Free AACN CCRN-Adult Practice Exam with Questions & Answers

Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

When a patient has been declared brain dead, the appropriate initial action for a nurse who has not previously discussed organ donation with a family is to consult the organ donation liaison. These professionals are trained to handle sensitive conversations about organ donation and can provide the necessary support and information to the family, ensuring that the process is handled respectfully and in accordance with legal and ethical guidelines. References: =

• CCRN (Adult) Certification Review Course Online: Professional Caring and Ethical Practice.
• 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

When seeking to make changes to a documentation screen in the electronic health record (EHR), it is crucial to involve all relevant stakeholders to ensure their buy-in and support. This includes discussing the proposed changes with those who will be directly impacted by it and obtaining their feedback. This collaborative approach can help in identifying potential issues and garnering the necessary support for the proposal, increasing the likelihood of it being accepted by the EHR committee in the future.References: = CCRN Exam Handbook, page 58

The patient has signs of severe hyponatremia, which is a low level of sodium in the blood. Hyponatremia can cause cerebral edema, which can lead to seizures, confusion, coma, and death. The patient needs a hypertonic solution, which is a fluid that has a higher concentration of solutes than the blood, to draw water out of the brain cells and restore the normal sodium level. 3% sodium chloride is a hypertonic solution that can be used to treat severe hyponatremia. 0.45% sodium chloride, 0.9% sodium chloride, and 5% dextrose with 0.25% sodium chloride are all hypotonic solutions, which are fluids that have a lower concentration of solutes than the blood, and would worsen the patient’s condition by adding more water to the blood and the brain.

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: Hyponatremia. 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. 303-304.

The patient has signs of myxedema coma, a life-threatening complication of hypothyroidism. The patient needs immediate treatment with thyroid hormone replacement, glucocorticoids, and supportive care. One of the supportive measures is to correct the hypothermia that often accompanies myxedema coma. A forced air warming blanket is a device that delivers warm air through a hose to a blanket that covers the patient. This helps to raise the patient’s core temperature and prevent further complications. Insulin drip is not indicated, as the patient does not have diabetes or hyperglycemia. 3% saline is a hypertonic solution that can worsen the hyponatremia and fluid overload that are common in myxedema coma. Diuretics are not recommended, as they can cause dehydration and electrolyte imbalance in the patient.

References:

• Myxedema Coma: Diagnosis and Treatment | AAFP
• Myxedema coma - UpToDate
• Myxedema: Symptoms, treatment & coma - Medical News Today

brain injury (TBI) is most suggestive of central diabetes insipidus (DI). This condition is caused by damage to the hypothalamus or pituitary gland, leading to insufficient secretion of antidiuretic hormone (ADH). The result is an inability to concentrate urine, leading to polyuria (excessive urine output) and potentially significant dehydration and electrolyte imbalances if not managed appropriately. References: =

• CCRN (Adult) Certification Review Course Online: Neurological Disorders and Endocrine Emergencies.
• 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

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome," is characterized by transient left ventricular dysfunction often precipitated by significant emotional or physical stress. The key findings of chest pain and ST elevation without significant coronary artery disease, along with left ventricular dysfunction and apical ballooning observed on imaging, are classic for takotsubo cardiomyopathy. This condition is often reversible and is associated with a temporary reduction in the heart's pumping ability, indicated by the reduced ejection fraction (EF) of 35%. 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

The patient's tachycardia and hypotension following bowel resection surgery indicate potential severe complications such as hemorrhage or septic shock, which require immediate intervention. If the on-call surgical resident does not provide new orders, the nurse must act promptly to prevent further deterioration by initiating the rapid response team (RRT). The RRT can provide critical interventions and facilitate timely transfer to a higher level of care if needed. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

When a physician has attempted to insert a central line multiple times without success, the nurse's responsibility includes ensuring patient safety and advocating for the patient. Continued attempts by the same physician may increase the risk of complications, such as infection or trauma. Therefore, the nurse should suggest that another physician, possibly one with more experience or skill in central line insertion, perform the procedure. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

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.