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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q247-Q252):

NEW QUESTION # 247
The critical care nurse has just completed hemodynamic numbers on his patient. He reports the following:
* CO: 5
* CVP: 6
* PAWP: 9
* SVR: 900
* PVR: 200
* LVSWI: 50
Based on these clinical findings, what intervention is indicated?

A. Administer fluid bolus
B. Continue to monitor patient's hemodynamics
C. Begin dopamine infusion
D. Start sodium nitroprusside (Nipride)

Answer: B

Explanation:
This patient's hemodynamic parameters are normal. The only intervention indicated at this point is to continue to monitor.
Normal Ranges:
* CO: 4-8 L/min
* CVP: 2-8 mm Hg
* PAWP: 8-12 mm Hg
* SVR: 800-1200 dynes-sec/cm-5
* PVR: 100-250 dynes-sec/cm-5
* LVSWI: 35-85 g-m/M2

NEW QUESTION # 248
Your patient is in the ICU following a motorcycle crash. He has sustained multiple rib fractures and is complaining of increased pain with deep breathing and coughing. Which of the following pain management techniques would BEST control his pain and allow him to take deep breaths and cough?

A. Thoracic epidural opioids
B. Propofol (Diprivan) infusion
C. Morphine continuous infusion
D. Distraction and imagery

Answer: A

Explanation:
Both opioids and local anesthetics, either alone or in combination, are commonly administered via the epidural route. A continual epidural is one of the most efficient routes of analgesia. The advantages of epidural analgesia include improved pain control with less sedation, lower overall opioid doses, and generally longer duration of pain management, without interfering with the ability to breathe deep and cough.
A continuous morphine infusion can cause a greater sleepiness and clouding of mentation, which can interfere with deep breathing and coughing. Distraction and imagery can be used with an opioid but would not be recommended to use instead of an opioid in this patient. Propofol (Diprivan) is used as a sedative in the ICU, but it does not have any analgesic properties and should not be used in place of an analgesic. Propofol should be used in an intubated patient only.

NEW QUESTION # 249
A patient presents to the emergency department after overdosing on propranolol. What antidote(s) would be indicated for this?

A. Kelocyanor
B. Sodium bicarbonate
C. Digibind
D. Glucagon and calcium

Answer: D

Explanation:
Antidotes help counteract the effects of poisons by neutralizing them or by antagonizing their effects within the body. Propranolol is a beta-blocker. A beta-blocker overdose can cause severe bradycardia and make it difficult for the patient to breathe. It can also cause dizziness and trembling. Glucagon and calcium should be administered in the case of a beta-blocker (or calcium channel blocker) overdose.
Digibind is indicated in the instance of digoxin overdose. Sodium bicarbonate is used when a patient presents with a tricyclic antidepressant (TCA) overdose. In the case of a cyanide overdose, kelocyanor is the antidote used.

NEW QUESTION # 250
Which of the following BEST describes the cause of a tension pneumothorax?

A. When air or gas enters the pleural space without an external wound
B. When air collects under positive pressure in the pleural space and collapses the lung
C. When positive pressure flows directly into the pleural cavity
D. When blood fills the lungs following injury

Answer: B

Explanation:
Injury to the lung parenchyma may cause a tension pneumothorax, which could result in hemodynamic collapse and is, therefore, a medical emergency. It occurs when air flows freely into the pleural space during inspiration and becomes trapped. Air collects under positive pressure in the pleural space (air in the pleural space is under higher pressure than air in an adjacent lung), collapses the lung, and shifts the heart and great vessels to the opposite side of the chest from the injury, causing hemodynamic collapse.
Management includes early detection of the tension pneumothorax and insertion of a chest tube.
* Open pneumothorax: atmospheric air (positive pressure) flows directly into the pleural cavity (negative pressure) usually from a sucking chest wound
* Closed pneumothorax: air or gas enters the pleural space without an external wound
* Hemothorax: occurs when blood fills the lung due to injury

NEW QUESTION # 251
A patient who is post repair of an abdominal aortic aneurysm should be monitored for which of the following complications?

A. acute CVA
B. acute hepatic dysfunction
C. atrial fibrillation
D. acute renal failure

Answer: D

Explanation:

Abdominal aortic aneurysm
An x-ray of a human body Description automatically generated
Acute renal failure is one of the possible complications of abdominal aortic aneurysm (AAA) repair, especially after open surgery. Acute renal failure is a sudden loss of kidney function that can cause fluid and electrolyte imbalance, acid-base disturbance, and uremic syndrome. Acute renal failure can occur due to several factors, such as hypoperfusion of the kidneys, atheroembolism, contrast-induced nephropathy, or ischemia-reperfusion injury12. The incidence of acute renal failure after AAA repair ranges from 2 to 25%, depending on the definition, the type of surgery, and the patient's risk factors13. Acute renal failure is associated with increased morbidity, mortality, and length of hospital stay after AAA repair13.
Other complications of AAA repair include bleeding, infection, wound complications, graft-related complications, bowel ischemia, spinal cord ischemia, and cardiac, pulmonary, or neurological events124.
Acute hepatic dysfunction, acute CVA, and atrial fibrillation are not specific complications of AAA repair, but they may occur in any major surgery or in patients with preexisting conditions.

NEW QUESTION # 252
......

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