Mixed Deck — All CCRN Topics Flashcards

A patient in the ICU develops cardiogenic shock following a large anterior wall myocardial infarction. The provider orders a dobutamine infusion. The nurse understands the primary therapeutic effect of this medication is to:

Answer: Increase myocardial contractility and cardiac output.

Dobutamine is a positive inotropic agent that primarily stimulates beta-1 adrenergic receptors. Its main therapeutic effect in cardiogenic shock is to increase myocardial contractility (in-o-tropy), which improves stroke volume and, consequently, cardiac output. While it has some mild vasodilatory effects, its main purpose is to improve the heart's pumping function.

To primarily lower an elevated PaCO2 in a volume-controlled ventilated patient, the nurse should anticipate:

Answer: Increasing the respiratory rate or tidal volume (minute ventilation)

CO2 elimination depends on minute ventilation, so raising rate or tidal volume lowers PaCO2.

Which coagulation abnormality is a hallmark of disseminated intravascular coagulation (DIC) in severe sepsis?

Answer: Simultaneous bleeding and microvascular thrombosis

DIC produces both clotting and bleeding due to consumption of clotting factors.

Nonmaleficence is best demonstrated when a nurse:

Answer: Double-checks a high-alert medication dose before administration

Nonmaleficence means avoiding harm, exemplified by preventing medication errors.

Which condition causes hypoxemia that does NOT correct with 100% supplemental oxygen?

Answer: Intrapulmonary shunt

True shunt allows blood to bypass ventilated alveoli, so it responds poorly to increased FiO2.

A target mean arterial pressure (MAP) of at least what value is recommended during septic shock resuscitation?

Answer: 65 mmHg

A MAP of at least 65 mmHg is the recommended initial perfusion target.

Which class of hemorrhagic shock corresponds to a 30-40% blood volume loss?

Answer: Class III

Class III hemorrhage involves 30-40% blood loss with marked tachycardia, hypotension, and altered mental status.

Which laboratory finding best distinguishes hyperosmolar hyperglycemic state (HHS) from DKA?

Answer: Profound hyperglycemia with minimal ketosis and near-normal pH

HHS is characterized by extreme hyperglycemia and high osmolality but little or no ketosis because residual insulin prevents lipolysis.

What is the recommended ventilation strategy for a trauma patient with ARDS?

Answer: Low tidal volume 6 mL/kg of predicted body weight

Low tidal volume (6 mL/kg PBW) lung-protective ventilation reduces ventilator-induced injury in ARDS.

A 76-year-old female is found unresponsive. In the ICU, she has a temperature of 34.4°C (94°F), heart rate of 45 bpm, blood pressure of 82/50 mmHg, periorbital edema, and a Glasgow Coma Scale score of 7. These clinical findings are most suggestive of which endocrine emergency?

Answer: Myxedema Coma

Myxedema coma is a life-threatening complication of severe, longstanding hypothyroidism. Its hallmark features include altered mental status, profound hypothermia, and a precipitating event. [12, 29] Bradycardia, hypotension, hypoventilation, and non-pitting edema (myxedema) are also classic signs. [2, 4, 6] The other conditions are typically associated with tachycardia and/or normo/hyperthermia.

A persistently low SvO2 (45%) most likely reflects:

Answer: Increased oxygen extraction from inadequate delivery

Low SvO2 indicates tissues are extracting more oxygen because delivery is inadequate.

Which ventilator setting most directly improves oxygenation in a hypoxemic patient?

Answer: Increasing PEEP and FiO2

PEEP and FiO2 are the primary settings adjusted to improve oxygenation.

Damage to the developing brain's motor control areas causes which of the following developmental conditions?

Answer: Cerebral palsy

Cerebral palsy (CP) is a group of permanent movement disorders that emerge in early childhood, resulting from non-progressive disturbances in the developing fetal or infant brain. These disturbances specifically affect the motor control areas of the brain, leading to challenges with muscle tone, movement, and posture. The other listed syndromes are genetic conditions with distinct etiologies.

Which intervention is the priority within the first hour of recognizing sepsis (sepsis bundle)?

Answer: Obtain lactate, blood cultures, and begin fluids plus broad-spectrum antibiotics

The hour-1 sepsis bundle includes measuring lactate, drawing cultures before antibiotics, starting fluids, and giving broad-spectrum antibiotics.

A patient with disseminated intravascular coagulation (DIC) would be expected to have which laboratory profile?

Answer: Low platelets, high D-dimer, prolonged PT/PTT, low fibrinogen

DIC consumes platelets and clotting factors and generates fibrin degradation products, producing thrombocytopenia, elevated D-dimer, prolonged PT/PTT, and low fibrinogen.

A patient with a high thoracic spinal cord injury is at risk for autonomic dysreflexia. Which trigger is most common?

Answer: Bladder distention

Bladder distention is the most common noxious stimulus triggering autonomic dysreflexia in high spinal cord injury.

Which medication is used to reverse the anticoagulant effect of dabigatran (a direct thrombin inhibitor) in life-threatening bleeding?

Answer: Idarucizumab (Praxbind)

Idarucizumab (Praxbind) is a monoclonal antibody fragment that specifically and rapidly reverses dabigatran's anticoagulant effect.

Which neuromuscular blocking agent is preferred in ICU patients with acute respiratory distress syndrome (ARDS) requiring paralysis?

Answer: Cisatracurium

Cisatracurium is preferred in ARDS because it undergoes Hofmann elimination (spontaneous degradation), making it independent of renal and hepatic function.

A patient is undergoing a spontaneous breathing trial (SBT) to assess for weaning readiness. Which of the following findings would be the strongest indicator of SBT failure, requiring the patient to be placed back on their previous ventilator settings?

Answer: A Rapid Shallow Breathing Index (RSBI) of 130 breaths/min/L.

The Rapid Shallow Breathing Index (RSBI), calculated as respiratory frequency divided by tidal volume (f/VT), is a key predictor of weaning success. A value greater than 105 breaths/min/L is highly predictive of weaning failure, indicating that the patient is breathing rapidly and shallowly and cannot sustain the work of breathing. While the other options may be signs of intolerance, an RSBI >105 is a more objective and critical indicator of failure.

The two guideline biochemical operators that are discharged from the endothelium of blood vessels and work to diminish blood flow to destinations of harm and preserve blood volume are:

Answer: Thromboxane A2 and endothelin

Thromboxane A2 (TXA2) is a potent vasoconstrictor and platelet aggregator released by activated platelets, contributing to clot formation and local vasoconstriction. Endothelin is a powerful vasoconstrictor released by endothelial cells in response to injury. Both substances work synergistically to diminish blood flow to sites of harm, thereby helping to preserve blood volume and promote hemostasis.