CCRN-K (Adult) cheat sheet

Clinical judgment in the CCRN-K sense is the observed, measurable application of nursing knowledge to a patient situation: recognize cues, analyze them against expected patterns, prioritize hypotheses, generate solutions, take action, and evaluate outcomes; the exam tests recognition of which step a described nurse behavior represents.

Airway–breathing–circulation precedes all other assessment in any deteriorating adult; a patient with stridor, absent breath sounds on one side, or a new oxygen requirement of more than 4 L/min to hold SpO2 above 92% is an immediate escalation, not a monitoring task.

Mean arterial pressure = (systolic + 2 × diastolic) ÷ 3; a MAP below 65 mmHg defines hypotension requiring intervention in most adults, and a narrowing pulse pressure with rising diastolic pressure suggests rising intracranial pressure or tamponade rather than simple hypovolemia.

Oliguria defined as urine output less than 0.5 mL/kg/h for 2 consecutive hours in an adult signals early acute kidney injury or hypoperfusion; report it rather than attributing it to Foley positioning or patient position alone.

Sepsis screening: suspected infection plus a change of 2 or more SOFA points; bedside red flags include respiratory rate 22 or higher, altered mentation, and systolic blood pressure 100 mmHg or lower - the qSOFA triad - and any two of the three warrant escalation.

Delirium is an acute fluctuating attention deficit with altered awareness; the Confusion Assessment Method requires acute onset/fluctuation plus inattention, and then either disorganized thinking or altered level of consciousness; hypoactive delirium is the most commonly missed form and is not the same as depression or dementia.

Pain as the fifth vital sign is now framed as a patient-reported outcome: reassess within 30 minutes after IV opioid and 60 minutes after oral analgesic, and treat a sedation score of 3 or higher or a respiratory rate below 10 as opioid-induced respiratory depression requiring naloxone consideration.

Deterioration often shows a change in the trend, not an abnormal single value: a 10-point rise in heart rate, a 20 mmHg fall in systolic pressure, or a rising early warning score over one shift should trigger a rapid response call even when each individual number remains within reference range.

Handoff and escalation are testable professional-caring behaviors: use a structured format (situation, background, assessment, recommendation), state a specific request and a time frame, and use closed-loop communication so the receiving clinician repeats back the plan.

Informed consent requires decision-making capacity, disclosure of risks, benefits, and alternatives, and voluntariness; the nurse's role is to verify the consent is informed and to witness the signature, not to obtain consent or to judge whether the patient should accept the procedure.

A patient with capacity may refuse any treatment, including life-sustaining therapy; document the refusal, ensure the patient understands consequences, and notify the provider - a competent refusal is not a psychiatric emergency.

Advance directives: a living will states treatment preferences; a durable power of attorney for health care names a surrogate; a do-not-resuscitate order is a physician order, not a document the family can sign; in the absence of a surrogate, follow the state hierarchy of decision makers.

Surrogate decision makers are held to substituted judgment - what the patient would have chosen - and only fall back to best interests when the patient's wishes are unknown; a surrogate cannot override a clearly documented prior capable wish.

Futility and conflict: when the care team believes a requested treatment is non-beneficial, the accepted path is ethics consultation and, if unresolved, the institution's conflict-resolution policy or transfer - not unilateral withdrawal or unilateral compliance.

Confidentiality under HIPAA permits disclosure of the minimum necessary information to those directly involved in care and to public health authorities as required by law; it does not permit discussing a patient in public areas or on social media, even without a name.

Mandatory reporting duties vary by state but commonly include suspected abuse or neglect of children, older adults, and dependent adults, plus specified communicable diseases and impaired colleagues; the nurse reports to the designated agency, not to the family first.

The impaired colleague: protect the patient first by removing the colleague from patient care, then report through the chain of command or employee assistance program; the nurse does not investigate or confront privately.

Professional caring behaviors that are scored on the exam include presence, active listening, respecting patient goals, advocating when the plan conflicts with the patient's stated values, and recognizing one's own bias or fatigue as a threat to safe judgment.