CCRN Comprehensive Review by Nurse Jenny

General Introduction

• Nurse Jenny from Nurse Life Academy provides a comprehensive CCRN review.
• Covers potential exam content and offers detailed explanations but not as detailed as individual system videos.

Question 1: Ventricular Septal Rupture

• Scenario: Patient with ST-segment elevation in V1-V4, underwent PCI, develops S3 heart sound, dyspnea, and a loud holosystolic murmur.
• Hemodynamic Parameters:
  • Correct Answer: C, Increased cardiac output and increased SVO2.
• Explanation:
  • Signs of ventricular septal rupture: Anterior infarction, new systolic murmur at lower left sternal border.
  • Ventricular septal rupture causes a hole between ventricles, mixing oxygenated with deoxygenated blood, increasing SVO2.

Question 2: Intra-abdominal Pressure Monitoring

• Scenario: Abdominal distension post-abdominal aortic aneurysm repair.
• Inaccurate Statement: B, Transducer should be leveled to phlebostatic axis.
• Explanation:
  • Transducer should be leveled to symphysis pubis or iliac crest.
  • Abdominal hypertension causes include massive fluid resuscitation and trauma.
  • Complications: Ischemia, infarction, decreased urine output, respiratory compromise.

Question 3: Pulmonary Edema and Mitral Regurgitation

• Scenario: Patient with tachycardia, tachypnea, crackles, and loud holosystolic murmur.
• Associated Condition: B, Mitral regurgitation.
• Explanation:
  • Prominent V waves on PAOP waveform indicate mitral regurgitation.
  • Possible cardiac emergency: Papillary muscle rupture.

Question 4: Lab Profile for Alcoholism and Cirrhosis

• Expected Lab Profile: A, Prolonged PTT, decreased albumin, increased bilirubin.
• Liver Functions: Filter toxins, synthesize proteins and coagulation factors.
• Lab Changes: Elevated ammonia, liver enzymes, PTINR, PTT; Low albumin, platelets, glucose.

Question 5: Symptoms of Subarachnoid Hemorrhage

• Symptoms: Headache, nuchal rigidity, photophobia, positive Kernig and Brudzinski signs.
• Diagnosis: B, Subarachnoid hemorrhage.
• Note: Symptoms also appear in meningitis due to meningeal irritation.

Question 6: Asthma and Ventilation Status

• Change Indicating Worsening: A, PaCO2 that is now normal.
• Explanation: Early stages: Respiratory alkalosis due to hyperventilation; worsening leads to normalizing PaCO2.

Question 7: Diabetes Insipidus (DI)

• Finding Indicative of DI: D, Serum sodium of 165 mEq/L.
• Explanation: Lack of ADH causes water loss, dilute urine, high serum sodium/osmolality.
• Treatment: Desmopressin (DDAVP).

Question 8: Lab Results in Diabetic Ketoacidosis (DKA)

• Expected Results: B, Hyperglycemia, hyperkalemia, acidosis, elevated serum osmolality.
• Explanation: Metabolic acidosis, ketone production, polyuria, polydipsia.

Question 9: High Magnesium Levels

• Non-Indication: C, Tetany.
• Explanation: High magnesium levels cause muscle relaxation, not contractions (tetany).

Question 10: Lab Findings in DIC

• Consistent Lab Findings: A, Decreased platelets, decreased fibrinogen, prolonged PT/PTT, increased FDPs.
• Explanation: Hypercoagulation with consumption of clotting factors leading to bleeding.

Question 11: Lab Results in Acute Pancreatitis

• Expected Results: B, Elevated serum amylase, decreased serum calcium, decreased total protein.
• Explanation: Elevated enzymes due to pancreatic damage, hypocalcemia due to autodigestion.

Question 12: Heart Failure and Heart Sounds

• Most Likely Sound: A, S3 heart sound.
• Explanation: S3 indicates fluid overload, blood backup into left atrium and lungs.

Question 13: Acute Kidney Injury Types

• Type Indicated: A, Prerenal.
• Explanation: High urine-specific gravity, low urine sodium, elevated BUN-to-creatinine ratio.

Question 14: Symptoms of Fat Embolism

• Specific Symptoms: D, Vomiting of fecal material.
• Explanation: Indicative of fat embolism, especially post bone fracture.

Question 15: Clinical Hallmarks of ARDS

• Hallmarks: C, Refractory hypoxemia, decreased lung compliance.
• Explanation: ARDS involves massive inflammatory response.

Question 16: End-of-Life Care for Heart Failure

• Appropriate Action: B, Arrange for neighbor to bring dog for a visit.
• Explanation: Meeting patient's end-of-life requests for comfort.

Question 17: Respiratory Distress with Sengstaken Blakemore Tube

• Priority Action: D, Cut and remove the SB tube.
• Explanation: Likely respiratory distress due to tube displacement.

Question 18: Signs of Small Bowel Obstruction

• Most Specific Sign: D, Vomiting of fecal material.

Question 19: Drug Overdose and Torsades de Pointes

• Likely Drug: D, Amitriptyline.
• Explanation: Tricyclic antidepressants can cause QT prolongation leading to torsades.

Question 20: Initial Management of Drug Overdose

• Priority: A, Securing the airway.
• Explanation: Airway management takes priority in overdose scenarios.

Additional Notes on Shock

• Key Differentiator: D, Decreased PAOP in hypovolemic shock, increased in cardiogenic shock.

Conclusion

• Encouragement for CCRN preparation and invitation for feedback on the review format.