PCCN practice exam notes (2024)Question & Answers !!, Exams of Nursing

Download PCCN practice exam notes (2024)Question & Answers !! and more Exams Nursing in PDF only on Docsity! PCCN practice exam notes (2024)Question & Answers !! 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 - Correct Answers ✅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, 0.52 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 - Correct Answers ✅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 PCCN practice exam notes (2024)Question & Answers !! 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 - Correct Answers ✅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 PaCO2 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? PCCN practice exam notes (2024)Question & Answers !! 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. - Correct Answers ✅suspect anastomosis leak and possible peritonitis Discharge education for (diet) post cholecystitis - Correct Answers ✅low-fat diet Assessment findings for large bowel obstruction vs small bowel obstruction - Correct Answers ✅LBO - lower abdominal pain, distention, NO vomiting SBO - high-pitched bowel sounds, n/v, acute pain Liver failure - ascites, rebound tenderness, jaundice pancreatitis/gallstones - low-grade fever, steatorrhea, no bowel sounds Determinants of cardiac output: - Correct Answers ✅CO = HR X SV (preload + afterload + contractility) PCCN practice exam notes (2024)Question & Answers !! s/s heart failure - Correct Answers ✅cardiac: tachycardic, weak pulse, jvd, s3, displaced pmi, cardiomegaly, valvular abnormalities, peripheral edema, + hepatojugular reflux pulmonary: bibasilar rales, pnd, dyspnea neurologic: fatigue, dizziness, change LOC, impending doom HFrEF (HF with reduced EF) - Correct Answers ✅EF: <40 HFpEF (HF with preserved EF) - Correct Answers ✅EF: >50 a patient with hypertrophic cardiomyopathy was just admitted to PCU. you are reviewing the admission order. which one concern you? a. oxygen 2L nc, continuous tele b. beta-blocker and amiodarone c. chest xray and 2-d echo d. dig and lasix daily - Correct Answers ✅d. dig and lasix daily be careful for + inotropes and diuretics for pt with cardiomyopathy which assessment data would be most consistent with pt diagnosed with dilated cardiomyopathy? a. tachycardia, with peaked t waves, htn, weak distal pulses PCCN practice exam notes (2024)Question & Answers !! b. 2nd degree hb, left bbb, htn, cool extremities c. afib with rvr, hypotension, pulmonary congestion d. bradycardia, diffuse st changes, wide aortic space arch on xray, flat jugular veins - Correct Answers ✅c. patient with HFrEF develops sudden onset of sob with b/l rales and pink frothy sputum. BP 110/60, HR 132, RR 28, 88% 2L nc. what is the best initial action? a. apply BiPAP and advocate for diuretic b. prepare intubation and d/c ace inhibitors c. start neb tx and request atb d. deliver o2 via NRB mask and give nitro - Correct Answers ✅a the monitor shows this rhythm (wide complex tachycardia) for a pt with AICD who is alert and oriented and bp of 110/70. the nurse prepares to administer: 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 - Correct Answers ✅b. no need to cardiovert patient is alert and stable PCCN practice exam notes (2024)Question & Answers !! a. cool extremities w minimal edema b. pale ext and painful ambulation c. hyperpigmented ext w increased edema d. warm ext w weak oulses - Correct Answers ✅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 - Correct Answers ✅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 - Correct Answers ✅d. PCCN practice exam notes (2024)Question & Answers !! 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 - Correct Answers ✅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 - Correct Answers ✅c. PCCN practice exam notes (2024)Question & Answers !! it would be reciprocal changes if there is ST depression not elevation ii, iii, and avf is located in inferior wall if new stent is occluded, st elevation would be on the anterior leads which is v2-v4 Dopamine - Correct Answers ✅+ inotrope - stimulate beta 1 and 2, catecholamine, acts as SNS increase HR, BP watch out for tachyarrythmias and v. ectopy dosing: 3-10 mcg/kg/min (+ intotrope) - inc CO >10 mcg/kg/min (vasoconstriction) - inc BP max 20 mcg/kg/min Dobutamine - Correct Answers ✅stimulates beta 1 receptors increase CO by increasing hr and contractility, inc urine output used ub cardiac sx and septic shock dosing: 2-20 mcg/kg/min IV (up to 40) PCCN practice exam notes (2024)Question & Answers !! hypothermic - Correct Answers ✅barbiturates and opiates Acetaminophen overdose - liver failure - Correct Answers ✅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 - Correct Answers ✅altered loc, alcohol breath, abg = - protect the airway, ng tube, lavage, fluids, seizure precautions, manage/tx electrolytes Cocaine - sympathetic response - Correct Answers ✅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 PCCN practice exam notes (2024)Question & Answers !! c. htn, bradycardia, pitting edema d. hypotension, hyperglycemia, bibasilar rales - Correct Answers ✅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 - Correct Answers ✅c. pathophysiological response for volume loss = vasoconstriction, sympathetic stimulation, hypovolemic shock - Correct Answers ✅- dec CO = dec preload - can caused by vasodilation, salt depletion - therapeutic goal: stop loss of volume, IV fluids anaphylactic shock - Correct Answers ✅- hypotension = inc permeability, massive vasodilation, generalized edema, laryngeal edema, bronchoconstriction - mast cells, basophils PCCN practice exam notes (2024)Question & Answers !! - third spacing of fluids - tx: identify and stop cause, block vasoactive mediators, antihistamines, bronchodilators, fluid resuscitation septic shock - Correct Answers ✅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