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AACN CCRN Exam
CCRN (Adult) - Direct Care Eligibility Pathway (Page 4 )

Updated On: 7-Feb-2026
Page 4 of 31
PDF with 150 Questions

A patient has gained 8 kg in the past week. Serum sodium is 115 mEq/L, CVP is 20 mm Hg, and serum osmolality is decreased. The patient has just experienced a generalized tonic-clonic seizure. In this situation, which of the following IV solutions should a nurse be prepared to administer?

  1. 3% sodium chloride
  2. 0.45% sodium chloride
  3. 0.9% sodium chloride
  4. 5% dextrose with 0.25% sodium chloride

Answer(s): A

Explanation:

The patient has signs of severe hyponatremia, which is a low level of sodium in the blood. Hyponatremia can cause cerebral edema, which can lead to seizures, confusion, coma, and death. The patient needs a hypertonic solution, which is a fluid that has a higher concentration of solutes than the blood, to draw water out of the brain cells and restore the normal sodium level. 3% sodium chloride is a hypertonic solution that can be used to treat severe hyponatremia. 0.45% sodium chloride, 0.9% sodium chloride, and 5% dextrose with 0.25% sodium chloride are all hypotonic solutions, which are fluids that have a lower concentration of solutes than the blood, and would worsen the patient's condition by adding more water to the blood and the brain.


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. AACN. (2020). Practice Alert: Hyponatremia. Retrieved from [Practice Alert], p. 1-2. Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical- surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier.
Retrieved from [Textbook], p. 303-304.



A patient who experienced a blunt chest trauma in an automobile crash is admitted with multiple rib fractures. The patient is dyspneic and hypotensive and is reporting left shoulder pain. On auscultation, a nurse notes that bowel sounds can be heard over the lower left thorax. These findings are consistent with

  1. ruptured abdominal viscus.
  2. ruptured diaphragm.
  3. flail chest.
  4. mediastinal shift.

Answer(s): B

Explanation:

The patient's findings are consistent with a ruptured diaphragm, which is a tear in the muscle that separates the chest and abdominal cavities. A blunt chest trauma can cause a sudden increase in intra-abdominal pressure, which can rupture the diaphragm and allow abdominal organs to herniate into the thorax. This can cause dyspnea, hypotension, shoulder pain, and bowel sounds over the lower thorax. A ruptured abdominal viscus would cause peritonitis, which would present with abdominal pain, distension, fever, and signs of sepsis. A flail chest would cause paradoxical chest movement, respiratory distress, and cyanosis. A mediastinal shift would cause tracheal deviation, decreased breath sounds, and jugular venous distension.


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. BCEN. (2020). Trauma Certified Registered Nurse (TCRN) Examination Content Outline. Retrieved from [TCRN Exam Content Outline], p. 8.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical- surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier.
Retrieved from [Textbook], p. 1789-1790.



The goal of PEEP therapy in acute lung injury (ALI) is to

  1. decrease PAP.
  2. decrease airway resistance.
  3. increase cardiac output.
  4. reduce physiologic shunting.

Answer(s): D

Explanation:

The goal of PEEP therapy in acute lung injury (ALI) is to reduce physiologic shunting, which is the perfusion of blood through unventilated or collapsed alveoli. This results in hypoxemia and impaired gas exchange. PEEP therapy increases the end-expiratory pressure and prevents alveolar collapse, thus improving ventilation and oxygenation. PEEP therapy does not necessarily decrease PAP (pulmonary artery pressure), decrease airway resistance, or increase cardiac output. In fact, PEEP therapy may have adverse effects on these parameters, such as increasing intrathoracic pressure, reducing venous return, and decreasing cardiac output.


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. AACN. (2020). Practice Alert: Acute Lung Injury/Acute Respiratory Distress Syndrome. Retrieved from [Practice Alert], p. 1-2.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical- surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier.
Retrieved from [Textbook], p. 1908-1910.



A patient's blood culture report notes the presence of vancomycin resistant enterococcus. The nurse should place the patient in which type of isolation?

  1. droplet
  2. airborne
  3. contact
  4. protective

Answer(s): C

Explanation:

The nurse should place the patient in contact isolation, which is a type of precaution used to prevent the transmission of microorganisms that are spread by direct or indirect contact with the patient or the patient's environment. Contact isolation requires the use of gloves and gowns when entering the patient's room, as well as dedicated patient-care equipment and proper hand hygiene. Vancomycin resistant enterococcus (VRE) is a type of bacteria that is resistant to the antibiotic vancomycin and can cause infections in various sites, such as the urinary tract, bloodstream, or wounds. VRE can be spread by contact with contaminated surfaces, equipment, or hands.


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. CDC. (2019). Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved from [CDC Guidelines], p. 69-70. CDC. (2019). Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory. Retrieved from [CDC Fact Sheet], p. 1-2.



A nurse has responded to a rapid response call on a medical-surgical floor in the hospital. The nurse finds the patient with the following data:

-BP
-HR 132
-RR 24
-T 102.3° F (39.0° C)
-SpO2 95%
-Ph 7.13
-PaCO2 34 mm Hg
-PaO2 88 mm Hg
-HCO3 14 mEq/L
-Na+ 142 mEq/L

The nurse should anticipate an order to administer which of the following?

  1. 8.4% sodium bicarbonate
  2. phenylephrine (Neo-Synephrine)
  3. 0.9% sodium chloride
  4. amiodarone (Cordarone)

Answer(s): B

Explanation:

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 guidelines.
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 complications.
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 injury.
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 effects.


Reference:

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.



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