CCRN Questions
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 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?
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 -
A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate
that this intervention is having it's intended effect?
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. -
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?
is a complication from a blood transfusion reaction, which causes acute lung injury typically within
6 hours of a blood transfusion. -
TRALI:
Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis. -
2 Hallmark signs of HIT:
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. -
Values in Early compensated Hypovolemic shock?
Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1.010
1
,BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is
typically 1-40 mEq/L. -
Post-renal failure values:
Stop Heparin and administer an alternative direct thrombin inhibitor. -
What to do in the event of HIT:
True - there is also no evidence that shows protamine, corticosteroids, and benadryl are effective
treatments for HIT -
Warfarin is contraindicated in HIT? T/F
Morphine, Nitro, Beta blockers and diuretics. -
Patients with right ventricular infarctions become preload dependent. Meds that
decrease preload should be avoided - which meds are these?
Magnesium -
Polymorphic ventricular tachycardia aka Torsades is treated by?
Atria & right ventricle because of the position of the heart in the chest.
PAOP 6, PA Pressure 40/24, RA Pressure 16 -
Myocardial contusions generally impact which parts of the heart? and what would the
values be?
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 -
Neurogenic shock signs?
Mitral stenosis - causes increased left atrial pressure during atrial contraction. -
What causes a larger than normal A wave on a PAOP?
Elevated PA pressures but have no impact on PAOP. -
Pulmonary HTN will result in what?
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. -
Infective Endocarditis can cause what kind of impairment?
Embolic ischemic stroke. -
Neurologic impairment could be a sign?
Extended release meds due to absorption concerns post-operatively -
Post bariatric surgery should avoid what kind of meds?
2
, sulfonylurea drug that is used in DI as an antidiuretic. It is primarily a glucose lowering agent.
(hypoglycemia) -
Chlorpropamide is a what?
No - pacing is the best instrument for symptomatic bradycardia. -
Will a cardiac transplant patient respond to atropine?
SIADH - causes retention of water. Urine production is minimal and concentrated & leads to an
increased urine osmolality. -
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is
what symptom?
SVR - Peripheral constriction -
What does Neo drug increase?
Administer 6mg adenosine rapidly IVP -
Treatment for narrow complex, regular rhythm?
6 hours - close monitoring is required to ensure the blood glucose level does not climb too quickly
while dextrose is being administered. -
Half life of metformin?
Record a daily weight at the same time each day. -
Most accurate reflection of daily fluid balance?
Cardiac tamponade -
Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs of
what?
Help maintaining a safe environment. HypoNa impairs judgment, and causes confusion. -
A patient with hyponatremia would need what?
Diffusion and osmosis. -
Peritoneal dialysis works on the principles of both?
Large fluid deficits and may require multiple liters of fluid, which is determined by the patient's
level of dehydration and hyperosmolality. -
HHNS leads to what?
Decrease in SBP>10 during inspiration. -
What parameters are consistent with Pulsus Paradoxes?
Lower the BP to at least 185/110. An elevated BP prior to rtPA can cause hemorrhage. -
Before administering rtPA what must happen?
Torsades -
Ibutilide can cause what?
3
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 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?
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 -
A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate
that this intervention is having it's intended effect?
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. -
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?
is a complication from a blood transfusion reaction, which causes acute lung injury typically within
6 hours of a blood transfusion. -
TRALI:
Decrease in platelet count over a 24 hr period.
New development of DVT despite being on VTE prophylaxis. -
2 Hallmark signs of HIT:
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. -
Values in Early compensated Hypovolemic shock?
Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1.010
1
,BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is
typically 1-40 mEq/L. -
Post-renal failure values:
Stop Heparin and administer an alternative direct thrombin inhibitor. -
What to do in the event of HIT:
True - there is also no evidence that shows protamine, corticosteroids, and benadryl are effective
treatments for HIT -
Warfarin is contraindicated in HIT? T/F
Morphine, Nitro, Beta blockers and diuretics. -
Patients with right ventricular infarctions become preload dependent. Meds that
decrease preload should be avoided - which meds are these?
Magnesium -
Polymorphic ventricular tachycardia aka Torsades is treated by?
Atria & right ventricle because of the position of the heart in the chest.
PAOP 6, PA Pressure 40/24, RA Pressure 16 -
Myocardial contusions generally impact which parts of the heart? and what would the
values be?
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 -
Neurogenic shock signs?
Mitral stenosis - causes increased left atrial pressure during atrial contraction. -
What causes a larger than normal A wave on a PAOP?
Elevated PA pressures but have no impact on PAOP. -
Pulmonary HTN will result in what?
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. -
Infective Endocarditis can cause what kind of impairment?
Embolic ischemic stroke. -
Neurologic impairment could be a sign?
Extended release meds due to absorption concerns post-operatively -
Post bariatric surgery should avoid what kind of meds?
2
, sulfonylurea drug that is used in DI as an antidiuretic. It is primarily a glucose lowering agent.
(hypoglycemia) -
Chlorpropamide is a what?
No - pacing is the best instrument for symptomatic bradycardia. -
Will a cardiac transplant patient respond to atropine?
SIADH - causes retention of water. Urine production is minimal and concentrated & leads to an
increased urine osmolality. -
Elevated urine osmolality; decreased serum osmolality; and decreased serum sodium is
what symptom?
SVR - Peripheral constriction -
What does Neo drug increase?
Administer 6mg adenosine rapidly IVP -
Treatment for narrow complex, regular rhythm?
6 hours - close monitoring is required to ensure the blood glucose level does not climb too quickly
while dextrose is being administered. -
Half life of metformin?
Record a daily weight at the same time each day. -
Most accurate reflection of daily fluid balance?
Cardiac tamponade -
Wide mediastinum on chest x-ray, narrow pulse pressure, and hypotension are signs of
what?
Help maintaining a safe environment. HypoNa impairs judgment, and causes confusion. -
A patient with hyponatremia would need what?
Diffusion and osmosis. -
Peritoneal dialysis works on the principles of both?
Large fluid deficits and may require multiple liters of fluid, which is determined by the patient's
level of dehydration and hyperosmolality. -
HHNS leads to what?
Decrease in SBP>10 during inspiration. -
What parameters are consistent with Pulsus Paradoxes?
Lower the BP to at least 185/110. An elevated BP prior to rtPA can cause hemorrhage. -
Before administering rtPA what must happen?
Torsades -
Ibutilide can cause what?
3
