CCRN Study Guides – AACN Critical Care Nursing Certification – Comprehensive
Study Notes and Practice Preparation Material
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? - Correct Answer -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 its intended effect? - Correct Answer -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? - Correct Answer -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: - Correct Answer -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: - Correct Answer -Decrease in platelet count over a 24 hr.
period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock? - Correct Answer -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.
1
, Post-renal failure values: - Correct Answer -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 me/L.
What to do in the event of HIT: - Correct Answer -Stop Heparin and administer an
alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F - Correct Answer -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? - Correct Answer -
Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsade’s is treated by? - Correct Answer -
Magnesium
Myocardial contusions generally impact which parts of the heart? And what would
the values be? - Correct Answer -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? - Correct Answer -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? - Correct Answer -Mitral
stenosis - causes increased left atrial pressure during atrial contraction.
Pulmonary HTN will result in what? - Correct Answer -Elevated PA pressures but
have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment? - Correct Answer -
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? - Correct Answer -Embolic ischemic stroke.
2
, Post bariatric surgery should avoid what kind of meds? - Correct Answer -Extended
release meds due to absorption concerns post-operatively
Chlorpropamide is a what? - Correct Answer -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? - Correct Answer -No - pacing
is the best instrument for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium
is what symptom? - Correct Answer -SIADH - causes retention of water. Urine
production is minimal and concentrated & leads to an increased urine osmolality.
What does Neo drug increase? - Correct Answer -SVR - Peripheral constriction
Treatment for narrow complex, regular rhythm? - Correct Answer -Administer 6mg
adenosine rapidly IVP
Half-life of metformin? - Correct Answer -6 hours - close monitoring is required to
ensure the blood glucose level does not climb too quickly while dextrose is being
administered.
Most accurate reflection of daily fluid balance? - Correct Answer -Record a daily
weight at the same time each day.
Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs
of what? - Correct Answer -Cardiac tamponade
A patient with hyponatremia would need what? - Correct Answer -Help maintaining
a safe environment. Hyponex impairs judgment, and causes confusion.
Peritoneal dialysis works on the principles of both? - Correct Answer -Diffusion and
osmosis.
HHNS leads to what? - Correct Answer -Large fluid deficits and may require multiple
liters of fluid, which is determined by the patient's level of dehydration and hyper
osmolality.
What parameters are consistent with Pulses Paradoxes? - Correct Answer -Decrease
in SBP>10 during inspiration.
Before administering tap what must happen? - Correct Answer -Lower the BP to at
least 185/110. An elevated BP prior to tap can cause hemorrhage.
Biotinide can cause what? - Correct Answer -Torsade’s
3
Study Notes and Practice Preparation Material
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? - Correct Answer -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 its intended effect? - Correct Answer -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? - Correct Answer -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: - Correct Answer -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: - Correct Answer -Decrease in platelet count over a 24 hr.
period.
New development of DVT despite being on VTE prophylaxis.
Values in Early compensated Hypovolemic shock? - Correct Answer -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.
1
, Post-renal failure values: - Correct Answer -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 me/L.
What to do in the event of HIT: - Correct Answer -Stop Heparin and administer an
alternative direct thrombin inhibitor.
Warfarin is contraindicated in HIT? T/F - Correct Answer -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? - Correct Answer -
Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsade’s is treated by? - Correct Answer -
Magnesium
Myocardial contusions generally impact which parts of the heart? And what would
the values be? - Correct Answer -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? - Correct Answer -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? - Correct Answer -Mitral
stenosis - causes increased left atrial pressure during atrial contraction.
Pulmonary HTN will result in what? - Correct Answer -Elevated PA pressures but
have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment? - Correct Answer -
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? - Correct Answer -Embolic ischemic stroke.
2
, Post bariatric surgery should avoid what kind of meds? - Correct Answer -Extended
release meds due to absorption concerns post-operatively
Chlorpropamide is a what? - Correct Answer -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? - Correct Answer -No - pacing
is the best instrument for symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium
is what symptom? - Correct Answer -SIADH - causes retention of water. Urine
production is minimal and concentrated & leads to an increased urine osmolality.
What does Neo drug increase? - Correct Answer -SVR - Peripheral constriction
Treatment for narrow complex, regular rhythm? - Correct Answer -Administer 6mg
adenosine rapidly IVP
Half-life of metformin? - Correct Answer -6 hours - close monitoring is required to
ensure the blood glucose level does not climb too quickly while dextrose is being
administered.
Most accurate reflection of daily fluid balance? - Correct Answer -Record a daily
weight at the same time each day.
Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs
of what? - Correct Answer -Cardiac tamponade
A patient with hyponatremia would need what? - Correct Answer -Help maintaining
a safe environment. Hyponex impairs judgment, and causes confusion.
Peritoneal dialysis works on the principles of both? - Correct Answer -Diffusion and
osmosis.
HHNS leads to what? - Correct Answer -Large fluid deficits and may require multiple
liters of fluid, which is determined by the patient's level of dehydration and hyper
osmolality.
What parameters are consistent with Pulses Paradoxes? - Correct Answer -Decrease
in SBP>10 during inspiration.
Before administering tap what must happen? - Correct Answer -Lower the BP to at
least 185/110. An elevated BP prior to tap can cause hemorrhage.
Biotinide can cause what? - Correct Answer -Torsade’s
3
