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AACN CCRN Exam Prep
CCRN (Adult) - Direct Care Eligibility Pathway (Page 15 )

Updated On: 7-Oct-2026
Page 6 of 31
PDF with 150 Questions

Which of the following ECG changes is expected in a patient with a potassium concentration of 3.0 mEq/L?

  1. ST segment depression, flattened and inverted T wave, and a U wave
  2. tall peaked T wave, prolonged PR interval, and prolonged QRS complex
  3. shortened QT interval and complete atrioventricular block
  4. inverted P wave, elevated T wave, and prolonged QT interval

Answer(s): A

Explanation:



A patient with a potassium concentration of 3.0 mEq/L has mild hypokalemia, which is a low level of potassium in the blood. Hypokalemia can cause various ECG changes that reflect the impairment of cardiac depolarization and repolarization. The most common ECG changes in mild hypokalemia are ST segment depression, flattened and inverted T wave, and a U wave, which is a positive deflection after the T wave. These ECG changes can be seen in the examples from the web search results.
Other ECG changes that may occur in more severe hypokalemia are prolonged QT interval, frequent ectopic beats, and arrhythmias.
Tall peaked T wave, prolonged PR interval, and prolonged QRS complex are ECG changes associated with hyperkalemia, which is a high level of potassium in the blood.
Shortened QT interval and complete atrioventricular block are not typical ECG changes of hypokalemia, but may occur in other electrolyte disorders, such as hypercalcemia.
Inverted P wave, elevated T wave, and prolonged QT interval are not specific ECG changes of hypokalemia, but may occur in other cardiac conditions, such as ischemia, myocarditis, or pericarditis.



A patient admits to a nurse that he has struggled with depression and feelings of isolation and abandonment since moving into a nursing home last year, but he has recently started taking an anti-depressant. The patient states, "Sometimes it takes everything I've got just to go on each day." Which of the following is the nurse's best initial response?

  1. "You sound like you've been really unhappy. Have you thought about harming yourself?"
  2. "Those feelings should resolve when the medication you've started has a chance to take effect."
  3. "I understand how you feel. We all get that way when we're depressed."
  4. "Have you talked to anyone about what is bothering you?"

Answer(s): A

Explanation:

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.



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

  1. dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix)
  2. nitroprusside (Nipride), fluid restrictions, and transvenous pacing
  3. nitroglycerin, fluid infusions, and morphine
  4. dobutamine (Dobutrex), fluid infusions, and transvenous pacing

Answer(s): D

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 afterload.
Fluid infusions are used to optimize RV preload and maintain adequate systemic perfusion.
Transvenous pacing is indicated for patients with symptomatic bradycardia or high-grade AV block that compromise hemodynamics.
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.



The intended effects of medications for a patient in acute CHF are to

  1. reduce CVP and increase SVR.
  2. reduce CVP and reduce SVR.
  3. increase CVP and reduce SVR.
  4. increase CVP and increase SVR.

Answer(s): B

Explanation:

The intended effects of medications for a patient in acute CHF are to reduce CVP and reduce SVR, as this would decrease the preload and afterload on the failing heart and improve the cardiac output and tissue perfusion. CVP (central venous pressure) is a measure of the pressure in the right atrium and reflects the volume status of the patient. SVR (systemic vascular resistance) is a measure of the resistance in the systemic circulation and reflects the tone of the blood vessels. Medications that can reduce CVP and SVR in acute CHF include diuretics, nitrates, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators.
Increasing CVP and reducing SVR would increase the preload and decrease the afterload, which may be beneficial for some patients with low cardiac output and low filling pressures, but not for patients with acute CHF and volume overload.
Reducing CVP and increasing SVR would decrease the preload and increase the afterload, which would worsen the cardiac function and oxygen demand in acute CHF3. Increasing CVP and increasing SVR would increase both the preload and the afterload, which would also worsen the cardiac function and oxygen demand in acute CHF3.


Reference:

1: Acute decompensated heart failure: Management - UpToDate4, p. 5-6.
2: Acute heart failure: diagnosis and management | Guidance | NICE, p. 8-9.
3: Hemodynamic monitoring in acute heart failure - UpToDate, p. 3-4.



Potentially life-threatening consequences of diabetic ketoacidosis (DKA) include

  1. cellular dehydration.
  2. intracellular hyperglycemia.
  3. metabolic alkalosis.
  4. respiratory alkalosis.

Answer(s): A

Explanation:





Cellular dehydration is one of the potentially life-threatening consequences of diabetic ketoacidosis (DKA), which is a condition that occurs when the body does not have enough insulin to use glucose for energy and starts to break down fat instead. This produces ketones, which are acidic substances that accumulate in the blood and urine. DKA causes hyperglycemia, which is a high level of glucose in the blood, and osmotic diuresis, which is the loss of water and electrolytes through the urine. This leads to cellular dehydration, which is the shrinkage of the cells due to the loss of water from the intracellular fluid. Cellular dehydration can affect the brain and cause neurological symptoms, such as confusion, lethargy, coma, and death.
Other potentially life-threatening consequences of DKA include metabolic acidosis, which is a low pH of the blood due to the excess of ketones, and respiratory compensation, which is the increase of the breathing rate and depth to expel carbon dioxide and lower the acidity of the blood.
These are not the same as metabolic alkalosis or respiratory alkalosis, which are conditions that cause a high pH of the blood due to the loss of acids or the retention of bases.
Intracellular hyperglycemia is not a consequence of DKA, as the glucose cannot enter the cells without insulin and remains in the extracellular fluid.



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