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

The patient’s present clinical status is most likely a result of a ventricular septal defect (VSD), which is a hole in the wall between the left and right ventricles. A VSD can occur as a mechanical complication of MI, usually within the first week, due to necrosis and rupture of the ventricular septum. A VSD causes a left-to-right shunt of blood, which leads to increased pulmonary pressure, pulmonary edema, and reduced cardiac output. The patient’s symptoms and signs are consistent with a VSD, such as severe chest pain, hypotension, tachycardia, respiratory distress, high PAOP with large V waves, low CI, cool and clammy skin, inspiratory crackles, and a loud blowing holosystolic murmur at the apex. A papillary muscle rupture, a cardiac tamponade, and an acute aortic insufficiency are other possible mechanical complications of MI, but they have different clinical manifestations. A papillary muscle rupture causes acute mitral regurgitation, which presents with a soft systolic murmur at the apex and pulmonary congestion1. A cardiac tamponade causes compression of the heart by pericardial fluid, which presents with hypotension, muffled heart sounds, and jugular venous distension2. An acute aortic insufficiency causes backflow of blood from the aorta to the left ventricle, which presents with a diastolic decrescendo murmur at the left sternal border and a wide pulse pressure3.

References:

• 1: Mechanical complications of acute myocardial infarction - UpToDate4, p. 2-3.
• 2: Cardiac tamponade - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.
• 3: Acute aortic regurgitation - Symptoms, diagnosis and treatment | BMJ Best Practice US, p. 1-2.

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.

Anaphylactic shock is characterized by widespread vasodilation due to the release of histamine and other inflammatory mediators. This vasodilation causes a significant drop in systemic vascular resistance and maldistribution of blood volume, leading to hypotension. The explanation addresses the pathophysiological changes that occur during anaphylactic shock. References: AACN Adult CCRN Certification Review Course, AACN CCRN Exam Handbook.