AACN CCRN-ADULT Online Practice Questions and Exam Preparation

AACN CCRN-ADULT Online Questions & Answers

• Question 81:

  A patient who sustained acute head trauma exhibited intermittent unconsciousness prior to admission. The patient is disoriented initially and exhibits rapid deterioration in neurological status shortly after admission. X-rays reveal a right temporal bone fracture, and a diagnosis of epidural hematoma is made. The deterioration in the patient's condition is most likely associated with

  A. arterial bleeding.
  B. venous bleeding.
  C. clot formation.
  D. intracranial aneurysm.
  A. arterial bleeding.

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  Explanation

  

  Epidural hematoma

  

  An epidural hematoma is a collection of blood that forms between the skull and the dura mater, the outermost layer of the meninges that cover the brain. The most common cause of an epidural hematoma is a head injury that fractures the temporal bone and tears the middle meningeal artery, which runs along the inner surface of the skull. Arterial bleeding is under high pressure and can rapidly expand the hematoma, compressing the brain and causing neurological deterioration. A typical symptom of an epidural hematoma is a brief loss of consciousness followed by a lucid interval and then a rapid decline in consciousness and brain function. This condition requires urgent surgical evacuation of the hematoma to prevent brain damage or death12. Venous bleeding, clot formation, and intracranial aneurysm are not the main factors associated with the deterioration of the patient's condition in this case.

• Question 82:

  Appropriate outcomes for a patient with status asthmaticus include

  A. increased PaCO2 and decreased FEV1.
  B. decreased peak flow rates and decreased wheezing.
  C. paradoxical breathing and increased FEV1.
  D. normal PaCO2 and increased FEV1.
  D. normal PaCO2 and increased FEV1.

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  Explanation

  The appropriate outcomes for a patient with status asthmaticus are normal PaCO2 and increased FEV1. Status asthmaticus is a severe and life-threatening asthma exacerbation that does not respond to conventional treatment. It causes severe bronchoconstriction, air trapping, and mucus plugging, leading to hypoxemia, hypercapnia, and respiratory failure. The goals of treatment are to reverse the airway obstruction, improve gas exchange, and prevent complications. PaCO2 is the partial pressure of carbon dioxide in the blood, which reflects the adequacy of ventilation. FEV1 is the forced expiratory volume in one second, which measures the amount of air that can be forcefully exhaled in the first second of a breath. It reflects the degree of bronchoconstriction and airflow limitation. A patient with status asthmaticus typically has elevated PaCO2 and reduced FEV1 due to poor ventilation and severe obstruction. Therefore, normalizing PaCO2 and increasing FEV1 indicate improvement in the patient's condition and response to treatment.

  References: Status Asthmaticus: Symptoms, Causes, Diagnosis, and Treatment - Healthline: This article states that "Status asthmaticus is a severe form of asthma with symptoms similar to a typical asthma attack. But for status asthmaticus, symptoms may worsen as the asthma attack continues. Status asthmaticus is an older, less precise term for what's now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn't improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours." Status Asthmaticus (Severe Acute Asthma) - WebMD: This article states that "Status asthmaticus is a severe asthma attack that doesn't get better with your usual treatments. It can be life-threatening and needs urgent medical attention. If you have a bad asthma attack and your rescue inhaler or your nebulizer doesn't help, you need medical care right away. If an attack comes on quickly and it doesn't respond to regular treatment, it can lead to status asthmaticus." Management of Status Asthmaticus | SpringerLink: This article states that "Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure despite aggressive treatment. It is defined as an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary in severity from mild to fatal. The pathophysiology of status asthmaticus is complex and involves airway inflammation, bronchospasm, airway edema, mucus plugging, and increased airway resistance. The clinical manifestations of status asthmaticus include dyspnea, wheezing, cough, chest tightness, tachypnea, tachycardia, hypoxemia, and hypercapnia. The diagnosis of status asthmaticus is based on history, physical examination, and laboratory tests, such as arterial blood gas analysis, spirometry, and chest radiography. The management of status asthmaticus consists of oxygen therapy, inhaled beta-2 agonists, systemic corticosteroids, and adjunctive therapies, such as anticholinergics, magnesium sulfate, ketamine, and noninvasive or invasive mechanical ventilation. The goals of treatment are to relieve bronchoconstriction, reduce airway inflammation, correct hypoxemia, normalize or reduce carbon dioxide levels, and avoid or treat complications."

• Question 83:

  A patient is admitted for hypertensive crisis. As a nurse is starting a peripheral IV, the patient appears increasingly anxious as the catheter is about to be inserted. The patient threatens to harm the nurse if the catheter insertion causes pain. Which of the following is the nurse's best action?

  A. Engage the patient in a conversation and encourage him to verbalize his feelings.
  B. Physically restrain the patient during the performance of the procedure.
  C. Ask another staff member to distract the patient during insertion.
  D. Tell the patient to remain still in a stern, authoritative voice.
  A. Engage the patient in a conversation and encourage him to verbalize his feelings.

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  Explanation

  When a patient exhibits anxiety and threats of harm, it is crucial to de- escalate the situation through verbal communication and engagement. By encouraging the patient to verbalize their feelings, the nurse can address the patient's fears and anxieties, reducing the likelihood of aggression. This approach promotes a therapeutic nurse-patient relationship and ensures the safety of both the patient and healthcare staff.

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

• Question 84:

  Patients in end-stage cardiomyopathy often exhibit which of the following symptoms of right-sided heart failure?

  A. hypotension and oliguria
  B. JVD and hepatomegaly
  C. hypertension and polyuria
  D. pulmonary edema and restlessness
  B. JVD and hepatomegaly

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  Explanation

  JVD stands for jugular venous distension, which is a sign of increased pressure in the right atrium and the superior vena cava. Hepatomegaly means enlargement of the liver, which can occur due to congestion of blood in the portal vein and the hepatic vein. Both JVD and hepatomegaly are common symptoms of right-sided heart failure, as they indicate fluid retention and backup in the systemic circulation12. Hypotension and oliguria are not specific to right-sided heart failure, as they can also occur in left-sided heart failure or other conditions that affect the cardiac output and renal perfusion. Hypertension and polyuria are unlikely to be seen in right-sided heart failure, as they indicate increased blood pressure and urine output, which are opposite to the effects of reduced cardiac function and fluid overload. Pulmonary edema and restlessness are more characteristic of left-sided heart failure, as they indicate fluid accumulation and impaired gas exchange in the lungs12.

• Question 85:

  There is an increase in catheter-associated urinary tract infections (CAUTIs) following a change in urinary catheter insertion trays. After conducting a literature review of evidence- based practices regarding indwelling catheter insertion and care, the nurse should

  A. locate a unit in the facility that still has the original trays in stock and restock the supply closet with these.
  B. contact the materials coordinator and request that the previous trays be re-ordered.
  C. share the results of the literature review with the physician team.
  D. lead a meeting in which the results of the literature review are presented, and staff input is obtained.
  D. lead a meeting in which the results of the literature review are presented, and staff input is obtained.

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  Explanation

  Conducting a literature review is an essential step in evidence-based practice. Sharing these findings with the staff and obtaining their input fosters a collaborative environment and ensures that the best practices are understood and implemented by all. This approach also helps identify any practical concerns or barriers to implementation. Simply switching back to the old trays without addressing the root cause or educating the staff may not prevent future CAUTIs.

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

• Question 86:

  A patient who was admitted after an open aortofemoral bypass for claudication at rest has a hemoglobin A1C of 8.9. The patient admits having poor control of blood glucose levels and is scared to use insulin as directed because of a few episodes of hypoglycemia. Which of the following should the nurse initially request to be consulted?

  A. endocrinology
  B. diabetes educator
  C. hospital pharmacist
  D. vascular surgeon
  B. diabetes educator

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  Explanation

• Question 87:

  An unconscious patient presents with the following laboratory values:

  

  Appropriate management of this patient should include

  A. IV hydration.
  B. hemodialysis.
  C. intubation.
  D. osmotic diuresis.
  A. IV hydration.

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  Explanation

  The laboratory values indicate hyperosmolar hyperglycemic state (HHS), characterized by high glucose levels, high osmolality, and dehydration. The primary management includes aggressive IV hydration to correct dehydration and improve circulation. Hemodialysis and intubation are not immediate priorities unless there are other indications, and osmotic diuresis is not appropriate in this context.

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

• Question 88:

  A patient is experiencing lower left quadrant pain with guarding, as well as abdominal distention and rigidity. KUB reveals free air in the abdominal cavity. Vital signs are: BP76/40 HR130 RR32 T101.7°F (38.7°C) A nurse would suspect

  A. perforated bowel.
  B. paralytic ileus.
  C. appendicitis.
  D. acute pancreatitis.
  A. perforated bowel.

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  Explanation

  The clinical presentation of lower left quadrant pain with guarding, abdominal distention, rigidity, and free air in the abdominal cavity on a KUB (kidney, ureter, and bladder) radiograph strongly suggests a perforated bowel. The presence of free air indicates that there is a breach in the gastrointestinal tract, allowing air to escape into the peritoneal cavity. The patient's vital signs, including hypotension (BP 76/40), tachycardia (HR 130), tachypnea (RR 32), and fever (T 101.7

• Question 89:

  The intended effects of medications for a patient in acute CHF are to

  A. reduce CVP and increase SVR.
  B. reduce CVP and reduce SVR.
  C. increase CVP and reduce SVR.
  D. increase CVP and increase SVR.
  B. reduce CVP and reduce SVR.

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  Explanation

  The intended effects of medications for a patient in acute CHF are to reduce CVP and reduce SVR, as this would decrease the preload and afterload on the failing heart and improve the cardiac output and tissue perfusion. CVP (central venous pressure) is a measure of the pressure in the right atrium and reflects the volume status of the patient. SVR (systemic vascular resistance) is a measure of the resistance in the systemic circulation and reflects the tone of the blood vessels. Medications that can reduce CVP and SVR in acute CHF include diuretics, nitrates, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators12. Increasing CVP and reducing SVR would increase the preload and decrease the afterload, which may be beneficial for some patients with low cardiac output and low filling pressures, but not for patients with acute CHF and volume overload3. Reducing CVP and increasing SVR would decrease the preload and increase the afterload, which would worsen the cardiac function and oxygen demand in acute CHF3. Increasing CVP and increasing SVR would increase both the preload and the afterload, which would also worsen the cardiac function and oxygen demand in acute CHF3.

  References:

  1: Acute decompensated heart failure: Management - UpToDate4, p. 5-6. 2: Acute heart failure: diagnosis and management | Guidance | NICE, p. 8-9.

  3: Hemodynamic monitoring in acute heart failure - UpToDate, p. 3-4.

• Question 90:

  Which of the following intubated patients is most at risk for developing ventilator-associated pneumonia (VAP)?

  A. 68-year-old patient, 142 kg, from an assisted living facility with COPD and dialysis- dependent renal disease
  B. 84-year-old patient, 38 kg, from a skilled nursing facility receiving chemotherapy for colorectal cancer
  C. 91-year-old patient, 54 kg, from home with osteoporosis and hypothyroidism
  D. 72-year-old patient, 81 kg, from a nursing home with heart failure and chronic bronchitis
  A. 68-year-old patient, 142 kg, from an assisted living facility with COPD and dialysis- dependent renal disease

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  Explanation

  Among the options, the 68-year-old patient with COPD and dialysis- dependent renal disease is at the highest risk for developing VAP. This is due to multiple risk factors including advanced age, chronic obstructive pulmonary disease (COPD), which predisposes to poor lung function and clearance of secretions, and the immunocompromised state from dialysis-dependent renal disease. The patient's higher body weight can also contribute to complications in mobility and ventilation management, further increasing the risk of VAP.

  References: = CCRN (Adult) Certification Review Course Online: Infectious Disease and Pulmonary Infections. 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