CCRN-Adult Questions and Answers

A serum potassium level of 7.2 mEq/L is critically high and can lead to life-threatening cardiac arrhythmias. The most immediate intervention is the administration of 50% dextrose followed by insulin, which helps drive potassium back into the cells, thereby rapidly lowering the serum potassium level. Hemodialysis and Kayexalate are also effective but may not act as quickly as the dextrose-insulin combination. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

When a patient exhibits anxiety and threats of harm, it is crucial to de-escalate the situation through verbal communication and engagement. By encouraging the patient to verbalize their feelings, the nurse can address the patient's fears and anxieties, reducing the likelihood of aggression. This approach promotes a therapeutic nurse-patient relationship and ensures the safety of both the patient and healthcare staff. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Pulsus paradoxus is defined as a decrease in systolic blood pressure (BP) of more than 10 mm Hg during normal inspiration. This phenomenon occurs due to the increased negative intrathoracic pressure during inspiration, which exaggerates the normal drop in systolic BP. It is often seen in conditions such as cardiac tamponade, constrictive pericarditis, and severe asthma or COPD exacerbations. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Salicylate poisoning

Alkalinization of urine is one of the main goals of treatment for salicylate poisoning, as it enhances the renal excretion of salicylate and reduces its reabsorption. Alkalinization of urine can be achieved by administering intravenous sodium bicarbonate and maintaining adequate hydration and urine output. Alkalinization of urine can be monitored by measuring the urine pH, which should be above 7.5. Osmotic diuresis, decrease in gastric pH, and decrease in CPK are not indicative of successful treatment for salicylate poisoning. Osmotic diuresis may occur as a result of salicylate toxicity, but it does not improve the elimination of salicylate. Decrease in gastric pH may impair the absorption of salicylate, but it does not affect the elimination of salicylate. Decrease in CPK may reflect the resolution of rhabdomyolysis, which is a possible complication of salicylate poisoning, but it does not reflect the clearance of salicylate.

References:

• Salicylate (aspirin) poisoning: Management - UpToDate1, p. 1-2.
• Salicylate poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice US2, p. 4-5.

Papillary muscle dysfunction, often resulting from myocardial infarction, can lead to mitral insufficiency (mitral regurgitation). The papillary muscles support the mitral valve, and if they are damaged, the valve may not close properly, causing blood to flow backward into the left atrium during systole. This condition is not associated with aortic stenosis, mitral stenosis, or aortic insufficiency. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Hypoperfusion is a condition in which the blood flow to the organs and tissues is insufficient to meet their metabolic demands. Hypoperfusion can result from third-degree AV block, which is a complete loss of communication between the atria and the ventricles. This causes the ventricles to beat very slowly or not at all, leading to a low cardiac output and reduced blood pressure. Hypoperfusion can cause symptoms such as dizziness, fainting, confusion, chest pain, shortness of breath, and shock12. Heart failure, hypoxia, and chest pain are possible complications of hypoperfusion, but they are not the most common problem in patients with third-degree AV block.

This is the nurse’s best initial response, as it expresses empathy, validates the patient’s feelings, and assesses the patient’s risk of suicide. Depression is a common and serious mental health condition that affects older adults, especially those living in nursing homes. Depression can cause persistent sadness, hopelessness, loss of interest, and suicidal thoughts or behaviors. The nurse should screen the patient for depression using a validated tool, such as the Patient Health Questionnaire (PHQ-9) 1, and ask about any suicidal ideation or plans. The nurse should also provide emotional support, education, and referral to appropriate resources for the patient.

B. “Those feelings should resolve when the medication you’ve started has a chance to take effect.”

This is not the nurse’s best initial response, as it dismisses the patient’s feelings, implies that the patient just needs to wait for the medication to work, and does not address the patient’s psychosocial needs. Antidepressants are one of the treatment options for depression, but they may take several weeks to show their full effect, and they may not work for everyone. The nurse should also explore other factors that may contribute to the patient’s depression, such as social isolation, loss of autonomy, chronic illness, or grief, and offer interventions that may help the patient cope, such as counseling, psychotherapy, cognitive-behavioral therapy, or social activities.

C. “I understand how you feel. We all get that way when we’re depressed.”

This is not the nurse’s best initial response, as it assumes that the nurse knows how the patient feels, minimizes the patient’s experience, and generalizes the patient’s condition. Depression is not a normal or inevitable part of aging, and it affects each person differently. The nurse should not compare the patient’s feelings to their own or to others, but rather acknowledge and respect the patient’s unique perspective and situation. The nurse should also avoid using words like “we” or “you” that may create a sense of distance or judgment, and instead use words like “I” or “me” that may convey a sense of empathy or rapport.

D. “Have you talked to anyone about what is bothering you?”

This is not the nurse’s best initial response, as it may sound like the nurse is trying to avoid listening to the patient, or that the patient is bothering the nurse with their problems. The nurse should not imply that the patient should talk to someone else, but rather show interest and willingness to listen to the patient. The nurse should also use open-ended questions that invite the patient to share more, such as “How are you feeling today?” or “What has been on your mind lately?” The nurse should also use active listening skills, such as nodding, paraphrasing, reflecting, or summarizing, to demonstrate understanding and engagement.

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.

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

Left shoulder pain, also known as Kehr sign, is a sign of splenic injury and diaphragmatic irritation. It is caused by the irritation of the phrenic nerve, which innervates both the diaphragm and the shoulder, by blood or other fluids in the left upper quadrant. Tachypnea, flank pain, and hiccoughs are not specific signs of splenic injury or diaphragmatic irritation.

References:

• Splenic trauma | Radiology Reference Article | Radiopaedia.org
• Recognition and management of diaphragmatic injury in adults
• Reference Guide for CCRN (Adult), page 14.

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.

The caloric irrigation test, also known as the oculovestibular reflex test, is used to assess brainstem function in patients, especially those who are comatose. In this test, cold water is introduced into the ear canal, which should induce a predictable response if the brainstem is intact. The normal response to cold water irrigation is nystagmus with slow deviation of the eyes toward the side of the cold water (in this case, the left) and a fast phase of eye movement (nystagmus) away from the side of the cold water (to the right). This indicates that the brainstem pathways are functioning properly. References: =

• 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

Spinal cord injury

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A sudden and severe headache in a patient with a spinal cord injury at T7 could be a symptom of autonomic dysreflexia12. This condition is a potentially life-threatening medical emergency that can occur in individuals with spinal cord injuries above the T6 level12. It is most commonly triggered by an overfull bladder or a blocked catheter12. Therefore, the nurse should first check for bladder distension123.

In a patient with a hemorrhaging renal laceration who remains hypotensive despite fluid resuscitation with two units of PRBCs and 500 mL of NS, administering norepinephrine (Levophed) is appropriate. Norepinephrine is a potent vasopressor that helps to increase blood pressure by vasoconstriction and improving cardiac output, which is critical in stabilizing a patient with severe hemorrhagic shock prior to surgery.References: = CCRN Exam Handbook, page 38

After gastric bypass surgery, the altered anatomy of the gastrointestinal tract makes it challenging to place a gastric tube. Performing the procedure under fluoroscopy provides real-time imaging guidance, ensuring correct placement and reducing the risk of complications, such as perforation or misplacement.References: = CCRN Exam Handbook, page 45

The patient has thrombocytopenia, which is a low platelet count that increases the risk of bleeding. Heparin is an anticoagulant that prevents clotting, but also increases the risk of bleeding. Therefore, heparin should be avoided in patients with thrombocytopenia. Hemodialysis can be performed without heparin by using alternative methods such as saline flushes, blood predilution, or specialized dialyzers that reduce clotting. Transfusing platelets during hemodialysis is not recommended, as platelets may be damaged by the extracorporeal circuit. Rescheduling hemodialysis may not be feasible, as the patient may have fluid overload, electrolyte imbalance, or uremia that require urgent dialysis.

References:

• Use and safety of heparin-free maintenance hemodialysis in the USA
• Anticoagulation for the hemodialysis procedure
• Dialysis without anticoagulation (Heparin Free Dialysis)

A copious amount of serous drainage from a liver resection incision may indicate a bile leak, which can cause pain, infection, and delayed healing. The nurse should anticipate applying several abdominal dressings to absorb the fluid and protect the wound. The nurse should also monitor the patient for signs of infection, such as fever, increased white blood cell count, and foul-smelling drainage. The nurse should notify the surgeon of the excessive drainage and follow the orders for further interventions, such as imaging studies, drainage catheter placement, or surgical repair. Antibiotics may be prescribed, but they are not the first-line treatment for a bile leak. Incision and debridement of the wound may be necessary if there is necrotic tissue or infection, but it is not the initial action. Applying a drainage pouch to the site may not be sufficient to contain the large amount of fluid and may increase the risk of skin breakdown.

References:

• Problems after cancer surgery to remove part of your liver: This article states that “The bile ducts connect the liver and gallbladder to the small bowel. There is a risk of bile leaking from the ducts on the cut surface of the liver. This may cause pain, sickness and a high temperature. Rarely, you might need another operation to repair the leak.”
• Understanding Liver Abscess Treatment - Saint Luke’s Health System: This article states that “The provider uses CT scan or ultrasound to help place the wire in the right spot. A thin, flexible tube (catheter) is then placed over the wire and into the abscess. The tube is left in place for 5 to 7 days to drain the fluid. In some cases, surgery may be done to cut into the liver abscess and drain it.”
• How Much Time Does it Take to Recover from Liver Surgery?: This article states that “If you have any drainage from your incision or if the area around your incision is puffy or red, visit your surgeon. Take a shower every day with warm water. When you are ready to take solid foods, make sure to eat 4 to 6 small meals every day. Do not lift heavy weights for 8 weeks after your surgery.”

The patient’s vital signs indicate hypertensive urgency or emergency (BP 190/100, HR 126), with a differential radial pulse, suggesting aortic dissection. Nitroprusside is a potent vasodilator used in the management of hypertensive crises and can help reduce blood pressure and the shear force on the aortic wall, which is crucial in managing aortic dissection. Nitroglycerin, diltiazem, and digoxin are not appropriate first-line therapies for this condition. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

A patient with acetaminophen overdose is at risk for acute liver failure, which can lead to coagulopathy. This condition is often marked by an increased International Normalized Ratio (INR) due to impaired synthesis of clotting factors in the liver. Decreasing level of consciousness can also result from hepatic encephalopathy, a complication of liver failure. References: = CCRN Exam Handbook and AACN's Certification Review Course materials.

A nurse should expect a plan of care that includes dobutamine (Dobutrex), fluid infusions, and transvenous pacing for a patient with a complicated RV infarction, as these interventions aim to improve RV function, increase cardiac output, and correct bradyarrhythmias. Dobutamine is an inotropic agent that increases myocardial contractility and reduces RV afterload1. Fluid infusions are used to optimize RV preload and maintain adequate systemic perfusion12. Transvenous pacing is indicated for patients with symptomatic bradycardia or high-grade AV block that compromise hemodynamics13. Dobutamine (Dobutrex), fluid restrictions, and furosemide (Lasix) are not appropriate for a patient with a complicated RV infarction, as they may worsen RV preload and cardiac output. Nitroprusside (Nipride), fluid restrictions, and transvenous pacing are not suitable for a patient with a complicated RV infarction, as they may cause excessive vasodilation and hypotension. Nitroglycerin, fluid infusions, and morphine are not optimal for a patient with a complicated RV infarction, as they may reduce RV preload and increase RV ischemia.

Dexmedetomidine (Precedex) is the most appropriate medication for managing agitation and delirium in a critically ill intubated patient. It provides sedation without significant respiratory depression and has analgesic properties, which makes it suitable for patients who are disoriented and confused. Unlike benzodiazepines (lorazepam and midazolam) or neuromuscular blockers (cisatracurium), dexmedetomidine can improve delirium outcomes and facilitates easier weaning from mechanical ventilation. References: = AACN Certification and Core Review for High Acuity and Critical Care, 7th Edition, AACN Handbook for CCRN Certification, pp. 57-60.

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.

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

The administration of hypertonic saline (3% Normal Saline) creates an osmotic gradient that pulls water out of the swollen brain tissue into the vascular system, helping to reduce cerebral edema. This is a critical intervention in managing increased intracranial pressure in patients with hemorrhagic stroke. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Lorazepam (Ativan) is most appropriate to administer in a patient who has smoked crack cocaine and is agitated, particularly after a generalized seizure. Benzodiazepines like lorazepam help to manage agitation and seizure activity associated with cocaine toxicity by providing sedative and anticonvulsant effects.References: = CCRN Exam Handbook, page 53

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.

An increase in peak inspiratory pressure (PIP) over time in a mechanically ventilated patient indicates a decrease in lung compliance. This means the lungs are becoming stiffer and less able to expand, which can be caused by conditions such as pulmonary edema, ARDS, or pneumothorax. It is important to address the underlying cause of decreased lung compliance to prevent further respiratory complications. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

Hyponatremia

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A patient with a sodium level of 114 mEq/L is most likely to develop seizures, which are a manifestation of severe hyponatremia and cerebral edema. Hyponatremia is a low level of sodium in the blood, which can cause water to move into the brain cells and cause them to swell. This can lead to increased intracranial pressure, neurological dysfunction, and seizures. Seizures are a medical emergency and require prompt treatment to prevent brain damage or death. Tetany, flaccid paralysis, and cardiac arrhythmias are not typical signs of hyponatremia, but may occur in other electrolyte disorders, such as hypocalcemia, hyperkalemia, or hypokalemia.

References:

• Overview of the treatment of hyponatremia in adults - UpToDate1, p. 1-2.
• Manifestations of hyponatremia and hypernatremia in adults - UpToDate2, p. 1-2.

The first step in developing an orientation plan is to assess the new nurse’s current knowledge and skills. This helps tailor the orientation to address any gaps and build on existing competencies. Understanding the new nurse's background ensures that the training is efficient and effective, focusing on areas that need improvement rather than repeating familiar information. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

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 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.

Haloperidol

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Haloperidol has a known side effect of prolonging the QT interval, which can lead to cardiac dysrhythmias123. Therefore, after the administration of haloperidol, it is important for a nurse to monitor for a prolonged QT interval and cardiac dysrhythmias123. This is why continuous cardiac monitoring is recommended if repeated doses are given1.

Among the options, the 68-year-old patient with COPD and dialysis-dependent renal disease is at the highest risk for developing VAP. This is due to multiple risk factors including advanced age, chronic obstructive pulmonary disease (COPD), which predisposes to poor lung function and clearance of secretions, and the immunocompromised state from dialysis-dependent renal disease. The patient's higher body weight can also contribute to complications in mobility and ventilation management, further increasing the risk of VAP. References: =

• CCRN (Adult) Certification Review Course Online: Infectious Disease and Pulmonary Infections.
• 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

Nutritional supplements are beneficial for patients with neutropenia secondary to chemotherapy, as they can help provide adequate calories, protein, vitamins, and minerals that are essential for immune function and tissue repair. Chemotherapy can cause side effects such as nausea, vomiting, loss of appetite, taste changes, and mouth sores, which can make it difficult for patients to eat enough food and meet their nutritional needs. Nutritional supplements can be in the form of oral drinks, shakes, bars, or powders, or they can be administered through a feeding tube or intravenously. The nurse should request nutritional supplements that are appropriate for the patient’s condition, preferences, and tolerance, and that are compatible with the neutropenic diet and food safety guidelines. The nurse should also monitor the patient’s weight, hydration, and laboratory values, and report any signs of malnutrition, infection, or intolerance to the provider.

References:

• Nutrition for the Person With Cancer During Treatment: A Guide for Patients and Families: This article states that “Nutritional supplements are products that can be used to add nutrients to your diet or to lower your risk of health problems. They can be in pill, capsule, tablet, or liquid form. They might have vitamins, minerals, amino acids, herbs, or other substances. Some examples of common supplements are calcium, iron, omega-3 fatty acids, vitamin C, and vitamin D. You might need supplements if you cannot get enough nutrients from foods or if you have certain health conditions that might cause a deficiency, such as cancer, diabetes, or chronic diarrhea.”
• Nutrition in Cancer Care (PDQ®)–Patient Version: This article states that “Nutritional support is therapy for people who do not get enough nourishment by eating or drinking. You may need nutritional support if you have trouble swallowing, have lost your appetite, or are losing weight. Nutritional support can be given in different ways: Enteral nutrition is liquid food given through a tube (called a feeding tube) into the stomach or small intestine. Parenteral nutrition is a liquid mixture of nutrients given through a vein (intravenous or IV). Oral nutrition is food or liquid taken by mouth. This includes nutritional supplements, such as drinks, shakes, bars, or powders that have protein, carbohydrates, fat, vitamins, and minerals.”
• Nutrition and Cancer: What You Need to Know: This article states that “Nutritional supplements can help you meet your calorie and protein needs when you are not able to eat enough food. They can also provide extra vitamins and minerals. There are many types of nutritional supplements, such as drinks, shakes, puddings, bars, and powders. Some are designed for people with cancer and have extra calories and protein. Your doctor, nurse, or dietitian can help you choose the best supplement for you. You can buy some supplements at the grocery store or pharmacy, but others may need a prescription.”

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 appropriate outcomes for a patient with status asthmaticus are normal PaCO2 and increased FEV1. Status asthmaticus is a severe and life-threatening asthma exacerbation that does not respond to conventional treatment. It causes severe bronchoconstriction, air trapping, and mucus plugging, leading to hypoxemia, hypercapnia, and respiratory failure. The goals of treatment are to reverse the airway obstruction, improve gas exchange, and prevent complications. PaCO2 is the partial pressure of carbon dioxide in the blood, which reflects the adequacy of ventilation. FEV1 is the forced expiratory volume in one second, which measures the amount of air that can be forcefully exhaled in the first second of a breath. It reflects the degree of bronchoconstriction and airflow limitation. A patient with status asthmaticus typically has elevated PaCO2 and reduced FEV1 due to poor ventilation and severe obstruction. Therefore, normalizing PaCO2 and increasing FEV1 indicate improvement in the patient’s condition and response to treatment.

References:

• Status Asthmaticus: Symptoms, Causes, Diagnosis, and Treatment - Healthline: This article states that “Status asthmaticus is a severe form of asthma with symptoms similar to a typical asthma attack. But for status asthmaticus, symptoms may worsen as the asthma attack continues. Status asthmaticus is an older, less precise term for what’s now more commonly known as acute severe asthma or a severe asthma exacerbation. It refers to an asthma attack that doesn’t improve with traditional treatments, such as inhaled bronchodilators. These attacks can last for several minutes or even hours.”
• Status Asthmaticus (Severe Acute Asthma) - WebMD: This article states that “Status asthmaticus is a severe asthma attack that doesn’t get better with your usual treatments. It can be life-threatening and needs urgent medical attention. If you have a bad asthma attack and your rescue inhaler or your nebulizer doesn’t help, you need medical care right away. If an attack comes on quickly and it doesn’t respond to regular treatment, it can lead to status asthmaticus.”
• Management of Status Asthmaticus | SpringerLink: This article states that “Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure despite aggressive treatment. It is defined as an acute exacerbation of asthma that remains unresponsive to initial treatment with bronchodilators. Status asthmaticus can vary in severity from mild to fatal. The pathophysiology of status asthmaticus is complex and involves airway inflammation, bronchospasm, airway edema, mucus plugging, and increased airway resistance. The clinical manifestations of status asthmaticus include dyspnea, wheezing, cough, chest tightness, tachypnea, tachycardia, hypoxemia, and hypercapnia. The diagnosis of status asthmaticus is based on history, physical examination, and laboratory tests, such as arterial blood gas analysis, spirometry, and chest radiography. The management of status asthmaticus consists of oxygen therapy, inhaled beta-2 agonists, systemic corticosteroids, and adjunctive therapies, such as anticholinergics, magnesium sulfate, ketamine, and noninvasive or invasive mechanical ventilation. The goals of treatment are to relieve bronchoconstriction, reduce airway inflammation, correct hypoxemia, normalize or reduce carbon dioxide levels, and avoid or treat complications.”

Conducting a literature review is an essential step in evidence-based practice. Sharing these findings with the staff and obtaining their input fosters a collaborative environment and ensures that the best practices are understood and implemented by all. This approach also helps identify any practical concerns or barriers to implementation. Simply switching back to the old trays without addressing the root cause or educating the staff may not prevent future CAUTIs. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

The nurse's role in this situation is to provide clear and compassionate guidance regarding the complex decision about continuing or discontinuing ventilator support. Referring to the hospital's policies provides a structured approach to making such decisions and ensures that the decision aligns with ethical and legal standards. This approach also supports the spouse by providing concrete information and a framework within which to make an informed decision. References: = CCRN Exam Handbook, AACN Adult CCRN Certification Review Course

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