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

The patient presents with dyspnea, jaw pain, chest tightness, and sinus tachycardia with ST segment elevation in lead V2 after a percutaneous coronary intervention (PCI). These symptoms are indicative of myocardial ischemia or infarction, likely due to a re-occlusion of the treated coronary artery. Coronary artery occlusion is a common cause of these acute symptoms post-PCI. Other options like pulmonary hypertension, vasovagal reaction, and cardiac tamponade are less consistent with the clinical presentation. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.

The patient’s data indicate that the patient is in shock, which is a life-threatening condition characterized by inadequate tissue perfusion and organ dysfunction. The patient has a low blood pressure, a high heart rate, a fever, and a metabolic acidosis, which suggest that the patient may have septic shock, which is caused by a severe infection that triggers a systemic inflammatory response. The nurse should anticipate an order to administer phenylephrine (Neo-Synephrine), which is a vasopressor agent that constricts the blood vessels and increases the blood pressure and tissue perfusion. Phenylephrine is recommended as a first-line agent for septic shock by the Surviving Sepsis Campaign guidelines1. 8.4% sodium bicarbonate is not indicated for the treatment of septic shock, as it may worsen the acid-base balance and increase the risk of complications2. 0.9% sodium chloride is a normal saline solution that may be used for fluid resuscitation, but it may not be sufficient to restore the blood pressure and may cause fluid overload, hyperchloremia, and kidney injury3. Amiodarone (Cordarone) is an antiarrhythmic drug that is used to treat ventricular tachycardia or fibrillation, but it is not effective for septic shock and may cause hypotension, bradycardia, and other adverse effects4.

References:

• Surviving Sepsis Campaign. (2020). Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Retrieved from 1, p. 16.
• Marik, P. E., & Bellomo, R. (2013). A rational approach to fluid therapy in sepsis. British Journal of Anaesthesia, 110(3), 323-329. Retrieved from 2, p. 327.
• Semler, M. W., & Rice, T. W. (2019). Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Trials, 20(1), 1-10. Retrieved from 3, p. 2-3.
• Lexicomp Online. (2021). Amiodarone. Retrieved from 4, p. 1-2.

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