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PCCN practice exam notes (2023)
Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizziness, recent K+ lvl is 3.4. What action would you do first? a. emergent defib b. amio 300mg IVP c. emergent cardioversion d. hang 10 mEq KCL/50mL D5W - answer C The nurse notes the following when analyzing a patient's telemetry strip: HR, 65/min and regular; PR interval, 0.22 seconds; QRS complex, 0.10 seconds; QTc, 0. seconds. Which of the following dysrhythmias is the patient at risk for? A. Atrial fibrillation because the PR interval is wide B. Sinus arrhythmia because the QRS complex is narrow C. Torsades de pointes because the QTc is wide D. Third-degree heart block because the PR interval is narrow - answer C. QT measurements reflect the duration of ventricular repolarization. Lengthening of QT interval is associated with arrhythmias, adverse cardiac events, and increased mortality because a longer QT duration places the vulnerable ventricular repolarization phase close to the next depolarization, increasing the likelihood of R-on-T. The most common arrhythmia that occurs with prolonged QTc is torsades de pointes. Atrial fibrillation, sinus bradycardia, and third-degree heart block are not typically associated with prolonged ventricular repolarization (QTc >0.50 seconds). A patient with chronic obstructive pulmonary disease (COPD) is admitted for worsening dyspnea and possible pneumonia. The current ABG results are pH, 7.19; PaO2, 52 mm Hg; PaCO2, 68 mm Hg; HCO3 - , 32 mmol/L. The nurse would interpret these results as A. Metabolic acidosis with hypoxemia B. Respiratory acidosis with hypoxemia C. Respiratory alkalosis with typical oxygenation for a COPD patient D. Metabolic alkalosis with typical oxygenation for a COPD patient - answer B. Based on the ABG analysis, the patient is experiencing a respiratory acidosis with hypoxemia most likely due to the pneumonia. A pH of 7.19 indicates acidosis; a PaCO of 68 mm Hg is elevated and a cause of acidosis; an HCO3 - of 32 mmol/L indicates renal compensation; a PaO2 of 52 mm Hg indicates hypoxemia 76-year-old patient is receiving gentamicin and linezolid for an infection. Which of the following potential complications is the most important for the nurse to monitor this patient for? A. Acute delirium
B. Acute kidney injury C. Acute hepatic failure D. Sepsis - answer B. Gentamicin is a nephrotoxic agent that places patients at risk for acute kidney injury, and this risk is increased in older patients. Acute delirium (A), liver failure (C), and sepsis (D) are all complications that could occur in an older adult with an infection but would not be caused by the administration of an antibiotic. An older patient is experiencing delirium 24 hours following hip replacement. Which intervention might worsen the patient's condition? A. Removing any unnecessary tubes and equipment from the room B. Assessing and treating the patient's pain every 2 hours C. Ensuring that the patient has the means to call for help D. Loosely applying soft restraints - answer D. Older patients are at increased risk for delirium during acute hospitalization. Interventions to manage acute delirium include removing or camouflaging tubes, removing unnecessary equipment, frequently reorienting the patient, and ensuring that the call bell is consistently within reach, assessing and treating pain effectively, and encouraging mobility and involvement in activities of daily living. Restraining the patient is contraindicated in the care of patients with delirium. A patient shows a new slight facial droop and the patient's right arm is weaker than the left. A priority intervention would be to A. Obtain a serum glucose level B. Obtain a full set of vital signs C. Initiate the stroke protocol D. Initiate the code response team - answer C. The stroke protocol should be activated as soon as signs of stroke are identified in a patient. Initial signs of stroke include facial droop, arm down drift, and garbled speech. For best outcomes, the time elapsed between initials signs of stroke and treatment must be as short as possible. Which of the following lab results shows acute pancreatitis? - answer elevated glucose, lipase, amylase, BUN/Cr, triglycerides, and bilirubin (know your lab values) low calcium, mag and potassium tx: fluids, rest pancreas, pain management, monitor and replace electrolytes, nutrition, surgery (first line if hemorrhagic/necrotizing) Post-op gastric bypass c/o tachycardia, tachypnea, diaphoresis, fever and reveals clean, dry, closed abd staple line and large firm abdomen. - answer suspect anastomosis leak and possible peritonitis
a. sedative to help pt tolerate ICD shock b. amiodarone bolus of 150 mg over 10 mins c. synchronized cardioversion d. adenosine 6mg rapid IV push - answer b. no need to cardiovert patient is alert and stable cardiogenic pulmonary edema - answer HF, MI, valvular disorders, cardiac tamponade, htn crisis, tachy dysrhythmias EKG = tachycardia, acute st segment and t wave Echo = MI, wall motion abnormalities, v dysfunctio - valve disease, LVH ABG = low o2 sat, respiratory alkalosis, refractory hypoxemia CXRAY = changes day to day or after tx TX: afterload reduction if SBP > vasoconstriction if hypotensive noncardiogenic pulmonary edema - answer DIRECT AND INDIRECT INJURY TO LUNGS XRAY = ARDS aortic dissection - answer sudden severe pain - sharp, severe flank and epigastric pain, changes of BP on each arm, hypotensive, pulseless extremity, peripheral vascular insufficiency, s3, tests: chest xray -wide sternum ekg: lvh, ami CT, TTE/TEE, MRI TX: BP MANAGEMENT (bblocker- esmolol, labetalol), vasodilators, tx pain and reduce stress if ascending aortic dissection - OR IMMEDIATELY a priority intervention for initial tx of htn crisis would be to administer: a. furosemide, diuretic b. isoproterenol, + inotrope c. esmolol, bblocker d. nicardipine, afterload reducer - answer d a pt admitted for afib with rvr. the decision on how you would treat the patient with this rhythm will be based on: a. history of afib and ptt b. potassium lvl and loc c. inr and if pt is taking anticoag
d. hr and hemodynamic stability - answer d. which physical assessment finding would the nurse anticipate in a patient with hx of venous stasis ulcers? a. cool extremities w minimal edema b. pale ext and painful ambulation c. hyperpigmented ext w increased edema d. warm ext w weak oulses - answer c a patient w history of iv drug abuse develops sudden hypotension, dyspnea, and a systolic murmur heard at the 5th ics left midclavicular line. the nurse suspects acute: a. aortic dissection b. mitral regurgitation c. cardiac tamponade d. ventricular septal defect - answer b. based on pt's history of iv drug abuse and also the location of the murmur the most likely cause for new pericardial friction rub in a patient who experience a lateral wall MI two days ago is: a. MI extending to the anterior wall b. LAD rupture c. papillary muscle rupture d. post infarction pericarditis - answer d. pericarditis - ischemia can lead to inflammation which action by a nurse would be first in a pt with vtach HR 135, RR 32, BP 90/48, conscious w complaints of dizziness and recent potassium of 3.4? a. emergent defibrillation b. emergent cardioversion c. amiodarone 300 mg IVP d. hang ordered 10 mEq KCL per 50 mL D5W IV bag - answer b. pt is unstable - dizzy, hypotensive, though conscious if pt. is stable, amiodarone is a choice 36 hours after an anterior STEMI with stent placement in the LAD, a pt develops st elevation in leads ii, iii, avf. the most likely reason is: a. these are reciprocal changes b. newly placed stent is occluded c. there is a new ischemia in a diff location d. this is an expected evolution of the MI - answer c. it would be reciprocal changes if there is ST depression not elevation
think about hypermetabolic state - vasoconstriction in which of the ff. intentional drug overdose admissions would the nurse anticipate hemodialysis being initiated? a. tricyclic antidepressant b. warfarin (coumadin) c. aspirin d. acetaminophen (tylenol) - answer c. hyperthermic - answer pt toxic exposure to salicylates and cocaine hypothermic - answer barbiturates and opiates Acetaminophen overdose - liver failure - answer n/v, RUQ pain, bleeding, elevated LFTs, bleeding, inc temp abg = hyperventilation, metabolic acidosis, respiratory alkalosis
- tx: nac (mucomyst), gastric lavage, charcoal, abg and lab/coag, seizures, fluids, hemodialysis Alcohol overdose - respiratory depression - seizures - liver failure - no direct antidote - answer altered loc, alcohol breath, abg =
- protect the airway, ng tube, lavage, fluids, seizure precautions, manage/tx electrolytes Cocaine - sympathetic response - answer hypoxia, stroke, head injury, hyperthermia, MI
- tx: benzo, vasodilators if htn, cooling, seizures tx which of the ff symptoms best describes the clinical assessment in hypovolemic shock? a. tachycardia, hypotension, oliguria b. tachycardia, hyperthermia, hypotension c. htn, bradycardia, pitting edema d. hypotension, hyperglycemia, bibasilar rales - answer a. which of the following is a compensatory mechanism of hemorrhagic shock? a. peripheral vasodilation b. parasympathetic stimulation c. increased reabsorption of sodium and water d. fluid shift to capillaries to interstitial space - answer c. pathophysiological response for volume loss = vasoconstriction, sympathetic stimulation, hypovolemic shock - answer - dec CO = dec preload
- can caused by vasodilation, salt depletion
- therapeutic goal: stop loss of volume, IV fluids anaphylactic shock - answer - hypotension = inc permeability, massive vasodilation, generalized edema, laryngeal edema, bronchoconstriction
- mast cells, basophils
- third spacing of fluids
- tx: identify and stop cause, block vasoactive mediators, antihistamines, bronchodilators, fluid resuscitation septic shock - answer local - systemic - sepsis - septic shock inflammation = massive vasodilation, capillary leak = acute ARDS increased RR, TV drop PaCO2 - respiratory alkalosis, cerebral vasoconstriction, cerebral ischemia = altered LOC, confusion, agitation, lethargy inadequate delivery of 02, lactic acidosis, plt abnormalities, insulin resistance/gluconeogenesis missing oxygen delivery to cells through ATP tx: identify and stop cause atb, fluids, vasopressors, vent, and oxygenation, restore balance which of the ff mechanisms contributes to hypotension in septci shock? a. elevated afterload b. inc cardiac contractility c. peripheral vasodilation d. dec vascular permeability - answer c. which of the ff variables would most likely be assessed in a pt with early/warm septic shock? a. HR 131, T 35.2/95.3, hands feet cool to touch b. HR 61, T 39.1/102.4, hand feet warm to touch c. HR 127, T 39.4/103, hand feet warm to touch d. HR 140, T 36.7/98.1, hand feet cool to touch - answer c. a post-op pt has a temp of 38C/101F, HR 97, BP 90/40, RR 26, and 92% on 40% FM. the nurse should anticipate: a. norepinephrine (levophed) infusion b. dopamine (intropin) infusion c. d5 0.45 NS/20 K at 150/hr d. 30 mL/kg NS bolus - answer D a pt. develop pleuritic chest pain, sob, hypoxia, coughing 3 days after admission for heart failure. the nurse SHOULD suspect: a. pulmonary embolism b. aortic dissection
