The CCRN (Adult) - Direct Care Eligibility Pathway (CCRN-Adult)

The nurse should respect the mother’s request and facilitate the family’s emotional needs during the end-of-life care. The nurse should also ensure the patient’s safety and dignity by preparing and organizing the necessary equipment and monitoring before moving the mother next to the patient. The other options are not appropriate because they either deny the mother’s request, imply that the patient is no longer alive, or delay the organ donation process.

References :

Donor Family Care Service - NHS Blood and Transplant

Family-Centered Care to Improve Family Consent for Organ Donation

In a patient with a hemorrhaging renal laceration who remains hypotensive despite fluid resuscitation with two units of PRBCs and 500 mL of NS, administering norepinephrine (Levophed) is appropriate. Norepinephrine is a potent vasopressor that helps to increase blood pressure by vasoconstriction and improving cardiac output, which is critical in stabilizing a patient with severe hemorrhagic shock prior to surgery. References : = CCRN Exam Handbook, page 38

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 muscles 1 2 . 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 support 3 .

Verified Answer : C. establish a schedule with the provider. Neurological assessments are important for monitoring the patient’s neurological status and detecting any changes that may indicate a complication or improvement. However, frequent interruptions of sleep can have negative effects on the patient’s health and well-being, such as impaired cognition, mood, immune function, and wound healing. Therefore, the nurse should collaborate with the provider to establish a schedule for neurologic assessments that balances the need for monitoring and the need for rest. This may involve reducing the frequency of assessments during the night, clustering other interventions to minimize disruptions, and using non-invasive methods of assessment when possible. Discontinuing neurologic assessments, encouraging the patient to sleep between assessments, or moving the patient to a quieter part of the unit are not appropriate actions as they do not address the root cause of the problem or ensure adequate monitoring of the patient’s condition.

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 vasodilators 1 2 . 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 overload 3 . Reducing CVP and increasing SVR would decrease the preload and increase the afterload, which would worsen the cardiac function and oxygen demand in acute CHF 3 . 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 CHF 3 .

References :

1 : Acute decompensated heart failure: Management - UpToDate 4 , 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.

The patient who has been in the unit for 60 hours and reports agitation, noise disturbances, and an inability to get peace and quiet may be experiencing sleep disturbances. Factors such as the ICU environment, frequent interventions, and the medications being administered (e.g., benzodiazepines, opioids, and bronchodilators) can significantly disrupt sleep patterns, leading to further agitation and delirium. Addressing the patient ' s sleep hygiene and implementing measures to promote rest can be beneficial. References : = CCRN Exam Handbook, page 52

Dopamine, when administered at a dose of 10 mcg/kg/min, acts primarily as an alpha-adrenergic agonist, leading to vasoconstriction. This results in increased systemic vascular resistance (SVR) and increased mean arterial pressure (MAP), which are desired outcomes in the treatment of septic shock. This effect helps improve perfusion to vital organs and stabilize hemodynamics in patients with septic shock. References : =

CCRN (Adult) Certification Review Course Online: Cardiovascular and Hemodynamics.

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

Pulmonary contusion leads to damage to lung parenchyma, resulting in alveolar hemorrhage and edema. This causes increased airway resistance and decreased gas diffusion due to the inflammatory response and accumulation of fluid within the alveoli, impairing effective gas exchange and reducing lung compliance. References : = CCRN Exam Handbook, page 40

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.