Changing the Concept of CCRN-Adult Exam Preparation 2024
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NEW QUESTION # 17
A nurse is precepting an experienced critical care nurse who is new to the facility. To develop the orientation plan, which of the following should the preceptor do first?
- A. Teach the new nurse about unit routines and practices.
- B. Explain patient care policies and procedures to the new nurse.
- C. Introduce the new nurse to staff and team members on the unit.
- D. Determine the knowledge and skills the new nurse needs to learn.
Answer: D
Explanation:
The first step in developing an orientation plan is to assess the new nurse's current knowledge and skills. This helps tailor the orientation to address any gaps and build on existing competencies. Understanding the new nurse's background ensures that the training is efficient and effective, focusing on areas that need improvement rather than repeating familiar information. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 18
A patient is receiving therapeutic hypothermia post-cardiac arrest. Which of the following orders should a nurse clarify?
- A. sequential compression devices
- B. ABGs every 4 hours and with any ventilator changes
- C. hourly intake and output
- D. chemistry labs every day
Answer: A
Explanation:
Sequential compression devices (SCDs) are not recommended for patients receiving therapeutic hypothermia (TH) post-cardiac arrest, because they may interfere with the cooling process and increase the risk of skin injury. SCDs are used to prevent deep vein thrombosis (DVT) by applying intermittent pneumatic pressure to the lower extremities, but they may also increase peripheral blood flow and heat exchange, which can counteract the effects of TH. SCDs may also cause skin breakdown, blisters, or burns in patients with impaired sensation and reduced perfusion due to TH. Therefore, a nurse should clarify the order for SCDs and consider alternative methods of DVT prophylaxis, such as pharmacological agents or early mobilization.
References:
* Therapeutic Hypothermia (TH) Education Components: This document states that "Avoid use of sequential compression devices (SCDs) during cooling phase as they may interfere with cooling process and increase risk of skin injury."
* Sequential Compression Devices: Clinical Effectiveness, Cost- Effectiveness and Guidelines: This document states that "One evidence-based guideline from the American Heart Association (AHA) and the American Stroke Association (ASA) recommended against the use of SCDs in patients undergoing therapeutic hypothermia after cardiac arrest, as they may interfere with the cooling process and increase the risk of skin injury."
NEW QUESTION # 19
A patient presents with the following hemodynamics:
MAP 40 mm Hg
PAD6 mm Hg
PAOP5 mm Hg
CI1.8 L/min/m2
SVR875 dynes/sec/cm-5
Which of the following is essential in the plan of care?
- A. whole blood
- B. fluid resuscitation
- C. vasopressors
- D. loop diuretic
Answer: B
Explanation:
The patient has signs of hypovolemic shock, which is characterized by low MAP, low PAOP, low CI, and high SVR. The patient needs fluid resuscitation to restore intravascular volume and improve tissue perfusion. Loop diuretic, vasopressors, and whole blood are not indicated in this case.
References:
* Reference Guide for CCRN (Adult), page 14.
* Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online - Individual Purchase, Module 1:
Cardiovascular, Part 1: Shock.
NEW QUESTION # 20
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. establish a schedule with the provider.
- B. encourage the patient to sleep between assessments.
- C. move the patient to the quieter part of the unit.
- D. discontinue neurologic assessments.
Answer: A
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 non-invasive 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.
NEW QUESTION # 21
Which of the following is the most common prerenal cause of acute tubular necrosis?
- A. shock
- B. crush injury
- C. beta-hemolytic streptococcal infection
- D. blood transfusion reaction
Answer: A
Explanation:
Shock is the most common prerenal cause of acute tubular necrosis (ATN). In the context of prerenal conditions, shock leads to decreased renal perfusion and subsequent ischemia, which can cause damage to the renal tubules. Other options such as blood transfusion reaction, crush injury, and beta-hemolytic streptococcal infection can lead to renal damage but are not the most common prerenal causes of ATN. References: CCRN Exam Handbook, AACN, page 28, section on Renal/GU.
NEW QUESTION # 22
A patient with acute renal failure has a serum potassium level of 7.2 mEq/L. The most appropriate immediate intervention for this patient is
- A. 3% NS infusion.
- B. hemodialysis.
- C. 50% dextrose and insulin.
- D. Kayexalate in sorbitol.
Answer: C
Explanation:
A serum potassium level of 7.2 mEq/L is critically high and can lead to life-threatening cardiac arrhythmias.
The most immediate intervention is the administration of 50% dextrose followed by insulin, which helps drive potassium back into the cells, thereby rapidly lowering the serum potassium level. Hemodialysis and Kayexalate are also effective but may not act as quickly as the dextrose-insulin combination. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 23
Treatment of cerebral vasospasm includes administration of
- A. propranolol (Inderal).
- B. nimodipine (Nimotop).
- C. lorazepam (Ativan).
- D. pentobarbital (Nembutal).
Answer: B
Explanation:
Nimodipine is a calcium channel blocker that is used to prevent or treat cerebral vasospasm after subarachnoid hemorrhage. It works by relaxing the smooth muscle of the cerebral arteries and improving blood flow to the brain. Nimodipine is the only FDA-approved agent for vasospasm and has been shown to reduce the risk of ischemic complications and improve neurological outcomes12. Lorazepam, propranolol, and pentobarbital are not effective for treating cerebral vasospasm and may have adverse effects on the patient's blood pressure, heart rate, and level of consciousness.
NEW QUESTION # 24
A ventilator-associated event (VAE) is best prevented by
- A. changing ventilator tubing daily.
- B. tracheal instillation of normal saline.
- C. minimizing tube feedings.
- D. subglottic suctioning.
Answer: D
Explanation:
Ventilator-associated events (VAEs) can be prevented by reducing the risk of aspiration and maintaining airway hygiene. Subglottic suctioning is an effective measure to remove secretions that accumulate above the endotracheal tube cuff, which can harbor bacteria and lead to infection. This intervention helps prevent the development of pneumonia and other VAEs. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 25
Family members have been complaining about limited visiting hours. To facilitate a potential change in practice, a nurse should first
- A. schedule an interdisciplinary team meeting to discuss visiting hours.
- B. begin a literature search on family visitation practices.
- C. consult with medical staff to change visiting hours.
- D. draft a new policy regarding visitation practices for the unit.
Answer: B
Explanation:
The initial step in facilitating a change in practice regarding visiting hours should involve a literature search on family visitation practices. This allows the nurse to gather evidence-based information that can support any proposed changes. After gathering sufficient evidence, the nurse can then schedule an interdisciplinary team meeting to discuss the findings, consult with medical staff, and draft a new policy if necessary. References:
CCRN Exam Handbook, AACN, page 35, section on Professional Caring and Ethical Practice.
NEW QUESTION # 26
A patient with a history of alcohol abuse has been admitted for progressive dyspnea and leg swelling.
Assessment findings include:
BP155/90
HR85
CVP12 mm Hg
Which of the following tests will provide the most definitive diagnosis?
- A. echocardiogram
- B. pro-BNP
- C. chest x-ray
- D. liver function panel
Answer: A
NEW QUESTION # 27
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. paralytic ileus.
- B. perforated bowel.
- C. acute pancreatitis.
- D. appendicitis.
Answer: B
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°F), are consistent with sepsis and shock, which are common complications of bowel perforation. References: CCRN Exam Handbook, AACN, page 30, section on Gastrointestinal.
NEW QUESTION # 28
A physician tries three times to insert a central line, then says, "I think I can get it this time." A nurse should
- A. allow the physician to try again.
- B. suggest that another physician insert the line.
- C. start a peripheral line.
- D. administer an analgesic.
Answer: B
Explanation:
When a physician has attempted to insert a central line multiple times without success, the nurse's responsibility includes ensuring patient safety and advocating for the patient. Continued attempts by the same physician may increase the risk of complications, such as infection or trauma. Therefore, the nurse should suggest that another physician, possibly one with more experience or skill in central line insertion, perform the procedure. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 29
A patient with a history of asthma presents with acute onset of dyspnea, a non-productive cough, and tachypnea. He is very anxious, restless, and tachycardic. Which of the following is a first-line drug for these symptoms?
- A. anticholinergic
- B. beta-agonist
- C. mast cell stabilizer
- D. leukotriene inhibitor
Answer: B
Explanation:
Beta-agonists are the first-line drugs for acute asthma exacerbations because they rapidly reverse bronchoconstriction and improve airflow. They act by stimulating beta-2 receptors in the smooth muscle of the airways, causing relaxation and dilation. Beta-agonists can be administered by inhalation, nebulization, or injection. Examples of beta-agonists include albuterol, levalbuterol, and terbutaline.
References:
* Management of Acute Asthma Exacerbations | AAFP: This article states that "Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."
* Asthma attack - Diagnosis and treatment - Mayo Clinic: This article states that "If you're in the yellow zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you can repeat the dose. Young children or people who have difficulty with an inhaler use a device called a nebulizer to inhale the medicine in a mist. Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."
NEW QUESTION # 30
Which of the following should the nurse expect in a patient with papillary muscle dysfunction?
- A. mitral insufficiency
- B. aortic insufficiency
- C. aortic stenosis
- D. mitral stenosis
Answer: A
Explanation:
Papillary muscle dysfunction, often resulting from myocardial infarction, can lead to mitral insufficiency (mitral regurgitation). The papillary muscles support the mitral valve, and if they are damaged, the valve may not close properly, causing blood to flow backward into the left atrium during systole. This condition is not associated with aortic stenosis, mitral stenosis, or aortic insufficiency. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 31
Which of the following is a late finding in hypovolemic shock?
- A. UO greater than 30 mL/hr
- B. tachycardia
- C. cool, dry skin
- D. hypotension
Answer: D
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."
NEW QUESTION # 32
Which of the following are physiologic effects of pulmonary contusion?
- A. increased airway resistance and decreased gas diffusion
- B. increased lung compliance and decreased dead space
- C. increased dead space and decreased airway resistance
- D. increased gas diffusion and decreased lung compliance
Answer: A
Explanation:
Pulmonary contusion leads to damage to lung parenchyma, resulting in alveolar hemorrhage and edema. This causes increased airway resistance and decreased gas diffusion due to the inflammatory response and accumulation of fluid within the alveoli, impairing effective gas exchange and reducing lung compliance.References: = CCRN Exam Handbook, page 40
NEW QUESTION # 33
For a patient with suspected pulmonary embolism, which of the following is the most definitive diagnostic test?
- A. ABG analysis
- B. ventilation scan
- C. chest x-ray
- D. pulmonary angiography
Answer: D
Explanation:
Pulmonary embolism
Pulmonary angiography is the most definitive diagnostic test for pulmonary embolism, as it provides a clear picture of the blood flow in the arteries of the lungs. It can detect even small clots and determine the location and extent of the obstruction. However, because it requires a high degree of skill to perform and has potentially serious risks, it is usually done when other tests fail to provide a definite diagnosis1. Other tests that can be used to diagnose pulmonary embolism include CT pulmonary angiography, ventilation-perfusion scan, D-dimer test, chest X-ray, ultrasound, and MRI23. However, these tests may have limitations such as low sensitivity, low specificity, radiation exposure, contrast allergy, or availability4.
References:
* Pulmonary embolism - Diagnosis and treatment - Mayo Clinic, under "Pulmonary angiogram".
* Pulmonary Embolism (PE): Symptoms, Signs & Treatment - Cleveland Clinic, under "How is a pulmonary embolism diagnosed?".
* Diagnosis of Pulmonary embolism and what are its different treatment options?, under "Diagnosis for Pulmonary embolism".
* Diagnosis of pulmonary embolism - UpToDate, under "Overview".
NEW QUESTION # 34
A patient who experienced a blunt chest trauma in an automobile crash is admitted with multiple rib fractures.
The patient is dyspneic and hypotensive and is reporting left shoulder pain. On auscultation, a nurse notes that bowel sounds can be heard over the lower left thorax. These findings are consistent with
- A. ruptured diaphragm.
- B. mediastinal shift.
- C. ruptured abdominal viscus.
- D. flail chest.
Answer: A
Explanation:
The patient's findings are consistent with a ruptured diaphragm, which is a tear in the muscle that separates the chest and abdominal cavities. A blunt chest trauma can cause a sudden increase in intra-abdominal pressure, which can rupture the diaphragm and allow abdominal organs to herniate into the thorax. This can cause dyspnea, hypotension, shoulder pain, and bowel sounds over the lower thorax. A ruptured abdominal viscus would cause peritonitis, which would present with abdominal pain, distension, fever, and signs of sepsis. A flail chest would cause paradoxical chest movement, respiratory distress, and cyanosis. A mediastinal shift would cause tracheal deviation, decreased breath sounds, and jugular venous distension.
References:
* AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
* AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
* BCEN. (2020). Trauma Certified Registered Nurse (TCRN) Examination Content Outline. Retrieved from [TCRN Exam Content Outline], p. 8.
* Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017).
Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO:
Elsevier. Retrieved from [Textbook], p. 1789-1790.
NEW QUESTION # 35
Pulsus paradoxus is defined as
- A. a decrease in systolic BP of greater than 10 mm Hg during normal expiration.
- B. an increase in systolic BP of greater than 10 mm Hg during normal inspiration.
- C. a decrease in systolic BP of greater than 10 mm Hg during normal inspiration.
- D. a decrease in diastolic BP of greater than 10 mm Hg during normal expiration.
Answer: C
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
NEW QUESTION # 36
Which of the following diagnostic procedures best pinpoints the location, size, and origin of a cerebral aneurysm?
- A. positron emission tomography (PET) scanning
- B. CT scanning
- C. MRI
- D. cerebral angiography
Answer: D
Explanation:
Cerebral angiography is considered the gold standard for diagnosing and pinpointing the location, size, and origin of cerebral aneurysms. It involves the use of contrast material injected into the cerebral arteries and imaging to provide detailed visualization of the blood vessels in the brain, which is essential for accurate diagnosis and planning treatment strategies. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
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NEW QUESTION # 37
Which of the following serum laboratory results is most concerning to a nurse who is caring for a patient with a Stage Ill pressure ulcer on the coccyx?
- A. glucose 125 mg/dL
- B. albumin 2.1 mg/dL
- C. hemoglobin 10.2 mg/dL
- D. WBC 6,000/mm3
Answer: B
Explanation:
For a patient with a Stage III pressure ulcer, a serum albumin level of 2.1 mg/dL is most concerning because it indicates severe hypoalbuminemia, which is associated with poor nutritional status and delayed wound healing. Adequate nutrition, particularly protein intake, is crucial for wound healing. The other lab results, while not ideal, are less immediately critical in the context of pressure ulcer healing. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 38
When assessing a patient who has acute pancreatitis, which of the following findings require immediate notification to the provider?
- A. shortness of breath
- B. hyperglycemia
- C. hypoactive bowel sounds
- D. vomiting
Answer: A
Explanation:
Acute pancreatitis
Shortness of breath is a sign of respiratory distress that may indicate a serious complication of acute pancreatitis, such as pleural effusion, atelectasis, or acute respiratory distress syndrome (ARDS). These conditions can impair oxygenation and ventilation, and may require supplemental oxygen or mechanical ventilation. The provider should be notified immediately if the patient has shortness of breath, as well as other signs of respiratory distress, such as cyanosis, tachypnea, or use of accessory muscles12. Hypoactive bowel sounds, hyperglycemia, and vomiting are common findings in acute pancreatitis, but they are not as urgent as shortness of breath. They may indicate paralytic ileus, pancreatic insufficiency, or gastric outlet obstruction, respectively. These conditions can be managed with supportive measures, such as intravenous fluids, antiemetics, analgesics, and nutritional support3 .
NEW QUESTION # 39
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