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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q133-Q138):

NEW QUESTION # 133
A patient who is confused and dyspneic is admitted with ABG values that reveal hypoxemia. Results from insertion of a pulmonary artery catheter are:
PAP 38/18 mm Hg
PAOP10 mm Hg
CI 3.5 L/min/m2
These values are most indicative of

A. hypovolemia.
B. pulmonary dysfunction.
C. hypervolemia.
D. left ventricular failure.

Answer: B

Explanation:
The patient's ABG values show hypoxemia, which is a low level of oxygen in the blood. This can be caused by various pulmonary disorders that impair gas exchange, such as pneumonia, pulmonary edema, pulmonary embolism, or acute respiratory distress syndrome (ARDS). The patient's PAP (pulmonary artery pressure) is elevated, indicating increased resistance in the pulmonary circulation. This can also result from pulmonary dysfunction, as the lungs become stiff and inflamed, or from pulmonary hypertension, which is a chronic condition that affects the small arteries in the lungs. The patient's PAOP (pulmonary artery occlusion pressure) is normal, suggesting that the left ventricle is not failing and that the patient is not hypovolemic or hypervolemic. The patient's CI (cardiac index) is also normal, indicating adequate cardiac output. Therefore, the most likely cause of the patient's hypoxemia and dyspnea is pulmonary dysfunction.
References:
* AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
* AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.

NEW QUESTION # 134
A patient is admitted with an acute anterior wall MI. Initial hemodynamic readings are:

The nurse anticipates initiating a plan of care for

A. cardiogenic shock.
B. volume overload.
C. pulmonary hypertension.
D. right ventricular infarct.

Answer: A

Explanation:
The hemodynamic readings provided (BP 80/60, HR 110, CVP 20 mm Hg, PAOP 26 mm Hg, CO 2.1 L/min, CI 1.3 L/min/m², PAP 42/32 mm Hg, SVR 1762 dynes/sec/cm) suggest cardiogenic shock. This condition is characterized by low cardiac output and index, elevated filling pressures (CVP and PAOP), and systemic vascular resistance. Cardiogenic shock often occurs following an acute anterior wall myocardial infarction (MI) due to extensive damage to the myocardium, leading to impaired contractility and inadequate tissue perfusion.References: = CCRN Exam Handbook, page 12

NEW QUESTION # 135
A patient with a history of asthma presents with acute onset of dyspnea, a non-productive cough, and tachypnea. He is very anxious, restless, and tachycardic. Which of the following is a first-line drug for these symptoms?

A. mast cell stabilizer
B. anticholinergic
C. leukotriene inhibitor
D. beta-agonist

Answer: D

Explanation:
Beta-agonists are the first-line drugs for acute asthma exacerbations because they rapidly reverse bronchoconstriction and improve airflow. They act by stimulating beta-2 receptors in the smooth muscle of the airways, causing relaxation and dilation. Beta-agonists can be administered by inhalation, nebulization, or injection. Examples of beta-agonists include albuterol, levalbuterol, and terbutaline.
References:
* Management of Acute Asthma Exacerbations | AAFP: This article states that "Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."
* Asthma attack - Diagnosis and treatment - Mayo Clinic: This article states that "If you're in the yellow zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you can repeat the dose. Young children or people who have difficulty with an inhaler use a device called a nebulizer to inhale the medicine in a mist. Quick-relief medicines include: Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others). Levalbuterol (Xopenex, Xopenex HFA)."

NEW QUESTION # 136
In a patient with status asthmaticus, which of the following indicate a deteriorating condition?

A. increased compliance and respiratory acidosis
B. decreased PaCO2 and increased minute ventilation
C. increased PaCO2 and decreased expiratory flow
D. respiratory alkalosis and increased expiratory flow

Answer: C

Explanation:
In status asthmaticus, a worsening condition is indicated by increased PaCO2 and decreased expiratory flow.
This reflects severe airway obstruction and ventilatory failure, leading to hypercapnia (elevated PaCO2) and a decrease in the ability to exhale effectively. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

NEW QUESTION # 137
In a patient with hypertensive crisis, neurologic changes are caused by

A. increased ICP as a result of loss of cerebral autoregulation.
B. vasospasm of the cerebral arterioles.
C. hypoxemia as a result of pulmonary interstitial edema.
D. excessive secretion of catecholamines.

Answer: A

Explanation:
In hypertensive crisis, neurologic changes are often caused by increased intracranial pressure (ICP) as a result of loss of cerebral autoregulation. Autoregulation normally maintains consistent cerebral blood flow despite changes in systemic blood pressure. In hypertensive crisis, the extremely high blood pressure overwhelms these mechanisms, leading to increased cerebral blood flow, disruption of the blood-brain barrier, and cerebral edema, which subsequently increases ICP and causes neurologic changes.References: = CCRN Exam Handbook, page 48

NEW QUESTION # 138
......

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