CCRN-Adult Exam Dumps - AACN CCRN Questions and Answers

In a patient with a hemorrhaging renal laceration who remains hypotensive despite fluid resuscitation with two units of PRBCs and 500 mL of NS, administering norepinephrine (Levophed) is appropriate. Norepinephrine is a potent vasopressor that helps to increase blood pressure by vasoconstriction and improving cardiac output, which is critical in stabilizing a patient with severe hemorrhagic shock prior to surgery.References: = CCRN Exam Handbook, page 38

The appropriate outcomes for a patient with status asthmaticus are normal PaCO2 and increased FEV1. Status asthmaticus is a severe and life-threatening asthma exacerbation that does not respond to conventional treatment. It causes severe bronchoconstriction, air trapping, and mucus plugging, leading to hypoxemia, hypercapnia, and respiratory failure. The goals of treatment are to reverse the airway obstruction, improve gas exchange, and prevent complications. PaCO2 is the partial pressure of carbon dioxide in the blood, which reflects the adequacy of ventilation. FEV1 is the forced expiratory volume in one second, which measures the amount of air that can be forcefully exhaled in the first second of a breath. It reflects the degree of bronchoconstriction and airflow limitation. A patient with status asthmaticus typically has elevated PaCO2 and reduced FEV1 due to poor ventilation and severe obstruction. Therefore, normalizing PaCO2 and increasing FEV1 indicate improvement in the patient’s condition and response to treatment.

References:

• Status Asthmaticus: Symptoms, Causes, Diagnosis, and Treatment - Healthline: This article states that “Status asthmaticus is a severe form of asthma with symptoms similar to a typical asthma attack. But for status asthmaticus, symptoms may worsen as the asthma attack continues. Status asthmaticus is an older, less precise term for what’s now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn’t improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours.”
• Status Asthmaticus (Severe Acute Asthma) - WebMD: This article states that “Status asthmaticus is a severe asthma attack that doesn’t get better with your usual treatments. It can be life-threatening and needs urgent medical attention. If you have a bad asthma attack and your rescue inhaler or your nebulizer doesn’t help, you need medical care right away. If an attack comes on quickly and it doesn’t respond to regular treatment, it can lead to status asthmaticus.”
• Management of Status Asthmaticus | SpringerLink: This article states that “Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure despite aggressive treatment. It is defined as an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary in severity from mild to fatal. The pathophysiology of status asthmaticus is complex and involves airway inflammation, bronchospasm, airway edema, mucus plugging, and increased airway resistance. The clinical manifestations of status asthmaticus include dyspnea, wheezing, cough, chest tightness, tachypnea, tachycardia, hypoxemia, and hypercapnia. The diagnosis of status asthmaticus is based on history, physical examination, and laboratory tests, such as arterial blood gas analysis, spirometry, and chest radiography. The management of status asthmaticus consists of oxygen therapy, inhaled beta-2 agonists, systemic corticosteroids, and adjunctive therapies, such as anticholinergics, magnesium sulfate, ketamine, and noninvasive or invasive mechanical ventilation. The goals of treatment are to relieve bronchoconstriction, reduce airway inflammation, correct hypoxemia, normalize or reduce carbon dioxide levels, and avoid or treat complications.”

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.

Dexmedetomidine (Precedex) is the most appropriate medication for managing agitation and delirium in a critically ill intubated patient. It provides sedation without significant respiratory depression and has analgesic properties, which makes it suitable for patients who are disoriented and confused. Unlike benzodiazepines (lorazepam and midazolam) or neuromuscular blockers (cisatracurium), dexmedetomidine can improve delirium outcomes and facilitates easier weaning from mechanical ventilation. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 57-60.

A patient with COPD may have a chronically elevated PaCO2 and rely on hypoxia as the main stimulus for breathing. If the patient receives too much oxygen, this may reduce the hypoxic drive and cause respiratory depression, leading to lethargy and hypercapnia. O2 toxicity, absorption atelectasis, and decreased end-tidal CO2 are unlikely to occur with 4 L/min of O2 via nasal cannula in a short period of time.

References:

• Reference Guide for CCRN (Adult), page 14.
• Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

A high mixed venous O2 saturation (SO2) indicates that the tissue cells are not extracting enough oxygen from the blood, which can be due to impaired cellular metabolism or increased oxygen delivery. In septic shock, there is often a mismatch between oxygen delivery and consumption, resulting in a high SO2 despite tissue hypoxia. Therefore, SO2 alone is not a reliable indicator of tissue perfusion in septic shock.

References:

• Mixed venous oxygen saturation (SvO2) monitoring • LITFL • CCC
• SvO2 to monitor resuscitation of septic patients: let’s just understand the basic physiology | Critical Care | Full Text
• Reference Guide for CCRN (Adult), page 14.

The actions taken by the nurse are best described as evidence-based practice. By reviewing the literature and developing a proposal referencing peer-reviewed articles, the nurse used current research findings to inform and change clinical practice. This approach ensures that patient care is based on the best available evidence, leading to improved patient outcomes.References: = CCRN Exam Handbook, page 59

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.

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.

Nutritional supplements are beneficial for patients with neutropenia secondary to chemotherapy, as they can help provide adequate calories, protein, vitamins, and minerals that are essential for immune function and tissue repair. Chemotherapy can cause side effects such as nausea, vomiting, loss of appetite, taste changes, and mouth sores, which can make it difficult for patients to eat enough food and meet their nutritional needs. Nutritional supplements can be in the form of oral drinks, shakes, bars, or powders, or they can be administered through a feeding tube or intravenously. The nurse should request nutritional supplements that are appropriate for the patient’s condition, preferences, and tolerance, and that are compatible with the neutropenic diet and food safety guidelines. The nurse should also monitor the patient’s weight, hydration, and laboratory values, and report any signs of malnutrition, infection, or intolerance to the provider.

References:

• Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families: This article states that “Nutritional supplements are products that can be used to add nutrients to your diet or to lower your risk of health problems. They can be in pill, capsule, tablet, or liquid form. They might have vitamins, minerals, amino acids, herbs, or other substances. Some examples of common supplements are calcium, iron, omega-3 fatty acids, vitamin C, and vitamin D. You might need supplements if you cannot get enough nutrients from foods or if you have certain health conditions that might cause a deficiency, such as cancer, diabetes, or chronic diarrhea.”
• Nutrition in Cancer Care (PDQ®)–Patient Version: This article states that “Nutritional support is therapy for people who do not get enough nourishment by eating or drinking. You may need nutritional support if you have trouble swallowing, have lost your appetite, or are losing weight. Nutritional support can be given in different ways: Enteral nutrition is liquid food given through a tube (called a feeding tube) into the stomach or small intestine. Parenteral nutrition is a liquid mixture of nutrients given through a vein (intravenous or IV). Oral nutrition is food or liquid taken by mouth. This includes nutritional supplements, such as drinks, shakes, bars, or powders that have protein, carbohydrates, fat, vitamins, and minerals.”
• Nutrition and Cancer: What You Need to Know: This article states that “Nutritional supplements can help you meet your calorie and protein needs when you are not able to eat enough food. They can also provide extra vitamins and minerals. There are many types of nutritional supplements, such as drinks, shakes, puddings, bars, and powders. Some are designed for people with cancer and have extra calories and protein. Your doctor, nurse, or dietitian can help you choose the best supplement for you. You can buy some supplements at the grocery store or pharmacy, but others may need a prescription.”