Exam (elaborations)
PASS the CCRN! Questions and verified answers
- Course
- Institution
PASS the CCRN! Questions and verified answers
[Show more]
Content preview
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
t t t t t t t t t t t t t t t t t t
headache and nausea. He reports he ran out of blood pressure meds three days ago, but also
t t t t t t t t t t t t t t t t t
appears to be confused to the date and situation. What is the most appropriate treatment
t t t t t t t t t t t t t t t
approach? - ANSWER: ➡ Rapidly lower the diastolic pressure to 100 with IV antihypertensive
t t t tt t t t t t t t t t t
meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive
t t t t t t t t t t t t t t
meds.
t t
The maximum initial decrease should be no more than 25% reduction from initial presenting
t t t t t t t t t t t t t
value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure.
t t t t t t t t t t t t t t t
A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this
t t t t t t t t t t t t t t
intervention is having it's intended effect? - ANSWER: ➡ ScvO2 of 72%
t t t t t t t t tt t t t
Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain
t t t t t t t t t t t t t t
a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%,
t t t t t t t t t t t t t t t t t
and urine output greater than 0.5 kg/hr
t t t t t t t
72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has
t t t t t t t t t t t t t t t t t t
been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet
t t t t t t t t t t t t
count decreased significantly to 43,000 and was found to have new DVT on his right upper
t t t t t t t t t t t t t t t t
extremity. What do you suspect is the most likely cause of these findings? - ANSWER: ➡ HIT
t t t t t t t t t t t t t t t tt t
The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period
t t t t t t t t t t t t t t t t
(>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new
t t t t t t t t t t t t t t
development of DVT despite being on VTE prophylaxis.
t t t t t t t t
TRALI: - ANSWER: ➡ is a complication from a blood transfusion reaction, which causes acute
t t tt t t t t t t t t t t t
lung injury typically within 6 hours of a blood transfusion.
t t t t t t t t t t
,2 Hallmark signs of HIT: - ANSWER: ➡ Decrease in platelet count over a 24 hr period.
t t t t t t tt t t t t t t t t t
New development of DVT despite being on VTE prophylaxis.
t t t t t t t t
Values in Early compensated Hypovolemic shock? - ANSWER: ➡ CO 4.0 L/min, HR 135, SV 65,
t t t t t t t tt t t t t t t t
SVR 1700, MAP 65
t t t t
In hypovolemic states, circulating volume is depleted therefore preload and contractility are
t t t t t t t t t t t
decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure
t t t t t t t t t t t t t t t t t
to preserve CO, MAP and cerebral perfusion.
t t t t t t t
Post-renal failure values: - ANSWER: ➡ Urine output < 200; urine sodium 30; BUN: Creatinine
t t t t tt t t t t t t t t t
ratio 15:1; urine specific gravity 1.010
t t t t t t
BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is
t t t t t t t t t t t t t t t
typically 1-40 mEq/L.
t t t
What to do in the event of HIT: - ANSWER: ➡ Stop Heparin and administer an alternative direct
t t t t t t t t t tt t t t t t t t
thrombin inhibitor.
t t
Warfarin is contraindicated in HIT? T/F - ANSWER: ➡ True - there is also no evidence that
t t t t t t t tt t t t t t t t t
shows protamine, corticosteroids, and benadryl are effective treatments for HIT
t t t t t t t t t t
Patients with right ventricular infarctions become preload dependent. Meds that decrease
t t t t t t t t t t
preload should be avoided - which meds are these? - ANSWER: ➡ Morphine, Nitro, Beta
t t t t t t t t t t t tt t t t
blockers and diuretics.
t t t
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
t t t t t t t t t t t t t
be? - ANSWER: ➡ Atria & right ventricle because of the position of the heart in the chest.
t t t tt t t t t t t t t t t t t t t t
, PAOP 6, PA Pressure 40/24, RA Pressure 16
t t t t t t t
Neurogenic shock signs? - ANSWER: ➡ CVP: 3, CI: 2.5, SVR: 650, SBP: 88
t t t t tt t t t t t t t t
Neuro shock is associated with a loss of sympathetic tone causing extensive peripheral
t t t t t t t t t t t t
vasodilation. Clinical signs and symptoms include hypotension, a low SVR, low CVP and low
t t t t t t t t t t t t t t
normal CI
t t
What causes a larger than normal A wave on a PAOP? - ANSWER: ➡ Mitral stenosis - causes
t t t t t t t t t t t t tt t t t t
increased left atrial pressure during atrial contraction.
t t t t t t t
Pulmonary HTN will result in what? - ANSWER: ➡ Elevated PA pressures but have no impact on
t t t t t t t tt t t t t t t t t
PAOP.
t
Infective Endocarditis can cause what kind of impairment? - ANSWER: ➡ Neurologic
t t t t t t t t t tt t
impairment. One of the risks of infective endocarditis is the bacterial strand breaking in the
t t t t t t t t t t t t t t t
heart and throwing bacterial emboli forward into the lungs from the right side of the heart or to
t t t t t t t t t t t t t t t t t t
the brain/body from the left side of the heart.
t t t t t t t t t
Neurologic impairment could be a sign? - ANSWER: ➡ Embolic ischemic stroke.
t t t t t t t tt t t t
Post bariatric surgery should avoid what kind of meds? - ANSWER: ➡ Extended release meds
t t t t t t t t t t tt t t t
due to absorption concerns post-operatively
t t t t t
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)
t t t t t t t t
Will a cardiac transplant patient respond to atropine? - ANSWER: ➡ No - pacing is the best
t t t t t t t t t tt t t t t t t
instrument for symptomatic bradycardia.
t t t t
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Fordenken. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $16.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
79373 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now