CCRN EXAM QUESTIONS WITH THE
LATEST AND UPDATED
SCORE(100% PASS)
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.
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 mEq/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.
LATEST AND UPDATED
SCORE(100% PASS)
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.
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 mEq/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.
