Free AACN CCRN-Adult Practice Exam with Questions & Answers | Set: 4

Cerebral angiography is considered the gold standard for diagnosing and pinpointing the location, size, and origin of cerebral aneurysms. It involves the use of contrast material injected into the cerebral arteries and imaging to provide detailed visualization of the blood vessels in the brain, which is essential for accurate diagnosis and planning treatment strategies. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

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Verified Answer: C. establish a schedule with the provider. Neurological assessments are important for monitoring the patient’s neurological status and detecting any changes that may indicate a complication or improvement. However, frequent interruptions of sleep can have negative effects on the patient’s health and well-being, such as impaired cognition, mood, immune function, and wound healing. Therefore, the nurse should collaborate with the provider to establish a schedule for neurologic assessments that balances the need for monitoring and the need for rest. This may involve reducing the frequency of assessments during the night, clustering other interventions to minimize disruptions, and using non-invasive methods of assessment when possible. Discontinuing neurologic assessments, encouraging the patient to sleep between assessments, or moving the patient to a quieter part of the unit are not appropriate actions as they do not address the root cause of the problem or ensure adequate monitoring of the patient’s condition.

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

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

A consistent prolongation of the P-R interval beyond 0.20 seconds indicates a first-degree atrioventricular (AV) block. This type of block is characterized by a delay in the conduction of electrical impulses through the AV node, resulting in a prolonged P-R interval. However, every P wave is still followed by a QRS complex, distinguishing it from higher-degree AV blocks where some P waves are not followed by QRS complexes.References: = CCRN Exam Handbook, page 35

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.References: = CCRN Exam Handbook, page 44

The patient’s data indicate that the patient is in shock, which is a life-threatening condition characterized by inadequate tissue perfusion and organ dysfunction. The patient has a low blood pressure, a high heart rate, a fever, and a metabolic acidosis, which suggest that the patient may have septic shock, which is caused by a severe infection that triggers a systemic inflammatory response. The nurse should anticipate an order to administer phenylephrine (Neo-Synephrine), which is a vasopressor agent that constricts the blood vessels and increases the blood pressure and tissue perfusion. Phenylephrine is recommended as a first-line agent for septic shock by the Surviving Sepsis Campaign guidelines1. 8.4% sodium bicarbonate is not indicated for the treatment of septic shock, as it may worsen the acid-base balance and increase the risk of complications2. 0.9% sodium chloride is a normal saline solution that may be used for fluid resuscitation, but it may not be sufficient to restore the blood pressure and may cause fluid overload, hyperchloremia, and kidney injury3. Amiodarone (Cordarone) is an antiarrhythmic drug that is used to treat ventricular tachycardia or fibrillation, but it is not effective for septic shock and may cause hypotension, bradycardia, and other adverse effects4.

References:

• Surviving Sepsis Campaign. (2020). Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Retrieved from 1, p. 16.
• Marik, P. E., & Bellomo, R. (2013). A rational approach to fluid therapy in sepsis. British Journal of Anaesthesia, 110(3), 323-329. Retrieved from 2, p. 327.
• Semler, M. W., & Rice, T. W. (2019). Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials, 20(1), 1-10. Retrieved from 3, p. 2-3.
• Lexicomp Online. (2021). Amiodarone. Retrieved from 4, p. 1-2.

The intended effects of medications for a patient in acute CHF are to reduce CVP and reduce SVR, as this would decrease the preload and afterload on the failing heart and improve the cardiac output and tissue perfusion. CVP (central venous pressure) is a measure of the pressure in the right atrium and reflects the volume status of the patient. SVR (systemic vascular resistance) is a measure of the resistance in the systemic circulation and reflects the tone of the blood vessels. Medications that can reduce CVP and SVR in acute CHF include diuretics, nitrates, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators12. Increasing CVP and reducing SVR would increase the preload and decrease the afterload, which may be beneficial for some patients with low cardiac output and low filling pressures, but not for patients with acute CHF and volume overload3. Reducing CVP and increasing SVR would decrease the preload and increase the afterload, which would worsen the cardiac function and oxygen demand in acute CHF3. Increasing CVP and increasing SVR would increase both the preload and the afterload, which would also worsen the cardiac function and oxygen demand in acute CHF3.

References:

• 1: Acute decompensated heart failure: Management - UpToDate4, p. 5-6.
• 2: Acute heart failure: diagnosis and management | Guidance | NICE, p. 8-9.
• 3: Hemodynamic monitoring in acute heart failure - UpToDate, p. 3-4.

Abdominal compartment syndrome (ACS) involves increased intra-abdominal pressure, which can significantly impact various body systems. One of the major concerns is its effect on respiratory function, leading to increased peak inspiratory pressure. This happens because the elevated pressure in the abdomen can push up against the diaphragm, making it harder for the lungs to expand during inhalation. Increased urine output is unlikely as ACS usually leads to decreased renal perfusion and output. Increased preload and decreased intracranial pressure are not typically associated with ACS. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course