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CCRN ADULT LEAKED TEST VERIFIED
CORRECT ANSWERS.
PAP - correct answer>> 20 - 30/8- 15 PAOP - correct answer>> 8 - 12 mmHg SVR PVR - correct answer>> 800 - 1200 50 - 250 CAPP - correct answer>> 60 - 80 CaO2 - correct answer>> 12 - 16 DO2 - correct answer>> 900 - 1100 VO2 - correct answer>> 250 - 350 SvO2 - correct answer>> 60 - 80 o Tension penumo s/s - correct answer>>· Tracheal deviation away from affected side · Tachycardia · Distended neck veins · Hypotension can compress aorta Chest tube tidaling in spontaneous and mechanically ventilated patient - correct answer>>spontaneously breathing patient: rise during inspiration and fall during expiration mechanically ventilated:
fall during inspiration and rise during expiration cranial nerves - correct answer>>o I- olfactory- smell o II- optic, NOT pupil reaction- vision o III ocularmotor- pupillary function IV- trochlear- eye movement o V trigeminal- chewing, face, teeth mouth sensation VI- abducens- eye movement VII- facial- taste, facial expression o VIII- vestibulocochlear- dolls eyes, hearing o IX glosspharyngeal- swallow, gag o X- vagus- pharyngeal/laryngeal movement, gag XI- spinal XII-hypoglossal- tongue muscles o All cranial nerves arise from brain stem except I and II On Old Olympus Towering Top A Famous Vocal German Viewed Some Hops CPP - correct answer>>CPP is 80-100, need minimum 50 With elevated ICP, maintain CPP at 70 ICP - correct answer>>o Normal is 0-10 mmHg o 10 - 20 mmHg is moderately high o increased is >20 mmHg Kehrs sign - correct answer>>left shouldr- ruptured spleen cullens sign - correct answer>>blue in periumbilical area § methemalbimun forms from digested blood and tracks around abdomen
- hemmorhaging pancreatitis
- § intraperitoneal bleeding grey turners sign - correct answer>>blue in flanks
- hemmorhaging pancreatitis
- retroperitoneal bleeding liver failure- prevent - correct answer>>§ Prevent low K- use aldactone (potassium sparing diuretic) to treat ascites
dopamine morphine- nitroglycerin- nifedipine- - correct answer>>afterload/arterial dilator afterload decrease increase afterload venous dilator- decrease preload venous/preload reducer. >1mcg/kg/min will dilate arteries arterial and venous dilator becks triad - correct answer>>cardiac tamponade hypotension, distended neck veins, muffled heart sounds mitral stenosis widened pulse prssure narrows pulse pressure - correct answer>>pink cheeks aortic regurgitation mitral regurgitation hypertrophic cardiomyopathy- syncope- problem filling dilated cardiomyopathy- problem ejecting. mitral regurgitation. hypotension. - correct answer>> pericarditis- - correct answer>>nonspecific ST in precordial. lean forward feels better B1 receptor- B receptor- a receptors- - correct answer>>increase heart rate, conductivity, myocardial contractility vasodilation, bronchodilation vasoconstriction
dilated cardiomyopathy - correct answer>>systolic dysfunction mitral valve regurgitation common due to ventricular dilation therapy: increase contractility decrease afterload decrease preload do not give negative inortopes (problem is systolic) S BP normal or low pulmonary edema du to poor ventricular emptying EF < give: beta blockers ACE diuretics dilators positive inotropes hypertrophic cardiomyopathy - correct answer>>problem with filling- diastolic dysfunction DO NOT GIVE + INOTROPES-may worsen filling cardiac death syncope- no perfusion chest pain give beta blockers (metoprolol)- increases filing time diuretics, calcium channel blockers give: beta blockers ACE low dose **** diuretics calcium channel blockers
renal failure - electrolytes - correct answer>>hyperkalemia hyperphosphatemia hypermagensemia hypocalcemia hypernatremia relationships: calcium and potassium calcium and magnesium potassium and magnesium calcium and phosphate - correct answer>>· Calcium and potassium inverted relationship · Calcium and magnesium correlate · Potassium and magnesium correlate calcium low, phosphate high exclusion to fibrolytic drugs - correct answer>>§ Evidence of hemorrhage § Stroke or head trauma in past 3 months § History of intracranial hemorrhage § Major surgery in the last 14 days § Active bleeding in past 21 days( EX: GI bleed) § MI in past 3 months § Seizure at onset of stroke (but history of seizure disorder OK) § Platelets < § Serum glucose < § INR >1.7 on warfarin § Persistent blood pressure elevation >185/ tearing or ripping crushing/pressure sharp sharp, pressure, indegestion, discomfort - correct answer>>aortic aneurysm MI PE angina intrapulmonary shunt - correct answer>>perfusion exceeds venetilation myocardial contusion - correct answer>>RV failure- look for R side symptoms lasix, diuril- ace inhibitors-
aldactone- - correct answer>>low k cough, hypekalemia hyperkalemia dichrotic notch - correct answer>>closure of aortic valve. inflate then pacemaker - correct answer>>pace, sense, inhibit tension hemothorax spontaneous or traumatic - correct answer>>trach deviation toward unaffected trach deviation toward unaffected trach deviation toward affected DI - correct answer>>>UOP low urine spec gravity (<1.005) high sodium >145 (bc no water to dilute) hyperosmolar serum >300 (bc no water to dilute) urine osmolality <200 (diluted urine) thirsty, dehydration, AMS SIADH - correct answer>>Increased blood volume decreased sodium level (dilutional hyponatremia) in blood serum hypo- osmolarity in blood (overdiluted) decreased UOP increased hyperosmolarity in urine increased sodium in urine (bc urine is dehydrated, more concentrated) DIC - correct answer>>§ Decreased platelets, § decreased hematocrit § decreased fibrinogen (<200), · Fibrinogen low because using it all up § increased FSP (>10), § increased PT >15, PTT >40, INR, § increased D dimer, § increased antithrombin III § definitive test is FSP. D dimer is not definitive but MUST be elevated
V3R, V4R- RCA, RV infarct RCA - correct answer>>inferior MI, posterior MI, and RV infarct LAD - correct answer>>anterior LV MI Anterior MI - correct answer>>o May develop second degree type II or RBBB- bad sign. LAD supplies common bundle of HIS o Development of systolic murmur, possible ventricular septal defect ventricular septal rupture o Higher mortality than inferior- heart failure o Associated with LAD occlusion elevation in V1, V2, V3 V o Reciprocal changes in II, III, aVF (inferior wall) Inferior MI - correct answer>>o Associated with RCA occlusion
- associated with RV infarct
- papillary muscle rupture o ST ekevation in II, III, aVF o Reciprocal changes in lateral wall (I, avL) o Associated with 2nd degree type I. 3rd degree heart block, and bradycardia o Mitral valuve regurgitation secondary to papillary muscle rupture o Tachycardia with inferior MI has higher mortality o Use beta blockers and nitro with caution 30% inferior wall MI patients also have right ventricular infarct R ventricular infarct- - correct answer>>kind of like CHF. Elevation in V1, V3, V4 (R side) o RCA supplies inferior wall and R ventricle. 30% inferior wall MI patients also have right ventricular infarct JVD, high CVP, hypotension. Clear lungs § Fluids, positive inotropes
· QT prolongation - correct answer>>o Can lead to torsades (give mag) o Amiodarone, quinidine, haloperidol, procainamide o Hypokalemia, hypocalcemia, hypomagnesemia Blood transfusion- watch for - correct answer>>hypocalcemia and hyperkalemia Where to auscultate: S3- L ventricular failure S3- R ventricular failure - correct answer>>5th L intercostal space at midclavicular line 5th LRintercostal space at midclavicular line Mumur for heart failure? - correct answer>>S S1 auscultate - correct answer>>apex of heart (5th intercostal space, midclavicular) mitral area closure of AV (mitral and tricuspid) valves systolic S2 auscultate - correct answer>>base of heart (R sternal border, 2nd intercostal space) (pulmonic area) closure of semiluner valves (aortic pulmonic valves) louder with PE normal split is split on inspiration and not on expiration. split on expiration means LBBB L atrial enlargement (mitral stenosis) notched P wave in lead II - correct answer>> S3 auscultate - correct answer>>aped with BELL of stethoscope apex of heart (5th intercostal space, midclavicular) S4 auscultate - correct answer>>apex with BELL of stethoscope apex of heart (5th intercostal space, midclavicular) angina can have s CO CI
