CCRN Exam Questions and Answers 100% Pass

CCRN Exam Questions and Answers 100% Pass SIADH - Answer- increased ADH level, holding on to too much water, dilutional hyponatremia. Decreased osmolarity=hypoosmolar. Decreased urinary output. CSF normal protein, glucose, WBCs, specific gravity, - Answer- Protein <100, Glucose: 70 WBCs: 4 cells/mm2 Specific gravity 1.007 Poikothermia - Answer- fluctuation of core body temperature of more than 2° C due to changes in ambient room temperature pathophysiology of a seizure - Answer- neurons in the cerebral cortex fire at the same time in a paroxysmal burst. System driven outcome - Answer- include length of stay, readmission rate, and resource utilization. Arterial supply to the brain: vertebrobasilar, common carotid, meningeal arteries - Answer- The vertebrobasilar arteries supply the posterior portion of the brain. The common carotid arteries supply the anterior area of the brain. The meningeal arteries supply the superior portion of the brain. Pheochromocytoma - Answer- a benign tumor of the adrenal medulla, causing hyper- secretion of epi/norepi. s/s: hypertension, sweating, headache, palpitations, apprehension, nausea/vomiting, tremor, pallor, abdominal pain, chest pain, and hyperglycemia. Acute radiation syndrome - Answer- what occurs in humans after whole body reception of large doses of ionizing radiation delivered over a short period of time. Circulatory collapse, increased intracranial pressure, vasculitis, and meningitis causing death within 3 days Complications of SIADH - Answer- seizure activity Treatment of SIADH (avoid what solutions?) - Answer- Fluid restriction 3% nacl (1500 osmolarity over 25cc/hr or less) Dont do hypotonic solutions! Asses for fluid overload hypertonic solutions - Answer- D5LR; D5 1/2 NS; D5NS hypotonic solutions - Answer- 0.5% NS (HNS or 0.45% NS); 2.5% dextrose in 0.45% NS (D2.5 45% NS) Osmolality and Sodium - Answer- 275-295= normal osmolality. Sodium=135-145. Usually two times the sodium Causes of SIADH - Answer- Viral PNA Oat cell carcinoma Head problems Increased serum osmolality Anesthesia and analgesics Stress Diabetes insipidus (urine specific gravity?) - Answer- No ADH, can't keep water, increased UOP. Hypernatremic, hyperosmolar, increased urinary output (6-24L a day of clear urine) urine specific gravity 1.001-1.005 Severe hypovolemia Causes of diabetes insipidus (what medication?) - Answer- Head problem Dilantin (DI) Treatment of diabetes insipidus (medication, fluid, monitoring x2) - Answer- Pitressin/vasopressin (same as ADH) Give fluids (increase intravascular volume) Monitor urine specific gravity EKG monitor for ischemia Hypoglycemia s/s - Answer- Low blood sugar- adrenaline released- liver converts glycogen into glucose, so: Tachycardia, palpitations, diaphoresis, irritable, restlessness Confusion, lethargy, slurred speech, seizure, coma, death. IF YOU ARE IN A BETA ADRENERGIC BLOCKER, you only see the CNS symptoms DKA (BS, breathing, acid vs K) - Answer- Blood Sugar 400 to 900, Dehydration, No insulin, Ketones, Kussmaul breathing (deep labored breathing). Whenever you see a high acid level you therefore see a high potassium level. For every drop of 0.1 in pH you see an increase by 0.6 of potassium HHNK (who gets, BS, breaths) - Answer- Hyperglycemic hyperosmolar non-ketotic coma. Common with old age, diet controlled diabetics, TPN patients, who get a lot of inteavascular sugar, and pancreatitis as pancreas is eating itself, does not work properly. Blood sugar , severe dehydration, about 6 to 10 Liters behind. Patient still makes insulin, so it can occur over months, preventing the breakdown of fats which causes no acidosis, little tiny baby breaths. Treatment DKA - Answer- insulin (a lot) A fair amount fluids first saline and then D5 1/2 NS Treatment HHNK - Answer- Only a little insulin A lot if fluids Leukopenia - Answer- Abnormally low WBC count < 5000. Caused by viral illness, bone marrow disorder or medications such as chemotherapy, HIV regimens, lupus and its meds, antibiotics such as bactrim and immunosuppressive meds. Patients present with malaise, chills, fever. Patients should have neutropenic precautions, assess root cause and delay treatment if necessary until levels are higher, steroids and monitoring. TIA - Answer- Can be a result of ischemic or hemorrhagic causes. Symptoms get better in 24 hours RIND (stands for) - Answer- Reversible ischemic neurological deficit. Can be a result of ischemic or hemorrhagic causes. Usually takes 3 months or more to improve Cerebral infarct (which artery, consequences) - Answer- Caused by a problem with the basal vertebral artery, leads to decreased blood flow to the brain stem or decreased blood flow to the carotid artery (depending on side, get hemi everything, 25% get hemianopsia) CVA goal, how is it done? - Answer- Decrease cerebral edema. Feed patients or their protein levels fall causing shifts into the cell. Cerebral perfusion pressure - Answer- MAP-ICP=CPP 70-95 Decorticating posturing - Answer- Occurs with injury to the cerebral cortex. Less severe Decerebrate posturing - Answer- Occurs with injury to the brain stem (midbrain, pons, medulla). More severe Brain death - Answer- a diagnosis of death based on the cessation of all signs of brain activity, as measured by electrical brain waves x30 min. encephalopathy - Answer- a disease in which the functioning of the brain is affected by vaso-spasm, ischemia, cerebral edema, hemorrhage, liver or kidney disease or increased ammonia level. Patient has confusion, lethargy, altered mental status. Must decrease ammonia to maintain mental status. ICH (Intracerebral hemorrhage) deficits first seen, diagnosis, treatment? - Answer- Bleeding into the parenchyma of the brain, caused by trauma, tumors, bleeding disorders, anticoagulant therapy or hypertension. HA, decreased LOC, progressing to deep coma, contralateral hemiplegia, ipsilateral dilated pupil, eventually trans-tentorial herniation. Diagnosed by CT(shows increased density and shift)/MRI(shows hematoma and associated edema). Treatment: based on location and extent. Surgery rarely improves neurological outcomes. Patients most often treated with medical management of increased ICP. Intraventricular hemorrhage (causes, treatment x3, monitoring) - Answer- Bleeding within ventricle of brain, Caused by trauma, neoplasm, AVM, HTN, aneurysm. Treatment: Correct coagulopathy, treat SBP> 180 mm Hg or DBP> 105 mm Hg Target SBP ≤ 150 mm Hg. Administer anti seizure medication. Monitor hematoma expansion with daily CT. If hydrocephalus suspected, placement of ventriculostomy drain and monitoring of ICP may be necessary. ICP= 70-95 subarachnoid hemorrhage (s/s, causes, diagnosis, treatment, complications) - Answer- Bleeding where the cerebrospinal fluid circulates. Cause