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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q497-Q502):

NEW QUESTION # 497
Of the following, the MOST common cause of Disseminated Intravascular Coagulation (DIC) is:

A. obstetric complications
B. surgery
C. sepsis
D. carcinoma

Answer: C

Explanation:
Disseminated Intravascular Coagulation (DIC) is a complex, diffuse response to systemic activation of the coagulation system. It is triggered by disease states or conditions systemically activating the coagulation system, resulting in the formation of micro-clots. These micro-clots obstruct the capillaries of organs and tissues, which initiates a series of events which result in both bleeding and thrombosis. It most commonly occurs in critically ill patients acutely due to sepsis, but can also occur in chronic forms with cancer. It can additionally be seen with traumatic injury and extensive surgery, and in obstetrical states such as eclampsia and preeclampsia, amniotic fluid embolism, and abortion.

NEW QUESTION # 498
The critical care nurse is precepting a new nurse who is caring for a patient with Wolff-Parkinson-White syndrome. Which of the following statements by the new nurse requires correction by the preceptor?

A. A delta wave may be present on the patient's EKG.
B. This disease increases the risk of bradycardia.
C. This disease only requires treatment if it is associated with symptomatic tachycardias.
D. This disease does not affect the function of the AV node.

Answer: B

Explanation:
Wolff-Parkinson-White syndrome is a condition in which electrical impulses from the atria bypass the AV node through accessory pathways, prematurely stimulating the ventricles. Wolff-Parkinson-White syndrome increases the risk of tachycardias, not bradycardias. While Wolff-Parkinson-White syndrome results in the AV node being bypassed, it does not affect the AV node itself. A delta wave is often noted in the EKGs of patients with Wolff-Parkinson-White syndrome. This condition does only require treatment if symptomatic tachycardias are present.

NEW QUESTION # 499
Assessment of a patient admitted with excruciating back pain reveals:

Appropriate therapy should include

A. diltiazem (Cardizem).
B. nitroprusside (Nipride).
C. nitroglycerin.
D. digoxin (Lanoxin).

Answer: B

Explanation:
The patient's vital signs indicate hypertensive urgency or emergency (BP 190/100, HR 126), with a differential radial pulse, suggesting aortic dissection. Nitroprusside is a potent vasodilator used in the management of hypertensive crises and can help reduce blood pressure and the shear force on the aortic wall, which is crucial in managing aortic dissection. Nitroglycerin, diltiazem, and digoxin are not appropriate first-line therapies for this condition. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

NEW QUESTION # 500
The nurse is caring for a critically ill patient with a history of treatment for depression. The patient tells the nurse, "I want to die. My life is not worth living anymore." The nurse should implement all of the following into the patient's plan of care EXCEPT:

A. request a psychiatric consult
B. allow the patient to lead the conversation
C. avoid asking the patient directly if they are presently feeling suicidal
D. consult with the doctor about the patient's previous psychiatric medication and the need to maintain the regimen while the patient is hospitalized

Answer: C

Explanation:
The nurse should not avoid asking the patient directly about current suicidal thoughts. It is important to note that you do not promote suicidal thoughts by asking the question. Often, the communication of feeling suicidal is a cover for wanting to discuss fear, pain, or loneliness. Similarly, if depression is suspected, ask directly, and allow the patient to initiate conversation. A psychiatric referral is recommended, and it is also important that healthcare providers do not forget to maintain the patient's psychiatric medication regimen while hospitalized to avoid worsening of the patient's psychological status.

NEW QUESTION # 501
A new graduate nurse in your ICU is struggling to have difficult conversations with patients and their families. As an experienced nurse, how should you facilitate his learning?

A. Tell him to focus on being more resilient in these situations
B. Encourage him to avoid assignments where these types of conversations are likely
C. Report his lack of communication skills to the nursing manager
D. Invite him to watch how you handle difficult conversations and debrief with him after each one

Answer: D

Explanation:
Inviting him to watch how you handle difficult conversations and debriefing with him after each one directly addresses the issue in a supportive manner, promoting learning and skill development. Telling him to focus on being more resilient in these situations may discourage him and does not support his learning. Encouraging him to avoid assignments where these types of conversations are likely does not address the problem and can hinder his development as a nurse. Reporting his lack of communication skills to the nursing manager should not be the initial approach, as individual skill deficits can often be addressed effectively through mentoring.

NEW QUESTION # 502
......

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