Anyone else studying for CCRN exam?

Specialties CCU

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  1. I have or would like to get my CCRN certification: (you may select more than one)

    • 851
      Yes
    • 17
      No
    • 365
      If yes: I get some kind of financial reward or incentive to achieve and maintain certification.
    • 331
      If yes: There is no financial reward or incentive at my institution for CCRN certification.
    • 360
      If yes: I have or can have CCRN on my name badge or there is other forms of acknowledgement.
    • 291
      If yes: I find the certification has empowered my practice and would encourage others to pursue it.
    • 13
      If yes: It really hasn't been worth the work and I would discourage others from pursuing it.
    • 5
      If no: I don't have the certification and feel no need or have had negative experiences.
    • 53
      If no: I would like to pursue it, but have had difficulty getting motivated.
    • 12
      I am undecided.

379 members have participated

Is there anyone else out there who is currently studying for the CCRN exam and would like to start a thread as perhaps a study and support group? I have just applied for the exam and have not yet set a date, but about in 3 months is when I will be taking it. I would love to be in communication with others in the same boat! I hope there is at least one other nurse out there! Thanks!

deeDawntee

Specializes in Travel Nursing, ICU, tele, etc.
Woooooooooowwww we have us a stickied thread :)

Hey - what do you guys think of this: 100% NRB, 89-90% SaO2 on screen, RR 19, somewhat labored. Decreased LOC.

ABG: 7.35, Po2 59, Co2 43, bicarb 23.3, SaO2 on ABG 87.7%.

Feet started off somewhat mottled, as the night progressed the mottling crept up the legs to the thighs.

CT scan ruled out pneumo. RUL/ML/LL infiltrates. Renal failure.

What would you do?

Oh, systolic dropped from 170 to 73 within 2 hours.

Very cool scenario!

Looks to me that the patient went from the hyperdynamic stage to the hypodynamic stage of septic shock.

I would have gotten him on a bipap immediately as bridge to likey intubation given his decreased level of consciousness. It would depend if he were able to maintain his airway or not (of course).

The guy needs a central line ASAP. In my institution, Levophed would be the pressor of choice, if ineffective Vaso would be added (at a set rate).

Lets get some antibiotics on board, probably Zosyn or Levaquin.

We need to give fluids per CVP, but lets get renal involved, given the failure. This may be a good time to intubate, since fluid balance will be an issue. Titrate Diprivan to effect. Send a sputum spec for culture.

Looks like the guy has some serious PVD. Is he diabetic? What is his Cardiac status? Lets get a cardiac enzyme series. The guy will probably needs an insulin gtt. Also, lets get a bedside ultrasound of his lower extremities after pt stabilized.

Also lets get a lactate, CMP, lytes, CBC with diff, what are his neutrophils? A Cortisol stim test, then q 8hr Solu Medrol asap.

Lets start replacing lytes per renal.

Hey Burnt, what really happened???!!! :uhoh3::uhoh3::uhoh3:

Specializes in Cardiac.
Ridiculous! Did he have an attitude too? What does he want, D50 one hour and turn up the insulin drip the next hour?:idea:

YES! He did have an attitude! He said, "let's try to stick to the protocol..." and he sighed and rolled his eyes. Protocol? I AM the protocol!

We were also drawing this poor lady Q2 BMPs. No line, so she got stuck every hour for the FSBG, and Q2 for the labs. Poor thing...

Specializes in LPN school.
Very cool scenario!

Looks to me that the patient went from the hyperdynamic stage to the hypodynamic stage of septic shock.

I would have gotten him on a bipap immediately as bridge to likey intubation given his decreased level of consciousness. It would depend if he were able to maintain his airway or not (of course).

The guy needs a central line ASAP. In my institution, Levophed would be the pressor of choice, if ineffective Vaso would be added (at a set rate).

Lets get some antibiotics on board, probably Zosyn or Levaquin.

We need to give fluids per CVP, but lets get renal involved, given the failure. This may be a good time to intubate, since fluid balance will be an issue. Titrate Diprivan to effect. Send a sputum spec for culture.

Looks like the guy has some serious PVD. Is he diabetic? What is his Cardiac status? Lets get a cardiac enzyme series. The guy will probably needs an insulin gtt. Also, lets get a bedside ultrasound of his lower extremities after pt stabilized.

Also lets get a lactate, CMP, lytes, CBC with diff, what are his neutrophils? A Cortisol stim test, then q 8hr Solu Medrol asap.

Lets start replacing lytes per renal.

Hey Burnt, what really happened???!!! :uhoh3::uhoh3::uhoh3:

Man......you are dead on, even down to the cortisol level, yea we started zosyn and vanq 1 gram. I'm genuinely impressed. The resident wasn't as sure as you were, especially about intubation; the on call anesthesiologist ended up "passing through" our unit ;) to take a look at the patient - we ended up intubating after he called the attending.

The interesting thing I thought was the ABG - normal CO2/PH (compensated) but vastly decreased PO2, on 100%. Shunting? beginning stage ARDS? It was interesting application of gasparas stuff - she talks about that kind of co2/po2 dicotomy. pt was definitely in septic shock (Dr Dawn, mad props for diagnosis):balloons:

I guess i'm just confused as to how a patient can maintain a normal CO2 but not get enough O2 with an A-a of 593 - I understand the idea behind physiologic peep, but it seems that if you're not diffusing O2 you wouldn't be diffusing CO2 the other way.

Specializes in Travel Nursing, ICU, tele, etc.

I guess i'm just confused as to how a patient can maintain a normal CO2 but not get enough O2 with an A-a of 593 - I understand the idea behind physiologic peep, but it seems that if you're not diffusing O2 you wouldn't be diffusing CO2 the other way.

What does Gasparis (or somebody) say, something like CO2 is 25 times more diffusable than O2. That may explain this. Obviously this guy isn't a COPDer.

Hey, I'm glad I guessed right. I love sepsis patients. And the Intensivists I work with would intubate in a heartbeat with those kind of numbers and clinical picture. SECURE THE AIRWAY!!!!

Hey did you ever check out that video on You-tube on CCRN. I loved the part about how we end up breathing for patients, we are the patients kidneys etc etc and what really ends up killing our patients is the heart finally gives out. Pretty cool I thought. Never really thought about it that way. But once a person is intubated, lung issues rarely kill people. So, I say intubate, man!!!! hehehe

(if I had anything to say about it!!)

Specializes in ICU, Research, Corrections.
I'm still here too!! Just busy witht hte kids goign back to school and trying to get in a little study time between work and all of the stuff with the kids. I have been doing some of the PASS CCRN quizes. Some of them make me feel very stupid. I have about a 50-70% pass rate!! Even on the cardio ones!!!! I am goign to do the PACWP website this week. We had to do it for work a couple of years ago.

Try to get yourself up to 80% on the PASS CCRN tests. Practice, practice, practice makes perfect. Read all the rationales for all the questions - even if you get them right. I am not talking about the book; study the CD. I didn't even touch my book.

IMHO, the PACWP website is too much information. Memorize all your values.......know what they mean and the implications of abnormalities. Got an intensive care nursing book that deals with Swann-Ganz explanations? Pull that sucker out! ;)

You can do it CVICURN2003 ;)

Specializes in ICU, Research, Corrections.

OK Dawn............what are you up to? You felt good, still good?

Test taking tip= You will get one piece of scratch paper. You will get one calculator, (which you will have no use for.) The test does not start until you tell the computer to start. Take your time and write down on the piece of scratch paper everything you have memorized for the test. Take your time writing; the test hasn't started yet! YOU are in control of when the test starts.

Your head can spin while analyzing all the info given in a question. Look at your scratch paper for abnormals and normals.

This tip was given to me by co-workers and was very helpful to me.

Cheers,

Hooz

Specializes in Travel Nursing, ICU, tele, etc.

Hi Hooz!!

Thanks for asking. I am feeling good about the test. I still have next weekend to go through stuff again. I feel pretty confident about Swans. I don't know, maybe I should be more worried? In any case, this process has been such a valuable experience. I'm looking forward about how to keep this thread alive. I hope a few of us will check in once in a while to encourage others in this process. Oh well, whatever will happen, will happen, I just have gotten attached to you guys!!!

Specializes in Travel Nursing, ICU, tele, etc.

Hey Hooz,

What has the response been to your new CCRN?

Specializes in Travel Nursing, ICU, tele, etc.

Hi fellow CCRNers! Another new experience for me. I took care of a patient with an acute exacerbation of Myasthenia Gravis. It had not been diagnosed, she presented to the ED with SOB and weakness. She was admitted with aspiration pneumonia. Thank goodness she was in the hospital, because she required emergent intubation a day later due to respiratory failure. She had a positive tensilon test, received daily doses of Immunoglobulin IV X5 days and is on pyridostigmine (Mestinon) which blocks the destruction of acetylcholine by cholinesterase which then promotes stimulation of the receptors. She has begun to be able to move her arms but not her legs and has a NIF on the vent of -20. I will be curious to see when she is actually extubated given the ongoing generalized weakness.

According to Dr Laura's big review book re: Myasthenia Gravis: Treatment may include immunosuppresive drugs such as steroids, or experimental use of cytotoxic drugs, Imuran or Cytoxan.

A side effect of the Mestinon may precipitate cholinergic crisis, for which Atropine is given. My pt was on a vent, but she did brady down, for which they tried Dopamine (not indicated anywhere in my references) and of course it did not work...but now have an order to give Atropine for symptomatic bradycardia. The woman has an incredible amt of oral secretions, which could certainly relate to the cholinergic stimulation.

Anyway, just wanted to share that with you. My first pt in this stage of MG. Very interesting as she pretty much followed the text book description down to the last detail. It will help me remember MG for the CCRN test!!!

Specializes in LPN school.

I just finished studying MG on the neuro part of the gasparas review book - what a great way to solidify it, dawn! Whats NIF of -20 mean? is that her inspiratory pressure? if it is then thats not bad at all...

My study update:

I'm hammering through the PACEP.org stuff today. I finished respiratory this morning. Hopefully i'll be able to revisit respiratory at the end of this week to review it/cement it.

Ever notice how after you study something for CCRN, you end up with a patient that coincides with what you've studied? It's uncanny how often thats happened to me since i've started working on the CCRN

here's hoping for a pt with a swan.......and a balloon pump.......on a ventilator........with ARDS..........

QUESTION FOR HOOZDO:

I've heard that the gasparas CCRN review/questions book is easier than the test....is that true? how about the pass CCRN questions? easier than the actual test?

Specializes in ICU, Research, Corrections.

QUESTION FOR HOOZDO:

I've heard that the gasparas CCRN review/questions book is easier than the test....is that true? how about the pass CCRN questions? easier than the actual test?

Howdy Burnt,

I did not do the Gasparas book. I only had the Dvds. The PASS CCRN questions are harder than the test in that the questions have much more hemodynamics thrown in. In other words, the questions and case scenarios set up in PASS CCRN are many........you will get much less of these questions on the real test.

IMO opinion - if you can get 80% on all the PASS CCRN sections, you will ace the test.

Happy studying :monkeydance:

Specializes in ICU, Research, Corrections.
Hey Hooz,

What has the response been to your new CCRN?

I get to get a new name badge that says RN, CCRN ;) Most of my coworkers already have their CCRN so I am just another fish in the sea of CCRNs :trout:

Remember, my workplace gives a hefty incentive for certifications - enough to make every nurse WANT to get a certification.

I have noticed more senior nurses want to brainstorm with me their complex patients. We always have before, but now they trust my advice more than ever. That is a good feeling. We have 3 new RNs on nights and they like to gather around and listen to us for learning purposes. Geez, I am smart all of sudden :uhoh3:

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