[Dec 29, 2024] Latest Questions CCRN-Adult Guide to Prepare Free Practice Tests
Reliable CCRN-Adult Dumps Questions Available as Web-Based Practice Test Engine
NEW QUESTION # 17
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. left ventricular failure.
- B. advanced heart failure.
- C. heart failure with preserved EF.
- D. heart failure with reduced EF.
Answer: C
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 # 18
An unconscious patient in hepatic failure secondary to alcoholism becomes acutely hypoglycemic. Glucagon administration is contraindicated for this patient because glucagon
- A. interferes with lactulose (Cephulac) therapy.
- B. is ineffective when hepatocytes are damaged.
- C. produces additional sedative effects.
- D. causes rebound hyperglycemia.
Answer: B
Explanation:
Glucagon is a hormone that stimulates the liver to release glucose from glycogen stores or from gluconeogenesis. However, when the hepatocytes are damaged by alcoholism or other causes of hepatic failure, glucagon is ineffective because the liver cannot respond to its signal. Glucagon administration is contraindicated for hypoglycemic patients with hepatic failure because it will not raise their blood glucose levels and may worsen their acidosis and electrolyte imbalance123 References:
* Hypoglycemia in Patients With Hepatic Failure - PubMed
* Glucagon - Wikipedia
* Frontiers | Glucagon Receptor Signaling and Lipid Metabolism
NEW QUESTION # 19
A patient reported to have smoked crack cocaine is brought to the hospital by paramedics and admitted in an agitated state. On the way to the hospital, the patient had a generalized seizure. The toxicology screen is positive for cocaine. Which of the following is most appropriate to administer?
- A. ipecac
- B. naloxone (Narcan)
- C. activated charcoal
- D. lorazepam (Ativan)
Answer: D
Explanation:
Lorazepam (Ativan) is most appropriate to administer in a patient who has smoked crack cocaine and is agitated, particularly after a generalized seizure. Benzodiazepines like lorazepam help to manage agitation and seizure activity associated with cocaine toxicity by providing sedative and anticonvulsant effects.References: = CCRN Exam Handbook, page 53
NEW QUESTION # 20
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 # 21
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 # 22
A patient is intubated, is unable to follow simple commands, and has no history of alcohol abuse. The patient has become increasingly disoriented and confused over the past 24 hours. After assessment and treatment of pain, the best medication intervention for management is
- A. cisatracurium (Nimbex).
- B. dexmedetomidine (Precedex).
- C. lorazepam (Ativan).
- D. midazolam (Versed).
Answer: B
Explanation:
Dexmedetomidine (Precedex) is the most appropriate medication for managing agitation and delirium in a critically ill intubated patient. It provides sedation without significant respiratory depression and has analgesic properties, which makes it suitable for patients who are disoriented and confused. Unlike benzodiazepines (lorazepam and midazolam) or neuromuscular blockers (cisatracurium), dexmedetomidine can improve delirium outcomes and facilitates easier weaning from mechanical ventilation. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 57-60.
NEW QUESTION # 23
A 22-year-old trauma patient sustained multiple fractures after a fall. The patient fell 50 feet from a cliff while rock climbing without a harness. The patient is intubated and sedated with casts to bilateral lower extremities.
The nurse should recognize that young adults are
- A. working through trust issues that cause them to test limits.
- B. developmentally vulnerable to peer pressure in extreme sports.
- C. influenced by long-time intervals spent in virtual reality.
- D. more likely to engage in risk-taking behaviors.
Answer: D
NEW QUESTION # 24
A patient with a hemorrhaging renal laceration has received two units of PRBCs and 500 mL of NS via IV bolus. Assessment reveals: BP 78/42; HR 148; UO 15 mL/hr; skin is cool and diaphoretic. While preparing the patient for emergency surgery, a nurse should administer
- A. norepinephrine (Levophed), 10 mcg/min.
- B. dopamine (Intropin), 3 mcg/kg/min.
- C. mannitol (Osmitrol), 25 g IV.
- D. an additional 500-mL bolus of NS.
Answer: A
Explanation:
In a patient with a hemorrhaging renal laceration who remains hypotensive despite fluid resuscitation with two units of PRBCs and 500 mL of NS, administering norepinephrine (Levophed) is appropriate. Norepinephrine is a potent vasopressor that helps to increase blood pressure by vasoconstriction and improving cardiac output, which is critical in stabilizing a patient with severe hemorrhagic shock prior to surgery.References: = CCRN Exam Handbook, page 38
NEW QUESTION # 25
A patient admitted with a diagnosis of pneumonia has a temperature of 103.2° F (39.5° C) and copious pulmonary secretions. ABG results drawn on room air are:
The nurse should expect that hemoglobin's affinity for oxygen in this patient to be
- A. increased.
- B. unpredictable.
- C. unchanged.
- D. decreased.
Answer: D
Explanation:
The patient's ABG results indicate respiratory acidosis (pH 7.33, PaCO2 48 mm Hg) with a slightly elevated temperature (103.2° F). In the context of fever and acidosis, hemoglobin's affinity for oxygen decreases, a phenomenon described by the Bohr effect. This means that hemoglobin will release oxygen more readily to the tissues. Factors like increased temperature and acidosis cause a rightward shift in the oxyhemoglobin dissociation curve, reducing the affinity of hemoglobin for oxygen.References: = CCRN Exam Handbook, page 44
NEW QUESTION # 26
Following a splenectomy, a patient is most at risk for
- A. pulmonary embolism.
- B. hypertension.
- C. sepsis.
- D. wound dehiscence.
Answer: C
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 # 27
An unconscious patient presents with the following laboratory values:
Appropriate management of this patient should include
- A. intubation.
- B. osmotic diuresis.
- C. hemodialysis.
- D. IV hydration.
Answer: D
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.
NEW QUESTION # 28
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 # 29
The underlying pathophysiology of disseminated intravascular coagulation (DIC) is best explained as
- A. inactivation of tissue thromboplastin.
- B. fragmentation of erythrocytes.
- C. depression of platelet aggregation.
- D. depletion of clotting factors.
Answer: D
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 # 30
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. Initial signs may include low hemoglobin and hematocrit.
- B. Parenteral administration of amino acids is the first-line treatment.
- C. Lipids are needed for the utilization of protein calorie replacements.
- D. Edema may mask physical signs of protein calorie malnutrition.
Answer: D
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 # 31
The intended effects of medications for a patient in acute CHF are to
- A. reduce CVP and increase SVR.
- B. increase CVP and reduce SVR.
- C. reduce CVP and reduce SVR.
- D. increase CVP and increase SVR.
Answer: C
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.
NEW QUESTION # 32
Potentially life-threatening consequences of diabetic ketoacidosis (DKA) include
- A. intracellular hyperglycemia.
- B. cellular dehydration.
- C. respiratory alkalosis.
- D. metabolic alkalosis.
Answer: B
Explanation:
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Cellular dehydration is one of the potentially life-threatening consequences of diabetic ketoacidosis (DKA), which is a condition that occurs when the body does not have enough insulin to use glucose for energy and starts to break down fat instead. This produces ketones, which are acidic substances that accumulate in the blood and urine. DKA causes hyperglycemia, which is a high level of glucose in the blood, and osmotic diuresis, which is the loss of water and electrolytes through the urine. This leads to cellular dehydration, which is the shrinkage of the cells due to the loss of water from the intracellular fluid. Cellular dehydration can affect the brain and cause neurological symptoms, such as confusion, lethargy, coma, and death12.
Other potentially life-threatening consequences of DKA include metabolic acidosis, which is a low pH of the blood due to the excess of ketones, and respiratory compensation, which is the increase of the breathing rate and depth to expel carbon dioxide and lower the acidity of the blood12. These are not the same as metabolic alkalosis or respiratory alkalosis, which are conditions that cause a high pH of the blood due to the loss of acids or the retention of bases2. Intracellular hyperglycemia is not a consequence of DKA, as the glucose cannot enter the cells without insulin and remains in the extracellular fluid12.
NEW QUESTION # 33
A patient with a sodium level of 114 mEq/L is most likely to develop
- A. tetany.
- B. seizures.
- C. flaccid paralysis.
- D. cardiac arrhythmias.
Answer: B
Explanation:
Hyponatremia
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A patient with a sodium level of 114 mEq/L is most likely to develop seizures, which are a manifestation of severe hyponatremia and cerebral edema. Hyponatremia is a low level of sodium in the blood, which can cause water to move into the brain cells and cause them to swell. This can lead to increased intracranial pressure, neurological dysfunction, and seizures. Seizures are a medical emergency and require prompt treatment to prevent brain damage or death. Tetany, flaccid paralysis, and cardiac arrhythmias are not typical signs of hyponatremia, but may occur in other electrolyte disorders, such as hypocalcemia, hyperkalemia, or hypokalemia.
References:
* Overview of the treatment of hyponatremia in adults - UpToDate1, p. 1-2.
* Manifestations of hyponatremia and hypernatremia in adults - UpToDate2, p. 1-2.
NEW QUESTION # 34
While recording hourly ventilator checks on a patient who is being mechanically ventilated, the nurse notes that the PIP has gradually increased by 5 cm H2O over the past 4 hours. This increase indicates
- A. an improvement in pulmonary function.
- B. a decrease in lung compliance.
- C. a decrease in airway resistance.
- D. a leak in the ET tube cuff.
Answer: B
Explanation:
An increase in peak inspiratory pressure (PIP) over time in a mechanically ventilated patient indicates a decrease in lung compliance. This means the lungs are becoming stiffer and less able to expand, which can be caused by conditions such as pulmonary edema, ARDS, or pneumothorax. It is important to address the underlying cause of decreased lung compliance to prevent further respiratory complications. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 35
Assessment of a patient with a head injury reveals increased muscle tone and contractured positioning of the upper extremities. A nurse should
- A. consult a physical therapist regarding appropriate positioning.
- B. recognize that contractures are an expected response after a head injury.
- C. obtain an order for a muscle relaxer.
- D. use wrist restraints to maintain upper extremity extension.
Answer: A
Explanation:
In patients with head injuries, increased muscle tone and contractured positioning (such as decorticate or decerebrate posturing) are signs of significant neurological impairment. It is essential to manage these symptoms to prevent further complications. Consulting a physical therapist is the best course of action to ensure appropriate positioning, prevent contractures, and manage spasticity effectively. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.
NEW QUESTION # 36
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