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AACN Critical Care Nursing Exam Sample Questions (Q63-Q68):
NEW QUESTION # 63
A 14-year-old post-MVC receives massive transfusion. Later, the abdomen is rigid. Which finding suggests abdominal compartment syndrome?
- A. Decreased PIP
- B. Decreased RA pressure
- C. Oliguria
- D. Polyuria
Answer: C
Explanation:
Abdominal compartment syndrome (ACS)occurs whenintra-abdominal pressure increases, impairing organ function.Oliguriais a key early sign due to decreased renal perfusion. Other signs may include increased ventilator pressures (PIP), hypotension, and a tense/distended abdomen.
"Oliguria and increased abdominal girth following trauma or transfusion suggest early abdominal compartment syndrome." (Referenced from CCRN Pediatric - Direct Care: Gastrointestinal, Abdominal Trauma and Compartment Syndrome)
NEW QUESTION # 64
A patient exhibits acute hypervigilance, refusal of treatment, impulsive acts, and hallucinations alternating with lucidity. Family members argue about the hallucinations. The nurse should:
- A. Encourage the family to go home until the behavior is resolved
- B. Reassure the family this behavior is expected in ICU
- C. Validate the hallucinations and use distraction therapy
- D. Role-model patient support and reassurance
Answer: D
Explanation:
These are classic symptoms ofICU delirium, especially in pediatric or neurologically impaired patients. The nurse shouldmodel supportive, calm behavior,reorient the patient, andeducate familyabout what they are witnessing. This helpsde-escalate tensionand provides therapeutic support.
"In managing ICU delirium, the nurse should support the patient, reduce stimuli, and help families understand and cope with the patient's altered mental status." (Referenced from CCRN Pediatric - Direct Care: Neurological, Delirium and Cognitive Dysfunction)
NEW QUESTION # 65
A 9-year-old boy scout was treated with Lyme disease. He expresses fear of going camping again because of deer ticks. The nurse's best response would be:
- A. "tell me more about your fears"
- B. "frequent checking for ticks will prevent infection"
- C. "I can't belive you're afraid of ticks"
- D. " just think of all the fun that you're going to miss if you will not go on camping"
Answer: B
Explanation:
Explanation: The nurse's best response would be "frequent checking for ticks will prevent infection." It identifies the concern and presents an appropriate protective intervention. Frequent and prompt removal of ticks decreases the chance of spread of Lyme disease to humans.
NEW QUESTION # 66
The nurse is caring for a 16 year-old boy with Hemophilia A, who was admitted after falling from a tree.
In understanding his behavior and in planning care for this client, what must the nurse understand about adolescents with hemophilia A?
- A. Explain limitations to peers
- B. Should have well planned activities
- C. Often take part in active sports
- D. Avoid any risk after bleeding episodes
Answer: C
Explanation:
Explanation: Adolescent hemophiliacs should be aware that contact sports may trigger bleeding.
However, developmental characteristics of this age group such as impulsivity, inexperience and peer pressure, place adolescents in unsafe environments.
NEW QUESTION # 67
Upon assessing the mouth of a 4 year-old child, the nurse noted that the teeth have chalky white-to- yellowish staining with pitting of the enamel. Which of the following conditions would most likely explain these findings?
- A. Oral iron therapy
- B. Tetracycline ingestion
- C. Poor oral hygiene
- D. Excessive fluoride intake
Answer: D
Explanation:
Explanation: The findings are indicative of Fluorosis, a condition characterized by an increase in the extent and degree of the enamel''s porosity. This problem is associated with repeated swallowing of toothpaste with fluoride and or drinking water with high levels of fluoride.
NEW QUESTION # 68
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