CCRN EXAM 2024-2025 WITH CORRECT
ANSWERS AND LATEST QUESTIONS
GRADED A+
Shock - ANS-a cellular disease due to inadequate perfusion or the inability for cells to use the oxygen
given
What happens with inadequate oxygen uptake by cells? - ANS-The body goes into anaerobic metabolism
which causes lactate to rise and leads to acidosis
What are the three stages of shock? - ANS-Compensatory
Progressive
Refractory
Uncal herniation - ANS-displacement of the temporal lobe against the brain stem and third cranial nerve
compresses the parasympathetic nervous system so dilated pupil on that side will be seen before LOC
What is the glascow coma scale - ANS-used to asses a pt's level of consciousness and assess functional
state of the brain as a whole
,Obtunded - ANS-the patient can speak, mumbles words
Stuporous - ANS-the patient cannot speak, but they may moan or grimace
homonymous hemianopsia - ANS-indicates cranial nerve three damage; occurs contralateral to the
problem
General rules for neurological assessment - ANS--eyes deviate to the pathology
-pupil changes are ipsilateral
-visual changes are contralateral
-motor changes are contralateral
-babinski is contralateral
-if the pathology is on both sides, then babinski is present in both sides
What mechanisms are activated in compensatory shock? - ANS-Sympathetic nervous system and renin-
angiotensin-aldosterone system (RAAS)
How is BP maintained from Sympathetic nervous system? - ANS-Increased HR, vasoconstriction, and
Contractility
How is BP maintained from RAAS? - ANS-Renin secretion causes vasoconstriction
Aldosterone release causes NA and H2O retention
Signs of Compensatory Shock - ANS--Tachycardia
-Tachypnea
-Respiratory alkalosis
-Oliguria
-Cool, pale skin
-Thirsty
-BP MAINTAINED
,Progressive Stage of Shock ( Mechanisms Failing) - ANS--worsening Tachycardia
HYPOTENSION
-metabolic acidosis
-changes in LOC
mottled skin
Refractory Stage of Shock (not responding to treatment) - ANS--severe hypoperfusion
-Failure of organs
Name the types of shock - ANS-Cardiogenic
Hypovolemic
Neurogenic
Anaphylactic
Septic
Obstructive
What are the causes of hypovolemic shock? - ANS-third-spacing, hemorrhage, GI bleed, burns, excessive
diuresis
What happens to the pulse pressure in hypovolemic shock? - ANS-Narrow
Everything decreases in hypovolemic shock except? - ANS-SVR increases
How do you treat hypovolemic shock? - ANS-aggressive fluid loading- LR is recommended by ACS
replace blood/plts as needed
avoid vasopressors
How do you treat hemorrhagic shock? - ANS-Stop the bleeding
, PRBCs with FFP/PLTs/Cryo
prevent hypothermia
will need calcium and magnesium replacement
Massive Transfusion Protocol - ANS-10 units PRBCs in 24 hours or 5 units in less than 3
What is the triad of death? - ANS-Hypothermia
Acidosis
Coagulopathy
Criteria for Systemic Inflammatory Response Syndrome (SIRS) - ANS-2 or more of the following
-T >38C or <36C
-HR>90
RR>20 or PACO2<32
WBCs >12 <4
Sepsis - ANS-organ dysfunction caused by an abnormal host response to a microorganism
infection + organ dysfunction
qSOFA - ANS-2 or more of:
Hypotension: SBP less than or equal to 100 mmHg
Altered mental status (any GCS less than 15)
Tachypnoea: RR greater than or equal to 22
identified patients with suspected infection who are likely to have a prolonged ICU stay or to die in the
hospital
septic shock - ANS-sepsis and uncontrollable decreased blood pressure
ANSWERS AND LATEST QUESTIONS
GRADED A+
Shock - ANS-a cellular disease due to inadequate perfusion or the inability for cells to use the oxygen
given
What happens with inadequate oxygen uptake by cells? - ANS-The body goes into anaerobic metabolism
which causes lactate to rise and leads to acidosis
What are the three stages of shock? - ANS-Compensatory
Progressive
Refractory
Uncal herniation - ANS-displacement of the temporal lobe against the brain stem and third cranial nerve
compresses the parasympathetic nervous system so dilated pupil on that side will be seen before LOC
What is the glascow coma scale - ANS-used to asses a pt's level of consciousness and assess functional
state of the brain as a whole
,Obtunded - ANS-the patient can speak, mumbles words
Stuporous - ANS-the patient cannot speak, but they may moan or grimace
homonymous hemianopsia - ANS-indicates cranial nerve three damage; occurs contralateral to the
problem
General rules for neurological assessment - ANS--eyes deviate to the pathology
-pupil changes are ipsilateral
-visual changes are contralateral
-motor changes are contralateral
-babinski is contralateral
-if the pathology is on both sides, then babinski is present in both sides
What mechanisms are activated in compensatory shock? - ANS-Sympathetic nervous system and renin-
angiotensin-aldosterone system (RAAS)
How is BP maintained from Sympathetic nervous system? - ANS-Increased HR, vasoconstriction, and
Contractility
How is BP maintained from RAAS? - ANS-Renin secretion causes vasoconstriction
Aldosterone release causes NA and H2O retention
Signs of Compensatory Shock - ANS--Tachycardia
-Tachypnea
-Respiratory alkalosis
-Oliguria
-Cool, pale skin
-Thirsty
-BP MAINTAINED
,Progressive Stage of Shock ( Mechanisms Failing) - ANS--worsening Tachycardia
HYPOTENSION
-metabolic acidosis
-changes in LOC
mottled skin
Refractory Stage of Shock (not responding to treatment) - ANS--severe hypoperfusion
-Failure of organs
Name the types of shock - ANS-Cardiogenic
Hypovolemic
Neurogenic
Anaphylactic
Septic
Obstructive
What are the causes of hypovolemic shock? - ANS-third-spacing, hemorrhage, GI bleed, burns, excessive
diuresis
What happens to the pulse pressure in hypovolemic shock? - ANS-Narrow
Everything decreases in hypovolemic shock except? - ANS-SVR increases
How do you treat hypovolemic shock? - ANS-aggressive fluid loading- LR is recommended by ACS
replace blood/plts as needed
avoid vasopressors
How do you treat hemorrhagic shock? - ANS-Stop the bleeding
, PRBCs with FFP/PLTs/Cryo
prevent hypothermia
will need calcium and magnesium replacement
Massive Transfusion Protocol - ANS-10 units PRBCs in 24 hours or 5 units in less than 3
What is the triad of death? - ANS-Hypothermia
Acidosis
Coagulopathy
Criteria for Systemic Inflammatory Response Syndrome (SIRS) - ANS-2 or more of the following
-T >38C or <36C
-HR>90
RR>20 or PACO2<32
WBCs >12 <4
Sepsis - ANS-organ dysfunction caused by an abnormal host response to a microorganism
infection + organ dysfunction
qSOFA - ANS-2 or more of:
Hypotension: SBP less than or equal to 100 mmHg
Altered mental status (any GCS less than 15)
Tachypnoea: RR greater than or equal to 22
identified patients with suspected infection who are likely to have a prolonged ICU stay or to die in the
hospital
septic shock - ANS-sepsis and uncontrollable decreased blood pressure
