CCRN-Adult CCRN (Adult) - Direct Care Eligibility Pathway Questions and Answers

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.

Ventilator-associated events (VAEs) can be prevented by reducing the risk of aspiration and maintaining airway hygiene. Subglottic suctioning is an effective measure to remove secretions that accumulate above the endotracheal tube cuff, which can harbor bacteria and lead to infection. This intervention helps prevent the development of pneumonia and other VAEs. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

In the setting of an acute anterior wall myocardial infarction (MI) with an S3 gallop, the patient is likely experiencing heart failure and possibly acute pulmonary edema. The appropriate treatment includes vasodilators to reduce afterload and diuretics to decrease preload and pulmonary congestion. This combination helps to improve cardiac output and reduce the workload on the heart. References: CCRN Exam Handbook, AACN, page 20, section on Cardiovascular.

This response is the most appropriate because it acknowledges the family’s concern, invites them to share their perspective, and opens up a dialogue about the patient’s condition and comfort. Communication with patients and families about illness progression and end of life requires sensitivity, empathy, and respect. The nurse should avoid making assumptions, giving false reassurance, or dismissing the family’s emotions. Instead, the nurse should explore the family’s understanding, expectations, and needs, and provide information and support accordingly12. Answer A is not appropriate because it does not address the family’s emotional distress or their perception of the patient’s suffering. Answer C is not appropriate because it may contradict the family’s observation or belief, and it may imply that the patient is not aware of their presence or care. Answer D is not appropriate because it may seem like the nurse is avoiding the issue or imposing a religious intervention that the family may not want or need.

The patient's tachycardia and hypotension following bowel resection surgery indicate potential severe complications such as hemorrhage or septic shock, which require immediate intervention. If the on-call surgical resident does not provide new orders, the nurse must act promptly to prevent further deterioration by initiating the rapid response team (RRT). The RRT can provide critical interventions and facilitate timely transfer to a higher level of care if needed. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Abdominal compartment syndrome (ACS) involves increased intra-abdominal pressure, which can significantly impact various body systems. One of the major concerns is its effect on respiratory function, leading to increased peak inspiratory pressure. This happens because the elevated pressure in the abdomen can push up against the diaphragm, making it harder for the lungs to expand during inhalation. Increased urine output is unlikely as ACS usually leads to decreased renal perfusion and output. Increased preload and decreased intracranial pressure are not typically associated with ACS. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

The first step in developing a teaching plan is to assess the learner’s needs, knowledge, and readiness to learn. This will help the nurse tailor the teaching plan to the individual’s learning style, preferences, and goals. Obtaining written information, determining a schedule, and encouraging observation are all strategies that can be used later in the teaching plan, but they are not the first step.

References:

• AACN Essentials of Critical Care Nursing, Fourth Edition, page 18.
• Patient Education and Counseling, page 3.

The initial step in facilitating a change in practice regarding visiting hours should involve a literature search on family visitation practices. This allows the nurse to gather evidence-based information that can support any proposed changes. After gathering sufficient evidence, the nurse can then schedule an interdisciplinary team meeting to discuss the findings, consult with medical staff, and draft a new policy if necessary. References: CCRN Exam Handbook, AACN, page 35, section on Professional Caring and Ethical Practice.

Glucagon is a hormone that stimulates the liver to release glucose from glycogen stores or from gluconeogenesis. However, when the hepatocytes are damaged by alcoholism or other causes of hepatic failure, glucagon is ineffective because the liver cannot respond to its signal. Glucagon administration is contraindicated for hypoglycemic patients with hepatic failure because it will not raise their blood glucose levels and may worsen their acidosis and electrolyte imbalance123

References:

• Hypoglycemia in Patients With Hepatic Failure - PubMed
• Glucagon - Wikipedia
• Frontiers | Glucagon Receptor Signaling and Lipid Metabolism

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.

Pulmonary hypertension leads to increased pressure in the pulmonary circulation, which can cause right ventricular hypertrophy and failure. This results in systemic venous congestion, presenting as distended neck veins. Crackles, rhonchi, and pink frothy sputum are more indicative of pulmonary edema or other respiratory conditions rather than pulmonary hypertension. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

Cerebral angiography is considered the gold standard for diagnosing and pinpointing the location, size, and origin of cerebral aneurysms. It involves the use of contrast material injected into the cerebral arteries and imaging to provide detailed visualization of the blood vessels in the brain, which is essential for accurate diagnosis and planning treatment strategies. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

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Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure that occurs when the heart muscle is stiff and does not relax well, causing high pressure in the heart and lungs. HFpEF is diagnosed when the patient has symptoms and signs of heart failure and a normal or high ejection fraction (EF), which is the percentage of blood pumped out of the left ventricle with each heartbeat. HFpEF is usually caused by conditions that affect the heart or blood vessels, such as aging, high blood pressure, diabetes, obesity, or kidney disease12

References:

• What Is Heart Failure with Preserved Ejection Fraction? - Healthline
• Heart failure with preserved ejection fraction - BMJ Best Practice

In status asthmaticus, a worsening condition is indicated by increased PaCO2 and decreased expiratory flow. This reflects severe airway obstruction and ventilatory failure, leading to hypercapnia (elevated PaCO2) and a decrease in the ability to exhale effectively. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

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

Alcohol withdrawal syndrome

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Answer: A

The patient’s symptoms of tremulousness, anxiety, and startle response suggest that he may be experiencing alcohol withdrawal, which can occur within hours to days after the last drink. Alcohol withdrawal can cause severe complications, such as seizures, delirium tremens, and death, if not treated promptly and appropriately. Alcohol withdrawal can also worsen GI bleeding by increasing gastric acid secretion, impairing clotting factors, and causing hypertension and tachycardia. Therefore, the most pertinent part of the patient’s history to obtain is the last alcohol intake, which can help determine the risk and severity of withdrawal and guide the management of the patient.

References:

• Management of moderate and severe alcohol withdrawal syndromes: This article states that “Symptoms of alcohol withdrawal occur because alcohol is a central nervous system depressant. When a person drinks frequently, the brain compensates for alcohol’s depressant effects by increasing the activity of excitatory neurotransmitters, such as norepinephrine, serotonin, dopamine, and glutamate, and reducing the activity of inhibitory neurotransmitters, such as gamma-aminobutyric acid (GABA). When alcohol intake is abruptly discontinued or reduced, this neuroadaptation is unmasked, resulting in a hyperexcitable state that is responsible for the characteristic withdrawal symptoms.”
• Alcoholic Gastritis: Causes, Symptoms and Treatment: This article states that “Alcohol Gastritis is a type of acute gastritis and is caused by excessive alcohol consumption. The sudden inflammation of the stomach lining can be very painful and cause severe stomach cramping, irritability and vomiting. While consuming too much alcohol is the main cause of Alcohol Gastritis, it often develops in connection with some sort of infection, direct irritation or localized tissue damage. It can be caused by: Taking non-steroidal, anti-inflammatory medications like aspirin or ibuprofen (i.e., NSAIDs). Certain bacterial infections. Bile reflux from proximal small intestine. Autoimmune disorders.”
• Can You Get Internal Bleeding from Alcohol Abuse: This article states that “Over time, alcohol abuse starts to eat away at the stomach lining. Continued drinking sets the stage for alcoholic gastritis to develop. Under these conditions, internal bleeding from alcohol abuse takes the form of blood oozing from stomach lines on an ongoing basis.”

The patient’s ABG values show hypoxemia, which is a low level of oxygen in the blood. This can be caused by various pulmonary disorders that impair gas exchange, such as pneumonia, pulmonary edema, pulmonary embolism, or acute respiratory distress syndrome (ARDS). The patient’s PAP (pulmonary artery pressure) is elevated, indicating increased resistance in the pulmonary circulation. This can also result from pulmonary dysfunction, as the lungs become stiff and inflamed, or from pulmonary hypertension, which is a chronic condition that affects the small arteries in the lungs. The patient’s PAOP (pulmonary artery occlusion pressure) is normal, suggesting that the left ventricle is not failing and that the patient is not hypovolemic or hypervolemic. The patient’s CI (cardiac index) is also normal, indicating adequate cardiac output. Therefore, the most likely cause of the patient’s hypoxemia and dyspnea is pulmonary dysfunction.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.

Given the symptoms of unilateral facial droop and slurred speech, a stroke is highly suspected. A head and neck CT scan is the most appropriate initial imaging to quickly evaluate for the presence of an ischemic or hemorrhagic stroke, which is critical for determining the appropriate treatment plan. An MRI may provide more detailed information later but is not the initial test of choice in the acute setting. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Asking the patient to explain what furosemide (Lasix) does for them assesses their understanding and allows the nurse to gauge their knowledge and correct any misconceptions. This method is more effective than asking yes/no questions, as it provides a comprehensive insight into the patient's medication literacy. References: = AACN Handbook for CCRN Certification, pp. 102-105.

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.

Spinal cord injury

The patient with a C5 spinal cord injury may have anxiety, fear, or depression due to the loss of function and independence. The patient may also have difficulty breathing, swallowing, or regulating body temperature. The patient may call the nurse frequently to seek reassurance, attention, or comfort. The nurse should respond with empathy and compassion, and provide the patient with emotional support and psychological counseling. The nurse should also assess the patient’s physical needs and provide adequate hydration, nutrition, and skin care. The nurse should not dismiss the patient’s requests, ignore the patient’s feelings, or limit the patient’s contact with the nurse. The nurse should also not give false reassurance or minimize the patient’s concerns. Therefore, the best response is to get someone to sit with the patient, such as a family member, a friend, or a volunteer. This will help the patient feel less isolated, anxious, or depressed, and provide the patient with a sense of security and companionship.

Nimodipine is a calcium channel blocker that is used to prevent or treat cerebral vasospasm after subarachnoid hemorrhage. It works by relaxing the smooth muscle of the cerebral arteries and improving blood flow to the brain. Nimodipine is the only FDA-approved agent for vasospasm and has been shown to reduce the risk of ischemic complications and improve neurological outcomes12. Lorazepam, propranolol, and pentobarbital are not effective for treating cerebral vasospasm and may have adverse effects on the patient’s blood pressure, heart rate, and level of consciousness.

For a patient with a Stage III pressure ulcer, a serum albumin level of 2.1 mg/dL is most concerning because it indicates severe hypoalbuminemia, which is associated with poor nutritional status and delayed wound healing. Adequate nutrition, particularly protein intake, is crucial for wound healing. The other lab results, while not ideal, are less immediately critical in the context of pressure ulcer healing. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

When dealing with a spouse who feels helpless, the most effective nursing intervention is to identify and reinforce their support systems. This helps the spouse feel less isolated and more empowered. Offering solutions to problems, encouraging other family members to make decisions, or providing reassurance that visiting is not necessary do not directly address the spouse's feelings of helplessness and may even contribute to feelings of exclusion or inadequacy. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

JVD stands for jugular venous distension, which is a sign of increased pressure in the right atrium and the superior vena cava. Hepatomegaly means enlargement of the liver, which can occur due to congestion of blood in the portal vein and the hepatic vein. Both JVD and hepatomegaly are common symptoms of right-sided heart failure, as they indicate fluid retention and backup in the systemic circulation12. Hypotension and oliguria are not specific to right-sided heart failure, as they can also occur in left-sided heart failure or other conditions that affect the cardiac output and renal perfusion. Hypertension and polyuria are unlikely to be seen in right-sided heart failure, as they indicate increased blood pressure and urine output, which are opposite to the effects of reduced cardiac function and fluid overload. Pulmonary edema and restlessness are more characteristic of left-sided heart failure, as they indicate fluid accumulation and impaired gas exchange in the lungs12.

In a patient with a chest tube, an air leak in the pleural space is indicated by an increase in bubbling in the water-seal chamber. Bubbling in this chamber occurs when air escapes from the pleural space into the chest drainage system. An increase in bubbling signifies an ongoing air leak, indicating that air is still entering the pleural space, often due to a bronchopleural fistula or lung injury.References: = CCRN Exam Handbook, page 36

The goal of PEEP therapy in acute lung injury (ALI) is to reduce physiologic shunting, which is the perfusion of blood through unventilated or collapsed alveoli. This results in hypoxemia and impaired gas exchange. PEEP therapy increases the end-expiratory pressure and prevents alveolar collapse, thus improving ventilation and oxygenation. PEEP therapy does not necessarily decrease PAP (pulmonary artery pressure), decrease airway resistance, or increase cardiac output. In fact, PEEP therapy may have adverse effects on these parameters, such as increasing intrathoracic pressure, reducing venous return, and decreasing cardiac output.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
• AACN. (2020). Practice Alert: Acute Lung Injury/Acute Respiratory Distress Syndrome. Retrieved from [Practice Alert], p. 1-2.
• Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier. Retrieved from [Textbook], p. 1908-1910.

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 muscles12. 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 support3 .

brain injury (TBI) is most suggestive of central diabetes insipidus (DI). This condition is caused by damage to the hypothalamus or pituitary gland, leading to insufficient secretion of antidiuretic hormone (ADH). The result is an inability to concentrate urine, leading to polyuria (excessive urine output) and potentially significant dehydration and electrolyte imbalances if not managed appropriately. References: =

• CCRN (Adult) Certification Review Course Online: Neurological Disorders and Endocrine Emergencies.
• 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

Acute peripheral arterial insufficiency typically presents with sudden, severe pain at rest, which may be accompanied by other signs such as pallor, paresthesia, paralysis, pulselessness, and poikilothermia (the six P's). This condition indicates a critical reduction in blood flow to the affected extremity, requiring immediate medical attention. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

Subcutaneous emphysema (SE) is a condition where gas or air accumulates in the subcutaneous tissue layer of the skin, causing swelling and a crackling sensation when touched. SE can occur after esophagectomy, a surgical procedure to remove part or all of the esophagus, due to air leakage from the anastomosis site or the lung. SE can also be a sign of a more serious complication, such as anastomotic leakage, mediastinitis, or tracheal injury12. Therefore, the nurse should expect an order for a CT scan, which is a diagnostic imaging test that can detect the source and extent of the air leakage and any associated complications. A CT scan can also guide the appropriate management of SE, which may include conservative measures, such as increasing the suction of the chest tube, or more invasive interventions, such as surgical repair or drainage123. Chest tube insertion, IV antibiotics, and gastric decompression are not likely to be ordered for SE after esophagectomy, as they do not address the underlying cause of the air leakage or the potential complications. Chest tube insertion may be indicated for pneumothorax, but not for SE alone. IV antibiotics may be indicated for infection, but not for SE alone. Gastric decompression may be indicated for gastric distension, but not for SE alone.

The nurse should place the patient in contact isolation, which is a type of precaution used to prevent the transmission of microorganisms that are spread by direct or indirect contact with the patient or the patient’s environment. Contact isolation requires the use of gloves and gowns when entering the patient’s room, as well as dedicated patient-care equipment and proper hand hygiene. Vancomycin resistant enterococcus (VRE) is a type of bacteria that is resistant to the antibiotic vancomycin and can cause infections in various sites, such as the urinary tract, bloodstream, or wounds. VRE can be spread by contact with contaminated surfaces, equipment, or hands.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
• CDC. (2019). Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Retrieved from [CDC Guidelines], p. 69-70.
• CDC. (2019). Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory. Retrieved from [CDC Fact Sheet], p. 1-2.

Verified Answer: B. Consult with the pharmacist on the effects of the specific herbs. Herbal therapy is a type of complementary and alternative medicine (CAM) that uses plants or plant extracts to treat various health conditions. Many patients use herbal therapy for various reasons, such as cultural beliefs, personal preferences, or dissatisfaction with conventional medicine. However, herbal therapy is not without risks and challenges, especially in the hospital setting. Some of the potential problems include lack of standardization, quality control, and regulation of herbal products; adverse effects and interactions with other medications; and ethical and legal issues regarding informed consent, documentation, and liability12. Therefore, the nurse’s first action should be to consult with the pharmacist on the effects of the specific herbs that the family wants to administer to the patient. The pharmacist can provide information on the safety, efficacy, dosage, and compatibility of the herbs with the patient’s condition and current medications. The nurse should also inform the patient’s primary provider and obtain an order for the herbs before allowing the patient to take them. The nurse should document the use of herbal therapy in the patient’s medical record and monitor the patient for any adverse effects or changes in response to other treatments. Informing the family that herbal therapy is not appropriate in the hospital is not respectful of the patient’s autonomy and cultural values. Allowing the patient to take the herbs without consulting the pharmacist and obtaining an order is not safe and may violate the hospital’s policies and standards of care.

In hypertensive crisis, neurologic changes are often caused by increased intracranial pressure (ICP) as a result of loss of cerebral autoregulation. Autoregulation normally maintains consistent cerebral blood flow despite changes in systemic blood pressure. In hypertensive crisis, the extremely high blood pressure overwhelms these mechanisms, leading to increased cerebral blood flow, disruption of the blood-brain barrier, and cerebral edema, which subsequently increases ICP and causes neurologic changes.References: = CCRN Exam Handbook, page 48

The most appropriate therapy for carboxyhemoglobinemia, which is carbon monoxide poisoning, is the administration of 100% oxygen. This treatment helps to displace carbon monoxide from hemoglobin, allowing oxygen to bind to hemoglobin and be transported to tissues more effectively. High-flow oxygen can significantly reduce the half-life of carboxyhemoglobin, facilitating faster recovery.References: = CCRN Exam Handbook, page 30

The patient’s present clinical status is most likely a result of a ventricular septal defect (VSD), which is a hole in the wall between the left and right ventricles. A VSD can occur as a mechanical complication of MI, usually within the first week, due to necrosis and rupture of the ventricular septum. A VSD causes a left-to-right shunt of blood, which leads to increased pulmonary pressure, pulmonary edema, and reduced cardiac output. The patient’s symptoms and signs are consistent with a VSD, such as severe chest pain, hypotension, tachycardia, respiratory distress, high PAOP with large V waves, low CI, cool and clammy skin, inspiratory crackles, and a loud blowing holosystolic murmur at the apex. A papillary muscle rupture, a cardiac tamponade, and an acute aortic insufficiency are other possible mechanical complications of MI, but they have different clinical manifestations. A papillary muscle rupture causes acute mitral regurgitation, which presents with a soft systolic murmur at the apex and pulmonary congestion1. A cardiac tamponade causes compression of the heart by pericardial fluid, which presents with hypotension, muffled heart sounds, and jugular venous distension2. An acute aortic insufficiency causes backflow of blood from the aorta to the left ventricle, which presents with a diastolic decrescendo murmur at the left sternal border and a wide pulse pressure3.

References:

• 1: Mechanical complications of acute myocardial infarction - UpToDate4, p. 2-3.
• 2: Cardiac tamponade - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.
• 3: Acute aortic regurgitation - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.

The patient has signs of severe hyponatremia, which is a low level of sodium in the blood. Hyponatremia can cause cerebral edema, which can lead to seizures, confusion, coma, and death. The patient needs a hypertonic solution, which is a fluid that has a higher concentration of solutes than the blood, to draw water out of the brain cells and restore the normal sodium level. 3% sodium chloride is a hypertonic solution that can be used to treat severe hyponatremia. 0.45% sodium chloride, 0.9% sodium chloride, and 5% dextrose with 0.25% sodium chloride are all hypotonic solutions, which are fluids that have a lower concentration of solutes than the blood, and would worsen the patient’s condition by adding more water to the blood and the brain.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
• AACN. (2020). Practice Alert: Hyponatremia. Retrieved from [Practice Alert], p. 1-2.
• Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier. Retrieved from [Textbook], p. 303-304.

The absence of regulators from O2 tanks is a serious issue that can affect patient care1. The nurse manager is in a position to address this problem effectively by ensuring the availability of necessary equipment2. Therefore, the best action would be to inform the nurse manager of the need for more regulators123. While documenting the issue and reporting to the shift supervisor are important, they do not directly address the problem. Forming a task force could be helpful, but it might take more time to implement solutions23.

In the context of cardiogenic shock managed with vasopressor and inotrope therapies, organ dysfunction from hypoperfusion can manifest as elevated creatinine and abdominal pain. Elevated creatinine indicates renal impairment, a common result of poor perfusion to the kidneys. Abdominal pain can indicate hypoperfusion to the gastrointestinal tract, leading to ischemic bowel or other GI complications. These symptoms are direct indicators of hypoperfusion and organ dysfunction. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course