Practice Test 1 CCRN (Pass CCRN)
A patient has CSF leaking from their nose after a transsphenoidal hypophysectomy, what do
you do? - ANS-It is regular to have a CSF leak for forty eight hrs after surgical treatment.
Cover with a sterile "moustache" 2x2 tapes underneath their nose to form a barrier.
If your dura isn't intact which you might anticipate a leak, however it does growth your
hazard of infection
A pneumothorax due to the ventilator is what? - ANS-Result of barotrauma- the vent pushes
air into the pleural space with every breath and because the parietal pleura isn't open (like
with a puncture) there's no wherein for the air to move- so you get a tension pneumothorax
A easy way to estimate CVP is to feature five cm to the measured top that the jugular veins
are distended above the sternal attitude (perspective of Louis) with the patient in a forty
five-diploma angle - ANS-
ACE-I can purpose what electrolyte imbalance? - ANS-Hyperkalemia- Prevent angio 1 from
converting to angio II. Angio II normally blocks aldosterone and cause vasoconstriction.
Aldosterone normally holds directly to Na and H2O in change for K (excretes it), however
because you do not have it you put off Na and H20 and maintain directly to K
Actual issues are worse than capability problems!! - ANS-
Advantages of an IABP vs pressors? - ANS-If you've got a hypotensive affected person with
excessive afterload giving them pressors will growth SVR, paintings at the coronary heart,
and myocardial oxygen intake. IABP will increase coronary artery perfusion and myocardial
oxygen with out increasing afterload or decreasing BP
Anterior wall MI - ANS-V2, V3, V4
Bleeding time is a reflection of what? - ANS-Platelet function. Clopidogrel and abciximab are
especially platelet aggregation inhibitors. Heparin is an indirect thrombin inhibitor, but it also
inhibits platelet aggregation
BNP is secreted in reaction to? - ANS-Ventricular wall stretch
Diastolic murmurs are continually pathologic. Systolic murmurs can be pathologic
(associated with valve disease or septal defects) or they can be useful related to turbulence
of blood flow - ANS-
Dobutamine is the drug of choice for cardiogenic shock - ANS-Beta-adrenergic stimulant,
increases HR and contractility
Drugs that may reason torsades de pointes - ANS-Amitriptyline (Elavil) reasons QT c
programming language prolongation and can purpose torsades . Other drugs- Class IA
antidysrhythmics (e.G., procainamide, quinidine, and disopyramide), Class III
antidysrhythmics (e.G., sotalol and amiodarone), tricyclic antidepressants (e.G., imipramine
[Tofranil]), and phenothiazines (e.G., chlorpromazine [Thorazine])
Every 1 inch increase in stomach girth equates to how a whole lot blood accumulation within
the abdomen - ANS-500-1000mL
Giving a malnourished affected person good enough nutrition might also bring about what
electrolyte disturbance? - ANS-Severe phosphate deficiency. This regularly is known as
refeeding syndrome. Nutritional help lets in the cells to begin making more adenosine
triphosphate (ATP), and phosphate supplies are depleted. The identical factor happens in
, diabetic ketoacidosis with treatment whilst insulin permits glucose to move into the cellular
growing manufacturing of ATP and depletion of phosphate.
How can you differentiate the purpose of jaundice? - ANS-An growth in direct bilirubin is
associated with biliary obstruction due to the fact direct bilirubin is conjugated. An growth in
oblique bilirubin is related to hepatic sickness or excessive hemolysis due to the fact indirect
bilirubin is unconjugated
How do you manipulate fluid repute in a affected person with a subarachnoid hemorrhage? -
ANS-You keep the patient hypervolemic with a PAOP (LV preload) extra than 12mmHg
(normal is 8-12). Keeping them hypervolemic aids within the prevention and treatment of
vasospam, which will increase the morbidity
How do you treat oversensing - ANS-Decrease the sensitivity if causing failure to fire
How does hypoxemia affect pulmonary vascular pressures? - ANS-It causes the vasculature
to constrict, which could lead to pulmonary high blood pressure
How does Milrinone work? - ANS-Inotropic agent, has arterial and venous vasodilating
characteristics- decreases preload and lessens the filling of the left aspect of the coronary
heart. Is indicated for chronic LV failure.
How does Nifedipine (Procardia) paintings? - ANS-Nifedipine decreases myocardial oxygen
intake by way of dilating veins and arteries, thereby lowering preload and afterload.
Nifedipine additionally decreases vasospasm and ability for vasospasm. Unlike diltiazem and
verapamil, nifedipine does now not considerably decrease contractility
How does positive strain air flow affect ICP - ANS-It increases intrathoracic stress, which
leads to accelerated ICP
Hyperkalemia can motive what? - ANS-Diarrhea-will increase gastric motility
Flaccid paralysis- partly depolarizes muscle cells, prevents further depolarization
Hyperthermia reason what change at the oxyhemoglobin dissociation curve? - ANS-It
reasons it to shift to the proper, which decreases hemoglobin's affinity for oxygen (does not
love it so it does not keep on to it). So your O2 sats might be lower than everyday
ex: Pa02 of 60 typically offers you an SaO2 of ninety%, but if your hyperthermic it might be
in the direction of 86%
If the ventricles are depolarized before the atria in a junctional rhythm you would count on to
find the P wave in which? - ANS-After the QRS
If you got an entire bunch of banked blood you also want to get platelets and plasma, why? -
ANS-RBCs do no longer comprise platelets; consequently sufferers receiving a couple of
transfusions will also need to receive platelets. Clotting abnormalities in those patients result
from hypocalcemia, thrombocytopenia, and depletion of clotting factors. Fresh frozen plasma
is also indicated to replace the clotting elements
If you be aware a unexpected change in diastolic pulmonary artery pressures you ought to
suspect what? - ANS-Proximal movement of the catheter. Recall that the systolic stress of
the pulmonary artery and the proper ventricle are approximately the same. The diastolic
strain in the pulmonary artery is generally approximately 10 mm Hg, while the diastolic
pressure of the proper ventricle is generally close to 0. Any surprising decrease inside the
PA diastolic pressure ought to lead you to suspect that the catheter has flipped back into the
proper ventricle
Inferior wall MI - ANS-II, III, and aVF
Lateral wall MI - ANS-Changes in V5, V6 and/or I and avL
Management of care for pt with DIC consists of... - ANS-Avoidance of injections, substitute
of fluids/blood/clotting factors, turning frequently and lightly, and now not the usage of
automated BP cuffs (risk of damage/trauma)
A patient has CSF leaking from their nose after a transsphenoidal hypophysectomy, what do
you do? - ANS-It is regular to have a CSF leak for forty eight hrs after surgical treatment.
Cover with a sterile "moustache" 2x2 tapes underneath their nose to form a barrier.
If your dura isn't intact which you might anticipate a leak, however it does growth your
hazard of infection
A pneumothorax due to the ventilator is what? - ANS-Result of barotrauma- the vent pushes
air into the pleural space with every breath and because the parietal pleura isn't open (like
with a puncture) there's no wherein for the air to move- so you get a tension pneumothorax
A easy way to estimate CVP is to feature five cm to the measured top that the jugular veins
are distended above the sternal attitude (perspective of Louis) with the patient in a forty
five-diploma angle - ANS-
ACE-I can purpose what electrolyte imbalance? - ANS-Hyperkalemia- Prevent angio 1 from
converting to angio II. Angio II normally blocks aldosterone and cause vasoconstriction.
Aldosterone normally holds directly to Na and H2O in change for K (excretes it), however
because you do not have it you put off Na and H20 and maintain directly to K
Actual issues are worse than capability problems!! - ANS-
Advantages of an IABP vs pressors? - ANS-If you've got a hypotensive affected person with
excessive afterload giving them pressors will growth SVR, paintings at the coronary heart,
and myocardial oxygen intake. IABP will increase coronary artery perfusion and myocardial
oxygen with out increasing afterload or decreasing BP
Anterior wall MI - ANS-V2, V3, V4
Bleeding time is a reflection of what? - ANS-Platelet function. Clopidogrel and abciximab are
especially platelet aggregation inhibitors. Heparin is an indirect thrombin inhibitor, but it also
inhibits platelet aggregation
BNP is secreted in reaction to? - ANS-Ventricular wall stretch
Diastolic murmurs are continually pathologic. Systolic murmurs can be pathologic
(associated with valve disease or septal defects) or they can be useful related to turbulence
of blood flow - ANS-
Dobutamine is the drug of choice for cardiogenic shock - ANS-Beta-adrenergic stimulant,
increases HR and contractility
Drugs that may reason torsades de pointes - ANS-Amitriptyline (Elavil) reasons QT c
programming language prolongation and can purpose torsades . Other drugs- Class IA
antidysrhythmics (e.G., procainamide, quinidine, and disopyramide), Class III
antidysrhythmics (e.G., sotalol and amiodarone), tricyclic antidepressants (e.G., imipramine
[Tofranil]), and phenothiazines (e.G., chlorpromazine [Thorazine])
Every 1 inch increase in stomach girth equates to how a whole lot blood accumulation within
the abdomen - ANS-500-1000mL
Giving a malnourished affected person good enough nutrition might also bring about what
electrolyte disturbance? - ANS-Severe phosphate deficiency. This regularly is known as
refeeding syndrome. Nutritional help lets in the cells to begin making more adenosine
triphosphate (ATP), and phosphate supplies are depleted. The identical factor happens in
, diabetic ketoacidosis with treatment whilst insulin permits glucose to move into the cellular
growing manufacturing of ATP and depletion of phosphate.
How can you differentiate the purpose of jaundice? - ANS-An growth in direct bilirubin is
associated with biliary obstruction due to the fact direct bilirubin is conjugated. An growth in
oblique bilirubin is related to hepatic sickness or excessive hemolysis due to the fact indirect
bilirubin is unconjugated
How do you manipulate fluid repute in a affected person with a subarachnoid hemorrhage? -
ANS-You keep the patient hypervolemic with a PAOP (LV preload) extra than 12mmHg
(normal is 8-12). Keeping them hypervolemic aids within the prevention and treatment of
vasospam, which will increase the morbidity
How do you treat oversensing - ANS-Decrease the sensitivity if causing failure to fire
How does hypoxemia affect pulmonary vascular pressures? - ANS-It causes the vasculature
to constrict, which could lead to pulmonary high blood pressure
How does Milrinone work? - ANS-Inotropic agent, has arterial and venous vasodilating
characteristics- decreases preload and lessens the filling of the left aspect of the coronary
heart. Is indicated for chronic LV failure.
How does Nifedipine (Procardia) paintings? - ANS-Nifedipine decreases myocardial oxygen
intake by way of dilating veins and arteries, thereby lowering preload and afterload.
Nifedipine additionally decreases vasospasm and ability for vasospasm. Unlike diltiazem and
verapamil, nifedipine does now not considerably decrease contractility
How does positive strain air flow affect ICP - ANS-It increases intrathoracic stress, which
leads to accelerated ICP
Hyperkalemia can motive what? - ANS-Diarrhea-will increase gastric motility
Flaccid paralysis- partly depolarizes muscle cells, prevents further depolarization
Hyperthermia reason what change at the oxyhemoglobin dissociation curve? - ANS-It
reasons it to shift to the proper, which decreases hemoglobin's affinity for oxygen (does not
love it so it does not keep on to it). So your O2 sats might be lower than everyday
ex: Pa02 of 60 typically offers you an SaO2 of ninety%, but if your hyperthermic it might be
in the direction of 86%
If the ventricles are depolarized before the atria in a junctional rhythm you would count on to
find the P wave in which? - ANS-After the QRS
If you got an entire bunch of banked blood you also want to get platelets and plasma, why? -
ANS-RBCs do no longer comprise platelets; consequently sufferers receiving a couple of
transfusions will also need to receive platelets. Clotting abnormalities in those patients result
from hypocalcemia, thrombocytopenia, and depletion of clotting factors. Fresh frozen plasma
is also indicated to replace the clotting elements
If you be aware a unexpected change in diastolic pulmonary artery pressures you ought to
suspect what? - ANS-Proximal movement of the catheter. Recall that the systolic stress of
the pulmonary artery and the proper ventricle are approximately the same. The diastolic
strain in the pulmonary artery is generally approximately 10 mm Hg, while the diastolic
pressure of the proper ventricle is generally close to 0. Any surprising decrease inside the
PA diastolic pressure ought to lead you to suspect that the catheter has flipped back into the
proper ventricle
Inferior wall MI - ANS-II, III, and aVF
Lateral wall MI - ANS-Changes in V5, V6 and/or I and avL
Management of care for pt with DIC consists of... - ANS-Avoidance of injections, substitute
of fluids/blood/clotting factors, turning frequently and lightly, and now not the usage of
automated BP cuffs (risk of damage/trauma)
