CCRN-Adult Leak Questions

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

For a patient with unstable angina, the major goal of treatment is to decrease myocardial oxygen consumption. This can be achieved by reducing heart rate, blood pressure, and myocardial contractility to lessen the workload on the heart and reduce the demand for oxygen. This helps in preventing further ischemia and potential myocardial infarction. Treatment strategies may include the use of medications such as beta-blockers, nitrates, and calcium channel blockers, which all help in decreasing the oxygen demand of the heart.References: = CCRN Exam Handbook, page 10

The clinical presentation of lower left quadrant pain with guarding, abdominal distention, rigidity, and free air in the abdominal cavity on a KUB (kidney, ureter, and bladder) radiograph strongly suggests a perforated bowel. The presence of free air indicates that there is a breach in the gastrointestinal tract, allowing air to escape into the peritoneal cavity. The patient's vital signs, including hypotension (BP 76/40), tachycardia (HR 130), tachypnea (RR 32), and fever (T 101.7°F), are consistent with sepsis and shock, which are common complications of bowel perforation. References: CCRN Exam Handbook, AACN, page 30, section on Gastrointestinal.

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