PASS the CCRN! Questions
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 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)
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 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)
