Pass The Ccrn
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Pt post-operative day 2 after a right hemicolectomy for ischemic bowel. The post-
operative course has been complicated with pain control concerns. As the patient is
getting out of bed for the first time the patient complains of sudden wet sounding
cough. The assesses new onset tachycardia - CORRECT ANSWER-Pulmonary
embolism - clinical signs of sudden SOB, anxiety points to PE
,Glucagon is an antidote for? - CORRECT ANSWER-Beta blockers
Which port do you get to measure mixed venous blood? - CORRECT ANSWER-
Distal port
DIC - which medication does the nurse anticipate to be ordered and started
urgently? - CORRECT ANSWER-Heparin continous infusion 4 units/kg/hr
Other tx would be to eliminate the cause.
Which lab value would expect to see in a patient with pancreatitis? - CORRECT
ANSWER-Decreased Albumin, elevated amylase and lipase
Reversal for warfarin overdose? - CORRECT ANSWER-Vit K
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? - CORRECT 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? - CORRECT
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? - CORRECT 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: - CORRECT 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: - CORRECT 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? - CORRECT 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.