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CCRN ADULT LEAKED EXAM VERIFIED
QUESTIONS AND CORRECT ANSWERS.
brain stem consists of - correct answer>>midbrain, pons, medulla oblongata midbrain - correct answer>>A small part of the brain above the pons that integrates sensory information and relays it upward. Reticulating activating system -- controls sleep/wake cycle pons - correct answer>>the part of the brainstem that links the medulla oblongata and the thalamus medulla oblongata - correct answer>>Part of the brainstem that controls vital life-sustaining functions such as heartbeat, breathing, blood pressure, and digestion. blood-brain barrier - correct answer>>Blood vessels (capillaries) that selectively let certain substances enter the brain tissue and keep other substances out permeable to H20 co2 o2 and lipid soluble substances restricts anitboitoics, heavy metals. toxins above _____ spinal cord injury need vent - correct answer>>C 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
types of leukocytes - correct answer>>neutrophils, eosinophils, basophils, lymphocytes, monocytes neutrophils - correct answer>>bacterial infection basophils - correct answer>>A circulating leukocyte that produces histamine. inflammatory response eosinophils - correct answer>>allergic reaction and parasitic infections mast cells - correct answer>>Cells that release chemicals (such as histamine) that promote inflammation. BNP - correct answer>>>100 Indicates HF Pao2 - correct answer>> 80 - 100 partial pressure of oxygen dissolved in the arterial blood PT - correct answer>> 12 - 15 seconds PTT - correct answer>> 60 - 90 seconds aPtt - correct answer>> 25 - 38 seconds - what you measure for heparin level ScVO2 - correct answer>> 70 - 80% - R atrium central line draw 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.
IABP inflates during - correct answer>>just as diastole begins - noted as dicrotic notch balloon in IABP inflated with - correct answer>>helium IABP placement - correct answer>>place tip of catheter just distal to L subclavian (1-2 cm below the top of the arch) IABP nursing - correct answer>>strict I/O --> may show migration of balloon to renal arteries zero to phlebostatic axis don't bend the affected limb sit no greater than 30 degrees HOB DIC labs - correct answer>>prolonged PT/PTT/BT low platelet count elevated D-dimer fragmented and helmet-shaped RBCs low fibrinogen ELEVATED fibrin depredations product schisocytes in peripheral smear DIC treatment - correct answer>>treat underlying cause 1st give FFP Heparin has no definite benefit Under 50,000 platelets - 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
critical hypoglycemia level - correct answer>>< normal anion gap - correct answer>> 8 - 16 mEq/L Encephalitis most common cause - correct answer>>viral edema grading - correct answer>>seconds per number rating primary causes of ARDS - correct answer>>aspiration pulmonary contusion near drowning secondary causes of ARDS - correct answer>>hypovolemic shock/sepsis what will ensure patient understanding - correct answer>>learning readiness what medications are not for pulmonary hypertension - correct answer>>beta blockers decrease right heart function and may increase pulmonary congestion SVR - correct answer>> 800 - 1200 Pulmonary Vascular Resistance (PVR) - correct answer>><2. 200 dynes 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
v fib treatment - correct answer>>d-fib h's and t's - correct answer>>5 H's H ypoxia H ypovolemia H ydrogen ion (acidosis) H ypo / H yper kalemia H ypothermia 5 T's T ension pneumothorax T amponade T oxins T hrombosis (pulmonary) T hrombosis (coronary) PEA treatment - correct answer>>CPR, Epi and check for shockable rhythm every 2 minutes treatment for heart failure - correct answer>>diuretics (1st line for systolic) ACEI (slows dz progression) BB (helpful if HF secondary to ischemia) Spironolactone 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.
ideal tidal volume - correct answer>>height and gender normal 6 - 8 cc/kg ideal body weight SBT failure - correct answer>>rr >35 sustained spo < changes in heart rate/blood pressure dyspnea anxiety P/F ration normal - correct answer>>> 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
infection Phenytoin can only be mixed with - correct answer>>normal saline - anticonvulsant small trachea perf treatemetn - correct answer>>can heal on their own - intubate for safety (ETT cuff inferior to perf) organ donor lab values - correct answer>>hematocrit >30% platelets > 80k INR < best cardiac marker - correct answer>>troponin I collagen plug for cath how long bedrest - correct answer>>1-2 hours primary pneumothorax common in - correct answer>>males 10 - 30 smokers rewarming post op medication to stop shiver - correct answer>>meperidine normal airway resistance - correct answer>>0.5 to 2.5 cm H2O/L/sec choose biggest ETT without trauma because if its 1/2 the size of airway it increases pressure x beta blockers decrease the response to - correct answer>>adrenergics Digoxin toxicity - correct answer>>-Cholinergic—nausea, vomiting, diarrhea, blurry yellow vision (think van Gogh), arrhythmias, AV block. - Can lead to hyperkalemia, which indicates poor prognosis.
Hashimoto's thyroiditis will have presence of - correct answer>>antithyroid microsomal antibodies --> autoimmune disease in which the body's own antibodies attack and destroy the cells of the thyroid gland CPP goal after tBI - correct answer>> 70 - 90 How to test for insulinemia - correct answer>>prolonged fasting transphenoidal hypophysectomy - correct answer>>- endoscopic procedure to remove a pituitary tumor
- incision of the sphenoid sinus (transphenoidal) without disturbing brain tissue look for hemorrhage --> lots of swallowing; or decreased vision bc near optic nerve SPO2 goal status asthmaticus - correct answer>>. 92% thyrotoxic crisis medications - correct answer>>propythorucil first followed 1 hour by N iodide paralytic ileus suspected follow up with - correct answer>>Xray Body Quadrants - correct answer>> acute gi bleed expect hgb - correct answer>>near baseline how to decrease pain with peritoneal dialysis - correct answer>>knee to chest positioning bronchiolitis obliterans with organizing pneumonia (BOOP) - correct answer>>treat with steroids
