CCRN/ Certified Medical-Surgical Registered
Nurse Exam 2024 Guaranteed Pass (COMPLIED
FROM REAL EXAM)
A 56 yr-old male is admitted to the ICU with a blood pressure of
225/135 and complains of a headache and nausea. He reports he ran
out of blood pressure meds three days ago, but also appears to be
confused to the date and situation. What is the most appropriate
treatment approach?
Rapidly lower the diastolic pressure to 100 with IV antihypertensive
meds, then continue to gradually reduce the diastolic pressure to 85
with oral antihypertensive meds.
The maximum initial decrease should be no more than 25% reduction
from initial presenting value. Reducing the blood pressure too quickly
can lead to cerebral edema or renal failure.
A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which
finding indicate that this intervention is having it's intended effect?
ScvO2 of 72%
,Early goal directed therapy for sepsis includes early fluid resuscitation at
30 ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated,
MAP greater than 65, ScvO2 greater than 70%, and urine output
greater than 0.5 kg/hr
72 male patient in ICU for 6 days on the ventilator for treatment of a
COPD exacerbation. He has been receiving VTE prophylaxis and
subcutaneous Heparin since admission. Today his platelet count
decreased significantly to 43,000 and was found to have new DVT on his
right upper extremity. What do you suspect is the most likely cause of
these findings?
HIT
The hallmark sign of HIT is a significant decrease in platelet count over a
24 hours period (>50%) within 5-10 days of administering Heparin. The
other hallmark sign is a new development of DVT despite being on VTE
prophylaxis.
TRALI:
is a complication from a blood transfusion reaction, which causes acute
lung injury typically within 6 hours of a blood transfusion.
,2 Hallmark signs of HIT:
Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock?
CO 4.0 L/min, HR 135, SV 65, SVR 1700, MAP 65
In hypovolemic states, circulating volume is depleted therefore preload
and contractility are decreased which leads to a decrease in SV and CO.
HR and SV increase as compensatory measure to preserve CO, MAP and
cerebral perfusion.
Post-renal failure values:
Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine
specific gravity 1.010
BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are
elevated. Urine sodium is typically 1-40 mEq/L.
, What to do in the event of HIT:
Stop Heparin and administer an alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F
True - there is also no evidence that shows protamine, corticosteroids,
and benadryl are effective treatments for HIT
Patients with right ventricular infarctions become preload dependent.
Meds that decrease preload should be avoided - which meds are these?
Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by?
Magnesium
Myocardial contusions generally impact which parts of the heart? and
what would the values be?
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