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AACN CCRN (Adult) - Direct Care Eligibility Pathway Sample Questions (Q743-Q748):

NEW QUESTION # 743
A 56-year-old male with no significant medical history presents to the ICU with a fever, rapid heart rate, and low blood pressure. He also shows altered mental status. Sepsis is suspected and one set of blood cultures has been obtained; however, three attempts to draw the second set of blood cultures have been unsuccessful. Which of the following next interventions is BEST?

A. Initiate aggressive fluid resuscitation
B. Have someone trained to perform ultrasound venepuncture attempt to draw blood cultures
C. Administer broad-spectrum antibiotics immediately
D. Immediately initiate a fourth attempt to draw blood cultures

Answer: C

Explanation:
The patient's physiological well-being should be the nurse's primary goal. Treating the underlying cause of sepsis is more important than obtaining diagnostic blood cultures and delaying antibiotic therapy to obtain blood cultures is inappropriate. Initiating aggressive fluid resuscitation may be important, but is not as important as administering antibiotics. Delaying antibiotics for further venepuncture attempts is incorrect.

NEW QUESTION # 744
Of the following, which hemodynamic profile MOST accurately reflects a patient in hypovolemic shock?

A. CI 2.2 L/min/m2, pulmonary arterial pressure 15 mm Hg, sinus tachycardia, cool/clammy skin
B. CI 2 L/min/m2, pulmonary arterial pressure 7 mm Hg, sinus tachycardia, cool/clammy skin
C. CI 2.1 L/min/m2, pulmonary arterial pressure 10 mm Hg, NSR, warm skin
D. CI 2.3 L/min/m2, pulmonary arterial pressure 17 mm Hg, sinus tachycardia, warm skin

Answer: B

Explanation:
Hypovolemic shock occurs when there is inadequate volume in the vascular space. This volume depletion may be caused by blood loss (either internal or external), or by the vascular fluid volume shifting out of the vascular space into other body fluid spaces. This loss of volume results in insufficient circulating blood to maintain tissue perfusion.
A normal cardiac Index (CI) lies between 2.5-4.3 L/min/m2. Therefore, a CI of 2 L/min/m2 indicates hypovolemic shock.
A pulmonary arterial pressure (PAP) is typically 8-20 mm Hg. Therefore, a low PAP of 7 mm Hg indicates hypovolemic shock.
Sinus tachycardia and cool/clammy skin are also indications of hypovolemic shock.

NEW QUESTION # 745
In a critically ill patient with rapidly developing hypocalcemia, which of the following signs and symptoms would NOT likely manifest?

A. Bronchospasms
B. Tetany
C. Seizures
D. Severe vomiting

Answer: D

Explanation:
True hypocalcemia is rare, as it is defined as a decrease in ionized calcium level, which is largely dependent on serum albumin level and serum pH. Critically ill patients may develop hypocalcemia related to either hypoalbuminemia or hypoparathyrodism. Symptomatic patients with classic clinical findings of acute hypocalcemia require immediate medical attention.
Signs and symptoms include:
* Wheezing
* Paralytic ileus
* Stridor
* Bronchospasms
* Increased irritability
* Confusion
* Hallucinations
* Seizures
* Tetany
* Respiratory arrest
* Positive Chvostek sign
* Positive Trousseau sign
ECG changes may include arrhythmias and a prolonged QT interval. Severe vomiting is not typically manifested in true hypocalcemia. Vomiting is not typical of hypocalcemia.

NEW QUESTION # 746
A patient is preparing for a surgery where about 4% of one lung will be removed. Which of the following terms BEST describes this surgery?

A. Lobectomy
B. Pneumonectomy
C. Wedge resection
D. Bronchoscopy

Answer: C

Explanation:
A wedge resection is the removal of a small, wedge-shaped section of the lung. While there are multiple types of procedures that involve removing a small piece of the lung, this procedure is the only answer that correctly fits a surgery where a small portion of the lung is removed. A lobectomy involves removal of an entire lobe of a lung. A pneumonectomy is removal of an entire lung. A bronchoscopy is an endoscopic exam performed through the trachea, not a surgical procedure.

NEW QUESTION # 747
The intended effects of medications for a patient in acute CHF are to

A. increase CVP and reduce SVR.
B. reduce CVP and increase SVR.
C. reduce CVP and reduce SVR.
D. increase CVP and increase SVR.

Answer: C

Explanation:
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.

NEW QUESTION # 748
......

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