CCRN Exam Comprehensive Review Guide

Aug 22, 2024

Nurse Life Academy: CCRN Comprehensive Review

Introduction

  • Nurse Jenny from Nurse Life Academy offers a comprehensive review for the CCRN exam.
  • Comprehensive but not exhaustive; covers major content points.
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Question Breakdown

Question 1: Ventricular Septal Rupture

  • Scenario: Post-PCI patient with S3 heart sound, crackles, and a loud holosystolic murmur.
  • Key Signs: ST elevation in V1-V4, anterior infarction risk, loud murmur at lower left sternal border.
  • Answer: Increased cardiac output and increased SvO2.
    • Explanation: Blood shunts from left to right ventricle, mixing oxygenated and deoxygenated blood, increasing SvO2.

Question 2: Intra-abdominal Pressure Monitoring

  • Scenario: Post-abdominal aortic aneurysm repair with abdominal distension.
  • Key Signs: Incorrect transducer leveling.
  • Answer: Transducer should be leveled to symphysis pubis or iliac crest, not phlebostatic axis.

Question 3: Mitral Regurgitation

  • Scenario: Patient with tachycardia and loud holosystolic murmur.
  • Key Signs: Prominent V waves on PAOP waveform.
  • Answer: Mitral regurgitation.
    • Explanation: Backflow into left atrium causes V waves; potential papillary muscle rupture.

Question 4: Liver Cirrhosis Lab Profile

  • Scenario: History of alcoholism and cirrhosis.
  • Key Labs: Prolonged PT, decreased albumin, increased bilirubin.
  • Answer: Prolonged PT, decreased albumin, increased bilirubin.
    • Explanation: Liver failure affects synthesis of clotting factors, albumin, and metabolism of bilirubin.

Question 5: Subarachnoid Hemorrhage

  • Scenario: Patient with headache, nuchal rigidity, photophobia.
  • Key Signs: Positive Kernig's and Brudzinski signs.
  • Answer: Subarachnoid hemorrhage.
    • Explanation: Meningeal irritation signs due to blood or infection presence.

Question 6: Asthma Ventilation Status Worsening

  • Scenario: ICU admission with asthma history.
  • Key Sign: PaCO2 normalization.
  • Answer: Normal PaCO2 indicates worsening; early stage is hypoventilation.

Question 7: Diabetes Insipidus

  • Scenario: Serum osmolarity and urine output analysis.
  • Key Sign: High serum sodium.
  • Answer: Serum sodium of 165 mEq/L.
    • Explanation: Lack of ADH leads to water loss and concentrated serum sodium.

Question 8: Diabetic Ketoacidosis (DKA)

  • Scenario: Type 1 diabetic lab results.
  • Key Indicators: Hyperglycemia, acidosis, hyperkalemia.
  • Answer: Hyperglycemia, hyperkalemia, acidosis, elevated serum osmolality.

Question 9: High Magnesium Levels

  • Scenario: Magnesium administration.
  • Key Sign: Diminished reflexes.
  • Answer: Tetany not related to high magnesium.

Question 10: Disseminated Intravascular Coagulation (DIC)

  • Scenario: Lab results for DIC.
  • Key Labs: Decreased platelets, prolonged PT/PTT, increased FDPs.
  • Answer: Decreased platelets, decreased fibrinogen, increased FDPs.

Question 11: Acute Pancreatitis

  • Scenario: Lab results for pancreatitis.
  • Key Indicators: Serum amylase, calcium.
  • Answer: Elevated amylase, decreased calcium.

Question 12: Heart Failure

  • Scenario: Heart sound analysis.
  • Key Sign: S3 heart sound.
  • Answer: S3 sound correlates with heart failure.

Question 13: Acute Kidney Injury (AKI)

  • Scenario: Analysis of lab values.
  • Key Indicators: Urine specific gravity, sodium.
  • Answer: Pre-renal injury recognized by urine concentration and sodium retention.

Question 14: Fat Embolism

  • Scenario: Symptoms post long-bone fracture.
  • Key Signs: Petechiae, chest pain, confusion.
  • Answer: Fat embolism indicated by petechiae.

Question 15: Acute Respiratory Distress Syndrome (ARDS)

  • Concept: Refractory hypoxemia, decreased lung compliance.
  • Answer: Typical ARDS presentation.

Question 16: End-of-Life Care

  • Scenario: Patient wish for pet visit.
  • Answer: Arrange for neighbor to bring pet.

Question 17: Esophageal Varices Complication

  • Scenario: Respiratory distress with Blakemore tube.
  • Emergency Action: Cut and remove tube to clear airway.

Question 18: Small Bowel Obstruction

  • Scenario: Vomiting analysis.
  • Key Sign: Vomiting fecal material.
  • Answer: Indicates small bowel obstruction.

Question 19: Torsades de Pointes Cause

  • Scenario: Drug overdose.
  • Key Drug: Amitriptyline (triggers QT prolongation).

Question 20: Initial Overdose Management

  • Scenario: Emergency management steps.
  • Answer: Secure airway as primary intervention.

Bonus: Shock Differentiation

  • Concept: Hypovolemic vs. cardiogenic shock.
  • Key Differential: Decreased PAOP in hypovolemic shock.

Conclusion

  • Encouragement to like, subscribe, and feedback.
  • Nurse Jenny offers additional content if requested.
  • Reminder of preparedness essential for CCRN success.

This review condenses critical topics for the CCRN exam, focusing on both clinical scenarios and the underlying physiological principles. It serves as a useful quick reference and study guide for nursing professionals preparing for their certification.