CCRN-Adult Exam Dumps - AACN CCRN Questions and Answers

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

Hyponatremia

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A patient with a sodium level of 114 mEq/L is most likely to develop seizures, which are a manifestation of severe hyponatremia and cerebral edema. Hyponatremia is a low level of sodium in the blood, which can cause water to move into the brain cells and cause them to swell. This can lead to increased intracranial pressure, neurological dysfunction, and seizures. Seizures are a medical emergency and require prompt treatment to prevent brain damage or death. Tetany, flaccid paralysis, and cardiac arrhythmias are not typical signs of hyponatremia, but may occur in other electrolyte disorders, such as hypocalcemia, hyperkalemia, or hypokalemia.

References:

• Overview of the treatment of hyponatremia in adults - UpToDate1, p. 1-2.
• Manifestations of hyponatremia and hypernatremia in adults - UpToDate2, p. 1-2.

The goal of PEEP therapy in acute lung injury (ALI) is to reduce physiologic shunting, which is the perfusion of blood through unventilated or collapsed alveoli. This results in hypoxemia and impaired gas exchange. PEEP therapy increases the end-expiratory pressure and prevents alveolar collapse, thus improving ventilation and oxygenation. PEEP therapy does not necessarily decrease PAP (pulmonary artery pressure), decrease airway resistance, or increase cardiac output. In fact, PEEP therapy may have adverse effects on these parameters, such as increasing intrathoracic pressure, reducing venous return, and decreasing cardiac output.

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: Acute Lung Injury/Acute Respiratory Distress Syndrome. 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. 1908-1910.

The best response is to assess the patient's feelings and understanding of their condition and prognosis. This response opens a dialogue and allows the nurse to provide education and emotional support based on the patient's specific concerns. Other responses may provide false reassurance or imply assumptions about the patient’s future without first understanding their current emotional state and concerns. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

Pulmonary embolism

Pulmonary angiography is the most definitive diagnostic test for pulmonary embolism, as it provides a clear picture of the blood flow in the arteries of the lungs. It can detect even small clots and determine the location and extent of the obstruction. However, because it requires a high degree of skill to perform and has potentially serious risks, it is usually done when other tests fail to provide a definite diagnosis1. Other tests that can be used to diagnose pulmonary embolism include CT pulmonary angiography, ventilation-perfusion scan, D-dimer test, chest X-ray, ultrasound, and MRI23. However, these tests may have limitations such as low sensitivity, low specificity, radiation exposure, contrast allergy, or availability4.

References:

• Pulmonary embolism - Diagnosis and treatment - Mayo Clinic, under “Pulmonary angiogram”.
• Pulmonary Embolism (PE): Symptoms, Signs & Treatment - Cleveland Clinic, under “How is a pulmonary embolism diagnosed?”.
• Diagnosis of Pulmonary embolism and what are its different treatment options?, under “Diagnosis for Pulmonary embolism”.
• Diagnosis of pulmonary embolism - UpToDate, under “Overview”.