PASS CCRN FINAL PAPER 2026 FULL STUDY
GUIDE
◉ A 65-year-old man is admitted to the critical care unit with a
diagnosis of septic shock. He has been receiving chemotherapy for
lung cancer. His skin is warm and dry, and he is restless. His white
blood cell count is elevated above normal. Hemoglobin, hematocrit,
and red blood cell count are normal.
Vital signs are blood pressure 80/50 mm Hg, heart rate 120
beats/min and regular, respiratory rate 32 breaths/min and regular,
and temperature 39° C.
Arterial blood gases reveal the following:
pH7.25PaO260 mm HgPaCO225 mm HgHCO313 mEq/LOxygen
saturation86%
Dobutamine is started at 10 mcg/kg/min. Normal saline is infusing
at 150 ml/hr. Which of the following would be most indicative of
improvement in this patient?
A.
Increase in venous oxygen saturation (SvO2)
,B.
Decrease in arterial lactate
C.
Increase in cardiac output
D.
Increase in urine output. Answer: B. Decrease in arterial lactate
Associate lactate with lactic acid. You know that a decrease in lactic
acid would indicate less anaerobic metabolism. Adequate oxygen
extraction and aerobic metabolism would decrease the lactic acid
level.
◉ The physician has prescribed mannitol for a patient with
intracranial hypertension. Which of the following is an important
consideration when administering mannitol?
A.
The drug must be protected from light.
B.
The drug must be administered through an in-line filter.
C.
The drug must be administered into a central venous catheter.
D.
,The drug must be refrigerated.. Answer: B. The drug must be
administered through an in-line filter.
◉ If a patient with a normal pH and temperature has a PaO2 of 60
mm Hg, his arterial oxygen saturation (SaO2) is closest to which of
the following values?
A.
75%
B.
90%
C.
95%
D.
99%. Answer: B. 90%
One way to remember this is to consider what level concerns you. At
an SaO2 of less than 90%, we get concerned because we are no
longer on the horizontal end of the oxyhemoglobin dissociation
curve. This means that there will be significant desaturation for
every drop in the PaO2 of even 1 mm Hg because we are on the
vertical limb of the curve. Note how significantly the saturation
dropped between the PaO2 of 60 mm Hg and 40 mm Hg.
, ◉ A patient had a craniotomy 2 days ago for removal of a tumor. He
is awake and talking to the nurse and demonstrates no neurologic
deficit. Blood pressure is 110/80 mm Hg, pulse is 92 beats/min, and
respiratory rate is 22 breaths/min. Urine outputs have been
approximately 60 ml/hr over the last 2 days, but he has had a recent
change. He has had 300 to 400 ml/hr of urine output over the last
several hours. The urine has a specific gravity of 1.002. The nurse
checks his serum glucose and finds that it is 100 mg/dl. The
intravenous solution most appropriate for fluid replacement would
be:
A.
5% dextrose in water (D5W).
B.
normal saline.
C.
lactated Ringer solution.
D.
10% dextrose in water (D10W).. Answer: A. 5% dextrose in water
(D5W).
D5W is an isotonic solution while in the bottle, but when it is
administered, the dextrose is quickly metabolized, leaving free
water. The patient in this case has indications of diabetes insipidus.
Patients with diabetes insipidus lose more water than sodium, and
GUIDE
◉ A 65-year-old man is admitted to the critical care unit with a
diagnosis of septic shock. He has been receiving chemotherapy for
lung cancer. His skin is warm and dry, and he is restless. His white
blood cell count is elevated above normal. Hemoglobin, hematocrit,
and red blood cell count are normal.
Vital signs are blood pressure 80/50 mm Hg, heart rate 120
beats/min and regular, respiratory rate 32 breaths/min and regular,
and temperature 39° C.
Arterial blood gases reveal the following:
pH7.25PaO260 mm HgPaCO225 mm HgHCO313 mEq/LOxygen
saturation86%
Dobutamine is started at 10 mcg/kg/min. Normal saline is infusing
at 150 ml/hr. Which of the following would be most indicative of
improvement in this patient?
A.
Increase in venous oxygen saturation (SvO2)
,B.
Decrease in arterial lactate
C.
Increase in cardiac output
D.
Increase in urine output. Answer: B. Decrease in arterial lactate
Associate lactate with lactic acid. You know that a decrease in lactic
acid would indicate less anaerobic metabolism. Adequate oxygen
extraction and aerobic metabolism would decrease the lactic acid
level.
◉ The physician has prescribed mannitol for a patient with
intracranial hypertension. Which of the following is an important
consideration when administering mannitol?
A.
The drug must be protected from light.
B.
The drug must be administered through an in-line filter.
C.
The drug must be administered into a central venous catheter.
D.
,The drug must be refrigerated.. Answer: B. The drug must be
administered through an in-line filter.
◉ If a patient with a normal pH and temperature has a PaO2 of 60
mm Hg, his arterial oxygen saturation (SaO2) is closest to which of
the following values?
A.
75%
B.
90%
C.
95%
D.
99%. Answer: B. 90%
One way to remember this is to consider what level concerns you. At
an SaO2 of less than 90%, we get concerned because we are no
longer on the horizontal end of the oxyhemoglobin dissociation
curve. This means that there will be significant desaturation for
every drop in the PaO2 of even 1 mm Hg because we are on the
vertical limb of the curve. Note how significantly the saturation
dropped between the PaO2 of 60 mm Hg and 40 mm Hg.
, ◉ A patient had a craniotomy 2 days ago for removal of a tumor. He
is awake and talking to the nurse and demonstrates no neurologic
deficit. Blood pressure is 110/80 mm Hg, pulse is 92 beats/min, and
respiratory rate is 22 breaths/min. Urine outputs have been
approximately 60 ml/hr over the last 2 days, but he has had a recent
change. He has had 300 to 400 ml/hr of urine output over the last
several hours. The urine has a specific gravity of 1.002. The nurse
checks his serum glucose and finds that it is 100 mg/dl. The
intravenous solution most appropriate for fluid replacement would
be:
A.
5% dextrose in water (D5W).
B.
normal saline.
C.
lactated Ringer solution.
D.
10% dextrose in water (D10W).. Answer: A. 5% dextrose in water
(D5W).
D5W is an isotonic solution while in the bottle, but when it is
administered, the dextrose is quickly metabolized, leaving free
water. The patient in this case has indications of diabetes insipidus.
Patients with diabetes insipidus lose more water than sodium, and
