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? - ANSRapidly 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? - ANSScvO2 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? - ANSHIT
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: - ANSis 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: - ANSDecrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock? - ANSCO 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: - ANSUrine 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: - ANSStop Heparin and administer an alternative direct
thrombin inhibitor.
, Warfarin is contraindicated in HIT? T/F - ANSTrue - 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? - ANSMorphine, Nitro, Beta blockers and
diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - ANSMagnesium
Myocardial contusions generally impact which parts of the heart? and what would the values
be? - ANSAtria & right ventricle because of the position of the heart in the chest.
PAOP 6, PA Pressure 40/24, RA Pressure 16
Neurogenic shock signs? - ANSCVP: 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? - ANSMitral stenosis - causes
increased left atrial pressure during atrial contraction.
Pulmonary HTN will result in what? - ANSElevated PA pressures but have no impact on
PAOP.
Infective Endocarditis can cause what kind of impairment? - ANSNeurologic 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? - ANSEmbolic ischemic stroke.
Post bariatric surgery should avoid what kind of meds? - ANSExtended release meds due to
absorption concerns post-operatively
Chlorpropamide is a what? - ANSsulfonylurea 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? - ANSNo - pacing is the best instrument
for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is what
symptom? - ANSSIADH - causes retention of water. Urine production is minimal and
concentrated & leads to an increased urine osmolality.
What does Neo drug increase? - ANSSVR - Peripheral constriction
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? - ANSRapidly 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? - ANSScvO2 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? - ANSHIT
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: - ANSis 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: - ANSDecrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock? - ANSCO 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: - ANSUrine 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: - ANSStop Heparin and administer an alternative direct
thrombin inhibitor.
, Warfarin is contraindicated in HIT? T/F - ANSTrue - 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? - ANSMorphine, Nitro, Beta blockers and
diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - ANSMagnesium
Myocardial contusions generally impact which parts of the heart? and what would the values
be? - ANSAtria & right ventricle because of the position of the heart in the chest.
PAOP 6, PA Pressure 40/24, RA Pressure 16
Neurogenic shock signs? - ANSCVP: 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? - ANSMitral stenosis - causes
increased left atrial pressure during atrial contraction.
Pulmonary HTN will result in what? - ANSElevated PA pressures but have no impact on
PAOP.
Infective Endocarditis can cause what kind of impairment? - ANSNeurologic 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? - ANSEmbolic ischemic stroke.
Post bariatric surgery should avoid what kind of meds? - ANSExtended release meds due to
absorption concerns post-operatively
Chlorpropamide is a what? - ANSsulfonylurea 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? - ANSNo - pacing is the best instrument
for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is what
symptom? - ANSSIADH - causes retention of water. Urine production is minimal and
concentrated & leads to an increased urine osmolality.
What does Neo drug increase? - ANSSVR - Peripheral constriction
