AACN PCCN Practice Test Review, Exams of Nursing

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Question and Answers 2024-

What are signs of dialysis disequilibrium syndrome - correct answer ✅✅ Headache Nausea/vomiting Restlessness AMS Agitation Seizures What causes disequilibrium syndrome? How can it be avoided? - correct answer ✅✅ This occurs when plasma solutes (i.e. urea) are lowered too quickly. Prevent by reducing dialysis time and increasing frequency. What causes myocarditis? - correct answer ✅✅ Recent viral infections Cocaine abuse Autoimmune disease (i.e. SLE) What is a key intervention to increase preload in the setting of cardiac tamponade while waiting for a pericardiocentesis? - correct answer ✅✅ Placing the patient in Trendelenburg's (feet above head). Consider: IVF D/C preload lowering agents: diuretics, nitrates, and morphine

Question and Answers 2024-

Signs of middle cerebral artery stroke - correct answer ✅✅ * Contralateral hemiplegia

• Sensory involvement
• Aphasia (if dominant hemisphere involved)
• Neglect (if non-dominant hemisphere involved) (i.e. denial of weakness)
• Homonymous hemianopsia (loss of same visual field in both eyes) Signs of anterior cerebral artery stroke - correct answer ✅✅ * Weakness or sensory loss of contralateral leg and proximal arm
• Behavior disturbance (confusion, indecisiveness, memory loss, urinary incontinence) Signs of posterior cerebral artery stroke - correct answer ✅✅ * Contralateral visual field loss
• Color blindness
• Impaired depth perception
• Memory loss
• Sensory loss
• Nystagmus
• Pupillary abnormalities
• Ataxia Signs of a vertebral artery stroke - correct answer ✅✅ * Ipsilateral numbness to face/nose/eye with contralateral numbness to body
• Facial weakness
• Vertigo
• Ataxia

Question and Answers 2024-

• Nystagmus
• Dysphagia
• Dysarthria Hematochezia - correct answer ✅✅ Bright red blood per rectum True/False: in a severe asthma attack, progression of PaCO2 to normal is a good sign. - correct answer ✅✅ False. Progression of PaCO2 to normal or increased level indicates impending respiratory failure. Fidelity - correct answer ✅✅ The duty to be faithful by keeping promises and fulfilling commitments. Beneficence - correct answer ✅✅ * Preventing harm to others *Promoting and acting for the good of others *Eliminating harmful circumstances Nonmaleficence - correct answer ✅✅ Do no harm Veracity - correct answer ✅✅ Truthfulness What is a common electrolyte abnormality in patients with cancer? - correct answer ✅✅ Hypercalcemia.

Question and Answers 2024-

It occurs in 33% of cancer patients. Caused by issue of calcium regulation (too much entering ECF or inadequate excretion by the kidneys). What is the definition of a STEMI? - correct answer ✅✅ ST elevation (> 1. mm) at the J point in >/= 2 contiguous leads True/false: a drop in hemoglobin/hematocrit occurs early in the setting of a bleed. - correct answer ✅✅ False. H/H may not change significantly for SEVERAL HOURS. What is the dose of IV fluid therapy used to prevent/correct AKI & target urine output? - correct answer ✅✅ 2-5 mL/kg/hr Target urine output: 200-300 mL/hr How does vasopressin work and what is it's indication? - correct answer ✅✅ Decreases portal hypertension by constricting splanchnic arteries --> decrease in portal blood flow Indication: Upper GIB in pt with h/o cirrhosis. With epicardial pacemakers, what should you do if there is failure to capture?

- correct answer ✅✅ Increase the output (mA) of the pacer until a QRS is seen What happens when a pacemaker's sensitivity (mV) is increased? - correct answer ✅✅ Increased sensitivity --> pacemaker becomes LESS SENSITIVE to the patient's intrinsic rhythm

Question and Answers 2024-

(Remember the fence analogy. Increased sensitivity = higher fence) Indications for a G-J tube - correct answer ✅✅ Patients who have delayed gastric emptying (and are intolerant of G tube feedings):

• Head injury
• Gastroparesis associated with uremia or DM
• Postop ileum Normal ABG Values: HCO3 - correct answer ✅✅ 22-26 mEq/L What medication category is contraindicated in the setting of hematochezia?

- correct answer ✅✅ NSAIDs What is the mechanism of action of phosphodiesterase inhibitors? - correct answer ✅✅ Relax airway smooth muscle --> bronchodilator and improved lung function. Indicated in mild COPD exacerbation. What are the key characteristics of arterial ulcers and where are they typically located? - correct answer ✅✅ * Location: most often on the foot, in between or at the tips of the toes, at pressure points from foot wear, on the heels and around lateral malleolus

• Size and shape: Most likely round, with a "punched out" appearance. They may range in size from small to large, with well-defined edges.
• Color: Yellow, brown or black in color. Skin may also appear pale and non- granulating.

Question and Answers 2024-

• Appearance: often deep, but may also appear shallow in early stages. Skin surrounding the wound is often thin, smooth, taut and dry. Loss of hair on the leg is also common.
• Exudate: often dry due to minimal drainage.
• Pain level: Reportedly very painful. Elevating the leg can increase this pain.
• Other distinguishing characteristics: Toenails often appear brittle, yellow, deformed, thick and dry. Pulse may be indistinguishable around the site of the wound. The area around the wound is likely cool or cold to the touch due to minimal blood circulation. What are the key characteristics of venous ulcers and where are they typically located? - correct answer ✅✅ * Location: usually on the inner lower leg, above the medial malleolus
• Size and shape: often shallow, but large, and typically have irregular edges that may also slope.
• Color: Typically ruddy red, with granular tissue. There may also be discoloration with yellow slough present.
• Appearance: Surrounding skin may be shiny, warm or scaly. Tunneling is uncommon.
• Exudate: moderate to heavy amount of exudate --> appear "wet."
• Pain level: Individuals often describe a dull, aching pain. This pain is likely more related to venous hypertension and resulting edema rather than from the wound itself. What ABG is commonly associated with pneumonia? - correct answer ✅✅ Respiratory alkalosis pH: low PaO2: low PaCO2: low (from hyperventilation in response to hypoxia)

Question and Answers 2024-

What conditions commonly cause respiratory acidosis? - correct answer ✅✅ * hypoventilation from respiratory center depression or neuromuscular disturbances

• acute respiratory failure
• PE What conditions are associated with bicarbonate loss --> metabolic acidosis?

- correct answer ✅✅ Diarrhea Renal failure Hyperkalemia Toxins What conditions are associated with acid loss --> metabolic alkalosis? - correct answer ✅✅ Nasogastric suctioning Vomiting Excessive diuresis Steroids Hypokalemia Ingestion of HCO3 (i.e. antacids) What are risk factors for developing DM? - correct answer ✅✅ Obesity: BMI > 27 kg/m HDL low: < 40 mg/dL Age > 45 Genetics: parents, grandparents or siblings with DM

Question and Answers 2024-

What are the criteria for metabolic syndrome? - correct answer ✅✅ 3+ of the following:

• waist circ >/= to 40 in (men) 35 in (women)
• BP >/= to 130/
• triglycerides >/= 150
• FBG >/= to 100
• HDL < 40 (men) and < 50 (women) What does having metabolic syndrome put a patient at risk for developing? - correct answer ✅✅ Diabetes Stroke Heart disease What is air leak syndrome and what are its key clinical signs? - correct answer ✅✅ It occurs when air leaks around a chest tube, into the interstitial spaces of the lungs. Signs: constant bubbling in the water chamber & persistent crepitus around chest tube insertion site. Tx: VATs What are symptoms of hypertrophic cardiomyopathy? - correct answer ✅✅ * Exercise induced syncope, CP, and SOB
• Palpitations What are symptoms of restrictive cardiomyopathy? - correct answer ✅✅ * DOE/fatigue

Question and Answers 2024-

• Elevated jugular venous pressure worsened with inspiration
• S4 and/or S3 heart sound
• Peripheral edema
• Ascites
• Rales What is the key difference between simple and complex seizures? - correct answer ✅✅ If a patient remains conscious, it's a simple seizure. Partial seizure presentation - correct answer ✅✅ The clinical presentation is related to the area of the brain affected:
• Motor events (face twitching, limb jerking)
• Automatism (lip smacking, fidgeting, blinking)
• Sensory events (numbness, tingling, visual, auditory, gustatory, vertiginous symptoms)
• Psychic evens (hallucinations, illusions)
• Autonomic events (diaphoresis, vomiting)
• Postictal confusion, amnesia What is myoclonus? - correct answer ✅✅ Sudden, brief involuntary twitching or jerking of a muscle or group of muscles What is tonic posturing? - correct answer ✅✅ Sustained tonic flexion or extension of the limbs Abrupt increase in mm tone of face

Question and Answers 2024-

What are reciprocal leads to the anterior heart (V2, V3, V4)? - correct answer ✅✅ Posterior: V7, V8, V What are reciprocal leads to the septum (V1, V2)? - correct answer ✅✅ (Leads on the opposite side of the septum) V5, V What are reciprocal leads to the lateral heart (I, aVL, V5, V6)? - correct answer ✅✅ Inferior: II, III, aVF What are reciprocal leads to the inferior heart (II, III, aVF)? - correct answer ✅✅ Partial lateral: I, aVL What are reciprocal leads to the posterior heart (V7, V8, V9) - correct answer ✅✅ V1, V2, V What are characteristics of an absence seizure? - correct answer ✅✅ Lasts seconds

• Momentary LOC
• May lose mm tone
• Blank stare, cessation of activity, eye blinking, lip smacking What are characteristics of a tonic-clonic (Grand Mal) seizure? - correct answer ✅✅ Lasts 3-5 minutes
• May be precluded by an aura or a cry from forced expiration
• LOC, loss of continence
• Symmetric tonic-clonic extremity movements

Question and Answers 2024-

• Possible apnea with cyanosis until tonic phase ends
• Postictal fatigue, mm soreness, confusion, lethargy, HA What are major complications of a seizure? - correct answer ✅✅ * Cerebral anoxia
• V Fib
• Neuroglycopenia (due to hypoglycemia)
• Respiratory arrest
• Clonic-tonic muscle activity can cause the release of intracellular potassium (--> dysrhythmias) and CK/myoglobin (--> rhabdo)