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Quiz Session - Attempts With Random Questions

AACN CCRN (Adult) Exam Questions

Page 10 of 50

181.

The critical care nurse knows that the V1 electrode should be placed:

  • at the fourth intercostal space, right sternal border

  • at the left midaxillary line at the V4 level

  • below the rib cage or on the hip

  • on the posterior shoulder as close as possible to where the arm joins the torso

Correct answer: at the fourth intercostal space, right sternal border

Correct placement of cardiac monitoring leads is essential to obtaining accurate information from any monitoring lead. Place V1 electrode at the fourth intercostal space at the right sternal border.

V6 should be applied at the left midaxillary line at the V4 level. Below the rib cage or on the hip is where the leg electrodes should be placed, while the arm electrodes should be applied on the posterior shoulder as close as possible to where the arm joins the torso (this keeps the anterior chest clear for defibrillation if needed).

182.

Which of the following factors is LEAST LIKELY to contribute to sleep disturbances in the critical care setting?

  • Nutrition

  • Metabolic changes 

  • Underlying cardiovascular disease 

  • Room temperature 

Correct answer: Nutrition

All critically ill patients experience altered sleep patterns. Patients experience lack of sleep for many reasons, not the least of which is the pain and anxiety from a critical illness that is within an environment inundated with life-saving activities of healthcare providers. Patients often complain that sleep deficit is a major stressor, along with the discomfort of unrelieved pain. 

Metabolic changes, underlying diseases (eg. cardiovascular disease, chronic obstructive pulmonary disease [COPD], dementia), and room temperature are all factors contributing to sleep disturbances. Medications and other overall environmental stimuli, as well as anxiety, fear, and delirium, are other factors contributing to altered sleep patterns. 

Nutrition is not a major contributor to sleep disturbances in the critical care setting, although there may be situations in which it will affect sleep. 

183.

Which of the following assessment findings would be consistent with a low platelet count from Heparin-Induced Thrombocytopenia (HIT)?

  • The presence of acute thrombosis development

  • The presence of metabolic acidosis

  • Elevation in liver enzymes ALT and AST

  • Decrease in neutrophils

Correct answer: The presence of acute thrombosis development 

Heparin-Induced Thrombocytopenia (HIT) is an immune-mediated reaction to heparin resulting in the formation of antiplatelet antibodies which activate platelets and form clots. This then leads to platelet consumption and a precipitous drop in platelet count, resulting in clinical thrombosis (venous thrombosis is most common), due to the antibody to the heparin antigen destroying the platelets. When HIT is suspected, all heparin is stopped, and confirmatory testing for HIT antibodies is performed. Treatment includes administration of direct thrombin inhibitors and patients should not receive heparin again. 

Metabolic acidosis could cause a low platelet count, but not thrombosis development. Liver dysfunction and failure typically also manifests with low platelets, but not thrombosis. Thrombocytopenia and neutropenia are frequently present with bone marrow suppression, not with HIT.

184.

Which of the following statements made by a patient indicates understanding of how a TAVR works?

  • I may have an increased risk of bleeding internally from my femoral artery afterwards.

  • I will have an incision in the center of my chest that will eventually heal.

  • This will significantly improve circulation to my heart muscle.

  • This procedure is not recommended for people who are not candidates for heart surgery.

Correct answer: I may have an increased risk of bleeding internally from my femoral artery afterwards.

A Transcatheter Aortic Valve Replacement (TAVR) is used to replace the aortic valve without requiring open-heart surgery. This means the patient will not have a sternotomy incision that will have to heal. A TAVR improves circulation produced by the heart, but is not designed to restore circulation to the myocardium. TAVRs are preferred in patients who are not candidates for more invasive surgeries.

185.

The charge nurse arrives at work for an ICU shift to discover that his coworker has called out sick and has been replaced with a float pool nurse. The float nurse is oriented to the ICU environment. However, she is not competent to care for patients on ventilators.

The float nurse states that she will care for the ventilator patients if shown what to do. The charge nurse should:

  • Assign her to nonventilated patients only 

  • Assign her to patients on ventilators and give her clear instructions on suctioning and alarms

  • Care for the patients himself, as the float nurse cannot properly care for the ICU patients

  • Request that the respiratory therapist review the ventilator settings with the float nurse prior to her assuming care 

Correct answer: Assign her to nonventilated patients only 

Planning care for critically ill patients begins with ensuring each nurse caring for a patient has the corresponding competencies and skills to meet the patient's needs. 

The American Association of Critical-Care Nurses (AACN) has developed the AACN Synergy Model for Patient Care to delineate core patient characteristics and needs that drive the core competencies of nurses required to care for patients and families. The model notes that when the patient characteristics and nurse competencies are linked, optimal patient outcomes result. 

In this case, the float nurse's knowledge of ventilator patients cannot be assured, and the charge nurse should only assign her to patients whose needs do not exceed the extent of her training and competence. Therefore, the patient with the lowest acuity and who requires care that is within the scope of the float pool nurse's skills should be assigned. 

186.

Which of the following is NOT considered a loop diuretic?

  • Chlorothiazide (Diuril)

  • Furosemide (Lasix)

  • Bumetanide (Bumex)

  • Torsemide (Demadex)

Correct answer: Chlorothiazide (Diuril)

Diuril is not considered a loop diuretic. It is a thiazide diuretic and works by enhancing the excretion of sodium, chloride, and water by inhibiting the transport of sodium across the renal tubular epithelium in the cortical diluting segment of the nephron. It also increases the excretion of potassium and bicarbonate. Thiazide diuretics are used in the management of edema and hypertension. 

Loop diuretics (Lasix, Bumex, and Demadex) are diuretics that act at the ascending loop of Henle in the kidney; they inhibit active transport of chloride and possibly sodium, resulting in enhanced excretion of sodium, chloride, potassium, hydrogen, magnesium, ammonium, and bicarbonate. Loop diuretics are usually used in the management of edema associated with HF (Heart Failure) or oliguric renal failure, as well as the management of hypertension.

187.

A nurse is instructing a patient with an aortic aneurysm on signs of aortic dissection. Which of the following is NOT a sign of aortic dissection?

  • Hemoptysis 

  • A sudden increase in existing chest or back pain

  • Oliguria

  • Weakness

Correct answer: Hemoptysis 

Hemoptysis is not a symptom of aortic dissection. An aortic dissection would not communicate with the airways, making hemoptysis an unlikely symptom in most situations. A sudden increase in existing chest or back pain can be an indicator of dissection. Oliguria and weakness are possible symptoms due to anemia and hypovolemia that may be caused by dissection.

188.

Which of the following is the MOST definitive test for the diagnosis of aortic dissection?

  • MRI

  • EKG

  • Echocardiogram

  • Chest x-ray

Correct answer: MRI

An MRI scan (or CT scan) is the most definitive test for the diagnosis of aortic dissection. An MRI determines the size of the aorta, size of the aneurysm, the extent of a dissection, the involvement of additional arterial branches, lumen diameter, and wall thickness.

Echocardiogram findings can visualize the location and size of an aneurysm. A chest x-ray may show the dilated aorta, widening of the mediastinum, and mediastinal mass. An EKG is not used to diagnose aortic disection.

189.

A 45-year-old woman has just been diagnosed with chronic heart failure. The nurse wants to ensure she understands the medications she is receiving in the ICU. Which of the following is the BEST approach?

  • Use the teach-back method to ensure comprehension

  • Providing her an evidence-based pamphlet written by the AHA about heart failure

  • Use written test to assess her understanding of the medications 

  • Ask her to identify any concepts or areas that she does not understand

Correct answer: Use the teach-back method to ensure comprehension

The teach-back method is a proven strategy to ensure patient comprehension and works by having the patient repeat the information back in their own words. Providing her an evidence-based pamphlet written by the AHA about heart failure may promote learning but does not allow the nurse to evaluate the patient's level of knowledge. Using the teach-back method is more effective than using a written test as it allows the nurse to better delve deeper into the patient's knowledge about particular topics. Having the patient identify any concepts or areas that she does not understand is not as effective as the teach-back method as there may be deficiencies that the patient does not recognize and that can be appreciated by the nurse using the teach-back method. 

190.

The nurse notices a pattern of increased anxiety among his patients when compared to other nurses' patients. What action by the nurse is BEST?

  • Ask for feedback from his colleagues about his therapeutic techniques

  • Perform a root cause analysis to examine potential reasons for anxiety 

  • Perform a literature review about anxiety 

  • Ask the charge nurse to equally distribute patients prone to anxiety when making assignments

Correct answer: Ask for feedback from his colleagues about his therapeutic techniques

A pattern of anxiety in the nurse's own patients when compared to others may indicate that the nurse's therapeutic techniques are not meeting his patient's needs. Asking for feedback from his colleagues about his therapeutic techniques may help provide an outside perspective that can better verify if this is the case. Performing a root cause analysis to examine potential reasons for anxiety is not necessary if there is already a clearly identifiable common factor. Performing a literature review about anxiety or asking the charge nurse to equally distribute patients prone to anxiety when making assignments are not as likely to be effective as asking for feedback about his therapeutic techniques.

191.

A hospital decides to establish a code blue committee to review their responses to cardiac and respiratory arrests. Which of the following AACN Synergy Model competencies does this BEST demonstrate?

  • Clinical inquiry

  • Response to diversity

  • Clinical judgement

  • Facilitation of learning

Correct answer: Clinical inquiry

The AACN Synergy Model is the source of content for 20% of the CCRN, making this concept a central component of the test. The eight components of the AACN Synergy Model are:

  • Clinical judgement
  • Advocacy and moral agency
  • Caring practices
  • Collaboration
  • Systems thinking
  • Response to diversity
  • Facilitation of learning
  • Clinical inquiry

Clinical inquiry refers to the ongoing process of questioning and evaluating practice and providing informed practice. Establishing a code blue committee demonstrates clinical inquiry better than it does the other competencies provided in the answers. Response to diversity refers to sensitivity to individual-specific needs during care. Clinical judgement refers to the clinical decision-making process and the rationale that it is founded on. Facilitation of learning refers to the teaching aspect of nursing.

192.

Which of the following is not a cause of unstable angina?

  • Left ventricular hypertrophy

  • Vasoconstriction

  • Nonocclusive thrombus

  • Inflammation or infection

Correct answer: Left ventricular hypertrophy

Unstable angina is an angina of new onset, increasing in frequency, or occurring at rest. Unstable angina is predominantly caused by conditions that diminish the flow of blood in the coronary arteries to adequately supply the heart with oxygen. Vasoconstriction or a nonocclusive thrombus present in the coronary artery can lead to this diminished blood flow to the heart and result in unstable angina. Inflammation and infection (ie, acute endocarditis) can also trigger unstable angina, particularly with the formation of embolisms from vegetative growth.

Left ventricular hypertrophy is often caused by long-standing, poorly controlled hypertension, but does not impact blood flow to the heart.

193.

A devout Jewish patient in the ICU requires a non-emergency procedure, but it is the Sabbath. How should the nurse proceed?

  • Ask the patient if they are okay with having the procedure performed on the Sabbath

  • Postpone the procedure until after the Sabbath, if medically acceptable

  • Proceed with the procedure since it's medically necessary.

  • Seek advice from the hospital's ethics committee

Correct answer: Ask the patient if they are okay with having the procedure performed on the Sabbath

A devout Jewish patient may have a problem having a medical procedure performed on the Sabbath; however, they may also be okay with it. The nurse should ask the patient instead of making assumptions about their religious practices. If the patient wants to delay the procedure, the healthcare team may postpone the procedure until after the Sabbath, if medically acceptable. The nurse can encourage the patient to proceed with the procedure if it's medically necessary, but should not pressure the patient and should allow them to make informed medical decisions that are consistent with their preferred religious practices. Seeking advice from the hospital's ethics committee is unlikely to be necessary.

194.

Which ECG leads will BEST show an acute inferior wall Myocardial Infarction (MI)?

  • II, III, aVF

  • I, aVF, aVL

  • II, III, aVL

  • I, II, aVR

Correct answer: II, III, aVF

The critical care nurse can locate an MI based on the ECG recording. Leads II, III, and aVF monitor the LV inferior wall, and thus inferior wall MI is diagnosed by indicative changes (ST elevation) in leads II, III, and aVF.

195.

The Glasgow Coma Scale (GCS) is a tool to measure neurologic status and level of consciousness (LOC) in a critically ill patient. Response is determined in three overall categories. Which of the following is NOT one of these categories when assessing a patient utilizing this scale?  

  • Pain stimuli response

  • Eye opening

  • Motor response

  • Verbal response

Correct answer: Pain stimuli response

The GCS is often used to monitor neurologic status in critically ill patients, because it provides a standardized approach to assessing and documenting LOC. Response is determined in three categories: eye opening, motor response, and verbal response.

GCS scores range from 3 to 15, with 15 indicating a patient that is alert, fully oriented, and following commands. As the GCS score decreases, the probability of a poor outcome increases. 

BehaviorScore
Eye Opening (E) 
Spontaneous4
To verbal stimuli3
To pain2
None1
Motor Response (M) 
Obeys commands6
Localizes pain5
Withdraws to pain4
Abnormal flexion3
Extensor response2
None1
Verbal Response (V) 
Oriented5
Confused4
Inappropriate words3
Incomprehensible sounds2
None1

*Coma score = Eye + Motor + Verbal

If a patient does not follow any of the above commands, the next step is to assess the response to pain stimuli in all four extremities. 

196.

Sodium, chloride, and bicarbonate are responsible for maintaining a normal anion gap in the body which is normally:

  • < 12 to 14 mEq/L

  • < 16 to 18 mEq/L

  • < 6 mEq/L

  • < 8 to 10 mEq/L

Correct answer: < 12 to 14 mEq/L

Diabetic Ketoacidosis (DKA) consists of the biobchemical triad of hyperglycemia, ketonemia, and metabolic acidosis. DKA is typically characterized by:

  • Hyperglycemia > 300 mg/dL
  • Low bicarbonate level < 15 mEq/L
  • Acidosis pH < 7.30

Sodium, chloride, and bicarbonate are responsible for maintaining a normal anion gap in the body which is normally less than 12 to 14 mEq/L.

197.

In patients with cardiac tamponade, there is an increase in Central Venous Pressure (CVP), Pulmonary Artery Diastolic pressure (PAD), and Pulmonary Artery Occlusion Pressure (PAOP), all within two to three mmHg of each other, referred to as diastolic plateau; this is accompanied by which three symptoms?

  • Muffled heart tones, decreased blood pressure, decreased cardiac output

  • Hypertension, muffled heart tones, and increased cardiac output

  • Tachycardia, restlessness, and muffled heart tones

  • Tachycardia, widening pulse pressure, and tachypnea

Correct answer: Muffled heart tones, decreased blood pressure, decreased cardiac output 

The pericardial sac is normally stiff and noncompliant. Cardiac tamponade occurs when bleeding into the pericardial sac causes compression on the heart, compromising cardiac function and cardiac output, and can be a life-threatening condition if not treated promptly. Signs and symptoms of this condition include tachycardia, SOB, anxiety, decreased LOC, Pulsus Paradoxus (PP), increased CVP, PAD, and PAOP. These values are often within two to three mmHg of one another, and this phenomenon is called diastolic plateau or equalization of pressures; it is accompanied by muffled heart tones, decreased BP and cardiac output.

198.

Pulmonary arterial hypertension (PAH) is BEST diagnosed with which of the following tests? 

  • Right-heart cardiac catheterization 

  • Echocardiogram 

  • 12-lead ECG

  • Pulmonary function testing (PFTs)

Correct answer: Right-heart cardiac catheterization 

PAH is a progressive, life-threatening disorder of the pulmonary circulation characterized by high pulmonary artery pressures (mean >25 mm Hg) leading from the right side of the heart to the lungs. This persistently high PAP ultimately leads to right ventricular failure. Signs and symptoms include pallor, dyspnea, fatigue, chest pain, and syncope. 

Right-heart cardiac catheterization is considered the gold standard for diagnosis with vasodilator (adenosine, nitric oxide, epoprostenol) testing for benefit from long-term therapy with calcium channel blockers. A positive response is a decrease in mean PAP of 10 to 40 mm Hg, with an increased or unchanged CO from baseline values. 

The other tests help in the diagnosis of PAH. 

199.

An African American patient with a history of sickle cell disease expresses frequent complaints of pain despite appropriate pain management interventions. The nurse notes that other healthcare team members appear skeptical about the patient's reports of pain. What is the MOST appropriate action for the nurse?

  • The nurse should advocate for the patient's needs and address possible implicit bias within the team

  • Because the patient's pain is being managed appropriately, the nurse should ignore the behavior of the other healthcare team members

  • Because the patient is complaining excessively, the nurse should ask the patient to minimize their complaints regarding their pain

  • The nurse should confront the healthcare team members about their skepticism

Correct answer: The nurse should advocate for the patient's needs and address possible implicit bias within the team

The nurse should advocate for the patient's needs as advocacy is one of the key roles of a nurse. As part of advocacy, the nurse should address any implicit biases within the healthcare team that may hinder proper care, in this case, potential underestimation of the patient's pain due to their ethnicity and disease. While confronting healthcare team members about their skepticism may seem like a form of advocacy, it is less likely to result in productive conversation than discussing potential biases. Ignoring the behavior of the other healthcare team members or asking the patient to minimize their complaints regarding their pain does not fulfill the nurse's duty to advocate for the patient.

200.

Which of the following types of cardiomyopathy may be idiopathic?

  • All types of cardiomyopathy may be idiopathic

  • Dilated cardiomyopathy

  • Restrictive cardiomyopathy

  • Hypertrophic cardiomyopathy

Correct answer: All types of cardiomyopathy may be idiopathic

While each type of cardiomyopathy has a distinct set of likely causes, all types of cardiomyopathies can be idiopathic and may not have a clearly identifiable cause. 

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