PCCN TEST EXAM 1 QUESTIONS WITH ACCURATE ANSWERS | Exams Advanced Education

PCCN TEST EXAM 1

1. A 49-year-old male was recently admitted with an inferior wall MI resulting from 100%

occlusion of the right coronary artery (RCA). The 12-lead ECG reveals ST elevation in

leads II, III, and a VF. You would expect to see reciprocal changes in which leads?

A. I, a VR

B. V1, V2

C. V3, V4

D. I, a VL - answer D. I, aVL. The RCA perfuses the inferior wall and the mirror

image or reciprocal change will be seen in the high lateral wall, which is reflected in

leads I, and aVL on the 12-Lead ECG. Leads V1 and V2 correlate with the septal area,

leads V3 and V4 correlate with the anterior area of the heart. The aVR lead does not

provide much diagnostic value as all energy is depolarizing away from this lead.

2. You are summoned to the room of a 30 year old female who is experiencing

sustained tonic-clonic convulsions while sitting in a chair. A family member states:"She

was just talking to us and suddenly she let out a shriek and started flopping like a fish

out of water." What is your initial priority of care?

A. Call for help and safety guide the patient to the floor.

B. Call for help and administer a prescribed antiepileptic.

C. Call for help and administer a prescribed benzodiazepine

D. Call for help and monitor the course of the seizure. - answer A. Call for help and

safely guide the patient to the floor. Patient safety is the first priority. Once the patient is

safe from immediate harm or injury, the seizure activity must be terminated. Seizure

abatement is accomplished by the administration of a benzodiazepine. Antiepileptic

medications are useful in the prevention of seizure of activity.

3. A 46 year old patient presents with pneumonia and sepsis. He was treated with 4

days of antibiotics and IV fluids. He is increasingly short of breath and is now on 100%

FiO2 via non-rebreather mask. You obtain an ABG with the following results: pH 7.20 /

PaCO2 68 / PaO2 102 / HCO3 28. A chest x-ray reveals bilateral pulmonary infiltrates.

The patient is likely developing:

A. Worsening pneumonia

B. Acute Respiratory Distress Syndrome

C. Pulmonary embolus

D. Atelectasis - answer B. Acute Respiratory Distress Syndrome. Criteria for ARDS

include bilateral pulmonary infiltrates on chest x-ray and a P/F ratio ≤ 300; it is further

rated as mild-moderate-severe ARDS based on the P/F ratio. To calculate the P/F ratio,

divide the PaO2 from an ABG by the FiO2. In this case 102 (PaO2) ÷ 1.0 (100% FiO2) =

102, making it borderline severe ARDS. Other criteria for ARDS include decreased

compliance, refractory hypoxemia and low expired minute volume. The patient needs to

be transferred to the ICU and will likely require intubation & mechanical ventilation.

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PCCN TEST EXAM 1

A 49-year-old male was recently admitted with an inferior wall MI resulting from 100% occlusion of the right coronary artery (RCA). The 12-lead ECG reveals ST elevation in leads II, III, and a VF. You would expect to see reciprocal changes in which leads? A. I, a VR B. V1, V C. V3, V D. I, a VL - answer D. I, aVL. The RCA perfuses the inferior wall and the mirror image or reciprocal change will be seen in the high lateral wall, which is reflected in leads I, and aVL on the 12-Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate with the anterior area of the heart. The aVR lead does not provide much diagnostic value as all energy is depolarizing away from this lead.
You are summoned to the room of a 30 year old female who is experiencing sustained tonic-clonic convulsions while sitting in a chair. A family member states:"She was just talking to us and suddenly she let out a shriek and started flopping like a fish out of water." What is your initial priority of care? A. Call for help and safety guide the patient to the floor. B. Call for help and administer a prescribed antiepileptic. C. Call for help and administer a prescribed benzodiazepine D. Call for help and monitor the course of the seizure. - answer A. Call for help and safely guide the patient to the floor. Patient safety is the first priority. Once the patient is safe from immediate harm or injury, the seizure activity must be terminated. Seizure abatement is accomplished by the administration of a benzodiazepine. Antiepileptic medications are useful in the prevention of seizure of activity.
A 46 year old patient presents with pneumonia and sepsis. He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath and is now on 100% FiO2 via non-rebreather mask. You obtain an ABG with the following results: pH 7.20 / PaCO2 68 / PaO2 102 / HCO3 28. A chest x-ray reveals bilateral pulmonary infiltrates. The patient is likely developing: A. Worsening pneumonia B. Acute Respiratory Distress Syndrome C. Pulmonary embolus D. Atelectasis - answer B. Acute Respiratory Distress Syndrome. Criteria for ARDS include bilateral pulmonary infiltrates on chest x-ray and a P/F ratio ≤ 300; it is further rated as mild-moderate-severe ARDS based on the P/F ratio. To calculate the P/F ratio, divide the PaO2 from an ABG by the FiO2. In this case 102 (PaO2) ÷ 1.0 (100% FiO2) = 102, making it borderline severe ARDS. Other criteria for ARDS include decreased compliance, refractory hypoxemia and low expired minute volume. The patient needs to be transferred to the ICU and will likely require intubation & mechanical ventilation.

A 56 year old male is admitted to the PCU with a hypertensive crisis. His blood pressure is now 205/125 mm Hg and his is complaining of a headache with nausea. He reports he ran out of blood pressure medication three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach? A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication, then gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medication. B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications, then switch to oral antihypertensive medications for maintenance C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medications. D. Slowly lower the diastolic pressure to 85 mm Hg with oral antihypertensive medications, then adjust dose for maintenance. - answer C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications, and then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medications. The patient is experiencing a hypertensive crisis with associated hypertensive encephalopathy. This requires emergent treatment by rapidly decreasing the diastolic blood pressure to around 100 mm Hg using intravenous antihypertensive medications. The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure. The initial decrease should take place over 2-6 hours. Once the BP is controlled and symptoms have resolved the patient should be transitioned to oral antihypertensive medications with a goal to reduce the diastolic pressure gradually to 85 mm Hg over the next 2-3 months.
Which of the following labs must be closely monitored when administering Lisinopril to a patient with systolic heart failure? A. Sodium B. Phosphate C. Magnesium D. Potassium - answer D. Potassium. Patients taking angiotensin converting enzyme inhibitors may experience hyperkalemia. ACE inhibitors block angiotensin II, which may lead to decreased aldosterone. Aldosterone is responsible for excreting potassium from the kidneys. Therefore, ACE inhibitors can cause potassium retention and potassium levels should be monitored closely. In addition, renal labs such as BUN and creatinine should be monitored. If the patient develops more than a 20% increase in the creatinine, the medication should be discontinued.
A 57 year old man was admitted with an acute myocardial infarction and is rapidly deteriorating. He has BP of 86/42 (57), heart rate of 110, weak, thread pulses, and mottled skin - especially at the knees. He has had minimal urine output the past 8 hours. A Rapid Response is activated. Which of the following medications would be the best option to increase the patient's cardiac output? A. Dobutamine

visualize the junction of the central venous access and the dialysis unit at all times. Disconnection can result in exsanguination within minutes.

Four hours after starting an insulin infusion in a patient admitted with diabetic ketoacidosis, the patient's blood glucose is 235 mg/dL. Which of the following fluids should be administered at this point? A. Hypertonic solution to hydrate the cell B. D5 .45 or D5 NS with a glucose source C. Isotonic saline bolus to maintain extracellular hydration D. Hypotonic saline to provide cellular hydration - answer B. D5.45 or D5NS with a glucose source. Dextrose should be included in IV fluids since the glucose has dropped below 250. This is done to prevent hypoglycemia.
A 45 year old male is admitted to the PCU with severe sepsis. You are administering lactated ringers 500 ml IV boluses. A central line has been placed. Which of the findings below indicate the fluid boluses are having its intended effect? A. MAP of 55 mm Hg B. ScuO2 of 52% C. Initial lactate level 4.2 mmol/L now 1.8 mmol/L D. Urine output of 15 ml/hour. - answer C. Initial lactate level 4.2 mmol/L, now 1. mmol/L. Early goal directed therapy for sepsis includes early fluid resuscitation at 30 mL/kg to maintain the MAP greater than 65 mm Hg, ScvO2 greater than 70%, and urine output greater than 0.5 mL/kg/hr. The goal is always to normalize the lactate level. The lactate clearance (lactate decreasing to 1.8 mmol/L) is a trend in the right direction and an indirect sign of increased perfusion.
A 72 year old male patient has been in the PCU for 6 days for treatment of a COPD exacerbation. He has been receiving VTE prophylaxis with subcutaneous Heparin since admission. Today, his platelet count decreased significantly to 43,000 and he was found to have a new DVT on his right upper extremity. What do you suspect is the most likely cause of these new findings? A. DIC B. ITP C. HIT D. TRALI - answer C. HIT. The hallmark sign of Heparin Induced Thrombocytopenia (HIT) is a significant decrease in platelet count over a 24-hour period (> 50%) within 5- 10 days of administering Heparin. The other hallmark sign is a new development of a DVT despite being on VTE prophylaxis. DIC and ITP can decrease platelet counts but with the specific scenario of a new DVT and precipitous drop in platelets the best answer is HIT. Transfusion related acute lung injury (TRALI) is a complication from a blood transfusion reaction, which causes acute lung injury typically within 6 hours of a blood transfusion.
Which set of hemodynamic parameters is associated with right-sided heart failure? A. Increased cardiac output, increased preload, increased afterload. B. Increased cardiac output, decreased preload, decreased afterload.

C. Decreased cardiac output, increased preload, increased afterload. D. Decreased cardiac output, decreased preload, decreased afterload. - answer C. Decreased cardiac output, increased preload, increased afterload. A failing right ventricle becomes congested and cannot propel blood forward to the left side of the heart, causing an increase in right sided preload; blood backs up. Decreased preload to the left side of the heart is seen as a decreased CO/CI. A reduction in perfusion to tissue prompts a compensatory response of vasoconstriction and increase in afterload.

You would expect which of the following laboratory findings in a patient with Diabetes Insipidus? A. Increased serum osmolality, decreased serum sodium, increased urine osmolality. B. Increased serum osmolality, decreased urine osmolality, increased serum sodium. C. Decreased serum osmolality, increased serum sodium, decreased urine osmolality. D. Decreased serum osmolality, decreased serum sodium, decreased urine osmolality - answer B. Increased serum osmolality, decreased urine osmolality, increased serum sodium. In Diabetes Insipidus there is a lack of ADH. The patient will have significant volume loss leaving an increased serum osmolality, the urine will be dilute (decreased urine osmolality) and hemoconcentration of blood resulting in increased sodium levels.
A 32-year-old male was admitted to the PCU with hypovolemia after a motorcycle accident. He sustained multiple injuries including a fractured tibia/fibula and a. splenic laceration. Which of the following hemodynamic profiles would be consistent with a diagnosis of early compensated hypovolemic shock? A. Normal cardiac output and stroke volume, increased afterload, MAP 65 m Hg B. Elevated ardiac output & stroke volume, low afterload, MAP 70 mm Hg C. Low cardiac output & stroke volume, high afterload, MAP 50 mm Hg D. Normal cardiac output & stroke volume, normal afterload, MAP 79 mm Hg. - answer 15A. Normal cardiac output & stroke volume, HR 135, elevated afterload, MAP 65 mm Hg. In hypovolemic states, circulating volume is depleted therefore preload and contractility are decreased which leads to a decrease in SV and CO. To compensate, HR increases to preserve CO, MAP and cerebral perfusion. In the setting of hypovolemic shock, the HR will increase and vasoconstriction will occur to maintain the CO and MAP. A high CO and low afterload are typically seen in early septic shock. A low CO and high afterload are commonly found in cardiogenic shock.
Your patient is admitted with an acute asthma exacerbation. An ABG is obtained because they continue to use accessory muscles with a RR of 38 per minute. The ABG results: pH 7.35 PaCO2 42, PaO2 82, HCO3 22. You suspect which of the following? A. No airflow obstruction B. Improvement in their condition C. Severe airflow obstruction D. Pneumonia - answer 16. C. Severe airflow obstruction. In a severe acute asthma exacerbation, bronchoconstriction leads to air trapping and ABGs often show a high normal pH and low PaCO2. When the airflow obstruction is severe, very little air is able to move, causing the PaCO2 to rise and the pH to fall. This ABG indicates the patient is

D> Decreased lipase, decreased amylase, hypercalcemia & hypokalemia - answer

A. Elevated lipase, elevated amylase, hypocalcemia & hyperglycemia. Hyperglycemia, amylase & lipase will be markedly elevated in pancreatitis. Hypocalcemia and hypokalemia are seen more commonly with acute pancreatitis.
A 54-year old male was admitted four days ago with a pulmonary embolism. The patient has been receiving low-molecular-weight Heparin for treatment. During your assessment you notice ecchymosis and necrotic areas around the injection sites. You also note that the patient's platelet count has dropped from 189000 to 65,000. HIT is diagnosed. Which intervention should anticipate first? A. Stop Heparin and administer an alternate direct thrombin inhibitor B. Administer protamine, corticosteroids, and diphenhydramine C. Ultrasound of extremities to assess for arterial and /or venous thrombosis D. Stop Heparin and administer Warfarin instead - answer 21. A. Stop Heparin and administer an alternate direct thrombin inhibitor. Heparin administration can cause HIT, therefore you should anticipate stopping Heparin and starting an alternative direct thrombin inhibitor. Assessing for secondary arterial and venous thrombosis is an important follow up. Warfarin is contraindicated in HIT until platelet activation is improving and thrombin generation is controlled. There is no evidence that shows protamine, corticosteroids, and diphenhydramine are effective treatments for HIT.
A 38 year old female with a 1 week history of productive cough, progressive shortness of breath and fever is admitted with a diagnosis of pneumonia. Her vital signs are: HR 198, RR 24, BP 106/54 (62), T38.9C. What are top priorities in her care? A. Administration of Heparin, IV fluds and SCD application B. Administration of IV fluids, antibiotics and assessing a lactate level C. Administration of IV fluids and Dopamine D. Administration of IV fluids, Dobutamine and acetaminophen. - answer 22. B. Administration of IV fluids, antibiotics & assessing a lactate level. This patient meets criteria for severe sepsis due to an elevated HR and fever. Early therapy includes antibiotics and obtaining a lactate level to help guide fluid resuscitation. Vasopressors should be utilized after fluid replacement/resuscitation has been optimized.
Which acid/base disturbance is associated with massive volume resuscitation with 0.9% Saline? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis - answer 23. A. Metabolic acidosis. Hyperchloremic metabolic acidosis is oftentimes associated with massive volume resuscitation with sodium chloride solution. HCO3 is lost through the renal tubules resulting in a base deficit. Chloride replaces the excreted HCO3.

Which of the following medications should be avoided in a patient with a right ventricular infarction who is experiencing tachycrdia and hypotension? A. Calcium channel blockers and ACE inhibitors B. Morphine and Nitroglycerin C. IV fluids and aspirin D. Plavix and Dobutamine - answer 24. B. Morphine and Nitroglycerin. A patient with a right ventricular infarction presenting with tachycardia and hypotension is showing signs of decompensation and shock. Often when the right ventricle is infarcted, the wall motion is stunned causing a reduction in forward flow of blood from the right to the left side of the heart. To improve forward flow, the treatment is IV fluid to maximize preload (think Starling's Law!). Patients with right ventricular infarctions can become preload dependent. Medications that decrease preload should be avoided. Examples include morphine, nitroglycerin, beta blockers and diuretics.
The emergency drug therapy of choice for polymorphic ventricular tachycardia is: A. Atropine B. Amiodarone C. Adenosine D. Magnesium - answer 25. D. Magnesium. Polymorphic ventricular tachycardia, or Torsades de Pointes, is best treated with the administration of magnesium. Other emergency antiarrhythmics have little benefit in states of hypomagnesemic induced polymorphic ventricular tachycardia.
The nurse is caring for a patient admitted to the PCU after a motor vehicle collision. The patient sustained a severe cardiac contusion. Which of the following sets of hemodynamic parameters would you expect in the setting of a cardiac contusion affecting the right ventricle? A. Decreased cardiac output, increased right heart preload, normal left heart preload B. Increased cardiac output, decreased right heart preload, increased left heart preload C. Decreased cardiac output, decreased right heart preload, increased left heart preload

answer 26. A. Decreased cardiac output, increased right heart preload, decreased left heart afterload. Myocardial contusions generally impact the atria & right ventricle because of the position of the heart in the chest. A decrease in RV contractility can lead to decreased RV ejection fraction, decreased preload to the left ventricle, and increased pulmonary vascular resistance. Because right ventricular contractility if often impaired, blood backs up to the right atrium resulting in an increased right atrial pressure or preload

A patient is admitted after being found down with an altered level of consciousness. Which of the following symptoms would indicate the patient may be experiencing alcohol withdrawal? A. Hypothermaia B. Hypermagnesemia

PCCN TEST EXAM 1 QUESTIONS WITH ACCURATE ANSWERS, Exams of Advanced Education

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PCCN TEST EXAM 1