Download PCCN QUESTIONS WITH ACCURATE ANSWERS and more Exams Advanced Education in PDF only on Docsity!
PCCN
epoetin alfa - answer anemia related to chronic kidney disease should be treated with ______________________. folic acid, Vitamin B12 - answer Name two treatments for megaloblastic anemia. infection - answer Glucose control (via insulin drip) in the post-CABG patient decreases the risk of ___________________. acidosis - answer In acute oliguric kidney injury, hyperkalemia leads to ____________________. right - answer Obstructive-sleep apnea patients are at risk for ________-sided heart failure. hydration - answer Acute pancreatitis patients need aggressive _________________________ as their first line treatment. right - answer The best way to diagnose pulmonary hypertension and get heart pressure measurements is ________-sided heart catheterization. False (hypoglycemia can cause stroke-like signs and symptoms) - answer True or False: hyperglycemia can cause stroke-like signs and symptoms. benzodiazepines - answer The goal of alcohol withdrawal management is adequate sedation with _____________________. heparin - answer If atrial fibrillation lasts more than 24 hours, the patient should get a ____________ drip at therapeutic levels beta blockers - answer Rate control for atrial fibrillation can be achieved with a cardizem drip. _______________ are also an alternative for rate control. transesophageal echocardiogram - answer A ___________________________________________ should be done before attempting to cardiovert a patient with atrial fibrillation. 15-20 - answer The ischemic stroke patient should have their blood pressure lowered ____-____% within the first day. A too-low BP can result in neurological worsening.
beta blockers - answer Cardiac surgery patients can be on _______________ pre- and post-operatively to control atrial fibrillation. preload - answer Nitroglycerin is contraindicated in right ventricular infarction because it decreases ____________________. seizures - answer Both hypernatremia and hyponatremia can cause _____________________. Sepsis - answer DIC is common in ____________ because coagulation is impaired. jaundice - answer _________________ is common in DIC patients because stress and hypotension can cause hepatocellular injury. true - answer True or False: Sputum cultures are not recommended for COPD exacerbation. False (Antibiotics are not recommended. Short-acting beta agonists are first line therapy.) - answer True or False: Antibiotics are recommended for COPD exacerbation. False (afterload and preload are increased with cardiogenic shock; afterload needs to be decreased and vasoconstrictors are contraindicated) - answer True or False: The goal of treatment for cardiogenic shock is to increase afterload with vasoconstrictors like norepinephrine (levophed). cardiogenic shock - answer Vasosonstrictors (norepinephrine), beta-blockers, and low molecular weight heparin should be avoided for patients with this condition. Vasopressin (ADH) - answer _______________________ can improve portal hypertension in upper GI bleed/liver cirrhosis patients. sepsis - answer ARDS is most often part of a systemic inflammatory process, particularly systemic ____________. endocarditis - answer A patient with a new systolic murmur should be evaluated for ____________________. true - answer True or False: acute ischemic stroke patients need to be as flat as possible in bed for the first 24 hours. False - answer True or False: A pulmonary embolism patient will have crackles in the lungs. supine - answer ____________ positioning should be avoided in pneumonia patients.
papillary muscle rupture - answer In an anterior/septal wall MI, changes are noted in leads V1-V4, with reciprocal changes in II, III, and aVF. Left ventricular failure, heart blocks, bundle branch blocks, and cardiogenic shock are complications. If a new loud murmur is auscultated in these patients, the nurse suspects a _________________________________. decrease - answer In DIC patients, PT and PTT will increase while platelets and fibrinogen levels ________________. cryoprecipitate - answer __________________ should be given to increase fibrinogen levels in DIC patients. c (respiratory alkalosis) - answer Which ABG imbalance will be seen in a patient with a pulmonary embolism? a. metabolic acidosis b. respiratory acidosis c. respiratory alkalosis d. metabolic alkalosis Caffeinated - answer ___________________ beverages can increase the effects of warfarin and should be consumed with caution. False (the patient should lie on the opposite side with the head of bed 30-45 degrees) - answer True or False: A patient that needs a thoracentesis but cannot sit up should lay flat on the affected side for the procedure. dumping syndrome - answer A syndrome that can happen after gastric surgery or because of parenteral feedings. A concentrated solution with high osmolality can draw fluid into the gut, causing abdominal discomfort/fullness, nausea, diarrhea, and dehydration with hypotension and tachycardia. Reducing the osmolality of the parenteral feedings and then raising it slowly helps the body adjust and relieves symptoms. endocarditis - answer Janeway lesions, splinter hemorrhages, mucosal petechiae, and Roth's spots are indicators of ______________________. fulminant hepatitis - answer An acute liver infection caused by hepatitis, viruses, toxins (carbon tetrachloride), Wilson's disease, and drugs (most commonly tylenol). polyurethane - answer This type of foam is hydrophobic. It can be used on all wounds except if painful, has tunneling or sinus tracts, resulting from deep trauma, or needs controlled growth of granulation. morphine, oxygen, loop diuretics, nitroglycerin - answer Main treatments of acute pulmonary edema.
10:1 - answer Normal BUN:Creatinine ratio acute lung injury - answer A problem characterized by crackling rales and wheezing, decreased pulmonary compliance, and cyanosis. Oxygen should be administered at 100% to keep sats above 90 because of the V/Q mismatch. complete coronary occlusion - answer In Q-wave myocardial infarctions, 80-90% of patients have ______________________________. metabolic syndrome - answer a syndrome of insulin resistance that puts patients at risk of diabetes. Characterized by abdominal obesity, high triglycerides, low HDL, high blood pressure, high fasting glucose, high C-reactive protein (proinflammatory state) and high fibrinogen levels (prothrombic state) 24-44 - answer Oxygen delivery with nasal cannula ranges from ____-____%. 95% - answer The oximetry of the post-cardiac surgery patient should be maintained at or above _____. 90% - answer The patient with acute lung injury receives oxygen to maintain SpO at _____. bleeding esophageal varices - answer What is the most common complication of portal hypertension? decrease - answer Diuresis and dehydration cause preload to ___________. cardiomyopathy - answer In the normal heart, a decrease in heart rate causes an increase in stroke volume. However, in _______________, this compensation may not happen and a decrease heart rate will cause lower cardiac output. thromboembolism - answer The nurse knows that the patient with dilated cardiomyopathy is at risk for sudden death from... cardiac tamponade - answer The risk of removal of epicardial pacing wires is __________________________________. nimodipine - answer cerebral vasospasm absolutely need _______________, even if hypotensive. A fluid bolus or vasopressor should be given for hypotension. calcium channel blockers - answer Heart failure patients with reduced ejection fraction cannot have ____________________. hypertrophic cardiomyopathy - answer Patients with this myopathy cannot be given inotropes like digoxin, dopamine, dobutamine, or milrinone.
if the thigh is flexed at the hip with the knee at 90 degrees, then extension in the knee is painful leading to resistance. aortic rupture - answer Cullen's sign is periumbilical ecchymosis found in the setting of necrotizing pancreatitis, abdominal trauma and _____________________. True - answer True or False: The atria cannot be paced when in atrial fibrillation. c (When the ventricles are thickened, as in hypertrophy, it is more difficult to fill them adequately. The atria eject more forcefully, and the vibration of this ejection causes the S4 heart sound. In the setting of pericarditis, a pericardial friction rub may be auscultated. A S3 heart sound (ventricular gallop) is auscultated in heart failure with fluid overload. A split S1 may be auscultated with a bundle branch block or frequent PVCs) - answer A S4 heart sound is expected in which of the following? A. Pericarditis B. Left ventricular failure C. Ventricular hypertrophy D. Bundle branch block Alpha - answer ____________ cells in the pancreas produce glucagon. b (The profound dehydration will lead to an elevated serum osmolality in Diabetes Insipidus because of the water loss. In diabetes insipidus there is a lack of ADH. The sodium level may elevate while the urine specific gravity will drop due to dilutional effects.) - answer A 56-year-old suffered a cardiopulmonary arrest & received 45 minutes of chest compressions. He has recovered, but has severe short term memory loss. On day 3 of his hospital stay, you notice his urine drainage bag is suddenly full. The urine is clear without color. He continues with UOP of 700-1000 mL per hour x 2 hours. Which of the following assessment findings would you expect? A. Serum sodium level of 126 B. Serum osmolality of 320 C. Urine specific gravity of 1. D. Serum potassium of 3. b - answer Earliest signs of increased intracranial pressure (ICP) include: A. Nystagmus B. Decreased level of consciousness C. Slurred speech D. Unequal pupils b (In acute asthma exacerbation, hypercapnia or elevated PaCO2 is an ominous sign and indicates the patient is becoming fatigued and going into acute respiratory failure.) - answer You administer Albuterol nebulizers to a patient having an asthmatic exacerbation. Their initial ABG was: pH 7.45/PaCO2 28/PaO2 142/HCO3 22.
An ominous sign of impending respiratory failure includes: A. Respiratory alkalosis B. Hypercapnia C. Hypoxemia D. Metabolic acidosis Kupchik, Nicole. ACE the PCCN®! You Can Do It! Practice Review Questions (p. 94). Kindle Edition. c (Diabetes Insipidus (DI) occurs when an individual has a deficiency or insensitivity to vasopressin (ADH). There are three types of DI: neurogenic DI, nephrogenic DI, and Dipsogenic DI. Neurogenic DI occurs when there has been damage to the posterior pituitary resulting in a deficiency of vasopressin. Nephrogenic DI occurs when the kidneys are not adequately responding to vasopressin. Dipsogenic DI occurs when there is excessive ingestion of water, which suppresses vasopressin release, which leads to polyuria. Diabetes Mellitus type 1 occurs from insufficient insulin production by pancreatic beta cells.) - answer 30. You are caring for a patient diagnosed with nephrogenic diabetes insipidus. Which of the following correctly identifies the cause of this disorder? A. Insufficient insulin production B. Ingestion of excessive amount of water resulting in suppression of vasopressin release C. The kidneys are not responding appropriately to vasopressin (ADH) D. Deficiency of vasopressin production secondary to damage to the posterior pituitary Norepinephrine (Levophed) - answer The Surviving Sepsis Guidelines recommend ________________________ as the first line vasopressor for hypotension that is no longer responsive to fluids. Vasopressin - answer ________________________ is a potent vasoconstrictor that has been found effective in refractory hypotension, but is not the first line drug therapy for hypotension in septic shock. fluids - answer Intravenous _____________ keep the kidneys flushed to prevent renal tubule damage from contrast material. basilar - answer With a _______________ skull fracture, improper insertion of an NG tube can result in cannulation of the brain. Insertion of any type of tube (NG, feeding, suction) should be avoided or performed by a provider using fluoroscopy. decrease - answer Beta blockers _________________ myocardial oxygen consumption. a (Beta-blockers help by slowing the heart rate to maximize diastolic filling time. In addition, beta blockers decrease myocardial oxygen consumption by decreasing
nephrotoxicity - answer Vancomycin has a high risk of _______________________ and an elevated serum creatinine is important to review with the providers to ensure the plan will be to continue to the planned medication treatment. bradycardia - answer _______________________ is the best indicator that shock is from a neurogenic cause such as spinal shock. d - answer An 18-year-old with Type 1 diabetes is admitted with a hyperglycemic emergency. Her initial glucose was 320 mg/dL with a potassium of 5.2. Your highest priority when caring for her is: A. Correcting her glucose levels B. Ensuring she eats dinner C. Restarting her home SQ insulin D. Correcting her fluid deficit b (Damage to the pancreas inhibits its endocrine function of insulin production. Without insulin, hyperglycemia ensues. Lipolysis from pancreatic enzyme causes increased free fatty acids in the vascular compartment that bind calcium. Thus, the patient may exhibit hypocalcemia. Hypokalemia can result from excessive vomiting.) - answer Which set of lab values is commonly seen in acute pancreatitis? A. Hyperglycemia, hypercalcemia, hyperkalemia B. Hyperglycemia, hypocalcemia, hypokalemia C. Hypoglycemia, hypocalcemia, hypokalemia D. Hypoglycemia, hypercalcemia, hyperkalemia a (Serious side effects of Depakote include an increased risk for infection, liver failure, and pancreatitis. In general, patients in the PCU should be assessed daily for discontinuation of invasive lines, tubes and drains, but this patient is at a increased risk.) - answer 99. A patient admitted to the PCU with seizures refractory to his current home medications. He is started on Depakote (Valproic acid). The patient has a central line and urinary catheter in place. Which action by the nurse demonstrates an understanding of medication side effects? A. Collaborate daily with the medical team to evaluate the need of the central line and urinary catheter B. Order seizure pads from central supply C. Apply sequential compression devices upon arrival to the unit D. Advocate for daily bowel care protocol down - answer Following pneumonectomy, or removal of the entire lung, the operative side is placed ___________ to allow for optimal expansion of the remaining lung. opposite - answer Following lobectomy, patients are positioned on the ___________ side to maximize perfusion and gas exchange in the unaffected size.
a (The bundle of His and right bundle branch are located primarily in the anterior wall, so both of these may be affected in an anterior MI. 2nd degree type II heart block occurs when conduction is blocked at the bundle of His or in one of the bundle branches. If the patient develops a 2nd degree Type 2 block, you should prepare to transcutaneous pace the patient and transfer to the ICU.) - answer A patient with an anterior wall MI should be monitored for which of the following complications? A. Right BBB & 2nd degree Type 2 heart block B. 1st degree heart block C. Aberrantly conducted rhythms D. Supraventricular tachycardia b (Glucagon hydrochloride is the antidote for calcium-channel antagonists and beta- adrenergic receptor antagonists. Flumazenil is given to reverse benzodiazepine effects. Naltrexone hydrochloride is given to treat alcohol or opiate dependence. Deferoxamine is used to treat acute iron toxicity.) - answer A patient with newly diagnosed dementia was admitted to the PCU after an accidental metoprolol overdose. The patient has a HR of 42. What medication would you expect the provider to order as an antidote? A. Flumazenil B. Glucagon hydrochloride C. Naltrexone hydrochloride D. Deferoxamine mesylate d (Side effects of dexamethasone include decreased potassium and calcium levels, hyperglycemia, and myopathy that results in proximal muscle weakness.) - answer A patient is admitted with adrenal insufficiency. The provider orders Dexamethasone (Decadron). Which side effect should you anticipate? A. Increased potassium level B. Increased calcium level C. Hypoglycemia D. Proximal muscle weakness d (Left ventricular failure causes backup of blood into the pulmonary vasculature, leading to crackles, insufficient cardiac output and hypotension. The S3 heart sound is caused by decreased ventricular compliance, as the ventricle is so full of blood that it is unable to stretch further.) - answer Clinical signs of cardiogenic shock secondary to acute left ventricular failure include: A. Hypotension, S4 heart sound, pericardial friction rub B. S3 heart sound, Hypotension, systolic murmur C. Diastolic murmur, S4 heart sound, Hypertension D. Crackles, S3 heart sound, hypotension d - answer 3. A patient is being treated for hypertensive crisis with labetalol (Normodyne) 10 mg IV every 2 hours PRN and Enalapril (Vasotec) 1.25 mg IV every 6 hours. The RN should hold the medications and notify the provider when lab findings show:
A. Ventricular dysrhythmias B. S3 ventricular gallop C. Hypovolemic shock D. Adrenal crisis c - answer A medication regimen for a patient with hypertrophic cardiomyopathy may include: A. Cardiac glycosides & beta blockers B. Beta blockers & vasopressors C. Calcium channel blockers & beta blockers D. Vasopressors & Inotropes Kupchik, Nicole. ACE the PCCN®! You Can Do It! Practice Review Questions (p. 169). Kindle Edition. b (Intermittent hemodialysis removes large amounts of fluid, electrolytes and waste over a short period of time. Electrolytes can shift rapidly, including calcium, potassium, and sodium. Impacts can be significant if not followed closely for the cardiovascular, respiratory, and neurologic systems. Hemodynamic monitoring can be helpful though not necessarily a priority in a hemodynamically stable patient. Decisions for continuing or stopping HD are not based on urine output production alone. Weight monitoring is important though on a daily basis and frequent electrolyte monitoring is a greater priority.) - answer A patient is admitted to the hospital with abdominal pain and nausea and was taken to the operating room for an emergent bowel resection. The post-operative course has been complicated by septic shock and acute kidney injury (AKI). The patient is placed on intermittent hemodialysis. The nurse recognizes which of the following is a priority to ensure safe patient care while receiving renal replacement therapy? A. Invasive hemodynamic monitoring to assess fluid volume status hourly B. Frequent electrolyte monitoring to identify electrolyte shifts C. Hourly urine output monitoring to know when hemodialysis should be discontinued D. Daily weight monitoring to assess fluid status optic nerve (CN II) - answer Test one eye at a time. Ask the patient to read his I.V. bag. Then have him count how many fingers you are holding up 6 inches in front of him. Which cranial nerve are you testing? oculomotor nerve - answer To test the patient's pupils, dim the lights, bring the light of the penlight from the outside periphery to the center of each eye, and note the response. Use the mm chart to describe pupil size; descriptions such as "small," "medium," and "large" are too subjective. Which cranial nerve are you testing? Trochlear nerve (CN IV) - answer To assess this nerve, instruct the patient to follow your finger while you move it down toward his nose. Which cranial nerve are you testing?
Trigeminal nerve (CN V) - answer If a patient has a problem with this nerve, it usually involves the forehead, cheek, or jaw—the three areas of this nerve. Check sensation in all three areas, using a soft and a dull object. Check sensation of the scalp, too. Abducens nerve (CN VI) - answer Ask the patient to look toward each ear. Then have him follow your fingers through the six cardinal fields of gaze. This nerve controls eye movement to the sides. Which nerve are you testing? Facial nerve (CN VII) - answer Assess the patient for facial symmetry. Have him wrinkle his forehead, close his eyes, smile, pucker his lips, show his teeth, and puff out his cheeks. Both sides of the face should move the same way. When the patient smiles, observe the nasolabial folds for weakness or flattening. Which cranial nerve are you testing? Acoustic nerve (CN VIII) - answer Check hearing by rubbing your fingers together by each ear. Which cranial nerve are you testing? glossopharyngeal and vagus (CN IX and X) - answer Assess the sense of taste on the back of the tongue. Observe the patient's ability to swallow by noting how he handles secretions. Ask the patient to open his mouth and say AHHHHHH. The uvula should be in the midline, and the palate should rise. Which cranial nerves are you testing? Spinal Accessory nerve (XI) - answer This nerve controls neck and shoulder movement. Ask the patient to raise his shoulders against your hands to assess the trapezius muscle. Then ask the patient to turn his head against your hand to assess the sternocleidomastoid muscle. Hypoglossal nerve (CN XII) - answer Ask the patient to stick out his tongue. It should be in the midline. Look for problems with eating, swallowing, or speaking. Which cranial nerve are you testing? Olfactory nerve (CN I) - answer To assess the nerve, use soap and coffee—both are easy to find on a unit. Or take a trip to the kitchen for cloves and vanilla. Which cranial nerve are you testing?
