PCCN Actual Final Exam Latest Update -

PCCN Actual Final Exam Latest Update - 200 Questions with 100% Verified Correct Answers Guaranteed A+

A 45-year old woman is admitted with type 1 diabetic mellitus. She is hyperventilating, has signs of dehydration (increased urine output and increased thirst), and is

tachycardic. Initial treatment would include:

• Diazoxide (Hyperstat) to inhibit the release of insulin
• glucose for hypoglycemia
• insulin therapy for ketoacidosis, fluid and electrolyte replacement
• intravenous fluids for dehydration and glucose for hypoglycemia - CORRECT

ANSWER: C. insulin therapy for ketoacidosis, fluid and electrolyte replacement

The patient is exhibiting the signs and symptoms of diabetic ketoacidosis (DKA). Signs of dehydration, such as polydipsia and polyphagia, are due to large urine output, increased thirst is secondary to dehydration and tachycardia is due to sympathetic nervous system stimulation from an increased glucose level and ketosis. Initial treatment would include insulin therapy, re-hydration with fluids and electrolyte replacement. Diazoxide would not be used since it inhibits insulin release (this patient requires insulin to lower glucose). The patient is not hypoglycemia. Signs and symptoms of hypoglycemia are similar; tachycardia, change in behavior (irritability) or level of consciousness, sweating and shaking.

A 45-year-old female with history of bipolar disorder is one-day postoperative following abdominal surgery. The patient slept only one or two hours during the night and is speaking rapidly, throwing her belongings at the nurses and insists she is going to leave

the hospital. The nurse should:

• Notify the mental health crisis team
• Notify social services
• Notify the nursing supervisor
• Notify the patient's husband - CORRECT ANSWER: A. Notify the mental health crisis

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In many hospitals, this can be the rapid response team. Not all hospitals have access to mental health professionals so the rapid response team answers these calls. The mental health crisis team is comprised of mental health professionals who can assess the mental status of the patients as well as the medical-surgical assessment. After the complete assessment is made, the decision of how to treat this possible exacerbation of her bipolar disorder may be made. The patient is at risk for hurting herself and others and may need continuing assessment of mental and surgical status beyond the rapid response team. Decisions will be made with the attending physician. Social services may help with placement, but not during an acute situation. The nursing supervisor may be notified as the rapid response team is notified; this is a great strategy; however, the supervisor may not have the ability to assess this complex patient. The supervisor is more able to delegate care and request more help to the area if needed. The patient's husband will need to be called after the immediate assessment is made.

A 55 year old male postoperative patient is demonstrating signs of pain; tachycardia, hypertension, abdominal guarding and increased respiratory rate. The patient refuses pain medication because he believes he will become addicted to the narcotics. What is the nurse's best response?

• Acknowledge that the patient is entitled to refuse pain medications
• Tell the patient that opioids have a low addiction rate when used for postoperative

pain while in the hospital

• Admire the patient's stoicism
• Acknowledge opioid addiction potential, and offer a back rub - CORRECT ANSWER:
• Tell the patient that opioids have a low addiction rate when used for postoperative

pain while in the hospital Many people are concerned about addiction rates of narcotics; however, the use of narcotics for postoperative pain while in the hospital has a very low addiction rate. The risk for abuse increases when patients go home with narcotics. Explaining to the patient that limited use in the hospital will increase his recovery and reduce inflammation is the correct response. Any patient may refuse medications after an explanation of the facts are given. A back rub or alternative care is a way to treat the patient if they absolutely refuse medications; however, the best answer is to correct the patient's misinformation about the use of narcotics during the immediate postoperative period.

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A 55-year old male is admitted from the ICU after an acute Type III aortic dissection.Treatment plan includes blood pressure control. What medications would the nurse anticipate in this patient?

• digoxin (Lanoxin) and furosemide (Lasix)
• metoprolol (Lopressor) and lisinopril (Prinivil)
• furosemide and spironolactone (Aldactone)

D. bumetanide (Bumex) and amlodipine (Norvasc) - CORRECT ANSWER: B.

metoprolol (Lopressor) and lisinopril (Prinivil) The blood pressure control of this patient is the most important treatment in his care.The two most common drugs for the treatment of an aortic dissection are a beta blocker and ACE inhibitor. Diuretics may be added for more control of blood pressure, but are not first-line drugs. Digoxin is not required for this patient.

A 68 year old male is 4 hours postoperative after percutaneous transluminal coronary angioplasty and stent placement and complains of flank pain. He is restless, tachycardic, hypotensive, and his hemoglobin and hematocrit levels (H+H) have dropped. Which of the following nursing actions is correct?

• Keep the head of the bed flat and apply pressure at the sheath site to stop bleeding.
• Notify a physician immediately and anticipate ultrasound-guided compression and

possible surgery to stop the bleeding.

• Notify a physician immediately, and anticipate anticoagulation or thrombolytic

therapy.

• Notify a physician immediately, stop anticoagulation therapy, and anticipate the need

for intravenous fluid and/or blood - CORRECT ANSWER: D. Notify a physician

immediately, stop anticoagulation therapy, and anticipate the need for intravenous fluid and/or blood This angioplasty and stent patient is probably experiencing a retroperitoneal arterial bleed into the flank area, requiring cessation of anticoagulants and preparation for fluid administration and/or blood. Lying the patient flat and applying pressure to the sheath site treats the bleeding or hematoma at the sheath site. Ultrasound-guided compression and surgery is indicated if a pulsatile mass or bruit occurs near the insertion site, indicating pseudoaneurysm or arteriovenous fistula formation. Anticoagulation therapy is indicated for decreased circulation in extrremity related to thrombus or embolus.

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A 70 year old female presents in cardiogenic shock secondary to myocardial infarction.Which of the following symptoms are consistent with cardiogenic shock?

• hypertension with systolic blood pressure greater than 90 mm Hg, bradycardia, chest

pain and tachypnea

• hypotension with systolic blood pressure less than 90 mm Hg, tachycardia,

dysrhythmias and tachypnea

• hypotension with systolic blood pressure less than 90 mm Hg, dysrhythmias and

slow, labored breathing

• hypotension with systolic blood pressure less than 90 mm Hg, bradycardia and slow,

labored breathing - CORRECT ANSWER: B. hypotension with systolic blood pressure

less than 90 mm Hg, tachycardia, dysrhythmias and tachypnea Cardiogenic shock presents with low cardiac output syndrome: tachycardia, low systolic pressure, elevated diastolic pressure (decreased pulse pressure), tachypnea due to tissue hypoxia, and dysrhythmias due to myocardial ischemia. Hypertension does not fit with low cardiac output syndrome, nor does slow labored breathing.

A complete assessment of a patient with a wound includes which of the following:

• a detailed description of the wound and vascular assessment
• a nutrition assessment
• laboratory findings, including hematology, microbiology and chemistries

D. all of the above - CORRECT ANSWER: D. all of the above

Accurate wound assessment on admission includes: detailed description of the wound, including wound location, length, width, depth and the presence and position of undermining, presence of cellulitis and drainage. Calculation of wound area of volume should be performed and documented at each patient visit. A nutrition assessment is key. Vascular assessment is also essential, especially if a patient presents with a chronic wound. A thorough vascular exam should be performed, including palpation of radial, femoral and pedal pulses. Signs of arterial obstruction include lack of peripheral pulses with poor capillary refill, think atrophic skin and hypertrophic deformed nails.Laboratory assessment to include hematology, complete blood count and differential, chemistries including metabolic panel, liver function tests, albumin, prealbumin, hemoglobin A1C, and microbiology, including previous cultures and pathology.

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