Preparing for CCRN

LCRN · May 10, 2005

Question for those CCRNs out there..... I have about 15 mths ICU experience and am preparing to take CCRN. We do the whole gambit in our ICU - trauma, neuro, fresh hearts, surgical, medical. About the only thing we do not do are MI ruleouts (they go to a coronary care unit). I've been studying the PASS CCRN book and am doing the questions on the CD that comes with the book. I am also planning to take a CCRN Review course this summer. I'm getting a little nervous because I am really, really starting to see that the more I learn, the more I realize I don't know.
So, how did you prepare for the exam? Any tips or pointers? Is my relatively short amount of critical care experience going to really work against me? Does anyone have websites with CCRN sample questions?
Thanks!

I'M ALSO ABOUT TO TAKE THE CCRN EXAM, I'VE BEEN IN CRITICAL CARE ABOUT 5 YEARS. PASS CCRN IS A GREAT BOOK BUT IT IS VERY DETAILED. I THINK A BIT TOO DETAILED. A GOOD CDROM THAT GIVES QUESTIONS AND DECENT RATIONALES IS CRITICAL CARE NURSING MADE INCREDIBLY EASY. I TOTALLY AGREE WITH YOU THAT THE MORE YOU READ, YOU REALIZE HOW MUCH YOU ENDLESSLY NEED TO KNOW.

GOOD LUCK WITH THE TEST!!!

LCRN · May 10, 2005

Hello All! I'm new to this site and think it's great! I'm still learning my way around though. I work in a medical/surgical ICU in a Trauma 1 center with about 500+ beds and we're currently expanding. I have an interesting patient presentation and unusual set of circumstances I'd like to share and would love to have any feedback.

Last week a 33 year old female entered the ER complaining of a severe headache with photophobia, N/V. Medical Hx consisted of being morbidly obese-->420 lbs., IDDM, migraines and mild hypertension. At 0100 she was medicated with anzemet and morphine per the ER sheet v/s at that time were ST110, 146/74, T99.2 and RR was normal, on RA Pox was 98%. The next entry was 0340 when she was found actively having seizures and was incontinent of urine. Ativan was given a total of 8mg IVP to stop convulsions, she was also intubated for airway protection and put on a propofol drip to decrease her peak airway pressures which were in the 60's at the initial time of intubation despite the ativan that was given. v/s were 106/54, ST 135, T99.0 and inital ABG was normal. Lab work that was drawn initially when she came in was normal-->wbc 6.4 h/h 12.2/38% all electrolytes wnl, ck/trop were added which were not elevated. She was then transferred the unit I was working that night-MICU

It was a very busy night in the ER with 2 traumas so my report was brief at best and did not include a thorough neuro assessment. On arrival to ICU-->pupils fixed and dilated 4mm bilat, - corneal reflex, -pain response, + babinski bilat. BP was now dropping, propofol was turned off prior to arrival to ICU. The dilemma I faced was our CT scan only accomodates up to 350 lbs., we do not have an open MRI. So we called all surrounding facilities and the company that distributed th CT machines to find out that 2 places could accomodate her weight but she had to be mobile, being able to walk and sit up. So now I have a patient who cannot be scanned, no neuro response off all medication, and now she starts requiring vasopressors. Next CBC showed wbc of 32,000 was done 6 hours after the initial, chem20 was wnl with an elevated glucose level of 360. Our docs were now questioning meningitis? They needed to do an LP but did not want to risk increasing intracranial pressure because of the lack of neuro response she was eliciting. So family was made aware of the current condition

Day#2 Remains unstable thru night now on vaso, levo, and neo to maintain a BP above 90 sys. Also requiring insulin gtt and fluid boluses. Put on Vanco and acyclivor. BUN/CR going up. Neuro in to see pt and does cold caloric test which did not elicit a response. Decided that LP needs to be done-->wbc18, glucose64 per CSF- serum glucose at the same time was 320. Our ID Doc feels it's bacterial meningitis because of the decreased glucose in spinal fluid. EEG reveals no brain waves on R hemisphere and minimal activity on L. patient is started on steroids.

Day#3 Now the RN's are pushing for an apnea test to be done for her to be declared brain dead however docs do not want to do that yet. We are unable to scan because of weight and now she's too unstable to be transported. We get a special bed to weigh her and she is 394 lbs. Her shoulder circumference is too large to fit in our scanner if we even were willing to attempt to scan her although the weight is too heavy per reccomendations.

Questions- Any differential diagnosis anyone can offer?

My predicament is I feel we are doing an injustice to the family by prolonging hope. If we were to do the apnea test we would be able to establish brain death per the current criteria. Any opinions?

Sorry it's lengthy- Thanks for any responses!

PJMommy · May 10, 2005

Hello All! I'm new to this site and think it's great! I'm still learning my way around though. I work in a medical/surgical ICU in a Trauma 1 center with about 500+ beds and we're currently expanding. I have an interesting patient presentation and unusual set of circumstances I'd like to share and would love to have any feedback.
Last week a 33 year old female entered the ER complaining of a severe headache with photophobia, N/V. Medical Hx consisted of being morbidly obese-->420 lbs., IDDM, migraines and mild hypertension. At 0100 she was medicated with anzemet and morphine per the ER sheet v/s at that time were ST110, 146/74, T99.2 and RR was normal, on RA Pox was 98%. The next entry was 0340 when she was found actively having seizures and was incontinent of urine. Ativan was given a total of 8mg IVP to stop convulsions, she was also intubated for airway protection and put on a propofol drip to decrease her peak airway pressures which were in the 60's at the initial time of intubation despite the ativan that was given. v/s were 106/54, ST 135, T99.0 and inital ABG was normal. Lab work that was drawn initially when she came in was normal-->wbc 6.4 h/h 12.2/38% all electrolytes wnl, ck/trop were added which were not elevated. She was then transferred the unit I was working that night-MICU
It was a very busy night in the ER with 2 traumas so my report was brief at best and did not include a thorough neuro assessment. On arrival to ICU-->pupils fixed and dilated 4mm bilat, - corneal reflex, -pain response, + babinski bilat. BP was now dropping, propofol was turned off prior to arrival to ICU. The dilemma I faced was our CT scan only accomodates up to 350 lbs., we do not have an open MRI. So we called all surrounding facilities and the company that distributed th CT machines to find out that 2 places could accomodate her weight but she had to be mobile, being able to walk and sit up. So now I have a patient who cannot be scanned, no neuro response off all medication, and now she starts requiring vasopressors. Next CBC showed wbc of 32,000 was done 6 hours after the initial, chem20 was wnl with an elevated glucose level of 360. Our docs were now questioning meningitis? They needed to do an LP but did not want to risk increasing intracranial pressure because of the lack of neuro response she was eliciting. So family was made aware of the current condition
Day#2 Remains unstable thru night now on vaso, levo, and neo to maintain a BP above 90 sys. Also requiring insulin gtt and fluid boluses. Put on Vanco and acyclivor. BUN/CR going up. Neuro in to see pt and does cold caloric test which did not elicit a response. Decided that LP needs to be done-->wbc18, glucose64 per CSF- serum glucose at the same time was 320. Our ID Doc feels it's bacterial meningitis because of the decreased glucose in spinal fluid. EEG reveals no brain waves on R hemisphere and minimal activity on L. patient is started on steroids.
Day#3 Now the RN's are pushing for an apnea test to be done for her to be declared brain dead however docs do not want to do that yet. We are unable to scan because of weight and now she's too unstable to be transported. We get a special bed to weigh her and she is 394 lbs. Her shoulder circumference is too large to fit in our scanner if we even were willing to attempt to scan her although the weight is too heavy per reccomendations.
Questions- Any differential diagnosis anyone can offer?
My predicament is I feel we are doing an injustice to the family by prolonging hope. If we were to do the apnea test we would be able to establish brain death per the current criteria. Any opinions?
Sorry it's lengthy- Thanks for any responses!

Hey LCRN -

Move this to a new thread and I bet you get more responses. Sounds like an interesting case and would like to see what others say. By the way, did they do a differential on her blood work? What were her bands?

TexasCCRN · May 10, 2005

Pass CCRN book is good, but as a second reference. Buy the Laura gasparis vonfrolio tapes, know those backwards and forwards. IF you have any questions or need more detail look it up in the pass ccrn. The tapes did it for me. They are great.

Good luck

SNEMU · May 10, 2006

I have been considering purchasing Laura Gaparis' CDs or DVDs and I was wondering if anyone has an opinion on which would be better to study from. I originally thouught that the DVDs would be better because I might be more focused if I am wathcing and listening, but the CDs would be more portable ( I could listen in my car). Any opinions?

japaho41 · May 16, 2006

Hey LCRN -
Move this to a new thread and I bet you get more responses. Sounds like an interesting case and would like to see what others say. By the way, did they do a differential on her blood work? What were her bands?

Despite the fact that you can't get a CT you could assume that the seizure may have been related to hemorrage. I didn't see where you mention nuchal rigidity to suspect menigitis. However all that is besides the fact now unfortunately.

JiffyGriff · May 17, 2006

Nuchal rigidity would be an important indicator in this case however, after I read this:

Last week a 33 year old female entered the ER complaining of a severe headache with photophobia

Meningitis was the first thing that popped into my head, with the exception of possibly something neuro.........however the falling bp and rising pulse put the meningitis over for me...........My question is why did it take the docs so long to suspect that?? and yes def. move this to another post....this one was def...hijacked........

I would like to hear more on preparing for the ccrn as I am planning on doing the same thing, so keep those coming...

dorimar, BSN, RN · May 19, 2006

Laura Gesparis tapes, practices tests over and over, and experience.

asylum5w2 · May 28, 2006

I took CCRN two years ago--I used Pass CCRN (bought it at one of her ccrn prep classes) and the Gasparis-Vonfrolio DVDs but my FAVORITE study method was Critical Care Examination Review by Laura Gasparis Vonfrolio. It is all practice tests with answers and rationale in the back. (much harder than the actual CCRN exam in my opinion) Good Luck!

Zee_RN, BSN, RN · Jun 7, 2006

Another vote for Laura Gasparis Vonfrolio. I listed to her tapes OVER and OVER and OVER. My KIDS could recite her. I also had the PASS CCRN book and used the CD for practice exam questions. Passed first try; just sent in for my recert!

ak47m203 · Sep 12, 2010

took the exam today...9/11/10 and passed. use pass ccrn and most of it is similar. like the aacn dvd too.

if you have a cd, do 150 questions q day for a week before the exam.