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PASS the CCRN! Questions and verified answers
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PASS the CCRN! Questions and verified answers
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PASS the CCRN! Questions and verifiedanswers
A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and complains of a
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headache and nausea. He reports he ran out of blood pressure meds three days ago, but also
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appears to be confused to the date and situation. What is the most appropriate treatment
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approach? - ANSWER: ➡ Rapidly lower the diastolic pressure to 100 with IV antihypertensive
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meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive
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meds.
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The maximum initial decrease should be no more than 25% reduction from initial presenting
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value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure.
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A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this
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intervention is having it's intended effect? - ANSWER: ➡ ScvO2 of 72%
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Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain
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a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%,
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and urine output greater than 0.5 kg/hr
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72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has
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been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet
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count decreased significantly to 43,000 and was found to have new DVT on his right upper
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extremity. What do you suspect is the most likely cause of these findings? - ANSWER: ➡ HIT
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The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period
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(>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new
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development of DVT despite being on VTE prophylaxis.
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TRALI: - ANSWER: ➡ is a complication from a blood transfusion reaction, which causes acute
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lung injury typically within 6 hours of a blood transfusion.
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,2 Hallmark signs of HIT: - ANSWER: ➡ Decrease in platelet count over a 24 hr period.
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New development of DVT despite being on VTE prophylaxis.
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Values in Early compensated Hypovolemic shock? - ANSWER: ➡ CO 4.0 L/min, HR 135, SV 65,
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SVR 1700, MAP 65
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In hypovolemic states, circulating volume is depleted therefore preload and contractility are
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decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure
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to preserve CO, MAP and cerebral perfusion.
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Post-renal failure values: - ANSWER: ➡ Urine output < 200; urine sodium 30; BUN: Creatinine
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ratio 15:1; urine specific gravity 1.010
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BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is
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typically 1-40 mEq/L.
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What to do in the event of HIT: - ANSWER: ➡ Stop Heparin and administer an alternative direct
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thrombin inhibitor.
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Warfarin is contraindicated in HIT? T/F - ANSWER: ➡ True - there is also no evidence that
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shows protamine, corticosteroids, and benadryl are effective treatments for HIT
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Patients with right ventricular infarctions become preload dependent. Meds that decrease
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preload should be avoided - which meds are these? - ANSWER: ➡ Morphine, Nitro, Beta
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blockers and diuretics.
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Polymorphic ventricular tachycardia aka Torsades is treated by? - ANSWER: ➡ Magnesium t t t t t t t t t tt t
Myocardial contusions generally impact which parts of the heart? and what would the values
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be? - ANSWER: ➡ Atria & right ventricle because of the position of the heart in the chest.
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, PAOP 6, PA Pressure 40/24, RA Pressure 16
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Neurogenic shock signs? - ANSWER: ➡ CVP: 3, CI: 2.5, SVR: 650, SBP: 88
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Neuro shock is associated with a loss of sympathetic tone causing extensive peripheral
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vasodilation. Clinical signs and symptoms include hypotension, a low SVR, low CVP and low
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normal CI
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What causes a larger than normal A wave on a PAOP? - ANSWER: ➡ Mitral stenosis - causes
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increased left atrial pressure during atrial contraction.
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Pulmonary HTN will result in what? - ANSWER: ➡ Elevated PA pressures but have no impact on
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PAOP.
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Infective Endocarditis can cause what kind of impairment? - ANSWER: ➡ Neurologic
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impairment. One of the risks of infective endocarditis is the bacterial strand breaking in the
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heart and throwing bacterial emboli forward into the lungs from the right side of the heart or to
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the brain/body from the left side of the heart.
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Neurologic impairment could be a sign? - ANSWER: ➡ Embolic ischemic stroke.
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Post bariatric surgery should avoid what kind of meds? - ANSWER: ➡ Extended release meds
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due to absorption concerns post-operatively
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Chlorpropamide is a what? - ANSWER: ➡ sulfonylurea drug that is used in DI as an antidiuretic. t t t t t tt t t t t t t t t t t
It is primarily a glucose lowering agent. (hypoglycemia)
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Will a cardiac transplant patient respond to atropine? - ANSWER: ➡ No - pacing is the best
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instrument for symptomatic bradycardia.
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