CCRN-Adult Exam Dumps : CCRN (Adult) - Direct Care Eligibility Pathway

The signs and symptoms described in the patient post-bariatric surgery, including anxiety, restlessness, increased abdominal pain, and subcutaneous crepitus over the neck, suggest a potential anastomotic leak, which is a surgical emergency. Given the vital signs indicating possible sepsis or shock (elevated heart rate, increased respiratory rate, and fever), immediate surgical intervention is likely required to repair the leak and prevent further complications. References: CCRN Exam Handbook, AACN, page 30, section on GI surgical emergencies.

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

Phentolamine (Regitine) is the antidote for norepinephrine extravasation, which is the leakage of the vasopressor from the vein into the surrounding tissue. Phentolamine reverses the vasoconstriction and ischemia caused by norepinephrine by blocking the alpha-adrenergic receptors. Phentolamine should be administered intradermally around the site of extravasation as soon as possible, and the infusion should be stopped but the IV catheter should not be removed until some of the norepinephrine is aspirated. A warm compress may worsen the tissue damage by increasing the absorption of norepinephrine, and lowering the extremity may increase the edema and pain. Removing the IV immediately may prevent the aspiration of norepinephrine and the administration of phentolamine.

References:

• Episode 240: What to do with norepinephrine extravasation: This article explains the steps to take when norepinephrine extravasates, including the use of phentolamine, and the reasons to avoid cold compress, lowering the extremity, and removing the IV.
• What are current recommendations for treatment of drug extravasation?: This article summarizes the latest recommendations for treatment of extravasation, and lists phentolamine as the immediate topical therapy for norepinephrine extravasation.