AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 61:

  An older adult patient reports an inability to sleep due to staff waking the patient for frequent neurological assessments. In order to minimize sleep disruptions, the nurse should

  A. encourage the patient to sleep between assessments.
  B. discontinue neurologic assessments.
  C. establish a schedule with the provider.
  D. move the patient to the quieter part of the unit.
  C. establish a schedule with the provider.

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  Explanation

  Verified Answer:

  C. establish a schedule with the provider. Neurological assessments are important for monitoring the patient's neurological status and detecting any changes that may indicate a complication or improvement. However, frequent interruptions of sleep can have negative effects on the patient's health and well-being, such as impaired cognition, mood, immune function, and wound healing. Therefore, the nurse should collaborate with the provider to establish a schedule for neurologic assessments that balances the need for monitoring and the need for rest. This may involve reducing the frequency of assessments during the night, clustering other interventions to minimize disruptions, and using noninvasive methods of assessment when possible. Discontinuing neurologic assessments, encouraging the patient to sleep between assessments, or moving the patient to a quieter part of the unit are not appropriate actions as they do not address the root cause of the problem or ensure adequate monitoring of the patient's condition.

• Question 62:

  Pulsus paradoxus is defined as

  A. a decrease in systolic BP of greater than 10 mm Hg during normal expiration.
  B. a decrease in systolic BP of greater than 10 mm Hg during normal inspiration.
  C. a decrease in diastolic BP of greater than 10 mm Hg during normal expiration.
  D. an increase in systolic BP of greater than 10 mm Hg during normal inspiration.
  B. a decrease in systolic BP of greater than 10 mm Hg during normal inspiration.

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  Explanation

  Pulsus paradoxus is defined as a decrease in systolic blood pressure (BP) of more than 10 mm Hg during normal inspiration. This phenomenon occurs due to the increased negative intrathoracic pressure during inspiration, which exaggerates the normal drop in systolic BP. It is often seen in conditions such as cardiac tamponade, constrictive pericarditis, and severe asthma or COPD exacerbations.

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

• Question 63:

  A nurse is caring for a patient who had a gastric bypass procedure 2 days ago. A physician has ordered a gastric tube to be placed due to increased abdominal distention. The nurse realizes that this procedure will most likely need to be done

  A. under fluoroscopy.
  B. by two nurses.
  C. using ultrasound.
  D. with a guide wire.
  A. under fluoroscopy.

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  Explanation

  After gastric bypass surgery, the altered anatomy of the gastrointestinal tract makes it challenging to place a gastric tube. Performing the procedure under fluoroscopy provides real-time imaging guidance, ensuring correct placement and reducing the risk of complications, such as perforation or misplacement.

  References: CCRN Exam Handbook, page 45

• Question 64:

  For a patient who sustained blunt renal trauma and a crush injury to the leg, monitoring should include observing for

  A. a shortened PR interval.
  B. tall peaked T waves.
  C. ST segment depression.
  D. a prolonged PR interval.
  B. tall peaked T waves.

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  Explanation

  Crush injuries can lead to significant muscle damage and rhabdomyolysis, resulting in the release of intracellular potassium into the bloodstream, causing hyperkalemia. Tall peaked T waves are a classic sign of hyperkalemia, which needs to be closely monitored in these patients.

  References: CCRN Exam Handbook and AACN's Certification Review Course materials.

• Question 65:

  The purpose of administering a sodium nitroprusside (Nipride) drip after a carotid endarterectomy is to

  A. promote myocardial contractility and thus enhance cerebral perfusion.
  B. increase coronary perfusion and thus increase cardiac output.
  C. decrease MAP and thus prevent hemorrhage at the operative site.
  D. increase afterload and thus promote vessel patency.
  C. decrease MAP and thus prevent hemorrhage at the operative site.

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  Explanation

  Sodium nitroprusside (Nipride) is administered after a carotid endarterectomy to decrease mean arterial pressure (MAP) and reduce the risk of hemorrhage at the surgical site. By lowering the blood pressure, it minimizes the chance of bleeding while ensuring adequate cerebral perfusion through careful monitoring.

  References: AACN Handbook for CCRN Certification, pp. 75-78.

• Question 66:

  A patient underwent a successful percutaneous coronary intervention to the left anterior descending coronary artery. The patient suddenly begins to complain of dyspnea, jaw pain, and chest tightness. The bedside monitor displays sinus tachycardia and ST segment elevation in lead V2. The patient's neck veins are flat and BP is 152/98. Which of the following is the most likely cause of the patient's symptoms?

  A. pulmonary hypertension
  B. coronary artery occlusion
  C. vasovagal reaction
  D. cardiac tamponade
  B. coronary artery occlusion

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  Explanation

  The patient presents with dyspnea, jaw pain, chest tightness, and sinus tachycardia with ST segment elevation in lead V2 after a percutaneous coronary intervention (PCI). These symptoms are indicative of myocardial ischemia or infarction, likely due to a re-occlusion of the treated coronary artery. Coronary artery occlusion is a common cause of these acute symptoms post-PCI. Other options like pulmonary hypertension, vasovagal reaction, and cardiac tamponade are less consistent with the clinical presentation.

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

• Question 67:

  Examination of a patient exhibiting Kernig's and Brudzinski's signs indicates which of the following?

  A. autonomic hyperreflexia
  B. adrenal insufficiency
  C. meningeal irritation
  D. increased intracranial pressure
  C. meningeal irritation

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  Explanation

  Kernig's and Brudzinski's signs are classic clinical indicators of meningeal irritation, commonly associated with conditions such as meningitis. Kernig's sign is positive when there is resistance and pain upon extending the knee from a flexed position, and Brudzinski's sign is positive when flexion of the neck causes involuntary flexion of the hips and knees. These signs are not indicative of autonomic hyperreflexia, adrenal insufficiency, or increased intracranial pressure.

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

• Question 68:

  The water retention associated with SIADH is characterized by

  A. fluid intake greater than UO, weight gain, and increased urine osmolality and sodium.
  B. UO greater than fluid intake, extreme weight gain, and mild (2+) pitting edema.
  C. UO greater than fluid intake and severe (4+) pitting edema.
  D. fluid intake greater than UO, increased serum osmolality and sodium, and severe (4+) pitting edema.
  A. fluid intake greater than UO, weight gain, and increased urine osmolality and sodium.

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  Explanation

  The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone (ADH), leading to water retention. This results in fluid intake being greater than urine output (UO), weight gain due to fluid retention, and concentrated urine with increased osmolality and sodium levels. SIADH does not typically present with severe pitting edema or increased serum osmolality and sodium.

  References: CCRN (Adult) Certification Review Course Online: Endocrine Emergencies. 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 69:

  A patient has been declared brain dead. A nurse would like the family to consider organ donation but has never requested this from a family before. The best initial action by the nurse is to

  A. consult the organ donation liaison.
  B. directly ask the patient's family members if they would consider organ donation.
  C. find out if the patient has an organ donor card.
  D. request that the physician discuss the issue with the family.
  A. consult the organ donation liaison.

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  Explanation

  When a patient has been declared brain dead, the appropriate initial action for a nurse who has not previously discussed organ donation with a family is to consult the organ donation liaison. These professionals are trained to handle sensitive

  conversations about organ donation and can provide the necessary support and information to the family, ensuring that the process is handled respectfully and in accordance with legal and ethical guidelines.

  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 70:

  A patient underwent bariatric surgery for weight loss 3 days ago. The patient appears anxious, restless, and reports increased abdominal pain over the last 24 hours. The nurse palpates mild subcutaneous crepitus over the neck. Vital signs are: BP 106/64

  HR 128

  RR 27

  T 100.4°F (38°C)

  Which action should the nurse anticipate?

  A. Obtain labs.
  B. Administer a 1000 mL bolus of normal saline.
  C. Provide broad spectrum antibiotics.
  D. Prepare the patient for surgery.
  D. Prepare the patient for surgery.

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  Explanation

  The signs and symptoms described in the patient post-bariatric surgery, including anxiety, restlessness, increased abdominal pain, and subcutaneous crepitus over the neck, suggest a potential anastomotic leak, which is a surgical emergency. Given the vital signs indicating possible sepsis or shock (elevated heart rate, increased respiratory rate, and fever), immediate surgical intervention is likely required to repair the leak and prevent further complications.

  References: CCRN Exam Handbook, AACN, page 30, section on GI surgical emergencies.