Ultimate Guide to Prepare Free AACN CCRN-Adult Exam Questions and Answer
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AACN CCRN-Adult Exam Syllabus Topics:
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NEW QUESTION # 416
Which of the following measures left ventricular preload?
- A. Pulmonary Artery Occlusion Pressure (PAOP)
- B. Systemic Vascular Resistance (SVR)
- C. Central Venous Pressure (CVP)
- D. Stroke Volume (SV)
Answer: A
Explanation:
Pulmonary Artery Occlusion, or Wedge, Pressure (PAOP) is pressure within the pulmonary arterial system. More specifically, with the insertion of 1.25 to 1.50 mL of air into the balloon port of the Pulmonary Artery (PA) catheter, the balloon becomes 'wedged' in a portion of the PA that is smaller than the balloon; this blocks blood flow distal to the catheter tip. When the mitral valve is open during ventricular diastole, the pressure that is sensed is that of the left ventricle, the Left Ventricular End- Diastolic Pressure (LVEDP), or LV preload. Normal LV preload is 8 to 12 mm Hg.
NEW QUESTION # 417
Analyze and interpret the ABG results:
* pH: 7.26
* PaCO2: 39 mmHg
* Bicarbonate: 20 mEq/L
- A. Fully compensated respiratory acidosis
- B. Normal ABG
- C. Acute (uncompensated) metabolic acidosis
- D. Partially compensated metabolic acidosis
Answer: C
Explanation:
Consider the following questions:
* Is the pH normal, acidotic or alkalotic?
* Are the pCO2 or HCO3 abnormal? Which one appears to influence the pH?
* If both the pCO2 and HCO3 are abnormal, the one which deviates most from the norm is most likely causing an abnormal pH.
Normal pH ranges from 7.35-7.45. Since this patient's pH is below 7.45, the patient is experiencing acidosis. Normal CO2 (carbon dioxide) levels range from 35-45 mmHg, and normal HCO3 (bicarbonate) levels range from 22-26 mEq/L. CO2 is the respiratory component and HCO3 is the metabolic component. The component that matches the pH is the system controlling the ABG. In this scenario, the bicarbonate is low, thus matching the pH, so this patient is in metabolic acidosis. Compensation can be seen when both the PaCO2 and HCO3 rise or fall together to maintain a normal pH. Partial compensation occurs when the PaCO2 and HCO3 rise or fall together but the pH remains abnormal.
In this scenario, no compensation has yet occurred, so the patient is in an acute or uncompensated situation.
Acute metabolic acidosis: pH < 7.35, PaCO2 is normal, and HCO3 < 22.
NEW QUESTION # 418
Which of the following factors directly affects myocardial oxygen demand?
- A. Afterload
- B. Heart rate
- C. Preload
- D. Right ventricular pressure
Answer: B
Explanation:
Major physiologic factors that determine the heart's demand for oxygen include the heart size, the left ventricular (LV) systolic pressure, the heart rate, and the level of myocardial inotropic state. Heart rate and contractility affect myocardial oxygen consumption. Any therapeutic intervention that diminishes heart size, LV pressure, heart rate, and inotropic state will decrease myocardial oxygen demand.
Preload, also known as the left ventricular end-diastolic pressure (LVEDP), is the amount of ventricular stretch at the end of diastole. Think of it as the heart loading up for the next big squeeze of the ventricles during systole. Some people remember this by using an analogy of a balloon. Blow air into the balloon and it stretches. The more air you blow in, the greater the stretch.
Afterload, also known as the systemic vascular resistance (SVR), is the amount of resistance the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation. It is the pressure that the ventricles must overcome to open the aortic and pulmonic valves and to pump blood into the systemic and pulmonary vasculature. If you think about the balloon analogy, afterload is represented by the knot at the end of the balloon. To get the air out, the balloon must work against that knot.
NEW QUESTION # 419
Treatment options for Heparin-Induced Thrombocytopenia (HIT) may include all of the following EXCEPT:
- A. utilizing alternative thrombin inhibitors
- B. administering erythropoietin
- C. discontinuing all heparin therapy
- D. initiating therapy with direct thrombin inhibitors
Answer: B
Explanation:
Heparin-Induced Thrombocytopenia (HIT) is a serious side effect that can occur during treatment with heparin. Heparin is a medication used to decrease clotting. Unfortunately, heparin can occasionally lead to low blood platelet counts and to life-threatening blood clots. Venous thrombosis is the most common and may result in limb ischemia and pulmonary emboli.
Treatment options include:
* All heparin should be stopped; however, discontinuation of heparin alone is not sufficient
* Administration of direct thrombin inhibitors (e.g., argatroban)
* Utilizing alternative thrombin inhibitors
Platelet infusions are usually necessary.
Patients diagnosed with HIT should not receive heparin again.
Erythropoietin stimulates the synthesis of red blood cells and will not treat HIT.
NEW QUESTION # 420
Which of the following methods of preventing aspiration in a patient who is receiving tube feedings is CORRECT?
- A. Provide bolus feedings to prevent constant exposure to the feeding solution
- B. Use sedatives sparingly
- C. Check feeding tube placement with a chest radiograph every 4 hours
- D. Check for gastric residuals at least once in a 12-hour shift
Answer: B
Explanation:
Prevention of aspiration includes using sedatives as sparingly as possible. In addition, maintaining the head of the bed at an elevation of 30-45 degrees, unless contraindicated, will greatly help to reduce the likelihood of aspiration occurring.
Bolus feedings should be avoided, as they increase the risk of aspiration. Gastric residuals should be checked at least once every 8 hours, preferably every 4 hours. While the placement of a feeding tube should be verified every 4 hours, this should not be done with a chest radiograph, as it is not feasible or economical.
NEW QUESTION # 421
In the critically ill patient with dementia, all of the following would be helpful interventions to include in the plan of care EXCEPT:
- A. decreasing noise and distractions
- B. encouraging patient input and participation in care
- C. providing a structured environment
- D. providing limited choices
Answer: D
Explanation:
The patient should always be an active participant in the plan of care and limiting choices would not be helpful. Providing options gives the patient a sense of independence and allows trust to be built between patients and healthcare professionals.
Providing a structured environment and implementing strategies such as dimming lights and decreasing noise are also helpful interventions for critically ill patients with dementia.
NEW QUESTION # 422
A male patient is admitted to the ICU after a motor vehicle accident (MVA) in which he sustained blunt trauma to his chest from the steering wheel and to his head from the dashboard. A projectile also caused a right leg injury. The patient has controlled bleeding from the right leg but suddenly becomes less responsive. The nurse notes muffled heart sounds, tachycardia, jugular vein distension (JVD), and decreasing blood pressure upon assessment.
Which of the following responses by the nurse is CORRECT?
- A. Rapid infusion of IV fluids followed by a STAT chest MRI
- B. Insert an arterial line and provide a bolus of crystalloids if the MAP <70 mm Hg
- C. Apply a tourniquet to the right leg proximal to the site of injury
- D. Prepare for a pericardiocentesis
Answer: D
Explanation:
Signs such as rapid heart rate, JVD, low blood pressure, pulsus paradoxus, and finally, ventricular fibrillation and cardiac arrest may ensue in cardiac tamponade. Coupled with the patient's recent history of blunt chest trauma, the nurse should rapidly infuse IV fluids and prepare for a pericardiocentesis to relieve (decompress) the pressure of the cardiac tamponade.
The bleeding from the leg is controlled, so the application of a tourniquet is unnecessary. While the patient's hypotension will require treatment that may include arterial line monitoring and IVF boluses, treating the underlying cause of the hypotension is more important. A STAT chest MRI is indicated in the case of aortic disruption. Echocardiography is generally used to confirm a diagnosis of cardiac tampanode.
NEW QUESTION # 423
Oxygen therapy that lasts longer than 48 hours should NOT exceed:
- A. 25%
- B. 30%
- C. 50%
- D. 40%
Answer: C
Explanation:
To reduce the likelihood of oxygen toxicity, oxygen therapy that lasts longer than 48 hours should not exceed 50%.
An oxygen concentration of 100% (FiO2 = 1.0) is regarded as safe for short periods of time (< 24 hours).
Oxygen concentrations greater than 50% for more than 24 to 48 hours may damage the lungs and worsen respiratory problems. Oxygen delivery levels are decreased as soon as PaO2 levels return to clinically acceptable levels (> 60 mmHg or higher).
NEW QUESTION # 424
Which of the following statements made by a student nurse indicates that they understand aortic rupture?
- A. Aortic rupture cannot be treated, and will always result in death.
- B. Aortic rupture refers to disruption of any layer of aortic vessel, not just to complete disruption of all three layers of the aorta.
- C. Both aortic rupture and aortic dissection are life-threatening emergencies.
- D. If aortic rupture occurs, treatment must be initiated within 30 minutes of the rupture occurring.
Answer: C
Explanation:
"Both aortic rupture and aortic dissection are life-threatening emergencies" is the correct answer, as aortic dissection carries a high risk of rupture occurring. Aortic rupture is a life-threatening emergency and requires immediate treatment. Waiting 30 minutes to initiate treatment is likely to result in death in many situations. Disruption of one or two of the layers of the aortic vessel is aortic dissection, not aortic rupture. While aortic rupture is associated with poor outcomes, it may be treatable.
NEW QUESTION # 425
A patient is admitted with anaphylactic shock secondary to a blood transfusion. The patient's spouse asks the nurse to explain how blood can cause a low blood pressure. The nurse responds that with anaphylactic shock the
- A. peripheral blood vessels dilate, and this creates a maldistribution of volume.
- B. autonomic nervous system is disrupted dropping blood pressure.
- C. kidneys excrete large amounts of urine dropping the blood pressure.
- D. heart muscle weakens and is unable to pump effectively.
Answer: A
Explanation:
Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 426
Which of the following clinical findings is consistent with a diagnosis of brain death?
- A. Positive Babinski reflex
- B. Chyene-Stokes respiration
- C. Absent corneal reflexes
- D. Sluggishly reactive pupils
Answer: C
Explanation:
Absent corneal reflexes are a clinical sign of brain death as they indicate a lack of cerebral activity. Brain dead patients do not have any functioning cranial nerve reflexes, such as the corneal reflex. Reactive pupils and spontaneous respirations, even if they follow the Cheyenne-Stokes respiratory pattern, are inconsistent with brain death as they suggest ongoing brain activity. The presence of a Babinski reflex doesn't necessarily indicate brain death, as it is a spinal reflex and can be present even when brain function has ceased.
NEW QUESTION # 427
The Model for End-Stage Liver Disease, or MELD, is often used to determine transplant priority. Which of the following laboratory values is NOT included in this model when determining patient priority for transplantation?
- A. Serum sodium
- B. AST and ALT
- C. Serum creatinine
- D. Age
Answer: B
Explanation:
MELD is a scoring system that stratifies the severity of end-stage liver disease, and is used for transplant planning. This frequently used tool is a calculation that incorporates the following data to measure disease severity:
* age
* serum creatinine
* serum sodium
* albumin
* International normalized ratio (INR)
Additional points are included if the patient undergoes dialysis at least twice in a week. The MELD score is used by United Network of Organ Sharing (UNOS) to determine hierarchy of transplantation need.
NEW QUESTION # 428
The MOST common electrolyte abnormality exhibited in a critically ill patient is:
- A. hyponatremia
- B. hyperkalemia
- C. hypernatremia
- D. hypokalemia
Answer: D
Explanation:
In the critically ill patient, electrolyte disorders are common due to vomiting and decreased oral intake.
Hypokalemia is the most common electrolyte abnormality in this population and is characterized by muscle weakness (including the heart), hypoventilation, abdominal cramping, confusion, irritability and/or lethargy. It is diagnosed when potassium levels are below 3.5 mEq/L and can lead to serious cardiac arrhythmias and even death if not adequately treated.
NEW QUESTION # 429
Which of the following interventions to promote patient sleep in the critical care environment is NOT evidence-based?
- A. Assessing the patient's normal sleep patterns
- B. Mimicking the patient's normal bedtime routine to the greatest extent possible
- C. Reducing noise and lights to a level that the nurse finds to not be disturbing
- D. Avoiding medications that disturb sleep patterns
Answer: C
Explanation:
Studies show that staff tends to tune out noises and lights in the critical care setting, and will normally underestimate the impact that these environmental factors will have on the patient. Assessing the patient's normal sleep patterns, mimicking the patient's normal bedtime routine to the greatest extent possible, and avoiding medications that disturb sleep patterns have all been shown to improve patients' sleep quality.
NEW QUESTION # 430
The nurse is caring for a patient who is in Acute Renal Failure (ARF) secondary to cardiogenic shock after experiencing an acute MI. What type of renal failure is occurring in this patient?
- A. Postrenal
- B. Intrarenal
- C. Prerenal
- D. Iatrogenic
Answer: C
Explanation:
ARF, which occurs secondary to cardiogenic shock, is considered prerenal failure. ARF, also known as Acute Kidney Injury (AKI), is classified according to etiology. Prerenal failure occurs as a response to hypotension and volume depletion. Intrarenal failure occurs in response to damage within the kidney itself from various toxic, ischemic or inflammatory causes. Postrenal failure occurs from urinary flow obstruction (partial or complete) by any cause.
NEW QUESTION # 431
The classic symptoms of anaphylaxis would include all of the following EXCEPT:
- A. wheezing
- B. dysphagia
- C. hyperthermia
- D. dizziness
Answer: C
Explanation:
Anaphylaxis is an acute multiorgan system reaction. The most common organ systems involved include the cutaneous, respiratory, cardiovascular, and Gastrointestinal (GI) systems.
* Cutaneous/ocular - Flushing, urticaria, angioedema, cutaneous and/or conjunctival pruritus, warmth, and swelling
* Respiratory - Nasal congestion, rhinorrhea, throat tightness, wheezing, shortness of breath, cough, hoarseness
* Cardiovascular - Dizziness, weakness, syncope, chest pain, palpitations
* Gastrointestinal - Dysphagia, nausea, vomiting, diarrhea, bloating, cramps
* Neurologic - Headache, dizziness, blurred vision, and seizure (very rare and often associated with hypotension)
* Other - Metallic taste, feeling of impending doom
Hyperthermia is not a classic symptom of anaphylaxis.
NEW QUESTION # 432
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. Introduce the new nurse to staff and team members on the unit.
- C. Determine the knowledge and skills the new nurse needs to learn.
- D. Explain patient care policies and procedures to the new nurse.
Answer: C
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 # 433
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