Management Questions for the CNN Exam — Practice Free

The current gold standard for chronic hyponatremia correction is a limit of 4-6 mEq/L in 24 hours, with an absolute maximum of 8 mEq/L. ODS (formerly central pontine myelinolysis) occurs when rapid osmotic shifts cause oligodendrocyte death. Exam Tip: NNCC focuses on safety. If a patient has high-risk factors (hypokalemia, alcoholism, malnutrition), the target should be the lower end (4-6 mEq/L). If over-correction occurs, the nurse must anticipate the DDAVP clamp strategy or administration of D5W to lower the sodium back to the target range.

The nurse facilitates SDM by providing evidence-based information on the benefits and burdens of dialysis versus Conservative Kidney Management (CKM). In advanced dementia, dialysis often fails to improve survival or quality of life and may increase distress via repeated vascular access and immobilization. Nurses advocate for the patient's prior values and may suggest a Time-Limited Trial (TLT) if consensus is not reached. NNCC Tip: CKM is a proactive, medically managed choice, not a withdrawal of care. Distinguish between CKM and no care.

1. Immediately stop the blood pump and clamp the venous line to prevent further air entry. 2. Place the patient in Trendelenburg (head down) and on their left side (Durant’s Maneuver). This position traps air in the apex of the right ventricle, preventing it from entering the pulmonary artery. 3. Administer 100% oxygen to accelerate air reabsorption. Rationale: Positioning is critical to prevent a lethal pulmonary embolism. NNCC Tip: Left side, head down is the classic exam answer for air embolism management.

Standard ml-for-ml replacement is the gold standard in the immediate post-op period. If UOP is 600 mL, replacement should be 600 mL plus calculated insensible losses (typically 30-50 mL/hr). Rationale: This compensates for the massive osmotic diuresis (due to urea and glucose) often seen in a newly functioning graft. NNCC Exam Tip: Watch for over-replacement leading to pulmonary edema versus under-replacement leading to acute tubular necrosis (ATN). Maintain euvolemia to ensure graft perfusion.

Initial fill volumes for pediatric PD are based on Body Surface Area (BSA) rather than weight. Recommended starting volume is 800–1100 mL/m² BSA. This can be gradually increased to 1200–1400 mL/m² as tolerated. Clinical Pearl: Using weight-based calculations (e.g., 20-40 mL/kg) often under-fills older children and over-fills infants. NNCC Exam Tip: Watch for distractors using weight-based formulas for PD volumes; BSA is the gold standard for pediatric PD prescription.