Ccrn Certification Examination Practice Questions and Answers with Rationale: First Edition

CCRN

CERTIFICATION

EXAMINATION

PRACTICE QUESTIONS

AND ANSWERS

WITH RATIONALE

FIRST EDITION

NGOZI I. MONEKE

Copyright © 2017 by Ngozi I. Moneke.

Library of Congress Control Number:      2017907670

ISBN:                     Hardcover               978-1-5434-2253-5

                                Softcover                 978-1-5434-2252-8

                                eBook                      978-1-5434-2251-1

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

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Rev. date: 07/11/2017

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CONTENTS

Adult Ccrn Exam

Introduction

Eligibility Requirements As Established By Aacn

Testable Nursing Actions

Test-Taking Tips For The Exam

Question: Cardiovascular System

Cardiovascular: Answers And Rationales

Question: Endocrine System

Endocrine: Answers And Rationales

Question: Gastrointestinal System

Gastrointestinal: Answers And Rationales

Question: Hematology And Immunology

Hematology And Immunology: Answers And Rationales

Question: Multisystem

Multisystem: Answers And Rationales

Question: Neurologic System

Neurology: Answers And Rationales

Question: Renal System

Renal: Answers And Rationales

Question: Professional Caring And Ethical Practice

Professional Practice And Caring And Ethical Practice: Answers And Rationales

Question: Pulmonary System

Pulmonary: Answers And Rationales

Selected References

About The Author

INTRODUCTION

CCRN is a certification for nurses who practice in acute/critical care settings such as ICU, CCU, MICU, Trauma unit, and critical care transport or flight unit.

Nurses who have passed the exam earn the right to place the CCRN credential after their name. The CCRN examination is offered by the American Association of Critical Care Nurses (AACN). The completion of the CCRN exam in itself is a personal and professional mark of excellence and distinguished achievement and proficiency.

In addition to the nurse’s qualification, CCRN certification examination requires knowledge of specific content areas/systems as defined by AACN Certification Corporation. These areas include but are not limited to cardiovascular, endocrine, gastrointestinal, neurology, hematology/immunology, renal, pulmonary, and professional caring and ethical practice - thorough learning and understanding in these content areas are essential for any nurse to pass CCRN exam. CCRN exam also involves the testing of the nurse’s cognitive ability – what he/she has learned and translation of that learning into practice. The aim of testing at a cognitive level is to give a better understanding of the critical care nurse’s ability in identifying issues at the clinical setting, plan strategically, implementing the plan, and evaluating the outcome – just like utilizing the nursing process.

In overall, CCRN certification exam is centered around on what the critical care nurse knows and understands, his/her analytic ability of a given clinical situations/issues, the ability to apply information/ knowledge to a specific patient conditions/issues, and the clinical judgement he/she employed to address the situation. The critical care nurse is evaluated on how sound/realistic/appropriate their patient care decisions-makings are.

In a clinical setting, such as in the Intensive Care Unit (ICU), it is always important for someone to know what is being done to address a given situation, but it is equally more important to know the rationale/why it’s being done. In other words, not only the What but the Why that matters most in a given decision-making process!

Unfortunately, the knowledge of all the content areas is not easy to be acquired and if obtained only clinically may not be enough, as those clinical experiences usually focused on practical content and not enough cognitively to cover those specific content areas needed to pass the CCRN exam. That is where this question and answer book, especially the comprehensive rationales aspect of the answers comes in, to help those users who may be interested in sitting and passing the CCRN certification exam.

The main goal of this book, is to provide the users valuable information that may be encountered in the actual CCRN exam and providing them with the information that will help them to excel in the exam. It is important to devote more study time on areas where you are weak. Although performing very well in one category of the exam may offset some weak areas, but this can only work to an extent. For example, if you do very well in cardiovascular system and perform poorly in other systems, there is more than likelihood you will not pass the exam.

The ability to learn, retain the information, and ultimately passing the CCRN certification exam demands that the aspiring critical care nurse must study very intensely at least six months before the exam to improve knowledge of the content areas being tested and will be able to translate his/her knowledge/learnings into his/her clinical practice, thereby promoting good quality patient care through their acquired knowledge.

It is also essential to note, I must say, that this question and answer book, like any other CCRN certification Q and A review book, is neither the only source to be utilized when preparing for the CCRN exam nor contain a comprehensive review of any particular topic or content. As such, the user of this book is advised to consult other CCRN certification exam preparatory sources for a more comprehensive material and information not covered in this Q and A book. Some of these resources include but are not limited to the current published AACN Procedure Manual for High Acuity, Progressive and Critical Care, 7th Ed., AJCC, Critical Care Nurse journals etc. These resources can be obtained from AACN Practice Resource Network (PRN): aacn.org/clinical-resources, aacn.org/education/publications. The exam application can be completed online, printed, mailed, or faxed to the AACN Certification Corporation. The website to access Acute/Critical Care Nursing Certification exam - Adult, Pediatric, or Neonatal, including preparation tools, handbooks, test plans, and a comprehensive testable nursing actions is: aacn.org/certification Phone: 800-899-2226.

ELIGIBILITY REQUIREMENTS AS ESTABLISHED BY AACN

CCRN exam requires knowledge for practice in acute/critical care settings. It is a three-hour test consisting of 150 multiple choice items. Of the 150 items, 125 are scored and 25 are used to gather statistical data on item performance to be used for formulating future exams. Eighty percent of each exam focuses on clinical judgment and is age-specific for the adult, pediatric, and neonatal populations. The remaining 20 percent covers professional caring and ethical practice.

Professional caring and ethical practice questions may be asked about any age across the lifespan, while clinical judgment questions are restricted to adult, neonatal, or pediatric populations. Per AACN, to be eligible to take the CCRN certification exam, you must:

1. Have a current, unencumbered licensure as an RN or APRN in the United States is required.

2. Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill patients during the previous two years with 875 of those hours accrued in the most recent year preceding application, OR practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely/critically ill patients with 144 of those hours accrued in the most recent year preceding application. Visit AACN.org to learn more.

CCRN Outcomes

– Provides a sense of pride and accomplishment.

– Maintain up-to-date knowledge of critical care nursing.

– A proof that you have a recognized growth and career-enhancing milestone.

– Reinforces achievement of special knowledge and experience required in critical care nursing.

– Provides high level of nurse autonomy and control over practice and lower rate of nurse burnout.

– Validates not only your knowledge of critical care, but also to your peers, hospital, physicians, patients, and nursing profession.

– Certified specialty nurses earn more!

TESTABLE NURSING ACTIONS

Cardiovascular System

Dysrhythmias, conduction defects, AVBs, bradycardia, pharmacology therapy, pacemakers settings, AICD defibrillators. Cardiovascular drugs—alpha/beta effects, cardiomyopathies (hypertrophic, dilated, restricted, idiopathic). High-risk obstetric cardiomyopathy: causes, types, and treatment therapy.

Acute MI, unstable anginas, cardiac surgeries (CABG, valve replacements), acute coronary syndrome, isoenzymes, cardiac tamponade, pericardiocentesis, immediate post PCI management, sheath removal techniques, papillary muscle rupture, acute coronary syndrome, bariatric

Acute heart failure (right and left heart failure, pulmonary edema, systolic/diastolic dysfunctions, ejection fractions). Aortic rupture or dissecting aneurysm (thoracic, abdominal), hemodynamics-set-up, waveforms, monitoring, and troubleshooting technique.

Shock states: septic shock, cardiogenic shock, hypovolemic shock, management therapy (e.g., norepinephrine, dobutamine, dopamine, vasopressin, phenylephrine, hemodynamics).

Hypertensive crisis – high-risk OB, preeclampsia, pulmonary hypertension (valvular defects, aortic stenosis, mitral stenosis), hemodynamics.

Pneumonias, acute inflammatory conditions-pericarditis, myocarditis, endocarditis, acute PVD (acute arterial occlusion, carotid artery stenosis, endarterectomy, peripheral stents), bypass surgeries, cardiac trauma—blunt or penetrating injury—stroke states: Ischemic/hemorrhagic management therapy,

Coagulopathies: DIC, DIC, high-risk OB HIT, ITP management therapies.

Endocrine System:

Diabetes type 1 and 2, acute hypoglycemia: causes, signs/symptoms. And management, hyperosmolar non-ketone coma in the elderly, diabetic ketoacidosis—youth and adult—recognition and treatment, diabetes insipidus, hyperglycemia, smogyi effect.

Gastrointestinal System:

Acute GI bleed (non-liver), acute abdominal trauma via MVA accident, penetrating or blunt injury, hepatic failure/coma, bowel infarction/obstruction/perforation. GI hemorrhage (upper and lower), gastric bypass, gastroesophageal reflux, peptic ulcer. Gastric surgery/infections, pancreatitis, bariatric surgery, postoperative management, hepatic failure, cirrhosis, esophageal varies, hepatitis.

Hematology and Immunology:

Immunosuppression—cancer, HIV/AIDs, sickle cell disease, immunosuppression—hepatitis, neoplasms, etc., organ transplantation, coagulopathies, DIC, coagulopathy, high-risk obstetrics, non-life-threatening. HELLP syndrome (causes and management therapy), postpartum hemorrhage.

Multisystem:

Multisystem trauma, toxic ingestions/inhalations, drug/alcohol overdose, poisoning and management (acetaminophen, salicylate poisoning, septic shock, and infectious diseases, SIRS/Sepsis/MODs), causes medical therapy (viral, bacterial), SIRS/SEPSIS in the elderly, sepsis treatment with inotropes most preferred and rationale: dopamine, norepinephrine (Levophed), dobutamine, phenylephrine, vasopressin, etc. Bacteremia conditions. Toxic exposures: phenytoin, lithium, salicylates, ethanol management therapy.

Neurologic System:

Arteriovenous Malformations (AVM) treatment and management, stroke (embolic and hemorrhagic), aneurysms, intracranial hemorrhage. Neurological surgery (craniotomy, evacuation of hematoma, tumor resection), skull fractures, tumor, postoperative care, ICP, CPP, infectious diseases (meningitis, seizure disorder, sedated patient management). Neurological signs (Brudzinski’s/Kernig’s sign). Diagnostic tests (MRI, CT scan). ICP monitoring, Cushing’s triad, CPP, cerebral infarcts/ hemorrhages, head injury (blunt), penetrating, encephalopathy.

Renal System:

• Acute renal failure

• Electrolyte imbalances/life- threatening electrolyte imbalances, potassium, magnesium, calcium

• Chronic renal failure (ESRD, AV Fistula)

• Renal trauma (penetrating and non-penetrating injuries)

• Renal therapies: indications and nursing management

– SCUF

– PD

– HD

– CVVH

Pulmonary System:

Status asthmaticus, exacerbation of COPD, emphysema, bronchitis, pulmonary embolus/ fat embolus

Acute respiratory distress syndrome, chronic lung disease, pulmonary trauma, pulmonary drugs

A-leak syndrome, respiratory diseases, thoracic surgeries (lung contusions, fractured ribs, hemothorax), ventilator management, aspiration pneumonia, VAP, acute respiratory distress syndrome (ARDS), acute respiratory failure, volutrauma/barotraumas, respiratory drugs, ABG interpretations, mixed venous gases.

Professional Caring and Ethical Practice

For a complete explanation of this category, refer to AACN synergy model for patient care. The synergy model refers to a holistic model of care where patient/family needs are matched to a nurse’s level of expertise, for optimal patient outcomes. In other words, nurse-patient/family assignments are based upon matching patient/family needs to nurse competencies. The Synergy Model specifically describes the working relationship that exist between the nurse-patient, nurse-nurse, and nurse-system. The Synergy Model is developed by the American Association of Critical Care Nurses. Testable nursing actions in this area comprised of the following:

• Clinical inquiry: This involves the ability to resolving clinical problems that occur at the bedside/care setting – identifying issues, questioning, finding the evidence, and making practice changes as indicated for a successful outcome.

• Advocacy/Moral Agency: This involves working on another’s behalf and representing the concerns of the patient/family/community and serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within the clinical setting. Nurses’ possess unique relationship with patients and families and are in the best position to serve as the patient and family’s advocate. The nurse gives voice to patient and family concerns.

• Responds to adversity: This involves the sensitivity to recognize, appreciate, and incorporate differences in the provision of care which may include, but are not limited to: individuality, cultural differences,