Free Practice Questions for AACN CCRN-Adult Exam

This is the nurse’s best initial response, as it expresses empathy, validates the patient’s feelings, and assesses the patient’s risk of suicide. Depression is a common and serious mental health condition that affects older adults, especially those living in nursing homes. Depression can cause persistent sadness, hopelessness, loss of interest, and suicidal thoughts or behaviors. The nurse should screen the patient for depression using a validated tool, such as the Patient Health Questionnaire (PHQ-9) 1, and ask about any suicidal ideation or plans. The nurse should also provide emotional support, education, and referral to appropriate resources for the patient.

B. “Those feelings should resolve when the medication you’ve started has a chance to take effect.”

This is not the nurse’s best initial response, as it dismisses the patient’s feelings, implies that the patient just needs to wait for the medication to work, and does not address the patient’s psychosocial needs. Antidepressants are one of the treatment options for depression, but they may take several weeks to show their full effect, and they may not work for everyone. The nurse should also explore other factors that may contribute to the patient’s depression, such as social isolation, loss of autonomy, chronic illness, or grief, and offer interventions that may help the patient cope, such as counseling, psychotherapy, cognitive-behavioral therapy, or social activities.

C. “I understand how you feel. We all get that way when we’re depressed.”

This is not the nurse’s best initial response, as it assumes that the nurse knows how the patient feels, minimizes the patient’s experience, and generalizes the patient’s condition. Depression is not a normal or inevitable part of aging, and it affects each person differently. The nurse should not compare the patient’s feelings to their own or to others, but rather acknowledge and respect the patient’s unique perspective and situation. The nurse should also avoid using words like “we” or “you” that may create a sense of distance or judgment, and instead use words like “I” or “me” that may convey a sense of empathy or rapport.

D. “Have you talked to anyone about what is bothering you?”

This is not the nurse’s best initial response, as it may sound like the nurse is trying to avoid listening to the patient, or that the patient is bothering the nurse with their problems. The nurse should not imply that the patient should talk to someone else, but rather show interest and willingness to listen to the patient. The nurse should also use open-ended questions that invite the patient to share more, such as “How are you feeling today?” or “What has been on your mind lately?” The nurse should also use active listening skills, such as nodding, paraphrasing, reflecting, or summarizing, to demonstrate understanding and engagement.

Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure that occurs when the heart muscle is stiff and does not relax well, causing high pressure in the heart and lungs. HFpEF is diagnosed when the patient has symptoms and signs of heart failure and a normal or high ejection fraction (EF), which is the percentage of blood pumped out of the left ventricle with each heartbeat. HFpEF is usually caused by conditions that affect the heart or blood vessels, such as aging, high blood pressure, diabetes, obesity, or kidney disease12

References:

What Is Heart Failure with Preserved Ejection Fraction? - Healthline

Heart failure with preserved ejection fraction - BMJ Best Practice

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.

Pulmonary hypertension leads to increased pressure in the pulmonary circulation, which can cause right ventricular hypertrophy and failure. This results in systemic venous congestion, presenting as distended neck veins. Crackles, rhonchi, and pink frothy sputum are more indicative of pulmonary edema or other respiratory conditions rather than pulmonary hypertension. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

The patient who has been in the unit for 60 hours and reports agitation, noise disturbances, and an inability to get peace and quiet may be experiencing sleep disturbances. Factors such as the ICU environment, frequent interventions, and the medications being administered (e.g., benzodiazepines, opioids, and bronchodilators) can significantly disrupt sleep patterns, leading to further agitation and delirium. Addressing the patient's sleep hygiene and implementing measures to promote rest can be beneficial.References: = CCRN Exam Handbook, page 52

A patient with acetaminophen overdose is at risk for acute liver failure, which can lead to coagulopathy. This condition is often marked by an increased International Normalized Ratio (INR) due to impaired synthesis of clotting factors in the liver. Decreasing level of consciousness can also result from hepatic encephalopathy, a complication of liver failure. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

Hyponatremia

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A patient with a sodium level of 114 mEq/L is most likely to develop seizures, which are a manifestation of severe hyponatremia and cerebral edema. Hyponatremia is a low level of sodium in the blood, which can cause water to move into the brain cells and cause them to swell. This can lead to increased intracranial pressure, neurological dysfunction, and seizures. Seizures are a medical emergency and require prompt treatment to prevent brain damage or death. Tetany, flaccid paralysis, and cardiac arrhythmias are not typical signs of hyponatremia, but may occur in other electrolyte disorders, such as hypocalcemia, hyperkalemia, or hypokalemia.

References:

Overview of the treatment of hyponatremia in adults - UpToDate1, p. 1-2.

Manifestations of hyponatremia and hypernatremia in adults - UpToDate2, p. 1-2.

Hypovolemic shock

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.

References:

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.”

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.

References:

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

Anticoagulation for the hemodialysis procedure

Dialysis without anticoagulation (Heparin Free Dialysis)

The laboratory values indicate hyperosmolar hyperglycemic state (HHS), characterized by high glucose levels, high osmolality, and dehydration. The primary management includes aggressive IV hydration to correct dehydration and improve circulation. Hemodialysis and intubation are not immediate priorities unless there are other indications, and osmotic diuresis is not appropriate in this context. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.