AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 51:

  A patient with type 1 diabetes admitted for DKA for the third time in 6 months reports not following the medication plan prescribed by the endocrinologist.

  Which of the following strategies should a nurse use first?

  A. Discuss ability to pay for medications and supplies.
  B. Provide low-literacy materials for diabetic education.
  C. Assure scheduled follow-up medical visits prior to discharge.
  D. Consult the diabetes nurse educator.
  A. Discuss ability to pay for medications and supplies.

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  Explanation

  For a patient with type 1 diabetes admitted for diabetic ketoacidosis (DKA) who reports not following the prescribed medication plan, assessing the patient's ability to afford medications and supplies is crucial. Financial barriers are a common reason for non- adherence to treatment plans. Addressing these barriers can help the healthcare team provide the necessary resources or support to ensure the patient can follow the prescribed regimen, potentially preventing future hospitalizations.

  References: CCRN (Adult) Certification Review Course Online: Behavioral/Psychosocial. 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 52:

  Following a splenectomy, a patient is most at risk for

  A. sepsis.
  B. pulmonary embolism.
  C. hypertension.
  D. wound dehiscence.
  A. sepsis.

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  Explanation

  The spleen plays a crucial role in filtering bacteria and old or damaged blood cells, as well as mounting an immune response. After a splenectomy, the patient is at increased risk for infections, particularly from encapsulated organisms like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. This heightened susceptibility to infection can lead to sepsis, a life-threatening condition.

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

• Question 53:

  An older adult patient has been in the unit for 60 hours. The patient has received benzodiazepines for agitation, opioids for persistent pain, and bronchodilators. The patient reports that there is too much noise, and they cannot get peace and quiet. The nurse should evaluate for

  A. sleep disturbances.
  B. an anxiety disorder.
  C. situational depression.
  D. acute manic episodes.
  A. sleep disturbances.

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  Explanation

  The patient who has been in the unit for 60 hours and reports agitation, noise disturbances, and an inability to get peace and quiet may be experiencing sleep disturbances. Factors such as the ICU environment, frequent interventions, and the medications being administered (e.g., benzodiazepines, opioids, and bronchodilators) can significantly disrupt sleep patterns, leading to further agitation and delirium. Addressing the patient's sleep hygiene and implementing measures to promote rest can be beneficial.

  References: CCRN Exam Handbook, page 52

• Question 54:

  A patient with a spinal cord injury at T7 tells the nurse that they now have a pounding headache. The nurse should

  A. check for bladder distension.
  B. administer PRN acetaminophen.
  C. place the patient in supine position.
  D. perform a stroke assessment.
  A. check for bladder distension.

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  Explanation

  

  Spinal cord injury

  

  An x-ray of a spine A sudden and severe headache in a patient with a spinal cord injury at T7 could be a symptom of autonomic dysreflexia12. This condition is a potentially life-threatening medical emergency that can occur in individuals with spinal cord injuries above the T6 level12. It is most commonly triggered by an overfull bladder or a blocked catheter12. Therefore, the nurse should first check for bladder distension123.

• Question 55:

  A patient with a sodium level of 114 mEq/L is most likely to develop

  A. tetany.
  B. flaccid paralysis.
  C. seizures.
  D. cardiac arrhythmias.
  C. seizures.

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  Explanation

  

  Hyponatremia

  

  A pink squares with black text

  A patient with a sodium level of 114 mEq/L is most likely to develop seizures, which are a manifestation of severe hyponatremia and cerebral edema. Hyponatremia is a low level of sodium in the blood, which can cause water to move into the

  brain cells and cause them to swell. This can lead to increased intracranial pressure, neurological dysfunction, and seizures. Seizures are a medical emergency and require prompt treatment to prevent brain damage or death. Tetany, flaccid

  paralysis, and cardiac arrhythmias are not typical signs of hyponatremia, but may occur in other electrolyte disorders, such as hypocalcemia, hyperkalemia, or hypokalemia.

  References:

  Overview of the treatment of hyponatremia in adults - UpToDate1, p. 1-2. Manifestations of hyponatremia and hypernatremia in adults - UpToDate2, p. 1-2.

• Question 56:

  A patient is admitted with Gl bleeding. During the assessment, the nurse notes the patient to be tremulous, anxious, and startles every time he is touched by the nurse. Which of the following is the most pertinent part of the patient's history to obtain?

  A. last alcohol intake
  B. medication history
  C. time of last meal
  D. psychiatric history
  A. last alcohol intake

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  Explanation

  

  Alcohol withdrawal syndrome

  

  Explore Answer: A The patient's symptoms of tremulousness, anxiety, and startle response suggest that he may be experiencing alcohol withdrawal, which can occur within hours to days after the last drink. Alcohol withdrawal can cause severe complications, such as seizures, delirium tremens, and death, if not treated promptly and appropriately. Alcohol withdrawal can also worsen GI bleeding by increasing gastric acid secretion, impairing clotting factors, and causing hypertension and

  tachycardia. Therefore, the most pertinent part of the patient's history to obtain is the last alcohol intake, which can help determine the risk and severity of withdrawal and guide the management of the patient.

  References:

  Management of moderate and severe alcohol withdrawal syndromes: This article states that "Symptoms of alcohol withdrawal occur because alcohol is a central nervous system depressant. When a person drinks frequently, the brain

  compensates for alcohol's depressant effects by increasing the activity of excitatory neurotransmitters, such as norepinephrine, serotonin, dopamine, and glutamate, and reducing the activity of inhibitory neurotransmitters, such as gammaaminobutyric acid (GABA). When alcohol intake is abruptly discontinued or reduced, this neuroadaptation is unmasked, resulting in a hyperexcitable state that is responsible for the characteristic withdrawal symptoms." Alcoholic Gastritis:

  Causes, Symptoms and Treatment: This article states that "Alcohol Gastritis is a type of acute gastritis and is caused by excessive alcohol consumption. The sudden inflammation of the stomach lining can be very painful and cause severe

  stomach cramping, irritability and vomiting. While consuming too much alcohol is the main cause of Alcohol Gastritis, it often develops in connection with some sort of infection, direct irritation or localized tissue damage. It can be caused by:

  Taking non-steroidal, anti-inflammatory medications like aspirin or ibuprofen (i.e., NSAIDs). Certain bacterial infections. Bile reflux from proximal small intestine. Autoimmune disorders."

  Can You Get Internal Bleeding from Alcohol Abuse: This article states that "Over time, alcohol abuse starts to eat away at the stomach lining. Continued drinking sets the stage for alcoholic gastritis to develop. Under these conditions, internal

  bleeding from alcohol abuse takes the form of blood oozing from stomach lines on an ongoing basis."

• Question 57:

  Which of the following is a sign of brain death?

  A. positive vestibulo-ocular reflex
  B. negative apnea test
  C. positive cough reflex
  D. negative cold caloric test
  B. negative apnea test

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  Explanation

  A negative apnea test means that the patient does not breathe spontaneously when disconnected from the ventilator and exposed to a high level of carbon dioxide, which normally stimulates breathing. A negative apnea test is one of the

  criteria for brain death, as it indicates the loss of brainstem function. A positive vestibulo- ocular reflex, also known as the oculocephalic or doll's eye reflex, means that the eyes move in the opposite direction of the head when the head is

  turned. A positive cough reflex means that the patient coughs when the trachea is stimulated. A negative cold caloric test means that the eyes do not move when cold water is injected into the ear canal. All these tests assess the integrity of

  the brainstem, and a positive result would exclude brain death.

  Therefore, the correct answer is

  B.

  References:

  Diagnosis of brain death - UpToDate, under "Apnea testing". Brain Death | Critical Care Medicine | JAMA | JAMA Network, under "How Is Brain Death Diagnosed?".

  The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by ..., under "Apnea Testing".

• Question 58:

  A patient with a history of six cardiac catheterizations relates that he has received differing instructions about the duration of required bedrest after the procedure. To further investigate this issue, which of the following is a nurse's most appropriate action?

  A. Ask about obtaining an independent evaluation of unit outcomes.
  B. Conduct an informal chart review and outcome evaluation of patients treated with different bedrest protocols.
  C. Review recent published research about bedrest protocols.
  D. Ask the nursing supervisor to request standardized physician orders for patients who have undergone catheterization.
  C. Review recent published research about bedrest protocols.

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  Explanation

  The nurse's most appropriate action is to review recent published research about bedrest protocols, as this would provide the nurse with the most current and reliable evidence to guide clinical practice and improve patient outcomes. Bedrest protocols after cardiac catheterization may vary depending on the type of access site, the use of closure devices, the patient's risk factors, and the clinician's preference. However, there is a growing body of research that supports early ambulation and shorter bedrest duration to reduce the risk of complications, such as bleeding, hematoma, back pain, and venous thromboembolism, and to enhance patient comfort and satisfaction123. Asking about obtaining an independent evaluation of unit outcomes, conducting an informal chart review and outcome evaluation of patients treated with different bedrest protocols, or asking the nursing supervisor to request standardized physician orders for patients who have undergone catheterization are not the most appropriate actions, as they may not reflect the best available evidence, may be biased or incomplete, or may not address the patient's concern.

  References:

  1: Bedrest After Cardiac Catheterization: A Systematic Review and Meta- analysis4, p. 1-2. 2: Early Ambulation After Cardiac Catheterization: A Literature Review, p. 1-2. 3: Bed Rest After Cardiac Catheterization: A Review of the Evidence, p. 1-2.

• Question 59:

  A patient with a hemorrhaging renal laceration has received two units of PRBCs and 500 mL of NS via IV bolus. Assessment reveals: BP 78/42; HR 148; UO 15 mL/hr; skin is cool and diaphoretic. While preparing the patient for emergency surgery, a nurse should administer

  A. norepinephrine (Levophed), 10 mcg/min.
  B. an additional 500-mL bolus of NS.
  C. mannitol (Osmitrol), 25 g IV.
  D. dopamine (Intropin), 3 mcg/kg/min.
  A. norepinephrine (Levophed), 10 mcg/min.

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  Explanation

  In a patient with a hemorrhaging renal laceration who remains hypotensive despite fluid resuscitation with two units of PRBCs and 500 mL of NS, administering norepinephrine (Levophed) is appropriate. Norepinephrine is a potent vasopressor that helps to increase blood pressure by vasoconstriction and improving cardiac output, which is critical in stabilizing a patient with severe hemorrhagic shock prior to surgery.

  References: = CCRN Exam Handbook, page 38

• Question 60:

  Which of the following is most often associated with damage to the alveolar capillary membrane secondary to aspiration?

  A. reabsorption atelectasis
  B. lung cavitation
  C. bronchopleural fistulas
  D. noncardiogenic pulmonary edema
  D. noncardiogenic pulmonary edema

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  Explanation

  Noncardiogenic pulmonary edema is most often associated with damage to the alveolar capillary membrane secondary to aspiration. This condition occurs when there is increased permeability of the alveolar-capillary barrier, leading to fluid leakage into the alveoli. It is a hallmark of Acute Respiratory Distress Syndrome (ARDS), which can be triggered by aspiration, resulting in inflammatory damage to the lungs.

  References: CCRN Exam Handbook, page 29