protein, carbohydrates, fat, vitamins, and minerals."

  Nutrition and Cancer: What You Need to Know: This article states that "Nutritional supplements can help you meet your calorie and protein needs when you are not able to eat enough food. They can also provide extra vitamins and minerals.

  There are many types of nutritional supplements, such as drinks, shakes, puddings, bars, and powders. Some are designed for people with cancer and have extra calories and protein. Your doctor, nurse, or dietitian can help you choose the

  best supplement for you. You can buy some supplements at the grocery store or pharmacy, but others may need a prescription."

• Question 145:

  Potentially life-threatening consequences of diabetic ketoacidosis (DKA) include

  A. cellular dehydration.
  B. intracellular hyperglycemia.
  C. metabolic alkalosis.
  D. respiratory alkalosis.
  A. cellular dehydration.

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  Explanation

  

  A bag of food on a hook

  

  Cellular dehydration is one of the potentially life-threatening consequences of diabetic ketoacidosis (DKA), which is a condition that occurs when the body does not have enough insulin to use glucose for energy and starts to break down fat instead. This produces ketones, which are acidic substances that accumulate in the blood and urine. DKA causes hyperglycemia, which is a high level of glucose in the blood, and osmotic diuresis, which is the loss of water and electrolytes through the urine. This leads to cellular dehydration, which is the shrinkage of the cells due to the loss of water from the intracellular fluid. Cellular dehydration can affect the brain and cause neurological symptoms, such as confusion, lethargy, coma, and death12. Other potentially life-threatening consequences of DKA include metabolic acidosis, which is a low pH of the blood due to the excess of ketones, and respiratory compensation, which is the increase of the breathing rate and depth to expel carbon dioxide and lower the acidity of the blood12. These are not the same as metabolic alkalosis or respiratory alkalosis, which are conditions that cause a high pH of the blood due to the loss of acids or the retention of bases2. Intracellular hyperglycemia is not a consequence of DKA, as the glucose cannot enter the cells without insulin and remains in the extracellular fluid12.

• Question 146:

  A patient with cardiogenic shock for several days has been managed aggressively with vasopressor and inotrope therapies. Which of the following indicates organ dysfunction from hypoperfusion?

  A. decreased insulin requirements and abdominal pain
  B. elevated creatinine and fever
  C. abdominal pain and elevated creatinine
  D. fever and decreased insulin requirements
  C. abdominal pain and elevated creatinine

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  Explanation

  In the context of cardiogenic shock managed with vasopressor and inotrope therapies, organ dysfunction from hypoperfusion can manifest as elevated creatinine and abdominal pain. Elevated creatinine indicates renal impairment, a common result of poor perfusion to the kidneys. Abdominal pain can indicate hypoperfusion to the gastrointestinal tract, leading to ischemic bowel or other GI complications. These symptoms are direct indicators of hypoperfusion and organ dysfunction.

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

• Question 147:

  A caloric irrigation test of the oculovestibular reflex is performed on a patient who is comatose following a hypoxic brain injury. When cold water is introduced into the left ear, nystagmus occurs with slow deviation of the eyes toward the left, followed by faster eye deviation to the right. This pattern is indicative of a

  A. persistent vegetative state.
  B. brain-stem infarction.
  C. normal response.
  D. third cranial nerve palsy.
  C. normal response.

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  Explanation

  The caloric irrigation test, also known as the oculovestibular reflex test, is used to assess brainstem function in patients, especially those who are comatose. In this test, cold water is introduced into the ear canal, which should induce a

  predictable response if the brainstem is intact. The normal response to cold water irrigation is nystagmus with slow deviation of the eyes toward the side of the cold water (in this case, the left) and a fast phase of eye movement (nystagmus)

  away from the side of the cold water (to the right). This indicates that the brainstem pathways are functioning properly.

  References: =

  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 148:

  The first priority in management of an acute GI hemorrhage is

  A. monitoring of serial Hgb and Hct.
  B. fluid resuscitation.
  C. pain relief.
  D. Sengstaken-Blakemore tube insertion.
  B. fluid resuscitation.

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  Explanation

  The first priority in the management of an acute gastrointestinal (GI) hemorrhage is fluid resuscitation. This is critical to maintaining hemodynamic stability and ensuring adequate perfusion of vital organs. Monitoring of serial hemoglobin and hematocrit (Hgb and Hct) levels, while important for ongoing assessment, is secondary to the immediate need to stabilize the patient's circulatory status. Pain relief and insertion of a Sengstaken-Blakemore tube may be part of the overall management plan but are not the first priority.

  References: CCRN Exam Handbook, AACN, page 27, section on GI emergencies.

• Question 149:

  Which of the following is a sign of splenic injury and diaphragmatic irritation?

  A. tachypnea
  B. flank pain
  C. left shoulder pain
  D. hiccoughs
  C. left shoulder pain

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  Explanation

  Left shoulder pain, also known as Kehr sign, is a sign of splenic injury and diaphragmatic irritation. It is caused by the irritation of the phrenic nerve, which innervates both the diaphragm and the shoulder, by blood or other fluids in the left

  upper quadrant. Tachypnea, flank pain, and hiccoughs are not specific signs of splenic injury or diaphragmatic irritation.

  References:

  Splenic trauma | Radiology Reference Article | Radiopaedia.org Recognition and management of diaphragmatic injury in adults Reference Guide for CCRN (Adult), page 14.

• Question 150:

  A patient is admitted for sepsis secondary to pneumonia. The patient has received 2000 mL of plasmalyte and their BP remains 80/50. What should the nurse anticipate next for the patient?

  A. dopamine
  B. norepinephrine
  C. 1L of plasmalyte
  D. vasopressin
  B. norepinephrine

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  Explanation