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CCRN ADULT LEAKED EXAM 2025 VERIFIED
QUESTIONS AND CORRECT ANSWERS.
Verbal Response (GCS) - correct answer>> 5 - oriented 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - none Motor response (GCS) - correct answer>>6 Obeys 5 Localizes 4 Withdraws 3 Flexion 2 Extension 1 None Intracranial Pressure (ICP) - correct answer>> 0 - 15 = normal The pressure within the cranial vault. Monroe-Kellie Doctrine - correct answer>>when one content in the skull increases, another must decrease to compensate and maintain normal ICP the three contents -- CSF, blood, tissue Signs of increased ICP - correct answer>>decreased LOC, disorientation, combativeness, pupil changes (not PERRL), respiratory changes (rate of pattern), motor changes (decreased motor response, abnormal posturing), increased temperature, headache, Nausea/vomiting, cardiac changes- HR, BP, papilledema (chronically increased ICP)
Cushing's triad - correct answer>>three classic signsâbradycardia, hypertension/widening pulse pressure, and bradypneaâseen with pressure on the medulla as a result of brain stem herniation CPP - correct answer>>MAP-ICP normal 60 - 80 epidural hematoma - correct answer>>a hematoma located on top of the dura key sign loss of conciousness regain lucidity, followed by repeat LOC subdural hematoma - correct answer>>a hematoma located beneath the dura acute, subacute or chronic vasospasm subarachnoid hemorrhage - correct answer>>common after 3 - 14 days give ca channel blocker to treat triple h therapy --> hypervolume, hemodiluce, hypertension basal ganglia - correct answer>>structures in the forebrain that help to control movement fine motor control frontal lobe - correct answer>>associated with reasoning, planning, parts of speech, movement, emotions, and problem solving occipital lobe - correct answer>>A region of the cerebral cortex that processes visual information temporal lobe - correct answer>>A region of the cerebral cortex responsible
normal CSF - correct answer>>CSF: Leukocytes = 0-6, Neutrophils = 0%, Glucose = 40-60, protein = 20- 50 Clear/colorless no RBC or wbc cranial nerves - correct answer>>12 pairs of nerves that carry messages to and from the brain olfactory optic oculmotor trochlear trigemnical abducens facial acoustic glossopharyngeal vagus spinal accessory hypoglossal eye movement nerves - correct answer>>III, IV, VI oculomotor, trochlear, abducens most affected nerve in basilar skull fracture - correct answer>>olfactory basilar skull fracture - correct answer>>Raccoon eyes (periorbital ecchymosis) and Battle's sign (mastoid ecchymosis) rhinorrhea most cerebral aneurysms are - correct answer>>in the circle of willis
most common cause of hemorrhagic CVA - correct answer>>htn abrupt onset of 'worst headache ever' embolic CVA - correct answer>>stroke due to blood clot - commonly from a fib Pituitary Brain Tumor - correct answer>>cushings/acromegaly menstrual dysfunction visual deficits frontal brain tumor - correct answer>>inappropriate behavior can't concentrate decreased recent memory expressive aphasia absence seizure - correct answer>>sudden loss of conciousness myoclonic seizure - correct answer>>sudden brief jerking motions atonic seizure - correct answer>>sudden loss of muscle tone clonic seisure - correct answer>>rhythmic muscle jerking tonic siezure - correct answer>>sustained muscle contraction status epilepticus - correct answer>>continuous seizure activity >30 mins Meningitis - correct answer>>inflammation of the meninges of the brain and spinal cord; bacterial, viral or fungal meningitis s/s - correct answer>>headache/fever/photophobia meningeal signs- nuchal rigidity, Kernig's sign (when hip flexed to 90 degrees, complete extension of the knee is restricted and painful)
SVO2 - correct answer>> 60 - 80% - PA cath Svo2 meaning - correct answer>>if low = tissue extracting more o2 aka CO not enough to meet demand if svo2 high and lactatee high = high extract by tissue and high CO (ominous) S1 - correct answer>>close of tricuspid and mitral S2 - correct answer>>close of pulmonic and aortic QT prolongation - correct answer>>decreased outward K+ current during repolarization phase of the cardiac action potentials results in QT prolongation, which can increase risk of Torsades and sudden death. common post op complication of CABG - correct answer>>a fib --> treat with amio or synch cardiovert report if chest tube output _________ / hour CABG - correct answer>> 100 Tell patient to _______ during chest tube removal - correct answer>>exhale anterior MI - correct answer>>V2 - V LAD inferior MI - correct answer>>II, III, aVF RCA lateral MI - correct answer>>I, aVL, V5, V Circumflex septal MI - correct answer>>V1, V
Posterior mi - correct answer>>V1, V labs for MI - correct answer>>CK 150 - 180 Troponin T > 0. Troponin I > 0. Myoglobin 17.4 - 105. ekg ischemia - correct answer>>ST depression T wave inversion ekg infarction - correct answer>>pathologic q wave, st elevation cell death 12 lead ecg - correct answer>>Limb leads: I, II, II, AVR, AVL, AVF Chest leads: Vâ , Vâ , Vâ , Vâ , Vâ
, Vâ oxyhemoglobin dissociation curve - correct answer>>Think of an exercising muscle for a rightward shift: Exercising muscle is: hot, acidic (lactic acid), hypercarbic, and has increased 2,3-DPG. Exercising muscle benefits from increased oxygen unloading from red blood cells. think cole for left shift decreased temp decreased H+ MI management - correct answer>>Meds: Morphine sulfate, aspirin, nitroglycerin, beta-blocker, IV fluid, O
MODS (multiple organ dysfunction syndrome) - correct answer>>complication of an form of shock due to inadequate tissue perfusion
- failure of 2 or more organ systems
- end result if shock isn't stopped MODS scoring - correct answer>>respiratory (P/F ratio); platelet count; bilirubin level; (HR*CVP/MAP); GCS; creatinine 0 - 24 9 - 12 25% mortality 13 - 16 50% mortality 17 - 20 75% mortality 21 - 24 100% mortality patient in sepsis/shock consult palliative - correct answer>>no later than 72 hours after admission initial phase of shock - correct answer>>aerobic metabolism is now anaerobic --> lactic acid build up compensatory phase of shock - correct answer>>sympathetic system stimulated --> catecholamines release, cardiac contractility increases vasoconstriction aldosterone released u/o drops increased hr increased glucose levels progressive stage of shock - correct answer>>vasodilation d/t lactic acidosis decrease in CO and BP, hypotension pallor cool/clammy skin
assist control ventilation - correct answer>>-Has a preset rate and preset tidal volume
- patient CAN breathe on own, uses own breaths
- when patient initiates own breath, vent will give preset tidal volume
- rate depends on patient's ABG's (CO2 level) the higher the CO2, the higher the rate
- PEEP will be used with assist control
- ranges from 5-15cm of H SIMV ventilation - correct answer>>volume delivered is controlled for each mechanical breath, patient determines own TV in between mechanical breaths, PEEP added to recruit alveoli peep - correct answer>>positive end-expiratory pressure - common mechanical ventilator setting in which airway pressure is maintained above atmospheric pressure plateau pressure - correct answer>>Measures the compliance the entire lung End inspiratory pause button peak pressure - correct answer>>Pressure required to get a volume of air into the lungs, fighting resistance Low BUN/Creatinine Ratio - correct answer>>Acute renal tubular disease low protein intake/liver disease/starvation
first line treatment to decrease cerebral edema - correct answer>>mannitol
- osmotic diuretic vasopressin used in caution with - correct answer>>heart disease --> it makes Na and water reabsorb Increased serum osmolality - correct answer>>regulates ADH to store more water initial management of severe asthma - correct answer>>Short acting beta agonists and corticosteroids CVP - correct answer>>RV preload svv - correct answer>>Stroke Volume Variation its the variation between SBP and DBP --> measure on end expire higher the variation usually the more fluid down tilt test - correct answer>>drop in the systolic blood pressure of 20 mmHg or an increase in the pulse rate of 20 beats per minute when a patient is moved from a supine to a sitting position; a finding suggestive of a relative hypovolemia. AV fistula - correct answer>>joining of an artery and vein together, usually in forearm causes more blood flow into the vein making HD treatments easier -- takes 2 to 3 months to mature graft does not take time to mature the right side of the heart is - correct answer>>volume dependent this is
why you can't use nitro with inferior/right ventricle heart attacks electrical conduction of the heart - correct answer>>sa node --> av node (slows conduction) --> bundle of his --> purkinje fibers 1 cardiac cycle is measured - correct answer>>R - R P wave - correct answer>>atrial depolarization QRS - correct answer>>ventricle depolarization T wave - correct answer>>ventricular repolarization STEMI vs Nstemi - correct answer>>STEMI - due to complete arterial occlusion NSTEMI - ARTERY NOT completely blocked or have collateral vessels contiguous leads - correct answer>>Two or more ECG leads that are anatomically close together and that cover the same general area of the heart; specifically, the walls of the left ventricle. occlusion of left main coronary artery - correct answer>>the widow maker - > cariogenic shock and death if not reperfused inferior wall MI s/s - correct answer>>hypotension with JVD and CLEAR LUNG SOUNDS atropine does not work for - correct answer>>people who have had heart transplants
TIA - correct answer>>transient ischemic attack; rapid onset and short duration - NO PERMANENT INJURY Penumbra - correct answer>>ischemic area of stroke that has reversible damage and can regain function tpa given for stroke within - correct answer>>3 hours from last known normal door to needle time 45 min Tpa vital sign check - correct answer>>every 15 mins for 2 hours every 30 mins for 6 hours every hour for 16 hours most common cause of hemorrhagic stroke - correct answer>>chronic uncontrolled HTN MOST COMMON CAUSE OF SUBARACHNOID HEMORRHAGE - correct answer>>aneurysm rupture stroke FAST - correct answer>>Face DROOPING Arms WEAKNESS Speech DIFFCULTY Time decerebrate or decorticate worse? - correct answer>>decerebrate - ominous extension dolls eyes are - correct answer>>GOOD absent = abnormal --> eyes stay midline or follow head when head is turned babinskis is - correct answer>>BAD positive
= bad Brudzinski's sign - correct answer>>Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. kernig's sign - correct answer>>Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. ventriculostomy leveled at - correct answer>>tragus/foramen of monro EVD considered - correct answer>>gold standard for measuring ICP higher paco2 (icp) - correct answer>>vasodilation increase icp lower paco2 (icp) - correct answer>>vasoconstrict decrease icp medications for increased ICP - correct answer>>mannitol osmotic diuretic first line hypertonic saline analgesics sedatives paralytics hypoglycemia s/s - correct answer>>headache, hungry, sweaty, shaky, confused what meds hide early s/s of hypoglycemia - correct answer>>beta blockers how fast to decrease BG in DKA/HHS - correct answer>> 50 - 100 mg/dl/hour anion gap - correct answer>>= Na +- (Cl- + HCO3-) Normal is between 8 and 12
hypercapnia avoid morphine in - correct answer>>renal dysfunction patients when to not perform a sedation awakening trial - correct answer>>patient with seizures, paralyzed, alcohol withdrawal, sedated for ICP management, RASS +3, +4; AGITATION most common entry for microbes into lungs - correct answer>>aspiration initial output from ostomy - correct answer>>>1500 - 2000 large volume liquid out to determine teaching the nurse must first - correct answer>>assess learning needs first grasping reflex normal or no? - correct answer>>shows cortical damage to the brain late complication of SAH - correct answer>>hydrocephalus Glasgow Coma Scale - correct answer>>eyes, verbal, motor Max- 15 pts, below 8= coma obtunded vs stuporous - correct answer>>stuporous will actually acknowledge external stimuli - obtunded they will be indifferent elemental diet - correct answer>>no protein only nonessential and essential amino acids test-retest reliability - correct answer>>using the same test on two occasions to measure consistency --> requires same measure
lithium level - correct answer>>0.6 - 1.2 acute mania 1.0 - 1.
1.5 is toxic T test - correct answer>>Compares mean values of a continuous variable between 2 categories/groups -- i.e. 2 units, 2 diseases. T think Two Heparin-induced thrombocytopenia (HIT) - correct answer>>>50% reduction in platelet count within 7-10 days of exposure of heparin
- Severe form results in global thromboembolism due to immune reaction with platelet factor 4 Monophasic defibrillator - correct answer>>single shock - 360 joules mitral valve regurgitation causes - correct answer>>L atrium and ventricle dilation and hypertrophy how long to continue heparin waiting for warfarin - correct answer>> 5 - 7 days pre cancerous findings colonoscopy - correct answer>>adenomatous polyps periumbilical ecchymosis - correct answer>>referred to as Cullen sign and may take hours or days to develop following abdominal trauma can show retroperitoneal bleeding or acute pancreatitis Situational Leadership Theory - correct answer>>This theory focused on a follower's competence and commitment, or development level (DL) in
