PASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CCRN! QuestionsPASS the CC...
PASS the CCRN! Questions
2 Hallmark signs of HIT: - ANSWER-Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
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.
78 yr old female fell at home 1 wk ago. She has been on Coumadin for A-fib for over 1 year. She presents
with a complaint of headache. Her family states: "Mom has been acting weird for the past couple days."
Scenario is consistent with? - ANSWER-Subdural hematoma
A subdural bleed is usually a slow accumulating, venous bleed. Abnormal neuro changes may not be
seen for days or weeks.
A 56 yr male presents in heart block with a ventricular rate of 38 caused from an intentional overdose
from CCB. What is appropriate antidote? - ANSWER-Calcium
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? - 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 continous infusion of Lorazepam for greater than 3 days can lead to an accumulation of? - ANSWER-
Propylene glycol.
,PASS the CCRN! Questions
A mechanically ventilated patient has been started on inhaled (Flolan) for the tx of ARDS and refractory
hypoxemia. Which hemodynamic value evaluates the effectiveness of this intervention? - ANSWER-
Decreased PAP
A medication regimen for a patient with hypertrophic Cardiomyopathy would include? - ANSWER-CCB &
Beta blockers
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
A patient is admitted with serum calcium of 15.1 mEq/L. Which of the following interventions should the
nurse anticipate? - ANSWER-Rule out hypokalemia, then administer diuretics.
A patient was 48-hours post aortic valve replacement. Which of following would be a major goal for this
patient? - ANSWER-Prevent thrombus - clot formation on the valve is a major complication of valvular
replacement, especially a mechanical valve.
A patient with chronic, severe mitral insufficiency is prone to which of the following dysrhythmias? -
ANSWER-A-fib
A patient with hyponatremia would need what? - ANSWER-Help maintaining a safe environment.
HypoNa impairs judgment, and causes confusion.
A person with disecting AAA would receive what drug? - ANSWER-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.
, PASS the CCRN! Questions
A pt with 3 vessel CABG with PA catheter in place. Pt has crackles in bilateral bases, s3,s4 heart sounds
are audible, in addition to holosystolic murmur. The nurse suspects mitral valve insufficiency. Which set
of data confirms this suspicion? - ANSWER-CVP elevated
PA pressure elevated
PAOP elevated
As mitral regurgitation develops blood moves back into the right atrium from the left ventricle. This in
turn causes an increase in left atrial pressure, pulmonary artery pressure, and cvp pressure.
A pt with ARDS needs to receive how many ml/kg of tidal volume? - ANSWER-4-5ml/kg tidal volume in
order to prevent volutrauma.
A lower respiratory rate will help provide this. Short expiratory time, PEEP, and larger tidal volumes will
all promote air trapping or auto peep. Thus increasing intrathoracic pressure and reducing cardiac
output.
A saddle embolus is life threatening and requires which immediate intervention? - ANSWER-IV
thrombolytic for clot lysis.
Subcutaneous and IV heparin inhibit thrombus growth and promote resolution of the formed clot, but
will treat the a saddle pulmonary embolus.
A shunt requires more than oxygen to correct hypoxemia, for example: - ANSWER-PEEP
a STAT CT is first priority to dx what: - ANSWER-Hemorrhagic or ischemic event
A sudden increase in left atrial diastolic pressure will result in? - ANSWER-Mitral regurgitation
ABG reveals pH 7.22, PaO2 42, PaCO 56, HCO3 28 - what is highest priority? - ANSWER-Increase PEEP
Ablify, haldol, seroquel, and droperidol can cause what? - ANSWER-QT prolongation
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