Easy To Download AACN CCRN-Adult Exam Dumps Updated 152 Questions
New Updated CCRN-Adult Exam Questions 2024
NEW QUESTION # 74
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. right upper
- C. left lower
- D. left upper
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 # 75
The nurse who is caring for a patient following an esophagectomy notes new subcutaneous emphysema in the upper chest and neck. The nurse should expect an order for
- A. chest tube insertion.
- B. gastric decompression.
- C. a CT scan.
- D. IV antibiotics.
Answer: C
Explanation:
Subcutaneous emphysema (SE) is a condition where gas or air accumulates in the subcutaneous tissue layer of the skin, causing swelling and a crackling sensation when touched. SE can occur after esophagectomy, a surgical procedure to remove part or all of the esophagus, due to air leakage from the anastomosis site or the lung. SE can also be a sign of a more serious complication, such as anastomotic leakage, mediastinitis, or tracheal injury12. Therefore, the nurse should expect an order for a CT scan, which is a diagnostic imaging test that can detect the source and extent of the air leakage and any associated complications. A CT scan can also guide the appropriate management of SE, which may include conservative measures, such as increasing the suction of the chest tube, or more invasive interventions, such as surgical repair or drainage123. Chest tube insertion, IV antibiotics, and gastric decompression are not likely to be ordered for SE after esophagectomy, as they do not address the underlying cause of the air leakage or the potential complications. Chest tube insertion may be indicated for pneumothorax, but not for SE alone. IV antibiotics may be indicated for infection, but not for SE alone. Gastric decompression may be indicated for gastric distension, but not for SE alone.
NEW QUESTION # 76
The purpose of administering a sodium nitroprusside (Nipride) drip after a carotid endarterectomy is to
- A. promote myocardial contractility and thus enhance cerebral perfusion.
- B. decrease MAP and thus prevent hemorrhage at the operative site.
- C. increase afterload and thus promote vessel patency.
- D. increase coronary perfusion and thus increase cardiac output.
Answer: B
Explanation:
Sodium nitroprusside (Nipride) is administered after a carotid endarterectomy to decrease mean arterial pressure (MAP) and reduce the risk of hemorrhage at the surgical site. By lowering the blood pressure, it minimizes the chance of bleeding while ensuring adequate cerebral perfusion through careful monitoring.
References: = AACN Handbook for CCRN Certification, pp. 75-78.
NEW QUESTION # 77
A patient has gained 8 kg in the past week. Serum sodium is 115 mEq/L, CVP is 20 mm Hg, and serum osmolality is decreased. The patient has just experienced a generalized tonic-clonic seizure. In this situation, which of the following IV solutions should a nurse be prepared to administer?
- A. 0.45% sodium chloride
- B. 3% sodium chloride
- C. 5% dextrose with 0.25% sodium chloride
- D. 0.9% sodium chloride
Answer: B
Explanation:
The patient has signs of severe hyponatremia, which is a low level of sodium in the blood. Hyponatremia can cause cerebral edema, which can lead to seizures, confusion, coma, and death. The patient needs a hypertonic solution, which is a fluid that has a higher concentration of solutes than the blood, to draw water out of the brain cells and restore the normal sodium level. 3% sodium chloride is a hypertonic solution that can be used to treat severe hyponatremia. 0.45% sodium chloride, 0.9% sodium chloride, and 5% dextrose with 0.25% sodium chloride are all hypotonic solutions, which are fluids that have a lower concentration of solutes than the blood, and would worsen the patient's condition by adding more water to the blood and the brain.
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.
* AACN. (2020). Practice Alert: Hyponatremia. Retrieved from [Practice Alert], p. 1-2.
* Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017).
Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO:
Elsevier. Retrieved from [Textbook], p. 303-304.
NEW QUESTION # 78
The first priority in management of an acute GI hemorrhage is
- A. pain relief.
- B. fluid resuscitation.
- C. monitoring of serial Hgb and Hct.
- D. Sengstaken-Blakemore tube insertion.
Answer: B
Explanation:
The first priority in the management of an acute gastrointestinal (GI) hemorrhage is fluid resuscitation. This is critical to maintaining hemodynamic stability and ensuring adequate perfusion of vital organs. Monitoring of serial hemoglobin and hematocrit (Hgb and Hct) levels, while important for ongoing assessment, is secondary to the immediate need to stabilize the patient's circulatory status. Pain relief and insertion of a Sengstaken-Blakemore tube may be part of the overall management plan but are not the first priority.
References: CCRN Exam Handbook, AACN, page 27, section on GI emergencies.
NEW QUESTION # 79
The underlying pathophysiology of disseminated intravascular coagulation (DIC) is best explained as
- A. fragmentation of erythrocytes.
- B. depletion of clotting factors.
- C. inactivation of tissue thromboplastin.
- D. depression of platelet aggregation.
Answer: B
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 # 80
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. cardiac tamponade
- B. vasovagal reaction
- C. pulmonary hypertension
- D. coronary artery occlusion
Answer: D
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 # 81
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 # 82
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. "I will check on you every 30 minutes."
- B. "You need to be repositioned only every 2 hours."
- C. "You are safe. Nothing will happen to you."
- D. "I will get someone to sit with you."
Answer: D
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 # 83
The rationale for initiating early enteral feeding in a patient with sepsis is to
- A. minimize translocation of GI bacteria.
- B. prevent pulmonary aspiration.
- C. minimize electrolyte imbalances and fluid shifts.
- D. increase GI motility.
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 # 84
A patient post-surgical externalized ventricular drain placement has treatment orders that include continuous cerebrospinal fluid (CSF) drainage at 10 mm Hg. Which of the following should the nurse anticipate with an increase in the ICP above 25 mm Hg?
- A. the amplitude of P2 greater than P1 on the waveform morphology
- B. a change in CSF drainage from clear to pink
- C. a decrease in the pulse pressure
- D. an increase in the cerebral perfusion pressure from 65 to 70
Answer: A
Explanation:
An increase in intracranial pressure (ICP) above 25 mm Hg often results in changes in the waveform morphology observed in the monitoring of intracranial pressure. Specifically, the amplitude of P2 becomes greater than P1, which is indicative of decreased intracranial compliance. This pattern is known as the
"pathological waveform," suggesting increased intracranial pressure and decreased ability of the brain to accommodate the pressure changes. References: CCRN Exam Handbook, AACN, page 23, section on Neurological.
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. decreased GFR
- B. splenomegaly
- C. Cheyne-Stokes respirations
- D. increased INR
Answer: D
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
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. a decrease in lung compliance.
- B. a decrease in airway resistance.
- C. an improvement in pulmonary function.
- D. a leak in the ET tube cuff.
Answer: A
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 # 87
Pulsus paradoxus is defined as
- A. a decrease in diastolic BP of greater than 10 mm Hg during normal expiration.
- B. an increase in systolic BP of greater than 10 mm Hg during normal inspiration.
- C. a decrease 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: C
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 # 88
A patient is receiving continuous enteral feedings via jejunostomy tube. The patient develops mild, intermittent diarrhea. Which of the following actions is most appropriate?
- A. Obtain an abdominal x-ray.
- B. Consider PICC line placement.
- C. Contact the physician for an order to hold feedings.
- D. Review the patient's formula with nutrition services.
Answer: D
Explanation:
Mild, intermittent diarrhea in a patient receiving continuous enteral feedings can often be managed by reviewing and possibly adjusting the feeding formula. This approach can address potential intolerance or sensitivity to the current formula. An abdominal x-ray or considering PICC line placement are not appropriate first-line responses to mild diarrhea, and holding feedings without further assessment could negatively impact the patient's nutritional status. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 89
A nurse is caring for a patient who had a gastric bypass procedure 2 days ago. A physician has ordered a gastric tube to be placed due to increased abdominal distention. The nurse realizes that this procedure will most likely need to be done
- A. with a guide wire.
- B. by two nurses.
- C. under fluoroscopy.
- D. using ultrasound.
Answer: C
Explanation:
After gastric bypass surgery, the altered anatomy of the gastrointestinal tract makes it challenging to place a gastric tube. Performing the procedure under fluoroscopy provides real-time imaging guidance, ensuring correct placement and reducing the risk of complications, such as perforation or misplacement.References: = CCRN Exam Handbook, page 45
NEW QUESTION # 90
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