AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 71:

  Which of the following are most indicative of acute pancreatitis?

  A. abdominal distention, decreased lipase level, hypertension
  B. Grey Turner's sign, hyperkalemia, right shoulder pain
  C. hypotension, jaundice, hyperalbuminuria
  D. severe mid-epigastric pain, leukocytosis, hypocalcemia
  D. severe mid-epigastric pain, leukocytosis, hypocalcemia

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  Explanation

  Acute pancreatitis is most commonly indicated by severe mid-epigastric pain, which often radiates to the back, leukocytosis (an elevated white blood cell count indicating inflammation), and hypocalcemia (low calcium levels in the blood). The inflammation of the pancreas leads to the release of digestive enzymes and inflammatory mediators that can cause widespread effects, including alterations in calcium metabolism.

  References: CCRN Exam Handbook, page 47

• Question 72:

  The underlying pathophysiology of disseminated intravascular coagulation (DIC) is best explained as

  A. depression of platelet aggregation.
  B. inactivation of tissue thromboplastin.
  C. depletion of clotting factors.
  D. fragmentation of erythrocytes.
  C. depletion of clotting factors.

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  Explanation

  Disseminated intravascular coagulation (DIC) is a condition where blood clots form excessively and block blood vessels, leading to organ damage and bleeding. The pathophysiology of DIC involves excess and unregulated thrombin generation, which consumes coagulation factors and platelets, and activates fibrinolysis1. Thus, in severe DIC there is paradoxically simultaneous thrombosis and spontaneous bleeding2. This is due to the depletion of clotting factors, which is a key aspect of the underlying pathophysiology of DIC12.

• Question 73:

  A patient with hypertension received tPA for an acute embolic stroke with complete resolution of symptoms. Twenty-four hours after tPA administration, the nurse should anticipate an order for

  A. diuretics.
  B. beta blockers.
  C. antiplatelet agents.
  D. calcium channel blockers.
  C. antiplatelet agents.

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  Explanation

• Question 74:

  A patient develops the dysrhythmia shown below:

  

  Blood pressure is 83/40. The patient is pale, diaphoretic, lethargic, and disoriented. The most appropriate treatment is

  A. defibrillation at 200 J.
  B. adenosine (Adenocard), 6 mg rapid IV bolus.
  C. lidocaine (Xylocaine), 1.5 mg/kg IV.
  D. cardioversion at 100 J.
  D. cardioversion at 100 J.

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  Explanation

  The dysrhythmia shown in the image is likely a rapid ventricular tachycardia (VT), given the hemodynamic instability (BP 83/40, patient pale, diaphoretic, lethargic, and disoriented). Synchronized cardioversion at 100 joules is the appropriate treatment for unstable VT, as it can effectively terminate the arrhythmia and restore normal sinus rhythm, addressing both the dysrhythmia and the patient's symptoms.

  References: CCRN Exam Handbook, page 33

• Question 75:

  A family member asks permission to visit a patient after work at 12:30 AM. On previous visits, the family member has been disruptive. To address the situation, a nurse should

  A. ask the family member to visit during scheduled visiting hours.
  B. ask the family member to visit before work.
  C. not allow the visit, as the patient will be sleeping.
  D. allow the family member to visit after setting behavioral limits.
  D. allow the family member to visit after setting behavioral limits.

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  Explanation

  While it is important to support family involvement, previous disruptive behavior necessitates setting clear behavioral limits to ensure a safe and therapeutic environment for the patient. Allowing the visit with established guidelines helps balance the need for patient support with maintaining unit order. This approach also respects the patient's rest and recovery needs.

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

• Question 76:

  In a patient with hypertensive crisis, neurologic changes are caused by

  A. excessive secretion of catecholamines.
  B. vasospasm of the cerebral arterioles.
  C. hypoxemia as a result of pulmonary interstitial edema.
  D. increased ICP as a result of loss of cerebral autoregulation.
  D. increased ICP as a result of loss of cerebral autoregulation.

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  Explanation

  In hypertensive crisis, neurologic changes are often caused by increased intracranial pressure (ICP) as a result of loss of cerebral autoregulation. Autoregulation normally maintains consistent cerebral blood flow despite changes in systemic blood pressure. In hypertensive crisis, the extremely high blood pressure overwhelms these mechanisms, leading to increased cerebral blood flow, disruption of the blood-brain barrier, and cerebral edema, which subsequently increases ICP and causes neurologic changes.

  References: CCRN Exam Handbook, page 48

• Question 77:

  A nurse has responded to a rapid response call on a medical-surgical floor in the hospital. The nurse finds the patient with the following data:

  BP72/30

  HR132

  RR24

  T102.3°F (39.0°C)

  SpO295%

  Ph7.13

  PaCO234 mm Hg

  PaO288 mm Hg

  HCO3 14 mEq/L

  Na+ 142 mEq/L

  The nurse should anticipate an order to administer which of the following?

  A. 8.4% sodium bicarbonate
  B. phenylephrine (Neo-Synephrine)
  C. 0.9% sodium chloride
  D. amiodarone (Cordarone)
  B. phenylephrine (Neo-Synephrine)

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  Explanation

  The patient's data indicate that the patient is in shock, which is a life- threatening condition characterized by inadequate tissue perfusion and organ dysfunction. The patient has a low blood pressure, a high heart rate, a fever, and a metabolic acidosis, which suggest that the patient may have septic shock, which is caused by a severe infection that triggers a systemic inflammatory response. The nurse should anticipate an order to administer phenylephrine (Neo-Synephrine), which is a vasopressor agent that constricts the blood vessels and increases the blood pressure and tissue perfusion. Phenylephrine is recommended as a first-line agent for septic shock by the Surviving Sepsis Campaign guidelines1. 8.4% sodium bicarbonate is not indicated for the treatment of septic shock, as it may worsen the acid-base balance and increase the risk of complications2. 0.9% sodium chloride is a normal saline solution that may be used for fluid resuscitation, but it may not be sufficient to restore the blood pressure and may cause fluid overload, hyperchloremia, and kidney injury3. Amiodarone (Cordarone) is an antiarrhythmic drug that is used to treat ventricular tachycardia or fibrillation, but it is not effective for septic shock and may cause hypotension, bradycardia, and other adverse effects4.

  References: Surviving Sepsis Campaign. (2020). Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID19). Retrieved from 1, p. 16. Marik, P. E., and Bellomo, R. (2013). A rational approach to fluid therapy in sepsis. British Journal of Anaesthesia, 110(3), 323-329. Retrieved from 2, p. 327. Semler, M. W., and Rice, T. W. (2019). Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials, 20(1), 1-10. Retrieved from 3, p. 2-3. Lexicomp Online. (2021). Amiodarone. Retrieved from 4, p. 1-2.

• Question 78:

  The spouse of a critically ill patient is indecisive, withdrawn, and tells the nurse, "I feel so helpless." Appropriate nursing interventions include

  A. offering solutions to problems identified by the spouse.
  B. encouraging other family members to make necessary decisions.
  C. providing reassurance that visiting is not always necessary.
  D. identifying and reinforcing the spouse's support systems.
  D. identifying and reinforcing the spouse's support systems.

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  Explanation

  When dealing with a spouse who feels helpless, the most effective nursing intervention is to identify and reinforce their support systems. This helps the spouse feel less isolated and more empowered. Offering solutions to problems, encouraging other family members to make decisions, or providing reassurance that visiting is not necessary do not directly address the spouse's feelings of helplessness and may even contribute to feelings of exclusion or inadequacy.

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

• Question 79:

  A patient post-surgical externalized ventricular drain placement has treatment orders that include continuous cerebrospinal fluid (CSF) drainage at 10 mm

  Hg. Which of the following should the nurse anticipate with an increase in the ICP above 25 mm Hg?

  A. a decrease in the pulse pressure
  B. a change in CSF drainage from clear to pink
  C. the amplitude of P2 greater than P1 on the waveform morphology
  D. an increase in the cerebral perfusion pressure from 65 to 70
  C. the amplitude of P2 greater than P1 on the waveform morphology

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  Explanation

  An increase in intracranial pressure (ICP) above 25 mm Hg often results in changes in the waveform morphology observed in the monitoring of intracranial pressure. Specifically, the amplitude of P2 becomes greater than P1, which is indicative of decreased intracranial compliance. This pattern is known as the "pathological waveform," suggesting increased intracranial pressure and decreased ability of the brain to accommodate the pressure changes.

  References: CCRN Exam Handbook, AACN, page 23, section on Neurological.

• Question 80:

  When caring for a patient with septic shock secondary to osteomyelitis, which of the following laboratory tests will best monitor response to therapy?

  A. basic metabolic panel
  B. complete blood count
  C. erythrocyte sedimentation rate
  D. blood cultures
  D. blood cultures

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  Explanation

  Blood cultures are the most definitive method to diagnose sepsis and monitor the response to therapy2. They can identify the causative organism and help guide antibiotic therapy2. In the case of osteomyelitis leading to septic shock, blood cultures can help confirm the presence of an ongoing systemic infection1. Other tests like the basic metabolic panel, complete blood count, and erythrocyte sedimentation rate can provide supportive information, but they are not as specific or definitive for monitoring response to therapy in septic shock secondary to osteomyelitis123.