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AACN CCRN Exam Prep
CCRN (Adult) - Direct Care Eligibility Pathway (Page 5 )

Updated On: 7-Oct-2026
Page 5 of 31
PDF with 150 Questions

Which of the following is most indicative of successful treatment for salicylate poisoning?

  1. osmotic diuresis
  2. decrease in gastric pH
  3. decrease in CPK
  4. alkalinization of urine

Answer(s): D

Explanation:



Alkalinization of urine is one of the main goals of treatment for salicylate poisoning, as it enhances the renal excretion of salicylate and reduces its reabsorption. Alkalinization of urine can be achieved by administering intravenous sodium bicarbonate and maintaining adequate hydration and urine output. Alkalinization of urine can be monitored by measuring the urine pH, which should be above 7.5. Osmotic diuresis, decrease in gastric pH, and decrease in CPK are not indicative of successful treatment for salicylate poisoning. Osmotic diuresis may occur as a result of salicylate toxicity, but it does not improve the elimination of salicylate. Decrease in gastric pH may impair the absorption of salicylate, but it does not affect the elimination of salicylate. Decrease in CPK may reflect the resolution of rhabdomyolysis, which is a possible complication of salicylate poisoning, but it does not reflect the clearance of salicylate.


Reference:

Salicylate (aspirin) poisoning: Management - UpToDate1, p. 1-2. Salicylate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice US2, p. 4-5.



A patient is admitted for sepsis secondary to pneumoni

  1. The patient has received 2000 mL of plasmalyte and their BP remains 80/50.
    What should the nurse anticipate next for the patient?
  2. dopamine
  3. norepinephrine
  4. 1L of plasmalyte
  5. vasopressin

Answer(s): B



A patient with a sodium level of 114 mEq/L is most likely to develop

  1. tetany.
  2. flaccid paralysis.
  3. seizures.
  4. cardiac arrhythmias.

Answer(s): C

Explanation:





A patient with a sodium level of 114 mEq/L is most likely to develop seizures, which are a manifestation of severe hyponatremia and cerebral edema. Hyponatremia is a low level of sodium in the blood, which can cause water to move into the brain cells and cause them to swell. This can lead to increased intracranial pressure, neurological dysfunction, and seizures. Seizures are a medical emergency and require prompt treatment to prevent brain damage or death. Tetany, flaccid paralysis, and cardiac arrhythmias are not typical signs of hyponatremia, but may occur in other electrolyte disorders, such as hypocalcemia, hyperkalemia, or hypokalemia.


Reference:

Overview of the treatment of hyponatremia in adults - UpToDate1, p. 1-2. Manifestations of hyponatremia and hypernatremia in adults - UpToDate2, p. 1-2.



A patient with a history of six cardiac catheterizations relates that he has received differing instructions about the duration of required bedrest after the procedure. To further investigate this issue, which of the following is a nurse's most appropriate action?

  1. Ask about obtaining an independent evaluation of unit outcomes.
  2. Conduct an informal chart review and outcome evaluation of patients treated with different bedrest protocols.
  3. Review recent published research about bedrest protocols.
  4. Ask the nursing supervisor to request standardized physician orders for patients who have undergone catheterization.

Answer(s): C

Explanation:

The nurse's most appropriate action is to review recent published research about bedrest protocols, as this would provide the nurse with the most current and reliable evidence to guide clinical practice and improve patient outcomes. Bedrest protocols after cardiac catheterization may vary depending on the type of access site, the use of closure devices, the patient's risk factors, and the clinician's preference. However, there is a growing body of research that supports early ambulation and shorter bedrest duration to reduce the risk of complications, such as bleeding, hematoma, back pain, and venous thromboembolism, and to enhance patient comfort and satisfaction.
Asking about obtaining an independent evaluation of unit outcomes, conducting an informal chart review and outcome evaluation of patients treated with different bedrest protocols, or asking the nursing supervisor to request standardized physician orders for patients who have undergone catheterization are not the most appropriate actions, as they may not reflect the best available evidence, may be biased or incomplete, or may not address the patient's concern.


Reference:

1: Bedrest After Cardiac Catheterization: A Systematic Review and Meta-analysis4, p. 1-2.
2: Early Ambulation After Cardiac Catheterization: A Literature Review, p. 1-2.
3: Bed Rest After Cardiac Catheterization: A Review of the Evidence, p. 1-2.



A patient is 2 days post MI. The patient was stable until this morning, when severe chest discomfort developed. Assessment reveals:

-BP 70/palpable
-HR 122
-RR 38
-PAOP 28 mm Hg, with large V waves
-CI 1.6 L/min/m2
-Cool, clammy skin

Inspiratory crackles throughout the lung field
Loud blowing holosystolic murmur at the apex
The patient's present clinical status is most likely a result of

  1. papillary muscle rupture.
  2. cardiac tamponade.
  3. acute aortic insufficiency.
  4. ventricular septal defect.

Answer(s): D

Explanation:

The patient's present clinical status is most likely a result of a ventricular septal defect (VSD), which is a hole in the wall between the left and right ventricles. A VSD can occur as a mechanical complication of MI, usually within the first week, due to necrosis and rupture of the ventricular septum. A VSD causes a left-to-right shunt of blood, which leads to increased pulmonary pressure, pulmonary edema, and reduced cardiac output. The patient's symptoms and signs are consistent with a VSD, such as severe chest pain, hypotension, tachycardia, respiratory distress, high PAOP with large V waves, low CI, cool and clammy skin, inspiratory crackles, and a loud blowing holosystolic murmur at the apex. A papillary muscle rupture, a cardiac tamponade, and an acute aortic insufficiency are other possible mechanical complications of MI, but they have different clinical manifestations. A papillary muscle rupture causes acute mitral regurgitation, which presents with a soft systolic murmur at the apex and pulmonary congestion.
A cardiac tamponade causes compression of the heart by pericardial fluid, which presents with hypotension, muffled heart sounds, and jugular venous distension.
An acute aortic insufficiency causes backflow of blood from the aorta to the left ventricle, which presents with a diastolic decrescendo murmur at the left sternal border and a wide pulse pressure.


Reference:

1: Mechanical complications of acute myocardial infarction - UpToDate4, p. 2-3.
2: Cardiac tamponade - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.
3: Acute aortic regurgitation - Symptoms, diagnosis and treatment | BMJ Best Practice US,
p. 1-2.



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