AACN CCRN-Adult CCRN (Adult) - Direct Care Eligibility Pathway Exam Practice Test

In a patient with a chest tube, an air leak in the pleural space is indicated by an increase in bubbling in the water-seal chamber. Bubbling in this chamber occurs when air escapes from the pleural space into the chest drainage system. An increase in bubbling signifies an ongoing air leak, indicating that air is still entering the pleural space, often due to a bronchopleural fistula or lung injury.References: = CCRN Exam Handbook, page 36

Hypokalemia

A patient with a potassium concentration of 3.0 mEq/L has mild hypokalemia, which is a low level of potassium in the blood. Hypokalemia can cause various ECG changes that reflect the impairment of cardiac depolarization and repolarization. The most common ECG changes in mild hypokalemia are ST segment depression, flattened and inverted T wave, and a U wave, which is a positive deflection after the T wave. These ECG changes can be seen in the examples from the web search results12. Other ECG changes that may occur in more severe hypokalemia are prolonged QT interval, frequent ectopic beats, and arrhythmias123. Tall peaked T wave, prolonged PR interval, and prolonged QRS complex are ECG changes associated with hyperkalemia, which is a high level of potassium in the blood12. Shortened QT interval and complete atrioventricular block are not typical ECG changes of hypokalemia, but may occur in other electrolyte disorders, such as hypercalcemia2. Inverted P wave, elevated T wave, and prolonged QT interval are not specific ECG changes of hypokalemia, but may occur in other cardiac conditions, such as ischemia, myocarditis, or pericarditis2.

Glucagon is a hormone that stimulates the liver to release glucose from glycogen stores or from gluconeogenesis. However, when the hepatocytes are damaged by alcoholism or other causes of hepatic failure, glucagon is ineffective because the liver cannot respond to its signal. Glucagon administration is contraindicated for hypoglycemic patients with hepatic failure because it will not raise their blood glucose levels and may worsen their acidosis and electrolyte imbalance123

References:

• Hypoglycemia in Patients With Hepatic Failure - PubMed
• Glucagon - Wikipedia
• Frontiers | Glucagon Receptor Signaling and Lipid Metabolism

Abdominal compartment syndrome (ACS) involves increased intra-abdominal pressure, which can significantly impact various body systems. One of the major concerns is its effect on respiratory function, leading to increased peak inspiratory pressure. This happens because the elevated pressure in the abdomen can push up against the diaphragm, making it harder for the lungs to expand during inhalation. Increased urine output is unlikely as ACS usually leads to decreased renal perfusion and output. Increased preload and decreased intracranial pressure are not typically associated with ACS. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Blood cultures are the most definitive method to diagnose sepsis and monitor the response to therapy2. They can identify the causative organism and help guide antibiotic therapy2. In the case of osteomyelitis leading to septic shock, blood cultures can help confirm the presence of an ongoing systemic infection1. Other tests like the basic metabolic panel, complete blood count, and erythrocyte sedimentation rate can provide supportive information, but they are not as specific or definitive for monitoring response to therapy in septic shock secondary to osteomyelitis123.

The intended effects of medications for a patient in acute CHF are to reduce CVP and reduce SVR, as this would decrease the preload and afterload on the failing heart and improve the cardiac output and tissue perfusion. CVP (central venous pressure) is a measure of the pressure in the right atrium and reflects the volume status of the patient. SVR (systemic vascular resistance) is a measure of the resistance in the systemic circulation and reflects the tone of the blood vessels. Medications that can reduce CVP and SVR in acute CHF include diuretics, nitrates, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and vasodilators12. Increasing CVP and reducing SVR would increase the preload and decrease the afterload, which may be beneficial for some patients with low cardiac output and low filling pressures, but not for patients with acute CHF and volume overload3. Reducing CVP and increasing SVR would decrease the preload and increase the afterload, which would worsen the cardiac function and oxygen demand in acute CHF3. Increasing CVP and increasing SVR would increase both the preload and the afterload, which would also worsen the cardiac function and oxygen demand in acute CHF3.

References:

• 1: Acute decompensated heart failure: Management - UpToDate4, p. 5-6.
• 2: Acute heart failure: diagnosis and management | Guidance | NICE, p. 8-9.
• 3: Hemodynamic monitoring in acute heart failure - UpToDate, p. 3-4.

Acute pancreatitis is most commonly indicated by severe mid-epigastric pain, which often radiates to the back, leukocytosis (an elevated white blood cell count indicating inflammation), and hypocalcemia (low calcium levels in the blood). The inflammation of the pancreas leads to the release of digestive enzymes and inflammatory mediators that can cause widespread effects, including alterations in calcium metabolism.References: = CCRN Exam Handbook, page 47

The signs and symptoms described in the patient post-bariatric surgery, including anxiety, restlessness, increased abdominal pain, and subcutaneous crepitus over the neck, suggest a potential anastomotic leak, which is a surgical emergency. Given the vital signs indicating possible sepsis or shock (elevated heart rate, increased respiratory rate, and fever), immediate surgical intervention is likely required to repair the leak and prevent further complications. References: CCRN Exam Handbook, AACN, page 30, section on GI surgical emergencies.

The patient’s findings are consistent with a ruptured diaphragm, which is a tear in the muscle that separates the chest and abdominal cavities. A blunt chest trauma can cause a sudden increase in intra-abdominal pressure, which can rupture the diaphragm and allow abdominal organs to herniate into the thorax. This can cause dyspnea, hypotension, shoulder pain, and bowel sounds over the lower thorax. A ruptured abdominal viscus would cause peritonitis, which would present with abdominal pain, distension, fever, and signs of sepsis. A flail chest would cause paradoxical chest movement, respiratory distress, and cyanosis. A mediastinal shift would cause tracheal deviation, decreased breath sounds, and jugular venous distension.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
• BCEN. (2020). Trauma Certified Registered Nurse (TCRN) Examination Content Outline. Retrieved from [TCRN Exam Content Outline], p. 8.
• Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier. Retrieved from [Textbook], p. 1789-1790.

Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

Noncardiogenic pulmonary edema is most often associated with damage to the alveolar capillary membrane secondary to aspiration. This condition occurs when there is increased permeability of the alveolar-capillary barrier, leading to fluid leakage into the alveoli. It is a hallmark of Acute Respiratory Distress Syndrome (ARDS), which can be triggered by aspiration, resulting in inflammatory damage to the lungs.References: = CCRN Exam Handbook, page 29

In patients with head injuries, increased muscle tone and contractured positioning (such as decorticate or decerebrate posturing) are signs of significant neurological impairment. It is essential to manage these symptoms to prevent further complications. Consulting a physical therapist is the best course of action to ensure appropriate positioning, prevent contractures, and manage spasticity effectively. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

A high mixed venous O2 saturation (SO2) indicates that the tissue cells are not extracting enough oxygen from the blood, which can be due to impaired cellular metabolism or increased oxygen delivery. In septic shock, there is often a mismatch between oxygen delivery and consumption, resulting in a high SO2 despite tissue hypoxia. Therefore, SO2 alone is not a reliable indicator of tissue perfusion in septic shock.

References:

• Mixed venous oxygen saturation (SvO2) monitoring • LITFL • CCC
• SvO2 to monitor resuscitation of septic patients: let’s just understand the basic physiology | Critical Care | Full Text
• Reference Guide for CCRN (Adult), page 14.

After gastric bypass surgery, the altered anatomy of the gastrointestinal tract makes it challenging to place a gastric tube. Performing the procedure under fluoroscopy provides real-time imaging guidance, ensuring correct placement and reducing the risk of complications, such as perforation or misplacement.References: = CCRN Exam Handbook, page 45

This is the nurse’s best initial response, as it expresses empathy, validates the patient’s feelings, and assesses the patient’s risk of suicide. Depression is a common and serious mental health condition that affects older adults, especially those living in nursing homes. Depression can cause persistent sadness, hopelessness, loss of interest, and suicidal thoughts or behaviors. The nurse should screen the patient for depression using a validated tool, such as the Patient Health Questionnaire (PHQ-9) 1, and ask about any suicidal ideation or plans. The nurse should also provide emotional support, education, and referral to appropriate resources for the patient.

B. “Those feelings should resolve when the medication you’ve started has a chance to take effect.”

This is not the nurse’s best initial response, as it dismisses the patient’s feelings, implies that the patient just needs to wait for the medication to work, and does not address the patient’s psychosocial needs. Antidepressants are one of the treatment options for depression, but they may take several weeks to show their full effect, and they may not work for everyone. The nurse should also explore other factors that may contribute to the patient’s depression, such as social isolation, loss of autonomy, chronic illness, or grief, and offer interventions that may help the patient cope, such as counseling, psychotherapy, cognitive-behavioral therapy, or social activities.

C. “I understand how you feel. We all get that way when we’re depressed.”

This is not the nurse’s best initial response, as it assumes that the nurse knows how the patient feels, minimizes the patient’s experience, and generalizes the patient’s condition. Depression is not a normal or inevitable part of aging, and it affects each person differently. The nurse should not compare the patient’s feelings to their own or to others, but rather acknowledge and respect the patient’s unique perspective and situation. The nurse should also avoid using words like “we” or “you” that may create a sense of distance or judgment, and instead use words like “I” or “me” that may convey a sense of empathy or rapport.

D. “Have you talked to anyone about what is bothering you?”

This is not the nurse’s best initial response, as it may sound like the nurse is trying to avoid listening to the patient, or that the patient is bothering the nurse with their problems. The nurse should not imply that the patient should talk to someone else, but rather show interest and willingness to listen to the patient. The nurse should also use open-ended questions that invite the patient to share more, such as “How are you feeling today?” or “What has been on your mind lately?” The nurse should also use active listening skills, such as nodding, paraphrasing, reflecting, or summarizing, to demonstrate understanding and engagement.

An increase in intracranial pressure (ICP) above 25 mm Hg often results in changes in the waveform morphology observed in the monitoring of intracranial pressure. Specifically, the amplitude of P2 becomes greater than P1, which is indicative of decreased intracranial compliance. This pattern is known as the "pathological waveform," suggesting increased intracranial pressure and decreased ability of the brain to accommodate the pressure changes. References: CCRN Exam Handbook, AACN, page 23, section on Neurological.

While it is important to support family involvement, previous disruptive behavior necessitates setting clear behavioral limits to ensure a safe and therapeutic environment for the patient. Allowing the visit with established guidelines helps balance the need for patient support with maintaining unit order. This approach also respects the patient's rest and recovery needs. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

The hemodynamic readings provided (BP 80/60, HR 110, CVP 20 mm Hg, PAOP 26 mm Hg, CO 2.1 L/min, CI 1.3 L/min/m², PAP 42/32 mm Hg, SVR 1762 dynes/sec/cm⁵) suggest cardiogenic shock. This condition is characterized by low cardiac output and index, elevated filling pressures (CVP and PAOP), and systemic vascular resistance. Cardiogenic shock often occurs following an acute anterior wall myocardial infarction (MI) due to extensive damage to the myocardium, leading to impaired contractility and inadequate tissue perfusion.References: = CCRN Exam Handbook, page 12

Lorazepam (Ativan) is most appropriate to administer in a patient who has smoked crack cocaine and is agitated, particularly after a generalized seizure. Benzodiazepines like lorazepam help to manage agitation and seizure activity associated with cocaine toxicity by providing sedative and anticonvulsant effects.References: = CCRN Exam Handbook, page 53

The nurse should place the patient in contact isolation, which is a type of precaution used to prevent the transmission of microorganisms that are spread by direct or indirect contact with the patient or the patient’s environment. Contact isolation requires the use of gloves and gowns when entering the patient’s room, as well as dedicated patient-care equipment and proper hand hygiene. Vancomycin resistant enterococcus (VRE) is a type of bacteria that is resistant to the antibiotic vancomycin and can cause infections in various sites, such as the urinary tract, bloodstream, or wounds. VRE can be spread by contact with contaminated surfaces, equipment, or hands.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
• CDC. (2019). Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved from [CDC Guidelines], p. 69-70.
• CDC. (2019). Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory. Retrieved from [CDC Fact Sheet], p. 1-2.

Conducting a literature review is an essential step in evidence-based practice. Sharing these findings with the staff and obtaining their input fosters a collaborative environment and ensures that the best practices are understood and implemented by all. This approach also helps identify any practical concerns or barriers to implementation. Simply switching back to the old trays without addressing the root cause or educating the staff may not prevent future CAUTIs. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

When dealing with a spouse who feels helpless, the most effective nursing intervention is to identify and reinforce their support systems. This helps the spouse feel less isolated and more empowered. Offering solutions to problems, encouraging other family members to make decisions, or providing reassurance that visiting is not necessary do not directly address the spouse's feelings of helplessness and may even contribute to feelings of exclusion or inadequacy. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

The nurse's role in this situation is to provide clear and compassionate guidance regarding the complex decision about continuing or discontinuing ventilator support. Referring to the hospital's policies provides a structured approach to making such decisions and ensures that the decision aligns with ethical and legal standards. This approach also supports the spouse by providing concrete information and a framework within which to make an informed decision. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

A patient with acetaminophen overdose is at risk for acute liver failure, which can lead to coagulopathy. This condition is often marked by an increased International Normalized Ratio (INR) due to impaired synthesis of clotting factors in the liver. Decreasing level of consciousness can also result from hepatic encephalopathy, a complication of liver failure. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

The dysrhythmia shown in the image is likely a rapid ventricular tachycardia (VT), given the hemodynamic instability (BP 83/40, patient pale, diaphoretic, lethargic, and disoriented). Synchronized cardioversion at 100 joules is the appropriate treatment for unstable VT, as it can effectively terminate the arrhythmia and restore normal sinus rhythm, addressing both the dysrhythmia and the patient's symptoms.References: = CCRN Exam Handbook, page 33

Ventricular assist device

Protein calorie malnutrition (PCM) is a condition that occurs when the body does not get enough protein and calories to meet its needs. PCM can affect the immune system, wound healing, and organ function. Patients with a left ventricular assist device (LVAD) are at risk of PCM due to increased metabolic demands, fluid retention, inflammation, and poor appetite. Edema, or swelling, is a common sign of fluid overload in patients with LVADs. However, edema can also mask the physical signs of PCM, such as muscle wasting, weight loss, and skin changes. Therefore, the nurse should consider edema as a potential factor that can interfere with the assessment of the patient’s nutritional status. Other methods to evaluate the patient’s nutritional needs include laboratory tests, dietary intake, and body mass index. The nurse should also collaborate with a dietitian to provide appropriate nutritional interventions for the patient, such as oral supplements, enteral feeding, or parenteral nutrition.

References:

• Caring for patients with a left ventricular assist device, page 28.
• Ventricular assist device (VAD) - Mayo Clinic, under “Why it’s done”.
• Preoperative Nutritional Optimization and Physical Exercise for …, under “Introduction”.
• Obesity in Patients with Advanced Heart Failure and Left Ventricular …, under “Introduction”.

Cerebral angiography is considered the gold standard for diagnosing and pinpointing the location, size, and origin of cerebral aneurysms. It involves the use of contrast material injected into the cerebral arteries and imaging to provide detailed visualization of the blood vessels in the brain, which is essential for accurate diagnosis and planning treatment strategies. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

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Cellular dehydration is one of the potentially life-threatening consequences of diabetic ketoacidosis (DKA), which is a condition that occurs when the body does not have enough insulin to use glucose for energy and starts to break down fat instead. This produces ketones, which are acidic substances that accumulate in the blood and urine. DKA causes hyperglycemia, which is a high level of glucose in the blood, and osmotic diuresis, which is the loss of water and electrolytes through the urine. This leads to cellular dehydration, which is the shrinkage of the cells due to the loss of water from the intracellular fluid. Cellular dehydration can affect the brain and cause neurological symptoms, such as confusion, lethargy, coma, and death12.

Other potentially life-threatening consequences of DKA include metabolic acidosis, which is a low pH of the blood due to the excess of ketones, and respiratory compensation, which is the increase of the breathing rate and depth to expel carbon dioxide and lower the acidity of the blood12. These are not the same as metabolic alkalosis or respiratory alkalosis, which are conditions that cause a high pH of the blood due to the loss of acids or the retention of bases2. Intracellular hyperglycemia is not a consequence of DKA, as the glucose cannot enter the cells without insulin and remains in the extracellular fluid12.

This response is the most appropriate because it acknowledges the family’s concern, invites them to share their perspective, and opens up a dialogue about the patient’s condition and comfort. Communication with patients and families about illness progression and end of life requires sensitivity, empathy, and respect. The nurse should avoid making assumptions, giving false reassurance, or dismissing the family’s emotions. Instead, the nurse should explore the family’s understanding, expectations, and needs, and provide information and support accordingly12. Answer A is not appropriate because it does not address the family’s emotional distress or their perception of the patient’s suffering. Answer C is not appropriate because it may contradict the family’s observation or belief, and it may imply that the patient is not aware of their presence or care. Answer D is not appropriate because it may seem like the nurse is avoiding the issue or imposing a religious intervention that the family may not want or need.

Alcohol withdrawal syndrome

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Answer: A

The patient’s symptoms of tremulousness, anxiety, and startle response suggest that he may be experiencing alcohol withdrawal, which can occur within hours to days after the last drink. Alcohol withdrawal can cause severe complications, such as seizures, delirium tremens, and death, if not treated promptly and appropriately. Alcohol withdrawal can also worsen GI bleeding by increasing gastric acid secretion, impairing clotting factors, and causing hypertension and tachycardia. Therefore, the most pertinent part of the patient’s history to obtain is the last alcohol intake, which can help determine the risk and severity of withdrawal and guide the management of the patient.

References:

• Management of moderate and severe alcohol withdrawal syndromes: This article states that “Symptoms of alcohol withdrawal occur because alcohol is a central nervous system depressant. When a person drinks frequently, the brain compensates for alcohol’s depressant effects by increasing the activity of excitatory neurotransmitters, such as norepinephrine, serotonin, dopamine, and glutamate, and reducing the activity of inhibitory neurotransmitters, such as gamma-aminobutyric acid (GABA). When alcohol intake is abruptly discontinued or reduced, this neuroadaptation is unmasked, resulting in a hyperexcitable state that is responsible for the characteristic withdrawal symptoms.”
• Alcoholic Gastritis: Causes, Symptoms and Treatment: This article states that “Alcohol Gastritis is a type of acute gastritis and is caused by excessive alcohol consumption. The sudden inflammation of the stomach lining can be very painful and cause severe stomach cramping, irritability and vomiting. While consuming too much alcohol is the main cause of Alcohol Gastritis, it often develops in connection with some sort of infection, direct irritation or localized tissue damage. It can be caused by: Taking non-steroidal, anti-inflammatory medications like aspirin or ibuprofen (i.e., NSAIDs). Certain bacterial infections. Bile reflux from proximal small intestine. Autoimmune disorders.”
• Can You Get Internal Bleeding from Alcohol Abuse: This article states that “Over time, alcohol abuse starts to eat away at the stomach lining. Continued drinking sets the stage for alcoholic gastritis to develop. Under these conditions, internal bleeding from alcohol abuse takes the form of blood oozing from stomach lines on an ongoing basis.”

Disseminated intravascular coagulation (DIC) is a condition where blood clots form excessively and block blood vessels, leading to organ damage and bleeding. The pathophysiology of DIC involves excess and unregulated thrombin generation, which consumes coagulation factors and platelets, and activates fibrinolysis1. Thus, in severe DIC there is paradoxically simultaneous thrombosis and spontaneous bleeding2. This is due to the depletion of clotting factors, which is a key aspect of the underlying pathophysiology of DIC12.

The patient has thrombocytopenia, which is a low platelet count that increases the risk of bleeding. Heparin is an anticoagulant that prevents clotting, but also increases the risk of bleeding. Therefore, heparin should be avoided in patients with thrombocytopenia. Hemodialysis can be performed without heparin by using alternative methods such as saline flushes, blood predilution, or specialized dialyzers that reduce clotting. Transfusing platelets during hemodialysis is not recommended, as platelets may be damaged by the extracorporeal circuit. Rescheduling hemodialysis may not be feasible, as the patient may have fluid overload, electrolyte imbalance, or uremia that require urgent dialysis.

References:

• Use and safety of heparin-free maintenance hemodialysis in the USA
• Anticoagulation for the hemodialysis procedure
• Dialysis without anticoagulation (Heparin Free Dialysis)

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.

Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or "broken heart syndrome," is characterized by transient left ventricular dysfunction often precipitated by significant emotional or physical stress. The key findings of chest pain and ST elevation without significant coronary artery disease, along with left ventricular dysfunction and apical ballooning observed on imaging, are classic for takotsubo cardiomyopathy. This condition is often reversible and is associated with a temporary reduction in the heart's pumping ability, indicated by the reduced ejection fraction (EF) of 35%. References: =

• American Association of Critical-Care Nurses (AACN). (2024). CCRN Exam Handbook. Retrieved from AACN CCRN Exam Handbook
• Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online. AACN

Acute peripheral arterial insufficiency typically presents with sudden, severe pain at rest, which may be accompanied by other signs such as pallor, paresthesia, paralysis, pulselessness, and poikilothermia (the six P's). This condition indicates a critical reduction in blood flow to the affected extremity, requiring immediate medical attention. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

The initial step in facilitating a change in practice regarding visiting hours should involve a literature search on family visitation practices. This allows the nurse to gather evidence-based information that can support any proposed changes. After gathering sufficient evidence, the nurse can then schedule an interdisciplinary team meeting to discuss the findings, consult with medical staff, and draft a new policy if necessary. References: CCRN Exam Handbook, AACN, page 35, section on Professional Caring and Ethical Practice.

Acute pancreatitis

Shortness of breath is a sign of respiratory distress that may indicate a serious complication of acute pancreatitis, such as pleural effusion, atelectasis, or acute respiratory distress syndrome (ARDS). These conditions can impair oxygenation and ventilation, and may require supplemental oxygen or mechanical ventilation. The provider should be notified immediately if the patient has shortness of breath, as well as other signs of respiratory distress, such as cyanosis, tachypnea, or use of accessory muscles12. Hypoactive bowel sounds, hyperglycemia, and vomiting are common findings in acute pancreatitis, but they are not as urgent as shortness of breath. They may indicate paralytic ileus, pancreatic insufficiency, or gastric outlet obstruction, respectively. These conditions can be managed with supportive measures, such as intravenous fluids, antiemetics, analgesics, and nutritional support3 .

The best response is to assess the patient's feelings and understanding of their condition and prognosis. This response opens a dialogue and allows the nurse to provide education and emotional support based on the patient's specific concerns. Other responses may provide false reassurance or imply assumptions about the patient’s future without first understanding their current emotional state and concerns. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

Splenomegaly

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The patient’s presentation is suggestive of splenic abscess, which is a rare but serious complication of splenomegaly. Splenic abscess is caused by bacterial or fungal infection of the spleen, usually from hematogenous spread or contiguous spread from adjacent organs. The most common symptoms are fever, chills, abdominal pain, and left shoulder pain (Kehr sign). The most significant laboratory finding is positive blood cultures, which indicate systemic infection and sepsis. Other laboratory findings may include leukocytosis, anemia, thrombocytopenia, elevated inflammatory markers, and abnormal liver function tests. However, these are nonspecific and may vary depending on the underlying cause of splenomegaly and the type of microorganism involved.

References:

• Splenic Abscess - Infectious Disease Advisor
• Cross-sectional imaging findings of splenic infections: is … - Springer

When a patient has been declared brain dead, the appropriate initial action for a nurse who has not previously discussed organ donation with a family is to consult the organ donation liaison. These professionals are trained to handle sensitive conversations about organ donation and can provide the necessary support and information to the family, ensuring that the process is handled respectfully and in accordance with legal and ethical guidelines. References: =

• CCRN (Adult) Certification Review Course Online: Professional Caring and Ethical Practice.
• American Association of Critical-Care Nurses (AACN). (2024). CCRN Exam Handbook. Retrieved from AACN CCRN Exam Handbook
• Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online. AACN

In the context of cardiogenic shock managed with vasopressor and inotrope therapies, organ dysfunction from hypoperfusion can manifest as elevated creatinine and abdominal pain. Elevated creatinine indicates renal impairment, a common result of poor perfusion to the kidneys. Abdominal pain can indicate hypoperfusion to the gastrointestinal tract, leading to ischemic bowel or other GI complications. These symptoms are direct indicators of hypoperfusion and organ dysfunction. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

The spleen plays a crucial role in filtering bacteria and old or damaged blood cells, as well as mounting an immune response. After a splenectomy, the patient is at increased risk for infections, particularly from encapsulated organisms like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. This heightened susceptibility to infection can lead to sepsis, a life-threatening condition. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

The caloric irrigation test, also known as the oculovestibular reflex test, is used to assess brainstem function in patients, especially those who are comatose. In this test, cold water is introduced into the ear canal, which should induce a predictable response if the brainstem is intact. The normal response to cold water irrigation is nystagmus with slow deviation of the eyes toward the side of the cold water (in this case, the left) and a fast phase of eye movement (nystagmus) away from the side of the cold water (to the right). This indicates that the brainstem pathways are functioning properly. References: =

• American Association of Critical-Care Nurses (AACN). (2024). CCRN Exam Handbook. Retrieved from AACN CCRN Exam Handbook
• Adult CCRN/CCRN-E/CCRN-K Certification Review Course Online. AACN