CCRN Questions and
Answers
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.
Post-renal failure values: -Correct 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: -Correct Answer= Stop Heparin and
administer an alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F -Correct 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? -Correct
Answer= Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? -Correct
Answer= Magnesium
Myocardial contusions generally impact which parts of the heart? and what
would the values be? -Correct 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? -Correct 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? -Correct Answer=
Mitral stenosis - causes increased left atrial pressure during atrial
contraction.
, Pulmonary HTN will result in what? -Correct Answer= Elevated PA pressures
but have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment? -Correct 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? -Correct Answer= Embolic ischemic
stroke.
Post bariatric surgery should avoid what kind of meds? -Correct Answer=
Extended release meds due to absorption concerns post-operatively
Chlorpropamide is a what? -Correct 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? -Correct Answer= No -
pacing is the best instrument for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased
serum sodium is what symptom? -Correct Answer= SIADH - causes retention
of water. Urine production is minimal and concentrated & leads to an
increased urine osmolality.
What does Neo drug increase? -Correct Answer= SVR - Peripheral
constriction
Treatment for narrow complex, regular rhythm? -Correct Answer= Administer
6mg adenosine rapidly IVP
Half life of metformin? -Correct Answer= 6 hours - close monitoring is
required to ensure the blood glucose level does not climb too quickly while
dextrose is being administered.
Most accurate reflection of daily fluid balance? -Correct Answer= Record a
daily weight at the same time each day.
Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension
are signs of what? -Correct Answer= Cardiac tamponade
A patient with hyponatremia would need what? -Correct Answer= Help
maintaining a safe environment. HypoNa impairs judgment, and causes
confusion.
Answers
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.
Post-renal failure values: -Correct 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: -Correct Answer= Stop Heparin and
administer an alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F -Correct 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? -Correct
Answer= Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? -Correct
Answer= Magnesium
Myocardial contusions generally impact which parts of the heart? and what
would the values be? -Correct 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? -Correct 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? -Correct Answer=
Mitral stenosis - causes increased left atrial pressure during atrial
contraction.
, Pulmonary HTN will result in what? -Correct Answer= Elevated PA pressures
but have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment? -Correct 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? -Correct Answer= Embolic ischemic
stroke.
Post bariatric surgery should avoid what kind of meds? -Correct Answer=
Extended release meds due to absorption concerns post-operatively
Chlorpropamide is a what? -Correct 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? -Correct Answer= No -
pacing is the best instrument for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased
serum sodium is what symptom? -Correct Answer= SIADH - causes retention
of water. Urine production is minimal and concentrated & leads to an
increased urine osmolality.
What does Neo drug increase? -Correct Answer= SVR - Peripheral
constriction
Treatment for narrow complex, regular rhythm? -Correct Answer= Administer
6mg adenosine rapidly IVP
Half life of metformin? -Correct Answer= 6 hours - close monitoring is
required to ensure the blood glucose level does not climb too quickly while
dextrose is being administered.
Most accurate reflection of daily fluid balance? -Correct Answer= Record a
daily weight at the same time each day.
Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension
are signs of what? -Correct Answer= Cardiac tamponade
A patient with hyponatremia would need what? -Correct Answer= Help
maintaining a safe environment. HypoNa impairs judgment, and causes
confusion.
