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NEW QUESTION # 23
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. It would be inappropriate for the hospital chaplain to document in the medical record.
- B. The chaplain may be of a specific denomination, but the chaplain provides resources to patients of many faiths and beliefs.
- C. A chaplain's visit will not benefit a patient who is comatose or non-communicative.
- D. The service should be provided only when specifically requested by the patient or family.
Answer: B
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 # 24
Pulsus paradoxus is defined as
- A. an increase in systolic BP of greater than 10 mm Hg during normal inspiration.
- B. a decrease in diastolic BP of greater than 10 mm Hg during normal expiration.
- C. a decrease in systolic BP of greater than 10 mm Hg during normal expiration.
- D. a decrease in systolic BP of greater than 10 mm Hg during normal inspiration.
Answer: D
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 # 25
A family member asks permission to visit a patient after work at 12:30 AM. On previous visits, the family member has been disruptive. To address the situation, a nurse should
- A. not allow the visit, as the patient will be sleeping.
- B. ask the family member to visit during scheduled visiting hours.
- C. ask the family member to visit before work.
- D. allow the family member to visit after setting behavioral limits.
Answer: D
Explanation:
While it is important to support family involvement, previous disruptive behavior necessitates setting clear behavioral limits to ensure a safe and therapeutic environment for the patient. Allowing the visit with established guidelines helps balance the need for patient support with maintaining unit order. This approach also respects the patient's rest and recovery needs. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 26
A patient who recently lost their spouse is admitted following an emergent cardiac catheterization. The procedure report states chest pain and ST elevation, no significant coronary artery disease, left ventricular dysfunction with apical ballooning, and an EF of 35%. These findings are consistent for
- A. hypertrophic cardiomyopathy.
- B. takotsubo cardiomyopathy.
- C. non ischemic cardiomyopathy.
- D. arrhythmogenic right ventricular cardiomyopathy.
Answer: B
Explanation:
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome," is characterized by transient left ventricular dysfunction often precipitated by significant emotional or physical stress. The key findings of chest pain and ST elevation without significant coronary artery disease, along with left ventricular dysfunction and apical ballooning observed on imaging, are classic for takotsubo cardiomyopathy. This condition is often reversible and is associated with a temporary reduction in the heart's pumping ability, indicated by the reduced ejection fraction (EF) of 35%. 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 # 27
An unconscious patient in hepatic failure secondary to alcoholism becomes acutely hypoglycemic. Glucagon administration is contraindicated for this patient because glucagon
- A. causes rebound hyperglycemia.
- B. is ineffective when hepatocytes are damaged.
- C. produces additional sedative effects.
- D. interferes with lactulose (Cephulac) therapy.
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 # 28
The intended effects of medications for a patient in acute CHF are to
- A. reduce CVP and increase SVR.
- B. increase CVP and increase SVR.
- C. reduce CVP and reduce SVR.
- D. increase CVP and reduce 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 # 29
A nurse who is providing care to a patient with a hemorrhagic stroke receives an order to administer 3% Normal Saline IV. The nurse should recognize the goal of therapy is to create an
- A. oncotic gradient which pulls fluid from the vascular system into the brain tissue.
- B. osmotic gradient which pulls fluid from the vascular system into the brain tissue.
- C. osmotic gradient which pulls fluid from the brain tissue into the vascular system.
- D. oncotic gradient which pulls fluid from the brain tissue into the vascular system.
Answer: C
Explanation:
The administration of hypertonic saline (3% Normal Saline) creates an osmotic gradient that pulls water out of the swollen brain tissue into the vascular system, helping to reduce cerebral edema. This is a critical intervention in managing increased intracranial pressure in patients with hemorrhagic stroke. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 30
Which of the following is most often associated with damage to the alveolar capillary membrane secondary to aspiration?
- A. reabsorption atelectasis
- B. noncardiogenic pulmonary edema
- C. lung cavitation
- D. bronchopleural fistulas
Answer: B
Explanation:
Noncardiogenic pulmonary edema is most often associated with damage to the alveolar capillary membrane secondary to aspiration. This condition occurs when there is increased permeability of the alveolar-capillary barrier, leading to fluid leakage into the alveoli. It is a hallmark of Acute Respiratory Distress Syndrome (ARDS), which can be triggered by aspiration, resulting in inflammatory damage to the lungs.References: = CCRN Exam Handbook, page 29
NEW QUESTION # 31
Which of the following is a sign of brain death?
- A. positive cough reflex
- B. negative apnea test
- C. negative cold caloric test
- D. positive vestibulo-ocular 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 # 32
The family of a patient requests permission to administer traditional herbs to the patient. Which of the following should be the nurse's first action?
- A. Inform the family that herbal therapy is not appropriate in the hospital.
- B. Consult with the pharmacist on the effects of the specific herbs.
- C. Obtain an order for the herbs.
- D. Allow the patient to take the herbs because they are natural.
Answer: B
Explanation:
Verified answer: B. Consult with the pharmacist on the effects of the specific herbs. Herbal therapy is a type of complementary and alternative medicine (CAM) that uses plants or plant extracts to treat various health conditions. Many patients use herbal therapy for various reasons, such as cultural beliefs, personal preferences, or dissatisfaction with conventional medicine. However, herbal therapy is not without risks and challenges, especially in the hospital setting. Some of the potential problems include lack of standardization, quality control, and regulation of herbal products; adverse effects and interactions with other medications; and ethical and legal issues regarding informed consent, documentation, and liability12. Therefore, the nurse's first action should be to consult with the pharmacist on the effects of the specific herbs that the family wants to administer to the patient. The pharmacist can provide information on the safety, efficacy, dosage, and compatibility of the herbs with the patient's condition and current medications. The nurse should also inform the patient's primary provider and obtain an order for the herbs before allowing the patient to take them. The nurse should document the use of herbal therapy in the patient's medical record and monitor the patient for any adverse effects or changes in response to other treatments. Informing the family that herbal therapy is not appropriate in the hospital is not respectful of the patient's autonomy and cultural values. Allowing the patient to take the herbs without consulting the pharmacist and obtaining an order is not safe and may violate the hospital's policies and standards of care.
NEW QUESTION # 33
Potentially life-threatening consequences of diabetic ketoacidosis (DKA) include
- A. cellular dehydration.
- B. respiratory alkalosis.
- C. intracellular hyperglycemia.
- D. metabolic alkalosis.
Answer: A
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 # 34
After consultation with the interdisciplinary team, a nurse implements progressive mobility by having the patient sit at the side of the bed. The patient's HR increases by 10, RR increases by 6, SpO2 remains at 94%, and BP remains stable. The patient states he is tired. Which of the following should be the nurse's next action?
- A. Discontinue the attempts to mobilize the patient.
- B. Wait for assistance from physical therapy to resume mobility.
- C. Return the patient to a supine position and notify the physician.
- D. Progress to sitting in a chair during the next activity.
Answer: C
Explanation:
The patient's increased heart rate and respiratory rate, along with the patient's statement of feeling tired, may indicate that the activity was too strenuous123. It's important to ensure patient safety and comfort, so the nurse should return the patient to a supine position123. The physician should be notified about the patient's response to the activity for further evaluation and to adjust the care plan if necessary123.
NEW QUESTION # 35
The most appropriate therapy for carboxyhemoglobinemia is
- A. 100% O2 administration.
- B. inhaled corticosteroids.
- C. hyperventilation.
- D. aerosolized beta-agonists.
Answer: A
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 # 36
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. head MRI.
- C. coagulation panel.
- D. triglyceride panel.
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 # 37
Which of the following serum laboratory results is most concerning to a nurse who is caring for a patient with a Stage Ill pressure ulcer on the coccyx?
- A. albumin 2.1 mg/dL
- B. glucose 125 mg/dL
- C. hemoglobin 10.2 mg/dL
- D. WBC 6,000/mm3
Answer: A
Explanation:
For a patient with a Stage III pressure ulcer, a serum albumin level of 2.1 mg/dL is most concerning because it indicates severe hypoalbuminemia, which is associated with poor nutritional status and delayed wound healing. Adequate nutrition, particularly protein intake, is crucial for wound healing. The other lab results, while not ideal, are less immediately critical in the context of pressure ulcer healing. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 38
A patient who underwent bowel resection surgery due to small bowel rupture is tachycardic and hypotensive.
A nurse calls the on-call surgical resident and reports the findings. No new orders are received. The nurse should continue to monitor the patient and
- A. consult the nearest nursing colleague.
- B. notify the charge nurse during nightly rounds.
- C. initiate the rapid response team.
- D. inform the clinical manager in the morning.
Answer: C
Explanation:
The patient's tachycardia and hypotension following bowel resection surgery indicate potential severe complications such as hemorrhage or septic shock, which require immediate intervention. If the on-call surgical resident does not provide new orders, the nurse must act promptly to prevent further deterioration by initiating the rapid response team (RRT). The RRT can provide critical interventions and facilitate timely transfer to a higher level of care if needed. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 39
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. left lower
- B. left upper
- C. right lower
- D. right upper
Answer: C
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 # 40
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 # 41
A patient underwent bariatric surgery for weight loss 3 days ago. The patient appears anxious, restless, and reports increased abdominal pain over the last 24 hours. The nurse palpates mild subcutaneous crepitus over the neck. Vital signs are:
BP 106/64
HR 128
RR 27
T 100.4° F (38°C)
Which action should the nurse anticipate?
- A. Administer a 1000 mL bolus of normal saline.
- B. Prepare the patient for surgery.
- C. Obtain labs.
- D. Provide broad spectrum antibiotics.
Answer: B
Explanation:
The signs and symptoms described in the patient post-bariatric surgery, including anxiety, restlessness, increased abdominal pain, and subcutaneous crepitus over the neck, suggest a potential anastomotic leak, which is a surgical emergency. Given the vital signs indicating possible sepsis or shock (elevated heart rate, increased respiratory rate, and fever), immediate surgical intervention is likely required to repair the leak and prevent further complications. References: CCRN Exam Handbook, AACN, page 30, section on GI surgical emergencies.
NEW QUESTION # 42
The spouse of a critically ill patient is indecisive, withdrawn, and tells the nurse, "I feel so helpless." Appropriate nursing interventions include
- A. providing reassurance that visiting is not always necessary.
- B. identifying and reinforcing the spouse's support systems.
- C. encouraging other family members to make necessary decisions.
- D. offering solutions to problems identified by the spouse.
Answer: B
Explanation:
When dealing with a spouse who feels helpless, the most effective nursing intervention is to identify and reinforce their support systems. This helps the spouse feel less isolated and more empowered. Offering solutions to problems, encouraging other family members to make decisions, or providing reassurance that visiting is not necessary do not directly address the spouse's feelings of helplessness and may even contribute to feelings of exclusion or inadequacy. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 43
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. lidocaine (Xylocaine), 1.5 mg/kg IV.
- B. defibrillation at 200 J.
- C. adenosine (Adenocard), 6 mg rapid IV bolus.
- D. cardioversion at 100 J.
Answer: D
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 # 44
Following a splenectomy, a patient is most at risk for
- A. sepsis.
- B. hypertension.
- C. pulmonary embolism.
- D. wound dehiscence.
Answer: A
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 # 45
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