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Quiz Session - Attempts With Random Questions

AACN CCRN (Adult) Exam Questions

Page 3 of 50

41.

The critical care nurse notes that a patient's central venous pressure (CVP) is currently 2 and systolic blood pressure (SBP) is 70. Based on these findings, what clinical intervention is a priority? 

  • Administer a fluid bolus of normal saline (NS) and reassess CVP

  • Begin a blood transfusion and reassess CVP 

  • Begin a dobutamine (Dobutrex) infusion and reassess CVP

  • Begin an albumin infusion and reassess CVP 

Correct answer: Administer a fluid bolus of normal saline (NS) and reassess CVP

CVP is important because it is used to approximate the right ventricular end-diastolic pressure (RVEDP). Ventricular end-diastolic pressures, both right and left, are used to estimate cardiac function and fluid status. 

A normal CVP is between 2 and 8 mm Hg. Low CVP values typically reflect hypovolemia or decreased venous return. If CVP, stroke volume (SV), and SBP are low, hypovolemia is assumed, and the priority intervention is to administer a fluid bolus of a crystalloid solution, such as NS or lactated Ringer's, in an attempt to correct the hypovolemia, followed by reassessment of CVP.

If the patient's reason for hypovolemia is due to excessive bleeding, a blood and/or albumin transfusion would be indicated, but an initial NS bolus is most appropriate in this scenario. Dobutamine may be indicated if CVP and SBP do not improve with fluid resuscitation.  

42.

Gastric lavage may be considered for patients with life-threatening ingestions within what time frame from toxic ingestion?

  • Within one hour

  • Within 90 minutes

  • Within two hours

  • Within four hours

Correct answer: Within one hour

Gastric lavage may be considered for patients with life-threatening ingestions as long as it is administered within one hour of ingestion.

Gastric lavage decreases ingestant absorption of the toxin(s), and significant amounts of the drug can be recovered the closer that lavage is performed to ingestion. This method is contraindicated in corrosive ingestions due to the risk of gastroesophageal perforation. It is also contraindicated with hydrocarbons due to the risk of aspiration-induced hydrocarbon pneumonitis.

43.

A busy ICU has experienced an increased number of medication errors over the past three months. Which of the following would be the MOST effective action for the unit to take?

  • Analyze the medication administration process

  • Continue monitoring the situation until a definitive pattern emerges

  • Provide staff with education on how to enter incident reports and avoid medication errors

  • Implement disciplinary actions for the staff who made errors

Correct answer: Analyze the medication administration process

Analyzing the medication administration process is a critical first step, as it can reveal underlying issues or systemic weaknesses contributing to errors. Continue monitoring the situation until a definitive pattern emerges is incorrect if a pattern has already been identified. Staff education or retraining and disciplinary actions are both reactive solutions that might not address underlying systemic problems causing the errors.

44.

The critical care nurse is providing teaching to a patient who experienced a Transient Ischemic Attack (TIA). Which of the following statements made by the patient indicates that they understand the teaching?

  • That was a close call. I need to get treatment before I have a big stroke.

  • The effects of this TIA will be permanent, but less severe than if I had a full stroke.

  • A TIA occurs when there is bleeding in the brain, but not enough to do any significant damage.

  • Once the TIA is over, I am fine and there is nothing more to worry about.

Correct answer: That was a close call. I need to get treatment before I have a big stroke.

A Transient Ischemic Attack (TIA) is a period of ischemia that resolves spontaneously prior to causing lasting tissue necrosis. While a TIA does not create any lasting effects, it is an important warning sign that an ischemic stroke may be impending. TIAs are caused by ischemia, not bleeding.

45.

Your patient just underwent a renal transplant. In the immediate postoperative period, which of the following urine output levels would you expect to observe in this patient? 

  • 200–300 mL/hr

  • 75–150 mL/hr

  • >1000 mL/hr

  • 10–20 mL/hr

Correct answer: 200–300 mL/hr

In the immediate postoperative period following a renal transplant, urine output of 200–300 mL/hr best indicates (a) well-functioning kidney(s). 

This output indicates diuresis (or polyuria), an increased or excessive production of urine. Studies suggest that early post-transplant polyuria is associated with good short-term and long-term renal transplantation outcomes.

46.

A conscious and competent patient has refused a blood transfusion due to religious beliefs, but the patient's condition is deteriorating and is likely to result in death without intervention. What response by the healthcare team is BEST?

  • Respect the patient's decision and withhold treatment

  • Overrule the patient's decision due to their deteriorating condition

  • Obtain a court order to treat the patient against their will

  • Wait until the patient loses conciousness the apply the principle of implied consent and administer the transfusion

Correct answer: Respect the patient's decision and withhold treatment

The patient's right to autonomy must be upheld, even if the patient's beliefs conflict with what is in their best interests medically. Overruling the patient's decision due to their deteriorating condition is unethical and illegal; the patient has the right to make their own decisions. While court involvement may be appropriate if the decision is being made for an unemancipated minor by a guardian, a court is unlikely to overrule a patient's right to autonomy. It is inappropriate to apply the principle of implied consent to an unconscious patient who has explicitly made their denial of consent known while they were conscious.

47.

The MOST important variable regulating Antidiuretic Hormone (ADH) secretion is:

  • increased serum osmolality

  • decreased serum osmolality

  • decreased serum glucose levels

  • increased serum glucose levels

Correct answer: increased serum osmolality

Antidiuretic Hormone (ADH) is produced by the hypothalamus and stored in the posterior pituitary gland at the base of the brain. ADH is normally released by the pituitary in response to sensors that detect an increase in serum osmolality, as this increase indicates dehydration. When serum osmolality is increased, ADH (which works primarily in the distal collecting tubules of the kidneys) decreases water excretion (conserving body water), thereby increasing urine concentration (osmolality), and hemodilution. This in turn corrects the increase in blood osmolality and returns these levels back to normal (thus correcting the dehydration). 

48.

When assessing a patient's pupillary reaction to light, the critical care nurse knows acceptable descriptions include all of the following EXCEPT:

  • pinpoint

  • brisk

  • sluggish

  • fixed

Correct answer: pinpoint

Assessment of pupil size and reaction to light is performed in all patients and provides information about the function of cranial nerves II (optic) and III (oculomotor). Pupils are assessed for size, shape, and reaction to light. These are measured in millimeters, not described by words such as large, small, pinpoint, or blown. Reaction to light is described as brisk, sluggish, or fixed/nonreactive. Both eyes are tested for direct and consensual response.

49.

The nurse is caring for a 32-year-old patient who was struck by a motorcycle. They sustained multiple injuries, including a fractured pelvis. It has been noted that they are in hypovolemic shock.

Which of the following clinical signs and symptoms indicate the patient is in the compensatory stage of hypovolemic shock?

  • Patient is confused, tachypneic, and has weak peripheral pulses

  • No visible signs and symptoms evident from ongoing cellular changes

  • Patient is unresponsive to verbal stimuli, tachycardic, and has absent bowel sounds

  • Patient has a WBC count of 18,000, serum lactate of > 4 mmol/L, and a positive blood culture

Correct answer: Patient is confused, tachypneic, and has weak peripheral pulses

Normal hemodynamics are consistent with CO 4–6 L/min, HR 60–100 bpm, SVR 800–1500 dynes/sec/cm-5, and MAP > 65 mmHg.

In hypovolemic states, circulating blood volume is depleted, either by blood loss (internal or external) or by the vascular fluid volume shifting out of the vascular space into other body fluid spaces. Tissue perfusion is inadequate due to the decrease in circulating blood, and as a result, right and left ventricular filling pressures are insufficient, decreasing stroke volume and cardiac output. The compensatory stage is composed of a number of physiologic events that represent an attempt to compensate for these decreases in CO and restore adequate oxygen and nutrient delivery to the tissues. The patient may be restless, confused or agitated, have an increased respiratory rate and heart rate, have a weak pulse, and have scant urine output with hypoactive bowel sounds.

In the initial stage of shock, there are no obvious signs and symptoms evident as the first cellular changes occur from the decrease in tissue perfusion. Generally, the progressive stage is marked by unconsciousness, increased heart rate, inadequate blood pressure, increased or shallow respirations, and absent bowel sounds. Septic shock is characterized by increased WBC ( > 12,000), serum lactate > 4 mmol/L, and in up to 50% of patients, a positive blood culture.

50.

A patient is immunocompromised and on a ventilator. Their family would like to perform a tribal ritual that involves sacrificing a live chicken in the presence of the patient and having them drink some of the chicken's blood. They inform the nurse that this ritual is a vital healing ritual in their culture and that the patient will be cursed in the afterlife if the ritual is not performed. Which response by the nurse is BEST?

  • "Sacrificing a live animal in the ICU and having the patient ingest its blood will not be possible. Are there any ways to alter this ritual?"

  • "We will need you to kill the chicken at least six feet away from the equipment and will have to give the blood through an NG tube."

  • "You will need to contact someone from administration to clear this ritual before we can allow it to be performed."

  • "We respect your cultural practices and will do everything we can to help you perform this ritual the way you'd like to."

Correct answer: "Sacrificing a live animal in the ICU and having the patient ingest its blood will not be possible. Are there any ways to alter this ritual?"

While the nurse and healthcare team should make every reasonable attempt possible to accommodate cultural and religious practices, practices that are a potential danger to the patient or to the ability to safely provide care for other patients cannot be accommodated. Killing a live animal in the ICU environment and having an immunocompromised patient ingest raw blood should be prohibited. The nurse should assess if there are other cultural practices that can be substituted. While it is important to demonstrate respect for the patient's cultural practices, clear boundaries must exist in some situations. The nurse does not need to involve administration to make the decision to not permit this ritual to be performed.

51.

Which of the following conditions MOST increases the risk of developing a pulmonary embolism (PE)?

  • Chronic obstructive pulmonary disorder (COPD)

  • Asthma

  • Pneumonia

  • Immune thrombocytopenia purpura (ITP)

Correct answer: Chronic obstructive pulmonary disorder (COPD)

The high incidence of right ventricular failure in COPD increases the risk of pulmonary embolus from right ventricular mural thrombi. PE in patients with COPD exacerbations may contribute to respiratory compromise.

COPD is associated with a higher incidence of PEs than asthma or pneumonia, both of which do not directly contribute to the development of PEs. ITP increases the risk of bleeding, not of thrombus development.

52.

The exam of choice for diagnosing a bowel obstruction is:

  • CT scan of abdomen and pelvis

  • radiographic films of abdomen and pelvis

  • ultrasound of abdomen and pelvis

  • small-bowel contrast enema

Correct answer: CT scan of abdomen and pelvis

The diagnostic exam of choice for bowel obstruction is a CT scan of the abdomen and pelvis with oral contrast as this test will show not only the location of the obstruction but also the etiology of it and the transition zone. 

Radiographic films will show only whether an obstruction is present. Sonography is helpful in the initial evaluation of abdominal pain related to intestinal obstruction but is not diagnostic. A small-bowel follow-through or water-soluble contrast enema may be necessary along with a CT for further information, but is insufficient by itself as a diagnostic tool.

53.

A patient is brought into the emergency department via ambulance following a motor vehicle accident. The patient has sustained a fracture to the femur and possible rib fractures. The patient is tachycardic and tachypneic, complaining of chest pain, shortness of breath, and becomes suddenly disoriented. 

The critical care nurse suspects which of the following conditions?

  • Pulmonary embolism 

  • Pulmonary contusion

  • Pneumothorax 

  • Atelectasis

Correct answer: Pulmonary embolism 

Pulmonary Embolism (PE) can be a major complication in trauma patients. The critical care nurse should look for chest pain, SOB (Shortness of Breath), sudden disorientation, decreased PaO2, tachycardia, and tachypnea in the trauma patient, indicating PE. A femur fracture can cause a fat embolism that ultimately leads to a PE. Nursing interventions for PE include immediately notifying the physician, assisting with transport to lung scan, monitoring the patient's ECG, and administering supplemental oxygen.

54.

Which of the following is LEAST LIKELY to be a complication of immobility?

  • Compartment syndrome

  • Venous thromboembolism (VTE)

  • Pressure injury 

  • Urinary tract infection (UTI)

Correct answer: Compartment syndrome

Compartment syndrome is normally caused by an injury, especially by a crush-related injury, and is not likely to be caused by immobility. 

Immobility can lead to VTEs, pressure ulcers, and muscle atrophy. UTIs can result from immobility, but compartment syndrome is less likely than a UTI. 

55.

Pain in the elderly patient is often reported differently than that of a younger patient due to all of the following changes that accompany aging EXCEPT:

  • social

  • physiological

  • psychological

  • cultural

Correct answer: social

Social changes may occur with age, but are not related to pain like other aging related changes.

Psychological, physiologic, and cultural changes occur with aging; some elderly patients may fear loss of control or independence, or may even associate pain with impending death. For these reasons, elderly patients may not report their pain accurately, as if to deny pain is to deny death. It is important for nurses to incorporate behavioral or physiologic indicators of pain into a variety of pain assessment strategies when caring for elderly patients.

56.

All the following are initial strategies that nurses can take to prevent delirium and decrease its effects on a critically ill patient, EXCEPT:  

  • Medicate when necessary to keep the patient safe 

  • Ambulate as soon as possible 

  • Promote normal sleep-wake cycles 

  • Educate family members to provide frequent reorientation 

Correct answer: Medicate when necessary to keep the patient safe 

Medications can sometimes be useful in the management of delirium, and may be necessary to keep the patient safe. However, many medications alter neurologic assessment, delay recovery, or even worsen symptoms. Environmental strategies, such as early mobility, promoting normal sleep-wake cycles, and frequent reorientation, may be very effective. These strategies should always be implemented first. 

If medications are required, they are combined with environmental strategies and used at the lowest dose possible for the shortest time possible. 

57.

Which of the following is MOST LIKELY to be the cause of hypertrophic cardiomyopathy?

  • Aortic stenosis

  • Chagas disease

  • Alcohol use

  • Myocardial fibrosis

Correct answer: Aortic stenosis

Hypertrophic cardiomyopathy is most likely to be caused by aortic stenosis, causing increased afterload and hypertrophy of the ventricular myocardium. Chagas disease and alcohol use are most likely to cause dilated cardiomyopathy, while myocardial fibrosis is most likely to cause restrictive cardiomyopathy.

58.

Bleeding is a common complication of fibrinolytic therapy. What is the MOST common location of bleeding?

  • Groin

  • Intracerebral 

  • Genitourinary 

  • Gastrointestinal 

Correct answer: Groin

Totally occluded arteries require immediate reperfusion therapy, such as fibrinolysis, angioplasty, or coronary artery bypass grafting (CABG), to effectively restore blood flow to the coronary artery. In the acute setting, for STEMI (ST-elevation myocardial infarction), fibrinolytic therapy is often the fastest, most universally available method for reperfusion if a catheterization laboratory is not available or operational 24 hours a day. 

Fibrinolytic therapy works by dissolving clots which are obstructing blood flow to the brain. The most common complication associated with fibrinolytic therapy is bleeding. Localized groin bleeding has the highest occurrence at 25–45%, followed by gastrointestinal bleeding at 4–10%. Intracerebral bleeding is the most dangerous complication, but its incidence is quite low at 1.45%. Genitourinary bleeding occurs in 1-5% of patients undergoing fibrinolytic therapy. 

59.

A critically ill patient is experiencing chest pain and palpitations, decreased deep tendon reflexes (DTRs), and muscle weakness. These signs are MOST OFTEN associated with which electrolyte disorder?

  • Hyperkalemia

  • Hypokalemia

  • Hypophosphatemia

  • Hyperphosphatemia

Correct answer: Hyperkalemia

In critically ill patients, Hyperkalemia, a serum potassium (K+) of more than 5.5 mEq/L, occurs due to increased potassium intake, decreased potassium excretion, and redistribution of K+ from intracellular to extracellular fluid. 

The most common causes of hyperkalemia are acute kidney injury (AKI), cellular destruction (eg, from crush injuries), and excess supplementation. Because potassium impacts normal neuromuscular and cardiac function, it often manifests first as changes in electrical conduction as cardiac contractility is decreased, demonstrated by changes on ECG tracings. Other signs include vague muscle weakness, decreased DTRs, flaccid paralysis, confusion, dyspnea, palpitations, chest pain, nausea or vomiting, diarrhea, and cramping. 

Hypokalemia presents with muscle weakness as well, but often includes weak respiratory muscles with subsequent hypoventilation, paralytic ileus, abdominal distention, and lethargy. 

Hyperphosphatemia presents with positive Trousseau or Chvostek signs, hyperreflexia, and seizures. 

Hypophosphatemia presents with bone pain, tachycardia, weight loss, and seizures. Muscle weakness and wasting are also indicative of this imbalance. 

60.

The children of a sedated patient who is unable to make decisions have conflicting views about the plan of care. The patient has two children and both share legal healthcare power of attorney. What should the nurse do FIRST?

  • Arrange a family meeting with the healthcare team to discuss the plan of care

  • Decide on the best plan of care based on the nurse's knowledge and experience

  • Select the plan of care preferred by the majority of the family members because the two healthcare POA's votes are tied

  • Consult the hospital's ethics committee to make the decision

Correct answer: Arrange a family meeting with the healthcare team to discuss the plan of care

The nurse should facilitate communication among the family members and healthcare team to ensure shared understanding and consensus regarding the plan of care. Reaching a consensus will be the easiest and most effective way to move forward with the patient's care if it is possible. The nurse should not decide on the plan of care independently. While consulting the ethics committee may be necessary at times, the first step should be a collaborative discussion and an attempt to reach a consensus. Consultation with the hospital's ethics committee may become necessary; however, reaching a consensus without outside intervention should be the initial priority. 

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