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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q140-Q145):

NEW QUESTION # 140
A patient is admitted for hypertensive crisis. As a nurse is starting a peripheral IV, the patient appears increasingly anxious as the catheter is about to be inserted. The patient threatens to harm the nurse if the catheter insertion causes pain. Which of the following is the nurse's best action?

A. Ask another staff member to distract the patient during insertion.
B. Physically restrain the patient during the performance of the procedure.
C. Tell the patient to remain still in a stern, authoritative voice.
D. Engage the patient in a conversation and encourage him to verbalize his feelings.

Answer: D

NEW QUESTION # 141
Which of the following can be a complication of positive end-expiratory pressure (PEEP)?

A. Hypertension
B. Hyponatremia
C. Hypoxemia
D. Barotrauma

Answer: D

Explanation:
PEEP/CPAP is indicated for hypoxemia, secondary to diffuse lung injury. It is used in conjunction with any of the ventilator modes to help stabilize alveolar lung volume and improve oxygenation.
Use of PEEP may increase the risk of barotrauma due to higher mean and peak airway pressures during ventilation. Barotrauma describes the damage to the pulmonary system due to alveolar rupture from excessive airway pressures or overdistention of alveoli. Alveolar gas enters the interstitial pulmonary structures, causing pneumothorax. The potential for pneumothorax should be considered whenever airway pressure increases acutely, as with the use of PEEP.
Other complications from PEEP include increases in intracranial pressure, decreased renal perfusion, hepatic congestion, and worsening of intracardiac shunts.
Hyponatremia is a common occurrence following the initiation of mechanical ventilation.
Hypertension is not a complication of PEEP.

NEW QUESTION # 142
All of the following arrhythmias originate in the ventricular muscle or Purkinje system of the heart EXCEPT:

A. Premature Ventricular Complexes (PVCs)
B. Accelerated ventricular rhythm
C. Ventricular Tachycardia (VT)
D. Supraventricular Tachycardia (SVT)

Answer: D

Explanation:
SVTs are characterized by any rhythm at a rate faster than 100 bpm that originates just above the ventricle or that utilize the atria or AV (Atrioventricular) junction as a part of the circuit that maintains the tachycardia. This type of arrhythmia can include sinus tachycardia, AT, atrial flutter, atrial fibrillation, and junctional tachycardia.
Arrhythmias originating in the ventricles (or Purkinje system) include:
* PVCs
* Ventricular rhythm and accelerated ventricular rhythm
* VT
* Ventricular Fibrillation (VF)
* Ventricular asystole

NEW QUESTION # 143
A patient with an acute anterior wall MI presents with an S3 gallop and the following values:

Which drug therapy would be most appropriate for this patient?

A. vasodilators and diuretics
B. vasodilators and positive inotropes
C. vasopressors and calcium-channel blockers
D. vasopressors and beta-blockers

Answer: A

Explanation:
In the setting of an acute anterior wall myocardial infarction (MI) with an S3 gallop, the patient is likely experiencing heart failure and possibly acute pulmonary edema. The appropriate treatment includes vasodilators to reduce afterload and diuretics to decrease preload and pulmonary congestion. This combination helps to improve cardiac output and reduce the workload on the heart. References: CCRN Exam Handbook, AACN, page 20, section on Cardiovascular.

NEW QUESTION # 144
Which of the following is LEAST LIKELY to be a complication of immobility in the ICU patient?

A. Delirium
B. Pressure injury
C. Fat embolism
D. Infection

Answer: C

Explanation:
Fat embolisms are normally caused by fractures of long bones, not by immobility. While Venous Thromboembolisms (VTEs) are a major risk factor associated with immobility, fat embolisms are not.
Pressure injuries, infections, and delirium are all common complications of immobility.

NEW QUESTION # 145
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