PASS the CCRN! Questions with correct
answers 2025
Av56vyr-
oldvmalevisvadmittedvtovthevICUvwithvavbloodvpressurevofv225/135vandvcomplainsvofvavheadachevan
dvnausea.vHevreportsvhevranvoutvofvbloodvpressurevmedsvthreevdaysvago,vbutvalsovappearsvtovbevco
nfusedvtovthevdatevandvsituation.vWhatvisvthevmostvappropriatevtreatmentvapproach?v-vcorrect-
answersv-
Rapidlyvlowervthevdiastolicvpressurevtov100vwithvIVvantihypertensivevmeds,vthenvcontinuevtovgrad
uallyvreducevthevdiastolicvpressurevtov85vwithvoralvantihypertensivevmeds.v
Thevmaximumvinitialvdecreasevshouldvbevnovmorevthanv25%vreductionvfromvinitialvpresentingvvalu
e.vReducingvthevbloodvpressurevtoovquicklyvcanvleadvtovcerebralvedemavorvrenalvfailure.
Avpatientvhasvsepsis,vreceivesvLactatedvringersv500mlvIVvbolus.vWhichvfindingvindicatevthatvthisvint
erventionvisvhavingvit'svintendedveffect?v-vcorrect-answersv-ScvO2vofv72%
Earlyvgoalvdirectedvtherapyvforvsepsisvincludesvearlyvfluidvresuscitationvatv30vml/kgvtovmaintainvavC
VPvofv8-12vorv12-
15vifvmechanicallyvventilated,vMAPvgreatervthanv65,vScvO2vgreatervthanv70%,vandvurinevoutputvgr
eatervthanv0.5vkg/hr
72vmalevpatientvinvICUvforv6vdaysvonvthevventilatorvforvtreatmentvofvavCOPDvexacerbation.vHevhasvb
eenvreceivingvVTEvprophylaxisvandvsubcutaneousvHeparinvsincevadmission.vTodayvhisvplateletvcou
,ntvdecreasedvsignificantlyvtov43,000vandvwasvfoundvtovhavevnewvDVTvonvhisvrightvuppervextremity.v
Whatvdovyouvsuspectvisvthevmostvlikelyvcausevofvthesevfindings?v-vcorrect-answersv-HIT
ThevhallmarkvsignvofvHITvisvavsignificantvdecreasevinvplateletvcountvovervav24vhoursvperiodv(>50%)v
withinv5-
10vdaysvofvadministeringvHeparin.vThevothervhallmarkvsignvisvavnewvdevelopmentvofvDVTvdespitevb
eingvonvVTEvprophylaxis.
TRALI:v-vcorrect-answersv-
isvavcomplicationvfromvavbloodvtransfusionvreaction,vwhichvcausesvacutevlungvinjuryvtypicallyvwithi
nv6vhoursvofvavbloodvtransfusion.
2vHallmarkvsignsvofvHIT:v-vcorrect-answersv-Decreasevinvplateletvcountvovervav24vhrvperiod.
NewvdevelopmentvofvDVTvdespitevbeingvonvVTEvprophylaxis.
ValuesvinvEarlyvcompensatedvHypovolemicvshock?v-vcorrect-answersv-
COv4.0vL/min,vHRv135,vSVv65,vSVRv1700,vMAPv65
Invhypovolemicvstates,vcirculatingvvolumevisvdepletedvthereforevpreloadvandvcontractilityvarevdecr
easedvwhichvleadsvtovavdecreasevinvSVvandvCO.vHRvandvSVvincreasevasvcompensatoryvmeasurevtovp
reservevCO,vMAPvandvcerebralvperfusion.
Post-renalvfailurevvalues:v-vcorrect-answersv-
Urinevoutputv<v200;vurinevsodiumv30;vBUN:vCreatininevratiov15:1;vurinevspecificvgravityv1.010
BUN:vCreatininevratiovisv15:1,vbutvbothvthevBUNv&vcreatininevarevelevated.vUrinevsodiumvisvtypicall
yv1-40vmEq/L.
WhatvtovdovinvtheveventvofvHIT:v-vcorrect-answersv-
StopvHeparinvandvadministervanvalternativevdirectvthrombinvinhibitor.
, WarfarinvisvcontraindicatedvinvHIT?vT/Fv-vcorrect-answersv-Truev-
vtherevisvalsovnovevidencevthatvshowsvprotamine,vcorticosteroids,vandvbenadrylvareveffectivevtreat
mentsvforvHIT
Patientsvwithvrightvventricularvinfarctionsvbecomevpreloadvdependent.vMedsvthatvdecreasevpreloa
dvshouldvbevavoidedv-vwhichvmedsvarevthese?v-vcorrect-answersv-
Morphine,vNitro,vBetavblockersvandvdiuretics.
PolymorphicvventricularvtachycardiavakavTorsadesvisvtreatedvby?v-vcorrect-answersv-Magnesium
Myocardialvcontusionsvgenerallyvimpactvwhichvpartsvofvthevheart?vandvwhatvwouldvthevvaluesvbe?
v-vcorrect-answersv-Atriav&vrightvventriclevbecausevofvthevpositionvofvthevheartvinvthevchest.v
PAOPv6,vPAvPressurev40/24,vRAvPressurev16
Neurogenicvshockvsigns?v-vcorrect-answersv-CVP:v3,vCI:v2.5,vSVR:v650,vSBP:v88
Neurovshockvisvassociatedvwithvavlossvofvsympatheticvtonevcausingvextensivevperipheralvvasodilati
on.vClinicalvsignsvandvsymptomsvincludevhypotension,vavlowvSVR,vlowvCVPvandvlowvnormalvCI
WhatvcausesvavlargervthanvnormalvAvwavevonvavPAOP?v-vcorrect-answersv-Mitralvstenosisv-
vcausesvincreasedvleftvatrialvpressurevduringvatrialvcontraction.
PulmonaryvHTNvwillvresultvinvwhat?v-vcorrect-answersv-
ElevatedvPAvpressuresvbutvhavevnovimpactvonvPAOP.
InfectivevEndocarditisvcanvcausevwhatvkindvofvimpairment?v-vcorrect-answersv-
Neurologicvimpairment.vOnevofvthevrisksvofvinfectivevendocarditisvisvthevbacterialvstrandvbreakingvi
answers 2025
Av56vyr-
oldvmalevisvadmittedvtovthevICUvwithvavbloodvpressurevofv225/135vandvcomplainsvofvavheadachevan
dvnausea.vHevreportsvhevranvoutvofvbloodvpressurevmedsvthreevdaysvago,vbutvalsovappearsvtovbevco
nfusedvtovthevdatevandvsituation.vWhatvisvthevmostvappropriatevtreatmentvapproach?v-vcorrect-
answersv-
Rapidlyvlowervthevdiastolicvpressurevtov100vwithvIVvantihypertensivevmeds,vthenvcontinuevtovgrad
uallyvreducevthevdiastolicvpressurevtov85vwithvoralvantihypertensivevmeds.v
Thevmaximumvinitialvdecreasevshouldvbevnovmorevthanv25%vreductionvfromvinitialvpresentingvvalu
e.vReducingvthevbloodvpressurevtoovquicklyvcanvleadvtovcerebralvedemavorvrenalvfailure.
Avpatientvhasvsepsis,vreceivesvLactatedvringersv500mlvIVvbolus.vWhichvfindingvindicatevthatvthisvint
erventionvisvhavingvit'svintendedveffect?v-vcorrect-answersv-ScvO2vofv72%
Earlyvgoalvdirectedvtherapyvforvsepsisvincludesvearlyvfluidvresuscitationvatv30vml/kgvtovmaintainvavC
VPvofv8-12vorv12-
15vifvmechanicallyvventilated,vMAPvgreatervthanv65,vScvO2vgreatervthanv70%,vandvurinevoutputvgr
eatervthanv0.5vkg/hr
72vmalevpatientvinvICUvforv6vdaysvonvthevventilatorvforvtreatmentvofvavCOPDvexacerbation.vHevhasvb
eenvreceivingvVTEvprophylaxisvandvsubcutaneousvHeparinvsincevadmission.vTodayvhisvplateletvcou
,ntvdecreasedvsignificantlyvtov43,000vandvwasvfoundvtovhavevnewvDVTvonvhisvrightvuppervextremity.v
Whatvdovyouvsuspectvisvthevmostvlikelyvcausevofvthesevfindings?v-vcorrect-answersv-HIT
ThevhallmarkvsignvofvHITvisvavsignificantvdecreasevinvplateletvcountvovervav24vhoursvperiodv(>50%)v
withinv5-
10vdaysvofvadministeringvHeparin.vThevothervhallmarkvsignvisvavnewvdevelopmentvofvDVTvdespitevb
eingvonvVTEvprophylaxis.
TRALI:v-vcorrect-answersv-
isvavcomplicationvfromvavbloodvtransfusionvreaction,vwhichvcausesvacutevlungvinjuryvtypicallyvwithi
nv6vhoursvofvavbloodvtransfusion.
2vHallmarkvsignsvofvHIT:v-vcorrect-answersv-Decreasevinvplateletvcountvovervav24vhrvperiod.
NewvdevelopmentvofvDVTvdespitevbeingvonvVTEvprophylaxis.
ValuesvinvEarlyvcompensatedvHypovolemicvshock?v-vcorrect-answersv-
COv4.0vL/min,vHRv135,vSVv65,vSVRv1700,vMAPv65
Invhypovolemicvstates,vcirculatingvvolumevisvdepletedvthereforevpreloadvandvcontractilityvarevdecr
easedvwhichvleadsvtovavdecreasevinvSVvandvCO.vHRvandvSVvincreasevasvcompensatoryvmeasurevtovp
reservevCO,vMAPvandvcerebralvperfusion.
Post-renalvfailurevvalues:v-vcorrect-answersv-
Urinevoutputv<v200;vurinevsodiumv30;vBUN:vCreatininevratiov15:1;vurinevspecificvgravityv1.010
BUN:vCreatininevratiovisv15:1,vbutvbothvthevBUNv&vcreatininevarevelevated.vUrinevsodiumvisvtypicall
yv1-40vmEq/L.
WhatvtovdovinvtheveventvofvHIT:v-vcorrect-answersv-
StopvHeparinvandvadministervanvalternativevdirectvthrombinvinhibitor.
, WarfarinvisvcontraindicatedvinvHIT?vT/Fv-vcorrect-answersv-Truev-
vtherevisvalsovnovevidencevthatvshowsvprotamine,vcorticosteroids,vandvbenadrylvareveffectivevtreat
mentsvforvHIT
Patientsvwithvrightvventricularvinfarctionsvbecomevpreloadvdependent.vMedsvthatvdecreasevpreloa
dvshouldvbevavoidedv-vwhichvmedsvarevthese?v-vcorrect-answersv-
Morphine,vNitro,vBetavblockersvandvdiuretics.
PolymorphicvventricularvtachycardiavakavTorsadesvisvtreatedvby?v-vcorrect-answersv-Magnesium
Myocardialvcontusionsvgenerallyvimpactvwhichvpartsvofvthevheart?vandvwhatvwouldvthevvaluesvbe?
v-vcorrect-answersv-Atriav&vrightvventriclevbecausevofvthevpositionvofvthevheartvinvthevchest.v
PAOPv6,vPAvPressurev40/24,vRAvPressurev16
Neurogenicvshockvsigns?v-vcorrect-answersv-CVP:v3,vCI:v2.5,vSVR:v650,vSBP:v88
Neurovshockvisvassociatedvwithvavlossvofvsympatheticvtonevcausingvextensivevperipheralvvasodilati
on.vClinicalvsignsvandvsymptomsvincludevhypotension,vavlowvSVR,vlowvCVPvandvlowvnormalvCI
WhatvcausesvavlargervthanvnormalvAvwavevonvavPAOP?v-vcorrect-answersv-Mitralvstenosisv-
vcausesvincreasedvleftvatrialvpressurevduringvatrialvcontraction.
PulmonaryvHTNvwillvresultvinvwhat?v-vcorrect-answersv-
ElevatedvPAvpressuresvbutvhavevnovimpactvonvPAOP.
InfectivevEndocarditisvcanvcausevwhatvkindvofvimpairment?v-vcorrect-answersv-
Neurologicvimpairment.vOnevofvthevrisksvofvinfectivevendocarditisvisvthevbacterialvstrandvbreakingvi
