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AACN PCCN Practice Exam | graded A+|
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who is at risk for MDRO infection - ✔✔patients with severe disease, including compromised host defenses from underlying medical conditions, recent surgery, or indwelling medical devices (ex: foleys or ET tubes)
what are classic signs of cardiac tamponade? - ✔✔hypotension, narrowing pulse pressure, tachycardia with weak, thready pulse, and tachypnea
what arrhythmia is mitral valve insufficiency associated with? - ✔✔afib
what defines oliguira? - ✔✔less than 500 ml of output per day
what does renal failure result in? - ✔✔acidosis
what type of HF are patients with OSA at risk for? - ✔✔right-sided HF
what is one of the hallmark features of pancreatitis? - ✔✔dehydration
what is treatment for pancreatitis? - ✔✔hydration, maintenance of electrolyte balance, nutritional support
what is unstable angina characterized by? - ✔✔new onset pain or increase in frequency/duration of pain. pain generally lasts 15-30 minutes. may be experienced at low exertion or rest and pain tends not to respond to SL nitro. symptoms may be accompanied by diaphoresis or dyspnea.
what is stable angina characterized by? - ✔✔pain on exertion or stress that is relieved by rest or SL Nitro. pain generally does not increase in severity over time
what characterizes an acute MI? - ✔✔constant, severe pain and may be accompanied by nausea, weakness, fatigue, anxiety. not relieved with rest, duration exceeds 30 minutes.
what are characteristics of dissection aortic aneurysm? - ✔✔pain is severe and unrelenting, commonly experienced in chest/abdomen and radiates to the back. pain does not improve spontaneously.
what procedure is most appropriate for obtaining heart pressure measurements and diagnosing pulmonary HTN? - ✔✔right sided heart cath
what is the best noninvasive test for pulmonary HTN? - ✔✔transthoracic echocardiogram
what is a reasonable goal for the first day Blood Pressure in a stroke patient? - ✔✔lower by 15-20% in the first day
what may improve the prognosis of patients with stroke? - ✔✔lowering body temp
what is common with sepsis? - ✔✔DIC
what is common in patients with DIC? - ✔✔jaundice due to increased bilirubin production secondary to hemolysis
what type of cardiomyopathy in pt with LV having increased muscle mass and fibrosis causing stiffness? -
✔✔hypertrophic
what defines mild COPD exacerbation? - ✔✔not requiring mechanical ventilation and having only one of the three cardinal symptoms: increased dyspnea, sputum purulence or sputum production
what test should NOT be performed during most COPD exacerbations? - ✔✔sputum culture
what does management of cardiogenic shock include? - ✔✔decreasing afterload (because CO is greatly diminished)
treat with ASA
IV heparin infusion bc at risk for LV ventricular and DV thrombosis and maintains coronary artery patency
what dysrhythmia is associated with chronic alcohol abuse? - ✔✔afib
what can trigger afib? - ✔✔hypoglycemia, surgery, chronic infections, binge drinking
what are the main complications from ETOH abuse? - ✔✔cardiomyopathy, atrial and ventricular dysrhythmias, variant angina
a patient with life threatening hyperkalemia is likely experiencing - ✔✔metabolic acidosis
to maintain physiologic pH during acidosis, hydrogen ions are driven from the blood and into the cell. to maintain electrical neutrality, potassium is expelled from the cell and serum potassium levels rise
what EKG changes with hyperkalemia? - ✔✔the earliest EKG change seen with hyperkalemia is peaked T waves. this can progress to widened QRS complexes and Vfib
position for patients with acute ischemic stroke? - ✔✔as flat as possible in bed for at least 24 hours from stroke onset, ideally with HOB between 0 to 30 degrees. some patients with acute ischemic stroke may develop increased ischemic symptoms upon standing, sitting, or elevating HOB due to reduction flow thru stenotic vessels or collateral pathways
what is one of most important cornerstones in management of patients with moderate to severe burn injury? - ✔✔nutrition. the hypermetabolic response in burn patients is characterized by hyperdynamic circulatory, physiologic, catabolic, and immune system responses. the administration of specific nutrients is an essential component of the management of the patient
what are the mechanisms for pulmonary HTN? - ✔✔excessive pulmonary blood flow, impeded pulmonary drainage, vasoconstriction from hypoxia or uncompensated hypercarbia, or hindered blood flow thru the pulmonary arteries
treatment of hypoglycemia is focused on reversing - ✔✔neural starvation - the brain is sensitive to low glucose states
what is the somogyi effect? - ✔✔tendency of the body to react to extremely low blood sugar by overcompensating, resulting in high blood sugar.
what type of MI is Mobitz II most commonly associated with? - ✔✔anteroseptal wall MI
what are idioventricular rhythms associated with? - ✔✔defects in the conduction system of the heart
following right pneumonectomy, how should nurse position the patient? - ✔✔on the right side. facilitates best gas exchange and ventilation
the best rational for using therapeutic touch is - ✔✔it decreases perception of pain in adult patients
what is indicated as initial treatment for complete heart block? - ✔✔atropine
what is key to medical management in descending dissection aortic aneurysm? - ✔✔controlling BP to maintain CO
family support techniques should begin with nurse - ✔✔establishing a rapport with the family
how long does ARDS take to develop? - ✔✔longer than 12 hours
what is ARDS associated with? - ✔✔multiple organ fialure
how is NSTEMI diagnosed? - ✔✔EKG signs are ambiguous and troponin is positive
how is unstable angina diagnosed? - ✔✔EKG signs are ambiguous and troponin is negative
what are the six risk factors for delirium? - ✔✔cognitive impairment, sleep deprivation, immobility, vision impairment, hearing impairment, and dehydration
what is first priority with acute GI bleed? - ✔✔start large bore IV
what is a coarse, grating sound with S1 and S2? - ✔✔pericardial friction rub
what does a pleural friction rub sound like? - ✔✔leather rubbing on leather, synchronous with respiratory movements
what does a ventricular septal defect produce? - ✔✔a systolic murmor
what are hallmark signs of ARDS? - ✔✔refractory hypoxemia and diffuse crackles
what electrolyte imbalances with initial DKA? - ✔✔hyperkalemia and hyponatremia
sodium is lost in urine with DKA
first hyperkalemia with extracellular shift of potassium in exchange of hydrogen, which is accumulated in acidosis, then the serum potassium is excreted and develops hypokalemia
classic s/s of pericarditis - ✔✔dull, aching substernal CP
pericardial friction rub
diffuse ST segment elevation
interventions for pericarditis - ✔✔have patient sit up and lean forward and administer morphine
what drug is indicated for anticoagulation therapy in patient with history of heparin induced
thrombocytopenia - ✔✔lepirudin (refludan)
what lab data should nurse anticipate with acute hepatic failure? - ✔✔decreased glucose, respiratory alkalosis
what are the two acid-base disturbances associated with acute hepatic failure? - ✔✔respiratory alkalosis and metabolic acidosis
what clotting factors does liver failure tend to decrease? - ✔✔prothrombin, fibrinogen, factors II, V, VII, and X
