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CCRN EXAM 1 NEWLY MODIFIED 2025/2026
LATEST UPDATE
The emergency drug therapy of choice for polymorphic ventricular tachycardia is:
A. Atropine
B. Amiodarone
C. Adenosine
D. Magnesium -- ANSWER--25. D. Magnesium. Polymorphic ventricular tachycardia, or
Torsades de Pointes, is best treated with the administration of magnesium. Other
emergency antiarrhythmics have little benefit in states of hypomagnesemic induced
polymorphic ventricular tachycardia.
A 72-year-old male patient has been in the ICU for 6 days on the ventilator for treatment of a
COPD exacerbation. He has been receiving VTE prophylaxis with subcutaneous Heparin
since admission. Today, his platelet count decreased significantly to 43,000 and he was found
to have a new DVT on his right upper extremity. What do you suspect is the most likely cause
of these new findings?
A. DIC
B. ITP
C. HIT
D. TRALI -- ANSWER--12. C. HIT. The hallmark sign of Heparin Induced
Thrombocytopenia (HIT) is a significant decrease in platelet count over a 24-hour period (>
50%) within 5 - 10 days of administering Heparin. The other hallmark sign is a new
development of a DVT despite being on VTE prophylaxis. DIC and ITP can decrease platelet
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counts but with the specific scenario of a new DVT and precipitous drop in platelets the best
answer is HIT. Transfusion related acute lung injury (TRALI) is a complication from a blood
transfusion reaction, which causes acute lung injury typically within 6 hours of a blood
transfusion.
Which set of hemodynamic parameters is associated with right-sided heart failure?
A. Increased CO/CI, increased CVP, increased PAOP, increased SVR
B. Increased CO/CI, decreased CVP, increased PAOP, decreased SVR
C. Decreased CO/CI, increased CVP, decreased/normal
PAOP, increased SVR
D. Decreased CO/CI, decreased CVP, decreased/normal
PAOP, decreased SVR -- ANSWER--13. C. Decreased CO/CI, increased CVP,
decreased/normal
PAOP, increased SVR. A failing right ventricle becomes congested and cannot propel blood
to the left side of the heart, causing an increase in CVP; blood backs up. Decreased preload to
the left side of the heart is seen as a decreased PAOP/CO/ CI. A reduction in perfusion to
tissue prompts a compensatory response of vasoconstriction and increase in SVR.
You would expect which of the following laboratory findings in a patient with Diabetes
Insipidus?
A. Increased serum osmolality, decreased serum sodium, increased urine osmolality
B. Increased serum osmolality, decreased urine osmolality, increased serum sodium
C. Decreased serum osmolality, increased serum sodium, decreased urine osmolality
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D. Decreased serum osmolality, decreased serum sodium, decreased urine osmolality --
ANSWER--14. B. Increased serum osmolality, decreased urine osmolality, increased
serum sodium. In Diabetes Insipidus there is a lack of ADH. The patient will have
significant volume loss leaving an increased serum osmolality, the urine will be dilute
(decreased urine osmo) and hemoconcentration of blood resulting in increased sodium
levels.
A 52-year-old male was admitted to the trauma ICU in hypovolemic shock after a motorcycle
accident. He sustained multiple injuries including a fractured pelvis and a splenic laceration.
Which of the following hemodynamic profiles would be consistent with the diagnosis of
hypovolemic shock?
A. Decreased cardiac output, decreased preload, increased afterload
B. Decreased cardiac output, increased preload, decreased afterload
C. Increased cardiac output, decreased preload, increased afterload
D. Increased cardiac output, increased preload, decreased afterload -- ANSWER--15. A.
Decreased cardiac output, decreased preload, increased afterload. In hypovolemic states
circulating volume is depleted, therefore the preload will decrease.
In response, the sympathetic nervous system and renin-angiotensin aldosterone system are
activated resulting in an increase in heart rate to compensate. In addition, those systems cause
vasoconstriction leading to an increase in the systemic vascular resistance SVR) in hopes of
increasing the blood pressure
Your patient is admitted with an acute asthma exacerbation. An ABG is obtained because they
continue to use accessory muscles with a RR of 38 per minute. The ABG results: pH
7.35 PaCO, 42, PaO, 82, HCO, 22. You suspect which of the following?
A. No airflow obstruction
B. Improvement in their condition
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C. Severe airflow obstruction
D. Pneumonia -- ANSWER--16. C. Severe airflow obstruction. In an acute asthma
exacerbation, bronchoconstriction leads to air trapping and ABGs often show a
high/normal pH and low PaCO. When the airflow obstruction is severe, very little air is
able to move, causing the PaCO, to rise and the pH to fall. This ABG indicates the patient
is likely going into respiratory fallure. Although
is breathing at a rate of 38 per minute.
technically this ABG is normal, it is not normal given the patient
17. Which of the following assessment and laboratory findings would you expect to observe
in a patient with post-renal kidney injury due to obstruction?
A. Decreased urine output, elevated urine sodium, normal urine specific gravity, elevated
BUN & creatinine
B. Increased urine output, decreased urine sodium, decreased urine specific gravity, normal
BUN & creatinine
C. Decreased urine output, decreased urine sodium, elevated urine specific gravity, elevated
BUN & creatinine
D. Increased urine output, elevated urine sodium, elevated urine specific gravity, elevated
BUN & creatinine -- ANSWER--17. C. Decreased urine output, decreased urine sodium,
elevated urine specific gravity, elevated BUN & creatinine.
In post-renal acute kidney injury, there is an obstruction that leads to decreased urine output.
This causes an increase in the BUN & creatinine with urinary sodium retention and
concentrated urine leading to an increase in urine specific gravity (weight of the urine). Once
the obstruction is relieved, abnormal laboratory findings often return to normal.
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CCRN EXAM 1 NEWLY MODIFIED 2025/2026
LATEST UPDATE
The emergency drug therapy of choice for polymorphic ventricular tachycardia is:
A. Atropine
B. Amiodarone
C. Adenosine
D. Magnesium -- ANSWER--25. D. Magnesium. Polymorphic ventricular tachycardia, or
Torsades de Pointes, is best treated with the administration of magnesium. Other
emergency antiarrhythmics have little benefit in states of hypomagnesemic induced
polymorphic ventricular tachycardia.
A 72-year-old male patient has been in the ICU for 6 days on the ventilator for treatment of a
COPD exacerbation. He has been receiving VTE prophylaxis with subcutaneous Heparin
since admission. Today, his platelet count decreased significantly to 43,000 and he was found
to have a new DVT on his right upper extremity. What do you suspect is the most likely cause
of these new findings?
A. DIC
B. ITP
C. HIT
D. TRALI -- ANSWER--12. C. HIT. The hallmark sign of Heparin Induced
Thrombocytopenia (HIT) is a significant decrease in platelet count over a 24-hour period (>
50%) within 5 - 10 days of administering Heparin. The other hallmark sign is a new
development of a DVT despite being on VTE prophylaxis. DIC and ITP can decrease platelet
Page 1 of 103
, 2
counts but with the specific scenario of a new DVT and precipitous drop in platelets the best
answer is HIT. Transfusion related acute lung injury (TRALI) is a complication from a blood
transfusion reaction, which causes acute lung injury typically within 6 hours of a blood
transfusion.
Which set of hemodynamic parameters is associated with right-sided heart failure?
A. Increased CO/CI, increased CVP, increased PAOP, increased SVR
B. Increased CO/CI, decreased CVP, increased PAOP, decreased SVR
C. Decreased CO/CI, increased CVP, decreased/normal
PAOP, increased SVR
D. Decreased CO/CI, decreased CVP, decreased/normal
PAOP, decreased SVR -- ANSWER--13. C. Decreased CO/CI, increased CVP,
decreased/normal
PAOP, increased SVR. A failing right ventricle becomes congested and cannot propel blood
to the left side of the heart, causing an increase in CVP; blood backs up. Decreased preload to
the left side of the heart is seen as a decreased PAOP/CO/ CI. A reduction in perfusion to
tissue prompts a compensatory response of vasoconstriction and increase in SVR.
You would expect which of the following laboratory findings in a patient with Diabetes
Insipidus?
A. Increased serum osmolality, decreased serum sodium, increased urine osmolality
B. Increased serum osmolality, decreased urine osmolality, increased serum sodium
C. Decreased serum osmolality, increased serum sodium, decreased urine osmolality
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D. Decreased serum osmolality, decreased serum sodium, decreased urine osmolality --
ANSWER--14. B. Increased serum osmolality, decreased urine osmolality, increased
serum sodium. In Diabetes Insipidus there is a lack of ADH. The patient will have
significant volume loss leaving an increased serum osmolality, the urine will be dilute
(decreased urine osmo) and hemoconcentration of blood resulting in increased sodium
levels.
A 52-year-old male was admitted to the trauma ICU in hypovolemic shock after a motorcycle
accident. He sustained multiple injuries including a fractured pelvis and a splenic laceration.
Which of the following hemodynamic profiles would be consistent with the diagnosis of
hypovolemic shock?
A. Decreased cardiac output, decreased preload, increased afterload
B. Decreased cardiac output, increased preload, decreased afterload
C. Increased cardiac output, decreased preload, increased afterload
D. Increased cardiac output, increased preload, decreased afterload -- ANSWER--15. A.
Decreased cardiac output, decreased preload, increased afterload. In hypovolemic states
circulating volume is depleted, therefore the preload will decrease.
In response, the sympathetic nervous system and renin-angiotensin aldosterone system are
activated resulting in an increase in heart rate to compensate. In addition, those systems cause
vasoconstriction leading to an increase in the systemic vascular resistance SVR) in hopes of
increasing the blood pressure
Your patient is admitted with an acute asthma exacerbation. An ABG is obtained because they
continue to use accessory muscles with a RR of 38 per minute. The ABG results: pH
7.35 PaCO, 42, PaO, 82, HCO, 22. You suspect which of the following?
A. No airflow obstruction
B. Improvement in their condition
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, 4
C. Severe airflow obstruction
D. Pneumonia -- ANSWER--16. C. Severe airflow obstruction. In an acute asthma
exacerbation, bronchoconstriction leads to air trapping and ABGs often show a
high/normal pH and low PaCO. When the airflow obstruction is severe, very little air is
able to move, causing the PaCO, to rise and the pH to fall. This ABG indicates the patient
is likely going into respiratory fallure. Although
is breathing at a rate of 38 per minute.
technically this ABG is normal, it is not normal given the patient
17. Which of the following assessment and laboratory findings would you expect to observe
in a patient with post-renal kidney injury due to obstruction?
A. Decreased urine output, elevated urine sodium, normal urine specific gravity, elevated
BUN & creatinine
B. Increased urine output, decreased urine sodium, decreased urine specific gravity, normal
BUN & creatinine
C. Decreased urine output, decreased urine sodium, elevated urine specific gravity, elevated
BUN & creatinine
D. Increased urine output, elevated urine sodium, elevated urine specific gravity, elevated
BUN & creatinine -- ANSWER--17. C. Decreased urine output, decreased urine sodium,
elevated urine specific gravity, elevated BUN & creatinine.
In post-renal acute kidney injury, there is an obstruction that leads to decreased urine output.
This causes an increase in the BUN & creatinine with urinary sodium retention and
concentrated urine leading to an increase in urine specific gravity (weight of the urine). Once
the obstruction is relieved, abnormal laboratory findings often return to normal.
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