CCRN-Adult Certification – Valid Exam Dumps Questions Study Guide! (Updated 152 Questions)
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NEW QUESTION # 36
A patient with an acute anterior wall MI presents with an S3 gallop and the following values:
Which drug therapy would be most appropriate for this patient?
- A. vasodilators and diuretics
- B. vasopressors and beta-blockers
- C. vasodilators and positive inotropes
- D. vasopressors and calcium-channel blockers
Answer: A
Explanation:
In the setting of an acute anterior wall myocardial infarction (MI) with an S3 gallop, the patient is likely experiencing heart failure and possibly acute pulmonary edema. The appropriate treatment includes vasodilators to reduce afterload and diuretics to decrease preload and pulmonary congestion. This combination helps to improve cardiac output and reduce the workload on the heart. References: CCRN Exam Handbook, AACN, page 20, section on Cardiovascular.
NEW QUESTION # 37
An older adult patient has been in the unit for 60 hours. The patient has received benzodiazepines for agitation, opioids for persistent pain, and bronchodilators. The patient reports that there is too much noise, and they cannot get peace and quiet. The nurse should evaluate for
- A. an anxiety disorder.
- B. acute manic episodes.
- C. situational depression.
- D. sleep disturbances.
Answer: D
Explanation:
The patient who has been in the unit for 60 hours and reports agitation, noise disturbances, and an inability to get peace and quiet may be experiencing sleep disturbances. Factors such as the ICU environment, frequent interventions, and the medications being administered (e.g., benzodiazepines, opioids, and bronchodilators) can significantly disrupt sleep patterns, leading to further agitation and delirium. Addressing the patient's sleep hygiene and implementing measures to promote rest can be beneficial.References: = CCRN Exam Handbook, page 52
NEW QUESTION # 38
A patient with a spinal cord injury at T7 tells the nurse that they now have a pounding headache. The nurse should
- A. administer PRN acetaminophen.
- B. perform a stroke assessment.
- C. place the patient in supine position.
- D. check for bladder distension.
Answer: D
Explanation:
Spinal cord injury
An x-ray of a spine Description automatically generated
A sudden and severe headache in a patient with a spinal cord injury at T7 could be a symptom of autonomic dysreflexia12. This condition is a potentially life-threatening medical emergency that can occur in individuals with spinal cord injuries above the T6 level12. It is most commonly triggered by an overfull bladder or a blocked catheter12. Therefore, the nurse should first check for bladder distension123.
NEW QUESTION # 39
Which of the following are most indicative of acute pancreatitis?
- A. severe mid-epigastric pain, leukocytosis, hypocalcemia
- B. abdominal distention, decreased lipase level, hypertension
- C. hypotension, jaundice, hyperalbuminuria
- D. Grey Turner's sign, hyperkalemia, right shoulder pain
Answer: A
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 # 40
A nurse has responded to a rapid response call on a medical-surgical floor in the hospital. The nurse finds the patient with the following data:
BP72/30
HR132
RR24
T102.3° F (39.0° C)
SpO295%
Ph7.13
PaCO234 mm Hg
PaO288 mm Hg
HCO3 14 mEq/L
Na+ 142 mEq/L
The nurse should anticipate an order to administer which of the following?
- A. 8.4% sodium bicarbonate
- B. 0.9% sodium chloride
- C. phenylephrine (Neo-Synephrine)
- D. amiodarone (Cordarone)
Answer: C
Explanation:
The patient's data indicate that the patient is in shock, which is a life-threatening condition characterized by inadequate tissue perfusion and organ dysfunction. The patient has a low blood pressure, a high heart rate, a fever, and a metabolic acidosis, which suggest that the patient may have septic shock, which is caused by a severe infection that triggers a systemic inflammatory response. The nurse should anticipate an order to administer phenylephrine (Neo-Synephrine), which is a vasopressor agent that constricts the blood vessels and increases the blood pressure and tissue perfusion. Phenylephrine is recommended as a first-line agent for septic shock by the Surviving Sepsis Campaign guidelines1. 8.4% sodium bicarbonate is not indicated for the treatment of septic shock, as it may worsen the acid-base balance and increase the risk of complications2.
0.9% sodium chloride is a normal saline solution that may be used for fluid resuscitation, but it may not be sufficient to restore the blood pressure and may cause fluid overload, hyperchloremia, and kidney injury3.
Amiodarone (Cordarone) is an antiarrhythmic drug that is used to treat ventricular tachycardia or fibrillation, but it is not effective for septic shock and may cause hypotension, bradycardia, and other adverse effects4.
References:
* Surviving Sepsis Campaign. (2020). Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Retrieved from 1, p. 16.
* Marik, P. E., & Bellomo, R. (2013). A rational approach to fluid therapy in sepsis. British Journal of Anaesthesia, 110(3), 323-329. Retrieved from 2, p. 327.
* Semler, M. W., & Rice, T. W. (2019). Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials,
20(1), 1-10. Retrieved from 3, p. 2-3.
* Lexicomp Online. (2021). Amiodarone. Retrieved from 4, p. 1-2.
NEW QUESTION # 41
Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include
- A. increases in PT, PTT, and FSP (FDP).
- B. decreases in PT and thrombin time.
- C. decreases in platelet count, thrombin time, and FSP (FDP).
- 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 # 42
To maintain adequate pain control in a post-surgical patient addicted to heroin, a nurse should plan to
- A. administer oral opioids only as needed.
- B. administer PCA with continuous and on-demand opioid delivery.
- C. avoid administering any intravenous pain medication.
- D. administer PCA opioids with on-demand dosing only.
Answer: B
Explanation:
For a post-surgical patient with a history of heroin addiction, a PCA (patient-controlled analgesia) with both continuous and on-demand opioid delivery ensures consistent pain control and addresses both baseline pain and breakthrough pain. This approach helps manage pain more effectively and can prevent withdrawal symptoms in patients with opioid tolerance. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 88-90.
NEW QUESTION # 43
Examination of a patient exhibiting Kernig's and Brudzinski's signs indicates which of the following?
- A. adrenal insufficiency
- B. increased intracranial pressure
- C. meningeal irritation
- D. autonomic hyperreflexia
Answer: C
Explanation:
Kernig's and Brudzinski's signs are classic clinical indicators of meningeal irritation, commonly associated with conditions such as meningitis. Kernig's sign is positive when there is resistance and pain upon extending the knee from a flexed position, and Brudzinski's sign is positive when flexion of the neck causes involuntary flexion of the hips and knees. These signs are not indicative of autonomic hyperreflexia, adrenal insufficiency, or increased intracranial pressure. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 44
A unit council is requesting to change a documentation screen of the electronic health record (EHR) at a large health system. The change was not discussed with the department prior to the request and was denied by the EHR committee. Which of the following strategies will most likely lead to accomplishing the team's goals?
- A. Discuss the proposed solution with stakeholders to determine buy in.
- B. Have nursing leadership evaluate the proposal before resubmitting the request.
- C. Attempt to change the process through another format.
- D. Work with key staff members to rewrite the request to present at the next meeting.
Answer: A
Explanation:
When seeking to make changes to a documentation screen in the electronic health record (EHR), it is crucial to involve all relevant stakeholders to ensure their buy-in and support. This includes discussing the proposed changes with those who will be directly impacted by it and obtaining their feedback. This collaborative approach can help in identifying potential issues and garnering the necessary support for the proposal, increasing the likelihood of it being accepted by the EHR committee in the future.References: = CCRN Exam Handbook, page 58
NEW QUESTION # 45
A patient is receiving therapeutic hypothermia post-cardiac arrest. Which of the following orders should a nurse clarify?
- A. chemistry labs every day
- B. sequential compression devices
- C. hourly intake and output
- D. ABGs every 4 hours and with any ventilator changes
Answer: B
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 # 46
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. Kayexalate in sorbitol.
- C. 50% dextrose and insulin.
- D. hemodialysis.
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 # 47
Which of the following is a sign of brain death?
- A. negative cold caloric test
- B. positive cough reflex
- C. negative apnea test
- D. positive vestibulo-ocular reflex
Answer: C
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 # 48
A patient lying on the left side in Trendelenburg position is in the correct position for postural drainage of which of the following lobes of the lungs?
- A. right lower
- B. left upper
- C. right upper
- D. left lower
Answer: A
Explanation:
For postural drainage of the right lower lobe, the patient should be positioned on their left side in the Trendelenburg position. This positioning utilizes gravity to facilitate the drainage of secretions from the right lower lobe of the lungs. In the Trendelenburg position, the body is laid flat on the back with the feet higher than the head, which helps drain the lower lobes effectively.References: = CCRN Exam Handbook, page 22
NEW QUESTION # 49
A patient underwent a successful percutaneous coronary intervention to the left anterior descending coronary artery. The patient suddenly begins to complain of dyspnea, jaw pain, and chest tightness. The bedside monitor displays sinus tachycardia and ST segment elevation in lead V2. The patient's neck veins are flat and BP is
152/98. Which of the following is the most likely cause of the patient's symptoms?
- A. coronary artery occlusion
- B. pulmonary hypertension
- C. cardiac tamponade
- D. vasovagal reaction
Answer: A
Explanation:
The patient presents with dyspnea, jaw pain, chest tightness, and sinus tachycardia with ST segment elevation in lead V2 after a percutaneous coronary intervention (PCI). These symptoms are indicative of myocardial ischemia or infarction, likely due to a re-occlusion of the treated coronary artery. Coronary artery occlusion is a common cause of these acute symptoms post-PCI. Other options like pulmonary hypertension, vasovagal reaction, and cardiac tamponade are less consistent with the clinical presentation. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 50
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. ventricular septal defect.
- B. papillary muscle rupture.
- C. acute aortic insufficiency.
- D. cardiac tamponade.
Answer: A
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 # 51
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