PASS the CCRN! Questions & 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?
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?
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?
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:
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:
Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock?
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:
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:
Stop Heparin and administer an alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F
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?
Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by?
Magnesium
Myocardial contusions generally impact which parts of the heart? and what would the
values be?
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?
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?
Mitral stenosis - causes increased left atrial pressure during atrial contraction.
Pulmonary HTN will result in what?
Elevated PA pressures but have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment?
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?
Embolic ischemic stroke.
Post bariatric surgery should avoid what kind of meds?
Extended release meds due to absorption concerns post-operatively
Chlorpropamide is a what?
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?
No - pacing is the best instrument for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is
what symptom?
SIADH - causes retention of water. Urine production is minimal and concentrated &
leads to an increased urine osmolality.
What does Neo drug increase?
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?
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?
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?
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:
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:
Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock?
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:
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:
Stop Heparin and administer an alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F
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?
Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by?
Magnesium
Myocardial contusions generally impact which parts of the heart? and what would the
values be?
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?
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?
Mitral stenosis - causes increased left atrial pressure during atrial contraction.
Pulmonary HTN will result in what?
Elevated PA pressures but have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment?
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?
Embolic ischemic stroke.
Post bariatric surgery should avoid what kind of meds?
Extended release meds due to absorption concerns post-operatively
Chlorpropamide is a what?
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?
No - pacing is the best instrument for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is
what symptom?
SIADH - causes retention of water. Urine production is minimal and concentrated &
leads to an increased urine osmolality.
What does Neo drug increase?
