CCRN Procedures Flashcards: 170 Practice Questions & Answers

The catheter has moved from the Right Ventricle (RV) to the Pulmonary Artery (PA). Key identifier: The diastolic pressure rises (from near-zero in the RV to ~10-15 mmHg in the PA) and the dicrotic notch appears (representing pulmonic valve closure). AACN Tip: If the catheter migrates back into the RV, it creates a high risk for ventricular arrhythmias (V-tach). Immediate action: Inflate the balloon to float it forward or notify the provider to pull it back. Never leave a catheter in the RV.

Beta-Blockers (e.g., Metoprolol). Unless contraindicated by severe bradycardia or active reactive airway disease, beta-blockers should be initiated or resumed on POD 1. POAF incidence peaks on POD 2-3 due to inflammation and a surge in sympathetic tone. Strategy: AACN focuses on prevention. If AFib occurs and causes hemodynamic instability (hypotension, heart failure), the answer is always immediate synchronized cardioversion.

Baroreceptor Reflex Stimulation. Manipulation of the carotid bulb during stenting/ballooning triggers the baroreceptors, leading to profound bradycardia and hypotension. Management: Usually transient. Give Atropine for bradycardia and IV fluids/vasopressors if hypotension persists. Exam Tip: Contrast this with CEA, where hypertension is more common post-op due to denervation of the carotid sinus.

Drainage >100 mL/hr for two consecutive hours (or >200 mL in a single hour) requires immediate notification. Rationale: Excessive drainage may indicate active surgical hemorrhage. Conversely, if drainage suddenly stops, monitor for signs of cardiac tamponade (Beck's Triad: hypotension, JVD, muffled heart sounds), as a clot may be obstructing the tube, causing blood to accumulate in the mediastinal space.

1. When the apnea test cannot be safely completed due to hemodynamic instability or severe hypoxemia. 2. When the clinical exam is precluded (e.g., severe facial trauma, pre-existing pupillary abnormalities). 3. When toxic drug levels or metabolic inhibitors are present but cannot be cleared. Exam Tip: CTA or Nuclear Medicine Scans are the current gold standard ancillaries as they confirm absence of cerebral blood flow.