CCRN-Adult Exam Prep

• This exam contains questions that a CCRN-Adult nurse would be expected to know
• It tests for the following criteria
• Diagnostic tests
• Prioritization of actions
• Assessment findings
• Appropriate interventions based on patient presentation

NSTEMI Diagnosis

• Electrocardiogram (ECG) is the most important diagnostic test for suspected NSTEMI in a patient with chest pain and difficulty breathing.

Emergency Department Priorities for Chest Pain with ST-Segment Elevation

• In the emergency department, the nurse should prioritize administering aspirin and nitroglycerin to a patient with chest pain and ST-segment elevation on the EKG.

Diagnosis of Unstable Angina

• Coronary angiography is the most appropriate diagnostic test to confirm unstable angina, characterized by unpredictable chest pain, even at rest.

Assessment Findings in Acute Arterial Occlusion

• Weak or absent peripheral pulses are characteristic assessment findings in acute arterial occlusion, along with sudden onset severe leg pain and pallor.

Priority Action for Carotid Artery Stenosis

• Assess the patient's airway, breathing, and circulation in a patient with a history of carotid artery stenosis presenting with sudden-onset weakness and difficulty speaking, a BP of 180/90 mmHg, and a heart rate of 110 bpm.

Preoperative Test for Endarterectomy

• Angiography is essential for evaluating the extent of artery blockage before an endarterectomy.

Purpose of Femoral-Popliteal Bypass Surgery

• Femoral-popliteal bypass surgery aims to restore blood flow to the lower leg in patients with severe peripheral arterial disease (PAD) or critical limb ischemia.

Initial Action for Heart Failure with Pulmonary Edema

• Administer oxygen therapy at 2 L/min via nasal cannula as the initial action for a patient with a history of heart failure presenting with acute dyspnea, crackles on lung auscultation, and frothy pink sputum.

Initial Nursing Action for Unequal Blood Pressure Readings in Thoracic Aortic Aneurysm

• Reassess the blood pressure in both arms using different cuffs in a patient with a thoracic aortic aneurysm who has unequal blood pressure readings between the arms.

Diagnostic Test for Suspected Aortic Dissection

• Prompt preparation for CT angiography (CTA) should be anticipated to confirm suspected aortic dissection in a 60-year-old patient with hypertension presenting with sudden-onset severe chest pain radiating to the back and unequal blood pressure in both arms.

Immediate Action for Suspected Aortic Dissection with Tearing Pain

• Notifying the healthcare provider immediately is the nurse's most important action for a patient with sudden, severe chest pain radiating to the back, described as tearing, and with a notable blood pressure difference between arms.

Priority Intervention for Postoperative Atrial Fibrillation After CABG

• Administer amiodarone (Cordarone) as the priority intervention in the immediate postoperative period following CABG surgery when the patient's cardiac rhythm is atrial fibrillation with rapid ventricular response.

Immediate Action for Postoperative Hypotension and Oliguria

• Administer a bolus of IV fluids for the patient with a heart rate of 110 bpm, blood pressure of 90/60 mmHg, and urine output of 20 mL/hr four hours after heart valve surgery and monitor them postoperatively.

Suspected Condition with Chest Pain, Dyspnea, and Muffled Heart Sounds

• Aortic dissection should be suspected in a patient presenting with sudden-onset chest pain radiating to the back, dyspnea, tachycardia, distended neck veins, and muffled heart sounds.

Priority Action for Chest Trauma with Muffled Heart Sounds

• Perform an immediate pericardiocentesis for the patient with anterior chest trauma, sudden-onset dyspnea, muffled heart sounds, and distended neck veins.

Initial Action for Bleeding Groin Puncture Site

• Apply firm pressure over the site of bleeding after cardiac catheterization.

Cardiogenic Shock

• Inadequate tissue perfusion is the reason for cardiogenic shock in a 58-year-old male patient presenting to the emergency room with symptoms of chest pain radiating down his left arm, dyspnea, and profuse sweating, with blood pressure 80/50 mm Hg, heart rate 110 bpm, and oxygen saturation 90% on room air.

Dilated Cardiomyopathy: Symptoms and Findings

• Dilated cardiomyopathy is the most likely diagnosis for a 58-year-old male patient with a history of uncontrolled diabetes who presents with fatigue, dyspnea, lower extremity edema, bilateral crackles on auscultation, and an enlarged left ventricle on echocardiogram.

Hypertrophic Obstructive Cardiomyopathy (HOCM)

• A 35-year-old female presents with asymmetric septal hypertrophy causing chest pain exacerbated by exercise and relieved by rest.

Dilated Cardiomyopathy Suspected

• Dilated cardiomyopathy is suspected in patients with unexplained dyspnea and fatigue, bilateral basilar crackles on lung auscultation, ventricular dilatation on echocardiography and impaired systolic function.

Restrictive Cardiomyopathy Confirmation

• An endomyocardial biopsy would confirm a diagnosis of restrictive cardiomyopathy, characterized by dyspnea on exertion, peripheral edema, fatigue, biatrial enlargement, and preserved ejection fraction.

Atrial Fibrillation: ECG Characteristics

• Atrial fibrillation's ECG shows irregular QRS complexes with no discernible P waves and an irregularly irregular rhythm.

Diagnostic Test for Elevated BNP in Heart Failure

• An echocardiogram should be anticipated in a 65-year-old male with a history of heart failure presenting with worsening dyspnea, bilateral crackles on lung auscultation, and a significantly elevated BNP level.

Initial Intervention for Severe Hypertension with Headache and Epistaxis

• Initiating IV labetalol infusion is the initial intervention for a 55-year-old patient with hypertension presenting to the emergency department with severe headache, blurred vision, and epistaxis, and exhibiting a BP of 220/120 mmHg.

Medication to Avoid with Prolonged QT Interval

• Amiodarone should be used with caution in a patient with a prolonged QT interval who presents with syncope, due to the risk of further prolonging the QT interval.

Suspecting Pulmonary Embolus after Respiratory Distress

• A pulmonary embolus should be suspected after being admitted with respiratory distress, a patient suddenly experiences chest pain, dyspnea, and tachycardia, and the nurse identifies an increased intensity of the pulmonary S2 sound upon auscultation.

ARDS in Sepsis

• Acute respiratory distress syndrome (ARDS) should be suspected when a patient admitted with severe sepsis suddenly develops dyspnea, tachypnea, and diffuse crackles on lung auscultation, with ABG analysis on 4L/min oxygen via nasal cannula showing a pH of 7.48, pCO2 of 30 mm Hg, pO2 of 55 mm Hg, and chest X-ray indicating bilateral opacities.

Acute Respiratory Failure Prioritization

• The patient with acute respiratory failure has arterial blood gas analysis of pH 7.30, pCO2 55 mm Hg, pO2 50 mm Hg. Initiating non-invasive positive pressure ventilation should be prioritized.

Hospital-Acquired Pneumonia (HAP) Management

• Arrange for emergent intubation and mechanical ventilation with worsening respiratory distress despite antibiotic therapy.

Nursing Intervention for Dysphagia and Aspiration

• Assess the patient's oxygenation and respiratory status for a 78-year-old patient with a history of dysphagia and recent aspiration episodes who presents to the emergency department with confusion, fever, and productive cough with purulent sputum.

ARDS Pathophysiology

• Sepsis-induced systemic inflammation primarily causes ARDS in pneumonia patients.

Dysphagia Complications

• Suspect silent aspiration during mealtime with sudden dyspnea and coughing.

Parkinson's Disease Nutrition

• Nursing identifies the need for swallowing exercises in the patient with Parkinson’s disease who experiences frequent episodes of coughing and choking.

COPD Nursing Interventions

• Administer a bronchodilator and corticosteroid nebulization for COPD patients with heightened dyspnea, productive cough, fever, and bilateral coarse crackles.

Asthma Exacerbation

• Assess for hypokalemia in the patient admitted with asthma who is experiencing tremors, tachycardia, and agitation while receiving albuterol nebulizations.

Severe Asthma

• Administer a short-acting beta-agonist (SABA) nebulizer treatment for a patient with severe asthma who has increased dyspnea, chest tightness, and audible wheezing, a respiratory rate of 28 breaths/min, heart rate of 110 bpm, oxygen saturation of 89% on room air, and a peak expiratory flow rate (PEFR) of 50% of predicted.

Respiratory Muscle Weakness: Failing Mechanical Ventilation Weaning

• A patient in the intensive care unit who fails multiple attempts to wean from mechanical ventilation requires respiratory muscle weakness to be suspected; arterial blood gas analysis shows pH 7.48, PaCO2 50 mmHg, PaO2 68 mmHg, and HCO3 32 mEq/L.

COPD: Why patients fail breathing trials

• Increased airway resistance is the main difficulty for COPD patients who cant tolerate trials off of ventilators.

COPD: Dyspnea, Tachypnea, and Reduced Breath Sounds

• Pneumothorax should be suspected in COPD patients with a sudden onset of dyspnea, tachypnea, and diminished breath sounds.

Post Thoracentesis Conditions

• Empyema should be suspected if a patient develops fever, chest pain, and purulent pleural fluid drainage, after a recent Thoracentesis

Smoking and High-Resolution CT Scan results

• A patient’s most likely diagnosis is Idiopathic pulmonary fibrosis (IPF). The patient has smoked in the past and has progressive Dyspnea and a dry cough recently and the CT scan shows the following: Bilaterial Reticular Opacities with Honeycombing

Pulmonary Fibrosis Management

• Lung transplantation referral is the best management strategy in patients who suspects the following: they have just been found to have subpleural, basal-predominant reticular opacities with traction bronchiectasis.

Pulmonary issue confirmation Test

• An Echocardiogram confirms if a patient has dyspnea and fatigue in their Pulmonary Arterial system

ABG imbalance, after asthma exacerbation

• Respiratory Acidosis is what a patient is experiencing the ABG results are as follows: pH 7.25, pCO2 60mm Hg, HCO3 24 mEq/L

Blunt Chest issue Nursing Intervetions

• The nurses priority intervention is to insert a chest tube to assist a motor vehicle accident patient who has paradoxical chest movement and decreased breath sounds. Also they have an oxygen saturation of 88% on room air.

Height Fall Conditions: which should nurse suspect

• when the physical examination reveals reduced breath sounds

on the left side and crepitus upon palpation of the chest wall? The nurse should expect:

Pneumothorax.

Thoracic Trauma Conditions:

• Conditions when the nurse should suspect upon assessment, the nurse

notes decreased breath sounds on the left side and tracheal deviation to the right: Tension pneumothorax

Trauma issues to suspect

• A patient has just received a blood transfusion after severe trauma and begins to have bilateral pulmonary infiltrates shortly after. The nurses should expect Transfusion-related acute lung injury (TRALI)

Hypotension from resuscitation: nurse prioritization

• Replace intravascular fluid with normal saline if a patient has hypotension despite volume resuscitation

Diabetes Insipidus

• Nephrogenic DI is caused by a lack of response to normal levels of antidiuretic hormone (ADH)

Which diseases relate to type 1A diabetes mellitus?

• Genetic predisposition and autoimmune attack

DKA primary metabolic issue

• Metabolic Acidosis

Hyperglycemia Underlying Mechanism

• Insulin resistance and decreased insulin production

Dehydration and Mental State Care

• The nurse needs which intervention quickly, based on these findings? The patient presents with altered mental status, extreme thirst, and polyuria, who has a history of type 2 diabetes.

Vital signs reveal hypotension

tachycardia

profound dehydration.

Laboratory findings show blood glucose >600 mg/dL and serum osmolality >320 mOsm/kg

Administering insulin intravenously and isotonic fluids rapidly.

ICU Admission Protocols

• Strictly staying to the current visitation policy.

Glucose Checks

• A patient admitted to the critical care unit exhibits altered mental status, diaphoreses, and tremors. The initial action of the nurse is to administer an intravenous glucose bolus, if a fingerstick reveals glucose in the area of 45mg/dL.

Medical Indications

• the following are indications of Hypothyroidism, if A 55-year-old female patient has presented over the time of a few months, they have dry skin, a hoarse voice and a protuberant tongue

Nursing Intervention

• Pharmacologically, its best to intervene

loop Diuretics, if hyponatremia is < 130mEq/L and osmolality is > mosmO/kg

Anemia Priority Intervention

• Transfusing packed red blood cells to raise oxygen levels.

Liver Issues

• Disseminating intravascular coagulation on DIC, if a liver patient present recent bleeding, and lab results shows prolong PT/INR, decreased platelet count.

Wiskott-Aldrich syndrome indication

• if a child is in and out of hospital with severe infections, as well as

Absent T lymphocytes and immunoglobulins

Leukemia Indications

• initiate contact precautions to prevent infection

Transmission when a patient with leukemia is admitted to ICU with Leukopenia.

Chemo Electrolyte Issues

• Aggressively hydrating electrolyte. A patient starts chemo, and develops nausea, hyperuricemia, hyperkalemia and hyperphosphatemia.

Platelet indications after septic shock

• patient will develop Petechiae and ecchymoses after bring admitted with Septic Shock and test will prove Thrombotic Thrombocytopenic Pupura.

Fever and hypotension reaction

• stop the transfusion and notify the blood bank, if your patient gets a fever , back pain and hypotension after a Blood transfer.

Post Surgery Care

• Start aggressive measures like a loop diuretic to increase urine output in the patient who as abdominal distension and absent bower sounds.

A patient has arrive to the ER with a crash, which test would be priority?

• Perform a CT because you are trying to rule out any abdominal bleeding.

Test for GI bleeds

• when the patient is presenting bright Red Hemantesis and metal, upper gastrointestinal hemorrhage.

Severe Abdominal Pain

• If the patient has had previous surgery and has severe abdominal pain when performing an exam you need to be on the lookout for, Mesenteric ichemia

Patient with Pancreatic Cancer Test

• If the patient has a Pancreatic Cancer is having problems with the whipple procedure and presents a paralytic ileus.

Elevated liver/enzyme issue diagnosis

• Alcoholic liver disease should be expected. They have also had the following issues. Pain in the abdomen area and they seem to be altered when doing a physical

What is wrong with patient that has severe Crohn’s disease?

• Malabsorption syndrome will most likely be causing is as well ad the liver enzyme decreasing due to the diarrhea issues.

If elevated the patient has had ETOH what is the next plan to follow?

• Severe Acute pancreatitis

A patient is having issues with his heart condition?

• A patient is having issues with is heart and AKI secondary to pre-renal factors

Kidney Disease what to look for a characteristic

• A patient will need kidney damage regardless of GFR

Renal infection what to look for

• Urosepsis needs to be addressed by the nurse

Hypernantemia causes?

• What causes high sodium electrolytes will be caused by sever dehydration.

The nurse can expect what with leg swelling patients?

• When the patient has redness warmth and tenderness due to CELLUITILs

Which way to deal with pain:

• Thorough assessment of the assessment will get you further when dealing with someone who has had a tibial facture.

Priority action with femur fracture:

• Immobilize the leg with a split to gain some assistance with action needed.

When should the Nurse question what the type of steppage gate looks like on a patient ?

• The following gate looks like: Dragging the legs and shuffling steps.

what should be expected to treat/test for if exhibiting redness and swelling with pain involved?

• bone scan

what could occur to a Pt . who has had a gym injury?

• rhabdomyolysis

Pt has weakness issue post crash/MVA.

• secure ABC;s! Administer 02 and prepare mechanical ventilation.

A patient is in a coma, what is not considered when eligibility is being assessed?

• Availability of ventilatory support!

What could be expected after a brain injury?

• Pt in neurological ICU with agitation

Q: What is the priority

• mixed delirium

a nurse must prioritize

• thorough neurological

• thorough neuro

Neuro issue priority

• assessing symptoms and starting lactulose therapy.

After some has a brain related issue the next set of action for the nurse

• ELEVATING HOB AND 02

The nurse should do what if unequal pupil are sluggish response to lights

• What should be suspected?-Brain Stem Herniation

The next the nurse should monitor:

• monitor neurology and follow facility policy after SAH.

Pt with severe TBi :

• what should be done- monitor neuro

The nurse should do what with a intubation pt

• Ventilator immediatley- patient with GBS

Which action should the nurse prioritize? musclar issue?

• prioritize CPAP!

Patient has had a siezure what is the next issue?

• perform Intubation

What should the nurse do if patient is having more of an issue with seizure activity after medication?

• A: Perform Lumbar Puntcure

Patient had a severe head/vomitt how should the nurse react

• D: High fowlers position.
• A Embolic Stoke.

pt has what after transient ischemic attack (TIA)

• nurse should ASSESS V/S and 02 support!
• A transient ischemic attack (TIA) what has occurred after all symptoms were resolved.

What is the pH should that the nurse expect

• A: administer sodium bicarbonate. what is most likely for that will occur with a pH of 7.1 HCO 15

Pt had symptoms from Dumping syndrome

• C: smaller portions.

Medication the Nurse should expect the patient to take

• The patient has a history of a kidney replacement. Furosemide

Pt nearing what will the nurse do?

• D: assist the family to understand and accept the care plan.

Cath?

• A patient is admitted and may need fluid and Cath in the action you may need is C, daily evaluation of Cath and needs.

The nurse need to prevent CA in the area on a bed patient, follow infection protection and provide care.

C. perform daily Evaluation if they need it if not remove it

Pediatrics with central catheter: which is correct?

• b: CHG site.

Central line-associated bloodstream infection (CLABSI)

• CHG insertion side , keep clean

Hypotension + dysrthmia

• What is the response by the nurse? 02 stats, Lung sounds

Bird Flu

• what precaution is needed? A

A bird flu test that could support the test, Influenza

• B : A/H5

MRSA precaution

• the number b: contact precaution + and promote hand hygiene The nurse must recognize to prioritize:

• A: Administer Supplemental oxygen

• B: Positive air support

Which best agents is first-line for septic shock?

• Norepinephrine is the medication needed for patient.

If there's an allergic shock pt what' is the 1st line treatment?

• Epinephrine is the shot for those that have an allergic reaction.

Pt having peanut reaction the nurse must?

• The patient is having problems with breathing, assess the patient and consider intubation.

what should nurse do regarding the family

• C DIM lights

Sleep disturbance

• Reclax

patient comes out after being on vent

• PICS

OD priority?

• AIRWAY!

treatment is being refused bc of religion...what is the plan?

• consult

The nurse does what with co workers?

• Notify manager

harmful/ wrong treatments..

• charge nurse PRIVATLEY

The nurse is ask info about patients problem

• seek HEALTh care team

what would the nurse do 1st if incorrect medication?

• A PROTECT THE PATIENT

the patients family is stressed what is the plan to help them?

• Listen

Pt. tolerating

• Pt. advocate for alternative to the Pt.

Team member is being disagree?

• express concern !
• Provide pt a holistic care =

How should talk with patient that has holistic cares?

• be honest and explain to procedure Pt are

Involving a patient =

• B. involvement where its best

the patient is speaking another language what needs o be done?

• A- INTERPENETER

System thinking

• A: recognize the systems that are delivery
• D: evidence based.

Is the pt ok -

• what's is the plan? C: COLLABORATIVE

Patient edcation should emphasize what?

• Patient involvement.