CCRN-Adult Pre-Exam Practice Tests | (Updated 152 Questions)
Valid CCRN-Adult Exam Q&A PDF - One Year Free Update
NEW QUESTION # 23
A patient is admitted for acute benzodiazepine overdose. Nursing interventions should include administration of
- A. flumazenil (Romazicon).
- B. naloxone (Narcan).
- C. sodium bicarbonate.
- D. osmotic diuretics.
Answer: A
Explanation:
Flumazenil is a benzodiazepine antagonist that can reverse the effects of benzodiazepine overdose. It acts by competitively inhibiting the activity at the benzodiazepine receptor, thus reversing sedation and other effects caused by benzodiazepines. Sodium bicarbonate, naloxone, and osmotic diuretics are not appropriate treatments for benzodiazepine overdose. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 24
Which of the following are most indicative of acute pancreatitis?
- A. abdominal distention, decreased lipase level, hypertension
- B. hypotension, jaundice, hyperalbuminuria
- C. Grey Turner's sign, hyperkalemia, right shoulder pain
- D. severe mid-epigastric pain, leukocytosis, hypocalcemia
Answer: D
Explanation:
Acute pancreatitis is most commonly indicated by severe mid-epigastric pain, which often radiates to the back, leukocytosis (an elevated white blood cell count indicating inflammation), and hypocalcemia (low calcium levels in the blood). The inflammation of the pancreas leads to the release of digestive enzymes and inflammatory mediators that can cause widespread effects, including alterations in calcium metabolism.References: = CCRN Exam Handbook, page 47
NEW QUESTION # 25
The goal of PEEP therapy in acute lung injury (ALI) is to
- A. decrease airway resistance.
- B. reduce physiologic shunting.
- C. increase cardiac output.
- D. decrease PAP.
Answer: B
Explanation:
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.
NEW QUESTION # 26
In a patient with hypertensive crisis, neurologic changes are caused by
- A. hypoxemia as a result of pulmonary interstitial edema.
- B. vasospasm of the cerebral arterioles.
- C. increased ICP as a result of loss of cerebral autoregulation.
- D. excessive secretion of catecholamines.
Answer: C
Explanation:
In hypertensive crisis, neurologic changes are often caused by increased intracranial pressure (ICP) as a result of loss of cerebral autoregulation. Autoregulation normally maintains consistent cerebral blood flow despite changes in systemic blood pressure. In hypertensive crisis, the extremely high blood pressure overwhelms these mechanisms, leading to increased cerebral blood flow, disruption of the blood-brain barrier, and cerebral edema, which subsequently increases ICP and causes neurologic changes.References: = CCRN Exam Handbook, page 48
NEW QUESTION # 27
A patient is admitted with an acute anterior wall MI. Initial hemodynamic readings are:
The nurse anticipates initiating a plan of care for
- A. pulmonary hypertension.
- B. right ventricular infarct.
- C. cardiogenic shock.
- D. volume overload.
Answer: C
Explanation:
The hemodynamic readings provided (BP 80/60, HR 110, CVP 20 mm Hg, PAOP 26 mm Hg, CO 2.1 L/min, CI 1.3 L/min/m², PAP 42/32 mm Hg, SVR 1762 dynes/sec/cm) suggest cardiogenic shock. This condition is characterized by low cardiac output and index, elevated filling pressures (CVP and PAOP), and systemic vascular resistance. Cardiogenic shock often occurs following an acute anterior wall myocardial infarction (MI) due to extensive damage to the myocardium, leading to impaired contractility and inadequate tissue perfusion.References: = CCRN Exam Handbook, page 12
NEW QUESTION # 28
Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include
- A. decreases in platelet count, thrombin time, and FSP (FDP).
- B. increases in platelet count and fibrinogen.
- C. increases in PT, PTT, and FSP (FDP).
- D. decreases in PT and thrombin time.
Answer: C
Explanation:
Laboratory values diagnostic for disseminated intravascular coagulation (DIC) include increased prothrombin time (PT), partial thromboplastin time (PTT), and fibrin split products (FSP), also known as fibrin degradation products (FDP). These increases indicate widespread clotting and subsequent fibrinolysis, which are characteristic of DIC. The consumption of clotting factors and platelets in DIC leads to prolonged clotting times and elevated levels of fibrin degradation products.References: = CCRN Exam Handbook, page 42
NEW QUESTION # 29
In septic shock, a mixed venous O2 saturation (SO2) of 84% indicates that
- A. O2 delivery to tissues is inadequate due to shunting.
- B. the tissue cells are being well oxygenated.
- C. the mixed venous pO2 is low.
- D. venous pO2 and saturation are irrelevant to tissue perfusion.
Answer: B
Explanation:
A high mixed venous O2 saturation (SO2) indicates that the tissue cells are not extracting enough oxygen from the blood, which can be due to impaired cellular metabolism or increased oxygen delivery. In septic shock, there is often a mismatch between oxygen delivery and consumption, resulting in a high SO2 despite tissue hypoxia. Therefore, SO2 alone is not a reliable indicator of tissue perfusion in septic shock.
References:
* Mixed venous oxygen saturation (SvO2) monitoring * LITFL * CCC
* SvO2 to monitor resuscitation of septic patients: let's just understand the basic physiology | Critical Care
| Full Text
* Reference Guide for CCRN (Adult), page 14.
NEW QUESTION # 30
A patient with a history of COPD is admitted with increasing dyspnea and fatigue. O2 is initiated via nasal cannula at 4 L/min with an O2 saturation of 99%. One hour later, the patient becomes lethargic. Which of the following is the most likely cause for the change in the patient's mental status?
- A. absorption atelectasis
- B. O2 toxicity
- C. depressed hypoxic drive
- D. decreased end-tidal CO2
Answer: C
Explanation:
A patient with COPD may have a chronically elevated PaCO2 and rely on hypoxia as the main stimulus for breathing. If the patient receives too much oxygen, this may reduce the hypoxic drive and cause respiratory depression, leading to lethargy and hypercapnia. O2 toxicity, absorption atelectasis, and decreased end-tidal CO2 are unlikely to occur with 4 L/min of O2 via nasal cannula in a short period of time.
References:
* Reference Guide for CCRN (Adult), page 14.
* Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?
NEW QUESTION # 31
The primary pathophysiology underlying acute respiratory failure in a patient with head trauma involves
- A. shifting of oxyhemoglobin dissociation curve to the left.
- B. hypercapnia related to decreased minute ventilation.
- C. dehydration related to diabetes insipidus.
- D. increased arterial oxygenation related to increased intrapulmonary shunt.
Answer: B
Explanation:
In a patient with head trauma, the primary pathophysiology underlying acute respiratory failure often involves hypercapnia due to decreased minute ventilation. Head trauma can impair the central nervous system's ability to regulate breathing, leading to inadequate ventilation and a build-up of carbon dioxide (CO2) in the blood.
Other factors like shifting of the oxyhemoglobin dissociation curve, increased intrapulmonary shunt, and dehydration due to diabetes insipidus may be present but are not the primary causes. References: CCRN Exam Handbook, AACN, page 25, section on Respiratory.
NEW QUESTION # 32
A ventilator-associated event (VAE) is best prevented by
- A. minimizing tube feedings.
- B. subglottic suctioning.
- C. changing ventilator tubing daily.
- D. tracheal instillation of normal saline.
Answer: B
Explanation:
Ventilator-associated events (VAEs) can be prevented by reducing the risk of aspiration and maintaining airway hygiene. Subglottic suctioning is an effective measure to remove secretions that accumulate above the endotracheal tube cuff, which can harbor bacteria and lead to infection. This intervention helps prevent the development of pneumonia and other VAEs. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.
NEW QUESTION # 33
A patient who had a liver resection now has a copious amount of serous drainage from the surgical incision.
Which of the following should a nurse anticipate when caring for this patient?
- A. applying a drainage pouch to the site
- B. administering antibiotics
- C. applying several abdominal dressings
- D. preparing for an incision and debridement of the wound
Answer: C
Explanation:
A copious amount of serous drainage from a liver resection incision may indicate a bile leak, which can cause pain, infection, and delayed healing. The nurse should anticipate applying several abdominal dressings to absorb the fluid and protect the wound. The nurse should also monitor the patient for signs of infection, such as fever, increased white blood cell count, and foul-smelling drainage. The nurse should notify the surgeon of the excessive drainage and follow the orders for further interventions, such as imaging studies, drainage catheter placement, or surgical repair. Antibiotics may be prescribed, but they are not the first-line treatment for a bile leak. Incision and debridement of the wound may be necessary if there is necrotic tissue or infection, but it is not the initial action. Applying a drainage pouch to the site may not be sufficient to contain the large amount of fluid and may increase the risk of skin breakdown.
References:
* Problems after cancer surgery to remove part of your liver: This article states that "The bile ducts connect the liver and gallbladder to the small bowel. There is a risk of bile leaking from the ducts on the cut surface of the liver. This may cause pain, sickness and a high temperature. Rarely, you might need another operation to repair the leak."
* Understanding Liver Abscess Treatment - Saint Luke's Health System: This article states that "The provider uses CT scan or ultrasound to help place the wire in the right spot. A thin, flexible tube (catheter) is then placed over the wire and into the abscess. The tube is left in place for 5 to 7 days to drain the fluid. In some cases, surgery may be done to cut into the liver abscess and drain it."
* How Much Time Does it Take to Recover from Liver Surgery?: This article states that "If you have any drainage from your incision or if the area around your incision is puffy or red, visit your surgeon. Take a shower every day with warm water. When you are ready to take solid foods, make sure to eat 4 to 6 small meals every day. Do not lift heavy weights for 8 weeks after your surgery."
NEW QUESTION # 34
To maintain adequate pain control in a post-surgical patient addicted to heroin, a nurse should plan to
- A. administer PCA with continuous and on-demand opioid delivery.
- B. avoid administering any intravenous pain medication.
- C. administer oral opioids only as needed.
- D. administer PCA opioids with on-demand dosing only.
Answer: A
Explanation:
For a post-surgical patient with a history of heroin addiction, a PCA (patient-controlled analgesia) with both continuous and on-demand opioid delivery ensures consistent pain control and addresses both baseline pain and breakthrough pain. This approach helps manage pain more effectively and can prevent withdrawal symptoms in patients with opioid tolerance. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 88-90.
NEW QUESTION # 35
During the monthly code team review, it is noted that regulators have been consistently missing from the O2 tanks. Which of the following is a nurse's best action?
- A. Report the missing regulators to the shift supervisor.
- B. Inform the nurse manager of the need for more regulators.
- C. Form a task force to try to find a solution.
- D. Document on the daily flow sheets when the regulators are missing.
Answer: B
Explanation:
The absence of regulators from O2 tanks is a serious issue that can affect patient care1. The nurse manager is in a position to address this problem effectively by ensuring the availability of necessary equipment2.
Therefore, the best action would be to inform the nurse manager of the need for more regulators123. While documenting the issue and reporting to the shift supervisor are important, they do not directly address the problem. Forming a task force could be helpful, but it might take more time to implement solutions23.
NEW QUESTION # 36
Which of the following should the nurse expect in a patient with papillary muscle dysfunction?
- A. aortic stenosis
- B. mitral stenosis
- C. mitral insufficiency
- D. aortic insufficiency
Answer: C
Explanation:
Papillary muscle dysfunction, often resulting from myocardial infarction, can lead to mitral insufficiency (mitral regurgitation). The papillary muscles support the mitral valve, and if they are damaged, the valve may not close properly, causing blood to flow backward into the left atrium during systole. This condition is not associated with aortic stenosis, mitral stenosis, or aortic insufficiency. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course
NEW QUESTION # 37
A patient who is post repair of an abdominal aortic aneurysm should be monitored for which of the following complications?
- A. atrial fibrillation
- B. acute CVA
- C. acute renal failure
- D. acute hepatic dysfunction
Answer: C
Explanation:
Abdominal aortic aneurysm
An x-ray of a human body Description automatically generated
Acute renal failure is one of the possible complications of abdominal aortic aneurysm (AAA) repair, especially after open surgery. Acute renal failure is a sudden loss of kidney function that can cause fluid and electrolyte imbalance, acid-base disturbance, and uremic syndrome. Acute renal failure can occur due to several factors, such as hypoperfusion of the kidneys, atheroembolism, contrast-induced nephropathy, or ischemia-reperfusion injury12. The incidence of acute renal failure after AAA repair ranges from 2 to 25%, depending on the definition, the type of surgery, and the patient's risk factors13. Acute renal failure is associated with increased morbidity, mortality, and length of hospital stay after AAA repair13.
Other complications of AAA repair include bleeding, infection, wound complications, graft-related complications, bowel ischemia, spinal cord ischemia, and cardiac, pulmonary, or neurological events124.
Acute hepatic dysfunction, acute CVA, and atrial fibrillation are not specific complications of AAA repair, but they may occur in any major surgery or in patients with preexisting conditions.
NEW QUESTION # 38
Which of the following is a sign of brain death?
- A. positive cough reflex
- B. negative apnea test
- C. negative cold caloric test
- D. positive vestibulo-ocular reflex
Answer: B
Explanation:
A negative apnea test means that the patient does not breathe spontaneously when disconnected from the ventilator and exposed to a high level of carbon dioxide, which normally stimulates breathing. A negative apnea test is one of the criteria for brain death, as it indicates the loss of brainstem function. A positive vestibulo-ocular reflex, also known as the oculocephalic or doll's eye reflex, means that the eyes move in the opposite direction of the head when the head is turned. A positive cough reflex means that the patient coughs when the trachea is stimulated. A negative cold caloric test means that the eyes do not move when cold water is injected into the ear canal. All these tests assess the integrity of the brainstem, and a positive result would exclude brain death. Therefore, the correct answer is B.
References:
* Diagnosis of brain death - UpToDate, under "Apnea testing".
* Brain Death | Critical Care Medicine | JAMA | JAMA Network, under "How Is Brain Death Diagnosed?".
* The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by ..., under "Apnea Testing".
NEW QUESTION # 39
A patient is admitted with a traumatic brain injury after being thrown from a horse. Despite numerous interventions, the patient is declared brain dead.
The parents have consented for organ donation, and the patient's mother requests to lay next to her daughter before being taken to the operating room.
Which of the following is the nurse's most appropriate response?
- A. "I will need a few minutes to prepare and organize this for you."
- B. "Please sit at the side of the bed, hold her hand, and talk to her."
- C. "It would be too risky to move all of the machines and wires."
- D. "We must obtain permission from the organ donation team first."
Answer: A
Explanation:
The nurse should respect the mother's request and facilitate the family's emotional needs during the end-of-life care. The nurse should also ensure the patient's safety and dignity by preparing and organizing the necessary equipment and monitoring before moving the mother next to the patient. The other options are not appropriate because they either deny the mother's request, imply that the patient is no longer alive, or delay the organ donation process.
References:
* Donor Family Care Service - NHS Blood and Transplant
* Family-Centered Care to Improve Family Consent for Organ Donation
NEW QUESTION # 40
Which of the following signs is most frequently associated with meningitis?
- A. positive Kernig's
- B. positive Babinski's
- C. positive Trousseau's
- D. positive Cullen's
Answer: A
Explanation:
Meningitis
A positive Kernig's sign is a clinical test for meningitis that involves flexing the hip and knee of the patient and then extending the knee. If the patient feels pain or resistance in the lower back or hamstring, the test is positive. A positive Kernig's sign indicates irritation of the meninges, the membranes that cover the brain and spinal cord. A positive Trousseau's sign is a sign of hypocalcemia that involves carpal spasm after inflating a blood pressure cuff. A positive Cullen's sign is a sign of retroperitoneal bleeding that involves bruising around the umbilicus. A positive Babinski's sign is a sign of upper motor neuron lesion that involves fanning of the toes when the sole of the foot is stroked.
References:
* Kernig's sign - Wikipedia
* Trousseau's sign - Wikipedia
* Cullen's sign - Wikipedia
* Babinski sign - Wikipedia
NEW QUESTION # 41
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