AACN Certification Exam Study Guides – American Association of
Critical-Care Nurses – Comprehensive Study Notes and Practice
Preparation Material
Cushing's Syndrome/Disease - Correct Answer -cortisol excess typically caused by pituitary
adenoma 60-70% of cases.
Central obesity w/ extremity wasting.
Dorsocervical fat pad.
Rounded faces.
Spontaneous bruising.
Purple striate
Hyperpigmentation
Poor wound healing/ skin infections.
Dexamethasone suppression test.
1mg dexamethasone at 2300 hours and measure serum cortisol at 0800.
Remove sources of excess and manage consequences (HTN, hypokalemia, and
hyperglycemia.)
Addison's disease - Correct Answer -Primary
Caused by damage to the adrenal cortex (autoimmune, TB, metastatic disease, deposition
diseases, and drug induced) leading to a decrease in cortisol production.
Secondary
Caused by pituitary failure to release ACTH (in any hypopituitary disorder) causing a
decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol production
from induced corticosteroid suppression.
Diabetes insipidus (DI) - Correct Answer -Insufficient ADH or decreased sensitivity to ADH
Nephron cannot conserve water.
Commonly caused by damage to the pituitary gland or hypothalamus (surgery, tumor,
meningitis, head injury).
Can be nephrogenic where the kidney in unable to respond to ADH.
Serum: Hypernatremia and hyperosmolarity.
Urine: Hyponatremia and hypoosmolality.
Replaced ADH and supportive fluid replacement.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Correct Answer -Excess ADH
production.
Nephron conserves excess water.
Caused by head injury and lung cancers.
Serum: Hyponatremia and hypoosmolality.
1
, Urine: Hypernatremia and hyperosmolarity.
Fluid overload.
Treat with:
Free water restriction
Loop diuretic and NS
IN extremes 3% saline
Transudate pleural effusion - Correct Answer -CHF
Constrictive pericarditis
Cirrhosis
SG <1.015
Protein <3 g/dl
LDH < 200
Fluid-serum protein ratio <0.5
Fluid -serum LDH ratio <0.5
Exudate pleural effusion - Correct Answer -Lung parenchymal infection
Malignancy
PE
SG >1.015
Protein >3 g/dl
LDH >200
Fluid-serum protein ratio >0.5
Fluid-serum LDH ratio >0.5
Fibrinolysis Contraindications - Correct Answer -Absolute
Hex of cerebrovascular event (ICH, intracranial neoplasm, aneurysm, AVM)
Non-hemorrhagic stroke or head trauma <3 months ago.
Cranial or spinal trauma <2 months ago.
Known bleeding disorder.
Active internal bleeding.
Relative
Hex of severe/poorly controlled HTN or severe, uncontrolled arterial HTN SBP>180 and
DBP >110
Ischemic stroke >3 months ago.
Trauma or major surgery in the last 3 weeks.
Puncture of a non-compressible vessel.
Hemorrhagic ophthalmic condition.
PT >15 sec or current use of anticoagulants.
Known or suspected pregnancy.
Subarachnoid hemorrhage (SAH) - Correct Answer -Bleeding into the subarachnoid space
secondary to a cerebral aneurysm or head injury.
Thunder clap headache.
Vomiting. Confusion/LOC.
Seizures.
Treatment:
BP Control
2
Critical-Care Nurses – Comprehensive Study Notes and Practice
Preparation Material
Cushing's Syndrome/Disease - Correct Answer -cortisol excess typically caused by pituitary
adenoma 60-70% of cases.
Central obesity w/ extremity wasting.
Dorsocervical fat pad.
Rounded faces.
Spontaneous bruising.
Purple striate
Hyperpigmentation
Poor wound healing/ skin infections.
Dexamethasone suppression test.
1mg dexamethasone at 2300 hours and measure serum cortisol at 0800.
Remove sources of excess and manage consequences (HTN, hypokalemia, and
hyperglycemia.)
Addison's disease - Correct Answer -Primary
Caused by damage to the adrenal cortex (autoimmune, TB, metastatic disease, deposition
diseases, and drug induced) leading to a decrease in cortisol production.
Secondary
Caused by pituitary failure to release ACTH (in any hypopituitary disorder) causing a
decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol production
from induced corticosteroid suppression.
Diabetes insipidus (DI) - Correct Answer -Insufficient ADH or decreased sensitivity to ADH
Nephron cannot conserve water.
Commonly caused by damage to the pituitary gland or hypothalamus (surgery, tumor,
meningitis, head injury).
Can be nephrogenic where the kidney in unable to respond to ADH.
Serum: Hypernatremia and hyperosmolarity.
Urine: Hyponatremia and hypoosmolality.
Replaced ADH and supportive fluid replacement.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) - Correct Answer -Excess ADH
production.
Nephron conserves excess water.
Caused by head injury and lung cancers.
Serum: Hyponatremia and hypoosmolality.
1
, Urine: Hypernatremia and hyperosmolarity.
Fluid overload.
Treat with:
Free water restriction
Loop diuretic and NS
IN extremes 3% saline
Transudate pleural effusion - Correct Answer -CHF
Constrictive pericarditis
Cirrhosis
SG <1.015
Protein <3 g/dl
LDH < 200
Fluid-serum protein ratio <0.5
Fluid -serum LDH ratio <0.5
Exudate pleural effusion - Correct Answer -Lung parenchymal infection
Malignancy
PE
SG >1.015
Protein >3 g/dl
LDH >200
Fluid-serum protein ratio >0.5
Fluid-serum LDH ratio >0.5
Fibrinolysis Contraindications - Correct Answer -Absolute
Hex of cerebrovascular event (ICH, intracranial neoplasm, aneurysm, AVM)
Non-hemorrhagic stroke or head trauma <3 months ago.
Cranial or spinal trauma <2 months ago.
Known bleeding disorder.
Active internal bleeding.
Relative
Hex of severe/poorly controlled HTN or severe, uncontrolled arterial HTN SBP>180 and
DBP >110
Ischemic stroke >3 months ago.
Trauma or major surgery in the last 3 weeks.
Puncture of a non-compressible vessel.
Hemorrhagic ophthalmic condition.
PT >15 sec or current use of anticoagulants.
Known or suspected pregnancy.
Subarachnoid hemorrhage (SAH) - Correct Answer -Bleeding into the subarachnoid space
secondary to a cerebral aneurysm or head injury.
Thunder clap headache.
Vomiting. Confusion/LOC.
Seizures.
Treatment:
BP Control
2
