AACN CCRN-Adult Exam Questions Instant Access

Question 1

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

AO2 delivery to tissues is inadequate due to shunting.

Bthe mixed venous pO2 is low.

Cvenous pO2 and saturation are irrelevant to tissue perfusion.

Dthe tissue cells are being well oxygenated.

Answer : D

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.

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.

Question 2

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?

AO2 toxicity

Babsorption atelectasis

Cdepressed hypoxic drive

Ddecreased end-tidal CO2

Answer : C

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 Guide for CCRN (Adult), page 14.

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

Question 3

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

Amore likely to engage in risk-taking behaviors.

Bdevelopmentally vulnerable to peer pressure in extreme sports.

Cworking through trust issues that cause them to test limits.

Dinfluenced by long-time intervals spent in virtual reality.

Answer : A

Question 4

A patient is recovering from CABG surgery. On postoperative day 3, the patient's laboratory values indicate thrombocytopenia and elevated liver function tests. The patient is scheduled for hemodialysis today. A nurse notifies the physician of the abnormal laboratory values. The nurse should next anticipate an order to

Aadminister heparin to prevent clot formation.

Bcomplete hemodialysis without heparin.

Ctransfuse platelets during hemodialysis.

Dreschedule hemodialysis.

Answer : B

The patient has thrombocytopenia, which is a low platelet count that increases the risk of bleeding. Heparin is an anticoagulant that prevents clotting, but also increases the risk of bleeding. Therefore, heparin should be avoided in patients with thrombocytopenia. Hemodialysis can be performed without heparin by using alternative methods such as saline flushes, blood predilution, or specialized dialyzers that reduce clotting. Transfusing platelets during hemodialysis is not recommended, as platelets may be damaged by the extracorporeal circuit. Rescheduling hemodialysis may not be feasible, as the patient may have fluid overload, electrolyte imbalance, or uremia that require urgent dialysis.

Use and safety of heparin-free maintenance hemodialysis in the USA

Anticoagulation for the hemodialysis procedure

Dialysis without anticoagulation (Heparin Free Dialysis)

Question 5

Which of the following intubated patients is most at risk for developing ventilator-associated pneumonia (VAP)?

A68-year-old patient, 142 kg, from an assisted living facility with COPD and dialysis-dependent renal disease

B84-year-old patient, 38 kg, from a skilled nursing facility receiving chemotherapy for colorectal cancer

C91-year-old patient, 54 kg, from home with osteoporosis and hypothyroidism

D72-year-old patient, 81 kg, from a nursing home with heart failure and chronic bronchitis

Answer : A

Among the options, the 68-year-old patient with COPD and dialysis-dependent renal disease is at the highest risk for developing VAP. This is due to multiple risk factors including advanced age, chronic obstructive pulmonary disease (COPD), which predisposes to poor lung function and clearance of secretions, and the immunocompromised state from dialysis-dependent renal disease. The patient's higher body weight can also contribute to complications in mobility and ventilation management, further increasing the risk of VAP. Reference: =

CCRN (Adult) Certification Review Course Online: Infectious Disease and Pulmonary Infections.

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

Question 6

Which of the following is a late finding in hypovolemic shock?

Atachycardia

BUO greater than 30 mL/hr

Ccool, dry skin

Dhypotension

Answer : D

Hypotension, or low blood pressure, is a late finding in hypovolemic shock, which means that it occurs when the condition has progressed to a severe stage. Hypotension indicates that the body's compensatory mechanisms, such as vasoconstriction, tachycardia, and increased cardiac output, have failed to maintain adequate perfusion and oxygen delivery to the vital organs. Hypotension is a sign of impending circulatory collapse and organ failure, and requires immediate intervention to restore blood volume and blood pressure. Hypotension is usually defined as a systolic blood pressure below 90 mmHg or a mean arterial pressure below 65 mmHg1.

Hypovolemic Shock: Causes, Symptoms and Treatment - Cleveland Clinic: This article states that ''As you keep losing blood or fluids, your systolic (top or first number) blood pressure comes down.'' and ''Your blood pressure drops very low and your heart rate and breathing get faster.''

Question 7

A patient with a C5 spinal cord injury calls the nurse every 15 minutes with requests for juice, water, and repositioning. Which of the following is the nurse's best response?

A'You need to be repositioned only every 2 hours.'

B'You are safe. Nothing will happen to you.'

C'I will check on you every 30 minutes.'

D'I will get someone to sit with you.'

Answer : D

The patient with a C5 spinal cord injury may have anxiety, fear, or depression due to the loss of function and independence. The patient may also have difficulty breathing, swallowing, or regulating body temperature. The patient may call the nurse frequently to seek reassurance, attention, or comfort. The nurse should respond with empathy and compassion, and provide the patient with emotional support and psychological counseling. The nurse should also assess the patient's physical needs and provide adequate hydration, nutrition, and skin care. The nurse should not dismiss the patient's requests, ignore the patient's feelings, or limit the patient's contact with the nurse. The nurse should also not give false reassurance or minimize the patient's concerns. Therefore, the best response is to get someone to sit with the patient, such as a family member, a friend, or a volunteer. This will help the patient feel less isolated, anxious, or depressed, and provide the patient with a sense of security and companionship.

AACN CCRN (Adult) - Direct Care Eligibility Pathway CCRN-Adult Exam Questions