PASS the CCRN! Questions
What is the Z point technique? - is a method used to estimate ventricular end diastolic pressure. It
is taken just before the closure of the mitral valve and is especially useful when an A wave does not exist
on the PAOP tracing such as in atrial fib.
CDC indications for urinary catheter include: - end-of-life care, strict I&O, immobility, select
surgical procedures, sacral wounds, urinary retention/obstruction
Warfarin is contraindicated in HIT? T/F - True - there is also no evidence that shows protamine,
corticosteroids, and benadryl are effective treatments for HIT
HHNS leads to what? - Large fluid deficits and may require multiple liters of fluid, which is
determined by the patient's level of dehydration and hyperosmolality.
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? - 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: - 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: - Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
,Values in Early compensated Hypovolemic shock? - 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.
Post-renal failure values: - 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
mEq/L.
What to do in the event of HIT: - Stop Heparin and administer an alternative direct thrombin
inhibitor.
Patients with right ventricular infarctions become preload dependent. Meds that decrease preload
should be avoided - which meds are these? - Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - Magnesium
Myocardial contusions generally impact which parts of the heart? and what would the values be? -
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? - 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? - Mitral stenosis - causes increased left
atrial pressure during atrial contraction.
, Pulmonary HTN will result in what? - Elevated PA pressures but have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment? - 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? - Embolic ischemic stroke.
Post bariatric surgery should avoid what kind of meds? - Extended release meds due to
absorption concerns post-operatively
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? - 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.
Chlorpropamide is a what? - 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? - No - pacing is the best instrument for
symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is what symptom?
- SIADH - causes retention of water. Urine production is minimal and concentrated & leads to an
increased urine osmolality.
What does Neo drug increase? - SVR - Peripheral constriction
What is the Z point technique? - is a method used to estimate ventricular end diastolic pressure. It
is taken just before the closure of the mitral valve and is especially useful when an A wave does not exist
on the PAOP tracing such as in atrial fib.
CDC indications for urinary catheter include: - end-of-life care, strict I&O, immobility, select
surgical procedures, sacral wounds, urinary retention/obstruction
Warfarin is contraindicated in HIT? T/F - True - there is also no evidence that shows protamine,
corticosteroids, and benadryl are effective treatments for HIT
HHNS leads to what? - Large fluid deficits and may require multiple liters of fluid, which is
determined by the patient's level of dehydration and hyperosmolality.
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? - 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: - 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: - Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis.
,Values in Early compensated Hypovolemic shock? - 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.
Post-renal failure values: - 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
mEq/L.
What to do in the event of HIT: - Stop Heparin and administer an alternative direct thrombin
inhibitor.
Patients with right ventricular infarctions become preload dependent. Meds that decrease preload
should be avoided - which meds are these? - Morphine, Nitro, Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - Magnesium
Myocardial contusions generally impact which parts of the heart? and what would the values be? -
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? - 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? - Mitral stenosis - causes increased left
atrial pressure during atrial contraction.
, Pulmonary HTN will result in what? - Elevated PA pressures but have no impact on PAOP.
Infective Endocarditis can cause what kind of impairment? - 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? - Embolic ischemic stroke.
Post bariatric surgery should avoid what kind of meds? - Extended release meds due to
absorption concerns post-operatively
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? - 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.
Chlorpropamide is a what? - 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? - No - pacing is the best instrument for
symptomatic bradycardia.
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is what symptom?
- SIADH - causes retention of water. Urine production is minimal and concentrated & leads to an
increased urine osmolality.
What does Neo drug increase? - SVR - Peripheral constriction
