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CCRN EXAM QUESTIONS AND ANSWERS
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CCRN EXAM QUESTIONS AND ANSWERS
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CCRN EXAM QUESTIONS AND ANSWERSA 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? - Answers -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? - Answers -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? - Answers -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: - Answers -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: - Answers -Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock? - Answers -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: - Answers -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: - Answers -Stop Heparin and administer an alternative
direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F - Answers -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? - Answers -Morphine,
Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - Answers -Magnesium
Myocardial contusions generally impact which parts of the heart? and what would the
values be? - Answers -Atria & right ventricle because of the position of the heart in the
chest.
PAOP 6, PA Pressure 40/24, RA Pressure 16
Neurogenic shock signs? - Answers -CVP: 3, CI: 2.5, SVR: 650, SBP: 88
Neuro shock is associated with a loss of sympathetic tone causing extensive peripheral
vasodilation. Clinical signs and symptoms include hypotension, a low SVR, low CVP
and low normal CI
What parameters are consistent with Pulsus Paradoxes? - Answers -Decrease in
SBP>10 during inspiration.
Before administering rtPA what must happen? - Answers -Lower the BP to at least
185/110. An elevated BP prior to rtPA can cause hemorrhage.
Ibutilide can cause what? - Answers -Torsades
A person with disecting AAA would receive what drug? - Answers -PRN IV narcotic
analgesia - BP management is a priority in the care of a patient with a dissecting AAA.
Pain is the primary driver of HTN.
Autonomic hyperreflexia is what? - Answers -This disorder is seen with spinal injuries
occurring above the T6 spine.
Cause of autonomic hyperreflexia? - Answers -Bladder obstruction, constipation,
pressure ulcers, and pain. Usually when the noxious stimulus is identified and removed,
, the symptoms resolve. Checking urinary catheter for obstruction is the most appropriate
next action.
MEDS for asymptomatic left ventricular systolic dysfunction? - Answers -ACE or (ARB),
beta-blockers and statins for all patients with a history of MI and for all patients with a
reduced ejection fraction.
What is the Z point technique? - Answers -is a method used to estimate ventricular end
diastolic pressure. It is taken just before the closure of the mitral valve and is especially
useful when an A wave does not exist on the PAOP tracing such as in atrial fib.
Ascites position for relief? - Answers -Place pt on left side.
DIC lab values? - Answers -Fibrinogen decreased
FSP elevated
Platelets decreased
D-dimer elevated
Decreased Albumin is an indicator of what? - Answers -Protein deficiency and poor
nutrition, which are major contributors to poor wound healing.
A continous infusion of Lorazepam for greater than 3 days can lead to an accumulation
of? - Answers -Propylene glycol.
Inability to communicate in full sentences may be a sign of what? - Answers -Severity of
asthma (high risk)
Management of high ICP includes? - Answers -Osmotic diuretics, hypertonic saline &
antihypertensives.
Causes increased left atrial pressure during atrial contraction - results in a larger than
normal A wave on the PAOP tracing? - Answers -Mitral Stenosis
Pulmonary htn will result in elevated PA pressures but have no impact on? - Answers -
PAOP
Elevated urine osmolality; decreased serum osmolality; decreased serum sodium? -
Answers -SIADH
Absolute contraindication for thrombolytic therapy? - Answers -Aortic dissection
Crackles in bilateral lower lobes and a s3 heart sounds are indicative of what? Tx? -
Answers -Fluid overload
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