PASS CCRN CERTIFICATION EVALUATION 2026
TESTED QUESTIONS SOLVED
◉ A patient has sepsis, receives Lactated ringers 500ml IV bolus.
Which finding indicate that this intervention is having it's 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 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? 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: 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: 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 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: 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: Answer: Stop Heparin and
administer an alternative direct thrombin inhibitor.
,◉ Warfarin is contraindicated in HIT? T/F 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? 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
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? Answer:
Mitral stenosis - causes increased left atrial pressure during atrial
contraction.
◉ Pulmonary HTN will result in what? Answer: Elevated PA
pressures but have no impact on PAOP.
◉ Infective Endocarditis can cause what kind of impairment?
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? Answer: Embolic
ischemic stroke.
◉ Post bariatric surgery should avoid what kind of meds? Answer:
Extended release meds due to absorption concerns post-operatively
◉ Chlorpropamide is a what? Answer: sulfonylurea drug that is used
in DI as an antidiuretic. It is primarily a glucose lowering agent.
(hypoglycemia)
TESTED QUESTIONS SOLVED
◉ A patient has sepsis, receives Lactated ringers 500ml IV bolus.
Which finding indicate that this intervention is having it's 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 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? 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: 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: 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 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: 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: Answer: Stop Heparin and
administer an alternative direct thrombin inhibitor.
,◉ Warfarin is contraindicated in HIT? T/F 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? 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
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? Answer:
Mitral stenosis - causes increased left atrial pressure during atrial
contraction.
◉ Pulmonary HTN will result in what? Answer: Elevated PA
pressures but have no impact on PAOP.
◉ Infective Endocarditis can cause what kind of impairment?
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? Answer: Embolic
ischemic stroke.
◉ Post bariatric surgery should avoid what kind of meds? Answer:
Extended release meds due to absorption concerns post-operatively
◉ Chlorpropamide is a what? Answer: sulfonylurea drug that is used
in DI as an antidiuretic. It is primarily a glucose lowering agent.
(hypoglycemia)
