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CCRN Questions Exam with complete solutions 2024_2025.
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CCRN Questions Exam with complete solutions 2024_2025.
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CCRN Questions Exam with completesolutions 2024/2025
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 about the date and
situation. What is the most appropriate treatment approach? - ANSWER-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? - ANSWER-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? - ANSWER-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: - ANSWER-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: - ANSWER-Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock? - ANSWER-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: - ANSWER-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: - ANSWER-Stop Heparin and administer an
alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F - ANSWER-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? - ANSWER-
Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - ANSWER-
Magnesium
Myocardial contusions generally impact which parts of the heart? and what would
the values be? - ANSWER-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? - ANSWER-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 causes a larger than normal A wave on a PAOP? - ANSWER-Mitral stenosis
- causes increased left atrial pressure during atrial contraction.
Pulmonary HTN will result in what? - ANSWER-Elevated PA pressures but have
no impact on PAOP.
Infective Endocarditis can cause what kind of impairment? - ANSWER-Neurologic
impairment. One of the risks of infective endocarditis is the bacterial strand
breaking in the heart and throwing bacterial emboli forward into the lungs from
the right side of the heart or to the brain/body from the left side of the heart.
Neurologic impairment could be a sign? - ANSWER-Embolic ischemic stroke.
Post bariatric surgery should avoid what kind of meds? - ANSWER-Extended
release meds due to absorption concerns post-operatively
Chlorpropamide is a what? - ANSWER-sulfonylurea drug that is used in DI as an
antidiuretic. It is primarily a glucose lowering agent. (hypoglycemia)
Will a cardiac transplant patient respond to atropine? - ANSWER-No - pacing is
the best instrument for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum
sodium is what symptom? - ANSWER-SIADH - causes retention of water. Urine
production is minimal and concentrated & leads to an increased urine osmolality.
What does Neo drug increase? - ANSWER-SVR - Peripheral constriction
Treatment for narrow complex, regular rhythm? - ANSWER-Administer 6mg
adenosine rapidly IVP
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