CCRN (Adult) – Direct Care Eligibility Pathway Exam Questions PDF download

QUESTION: 25

Potentially life-threatening consequences of diabetic ketoacidosis (DKA) include

cellular dehydration.
intracellular hyperglycemia.
metabolic alkalosis.
respiratory alkalosis.

Answer(s): A

Explanation:

Cellular dehydration is one of the potentially life-threatening consequences of diabetic ketoacidosis (DKA), which is a condition that occurs when the body does not have enough insulin to use glucose for energy and starts to break down fat instead. This produces ketones, which are acidic substances that accumulate in the blood and urine. DKA causes hyperglycemia, which is a high level of glucose in the blood, and osmotic diuresis, which is the loss of water and electrolytes through the urine. This leads to cellular dehydration, which is the shrinkage of the cells due to the loss of water from the intracellular fluid. Cellular dehydration can affect the brain and cause neurological symptoms, such as confusion, lethargy, coma, and death.
Other potentially life-threatening consequences of DKA include metabolic acidosis, which is a low pH of the blood due to the excess of ketones, and respiratory compensation, which is the increase of the breathing rate and depth to expel carbon dioxide and lower the acidity of the blood.
These are not the same as metabolic alkalosis or respiratory alkalosis, which are conditions that cause a high pH of the blood due to the loss of acids or the retention of bases.
Intracellular hyperglycemia is not a consequence of DKA, as the glucose cannot enter the cells without insulin and remains in the extracellular fluid.

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QUESTION: 26

Postoperatively, symptoms that may indicate hemothorax or internal bleeding in a video-assisted thoracic surgery (VATS) patient include

diminished breath sounds.
pain with deep inspiration.
bradycardia.
hypertension.

Answer(s): A

Explanation:

Diminished breath sounds are one of the symptoms that may indicate hemothorax or internal bleeding in a video-assisted thoracic surgery (VATS) patient. VATS is a minimally invasive surgical technique that uses a small video camera (thoracoscope) and special instruments to access the chest cavity through small incisions.
Hemothorax is a condition where blood accumulates in the pleural space, the area between the lungs and the chest wall.
Hemothorax can occur as a complication of VATS due to injury to the lung, blood vessels, or chest wall during the procedure.
Hemothorax can cause compression of the lung and reduce its expansion, leading to diminished breath sounds on the affected side.
Other symptoms of hemothorax may include chest pain, shortness of breath, low blood pressure, rapid heart rate, and pale or clammy skin.
Internal bleeding is another possible complication of VATS that can cause similar symptoms as hemothorax. Internal bleeding can occur due to damage to the major vessels, such as the aorta, pulmonary artery, or vena cava, during VATS. Internal bleeding can cause hypovolemia, which is a decrease in the volume of blood in the body, and hypoxemia, which is a low level of oxygen in the blood. These conditions can impair the delivery of oxygen to the tissues and organs, including the lungs, and cause diminished breath sounds, as well as other signs of shock, such as confusion, weakness, dizziness, and loss of consciousness.
Pain with deep inspiration, bradycardia, and hypertension are not typical symptoms of hemothorax or internal bleeding in a VATS patient. Pain with deep inspiration may be a normal postoperative finding after VATS, as the incisions and the chest tube may cause discomfort. Bradycardia and hypertension may be caused by other factors, such as medications, cardiac disorders, or neurological conditions, but they are not directly related to hemothorax or internal bleeding .

Reference:

1: Video-Assisted Thoracoscopic Surgery (VATS) | Johns Hopkins Medicine
2: Hemothorax: Causes, Symptoms, Diagnosis & Treatment - Cleveland Clinic2
3: Complications of video-assisted thoracoscopic surgery: a retrospective analysis of 3000 cases - PubMed

: Major vascular complications after video-assisted thoracoscopic surgery: a case report and literature review - PubMed
: Video-Assisted Thoracoscopic Surgery (VATS) | Michigan Medicine : Bradycardia - Symptoms and causes - Mayo Clinic
: High blood pressure (hypertension) - Symptoms and causes - Mayo Clinic

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QUESTION: 27

A patient who is post repair of an abdominal aortic aneurysm should be monitored for which of the following complications?

acute renal failure
acute hepatic dysfunction
acute CVA
atrial fibrillation

Answer(s): A

Explanation:

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 injury.
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 factors.
Acute renal failure is associated with increased morbidity, mortality, and length of hospital stay after AAA repair.

Other complications of AAA repair include bleeding, infection, wound complications, graft-related complications, bowel ischemia, spinal cord ischemia, and cardiac, pulmonary, or neurological events.
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.

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QUESTION: 28

A patient with hypertension received tPA for an acute embolic stroke with complete resolution of symptoms. Twenty-four hours after tPA administration, the nurse should anticipate an order for

diuretics.
beta blockers.
antiplatelet agents.
calcium channel blockers.

Answer(s): C

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QUESTION: 29

A 22-year-old trauma patient sustained multiple fractures after a fall. The patient fell 50 feet from a cliff while rock climbing without a harness. The patient is intubated and sedated with casts to bilateral lower extremities. The nurse should recognize that young adults are

more likely to engage in risk-taking behaviors.
developmentally vulnerable to peer pressure in extreme sports.
working through trust issues that cause them to test limits.
influenced by long-time intervals spent in virtual reality.

Answer(s): A

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QUESTION: 30

In septic shock, a mixed venous O2 saturation (SO2) of 84% indicates that

O2 delivery to tissues is inadequate due to shunting.
the mixed venous pO2 is low.
venous pO2 and saturation are irrelevant to tissue perfusion.
the tissue cells are being well oxygenated.

Answer(s): D

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.

Reference:

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.

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QUESTION: 31

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?

O2 toxicity
absorption atelectasis
depressed hypoxic drive
decreased end-tidal CO2

Answer(s): 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.

Reference:

Reference Guide for CCRN (Adult), page 14.

Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

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QUESTION: 32

A patient is admitted following a motor vehicle crash. A fluid challenge is initiated immediately after assessing a BP of 80/palpable. Fifteen minutes later,
vital signs are as follows:
BP
HR 150
RR 36
The most appropriate action should be to

administer a vasopressor.
administer a second fluid challenge.
request a CT scan of the chest.
request an abdominal ultrasound.

Answer(s): B

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AACN CCRN (Adult) – Direct Care Eligibility Pathway CCRN-Adult Dumps in PDF

Free AACN CCRN-Adult Real Questions (page: 14)

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QUESTION: 32