Free Dec-2024 UPDATED AACN CCRN-Adult Certification Exam Dumps is Online
AACN Exam 2024 CCRN-Adult Dumps Updated Questions
NEW QUESTION # 63
A patient is 2 days post MI. The patient was stable until this morning, when severe chest discomfort developed. Assessment reveals:
BP70/palpable
HR122
RR38
PAOP28 mm Hg, with large V waves
CI1.6 L/min/m2
Cool, clammy skin
Inspiratory crackles throughout the lung field
Loud blowing holosystolic murmur at the apex
The patient's present clinical status is most likely a result of
- A. cardiac tamponade.
- B. ventricular septal defect.
- C. papillary muscle rupture.
- D. acute aortic insufficiency.
Answer: B
Explanation:
The patient's present clinical status is most likely a result of a ventricular septal defect (VSD), which is a hole in the wall between the left and right ventricles. A VSD can occur as a mechanical complication of MI, usually within the first week, due to necrosis and rupture of the ventricular septum. A VSD causes a left-to-right shunt of blood, which leads to increased pulmonary pressure, pulmonary edema, and reduced cardiac output. The patient's symptoms and signs are consistent with a VSD, such as severe chest pain, hypotension, tachycardia, respiratory distress, high PAOP with large V waves, low CI, cool and clammy skin, inspiratory crackles, and a loud blowing holosystolic murmur at the apex. A papillary muscle rupture, a cardiac tamponade, and an acute aortic insufficiency are other possible mechanical complications of MI, but they have different clinical manifestations. A papillary muscle rupture causes acute mitral regurgitation, which presents with a soft systolic murmur at the apex and pulmonary congestion1. A cardiac tamponade causes compression of the heart by pericardial fluid, which presents with hypotension, muffled heart sounds, and jugular venous distension2.
An acute aortic insufficiency causes backflow of blood from the aorta to the left ventricle, which presents with a diastolic decrescendo murmur at the left sternal border and a wide pulse pressure3.
References:
* 1: Mechanical complications of acute myocardial infarction - UpToDate4, p. 2-3.
* 2: Cardiac tamponade - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.
* 3: Acute aortic regurgitation - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.
NEW QUESTION # 64
A patient with a left ventricular assist device has been hospitalized for 5 days. A nurse notes anasarca and skin breakdown over multiple pressure points. When addressing the patient's nutritional needs, which of the following should the nurse consider?
- A. Lipids are needed for the utilization of protein calorie replacements.
- B. Edema may mask physical signs of protein calorie malnutrition.
- C. Initial signs may include low hemoglobin and hematocrit.
- D. Parenteral administration of amino acids is the first-line treatment.
Answer: B
Explanation:
Ventricular assist device
Protein calorie malnutrition (PCM) is a condition that occurs when the body does not get enough protein and calories to meet its needs. PCM can affect the immune system, wound healing, and organ function. Patients with a left ventricular assist device (LVAD) are at risk of PCM due to increased metabolic demands, fluid retention, inflammation, and poor appetite. Edema, or swelling, is a common sign of fluid overload in patients with LVADs. However, edema can also mask the physical signs of PCM, such as muscle wasting, weight loss, and skin changes. Therefore, the nurse should consider edema as a potential factor that can interfere with the assessment of the patient's nutritional status. Other methods to evaluate the patient's nutritional needs include laboratory tests, dietary intake, and body mass index. The nurse should also collaborate with a dietitian to provide appropriate nutritional interventions for the patient, such as oral supplements, enteral feeding, or parenteral nutrition.
References:
* Caring for patients with a left ventricular assist device, page 28.
* Ventricular assist device (VAD) - Mayo Clinic, under "Why it's done".
* Preoperative Nutritional Optimization and Physical Exercise for ..., under "Introduction".
* Obesity in Patients with Advanced Heart Failure and Left Ventricular ..., under "Introduction".
NEW QUESTION # 65
The underlying pathophysiology of disseminated intravascular coagulation (DIC) is best explained as
- A. fragmentation of erythrocytes.
- B. depression of platelet aggregation.
- C. depletion of clotting factors.
- D. inactivation of tissue thromboplastin.
Answer: C
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.
NEW QUESTION # 66
A patient who is post repair of an abdominal aortic aneurysm should be monitored for which of the following complications?
- A. atrial fibrillation
- B. acute renal failure
- C. acute CVA
- D. acute hepatic dysfunction
Answer: B
Explanation:
Abdominal aortic aneurysm
An x-ray of a human body Description automatically generated
Acute renal failure is one of the possible complications of abdominal aortic aneurysm (AAA) repair, especially after open surgery. Acute renal failure is a sudden loss of kidney function that can cause fluid and electrolyte imbalance, acid-base disturbance, and uremic syndrome. Acute renal failure can occur due to several factors, such as hypoperfusion of the kidneys, atheroembolism, contrast-induced nephropathy, or ischemia-reperfusion injury12. The incidence of acute renal failure after AAA repair ranges from 2 to 25%, depending on the definition, the type of surgery, and the patient's risk factors13. Acute renal failure is associated with increased morbidity, mortality, and length of hospital stay after AAA repair13.
Other complications of AAA repair include bleeding, infection, wound complications, graft-related complications, bowel ischemia, spinal cord ischemia, and cardiac, pulmonary, or neurological events124.
Acute hepatic dysfunction, acute CVA, and atrial fibrillation are not specific complications of AAA repair, but they may occur in any major surgery or in patients with preexisting conditions.
NEW QUESTION # 67
Which of the following are physiologic effects of pulmonary contusion?
- A. increased gas diffusion and decreased lung compliance
- B. increased lung compliance and decreased dead space
- C. increased dead space and decreased airway resistance
- D. increased airway resistance and decreased gas diffusion
Answer: D
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 # 68
Which of the following assessment findings would be found in a patient with pulmonary hypertension?
- A. pink frothy sputum
- B. distended neck veins
- C. rhonchi in the apices bilaterally
- D. crackles in the bases bilaterally
Answer: B
Explanation:
Pulmonary hypertension leads to increased pressure in the pulmonary circulation, which can cause right ventricular hypertrophy and failure. This results in systemic venous congestion, presenting as distended neck veins. Crackles, rhonchi, and pink frothy sputum are more indicative of pulmonary edema or other respiratory conditions rather than pulmonary hypertension. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 69
A patient with unilateral facial droop and slurred speech has a history of hyperlipidemia and hypertension. The nurse should anticipate an order for a
- A. head and neck CT scan.
- B. coagulation panel.
- C. triglyceride panel.
- D. head MRI.
Answer: A
Explanation:
Given the symptoms of unilateral facial droop and slurred speech, a stroke is highly suspected. A head and neck CT scan is the most appropriate initial imaging to quickly evaluate for the presence of an ischemic or hemorrhagic stroke, which is critical for determining the appropriate treatment plan. An MRI may provide more detailed information later but is not the initial test of choice in the acute setting. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 70
The most appropriate therapy for carboxyhemoglobinemia is
- A. aerosolized beta-agonists.
- B. 100% O2 administration.
- C. inhaled corticosteroids.
- D. hyperventilation.
Answer: B
Explanation:
The most appropriate therapy for carboxyhemoglobinemia, which is carbon monoxide poisoning, is the administration of 100% oxygen. This treatment helps to displace carbon monoxide from hemoglobin, allowing oxygen to bind to hemoglobin and be transported to tissues more effectively. High-flow oxygen can significantly reduce the half-life of carboxyhemoglobin, facilitating faster recovery.References: = CCRN Exam Handbook, page 30
NEW QUESTION # 71
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.
Answer: A
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
NEW QUESTION # 72
A nurse is caring for a patient with pulmonary fibrosis who is exhibiting shortness of breath, tachypnea, and feels a sense of impending doom. In order to relieve these symptoms, the nurse should anticipate an order for
- A. diazepam.
- B. morphine.
- C. hydromorphone.
- D. lorazepam.
Answer: B
Explanation:
Morphine is often used to relieve symptoms such as shortness of breath and anxiety in patients with pulmonary fibrosis. It works by reducing the sensation of dyspnea and the sense of impending doom by decreasing the respiratory drive and alleviating anxiety through its sedative effects. Additionally, morphine can help reduce tachypnea by slowing down the respiratory rate. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 73
Pulsus paradoxus is defined as
- A. a decrease in diastolic BP of greater than 10 mm Hg during normal expiration.
- B. a decrease in systolic BP of greater than 10 mm Hg during normal inspiration.
- C. an increase in systolic BP of greater than 10 mm Hg during normal inspiration.
- D. a decrease in systolic BP of greater than 10 mm Hg during normal expiration.
Answer: B
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 # 74
A patient is recovering from CABG surgery. On postoperative day 3, the patient's laboratory values indicate thrombocytopenia and elevated liver function tests. The patient is scheduled for hemodialysis today. A nurse notifies the physician of the abnormal laboratory values. The nurse should next anticipate an order to
- A. administer heparin to prevent clot formation.
- B. transfuse platelets during hemodialysis.
- C. complete hemodialysis without heparin.
- D. reschedule hemodialysis.
Answer: C
Explanation:
The patient has thrombocytopenia, which is a low platelet count that increases the risk of bleeding. Heparin is an anticoagulant that prevents clotting, but also increases the risk of bleeding. Therefore, heparin should be avoided in patients with thrombocytopenia. Hemodialysis can be performed without heparin by using alternative methods such as saline flushes, blood predilution, or specialized dialyzers that reduce clotting.
Transfusing platelets during hemodialysis is not recommended, as platelets may be damaged by the extracorporeal circuit. Rescheduling hemodialysis may not be feasible, as the patient may have fluid overload, electrolyte imbalance, or uremia that require urgent dialysis.
References:
* Use and safety of heparin-free maintenance hemodialysis in the USA
* Anticoagulation for the hemodialysis procedure
* Dialysis without anticoagulation (Heparin Free Dialysis)
NEW QUESTION # 75
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. loop diuretic
- B. vasopressors
- C. whole blood
- D. fluid resuscitation
Answer: D
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 # 76
An oncology patient presents with hematuria and bleeding from previous injection sites. Which diagnostic test result should the nurse review first?
- A. complete metabolic panel
- B. complete blood count
- C. coagulation panel
- D. arterial blood gas
Answer: C
Explanation:
For an oncology patient presenting with hematuria and bleeding from injection sites, reviewing the coagulation panel first is crucial. This test will provide information on the patient's clotting status, helping to identify potential coagulopathies such as disseminated intravascular coagulation (DIC), which is common in cancer patients. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 112-115.
NEW QUESTION # 77
Which of the following is a late finding in hypovolemic shock?
- A. hypotension
- B. cool, dry skin
- C. UO greater than 30 mL/hr
- 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 # 78
A nurse admits a patient awaiting surgery for an unstable pelvic fracture following a fall in which no other injuries were sustained. The nurse should prioritize
- A. transportation to radiology for an MRI.
- B. administration of a sedative to reduce movement.
- C. type and crossmatch PRBC prior to surgery.
- D. placement of a binder across the patient's hips.
Answer: D
Explanation:
In the context of an unstable pelvic fracture, placing a binder across the patient's hips is crucial to stabilize the fracture and reduce the risk of further internal bleeding and damage. This intervention helps in temporarily stabilizing the pelvis until definitive surgical treatment can be performed. Transporting the patient for an MRI is not the immediate priority, as the primary goal is to stabilize the patient. Type and crossmatching PRBCs are important but should follow immediate stabilization measures. Administering a sedative to reduce movement can be considered, but it is not the top priority over physical stabilization of the fracture.
References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 79
In a patient with hypertensive crisis, neurologic changes are caused by
- A. vasospasm of the cerebral arterioles.
- B. hypoxemia as a result of pulmonary interstitial edema.
- C. excessive secretion of catecholamines.
- D. increased ICP as a result of loss of cerebral autoregulation.
Answer: D
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
NEW QUESTION # 80
Which of the following is most indicative of successful treatment for salicylate poisoning?
- A. osmotic diuresis
- B. decrease in gastric pH
- C. alkalinization of urine
- D. decrease in CPK
Answer: C
Explanation:
Salicylate poisoning
Alkalinization of urine is one of the main goals of treatment for salicylate poisoning, as it enhances the renal excretion of salicylate and reduces its reabsorption. Alkalinization of urine can be achieved by administering intravenous sodium bicarbonate and maintaining adequate hydration and urine output. Alkalinization of urine can be monitored by measuring the urine pH, which should be above 7.5. Osmotic diuresis, decrease in gastric pH, and decrease in CPK are not indicative of successful treatment for salicylate poisoning. Osmotic diuresis may occur as a result of salicylate toxicity, but it does not improve the elimination of salicylate. Decrease in gastric pH may impair the absorption of salicylate, but it does not affect the elimination of salicylate. Decrease in CPK may reflect the resolution of rhabdomyolysis, which is a possible complication of salicylate poisoning, but it does not reflect the clearance of salicylate.
References:
* Salicylate (aspirin) poisoning: Management - UpToDate1, p. 1-2.
* Salicylate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice US2, p. 4-5.
NEW QUESTION # 81
A patient's blood culture report notes the presence of vancomycin resistant enterococcus. The nurse should place the patient in which type of isolation?
- A. contact
- B. protective
- C. droplet
- D. airborne
Answer: A
Explanation:
The nurse should place the patient in contact isolation, which is a type of precaution used to prevent the transmission of microorganisms that are spread by direct or indirect contact with the patient or the patient's environment. Contact isolation requires the use of gloves and gowns when entering the patient's room, as well as dedicated patient-care equipment and proper hand hygiene. Vancomycin resistant enterococcus (VRE) is a type of bacteria that is resistant to the antibiotic vancomycin and can cause infections in various sites, such as the urinary tract, bloodstream, or wounds. VRE can be spread by contact with contaminated surfaces, equipment, or hands.
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.
* CDC. (2019). Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved from [CDC Guidelines], p. 69-70.
* CDC. (2019). Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory. Retrieved from
[CDC Fact Sheet], p. 1-2.
NEW QUESTION # 82
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. cardioversion at 100 J.
- B. lidocaine (Xylocaine), 1.5 mg/kg IV.
- C. adenosine (Adenocard), 6 mg rapid IV bolus.
- D. defibrillation at 200 J.
Answer: A
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
NEW QUESTION # 83
For a patient who sustained blunt renal trauma and a crush injury to the leg, monitoring should include observing for
- A. a prolonged PR interval.
- B. a shortened PR interval.
- C. ST segment depression.
- D. tall peaked T waves.
Answer: D
Explanation:
Crush injuries can lead to significant muscle damage and rhabdomyolysis, resulting in the release of intracellular potassium into the bloodstream, causing hyperkalemia. Tall peaked T waves are a classic sign of hyperkalemia, which needs to be closely monitored in these patients. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
NEW QUESTION # 84
A caloric irrigation test of the oculovestibular reflex is performed on a patient who is comatose following a hypoxic brain injury. When cold water is introduced into the left ear, nystagmus occurs with slow deviation of the eyes toward the left, followed by faster eye deviation to the right. This pattern is indicative of a
- A. third cranial nerve palsy.
- B. persistent vegetative state.
- C. brain-stem infarction.
- D. normal response.
Answer: D
Explanation:
The caloric irrigation test, also known as the oculovestibular reflex test, is used to assess brainstem function in patients, especially those who are comatose. In this test, cold water is introduced into the ear canal, which should induce a predictable response if the brainstem is intact. The normal response to cold water irrigation is nystagmus with slow deviation of the eyes toward the side of the cold water (in this case, the left) and a fast phase of eye movement (nystagmus) away from the side of the cold water (to the right). This indicates that the brainstem pathways are functioning properly. References: =
* 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 # 85
A patient was admitted 3 days ago for an overdose of acetaminophen (Tylenol). The patient is developing a decreasing level of consciousness. Which the following is the most likely finding?
- A. splenomegaly
- B. decreased GFR
- C. increased INR
- D. Cheyne-Stokes respirations
Answer: C
Explanation:
A patient with acetaminophen overdose is at risk for acute liver failure, which can lead to coagulopathy. This condition is often marked by an increased International Normalized Ratio (INR) due to impaired synthesis of clotting factors in the liver. Decreasing level of consciousness can also result from hepatic encephalopathy, a complication of liver failure. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
NEW QUESTION # 86
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