2024 CCRN-Adult: CCRN (Adult) - Direct Care Eligibility Pathway Useful Exam Torrent

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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q66-Q71):

NEW QUESTION # 66
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

A. reschedule hemodialysis.
B. transfuse platelets during hemodialysis.
C. administer heparin to prevent clot formation.
D. complete hemodialysis without heparin.

Answer: D

Explanation:
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)

NEW QUESTION # 67
A nurse should expect which of the following plans of care for a patient with a complicated RV infarction?

A. dobutamine (Dobutrex), fluid infusions, and transvenous pacing
B. dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix)
C. nitroglycerin, fluid infusions, and morphine
D. nitroprusside (Nipride), fluid restrictions, and transvenous pacing

Answer: A

Explanation:
A nurse should expect a plan of care that includes dobutamine (Dobutrex), fluid infusions, and transvenous pacing for a patient with a complicated RV infarction, as these interventions aim to improve RV function, increase cardiac output, and correct bradyarrhythmias. Dobutamine is an inotropic agent that increases myocardial contractility and reduces RV afterload1. Fluid infusions are used to optimize RV preload and maintain adequate systemic perfusion12. Transvenous pacing is indicated for patients with symptomatic bradycardia or high-grade AV block that compromise hemodynamics13. Dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix) are not appropriate for a patient with a complicated RV infarction, as they may worsen RV preload and cardiac output. Nitroprusside (Nipride), fluid restrictions, and transvenous pacing are not suitable for a patient with a complicated RV infarction, as they may cause excessive vasodilation and hypotension. Nitroglycerin, fluid infusions, and morphine are not optimal for a patient with a complicated RV infarction, as they may reduce RV preload and increase RV ischemia.

NEW QUESTION # 68
After consultation with the interdisciplinary team, a nurse implements progressive mobility by having the patient sit at the side of the bed. The patient's HR increases by 10, RR increases by 6, SpO2 remains at 94%, and BP remains stable. The patient states he is tired. Which of the following should be the nurse's next action?

A. Wait for assistance from physical therapy to resume mobility.
B. Discontinue the attempts to mobilize the patient.
C. Return the patient to a supine position and notify the physician.
D. Progress to sitting in a chair during the next activity.

Answer: C

Explanation:
The patient's increased heart rate and respiratory rate, along with the patient's statement of feeling tired, may indicate that the activity was too strenuous123. It's important to ensure patient safety and comfort, so the nurse should return the patient to a supine position123. The physician should be notified about the patient's response to the activity for further evaluation and to adjust the care plan if necessary123.

NEW QUESTION # 69
For a patient who sustained blunt renal trauma and a crush injury to the leg, monitoring should include observing for

A. a shortened PR interval.
B. a prolonged PR interval.
C. ST segment depression.
D. tall peaked T waves.

Answer: D

Explanation:
Crush injuries can lead to significant muscle damage and rhabdomyolysis, resulting in the release of intracellular potassium into the bloodstream, causing hyperkalemia. Tall peaked T waves are a classic sign of hyperkalemia, which needs to be closely monitored in these patients. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

NEW QUESTION # 70
A patient who sustained a C4 fracture requests to be taken off the ventilator 3 days after the initial injury, indicating, "I can't live hooked to this machine." The nurse's best response to this patient would be,

A. "Do you feel that you will be hooked up to this machine forever?"
B. "Many quadriplegics live fulfilling lives as they adjust to their new lifestyle."
C. "After you have started the rehabilitation process, your outlook will improve."
D. "Eventually your diaphragm will regain its function, allowing you to breathe independently."

Answer: A

Explanation:
The best response is to assess the patient's feelings and understanding of their condition and prognosis. This response opens a dialogue and allows the nurse to provide education and emotional support based on the patient's specific concerns. Other responses may provide false reassurance or imply assumptions about the patient's future without first understanding their current emotional state and concerns. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

NEW QUESTION # 71
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