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

For a post-surgical patient with a history of heroin addiction, a PCA (patient-controlled analgesia) with both continuous and on-demand opioid delivery ensures consistent pain control and addresses both baseline pain and breakthrough pain. This approach helps manage pain more effectively and can prevent withdrawal symptoms in patients with opioid tolerance. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 88-90.

Morphine is often used to relieve symptoms such as shortness of breath and anxiety in patients with pulmonary fibrosis. It works by reducing the sensation of dyspnea and the sense of impending doom by decreasing the respiratory drive and alleviating anxiety through its sedative effects. Additionally, morphine can help reduce tachypnea by slowing down the respiratory rate. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Cardiogenic pulmonary edema is primarily caused by left ventricular (LV) noncompliance. When the left ventricle is unable to properly fill or eject blood, pressure increases in the left atrium and pulmonary veins, leading to fluid leakage into the pulmonary interstitium and alveoli, causing pulmonary edema. Elevated PAOP readings, RV chamber enlargement, and pulmonary hypertension are not primary causes of cardiogenic pulmonary edema but can be related to other cardiac conditions. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Meningitis

A positive Kernig’s sign is a clinical test for meningitis that involves flexing the hip and knee of the patient and then extending the knee. If the patient feels pain or resistance in the lower back or hamstring, the test is positive. A positive Kernig’s sign indicates irritation of the meninges, the membranes that cover the brain and spinal cord. A positive Trousseau’s sign is a sign of hypocalcemia that involves carpal spasm after inflating a blood pressure cuff. A positive Cullen’s sign is a sign of retroperitoneal bleeding that involves bruising around the umbilicus. A positive Babinski’s sign is a sign of upper motor neuron lesion that involves fanning of the toes when the sole of the foot is stroked.

References:

Kernig’s sign - Wikipedia

Trousseau’s sign - Wikipedia

Cullen’s sign - Wikipedia

Babinski sign - Wikipedia

Mitral stenosis leads to increased pressure in the left atrium, which can cause atrial enlargement and predispose patients to atrial fibrillation. Atrial fibrillation is the most common arrhythmia associated with mitral stenosis due to the structural changes in the atrium. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

The patient’s increased heart rate and respiratory rate, along with the patient’s statement of feeling tired, may indicate that the activity was too strenuous123. It’s important to ensure patient safety and comfort, so the nurse should return the patient to a supine position123. The physician should be notified about the patient’s response to the activity for further evaluation and to adjust the care plan if necessary123.

Early enteral feeding in patients with sepsis is crucial as it helps maintain gut integrity, thereby minimizing the translocation of gastrointestinal (GI) bacteria. The presence of nutrients in the gut lumen supports the mucosal barrier function and reduces bacterial translocation, which can lead to secondary infections and further complications in septic patients. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

Disseminated intravascular coagulation (DIC) is a condition where blood clots form excessively and block blood vessels, leading to organ damage and bleeding. The pathophysiology of DIC involves excess and unregulated thrombin generation, which consumes coagulation factors and platelets, and activates fibrinolysis1. Thus, in severe DIC there is paradoxically simultaneous thrombosis and spontaneous bleeding2. This is due to the depletion of clotting factors, which is a key aspect of the underlying pathophysiology of DIC12.

Mild, intermittent diarrhea in a patient receiving continuous enteral feedings can often be managed by reviewing and possibly adjusting the feeding formula. This approach can address potential intolerance or sensitivity to the current formula. An abdominal x-ray or considering PICC line placement are not appropriate first-line responses to mild diarrhea, and holding feedings without further assessment could negatively impact the patient's nutritional status. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

The laboratory values indicate hyperosmolar hyperglycemic state (HHS), characterized by high glucose levels, high osmolality, and dehydration. The primary management includes aggressive IV hydration to correct dehydration and improve circulation. Hemodialysis and intubation are not immediate priorities unless there are other indications, and osmotic diuresis is not appropriate in this context. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.