PCCN practice exam notes Questions with Answers 2024, Exams of Nursing

Download PCCN practice exam notes Questions with Answers 2024 and more Exams Nursing in PDF only on Docsity! PCCN practice exam notes Questions with Answers 2024 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 \ n ✔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 \ n ✔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 \ n ✔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? A. Acute delirium B. Acute kidney injury C. Acute hepatic failure D. Sepsis \ n ✔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 \ n ✔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 \ n ✔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? \ n ✔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. \ n ✔suspect anastomosis leak and possible peritonitis Discharge education for (diet) post cholecystitis \ n ✔low-fat diet Assessment findings for large bowel obstruction vs small bowel obstruction \ n ✔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 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 \ n ✔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 \ n ✔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 \ n ✔c. 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 \ n ✔+ 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 \ n ✔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) monitor for: tachycardia, hypotension, hypertension, ectopy and hypokalemia which of the ff assessments for pt with hd with HFrEF on dobutamine indicates that the decrease from 5 mcg/kg/min to 2.5 mcg/kg/min is being well tolerated? a. decreasing MAP b. inc HR c. inc CVP d. decreasing number of PVCs per minute \ n ✔d. while caring for pt with dm who had an infected hip replacement removed and has a VAC drainage system, the nurse must remember to: a. empty drainage every shift b. maintain an unsealed dressing c. maintain continuous suction d. change sponge q4h \ n ✔C. Rhabdomyolysis \ n ✔- inc BUN/Cr, serum CK, myoglobinuria, metabolic acidosis tx: fluids, eliminate cause, support renal, UO >150mL/hr, mannitol (osmitrol) and furosemide when assessing a pt with suspected cocaine intoxication you expect to see: a. c/p, hypothermia, hypoxia b. tachycardia, c/p, hyperthermia c. hyperthermia, hypotension, drowsy d. anxiety, htn, hematuria \ n ✔b. 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) \ n ✔c. hyperthermic \ n ✔pt toxic exposure to salicylates and cocaine hypothermic \ n ✔barbiturates and opiates Acetaminophen overdose - liver failure \ n ✔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 \ n ✔altered loc, alcohol breath, abg = - protect the airway, ng tube, lavage, fluids, seizure precautions, manage/tx electrolytes Cocaine - sympathetic response \ n ✔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 \ n ✔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 \ n ✔c. pathophysiological response for volume loss = vasoconstriction, sympathetic stimulation, hypovolemic shock \ n ✔- dec CO = dec preload - can caused by vasodilation, salt depletion - therapeutic goal: stop loss of volume, IV fluids anaphylactic shock \ n ✔- 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 \ n ✔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 \ n ✔c.