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AACN CCRN Exam
CCRN (Adult) - Direct Care Eligibility Pathway (Page 3 )

Updated On: 7-Feb-2026
Page 3 of 31
PDF with 150 Questions

The nurse is caring for a patient with neutropenia secondary to chemotherapy.
When communicating dietary needs to the provider, the nurse should request which of the following to improve the patient's immune function?

  1. low protein diet
  2. total parental nutrition
  3. high carbohydrate diet
  4. nutritional supplements

Answer(s): D

Explanation:

Nutritional supplements are beneficial for patients with neutropenia secondary to chemotherapy, as they can help provide adequate calories, protein, vitamins, and minerals that are essential for immune function and tissue repair. Chemotherapy can cause side effects such as nausea, vomiting,

loss of appetite, taste changes, and mouth sores, which can make it difficult for patients to eat enough food and meet their nutritional needs. Nutritional supplements can be in the form of oral drinks, shakes, bars, or powders, or they can be administered through a feeding tube or intravenously. The nurse should request nutritional supplements that are appropriate for the patient's condition, preferences, and tolerance, and that are compatible with the neutropenic diet and food safety guidelines. The nurse should also monitor the patient's weight, hydration, and laboratory values, and report any signs of malnutrition, infection, or intolerance to the provider.


Reference:

Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families: This article states that "Nutritional supplements are products that can be used to add nutrients to your diet or to lower your risk of health problems. They can be in pill, capsule, tablet, or liquid form. They might have vitamins, minerals, amino acids, herbs, or other substances. Some examples of common supplements are calcium, iron, omega-3 fatty acids, vitamin C, and vitamin D. You might need supplements if you cannot get enough nutrients from foods or if you have certain health conditions that might cause a deficiency, such as cancer, diabetes, or chronic diarrhea." Nutrition in Cancer Care (PDQ®)­Patient Version: This article states that "Nutritional support is therapy for people who do not get enough nourishment by eating or drinking. You may need nutritional support if you have trouble swallowing, have lost your appetite, or are losing weight. Nutritional support can be given in different ways: Enteral nutrition is liquid food given through a tube (called a feeding tube) into the stomach or small intestine. Parenteral nutrition is a liquid mixture of nutrients given through a vein (intravenous or IV). Oral nutrition is food or liquid taken by mouth. This includes nutritional supplements, such as drinks, shakes, bars, or powders that have protein, carbohydrates, fat, vitamins, and minerals."
Nutrition and Cancer: What You Need to Know: This article states that "Nutritional supplements can help you meet your calorie and protein needs when you are not able to eat enough food. They can also provide extra vitamins and minerals. There are many types of nutritional supplements, such as drinks, shakes, puddings, bars, and powders. Some are designed for people with cancer and have extra calories and protein. Your doctor, nurse, or dietitian can help you choose the best supplement for you. You can buy some supplements at the grocery store or pharmacy, but others may need a prescription."



Appropriate outcomes for a patient with status asthmaticus include

  1. increased PaCO2 and decreased FEV1.
  2. decreased peak flow rates and decreased wheezing.
  3. paradoxical breathing and increased FEV1.
  4. normal PaCO2 and increased FEV1.

Answer(s): D

Explanation:

The appropriate outcomes for a patient with status asthmaticus are normal PaCO2 and increased FEV1. Status asthmaticus is a severe and life-threatening asthma exacerbation that does not respond to conventional treatment. It causes severe bronchoconstriction, air trapping, and mucus plugging, leading to hypoxemia, hypercapnia, and respiratory failure. The goals of treatment are to reverse the airway obstruction, improve gas exchange, and prevent complications. PaCO2 is the partial pressure of carbon dioxide in the blood, which reflects the adequacy of ventilation. FEV1 is the forced expiratory volume in one second, which measures the amount of air that can be forcefully exhaled in the first second of a breath. It reflects the degree of bronchoconstriction and airflow limitation. A patient with status asthmaticus typically has elevated PaCO2 and reduced FEV1 due to poor ventilation and severe obstruction. Therefore, normalizing PaCO2 and increasing FEV1 indicate improvement in the patient's condition and response to treatment.


Reference:

Status Asthmaticus: Symptoms, Causes, Diagnosis, and Treatment - Healthline: This article states that "Status asthmaticus is a severe form of asthma with symptoms similar to a typical asthma attack. But for status asthmaticus, symptoms may worsen as the asthma attack continues. Status asthmaticus is an older, less precise term for what's now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn't improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours."
Status Asthmaticus (Severe Acute Asthma) - WebMD: This article states that "Status asthmaticus is a severe asthma attack that doesn't get better with your usual treatments. It can be life-threatening and needs urgent medical attention. If you have a bad asthma attack and your rescue inhaler or your nebulizer doesn't help, you need medical care right away. If an attack comes on quickly and it doesn't respond to regular treatment, it can lead to status asthmaticus." Management of Status Asthmaticus | SpringerLink: This article states that "Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure despite aggressive treatment. It is defined as an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary in severity from mild to fatal. The pathophysiology of status asthmaticus is complex and involves airway inflammation, bronchospasm, airway edema, mucus plugging, and increased airway resistance. The clinical manifestations of status asthmaticus include dyspnea, wheezing, cough, chest tightness, tachypnea, tachycardia, hypoxemia, and hypercapnia. The diagnosis of status asthmaticus is based on history, physical examination, and laboratory tests, such as arterial blood gas analysis, spirometry, and chest radiography. The management of status asthmaticus consists of oxygen therapy, inhaled beta-2 agonists, systemic corticosteroids, and adjunctive therapies, such as anticholinergics, magnesium sulfate, ketamine, and noninvasive or invasive mechanical ventilation. The goals of treatment are to relieve bronchoconstriction, reduce airway inflammation, correct hypoxemia, normalize or reduce carbon dioxide levels, and avoid or treat complications."



Which of the following is a late finding in hypovolemic shock?

  1. tachycardia
  2. UO greater than 30 mL/hr
  3. cool, dry skin
  4. hypotension

Answer(s): D

Explanation:



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 mmHg.


Reference:

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."



A patient who is confused and dyspneic is admitted with ABG values that reveal hypoxemi

  1. Results from insertion of a pulmonary artery catheter are:
    PAP 38/18 mm Hg
    PAOP 10 mm Hg
    CI 3.5 L/min/m2
    These values are most indicative of
  2. hypovolemia.
  3. hypervolemia.
  4. pulmonary dysfunction.
  5. left ventricular failure.

Answer(s): C

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.


Reference:

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.



A patient with end-stage COPD who has failed multiple mechanical ventilation weaning trials communicates a desire to discontinue mechanical ventilation and be extubated.
Which of the following is a nurse's best response?

  1. Advocate with the care team for a withdrawal of treatment plan.
  2. Encourage the patient to continue with current medications and attempts to wean.
  3. Explore the patient's reasons for the request and understanding of potential consequences.
  4. Refer the patient's request to the healthcare facility's ethics committee for review.

Answer(s): C

Explanation:

The nurse's best response is to explore the patient's reasons for the request and understanding of potential consequences, as this demonstrates respect for the patient's autonomy and dignity, as well as provides an opportunity to assess the patient's decision-making capacity, goals of care, and preferences for end-of-life care. The nurse should also provide emotional support, education, and symptom management to the patient and family. Advocating with the care team for a withdrawal of treatment plan, encouraging the patient to continue with current medications and attempts to wean, or referring the patient's request to the healthcare facility's ethics committee for review are not appropriate responses, as they may undermine the patient's right to self-determination, impose the nurse's own values or beliefs, or delay the implementation of the patient's wishes.


Reference:

AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 19. AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2. AACN. (2020). Practice Recommendations for End-of-Life Care in the Intensive Care Unit. Retrieved from [Practice Recommendations], p. 14-15.
NICE. (2019). End of life care for adults: service delivery. Retrieved from [NICE Guidance], p. 4.



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