2024-2025 PASS The CCRN Questions With
100% Correct Answers
A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and states that
he has a headache and nausea. He states 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 reduce the diastolic pressure to 100 with IV
antihypertensive meds, followed by a slow reduction in the diastolic pressure to 85 with
oral antihypertensive meds. A maximal initial reduction not to exceed more than 25%
reduction from the initial presenting value. If the blood pressure is reduced too quickly,
the patient can develop cerebral edema or renal failure.
A patient is in sepsis and receives Lactated ringers 500ml IV bolus. Which finding
indicates this intervention is having its intended effect? - 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-yr male patient has been in the ICU for 6 days and has been on the ventilator since
his admission for the treatment of a COPD exacerbation. He has been receiving VTE
prophylaxis and subcutaneous heparin. Today his platelet count dropped significantly to
43000 and was found to have new DVT on his right upper extremity. What do you
suspect is the most likely cause of these findings? - Answer HIT
The typical sign of HIT involves a platelet count drop, with a significant decrease of
more than 50% occurring within 5-10 days of the administration of heparin. New
development of DVT despite being on VTE prophylaxis is another classic sign.
TRALI: - A complication arising due to a blood transfusion reaction, leading to acute
lung injury, typically within 6 hours of a blood transfusion.
,2 Hallmark signs of HIT: - 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? - 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 results in a fall in the SV and CO. As a consequence, HR and SV
rise as compensatory mechanism in order to maintain CO and MAP and cerebral
perfusion.
Post-renal failure values - 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 usually 1-40 mEq/L.
What to do if HIT: - Answer Stop Heparin and give an alternative direct thrombin
inhibitor.
Warfarin is contraindicated in HIT? T/F - Answer True - also no evidence that protamine,
corticosteroids, and benadryl are effective in the treatment of HIT
Patients with right ventricular infarctions become preload dependent. Meds that
decrease preload should be avoided - which meds are these? - Answer Morphine, Nitro,
Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - Answer Magnesium
Myocardial contusions generally impact which parts of the heart? and what would the
values be? - 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? - Answer CVP: 3, CI: 2.5, SVR: 650, SBP: 88
Neuroshock is associated with a loss of sympathetic tone that results in profound
peripheral vasodilation. Clinical manifestations include hypotension, a low SVR, low
CVP and a low normal CI
What would cause an A wave larger than normal on a PAOP? - Answer Mitral stenosis -
from increased left atrial pressure during atrial contraction.
Pulmonary HTN will cause what? - Answer Elevates PA pressures but have no affect on
PAOP.
What type of impairment might Infective Endocarditis cause? -Answer Neurologic
impairment. A known risk from infective endocarditis is that the bacterial strand breaks
in the heart and throws 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 of? -Answer Embolic ischemic stroke.
Name the type of meds that should be avoided post bariatric surgery. - Answer
Extended release meds due to absorption concerns post-operatively
Chlorpropamide is a _______. - Answer sulfonylurea drug that is used in DI as an
antidiuretic. It is mainly a glucose lowering agent. (hypoglycemia)
Will a cardiac transplant patient respond to atropine? - Answer No - pacing is the best
instrument for symptomatic bradycardia.
100% Correct Answers
A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and states that
he has a headache and nausea. He states 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 reduce the diastolic pressure to 100 with IV
antihypertensive meds, followed by a slow reduction in the diastolic pressure to 85 with
oral antihypertensive meds. A maximal initial reduction not to exceed more than 25%
reduction from the initial presenting value. If the blood pressure is reduced too quickly,
the patient can develop cerebral edema or renal failure.
A patient is in sepsis and receives Lactated ringers 500ml IV bolus. Which finding
indicates this intervention is having its intended effect? - 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-yr male patient has been in the ICU for 6 days and has been on the ventilator since
his admission for the treatment of a COPD exacerbation. He has been receiving VTE
prophylaxis and subcutaneous heparin. Today his platelet count dropped significantly to
43000 and was found to have new DVT on his right upper extremity. What do you
suspect is the most likely cause of these findings? - Answer HIT
The typical sign of HIT involves a platelet count drop, with a significant decrease of
more than 50% occurring within 5-10 days of the administration of heparin. New
development of DVT despite being on VTE prophylaxis is another classic sign.
TRALI: - A complication arising due to a blood transfusion reaction, leading to acute
lung injury, typically within 6 hours of a blood transfusion.
,2 Hallmark signs of HIT: - 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? - 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 results in a fall in the SV and CO. As a consequence, HR and SV
rise as compensatory mechanism in order to maintain CO and MAP and cerebral
perfusion.
Post-renal failure values - 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 usually 1-40 mEq/L.
What to do if HIT: - Answer Stop Heparin and give an alternative direct thrombin
inhibitor.
Warfarin is contraindicated in HIT? T/F - Answer True - also no evidence that protamine,
corticosteroids, and benadryl are effective in the treatment of HIT
Patients with right ventricular infarctions become preload dependent. Meds that
decrease preload should be avoided - which meds are these? - Answer Morphine, Nitro,
Beta blockers and diuretics.
Polymorphic ventricular tachycardia aka Torsades is treated by? - Answer Magnesium
Myocardial contusions generally impact which parts of the heart? and what would the
values be? - 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? - Answer CVP: 3, CI: 2.5, SVR: 650, SBP: 88
Neuroshock is associated with a loss of sympathetic tone that results in profound
peripheral vasodilation. Clinical manifestations include hypotension, a low SVR, low
CVP and a low normal CI
What would cause an A wave larger than normal on a PAOP? - Answer Mitral stenosis -
from increased left atrial pressure during atrial contraction.
Pulmonary HTN will cause what? - Answer Elevates PA pressures but have no affect on
PAOP.
What type of impairment might Infective Endocarditis cause? -Answer Neurologic
impairment. A known risk from infective endocarditis is that the bacterial strand breaks
in the heart and throws 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 of? -Answer Embolic ischemic stroke.
Name the type of meds that should be avoided post bariatric surgery. - Answer
Extended release meds due to absorption concerns post-operatively
Chlorpropamide is a _______. - Answer sulfonylurea drug that is used in DI as an
antidiuretic. It is mainly a glucose lowering agent. (hypoglycemia)
Will a cardiac transplant patient respond to atropine? - Answer No - pacing is the best
instrument for symptomatic bradycardia.
