Ace AACN CCRN-Adult Certification with Actual Questions Dec 26, 2024 Updated
2024 The Most Effective CCRN-Adult with 152 Questions Answers
NEW QUESTION # 82
Which of the following is a sign of brain death?
- A. positive vestibulo-ocular reflex
- B. negative apnea test
- C. negative cold caloric test
- D. positive cough reflex
Answer: B
Explanation:
A negative apnea test means that the patient does not breathe spontaneously when disconnected from the ventilator and exposed to a high level of carbon dioxide, which normally stimulates breathing. A negative apnea test is one of the criteria for brain death, as it indicates the loss of brainstem function. A positive vestibulo-ocular reflex, also known as the oculocephalic or doll's eye reflex, means that the eyes move in the opposite direction of the head when the head is turned. A positive cough reflex means that the patient coughs when the trachea is stimulated. A negative cold caloric test means that the eyes do not move when cold water is injected into the ear canal. All these tests assess the integrity of the brainstem, and a positive result would exclude brain death. Therefore, the correct answer is B.
References:
* Diagnosis of brain death - UpToDate, under "Apnea testing".
* Brain Death | Critical Care Medicine | JAMA | JAMA Network, under "How Is Brain Death Diagnosed?".
* The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by ..., under "Apnea Testing".
NEW QUESTION # 83
An older adult patient is admitted with acute exacerbation of congestive heart failure. An echocardiogram indicates that EF is unchanged at 50%. The patient is most likely experiencing
- A. heart failure with preserved EF.
- B. heart failure with reduced EF.
- C. advanced heart failure.
- D. left ventricular failure.
Answer: A
Explanation:
Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure that occurs when the heart muscle is stiff and does not relax well, causing high pressure in the heart and lungs. HFpEF is diagnosed when the patient has symptoms and signs of heart failure and a normal or high ejection fraction (EF), which is the percentage of blood pumped out of the left ventricle with each heartbeat. HFpEF is usually caused by conditions that affect the heart or blood vessels, such as aging, high blood pressure, diabetes, obesity, or kidney disease12 References:
* What Is Heart Failure with Preserved Ejection Fraction? - Healthline
* Heart failure with preserved ejection fraction - BMJ Best Practice
NEW QUESTION # 84
A patient admits to a nurse that he has struggled with depression and feelings of isolation and abandonment since moving into a nursing home last year, but he has recently started taking an anti-depressant. The patient states, "Sometimes it takes everything I've got just to go on each day." Which of the following is the nurse's best initial response?
- A. "Those feelings should resolve when the medication you've started has a chance to take effect."
- B. "Have you talked to anyone about what is bothering you?"
- C. "I understand how you feel. We all get that way when we're depressed."
- D. "You sound like you've been really unhappy. Have you thought about harming yourself?"
Answer: D
Explanation:
This is the nurse's best initial response, as it expresses empathy, validates the patient's feelings, and assesses the patient's risk of suicide. Depression is a common and serious mental health condition that affects older adults, especially those living in nursing homes. Depression can cause persistent sadness, hopelessness, loss of interest, and suicidal thoughts or behaviors. The nurse should screen the patient for depression using a validated tool, such as the Patient Health Questionnaire (PHQ-9) 1, and ask about any suicidal ideation or plans. The nurse should also provide emotional support, education, and referral to appropriate resources for the patient.
B: "Those feelings should resolve when the medication you've started has a chance to take effect." This is not the nurse's best initial response, as it dismisses the patient's feelings, implies that the patient just needs to wait for the medication to work, and does not address the patient's psychosocial needs.
Antidepressants are one of the treatment options for depression, but they may take several weeks to show their full effect, and they may not work for everyone. The nurse should also explore other factors that may contribute to the patient's depression, such as social isolation, loss of autonomy, chronic illness, or grief, and offer interventions that may help the patient cope, such as counseling, psychotherapy, cognitive-behavioral therapy, or social activities.
C: "I understand how you feel. We all get that way when we're depressed." This is not the nurse's best initial response, as it assumes that the nurse knows how the patient feels, minimizes the patient's experience, and generalizes the patient's condition. Depression is not a normal or inevitable part of aging, and it affects each person differently. The nurse should not compare the patient's feelings to their own or to others, but rather acknowledge and respect the patient's unique perspective and situation. The nurse should also avoid using words like "we" or "you" that may create a sense of distance or judgment, and instead use words like "I" or "me" that may convey a sense of empathy or rapport.
D: "Have you talked to anyone about what is bothering you?"
This is not the nurse's best initial response, as it may sound like the nurse is trying to avoid listening to the patient, or that the patient is bothering the nurse with their problems. The nurse should not imply that the patient should talk to someone else, but rather show interest and willingness to listen to the patient. The nurse should also use open-ended questions that invite the patient to share more, such as "How are you feeling today?" or "What has been on your mind lately?" The nurse should also use active listening skills, such as nodding, paraphrasing, reflecting, or summarizing, to demonstrate understanding and engagement.
NEW QUESTION # 85
Following a splenectomy, a patient is most at risk for
- A. sepsis.
- B. hypertension.
- C. pulmonary embolism.
- D. wound dehiscence.
Answer: A
Explanation:
The spleen plays a crucial role in filtering bacteria and old or damaged blood cells, as well as mounting an immune response. After a splenectomy, the patient is at increased risk for infections, particularly from encapsulated organisms like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
This heightened susceptibility to infection can lead to sepsis, a life-threatening condition. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 86
A patient with a C5 spinal cord injury calls the nurse every 15 minutes with requests for juice, water, and repositioning. Which of the following is the nurse's best response?
- A. "You are safe. Nothing will happen to you."
- B. "I will get someone to sit with you."
- C. "I will check on you every 30 minutes."
- D. "You need to be repositioned only every 2 hours."
Answer: B
Explanation:
Spinal cord injury
The patient with a C5 spinal cord injury may have anxiety, fear, or depression due to the loss of function and independence. The patient may also have difficulty breathing, swallowing, or regulating body temperature.
The patient may call the nurse frequently to seek reassurance, attention, or comfort. The nurse should respond with empathy and compassion, and provide the patient with emotional support and psychological counseling.
The nurse should also assess the patient's physical needs and provide adequate hydration, nutrition, and skin care. The nurse should not dismiss the patient's requests, ignore the patient's feelings, or limit the patient's contact with the nurse. The nurse should also not give false reassurance or minimize the patient's concerns.
Therefore, the best response is to get someone to sit with the patient, such as a family member, a friend, or a volunteer. This will help the patient feel less isolated, anxious, or depressed, and provide the patient with a sense of security and companionship.
NEW QUESTION # 87
Postoperatively, symptoms that may indicate hemothorax or internal bleeding in a video-assisted thoracic surgery (VATS) patient include
- A. diminished breath sounds.
- B. pain with deep inspiration.
- C. hypertension.
- D. bradycardia.
Answer: A
Explanation:
Hemothorax
Diminished breath sounds are one of the symptoms that may indicate hemothorax or internal bleeding in a video-assisted thoracic surgery (VATS) patient. VATS is a minimally invasive surgical technique that uses a small video camera (thoracoscope) and special instruments to access the chest cavity through small incisions1.
Hemothorax is a condition where blood accumulates in the pleural space, the area between the lungs and the chest wall2. Hemothorax can occur as a complication of VATS due to injury to the lung, blood vessels, or chest wall during the procedure3. Hemothorax can cause compression of the lung and reduce its expansion, leading to diminished breath sounds on the affected side2. Other symptoms of hemothorax may include chest pain, shortness of breath, low blood pressure, rapid heart rate, and pale or clammy skin2.
Internal bleeding is another possible complication of VATS that can cause similar symptoms as hemothorax.
Internal bleeding can occur due to damage to the major vessels, such as the aorta, pulmonary artery, or vena cava, during VATS. Internal bleeding can cause hypovolemia, which is a decrease in the volume of blood in the body, and hypoxemia, which is a low level of oxygen in the blood. These conditions can impair the delivery of oxygen to the tissues and organs, including the lungs, and cause diminished breath sounds, as well as other signs of shock, such as confusion, weakness, dizziness, and loss of consciousness.
Pain with deep inspiration, bradycardia, and hypertension are not typical symptoms of hemothorax or internal bleeding in a VATS patient. Pain with deep inspiration may be a normal postoperative finding after VATS, as the incisions and the chest tube may cause discomfort. Bradycardia and hypertension may be caused by other factors, such as medications, cardiac disorders, or neurological conditions, but they are not directly related to hemothorax or internal bleeding .
References:
* 1: Video-Assisted Thoracoscopic Surgery (VATS) | Johns Hopkins Medicine
* 2: Hemothorax: Causes, Symptoms, Diagnosis & Treatment - Cleveland Clinic2
* 3: Complications of video-assisted thoracoscopic surgery: a retrospective analysis of 3000 cases - PubMed
* : Major vascular complications after video-assisted thoracoscopic surgery: a case report and literature review - PubMed
* : Video-Assisted Thoracoscopic Surgery (VATS) | Michigan Medicine
* : Bradycardia - Symptoms and causes - Mayo Clinic
* : High blood pressure (hypertension) - Symptoms and causes - Mayo Clinic
NEW QUESTION # 88
The dysrhythmia most commonly associated with mitral stenosis is
- A. sinus bradycardia.
- B. idioventricular rhythm.
- C. atrial fibrillation.
- D. second-degree AV heart block, Mobitz Type II.
Answer: C
Explanation:
Mitral stenosis leads to increased pressure in the left atrium, which can cause atrial enlargement and predispose patients to atrial fibrillation. Atrial fibrillation is the most common arrhythmia associated with mitral stenosis due to the structural changes in the atrium. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
NEW QUESTION # 89
A patient with cardiogenic shock for several days has been managed aggressively with vasopressor and inotrope therapies. Which of the following indicates organ dysfunction from hypoperfusion?
- A. fever and decreased insulin requirements
- B. abdominal pain and elevated creatinine
- C. elevated creatinine and fever
- D. decreased insulin requirements and abdominal pain
Answer: B
Explanation:
In the context of cardiogenic shock managed with vasopressor and inotrope therapies, organ dysfunction from hypoperfusion can manifest as elevated creatinine and abdominal pain. Elevated creatinine indicates renal impairment, a common result of poor perfusion to the kidneys. Abdominal pain can indicate hypoperfusion to the gastrointestinal tract, leading to ischemic bowel or other GI complications. These symptoms are direct indicators of hypoperfusion and organ dysfunction. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 90
Which of the following are most indicative of acute pancreatitis?
- A. Grey Turner's sign, hyperkalemia, right shoulder pain
- B. hypotension, jaundice, hyperalbuminuria
- C. abdominal distention, decreased lipase level, hypertension
- D. severe mid-epigastric pain, leukocytosis, hypocalcemia
Answer: D
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
NEW QUESTION # 91
A nurse should expect which of the following plans of care for a patient with a complicated RV infarction?
- A. nitroprusside (Nipride), fluid restrictions, and transvenous pacing
- B. dobutamine (Dobutrex), fluid infusions, and transvenous pacing
- C. dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix)
- D. nitroglycerin, fluid infusions, and morphine
Answer: B
Explanation:
A nurse should expect a plan of care that includes dobutamine (Dobutrex), fluid infusions, and transvenous pacing for a patient with a complicated RV infarction, as these interventions aim to improve RV function, increase cardiac output, and correct bradyarrhythmias. Dobutamine is an inotropic agent that increases myocardial contractility and reduces RV afterload1. Fluid infusions are used to optimize RV preload and maintain adequate systemic perfusion12. Transvenous pacing is indicated for patients with symptomatic bradycardia or high-grade AV block that compromise hemodynamics13. Dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix) are not appropriate for a patient with a complicated RV infarction, as they may worsen RV preload and cardiac output. Nitroprusside (Nipride), fluid restrictions, and transvenous pacing are not suitable for a patient with a complicated RV infarction, as they may cause excessive vasodilation and hypotension. Nitroglycerin, fluid infusions, and morphine are not optimal for a patient with a complicated RV infarction, as they may reduce RV preload and increase RV ischemia.
NEW QUESTION # 92
In order to meet the spiritual needs of critically ill patients and their families, which of the following should the nurse understand regarding chaplain services?
- A. It would be inappropriate for the hospital chaplain to document in the medical record.
- B. The service should be provided only when specifically requested by the patient or family.
- C. A chaplain's visit will not benefit a patient who is comatose or non-communicative.
- D. The chaplain may be of a specific denomination, but the chaplain provides resources to patients of many faiths and beliefs.
Answer: D
Explanation:
Chaplain services in hospitals are designed to address the spiritual needs of patients and their families, regardless of their specific faith or belief system. While a chaplain may belong to a particular denomination, they are trained to provide support and resources to people of various faiths and spiritual beliefs. This approach helps ensure that all patients receive appropriate spiritual care, which can be a crucial part of holistic care in critical situations. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 93
The rationale for initiating early enteral feeding in a patient with sepsis is to
- A. minimize translocation of GI bacteria.
- B. minimize electrolyte imbalances and fluid shifts.
- C. increase GI motility.
- D. prevent pulmonary aspiration.
Answer: A
Explanation:
Early enteral feeding in patients with sepsis is crucial as it helps maintain gut integrity, thereby minimizing the translocation of gastrointestinal (GI) bacteria. The presence of nutrients in the gut lumen supports the mucosal barrier function and reduces bacterial translocation, which can lead to secondary infections and further complications in septic patients. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
NEW QUESTION # 94
A patient is admitted with a femoral shaft fracture and an oblique fracture of three ribs on the right side. The patient suddenly reports shortness of breath. Assessment reveals new-onset headache, central and peripheral cyanosis, and petechiae of the neck and anterior chest wall. Available data are:
The nurse should suspect the development of
- A. a pulmonary embolus.
- B. a fat embolus
- C. sepsis.
- D. acute pulmonary edema.
Answer: B
Explanation:
The patient's clinical presentation and recent history of femoral shaft and rib fractures are highly suggestive of a fat embolism syndrome (FES). FES typically occurs after long bone fractures and is characterized by sudden onset of respiratory distress, neurological symptoms, and petechial rash, which aligns with the new-onset headache, central and peripheral cyanosis, and petechiae of the neck and anterior chest wall observed in this patient. The fat emboli originate from the bone marrow and enter the bloodstream, traveling to the lungs and other organs, leading to respiratory and systemic symptoms. References: =
* CCRN (Adult) Certification Review Course Online: Pulmonary Embolism and Fat Embolism.
* 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
NEW QUESTION # 95
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. share the results of the literature review with the physician team.
- C. lead a meeting in which the results of the literature review are presented, and staff input is obtained.
- D. contact the materials coordinator and request that the previous trays be re-ordered.
Answer: C
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
NEW QUESTION # 96
Which of the following is a cause of cardiogenic pulmonary edema?
- A. RV chamber enlargement
- B. elevated PAOP reading
- C. LV noncompliance
- D. pulmonary hypertension
Answer: C
Explanation:
Cardiogenic pulmonary edema is primarily caused by left ventricular (LV) noncompliance. When the left ventricle is unable to properly fill or eject blood, pressure increases in the left atrium and pulmonary veins, leading to fluid leakage into the pulmonary interstitium and alveoli, causing pulmonary edema. Elevated PAOP readings, RV chamber enlargement, and pulmonary hypertension are not primary causes of cardiogenic pulmonary edema but can be related to other cardiac conditions. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 97
Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include
- A. increases in PT, PTT, and FSP (FDP).
- B. decreases in platelet count, thrombin time, and FSP (FDP).
- C. decreases in PT and thrombin time.
- D. increases in platelet count and fibrinogen.
Answer: A
Explanation:
Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include increased prothrombin time (PT), partial thromboplastin time (PTT), and fibrin split products (FSP), also known as fibrin degradation products (FDP). These increases indicate widespread clotting and subsequent fibrinolysis, which are characteristic of DIC. The consumption of clotting factors and platelets in DIC leads to prolonged clotting times and elevated levels of fibrin degradation products.References: = CCRN Exam Handbook, page 42
NEW QUESTION # 98
Which of the following is a late finding in hypovolemic shock?
- A. hypotension
- B. UO greater than 30 mL/hr
- C. cool, dry skin
- D. tachycardia
Answer: A
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 # 99
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