Question 1

Treatment of cerebral vasospasm includes administration of

Accepted Answer

C

Explanation: Nimodipine is a calcium channel blocker that is used to prevent or treat cerebral vasospasm after subarachnoid hemorrhage. It works by relaxing the smooth muscle of the cerebral arteries and improving blood flow to the brain. Nimodipine is the only FDA-approved agent for vasospasm and has been shown to reduce the risk of ischemic complications and improve neurological outcomes12. Lorazepam, propranolol, and pentobarbital are not effective for treating cerebral vasospasm and may have adverse effects on the patient’s blood pressure, heart rate, and level of consciousness.

Question 2

A patient with acute renal failure has a serum potassium level of 7.2 mEq/L. The most appropriate immediate intervention for this patient is

Accepted Answer

D

Explanation: A serum potassium level of 7.2 mEq/L is critically high and can lead to life-threatening cardiac arrhythmias. The most immediate intervention is the administration of 50% dextrose followed by insulin, which helps drive potassium back into the cells, thereby rapidly lowering the serum potassium level. Hemodialysis and Kayexalate are also effective but may not act as quickly as the dextrose-insulin combination. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 3

A patient with cardiogenic shock for several days has been managed aggressively with vasopressor and inotrope therapies. Which of the following indicates organ dysfunction from hypoperfusion?

Accepted Answer

C

Explanation: In the context of cardiogenic shock managed with vasopressor and inotrope therapies, organ dysfunction from hypoperfusion can manifest as elevated creatinine and abdominal pain. Elevated creatinine indicates renal impairment, a common result of poor perfusion to the kidneys. Abdominal pain can indicate hypoperfusion to the gastrointestinal tract, leading to ischemic bowel or other GI complications. These symptoms are direct indicators of hypoperfusion and organ dysfunction. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 4

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

Accepted Answer

A

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. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 5

The family of a patient with trauma believes that the patient is in pain and requests that a neighbor,
a therapeutic touch practitioner, be allowed to see the patient. Unit policy allows visits by immediate
family only. Which of the following is the most important consideration in a nurse's decision about
facilitating the visit?

Accepted Answer

D

Explanation: The primary consideration is to ensure that the family understands the unit's visitation policies. While alternative modalities like therapeutic touch can be beneficial, the nurse must adhere to established policies and explain the rationale to the family. This helps maintain the integrity of unit operations and ensures that all patients receive equitable care. Explaining the policies also provides an opportunity to discuss alternative ways to support the patient within the existing framework. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 6

A nurse is caring for a patient with pulmonary fibrosis who is exhibiting shortness of breath,
tachypnea, and feels a sense of impending doom. In order to relieve these symptoms, the nurse
should anticipate an order for

Accepted Answer

A

Explanation: Morphine is often used to relieve symptoms such as shortness of breath and anxiety in patients with pulmonary fibrosis. It works by reducing the sensation of dyspnea and the sense of impending doom by decreasing the respiratory drive and alleviating anxiety through its sedative effects. Additionally, morphine can help reduce tachypnea by slowing down the respiratory rate. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 7

The most appropriate therapy for carboxyhemoglobinemia is

Accepted 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. Reference: = CCRN Exam Handbook, page 30

Question 8

While recording hourly ventilator checks on a patient who is being mechanically ventilated, the
nurse notes that the PIP has gradually increased by 5 cm H2O over the past 4 hours. This increase
indicates

Accepted Answer

D

Explanation: An increase in peak inspiratory pressure (PIP) over time in a mechanically ventilated patient indicates a decrease in lung compliance. This means the lungs are becoming stiffer and less able to expand, which can be caused by conditions such as pulmonary edema, ARDS, or pneumothorax. It is important to address the underlying cause of decreased lung compliance to prevent further respiratory complications. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 9

A patient with an acute anterior wall MI presents with an S3 gallop and the following values: https://kxbjsyuhceggsyvxdkof.supabase.co/storage/v1/object/public/file-images/AACN_CCRN-ADULT/page_83_img_1.jpg Which drug therapy would be most appropriate for this patient?

Accepted Answer

C

Explanation: In the setting of an acute anterior wall myocardial infarction (MI) with an S3 gallop, the patient is likely experiencing heart failure and possibly acute pulmonary edema. The appropriate treatment includes vasodilators to reduce afterload and diuretics to decrease preload and pulmonary congestion. This combination helps to improve cardiac output and reduce the workload on the heart. Reference: CCRN Exam Handbook, AACN, page 20, section on Cardiovascular.

Question 10

Following a splenectomy, a patient is most at risk for

Accepted 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. Reference: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

Question 11

Which of the following are physiologic effects of pulmonary contusion?

Accepted Answer

C

Explanation: Pulmonary contusion leads to damage to lung parenchyma, resulting in alveolar hemorrhage and edema. This causes increased airway resistance and decreased gas diffusion due to the inflammatory response and accumulation of fluid within the alveoli, impairing effective gas exchange and reducing lung compliance. Reference: = CCRN Exam Handbook, page 40

Question 12

The rationale for initiating early enteral feeding in a patient with sepsis is to

Accepted Answer

A

Explanation: Early enteral feeding in patients with sepsis is crucial as it helps maintain gut integrity, thereby minimizing the translocation of gastrointestinal (GI) bacteria. The presence of nutrients in the gut lumen supports the mucosal barrier function and reduces bacterial translocation, which can lead to secondary infections and further complications in septic patients. Reference: = CCRN Exam Handbook and AACN's Certification Review Course materials.

Question 13

An experienced nurse new to a unit believes the literature does not support current unit practice of a
fixed-dose nitroglycerin IV (Tridil) infusion in all postoperative cardiac surgery patients for 24 hours.
The nurse develops a proposal referencing peer-reviewed articles. Based on the proposal, unit
leaders agree to remove the nitroglycerin IV (Tridil) infusion from the standard order set. The actions
taken by the nurse are best described as

Accepted Answer

D

Explanation: 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. Reference: = CCRN Exam Handbook, page 59

Question 14

For a patient who sustained blunt renal trauma and a crush injury to the leg, monitoring should include observing for

Accepted Answer

B

Explanation: Crush injuries can lead to significant muscle damage and rhabdomyolysis, resulting in the release of intracellular potassium into the bloodstream, causing hyperkalemia. Tall peaked T waves are a classic sign of hyperkalemia, which needs to be closely monitored in these patients. Reference: = CCRN Exam Handbook and AACN's Certification Review Course materials.

Question 15

A patient admitted with a diagnosis of pneumonia has a temperature of 103.2° F (39.5° C) and copious pulmonary secretions. ABG results drawn on room air are: https://kxbjsyuhceggsyvxdkof.supabase.co/storage/v1/object/public/file-images/AACN_CCRN-ADULT/page_64_img_1.jpg The nurse should expect that hemoglobin's affinity for oxygen in this patient to be

Accepted Answer

D

Explanation: The patient's ABG results indicate respiratory acidosis (pH 7.33, PaCO2 48 mm Hg) with a slightly elevated temperature (103.2° F). In the context of fever and acidosis, hemoglobin's affinity for oxygen decreases, a phenomenon described by the Bohr effect. This means that hemoglobin will release oxygen more readily to the tissues. Factors like increased temperature and acidosis cause a rightward shift in the oxyhemoglobin dissociation curve, reducing the affinity of hemoglobin for oxygen. Reference: = CCRN Exam Handbook, page 44

Free AACN CCRN (Adult) Direct Care Pathway Actual Exam Questions