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Barron's CCRN Practice Exam 2025 Verified
Questions and Answers.
"high dose" dopamine causes vasoconstriction and (C) Increase afterload - correct answer>>What is the primary hemodynamic effect of: Dopamine >10 mcg/kg/min (A) Increase preload (B) Decrease preload (C) Increase afterload (D) Decreased afterload (E) Increase contractility (D) Decrease contractility Pulmonary HTN and cor pulmonale; Mitral, aortic, or tricuspid insufficiency - correct answer>>What causes the S3 sound? during diastole - correct answer>>When are coronary arteries perfused? S3 heart sound - correct answer>>What may you hear before crackles when a patient is going into heart failure?
Variant or Prinzmetal's Angina - correct answer>>What is this called? Unstable angina with transient ST segment elevation Can occur at rest or may be cyclic (occurring at the same time daily) troponin negative Can be precipitated by nicotine, coke, or ETOH RCA, inferior LV - correct answer>>There are changes in leads II, III, aVF....what type of MI? LAD, anterior LV - correct answer>>There are changes in leads V1, V3 V3, V circumflex, lateral LV - correct answer>>There are changes in leads V5, V6, I, aVL Low lateral LB - correct answer>>There are changes in leads V5, V high lateral LB - correct answer>>There are changes in leads I aVL RCA, posterior LV - correct answer>>There are changes in leads V1 and V RCA, right ventricular infarct - correct answer>>There are changes in leads V3R, V4R Marked ELEVATION of troponin/CK-MB: due to miocardial stunning when vessel opens reperfusion arrhythmias: VT, Vfib, accelerated idioventricular rhythm (due to stunning)
Haldol Quinidine Procainamide Low mag, calcium, or potassium - correct answer>>Causes of prolonged QT Amiodarone 150 mg IV over 10 min; Prepare for elective synchronized cardioversion. - correct answer>>Your patient has a pacemaker and has gone into Vtach. The pacemaker does not correct the rhythm and your patient goes unresponsive. What do you do?
- Jungular Vein Distention
- Ascending Dependent Edema
- Weight Gain
- Hepatomegaly (Liver Enlargement) - correct answer>>right sided heart failure
- SOB
- Crackles
- Oliguria
- Frothy Sputum
- Displaced Apical Pulse (Hypertrophy) *left goes away from lungs...takes your breath away - correct answer>>Left sided heart failure A mechanical pump that helps the ventricles pump blood, easing the workload of the heart in patients with left ventricular heart failure, cardiogenic shock, and cardiac myopathies. - correct answer>>Ventricular assist device (VAD)
inflates (INCREASES CORONARY ARTERY PERFUSION) and deflates ( DECREASES AFTERLOAD) Inflates at dicrotic notch of the arterial waveform, beginning of diastole Deflates before systole begins, determined by set trigger for deflation, Rwave of ECG or upstroke of arterial pressure wave - correct answer>>IABP tamponade pericarditis long CABG can increase bleeding risk due to increased heparin dose in surgery - correct answer>>CABG (Coronary Artery Bypass Graft) complications Narrowed pulse pressure (IE 82/68) Pulsus paradoxus: excessive drop is SBP (>12mmgh during inspiration). Cardiac muscle restriction due to tamponade with inspiration, intrathoracic pressure increases thus decreasing venous return Restlessness and agitation. Distended neck veins (JVD), hypotension, diminished heart sounds (Beck's triad); equalization of CVP: pulmonary artery diastolic and PAOP - correct answer>>Signs of cardiac tamponade 4 - 12 mmHg - correct answer>>PAWP (pulmonary artery wedge pressure) (same as PAOP) normal? hypovolemia (low PAWP, low volume) normal is 4- 12 - correct answer>>PAWP (same as PAOP) of 1-3 mmhg means?
Thus if a patient has a CO level of 40%, they cannot have more than 60% O sat. Treatment is 100% fiO2 until CO is >10% or hyperbaric - correct answer>>what is the normal level for carbon monoxide? What should be considered when monitoring O2 sats? What is the treatment for excess? suspected pneumothorax hemodynamic instability/life threatening arrhthmias secretions/aspiration risks - correct answer>>contraindications to NIV (BiPAP/CPAP)? Increased WOB/hypoxic respiratory failure. Example: a patient that has pulmonary edema and can follow verbal commands. - correct answer>>CPAP is indicated for patients who: Need both ventilation (IPAP) and oxygenation (EPAP) hypoxic and hypercapneic resp failure - correct answer>>BiPAP is indicated for patients who: (1) > 60% oxygen (2) inhalation of salbutamol (3) IV hydrocortisone (4) oral prednisolone - correct answer>>Status asthmaticus treatment Use low rate to increase exhalation time Use low tidal volumes to prevent auto-PEEP Increase inspiration/expiration (I/E) ratio, often greater than 1:3-4, to allow time for optimal exhalation and prevent auto-PEEP - correct answer>>status asthmaticus ventilator considerations
serious airflow obstruction or pneumothorax. Status asthmaticus---> Intubate - correct answer>>A silent chest may indicate fat emboli - correct answer>>your patient suffered a femur fracture, they are developing petechiae and a cough, low grade fever and anxiety. What could be going on? ALI and ARDS are the most common cause of this - correct answer>>noncardiogenic pulmonary edema causes? No. Can make it worse - correct answer>>should steroids be used in ARDS? limit to 30 or less - correct answer>>Plateau pressure in ARDS? limit tidal volues to 4-6 ml/kg ---> permissive hypercapnea to prevent volutrauma. - correct answer>>Vt in ARDS? tension, possibly life threatening. Air is unable to escape, causes mediastinal shift, tracheal deviation AWAY FROM AFFECTED SIDE distended neck veins hypotension *other symptoms similar to regular pneumo - correct answer>>which is worse, tension pneumo or a regular pneumo? tracheal deviation TOWARD AFFECTED SIDE decreased/absent breath sounds hypoxia unequal chest excursion chest pain
pontine problem - correct answer>>Apneustic breathing is an indication of what kind of neuro problem? medulla - correct answer>>ataxia is an indication of what kind of neuro problem? toward the pathology - correct answer>>If you patient has a left sided stroke, his eyes may deviate toward or away from the affected side? right side, contralateral - correct answer>>your patient is having hemianopsia in his left eye, you know this means that he had a left or right sided stroke? blown pupil - correct answer>>in an uncal herniation, what will you see first, LOC change or blown pupil on the side affected? epidural hematoma in temporal area (uncal herniation occurs due to displacement of temporal lobe against brain stem and 3rd cranial nerve-
oculomoter) - correct answer>>what is the most common cause of uncal herniation? swelling on both sides-->downward displacement of hemispheres slight change in LOC then coma constriction of pupils (1-3mm) then both dilate Bil. Babinski Causes are cerebral edema secondary to stroke or encephalopathy - correct answer>>what happens in central herniation?
Think P aPneustic breathing Pinpoint Pupils Parasympathetic innervation - correct answer>>Pontine stroke S+S to prevent elevated ICP - correct answer>>why is decadron given in neuro cases? Decreased level of consciousness - correct answer>>first sign of increased ICP 0 - 10 - correct answer>>normal ICP CPP = MAP - ICP - correct answer>>how to calculate cerebral perfusion pressure? 80 - 100 minimum is 50 brain death is under 30 - correct answer>>average CPP? VERY BAD results in poor cerebral perfusion CPP= MAP-ICP - correct answer>>high ICP with hypotension...
- Elevated systolic BP
- Bradycardia
- Irregular respirations - correct answer>>Cushing's triad consists of: A waves are "awful" - correct answer>>"A" Waves of ICP monitoring
Battles sign/raccoon eyes/otorrhea - correct answer>>your patient with a skull fracture (you're not sure where) has lost cranial nerve I, sense of smell and has a runny nose. What do you suspect? cerebral hypermetabolism (after 30 mins) - correct answer>>in status epilecticus, what is death due to? bacterial meningitis - correct answer>>Low glucose in CSF viral meningitis (60% is normal glucose) - correct answer>>normal glucose in CSF 8 - 12 mins - correct answer>>after how long would you reconnect vent and do an ABG for apnea test? 8 - 10 mins with pco2 >60 or >20 from baseline - correct answer>>positive apnea test for brain death Tensilon test: Myasthenic--> improved symptoms Cholinergic---> increased weakness and SLUDGE - correct answer>>Myasthenic Crisis vs. Cholinergic Crisis salivation, lacrimation, urination, defecation, GI upset, emesis, miosis cholinergic crisis S+S - correct answer>>SLUDGE
atelectasis LLL left pleural effusion --->due to elevation of left diaphragm (side of pancreas body) bil. crackles ARDS ---> due to phospholipase A relsease which "kills" type II alveolar cells thus decreasing surfactant. - correct answer>>pulmonary complications of pancreatitis bruising in flank area (lower back area) hemorrhagic pancreatitis - correct answer>>Grey Turner's sign ecchymosis in umbilical area, seen with pancreatitis hemorrhagic pancreatitis Methemalbumin forms from digested blood and tracks around the abd from the inflamed pancreas - correct answer>>Cullen's sign low calcium. It's used up for autodigestion. trousseau's sign, prolonged QT, seizures - correct answer>>what electrolyte abnormality in pancreatitis? Referred pain down the left shoulder; indicative of a ruptured spleen (may also have abd distention and absent bowel sounds). - correct answer>>Kehr's sign intraperitoneal bleeding - correct answer>>Cullen's sign + abdominal trauma. Where is the injury?
Increasedf pt, ptt, inr, bleeding time pos Ddimer (must be elevated) - correct answer>>Lab values for DIC? tranfusions (PLT, FFP), cryoprecipitate (contains coagulation factors) vit k - correct answer>>tx of DIC in addition to treating underlying cause white clot syndrome due to immune response (IgG) results in white clots that consume plts (PLT <10k) stop heparin start argatroban, start warfarin - correct answer>>HIT aka only a decrease in PLT on CBC, other values normal conditions can lead to it, like lupus chronic lymphocytic leukemia, some drugs - correct answer>>ITP S+S acute mitral valve insufficiency could mean acute inferior wall MI or papillary muscle dysfunction or rupture---> emergency - correct answer>>giant V waves on PA cath inflation 60 - 80% too high or too low BAD high=sepsis, low temp, or paralysis low =fever, hypoxia, hypotension, hypovolemia, low hgb - correct answer>>normal SvO2 value
high=sepsis, low temp, or paralysis - correct answer>>high SvO2 of 90% could indicate SV - correct answer>>CO = HR x __ 4 - 8 L/min - correct answer>>Normal cardiac output? 50 - 100 kind of like HR - correct answer>>normal SV? most likely dueto VSD - correct answer>>murmur at the left sternal border after acute anterior MI, due to what possible problem? (ST elevation in leads V2, V3, V4) acute mitral regurg due to papillary muscle rupture/dysfunction - correct answer>>Acute inferior wall MI (ST elevation in leads II, III, and aVF), loud holosystolic murmur at apex radiating to axilla and crackles throughout. What could be the problem? lopresso or calcium channel blockers. lopressor increases filling time by slowing things down in disorders like cardiomyopathy. Digoxin would help with patient's who have issues with ejecting, or systolic heart failure (left ventricle). - correct answer>>filling heart problems should be treated with what kind of drug? Lopressor or digoxin? or should calcium channel blockers be considered? JVD, peripheral edema, abdominal pain due to liver engorgement. - correct answer>>right ventricular failure S+S crackles, S3, dyspnea - correct answer>>left ventricular failure S+S
(B) Decrease preload (C) Increase afterload (D) Decreased afterload (E) Increase contractility (F) Decrease contractility E) increases contractility - correct answer>>What is the primary hemodynamic effect of: Dobutamine (A) Increase preload (B) Decrease preload (C) Increase afterload (D) Decreased afterload (E) Increase contractility (D) Decrease contractility B) Decrease preload - correct answer>>What is the primary hemodynamic effect of: Nitroglycerin (A) Increase preload
(B) Decrease preload (C) Increase afterload (D) Decreased afterload (E) Increase contractility (D) Decrease contractility (C) Increase afterload - correct answer>>What is the primary hemodynamic effect of: Norepinephrine (A) Increase preload (B) Decrease preload (C) Increase afterload (D) Decreased afterload (E) Increase contractility (D) Decrease contractility (B) Decrease preload AND (D) Decreased afterload - correct answer>>What is the primary hemodynamic effect of:
