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PASS CCRN EXAM SCRIPT 2026 PRACTICE
SOLUTION BUNDLED
◉ What ventilator parameter indicates fluid volume excess? Answer: An A:a gradient greater than 10 mm Hg is a reflection of a diffusion defect. Note that the process of diffusion is between A (alveolus) and (a) arterial blood. An increase in intraalveolar fluid dilutes and inactivates surfactant, causing alveolar collapse (decreasing vital capacity) and decreases lung compliance. Peak inspiratory pressure increases reflect a decrease in lung compliance ◉ What does autonomy refer to? Answer: The patient's right to make decisions for themselves ◉ What does beneficence mean? Answer: Obligation to do good ◉ What does nonmaleficence mean? Answer: Obligation to do no harm ◉ What does fidelity mean? Answer: the obligation to abide by agreements and responsibilities ◉ What does veracity mean? Answer: The obligation to tell the truth
◉ What are Diagnosis-Related groups? Answer: DRGs constitute a prospective payment program for Medicare patients. Payment is based on primary and secondary diagnosis, primary and secondary procedures, age, and length of hospitalization ◉ BNP is secreted in response to? Answer: Ventricular wall stretch ◉ What are omnious signs in a patient with status asthmaticus? Answer: A normalization or increase in the PaCO2. This patient is still tachypneic, and if ventilation is normal, PaCO2 should be decreased. The other ominous sign in this patient would be absence of wheezing or rhonchi, because they would indicate that ventilation is insufficient to cause these noises. ◉ What problems arise from losses from the GI tract? Answer: Any loss results in hypokalemia. Vomiting results in loss of acidic contents, whereas losses below the pylorus result is alkalitic losses leading to metabolic acidosis. Fluid is sequestered in the intestine leading to hypovolemia, which could cause hypovolemic shock. ◉ Actual problems are worse than potential problems!! Answer: ◉ How can you differentiate the cause of jaundice? Answer: An increase in direct bilirubin is associated with biliary obstruction because direct bilirubin is conjugated. An increase in indirect
2nd letter-chamber sensed ◉ What is the difference between an anaphylactic and anaphylactoid reaction? Answer: Anaphylactoid reaction is clinically indistinguishable from anaphylactic reaction but does not require previous exposure to the antigen. Anaphylactoid reaction is not IgE mediated, and direct activation and degranulation of mast cells are thought to be triggered by the complement system. Anaphylactic reaction requires previous exposure to the antigen and is IgE mediated ◉ Mitral stenosis is associated with what? Answer: Pinkish discoloration of the cheeks. It is a diastolic murmur ◉ What murmur is associated with widened pulse pressure? Answer: Aortic regurg ◉ What murmur is associated with narrowed pulse pressure? Answer: Mitral regurg ◉ What lead changes are associated with left ventricle hyperthrophy? Answer: Strain pattern in V5 and V6 (asymmetric T wave inversion)
When the depth of the S wave in lead V1 or V2 plus the height of the R wave in lead V5 or V6 is 35 mm or greater, this constitutes voltage ◉ What lead changes are associated with right ventricle hypertrophy? Answer: strain pattern in V1 and V2. Prominent R wave in V1 reverse progression of the R wave across the precordium. ◉ What organ system is the most common to fail in severe sepsis? Answer: Hematologic- coagulopathies are common in severe sepsis ◉ What are the early signs of hypoglycemia? Answer: The early signs of hypoglycemia are mediated by the sympathetic nervous system, which acts to mobilize glucose stores (tachycardia, tachypnea, diaphoresis). Later signs of hypoglycemia are related to low glucose levels in the brain (neuroglycopenia) **Early signs can be masked in pts taking beta-blockers ◉ What is the systolic BP at different locations if you are able to palpate a pulse? Answer: If the radial artery can be palpated, the systolic BP is at least 80 mm Hg. If the brachial artery can be palpated, the systolic BP is at least 70 mm Hg. If only the carotid artery can be palpated, the systolic BP is approximately 60 mm Hg
◉ How does positive pressure ventilation affect ICP Answer: It increases intrathoracic pressure, which leads to increased ICP ◉ What is the difference between active and passive euthanasia? Answer: Passive euthanasia is allowing a person to die without taking lifesaving measures. Hydration and nutrition is usually maintained. Active euthanasia is doing something that causes death ◉ To minimize respiratory fluctuations on PAOP, you measure it Answer: At the end of expiration Patient breathing-peak Ventilator-valley ◉ Lateral wall MI Answer: Changes in V5, V6 and/or I and avL ◉ Anterior wall MI Answer: V2, V3, V ◉ Inferior wall MI Answer: II, III, and aVF ◉ Bleeding time is a reflection of what? Answer: Platelet function. Clopidogrel and abciximab are specifically platelet aggregation inhibitors. Heparin is an indirect thrombin inhibitor, but it also inhibits platelet aggregation
◉ What is the earliest sign of hepatic failure in MODS? Answer: Hypoglycemia- liver helps form and breakdown glycogen. Ascites, increased serum bilirubin and increased ammonia levels take time to develop ◉ Dobutamine is the drug of choice for cardiogenic shock Answer: Beta-adrenergic stimulant, increases HR and contractility ◉ What EKG changes occur with LBBB? Answer: QRS complex greater than 0.12 second in duration and a QRS complex that is positive in leads V5 and V6 (consider these left ventricular leads) and negative in leads V1 and V2 (right ventricle leads) RBBB- QRS upright in V1 V2, negative in V5 V ◉ SaO2 has the least impact on oxygen delivery. Hemoglobin and cardiac index are more important Answer: ◉ Weakness, fatigue, muscle pain, and abdominal discomfort in a patient taking Metformin may indicate what? Answer: Lactic acidosis and rhadomyolysis ◉ How does Nifedipine (Procardia) work? Answer: Nifedipine decreases myocardial oxygen consumption by dilating veins and arteries, thereby decreasing preload and afterload. Nifedipine also
◉ How does hypoxemia affect pulmonary vascular pressures? Answer: It causes the vasculature to constrict, which can lead to pulmonary hypertension ◉ If you notice a sudden change in diastolic pulmonary artery pressures you should suspect what? Answer: Proximal movement of the catheter. Recall that the systolic pressure of the pulmonary artery and the right ventricle are approximately the same. The diastolic pressure in the pulmonary artery is normally approximately 10 mm Hg, whereas the diastolic pressure of the right ventricle is normally close to 0. Any sudden decrease in the PA diastolic pressure should lead you to suspect that the catheter has flipped back into the right ventricle ◉ What is DIC? Answer: DIC is a consumptive coagulopathy. The clotting cascade is stimulated, causing clotting in the microcirculation. Platelet and clotting factors (including fibrinogen) are consumed and become depleted. Clotting studies are prolonged. The massive clotting stimulates the fibrinolytic system. FDPs are the result of this fibrinolysis, and they trigger more bleeding ◉ Management of care for pt with DIC includes... Answer: Avoidance of injections, replacement of fluids/blood/clotting factors, turning frequently and gently, and not using automated BP cuffs (risk of injury/trauma)
◉ Drugs that may cause torsades de pointes Answer: Amitriptyline (Elavil) causes QT interval prolongation and may cause torsades. Other drugs- Class IA antidysrhythmics (e.g., procainamide, quinidine, and disopyramide), Class III antidysrhythmics (e.g., sotalol and amiodarone), tricyclic antidepressants (e.g., imipramine [Tofranil]), and phenothiazines (e.g., chlorpromazine [Thorazine]) ◉ Advantages of an IABP vs pressors? Answer: If you have a hypotensive patient with high afterload giving them pressors will increase SVR, work on the heart, and myocardial oxygen consumption. IABP increases coronary artery perfusion and myocardial oxygen without increasing afterload or decreasing BP ◉ What are the determinants of oxygen diffusion Answer: Surface area available for gas transfer Thickness of the alveolar-capillary membrane Diffusion coefficient of gas Driving pressure ◉ What affects the driving pressure of oxygen? Answer: Oxygen concentration (FiO2) and barometric pressure- so to increase SaO you either have to increase FiO2 or increase pressure (either by hyperbarics or PEEP/CPAP)
they would decrease RAP and CO. Dobutamine is needed to improve RV contractility ◉ How does Milrinone work? Answer: Inotropic agent, has arterial and venous vasodilating qualities- decreases preload and lessens the filling of the left side of the heart. Is indicated for chronic LV failure. ◉ Hyperthermia cause what change on the oxyhemoglobin dissociation curve? Answer: It causes it to shift to the right, which decreases hemoglobin's affinity for oxygen (doesn't like it so it doesn't hold on to it). So your O2 sats would be lower than normal ex: Pa02 of 60 normally gives you an SaO2 of 90%, but if your hyperthermic it would be closer to 86% ◉ What activities increase myocardial ischemia? Answer: Using the bedpan, having the bed changed, having painful procedures (such as the insertion of an intravenous catheter), and being weighed on an overbed scale increase myocardial oxygen consumption and may cause myocardial ischemia. Eating a meal also may shunt blood to the gastrointestinal tract and cause myocardial ischemia ◉ What is the primary role of the case manager? Answer: Advocate- informing and supporting in decision making, informing about available resources and negotiating access to resources
◉ What are the current guidelines on providing oxygen to COPD patients Answer: Maintain hypoxemia (lower than normal O2 in blood) but prevent hypoxia (low O2 to tissues). This is achieved by maintain SaO2/SpO2 around 90%. Therefore some patients may need more than 2L of oxygen. ◉ What electrolytes may be involved in a patient with prolonged QT Answer: Potassium, calcium, and magnesium. Low levels of any of these would result in prolonged repolarization, which would be seen as a prolonged QT segment ◉ If the ventricles are depolarized before the atria in a junctional rhythm you would expect to find the P wave where? Answer: After the QRS ◉ A patient has CSF leaking from their nose after a transsphenoidal hypophysectomy, what do you do? Answer: It is normal to have a CSF leak for 48 hrs after surgery. Cover with a sterile "moustache" 2x tapes under their nose to form a barrier. If your dura is not intact that you would expect a leak, but it does increase your risk of infection ◉ What is Wernicke's syndrome and what is it associated with? Answer: Thiamine is necessary for use of glucose. Administration of glucose in patients with thiamine deficiency may cause Wernicke's syndrome (also called Wernicke's encephalopathy). The syndrome is
◉ Pt with multiple traumas has a temp of 39, is restless/agitated, has warm/dry skin and his hemodynamics are as follows... BP- 88/48 HR-124 CO-10.5 CI-5.35 RAP-4 PAOP-3 SVR-452 VSat- 90 What does this represent and what med would treat it? Answer: Distributive shock (septic shock- temp). Most specific characteristic of distributive shocks is low SVR (afterload). Goal is to restore afterload and perfusion gradient- which is done by the use of pressors (restore vascular tone caused by massive vasodilation) ◉ What is Wolff-Parkinson-White syndrome and how is it treated? Answer: There is an extra pathway between your hearts upper and lower chambers causing a rapid heartbeat. Lidocain and amiodarone may be used in treatment, as well as adenosine if experiencing SVT. DON't give verapamil because it slows conduction through the AV node which could lead to severe tachycardias ◉ If you got a whole bunch of banked blood you also need to get platelets and plasma, why? Answer: RBCs do not contain platelets; therefore patients receiving multiple transfusions also will need to receive platelets. Clotting abnormalities in these patients result from hypocalcemia, thrombocytopenia, and depletion of clotting factors. Fresh frozen plasma also is indicated to replace the clotting factors
◉ What conditions would lead to a shift in the PMI from the midclavicular line to the anterior axillary line? Answer: LV hypertrophy, right tension pneumo, right pleural effusion- think any pressure on the right side will shift things toward the left Pericardial effusion- layer of fluid over the heart which will dampen the sounds but not cause a shift to the left ◉ What does failure to capture indicate and how do you correct it? Answer: failure to capture occurs when the electricity from the pacemaker does not cause depolarization of the ventricle (or atria if an atrial pacemaker). It would be logical to consider using more electricity (i.e., milliamperage). You can also try repositioning the pt on the side before they lost capture ◉ What is failure to sense and what do you do for it? Answer: Pacer spikes seen indiscriminately within pts own rhythm. Increase the sensitivity ◉ What is oversensing on a pacemaker? Answer: Oversensing occurs when the pacemaker senses an event besides what it is intended to sense and is inhibited by this event. Ex; The pacer senses the T wave or other inappropriate signals and is inhibited ◉ How do you treat oversensing Answer: Decrease the sensitivity if causing failure to fire
an example of translation of evidence. A pilot test would be an example of implementation of evidence ◉ What are the purpose of chest PT? Answer: increase mucociliary clearance of secretions which decreases airway resistance and decreases shunt ◉ The reshaping that occurs with HF results in the heart taking on what shape? Answer: More spherical shape- think the PMI gets displaced to the left ◉ What are signs of oxygen toxicity? Answer: Early indications of oxygen toxicity are substernal distress, paresthesias in extremities, and gastrointestinal symptoms (e.g., anorexia, nausea, vomiting, fatigue, malaise, dyspnea, and restlessness). Late indications are hypercapnia, cyanosis, decreasing compliance, increasing A:a gradient, and pulmonary edema ◉ What is the best fluid for patients with DI? Answer: D5W- Patients with diabetes insipidus lose more water than sodium, and they need to be treated with more water than sodium. Saline and lactated Ringer's solution would contribute to the hypernatremia. D10W could cause a hypertonic diuresis. ◉ What do you need to consider when monitoring a patient who has received massive transfusion? Answer: Hyperkalemia, hypocalcemia,
hypothermia, and decreased tissue oxygen delivery caused by decreased levels of 2,3-diphosphoglycerate ◉ Normal arterial oxygen saturation is ~100%, and normal venous oxygen saturation is ~75%. The tissues used 25%. The normal arterial oxygen content is ~20 mL/dL, and normal venous oxygen content is ~15 mL/dL. The tissues used 25%. The normal oxygen delivery (DO2) is ~1000 mL/min, and normal VO2 is ~250 mL/min. The tissues used 25%. The normal DO2I is ~600 mL/min/m2, so consider what is 25% of 600 mL/min/m2? The normal VO2I is ~ mL/min/m2 Answer: 100 out, 25 used, 75 reserved ◉ Your pt has a pneumothorax. He complains of tingling around his mouth and fingertips and feeling light-headed. BP is normal, HR in 110s, RR is 36, temp normal. What is causing the tingling? Answer: Decreased serum Ionized Ca. Hyperventilation causes hypocapnia and respiratory alkalosis. Alkalosis causes an increase in the binding between calcium and albumin. This reduces the serum ionized calcium level and causes of symptoms of hypocalcemia Associate these symptoms with tetany and low Ca ◉ What is volutrauma Answer: Shearing of alveolar associated with high tidal volumes
