AACN Updated CCRN-Adult Exam Questions and Answers by kane

In the context of an unstable pelvic fracture, placing a binder across the patient's hips is crucial to stabilize the fracture and reduce the risk of further internal bleeding and damage. This intervention helps in temporarily stabilizing the pelvis until definitive surgical treatment can be performed. Transporting the patient for an MRI is not the immediate priority, as the primary goal is to stabilize the patient. Type and crossmatching PRBCs are important but should follow immediate stabilization measures. Administering a sedative to reduce movement can be considered, but it is not the top priority over physical stabilization of the fracture. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Acute pancreatitis is most commonly indicated by severe mid-epigastric pain, which often radiates to the back, leukocytosis (an elevated white blood cell count indicating inflammation), and hypocalcemia (low calcium levels in the blood). The inflammation of the pancreas leads to the release of digestive enzymes and inflammatory mediators that can cause widespread effects, including alterations in calcium metabolism.References: = CCRN Exam Handbook, page 47

A negative apnea test means that the patient does not breathe spontaneously when disconnected from the ventilator and exposed to a high level of carbon dioxide, which normally stimulates breathing. A negative apnea test is one of the criteria for brain death, as it indicates the loss of brainstem function. A positive vestibulo-ocular reflex, also known as the oculocephalic or doll’s eye reflex, means that the eyes move in the opposite direction of the head when the head is turned. A positive cough reflex means that the patient coughs when the trachea is stimulated. A negative cold caloric test means that the eyes do not move when cold water is injected into the ear canal. All these tests assess the integrity of the brainstem, and a positive result would exclude brain death. Therefore, the correct answer is B.

References:

• Diagnosis of brain death - UpToDate, under “Apnea testing”.
• Brain Death | Critical Care Medicine | JAMA | JAMA Network, under “How Is Brain Death Diagnosed?”.
• The 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by …, under “Apnea Testing”.

In a patient with head trauma, the primary pathophysiology underlying acute respiratory failure often involves hypercapnia due to decreased minute ventilation. Head trauma can impair the central nervous system's ability to regulate breathing, leading to inadequate ventilation and a build-up of carbon dioxide (CO2) in the blood. Other factors like shifting of the oxyhemoglobin dissociation curve, increased intrapulmonary shunt, and dehydration due to diabetes insipidus may be present but are not the primary causes. References: CCRN Exam Handbook, AACN, page 25, section on Respiratory.