CCRN CCRN-Adult Updated Exam

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.”

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.