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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q492-Q497):

NEW QUESTION # 492
Which of the following strategies is BEST for optimizing ventilation in a patient with ARDS?

A. High tidal volume ventilation
B. Hyperventilation
C. Ventilating in the supine position
D. Permissive hypercapnia

Answer: D

Explanation:
Permissive hypercapnia is a lung-protective ventilation strategy commonly used in ARDS (Acute Respiratory Distress Syndrome) to allow for lower tidal volumes, thus preventing lung injury. High tidal volume ventilation is contraindicated as it could lead to ventilator-induced lung injury due to the fact that some lung volume is occupied by fluid. Hyperventilation could lead to alkalosis. Ventilating in the prone position can optimize ventilation for a patient with ARDS; however, ventilating in the supine position is not advantageous.

NEW QUESTION # 493
Which of the following statements made by a student nurse indicates that they understand the pathology of cardiac tamponade?

A. Both the rate of bleeding and the amount of blood impact how severe a cardiac tamponade will be.
B. A cardiac tamponade can occur when the heart is compressed by fluid building up anywhere in the thoracic cavity.
C. Chest x-ray is the ideal way to confirm the diagnosis of cardiac tamponade.
D. Cardiac tamponade may cause severe distress, but rarely causes death.

Answer: A

Explanation:
Cardiac tamponade occurs with bleeding into the pericardial sac. While the amount of bleeding affects the pressure applied on the heart, the speed of bleeding also affects the ability of the heart and pericardium to compensate. Cardiac tamponade often leads to death if untreated. While a chest x-ray may be used to diagnose cardiac tamponade, and echocardiogram is the ideal diagnostic method.
Cardiac tamponade occurs when fluid builds up specifically in the pericardial sac.

NEW QUESTION # 494
While recording hourly ventilator checks on a patient who is being mechanically ventilated, the nurse notes that the PIP has gradually increased by 5 cm H2O over the past 4 hours. This increase indicates

A. a decrease in lung compliance.
B. an improvement in pulmonary function.
C. a decrease in airway resistance.
D. a leak in the ET tube cuff.

Answer: A

Explanation:
An increase in peak inspiratory pressure (PIP) over time in a mechanically ventilated patient indicates a decrease in lung compliance. This means the lungs are becoming stiffer and less able to expand, which can be caused by conditions such as pulmonary edema, ARDS, or pneumothorax. It is important to address the underlying cause of decreased lung compliance to prevent further respiratory complications. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

NEW QUESTION # 495
Which of the following sets of arterial blood gas (ABG) results indicates acute respiratory failure (ARF) that requires immediate endotracheal intubation?

A. pH 7.31, PaO2 55 mm Hg, PaCO2 52 mm Hg
B. pH 7.32, PaO2 65 mm Hg, PaCO2 20 mm Hg
C. pH 7.30, PaO2 60 mm Hg, PaCO2 48 mm Hg
D. pH 7.25, PaO2 58 mm Hg, PaCO2 53 mm Hg

Answer: D

Explanation:
Indications for the need of mechanical ventilation include:
* PaO2 < 60 mm Hg
* PaCO2 < 30 or > 50 mm Hg
* RR > 30-35 BPM or <10 BPM
* pH </= 7.25
Therefore, the patient with the ABGs of pH 7.25, PaO2 58 and PaCO2 53 mm Hg meets the criteria for ARF in need of ventilation.

NEW QUESTION # 496
A nurse is caring for a Korean patient who refuses to make eye contact. What of the following responses by the nurse is BEST?

A. "Do you have any cultural preferences regarding making eye contact?"
B. "Has anyone at home been physically abusive towards you?"
C. "Would you please look at me while I am speaking so that I know you're paying attention?"
D. "I notice that you're avoiding me. Do you feel uncomfortable with me as your nurse?"

Answer: A

Explanation:
In some cultures, including many Asian cultures, avoiding direct eye contact is considered respectful, especially with authority figures like healthcare providers. The nurse should directly ask the patient about their cultural practices to avoid any misunderstandings. The nurse should not assume that a lack of eye contact is an indicator of abuse. The nurse should not address the behavior until they understand if there is any cultural significance to the behavior.

NEW QUESTION # 497
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