CCRN® Certification Review Vocabulary

These vocabulary flashcards cover essential terms, diagnostic signs, and physiological parameters from the CCRN® review course, spanning cardiovascular, pulmonary, neurological, renal, and gastrointestinal systems, as well as ethical practice.

Preload

The initial stretching of the myocardium prior to contraction, related to the sarcomere length at the end of diastole.

Afterload

The resistance the ventricles must overcome to eject blood; estimated as Systemic Vascular Resistance ($SVR$) for the left side and Pulmonary Vascular Resistance ($PVR$) for the right side.

S3 (Ventricular Gallop)

A heart sound heard when preload is elevated, associated with fluid overload; often described using the cadence "Ken-tuck-y" or "I Be-lieve."

S4 (Atrial Gallop)

A pre-systolic heart sound caused by the vibration of atria ejecting into non-compliant ventricles, associated with ischemia, hypertension, or hypertrophy.

Prinzmetal’s (Variant) Angina

Sudden chest pain caused by coronary vasospasm, often occurring at rest or during sleep, characterized by transient ECG changes during symptoms.

STEMI

An acute coronary syndrome involving complete arterial occlusion, characterized by ST elevation of $\ge 2\,mm$ in precordial leads ($V2/V3$) or $\ge 1\,mm$ in limb leads.

NSTEMI

A partial occlusion of coronary arteries characterized by elevated troponin levels and ECG changes such as ST depression or T wave inversion.

Retroperitoneal Bleed (RBH)

A complication of the femoral approach for PCI characterized by tachycardia, hypotension, and back/groin pain.

Aspirin

The first medication prioritized in ACS; it inhibits cyclooxygenase-1 within platelets to prevent the formation of thromboxane $A2$, disabling platelet aggregation.

Nitroglycerin

A potent vasodilator and venodilator that decreases preload and myocardial oxygen consumption; contraindicated in right ventricular infarction.

Beta Blockers

Cardio-protective medications that blunt the sympathetic nervous system, slow heart rate, and prevent cardiac remodeling; administered within 24 hours of MI if the patient is stable.

Pathologic Q-wave

An ECG finding indicative of myocardial necrosis, defined as being $\ge 0.04\,seconds$ wide and $\ge 25\%$ of the height of the R wave.

Dressler’s Syndrome

An autoimmune or viral inflammatory response occurring 2 to 12 weeks after an MI, causing pericarditis symptoms.

Beck’s Triad

The clinical sign for cardiac tamponade consisting of elevated CVP with JVD, hypotension with narrow pulse pressure, and muffled heart sounds.

BNP (B-type Natriuretic Peptide)

A hormone secreted by ventricles in response to stretch; levels $> 300\,pg/mL$ are consistent with heart failure.

HFrEF

Heart failure with reduced ejection fraction, defined as an $EF \le 40\%$, characterized by a contractility issue.

SGLT-2 Inhibitors

A pillar of heart failure management that reduces preload by decreasing glucose and sodium reabsorption in the nephron, providing a mild diuretic effect.

Takotsubo Cardiomyopathy

Also known as "Broken Heart Syndrome," characterized by weakening and apical ballooning of the left ventricle due to severe stress.

Mitral Regurgitation

An insufficiency causing a systolic murmur at the 5th intercostal space, mid-clavicular line, often appearing after a papillary muscle rupture.

Aortic Stenosis

A narrowing of the aortic valve causing a systolic murmur at the 2nd intercostal space, right sternal border, leading to increased afterload and left ventricular hypertrophy.

Janeway Lesions

Non-tender, red or purple spots on the palms or soles associated with infective endocarditis.

Adenosine

A medication used in SVT to slow AV node conduction time; typically administered as a rapid $6\,mg$ IV push, followed by $12\,mg$ if needed.

Wolff-Parkinson-White (WPW)

A pre-excitation arrhythmia involving an accessory pathway (Bundle of Kent) characterized by a short PR interval ($< 0.12\,sec$) and a delta wave.

Atropine

A medication for symptomatic bradycardia that inhibits the parasympathetic nervous system to increase the discharge rate of the SA node; dose is $1.0\,mg$ IV.

Failure to Capture

A pacemaker issue where the stimulus is delivered but fails to polarize the myocardium, seen as a pacer spike not followed by a QRS.

Torsades de Pointes

A polymorphic ventricular tachycardia often caused by hypomagnesemia or a prolonged QT interval; treated with magnesium sulfate.

Nitroprusside Toxicity

A risk of prolonged Nipride administration, especially in renal/liver failure, leading to thiocyanate accumulation, characterized by tinnitus and altered mental status.

Ankle-Brachial Index (ABI)

A diagnostic for Peripheral Arterial Disease calculated by dividing the ankle systolic pressure by the brachial systolic pressure; $< 0.4$ indicates severe obstruction.

Phlebostatic Axis

The reference point for leveling hemodynamic transducers, located at the 4th intercostal space and 1/2 of the AP diameter.

SvO2

True mixed venous oxygen saturation, typically $65\% - 75\%$, reflecting the balance between oxygen delivery ($DO2$) and oxygen consumption ($VO2$).

IABP (Intra-Aortic Balloon Pump)

A circulatory support device that inflates during diastole to increase coronary perfusion and deflates prior to systole to decrease afterload.

DKA (Diabetic Ketoacidosis)

A hyperglycemic crisis primarily in Type 1 diabetics involving metabolic acidosis (pH $< 7.30$), an anion gap $> 12$, and ketone production.

HHS (Hyperosmolar Hyperglycemic Syndrome)

A hyperglycemic emergency primarily in Type 2 diabetics involving extreme dehydration, glucose levels often $> 600\,mg/dL$, and the absence of ketones.

SIADH

A state of excess anti-diuretic hormone leading to water intoxication, dilutional hyponatremia ($Na+ < 136\,mEq/L$), and dark, concentrated urine.

Diabetes Insipidus (DI)

A condition resulting from a lack of ADH characterized by polyuria ($500+\,mL/hr$), low urine specific gravity ($< 1.005$), and hypernatremia.

Thyroid Storm

A life-threatening form of hyperthyroidism characterized by extreme tachycardia, hyperpyrexia, and hypertension with a wide pulse pressure.

Addison’s Disease

Chronic adrenal insufficiency resulting in a lack of cortisol, aldosterone, and sex hormones, characterized by salt cravings and hyperpigmentation.

Cullen’s Sign

A bluish discoloration or bruising around the umbilicus, indicating hemorrhagic pancreatitis or intra-abdominal bleeding.

Grey-Turner’s Sign

Flank ecchymosis indicating retroperitoneal hemorrhage, often seen in severe pancreatitis or GI trauma.

Intra-Abdominal Hypertension (IAH)

Increased intra-abdominal pressure ($> 12\,mm\,Hg$) that can lead to kidney injury, respiratory compromise, and decreased venous return.

Hepatic Encephalopathy

A nervous system disorder caused by severe liver disease, characterized by altered mental status and asterixis (flapping hands) due to elevated ammonia levels.

DIC (Disseminated Intravascular Coagulation)

A consumptive coagulopathy characterized by decreased platelets and fibrinogen, increased D-dimer, and simultaneous microvascular clotting and bleeding.

HIT (Heparin Induced Thrombocytopenia) Type 2

An immune-mediated disorder where the platelet count drops by $\ge 50\%$ within 5–10 days of heparin exposure, increasing the risk of systemic thrombosis.

TRALI (Transfusion Related Acute Lung Injury)

A non-cardiogenic pulmonary edema causing ARDS-like symptoms during or after a transfusion, caused by an inflammatory capillary leak.

Guillain-Barre Syndrome

An autoimmune attack on the peripheral nervous system causing ascending paralysis, diagnosed via high protein levels in the CSF (albuminocytologic dissociation).

Tumor Lysis Syndrome

An oncologic emergency from chemotherapy causing cell lysis and leakage of intracellular $K+$, $PO4$, and nucleic acids, leading to hyperuricemia and AKI.

Refractory Hypoxemia

A hallmark sign of ARDS where the $PaO2$ remains low despite increasing the $FiO2$, typically addressed by increasing PEEP.

Monro-Kellie Doctrine

The principle that the sum of volumes of brain tissue, CSF, and blood is constant; an increase in one must be offset by a decrease in another to maintain ICP.

Cerebral Perfusion Pressure (CPP)

The pressure gradient driving blood flow to the brain, calculated as $MAP - ICP$; the target goal is typically $60 - 70\,mm\,Hg$.

Cushing’s Triad

A late sign of increased ICP consisting of bradycardia, irregular breathing, and systolic hypertension with a wide pulse pressure.

Autonomic Dysreflexia

A medical emergency in SCI patients (above $T6$) triggered by noxious stimuli, characterized by sudden severe hypertension and bradycardia.

Oculocephalic Reflex (Doll’s Eyes)

A test for brainstem function; a positive (normal) response is eyes moving opposite the head turn, while a negative (fixed) response indicates brain death.

ATN (Acute Tubular Necrosis)

A type of intra-renal AKI involving structural damage to the nephron, often progressing through oliguric, diuretic, and recovery phases.

Beneficence

An ethical principle meaning to "do good" for others and act in the patient's best interest.

Veracity

An ethical principle involving truth, honesty, and integrity in communication with patients and families.