Free AACN CCRN-Adult Practice Exam with Questions & Answers | Set: 5

Kernig's and Brudzinski's signs are classic clinical indicators of meningeal irritation, commonly associated with conditions such as meningitis. Kernig's sign is positive when there is resistance and pain upon extending the knee from a flexed position, and Brudzinski's sign is positive when flexion of the neck causes involuntary flexion of the hips and knees. These signs are not indicative of autonomic hyperreflexia, adrenal insufficiency, or increased intracranial pressure. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

The administration of hypertonic saline (3% Normal Saline) creates an osmotic gradient that pulls water out of the swollen brain tissue into the vascular system, helping to reduce cerebral edema. This is a critical intervention in managing increased intracranial pressure in patients with hemorrhagic stroke. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Alcohol withdrawal syndrome

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Answer: A

The patient’s symptoms of tremulousness, anxiety, and startle response suggest that he may be experiencing alcohol withdrawal, which can occur within hours to days after the last drink. Alcohol withdrawal can cause severe complications, such as seizures, delirium tremens, and death, if not treated promptly and appropriately. Alcohol withdrawal can also worsen GI bleeding by increasing gastric acid secretion, impairing clotting factors, and causing hypertension and tachycardia. Therefore, the most pertinent part of the patient’s history to obtain is the last alcohol intake, which can help determine the risk and severity of withdrawal and guide the management of the patient.

References:

• Management of moderate and severe alcohol withdrawal syndromes: This article states that “Symptoms of alcohol withdrawal occur because alcohol is a central nervous system depressant. When a person drinks frequently, the brain compensates for alcohol’s depressant effects by increasing the activity of excitatory neurotransmitters, such as norepinephrine, serotonin, dopamine, and glutamate, and reducing the activity of inhibitory neurotransmitters, such as gamma-aminobutyric acid (GABA). When alcohol intake is abruptly discontinued or reduced, this neuroadaptation is unmasked, resulting in a hyperexcitable state that is responsible for the characteristic withdrawal symptoms.”
• Alcoholic Gastritis: Causes, Symptoms and Treatment: This article states that “Alcohol Gastritis is a type of acute gastritis and is caused by excessive alcohol consumption. The sudden inflammation of the stomach lining can be very painful and cause severe stomach cramping, irritability and vomiting. While consuming too much alcohol is the main cause of Alcohol Gastritis, it often develops in connection with some sort of infection, direct irritation or localized tissue damage. It can be caused by: Taking non-steroidal, anti-inflammatory medications like aspirin or ibuprofen (i.e., NSAIDs). Certain bacterial infections. Bile reflux from proximal small intestine. Autoimmune disorders.”
• Can You Get Internal Bleeding from Alcohol Abuse: This article states that “Over time, alcohol abuse starts to eat away at the stomach lining. Continued drinking sets the stage for alcoholic gastritis to develop. Under these conditions, internal bleeding from alcohol abuse takes the form of blood oozing from stomach lines on an ongoing basis.”

Haloperidol

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Haloperidol has a known side effect of prolonging the QT interval, which can lead to cardiac dysrhythmias123. Therefore, after the administration of haloperidol, it is important for a nurse to monitor for a prolonged QT interval and cardiac dysrhythmias123. This is why continuous cardiac monitoring is recommended if repeated doses are given1.

Abdominal aortic aneurysm

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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.