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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q89-Q94):

NEW QUESTION # 89
Appropriate outcomes for a patient with status asthmaticus include

A. normal PaCO2 and increased FEV1.
B. increased PaCO2 and decreased FEV1.
C. paradoxical breathing and increased FEV1.
D. decreased peak flow rates and decreased wheezing.

Answer: A

Explanation:
The appropriate outcomes for a patient with status asthmaticus are normal PaCO2 and increased FEV1. Status asthmaticus is a severe and life-threatening asthma exacerbation that does not respond to conventional treatment. It causes severe bronchoconstriction, air trapping, and mucus plugging, leading to hypoxemia, hypercapnia, and respiratory failure. The goals of treatment are to reverse the airway obstruction, improve gas exchange, and prevent complications. PaCO2 is the partial pressure of carbon dioxide in the blood, which reflects the adequacy of ventilation. FEV1 is the forced expiratory volume in one second, which measures the amount of air that can be forcefully exhaled in the first second of a breath. It reflects the degree of bronchoconstriction and airflow limitation. A patient with status asthmaticus typically has elevated PaCO2 and reduced FEV1 due to poor ventilation and severe obstruction. Therefore, normalizing PaCO2 and increasing FEV1 indicate improvement in the patient's condition and response to treatment.
References:
* Status Asthmaticus: Symptoms, Causes, Diagnosis, and Treatment - Healthline: This article states that
"Status asthmaticus is a severe form of asthma with symptoms similar to a typical asthma attack. But for status asthmaticus, symptoms may worsen as the asthma attack continues. Status asthmaticus is an older, less precise term for what's now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn't improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours."
* Status Asthmaticus (Severe Acute Asthma) - WebMD: This article states that "Status asthmaticus is a severe asthma attack that doesn't get better with your usual treatments. It can be life-threatening and needs urgent medical attention. If you have a bad asthma attack and your rescue inhaler or your nebulizer doesn't help, you need medical care right away. If an attack comes on quickly and it doesn't respond to regular treatment, it can lead to status asthmaticus."
* Management of Status Asthmaticus | SpringerLink: This article states that "Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure despite aggressive treatment.
It is defined as an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary in severity from mild to fatal. The pathophysiology of status asthmaticus is complex and involves airway inflammation, bronchospasm, airway edema, mucus plugging, and increased airway resistance. The clinical manifestations of status asthmaticus include dyspnea, wheezing, cough, chest tightness, tachypnea, tachycardia, hypoxemia, and hypercapnia. The diagnosis of status asthmaticus is based on history, physical examination, and laboratory tests, such as arterial blood gas analysis, spirometry, and chest radiography. The management of status asthmaticus consists of oxygen therapy, inhaled beta-2 agonists, systemic corticosteroids, and adjunctive therapies, such as anticholinergics, magnesium sulfate, ketamine, and noninvasive or invasive mechanical ventilation. The goals of treatment are to relieve bronchoconstriction, reduce airway inflammation, correct hypoxemia, normalize or reduce carbon dioxide levels, and avoid or treat complications."

NEW QUESTION # 90
A patient lying on the left side in Trendelenburg position is in the correct position for postural drainage of which of the following lobes of the lungs?

A. right upper
B. left upper
C. left lower
D. right lower

Answer: D

Explanation:
For postural drainage of the right lower lobe, the patient should be positioned on their left side in the Trendelenburg position. This positioning utilizes gravity to facilitate the drainage of secretions from the right lower lobe of the lungs. In the Trendelenburg position, the body is laid flat on the back with the feet higher than the head, which helps drain the lower lobes effectively.References: = CCRN Exam Handbook, page 22

NEW QUESTION # 91
Which of the following is a sign of splenic injury and diaphragmatic irritation?

A. left shoulder pain
B. tachypnea
C. hiccoughs
D. flank pain

Answer: A

Explanation:
Left shoulder pain, also known as Kehr sign, is a sign of splenic injury and diaphragmatic irritation. It is caused by the irritation of the phrenic nerve, which innervates both the diaphragm and the shoulder, by blood or other fluids in the left upper quadrant. Tachypnea, flank pain, and hiccoughs are not specific signs of splenic injury or diaphragmatic irritation.
References:
* Splenic trauma | Radiology Reference Article | Radiopaedia.org
* Recognition and management of diaphragmatic injury in adults
* Reference Guide for CCRN (Adult), page 14.

NEW QUESTION # 92
A patient with history of hypothyroidism is admitted with severe confusion and nonpitting edema. The nurse should anticipate which order?

A. 3% saline 150 mL/hour
B. diuretics
C. insulin drip
D. forced air warming blanket

Answer: D

Explanation:
The patient has signs of myxedema coma, a life-threatening complication of hypothyroidism. The patient needs immediate treatment with thyroid hormone replacement, glucocorticoids, and supportive care. One of the supportive measures is to correct the hypothermia that often accompanies myxedema coma. A forced air warming blanket is a device that delivers warm air through a hose to a blanket that covers the patient. This helps to raise the patient's core temperature and prevent further complications. Insulin drip is not indicated, as the patient does not have diabetes or hyperglycemia. 3% saline is a hypertonic solution that can worsen the hyponatremia and fluid overload that are common in myxedema coma. Diuretics are not recommended, as they can cause dehydration and electrolyte imbalance in the patient.
References:
* Myxedema Coma: Diagnosis and Treatment | AAFP
* Myxedema coma - UpToDate
* Myxedema: Symptoms, treatment & coma - Medical News Today

NEW QUESTION # 93
The primary pathophysiology underlying acute respiratory failure in a patient with head trauma involves

A. dehydration related to diabetes insipidus.
B. increased arterial oxygenation related to increased intrapulmonary shunt.
C. hypercapnia related to decreased minute ventilation.
D. shifting of oxyhemoglobin dissociation curve to the left.

Answer: C

Explanation:
In a patient with head trauma, the primary pathophysiology underlying acute respiratory failure often involves hypercapnia due to decreased minute ventilation. Head trauma can impair the central nervous system's ability to regulate breathing, leading to inadequate ventilation and a build-up of carbon dioxide (CO2) in the blood.
Other factors like shifting of the oxyhemoglobin dissociation curve, increased intrapulmonary shunt, and dehydration due to diabetes insipidus may be present but are not the primary causes. References: CCRN Exam Handbook, AACN, page 25, section on Respiratory.

NEW QUESTION # 94
......

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