Practice Test 1 CCRN (Pass CCRN)
A patient has CSF leaking from their nose after a transsphenoidal hypophysectomy, what do you do? -
ANSWER-It is normal to have a CSF leak for 48 hrs after surgery. Cover with a sterile "moustache" 2x2
tapes under their nose to form a barrier.
If your dura is not intact that you would expect a leak, but it does increase your risk of infection
A pneumothorax caused by the ventilator is what? - ANSWER-Result of barotrauma- the vent pushes air
into the pleural space with each breath and because the parietal pleura is not open (like with a
puncture) there is no where for the air to go- so you get a tension pneumothorax
A simple way to estimate CVP is to add 5 cm to the measured height that the jugular veins are distended
above the sternal angle (angle of Louis) with the patient in a 45-degree angle - ANSWER-
ACE-I can cause what electrolyte imbalance? - ANSWER-Hyperkalemia- Prevent angio 1 from converting
to angio II. Angio II usually blocks aldosterone and cause vasoconstriction. Aldosterone usually holds on
to Na and H2O in exchange for K (excretes it), but since you don't have it you get rid of Na and H20 and
hold on to K
Actual problems are worse than potential problems!! - ANSWER-
Advantages of an IABP vs pressors? - ANSWER-If you have a hypotensive patient with high afterload
giving them pressors will increase SVR, work on the heart, and myocardial oxygen consumption. IABP
increases coronary artery perfusion and myocardial oxygen without increasing afterload or decreasing
BP
Anterior wall MI - ANSWER-V2, V3, V4
Bleeding time is a reflection of what? - ANSWER-Platelet function. Clopidogrel and abciximab are
specifically platelet aggregation inhibitors. Heparin is an indirect thrombin inhibitor, but it also inhibits
platelet aggregation
BNP is secreted in response to? - ANSWER-Ventricular wall stretch
, Practice Test 1 CCRN (Pass CCRN)
Diastolic murmurs are always pathologic. Systolic murmurs can be pathologic (related to valve disease or
septal defects) or they can be functional related to turbulence of blood flow - ANSWER-
Dobutamine is the drug of choice for cardiogenic shock - ANSWER-Beta-adrenergic stimulant, increases
HR and contractility
Drugs that may cause torsades de pointes - ANSWER-Amitriptyline (Elavil) causes QT interval
prolongation and may cause torsades . Other drugs- Class IA antidysrhythmics (e.g., procainamide,
quinidine, and disopyramide), Class III antidysrhythmics (e.g., sotalol and amiodarone), tricyclic
antidepressants (e.g., imipramine [Tofranil]), and phenothiazines (e.g., chlorpromazine [Thorazine])
Every 1 inch increase in abdominal girth equates to how much blood accumulation in the abdomen -
ANSWER-500-1000mL
Giving a malnourished patient adequate nutrition may result in what electrolyte disturbance? -
ANSWER-Severe phosphate deficiency. This often is called refeeding syndrome. Nutritional support
allows the cells to begin making more adenosine triphosphate (ATP), and phosphate supplies are
depleted. The same thing happens in diabetic ketoacidosis with treatment when insulin allows glucose
to move into the cell increasing production of ATP and depletion of phosphate.
How can you differentiate the cause of jaundice? - ANSWER-An increase in direct bilirubin is associated
with biliary obstruction because direct bilirubin is conjugated. An increase in indirect bilirubin is
associated with hepatic disease or excessive hemolysis because indirect bilirubin is unconjugated
How do you manage fluid status in a patient with a subarachnoid hemorrhage? - ANSWER-You keep the
patient hypervolemic with a PAOP (LV preload) greater than 12mmHg (normal is 8-12). Keeping them
hypervolemic aids in the prevention and treatment of vasospam, which increases the morbidity
How do you treat oversensing - ANSWER-Decrease the sensitivity if causing failure to fire
How does hypoxemia affect pulmonary vascular pressures? - ANSWER-It causes the vasculature to
constrict, which can lead to pulmonary hypertension
A patient has CSF leaking from their nose after a transsphenoidal hypophysectomy, what do you do? -
ANSWER-It is normal to have a CSF leak for 48 hrs after surgery. Cover with a sterile "moustache" 2x2
tapes under their nose to form a barrier.
If your dura is not intact that you would expect a leak, but it does increase your risk of infection
A pneumothorax caused by the ventilator is what? - ANSWER-Result of barotrauma- the vent pushes air
into the pleural space with each breath and because the parietal pleura is not open (like with a
puncture) there is no where for the air to go- so you get a tension pneumothorax
A simple way to estimate CVP is to add 5 cm to the measured height that the jugular veins are distended
above the sternal angle (angle of Louis) with the patient in a 45-degree angle - ANSWER-
ACE-I can cause what electrolyte imbalance? - ANSWER-Hyperkalemia- Prevent angio 1 from converting
to angio II. Angio II usually blocks aldosterone and cause vasoconstriction. Aldosterone usually holds on
to Na and H2O in exchange for K (excretes it), but since you don't have it you get rid of Na and H20 and
hold on to K
Actual problems are worse than potential problems!! - ANSWER-
Advantages of an IABP vs pressors? - ANSWER-If you have a hypotensive patient with high afterload
giving them pressors will increase SVR, work on the heart, and myocardial oxygen consumption. IABP
increases coronary artery perfusion and myocardial oxygen without increasing afterload or decreasing
BP
Anterior wall MI - ANSWER-V2, V3, V4
Bleeding time is a reflection of what? - ANSWER-Platelet function. Clopidogrel and abciximab are
specifically platelet aggregation inhibitors. Heparin is an indirect thrombin inhibitor, but it also inhibits
platelet aggregation
BNP is secreted in response to? - ANSWER-Ventricular wall stretch
, Practice Test 1 CCRN (Pass CCRN)
Diastolic murmurs are always pathologic. Systolic murmurs can be pathologic (related to valve disease or
septal defects) or they can be functional related to turbulence of blood flow - ANSWER-
Dobutamine is the drug of choice for cardiogenic shock - ANSWER-Beta-adrenergic stimulant, increases
HR and contractility
Drugs that may cause torsades de pointes - ANSWER-Amitriptyline (Elavil) causes QT interval
prolongation and may cause torsades . Other drugs- Class IA antidysrhythmics (e.g., procainamide,
quinidine, and disopyramide), Class III antidysrhythmics (e.g., sotalol and amiodarone), tricyclic
antidepressants (e.g., imipramine [Tofranil]), and phenothiazines (e.g., chlorpromazine [Thorazine])
Every 1 inch increase in abdominal girth equates to how much blood accumulation in the abdomen -
ANSWER-500-1000mL
Giving a malnourished patient adequate nutrition may result in what electrolyte disturbance? -
ANSWER-Severe phosphate deficiency. This often is called refeeding syndrome. Nutritional support
allows the cells to begin making more adenosine triphosphate (ATP), and phosphate supplies are
depleted. The same thing happens in diabetic ketoacidosis with treatment when insulin allows glucose
to move into the cell increasing production of ATP and depletion of phosphate.
How can you differentiate the cause of jaundice? - ANSWER-An increase in direct bilirubin is associated
with biliary obstruction because direct bilirubin is conjugated. An increase in indirect bilirubin is
associated with hepatic disease or excessive hemolysis because indirect bilirubin is unconjugated
How do you manage fluid status in a patient with a subarachnoid hemorrhage? - ANSWER-You keep the
patient hypervolemic with a PAOP (LV preload) greater than 12mmHg (normal is 8-12). Keeping them
hypervolemic aids in the prevention and treatment of vasospam, which increases the morbidity
How do you treat oversensing - ANSWER-Decrease the sensitivity if causing failure to fire
How does hypoxemia affect pulmonary vascular pressures? - ANSWER-It causes the vasculature to
constrict, which can lead to pulmonary hypertension
