AACN Updated CCRN-Adult Exam Questions and Answers by lilian

The patient's ABG results indicate respiratory acidosis (pH 7.33, PaCO2 48 mm Hg) with a slightly elevated temperature (103.2° F). In the context of fever and acidosis, hemoglobin's affinity for oxygen decreases, a phenomenon described by the Bohr effect. This means that hemoglobin will release oxygen more readily to the tissues. Factors like increased temperature and acidosis cause a rightward shift in the oxyhemoglobin dissociation curve, reducing the affinity of hemoglobin for oxygen.References: = CCRN Exam Handbook, page 44

The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone (ADH), leading to water retention. This results in fluid intake being greater than urine output (UO), weight gain due to fluid retention, and concentrated urine with increased osmolality and sodium levels. SIADH does not typically present with severe pitting edema or increased serum osmolality and sodium. References: =

• CCRN (Adult) Certification Review Course Online: 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

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 nurse’s best response is to explore the patient’s reasons for the request and understanding of potential consequences, as this demonstrates respect for the patient’s autonomy and dignity, as well as provides an opportunity to assess the patient’s decision-making capacity, goals of care, and preferences for end-of-life care. The nurse should also provide emotional support, education, and symptom management to the patient and family. Advocating with the care team for a withdrawal of treatment plan, encouraging the patient to continue with current medications and attempts to wean, or referring the patient’s request to the healthcare facility’s ethics committee for review are not appropriate responses, as they may undermine the patient’s right to self-determination, impose the nurse’s own values or beliefs, or delay the implementation of the patient’s wishes.

References:

• AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 19.
• AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
• AACN. (2020). Practice Recommendations for End-of-Life Care in the Intensive Care Unit. Retrieved from [Practice Recommendations], p. 14-15.
• NICE. (2019). End of life care for adults: service delivery. Retrieved from [NICE Guidance], p. 4.