AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 41:

  A patient who underwent bowel resection surgery due to small bowel rupture is tachycardic and hypotensive. A nurse calls the on-call surgical resident and reports the findings. No new orders are received. The nurse should continue to monitor the patient and

  A. notify the charge nurse during nightly rounds.
  B. inform the clinical manager in the morning.
  C. initiate the rapid response team.
  D. consult the nearest nursing colleague.
  C. initiate the rapid response team.

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  Explanation

  The patient's tachycardia and hypotension following bowel resection surgery indicate potential severe complications such as hemorrhage or septic shock, which require immediate intervention. If the on-call surgical resident does not provide new orders, the nurse must act promptly to prevent further deterioration by initiating the rapid response team (RRT). The RRT can provide critical interventions and facilitate timely transfer to a higher level of care if needed.

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

• Question 42:

  An unconscious patient in hepatic failure secondary to alcoholism becomes acutely hypoglycemic. Glucagon administration is contraindicated for this patient because glucagon

  A. interferes with lactulose (Cephulac) therapy.
  B. produces additional sedative effects.
  C. is ineffective when hepatocytes are damaged.
  D. causes rebound hyperglycemia.
  C. is ineffective when hepatocytes are damaged.

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  Explanation

  Glucagon is a hormone that stimulates the liver to release glucose from glycogen stores or from gluconeogenesis. However, when the hepatocytes are damaged by alcoholism or other causes of hepatic failure, glucagon is ineffective because the liver cannot respond to its signal. Glucagon administration is contraindicated for hypoglycemic patients with hepatic failure because it will not raise their blood glucose levels and may worsen their acidosis and electrolyte imbalance123

  References: Hypoglycemia in Patients With Hepatic Failure - PubMed Glucagon - Wikipedia Frontiers | Glucagon Receptor Signaling and Lipid Metabolism

• Question 43:

  A patient is intubated and receiving assist control mechanical ventilation and is on a norepinephrine drip following a head injury. Patient data are:

  

  Which of the following interventions will improve cerebral perfusion?

  A. increasing the norepinephrine rate
  B. administering prescribed acetaminophen
  C. requesting an ABG
  D. suctioning the airway
  B. administering prescribed acetaminophen

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  Explanation

• Question 44:

  A unit council is requesting to change a documentation screen of the electronic health record (EHR) at a large health system. The change was not discussed with the department prior to the request and was denied by the EHR committee. Which of the following strategies will most likely lead to accomplishing the team's goals?

  A. Have nursing leadership evaluate the proposal before resubmitting the request.
  B. Discuss the proposed solution with stakeholders to determine buy in.
  C. Work with key staff members to rewrite the request to present at the next meeting.
  D. Attempt to change the process through another format.
  B. Discuss the proposed solution with stakeholders to determine buy in.

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  Explanation

  When seeking to make changes to a documentation screen in the electronic health record (EHR), it is crucial to involve all relevant stakeholders to ensure their buy-in and support. This includes discussing the proposed changes with those who will be directly impacted by it and obtaining their feedback. This collaborative approach can help in identifying potential issues and garnering the necessary support for the proposal, increasing the likelihood of it being accepted by the EHR committee in the future.

  References: CCRN Exam Handbook, page 58

• Question 45:

  A patient is admitted with anaphylactic shock secondary to a blood transfusion. The patient's spouse asks the nurse to explain how blood can cause a low blood pressure. The nurse responds that with anaphylactic shock the

  A. heart muscle weakens and is unable to pump effectively.
  B. peripheral blood vessels dilate, and this creates a maldistribution of volume.
  C. kidneys excrete large amounts of urine dropping the blood pressure.
  D. autonomic nervous system is disrupted dropping blood pressure.
  B. peripheral blood vessels dilate, and this creates a maldistribution of volume.

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  Explanation

  Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock.

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

• Question 46:

  An experienced nurse new to a unit believes the literature does not support current unit practice of a fixed-dose nitroglycerin IV (Tridil) infusion in all postoperative cardiac surgery patients for 24 hours. The nurse develops a proposal referencing peer-reviewed articles. Based on the proposal, unit leaders agree to remove the nitroglycerin IV (Tridil) infusion from the standard order set. The actions taken by the nurse are best described as

  A. collaboration with a team.
  B. a clinical research study.
  C. a performance improvement project.
  D. evidence-based practice.
  D. evidence-based practice.

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  Explanation

  The actions taken by the nurse are best described as evidence-based practice. By reviewing the literature and developing a proposal referencing peer-reviewed articles, the nurse used current research findings to inform and change clinical practice. This approach ensures that patient care is based on the best available evidence, leading to improved patient outcomes.

  References: CCRN Exam Handbook, page 59

• Question 47:

  The family of a patient requests permission to administer traditional herbs to the patient. Which of the following should be the nurse's first action?

  A. Inform the family that herbal therapy is not appropriate in the hospital.
  B. Consult with the pharmacist on the effects of the specific herbs.
  C. Allow the patient to take the herbs because they are natural.
  D. Obtain an order for the herbs.
  B. Consult with the pharmacist on the effects of the specific herbs.

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  Explanation

  Verified Answer:

  B. Consult with the pharmacist on the effects of the specific herbs. Herbal therapy is a type of complementary and alternative medicine (CAM) that uses plants or plant extracts to treat various health conditions. Many patients use herbal therapy for various reasons, such as cultural beliefs, personal preferences, or dissatisfaction with conventional medicine. However, herbal therapy is not without risks and challenges, especially in the hospital setting. Some of the potential problems include lack of standardization, quality control, and regulation of herbal products; adverse effects and interactions with other medications; and ethical and legal issues regarding informed consent, documentation, and liability12. Therefore, the nurse's first action should be to consult with the pharmacist on the effects of the specific herbs that the family wants to administer to the patient. The pharmacist can provide information on the safety, efficacy, dosage, and compatibility of the herbs with the patient's condition and current medications. The nurse should also inform the patient's primary provider and obtain an order for the herbs before allowing the patient to take them. The nurse should document the use of herbal therapy in the patient's medical record and monitor the patient for any adverse effects or changes in response to other treatments. Informing the family that herbal therapy is not appropriate in the hospital is not respectful of the patient's autonomy and cultural values. Allowing the patient to take the herbs without consulting the pharmacist and obtaining an order is not safe and may violate the hospital's policies and standards of care.

• Question 48:

  A nurse is providing care to a patient diagnosed with abdominal compartment syndrome. The nurse should recognize the patient is most at risk for developing

  A. increased urine output.
  B. increased preload.
  C. increased peak inspiratory pressure.
  D. decreased intracranial pressure.
  C. increased peak inspiratory pressure.

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  Explanation

  Abdominal compartment syndrome (ACS) involves increased intra- abdominal pressure, which can significantly impact various body systems. One of the major concerns is its effect on respiratory function, leading to increased peak inspiratory pressure. This happens because the elevated pressure in the abdomen can push up against the diaphragm, making it harder for the lungs to expand during inhalation. Increased urine output is unlikely as ACS usually leads to decreased renal perfusion and output. Increased preload and decreased intracranial pressure are not typically associated with ACS.

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

• Question 49:

  Which of the following is a late finding in hypovolemic shock?

  A. tachycardia
  B. UO greater than 30 mL/hr
  C. cool, dry skin
  D. hypotension
  D. hypotension

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  Explanation

  

  Hypovolemic shock Hypotension, or low blood pressure, is a late finding in hypovolemic shock, which means that it occurs when the condition has progressed to a severe stage. Hypotension indicates that the body's compensatory mechanisms, such as vasoconstriction, tachycardia, and increased cardiac output, have failed to maintain adequate perfusion and oxygen delivery to the vital organs. Hypotension is a sign of impending circulatory collapse and organ failure, and requires immediate intervention to restore blood volume and blood pressure. Hypotension is usually defined as a systolic blood pressure below 90 mmHg or a mean arterial pressure below 65 mmHg1.

  References: Hypovolemic Shock: Causes, Symptoms and Treatment - Cleveland Clinic: This article states that "As you keep losing blood or fluids, your systolic (top or first number) blood pressure comes down." and "Your blood pressure drops very low and your heart rate and breathing get faster."

• Question 50:

  An oncology patient presents with hematuria and bleeding from previous injection sites. Which diagnostic test result should the nurse review first?

  A. complete blood count
  B. arterial blood gas
  C. complete metabolic panel
  D. coagulation panel
  D. coagulation panel

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  Explanation

  For an oncology patient presenting with hematuria and bleeding from injection sites, reviewing the coagulation panel first is crucial. This test will provide information on the patient's clotting status, helping to identify potential coagulopathies such as disseminated intravascular coagulation (DIC), which is common in cancer patients.

  References: AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 112

  115.