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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q199-Q204):

NEW QUESTION # 199
The nurse is caring for a patient who requires oral placement of an endotracheal (ET) tube. Which nursing action is a priority when preliminarily confirming proper ET tube placement?

A. Auscultate for breath sounds over the stomach
B. Provide frequent oral hygiene
C. Obtain a chest x-ray
D. Anchor the tubing with tape or a special ET fixation device

Answer: A

Explanation:
Though all the answer choices are important nursing interventions to ensure adequate oxygenation to the patient with an ET tube, the nurse's priority when confirming proper ET tube placement is to auscultate for the presence of bilateral breath sounds, along with equal chest excursion during inspiration and the absence of breath sounds over the stomach, to preliminarily confirm proper tube placement. If breath sounds are heard over the stomach, the tube should be pulled out until the nurse can no longer hear breath sounds over the stomach, and can hear them bilaterally in the lung fields.
An end-tidal CO2 with waveform verification monitor is used as an immediate assessment for determining tracheal placement. A portable bedside chest x-ray verifies proper tube placement.
Once proper placement is confirmed, the tube is anchored with either tape or a special ET fixation device to prevent movement. The centimeter marking of the ET tube at the lip is documented and checked during each shift to monitor proper tube placement.

NEW QUESTION # 200
Which of the following would be considered a physiologic manifestation of anxiety?

A. Fidgeting
B. Apprehension
C. Increased heart rate
D. Crying

Answer: C

Explanation:
Chest pain would be considered a physiologic manifestation of anxiety.
Fidgeting and crying would be a behavioral manifestation of anxiety. Apprehension would be a cognitive manifestation of anxiety.

NEW QUESTION # 201
Which of the following patients would the critical care nurse suspect MOST LIKELY be at risk for a bowel infarction?

A. A middle-aged patient with COPD
B. A middle-aged patient with a history of stroke
C. An elderly patient with atherosclerosis
D. An elderly patient with hyperthyroidism

Answer: C

Explanation:
The elderly patient with systemic atherosclerosis is particularly at risk for intestinal ischemia. In one large retrospective study, hyperthyroidism, stroke, and COPD (Chronic Obstructive Pulmonary Disease) were statistically significant independent predictors of mortality.
Other causes/risk factors include:
* Atherosclerosis
* Emboli in patients with endocarditis or atrial fibrillation
* Cholesterol plaques that become dislodged
* A thrombus after an MI
* Hyper-coagulation
* Heart failure
* Cirrhosis
Conditions that can reduce blood flow to the major mesenteric vessels can cause a bowel infarction.

NEW QUESTION # 202
A patient is intubated, is unable to follow simple commands, and has no history of alcohol abuse. The patient has become increasingly disoriented and confused over the past 24 hours. After assessment and treatment of pain, the best medication intervention for management is

A. cisatracurium (Nimbex).
B. midazolam (Versed).
C. lorazepam (Ativan).
D. dexmedetomidine (Precedex).

Answer: D

Explanation:
Dexmedetomidine (Precedex) is the most appropriate medication for managing agitation and delirium in a critically ill intubated patient. It provides sedation without significant respiratory depression and has analgesic properties, which makes it suitable for patients who are disoriented and confused. Unlike benzodiazepines (lorazepam and midazolam) or neuromuscular blockers (cisatracurium), dexmedetomidine can improve delirium outcomes and facilitates easier weaning from mechanical ventilation. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 57-60.

NEW QUESTION # 203
An 82-year-old female arrives at the emergency department with complaints of abdominal cramping, nausea and diarrhe a. She has a history of renal failure and type 2 diabetes mellitus (T2DM). The nurse establishes an IV line and draws the patient's blood for lab studies. The patient's serum potassium level is 6.3 mEq/L.
During a physical assessment of this patient, which of the following signs and symptoms would be expected?

A. Narrowed QRS complex
B. Palpitations
C. Increased deep tendon reflex (DTR) response
D. Tachycardia

Answer: B

Explanation:
Serum potassium (K+) impacts normal neuromuscular and cardiac function. Hyperkalemia is diagnosed with serum K+ levels > 5.5 mEq/L (normal values range from 3.5-5.5 mEq/L).
A nurse would expect this patient with hyperkalemia to have chest pain, palpitations, dyspnea, vague muscle weakness, mental confusion, nausea, diarrhea, cramping, flaccid paralysis and decreased DTRs.
The muscle weakness would most likely originate in the legs and travel to the trunk.
Other cardiac abnormalities include bradycardia, tall/peaked T waves, a shortened QT interval, slowed intraventricular conduction, and a widened QRS complex.

NEW QUESTION # 204
......

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