CCRN-Adult Exam Dumps - AACN CCRN Questions and Answers

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.

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”.

A consistent prolongation of the P-R interval beyond 0.20 seconds indicates a first-degree atrioventricular (AV) block. This type of block is characterized by a delay in the conduction of electrical impulses through the AV node, resulting in a prolonged P-R interval. However, every P wave is still followed by a QRS complex, distinguishing it from higher-degree AV blocks where some P waves are not followed by QRS complexes.References: = CCRN Exam Handbook, page 35

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.

This is the nurse’s best initial response, as it expresses empathy, validates the patient’s feelings, and assesses the patient’s risk of suicide. Depression is a common and serious mental health condition that affects older adults, especially those living in nursing homes. Depression can cause persistent sadness, hopelessness, loss of interest, and suicidal thoughts or behaviors. The nurse should screen the patient for depression using a validated tool, such as the Patient Health Questionnaire (PHQ-9) 1, and ask about any suicidal ideation or plans. The nurse should also provide emotional support, education, and referral to appropriate resources for the patient.

B. “Those feelings should resolve when the medication you’ve started has a chance to take effect.”

This is not the nurse’s best initial response, as it dismisses the patient’s feelings, implies that the patient just needs to wait for the medication to work, and does not address the patient’s psychosocial needs. Antidepressants are one of the treatment options for depression, but they may take several weeks to show their full effect, and they may not work for everyone. The nurse should also explore other factors that may contribute to the patient’s depression, such as social isolation, loss of autonomy, chronic illness, or grief, and offer interventions that may help the patient cope, such as counseling, psychotherapy, cognitive-behavioral therapy, or social activities.

C. “I understand how you feel. We all get that way when we’re depressed.”

This is not the nurse’s best initial response, as it assumes that the nurse knows how the patient feels, minimizes the patient’s experience, and generalizes the patient’s condition. Depression is not a normal or inevitable part of aging, and it affects each person differently. The nurse should not compare the patient’s feelings to their own or to others, but rather acknowledge and respect the patient’s unique perspective and situation. The nurse should also avoid using words like “we” or “you” that may create a sense of distance or judgment, and instead use words like “I” or “me” that may convey a sense of empathy or rapport.

D. “Have you talked to anyone about what is bothering you?”

This is not the nurse’s best initial response, as it may sound like the nurse is trying to avoid listening to the patient, or that the patient is bothering the nurse with their problems. The nurse should not imply that the patient should talk to someone else, but rather show interest and willingness to listen to the patient. The nurse should also use open-ended questions that invite the patient to share more, such as “How are you feeling today?” or “What has been on your mind lately?” The nurse should also use active listening skills, such as nodding, paraphrasing, reflecting, or summarizing, to demonstrate understanding and engagement.

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

The absence of regulators from O2 tanks is a serious issue that can affect patient care1. The nurse manager is in a position to address this problem effectively by ensuring the availability of necessary equipment2. Therefore, the best action would be to inform the nurse manager of the need for more regulators123. While documenting the issue and reporting to the shift supervisor are important, they do not directly address the problem. Forming a task force could be helpful, but it might take more time to implement solutions23.

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.

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