AACN CCRN-Adult Exam Questions Instant Access

Question 1

A patient is admitted with a traumatic brain injury. During assessment, a nurse notes increased urinary output from the catheter. Which of the following should the nurse suspect?

Asyndrome of inappropriate antidiuretic hormone (SIADH)

Bcentral diabetes insipidus

Ccerebral salt wasting

Dnephrogenic diabetes insipidus

Answer : B

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. Reference: =

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

Question 2

A patient with history of hypothyroidism is admitted with severe confusion and nonpitting edem

a. The nurse should anticipate which order?

Ainsulin drip

B3% saline 150 mL/hour

Cdiuretics

Dforced air warming blanket

Answer : D

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.

Myxedema Coma: Diagnosis and Treatment | AAFP

Myxedema coma - UpToDate

Myxedema: Symptoms, treatment & coma - Medical News Today

Question 3

Pulsus paradoxus is defined as

Aa decrease in systolic BP of greater than 10 mm Hg during normal expiration.

Ba decrease in systolic BP of greater than 10 mm Hg during normal inspiration.

Ca decrease in diastolic BP of greater than 10 mm Hg during normal expiration.

Dan increase in systolic BP of greater than 10 mm Hg during normal inspiration.

Answer : B

Pulsus paradoxus is defined as a decrease in systolic blood pressure (BP) of more than 10 mm Hg during normal inspiration. This phenomenon occurs due to the increased negative intrathoracic pressure during inspiration, which exaggerates the normal drop in systolic BP. It is often seen in conditions such as cardiac tamponade, constrictive pericarditis, and severe asthma or COPD exacerbations. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 4

A nurse admits a patient awaiting surgery for an unstable pelvic fracture following a fall in which no other injuries were sustained. The nurse should prioritize

Atransportation to radiology for an MRI.

Btype and crossmatch PRBC prior to surgery.

Cplacement of a binder across the patient's hips.

Dadministration of a sedative to reduce movement.

Answer : C

In the context of an unstable pelvic fracture, placing a binder across the patient's hips is crucial to stabilize the fracture and reduce the risk of further internal bleeding and damage. This intervention helps in temporarily stabilizing the pelvis until definitive surgical treatment can be performed. Transporting the patient for an MRI is not the immediate priority, as the primary goal is to stabilize the patient. Type and crossmatching PRBCs are important but should follow immediate stabilization measures. Administering a sedative to reduce movement can be considered, but it is not the top priority over physical stabilization of the fracture. Reference: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Question 5

A patient with a history of six cardiac catheterizations relates that he has received differing instructions about the duration of required bedrest after the procedure. To further investigate this issue, which of the following is a nurse's most appropriate action?

AAsk about obtaining an independent evaluation of unit outcomes.

BConduct an informal chart review and outcome evaluation of patients treated with different bedrest protocols.

CReview recent published research about bedrest protocols.

DAsk the nursing supervisor to request standardized physician orders for patients who have undergone catheterization.

Answer : C

The nurse's most appropriate action is to review recent published research about bedrest protocols, as this would provide the nurse with the most current and reliable evidence to guide clinical practice and improve patient outcomes. Bedrest protocols after cardiac catheterization may vary depending on the type of access site, the use of closure devices, the patient's risk factors, and the clinician's preference. However, there is a growing body of research that supports early ambulation and shorter bedrest duration to reduce the risk of complications, such as bleeding, hematoma, back pain, and venous thromboembolism, and to enhance patient comfort and satisfaction123. Asking about obtaining an independent evaluation of unit outcomes, conducting an informal chart review and outcome evaluation of patients treated with different bedrest protocols, or asking the nursing supervisor to request standardized physician orders for patients who have undergone catheterization are not the most appropriate actions, as they may not reflect the best available evidence, may be biased or incomplete, or may not address the patient's concern.

1: Bedrest After Cardiac Catheterization: A Systematic Review and Meta-analysis4, p. 1-2.

2: Early Ambulation After Cardiac Catheterization: A Literature Review, p. 1-2.

3: Bed Rest After Cardiac Catheterization: A Review of the Evidence, p. 1-2.

Question 6

A patient underwent a successful percutaneous coronary intervention to the left anterior descending coronary artery. The patient suddenly begins to complain of dyspnea, jaw pain, and chest tightness. The bedside monitor displays sinus tachycardia and ST segment elevation in lead V2. The patient's neck veins are flat and BP is 152/98. Which of the following is the most likely cause of the patient's symptoms?

Apulmonary hypertension

Bcoronary artery occlusion

Cvasovagal reaction

Dcardiac tamponade

Answer : B

The patient presents with dyspnea, jaw pain, chest tightness, and sinus tachycardia with ST segment elevation in lead V2 after a percutaneous coronary intervention (PCI). These symptoms are indicative of myocardial ischemia or infarction, likely due to a re-occlusion of the treated coronary artery. Coronary artery occlusion is a common cause of these acute symptoms post-PCI. Other options like pulmonary hypertension, vasovagal reaction, and cardiac tamponade are less consistent with the clinical presentation. Reference: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

Question 7

A patient is admitted with a traumatic brain injury after being thrown from a horse. Despite numerous interventions, the patient is declared brain dead.

The parents have consented for organ donation, and the patient's mother requests to lay next to her daughter before being taken to the operating room.

Which of the following is the nurse's most appropriate response?

A'I will need a few minutes to prepare and organize this for you.'

B'It would be too risky to move all of the machines and wires.'

C'We must obtain permission from the organ donation team first.'

D'Please sit at the side of the bed, hold her hand, and talk to her.'

Answer : A

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.

Donor Family Care Service - NHS Blood and Transplant

Family-Centered Care to Improve Family Consent for Organ Donation

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