Updated Dec-2024 Test Engine to Practice CCRN-Adult Dumps & Practice Exam
Dumps Collection CCRN-Adult Test Engine Dumps Training With 152 Questions
NEW QUESTION # 68
A patient is intubated and receiving assist control mechanical ventilation and is on a norepinephrine drip following a head injury. Patient data are:
Which of the following interventions will improve cerebral perfusion?
- A. increasing the norepinephrine rate
- B. requesting an ABG
- C. suctioning the airway
- D. administering prescribed acetaminophen
Answer: D
NEW QUESTION # 69
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. A chaplain's visit will not benefit a patient who is comatose or non-communicative.
- B. It would be inappropriate for the hospital chaplain to document in the medical record.
- C. The chaplain may be of a specific denomination, but the chaplain provides resources to patients of many faiths and beliefs.
- D. The service should be provided only when specifically requested by the patient or family.
Answer: C
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 # 70
The most appropriate therapy for carboxyhemoglobinemia is
- A. inhaled corticosteroids.
- B. hyperventilation.
- C. 100% O2 administration.
- D. aerosolized beta-agonists.
Answer: C
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 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. Attempt to change the process through another format.
- C. Have nursing leadership evaluate the proposal before resubmitting the request.
- 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 # 72
An unconscious patient presents with the following laboratory values:
Appropriate management of this patient should include
- A. osmotic diuresis.
- B. intubation.
- 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 # 73
A patient who sustained acute head trauma exhibited intermittent unconsciousness prior to admission. The patient is disoriented initially and exhibits rapid deterioration in neurological status shortly after admission.
X-rays reveal a right temporal bone fracture, and a diagnosis of epidural hematoma is made. The deterioration in the patient's condition is most likely associated with
- A. venous bleeding.
- B. clot formation.
- C. arterial bleeding.
- D. intracranial aneurysm.
Answer: C
Explanation:
Epidural hematoma
An epidural hematoma is a collection of blood that forms between the skull and the dura mater, the outermost layer of the meninges that cover the brain. The most common cause of an epidural hematoma is a head injury that fractures the temporal bone and tears the middle meningeal artery, which runs along the inner surface of the skull. Arterial bleeding is under high pressure and can rapidly expand the hematoma, compressing the brain and causing neurological deterioration. A typical symptom of an epidural hematoma is a brief loss of consciousness followed by a lucid interval and then a rapid decline in consciousness and brain function. This condition requires urgent surgical evacuation of the hematoma to prevent brain damage or death12. Venous bleeding, clot formation, and intracranial aneurysm are not the main factors associated with the deterioration of the patient's condition in this case.
NEW QUESTION # 74
Which of the following signs is most frequently associated with meningitis?
- A. positive Trousseau's
- B. positive Babinski's
- C. positive Cullen's
- D. positive Kernig's
Answer: D
Explanation:
Meningitis
A positive Kernig's sign is a clinical test for meningitis that involves flexing the hip and knee of the patient and then extending the knee. If the patient feels pain or resistance in the lower back or hamstring, the test is positive. A positive Kernig's sign indicates irritation of the meninges, the membranes that cover the brain and spinal cord. A positive Trousseau's sign is a sign of hypocalcemia that involves carpal spasm after inflating a blood pressure cuff. A positive Cullen's sign is a sign of retroperitoneal bleeding that involves bruising around the umbilicus. A positive Babinski's sign is a sign of upper motor neuron lesion that involves fanning of the toes when the sole of the foot is stroked.
References:
* Kernig's sign - Wikipedia
* Trousseau's sign - Wikipedia
* Cullen's sign - Wikipedia
* Babinski sign - Wikipedia
NEW QUESTION # 75
A patient with a history of asthma presents with acute onset of dyspnea, a non-productive cough, and tachypnea. He is very anxious, restless, and tachycardic. Which of the following is a first-line drug for these symptoms?
- A. leukotriene inhibitor
- B. beta-agonist
- C. mast cell stabilizer
- D. anticholinergic
Answer: B
Explanation:
Beta-agonists are the first-line drugs for acute asthma exacerbations because they rapidly reverse bronchoconstriction and improve airflow. They act by stimulating beta-2 receptors in the smooth muscle of the airways, causing relaxation and dilation. Beta-agonists can be administered by inhalation, nebulization, or injection. Examples of beta-agonists include albuterol, levalbuterol, and terbutaline.
References:
* Management of Acute Asthma Exacerbations | AAFP: This article states that "Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."
* Asthma attack - Diagnosis and treatment - Mayo Clinic: This article states that "If you're in the yellow zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you can repeat the dose. Young children or people who have difficulty with an inhaler use a device called a nebulizer to inhale the medicine in a mist. Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."
NEW QUESTION # 76
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. vasodilators and positive inotropes
- C. vasopressors and calcium-channel blockers
- D. vasopressors and beta-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 # 77
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. brain-stem infarction.
- C. persistent vegetative state.
- 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 # 78
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. sepsis.
- B. acute pulmonary edema.
- C. a pulmonary embolus.
- D. a fat embolus
Answer: D
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 # 79
Potentially life-threatening consequences of diabetic ketoacidosis (DKA) include
- A. respiratory alkalosis.
- B. intracellular hyperglycemia.
- C. metabolic alkalosis.
- D. cellular dehydration.
Answer: D
Explanation:
A bag of food on a hook Description automatically generated
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 # 80
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. using ultrasound.
- B. with a guide wire.
- C. under fluoroscopy.
- D. by two nurses.
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 # 81
A patient with a history of alcohol abuse has been admitted for progressive dyspnea and leg swelling.
Assessment findings include:
BP155/90
HR85
CVP12 mm Hg
Which of the following tests will provide the most definitive diagnosis?
- A. pro-BNP
- B. echocardiogram
- C. chest x-ray
- D. liver function panel
Answer: B
NEW QUESTION # 82
Which of the following ECG changes is expected in a patient with a potassium concentration of 3.0 mEq/L?
- A. inverted P wave, elevated T wave, and prolonged QT interval
- B. tall peaked T wave, prolonged PR interval, and prolonged QRS complex
- C. shortened QT interval and complete atrioventricular block
- D. ST segment depression, flattened and inverted T wave, and a U wave
Answer: D
Explanation:
Hypokalemia
A patient with a potassium concentration of 3.0 mEq/L has mild hypokalemia, which is a low level of potassium in the blood. Hypokalemia can cause various ECG changes that reflect the impairment of cardiac depolarization and repolarization. The most common ECG changes in mild hypokalemia are ST segment depression, flattened and inverted T wave, and a U wave, which is a positive deflection after the T wave.
These ECG changes can be seen in the examples from the web search results12. Other ECG changes that may occur in more severe hypokalemia are prolonged QT interval, frequent ectopic beats, and arrhythmias123. Tall peaked T wave, prolonged PR interval, and prolonged QRS complex are ECG changes associated with hyperkalemia, which is a high level of potassium in the blood12. Shortened QT interval and complete atrioventricular block are not typical ECG changes of hypokalemia, but may occur in other electrolyte disorders, such as hypercalcemia2. Inverted P wave, elevated T wave, and prolonged QT interval are not specific ECG changes of hypokalemia, but may occur in other cardiac conditions, such as ischemia, myocarditis, or pericarditis2.
NEW QUESTION # 83
Which of the following is most indicative of successful treatment for salicylate poisoning?
- A. decrease in CPK
- B. decrease in gastric pH
- C. alkalinization of urine
- D. osmotic diuresis
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 # 84
A common problem in patients with third-degree AV block is
- A. hypoperfusion.
- B. heart failure.
- C. hypoxia.
- D. chest pain.
Answer: A
Explanation:
Hypoperfusion is a condition in which the blood flow to the organs and tissues is insufficient to meet their metabolic demands. Hypoperfusion can result from third-degree AV block, which is a complete loss of communication between the atria and the ventricles. This causes the ventricles to beat very slowly or not at all, leading to a low cardiac output and reduced blood pressure. Hypoperfusion can cause symptoms such as dizziness, fainting, confusion, chest pain, shortness of breath, and shock12. Heart failure, hypoxia, and chest pain are possible complications of hypoperfusion, but they are not the most common problem in patients with third-degree AV block.
NEW QUESTION # 85
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. lorazepam (Ativan)
- B. naloxone (Narcan)
- C. ipecac
- D. activated charcoal
Answer: A
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 # 86
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. defibrillation at 200 J.
- B. cardioversion at 100 J.
- C. lidocaine (Xylocaine), 1.5 mg/kg IV.
- D. adenosine (Adenocard), 6 mg rapid IV bolus.
Answer: B
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 # 87
A patient is experiencing lower left quadrant pain with guarding, as well as abdominal distention and rigidity.
KUB reveals free air in the abdominal
cavity. Vital signs are:
BP76/40
HR130
RR32
T101.7° F (38.7°C)
A nurse would suspect
- A. paralytic ileus.
- B. acute pancreatitis.
- C. perforated bowel.
- D. appendicitis.
Answer: C
Explanation:
The clinical presentation of lower left quadrant pain with guarding, abdominal distention, rigidity, and free air in the abdominal cavity on a KUB (kidney, ureter, and bladder) radiograph strongly suggests a perforated bowel. The presence of free air indicates that there is a breach in the gastrointestinal tract, allowing air to escape into the peritoneal cavity. The patient's vital signs, including hypotension (BP 76/40), tachycardia (HR
130), tachypnea (RR 32), and fever (T 101.7°F), are consistent with sepsis and shock, which are common complications of bowel perforation. References: CCRN Exam Handbook, AACN, page 30, section on Gastrointestinal.
NEW QUESTION # 88
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