Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

PCCN Practice Questions: Critical Care Nursing Scenarios and Answers, Exams of Nursing

A series of multiple-choice questions designed to test knowledge in critical care nursing. Each question presents a clinical scenario involving a patient with a specific condition, followed by multiple answer choices. The correct answer is provided along with a brief explanation, highlighting key concepts and rationale for the chosen answer. The questions cover a range of critical care topics, including respiratory distress, cardiac emergencies, and post-operative management.

Typology: Exams

2024/2025

Available from 11/12/2024

mike4day
mike4day šŸ‡¬šŸ‡§

129 documents

Partial preview of the text

Download PCCN Practice Questions: Critical Care Nursing Scenarios and Answers and more Exams Nursing in PDF only on Docsity!

PCCN questions

Two days following a near-drowning accident, a pt is dyspneic, using accessory muscles, expectorating large amounts of secretions and reporting feeling of impending death. Changes to the assessment data include RR- 24 TO 36 CXR clear to bilateral diffuse infiltrates ABG 40% face mask or 100% non-rebreather mask pO2 120 mm Hg to 56 mm Hg pCO2 33 mmHg to 56 mmHg pH 7.42 to 7. HCO3 24 meq/L to 27 mEq/L Which of the ff do these changes most likely represent A. aspiration pneumonia B. pulmonary embolism C. interstitial pneumonitis D. ARDS - correct answer D. The onset of symptoms occured within 48 hours of the incident. THe bilateral diffuse infiltrates and ABG results indicating hypoxemia and CO2 retention are all consistent with ARDS. Aspiration pneumonia should include hypoxxemia, respiratory alkalosis. The CXR results would reveal an area of opacity with aspiration pneumonia rather than diffuse infiltrates. Interstitial lung disease invlolves an inflammation of supportive tissue between the air sacs rather than inflammation in the air sacs themselves. Symptoms would be SOB and a dry cough. A pt reports chest pain that is sharp, constant, worse when lying down and alleviated with sitting up and leaning forward. The most likely cause of these findings is A. ACS B. pericarditis C. PE

D. AAA - correct answer B Pericarditis is inflammation of the pericardial sac. The damaged epicardium becomes rough and inflamed and irritates the pericardium lying adjacent to it, precipitating pericarditis. Pain is the most common symptom of pericarditis. THe pain is sharp, constant and is alleviated when sitting up and leaning forward. A pt tells a nurse, "I don't know how I'm going to pay for this hospitalization." The nurse should A. arrange a meeting with hospital social services staff B. Notify the business office so a payment plan can be designed C. redirect the pt toward meeting psychologic needs D. give the pt applications for public assistance medical coverage - correct answer A. Collaboration with a social worker is indicated in this case the social worker can assist the pt in identifying ways to address the financial implications of this hospitalization and help identify methods of payments. A cardiac pt with with DNR status is being managed medically. The nurse notes a new cough, thick yellow sputum and a temperature of 101.4 (38.4) Coarse crackles are present in the right upper field. The nurse should most immediately anticipate A. blood and sputum cultures followed by a broad spectrum abx B. mucolytics and judicious IV fluid administration C. an antyipyretic and conservative management D. NPO status and encouragement of frequent activity - correct answer A. This pt symptoms are consistent with pneumonia. Management should include abx therapy, oxygen therapy for hypoxemia, mechanical ventilation if acute respiratory failure develops, fluid management for hydration, nutritional support, and treatment of associated medical problems and complications. Which of the ff findings is most indicative of a ruptured aortic aneurysm A. Back pain B. bounding peripheral pulses C. intermittent claudication D. warm, flushed skin - correct answer A. An aneurysm is the localized dilation of an artery. Should an aneurysm rupture, blood will build up under pressure in the tissues surrounding the aorta, which can result in acute pain and tenderness in theses areas. This is particularly the case if the aneurysm leaks from the back of the aorta. Ruptured AAA presents with a classic triad of pain in the flank or back, hypotension and a pulsatile abdominal mass; however, only about half of the full triad. The pt will

complain of the pain and may feel cold, sweaty and faint on standing. The pt may also report abdominal pain. A small percentage may have vomiting According to recommendations based on research findings, pain assessment should occur A. based on changes in vital signs B. only when the pt movements indicate the pt is seeking attention C. routinely, regardless of physical findings D. only when the presence of pain can be validated - correct answer C. Pain is considered the fifth vital sign and must be assessed regularly. Presence of physical findings may be part of the comprehensive assessment of pain. However, physical findings may not be present in all patients with pain A pt with a tracheostomy requires frequent suctioning for thick sputum, A nurse finds a colleague instilling saline in the endotracheal tube prior to suctioning. The most appropriate response by the nurse would be to A. report the colleague to the charge nurse or manager B. noted the practice on the pt chart to ensure consistency of suctioning techniques C. ask the attending physician to review the suctioning policy. D. collaborate with the colleague to review the evidence about this practice. - correct answer D. In addition to an unappreciable increase in sputum recovery, use of NS adversely affects arterial and global tissue oxygenation and dislodges bacterial colonies, thus contributing to lower airway contamination. Other harmful pt outcomes have been reported in the nursing literature, including delays in return to baseline vital signs, Spo2 and intracranial pressure. Because no solid scientifically based benefits for routine use of normal saline have been shown, it is highly recommended that this potentially harmful practice be abandoned. Instead, treatment considerations should center on ways to prevent the development of thick tenacious secretions. A review of these data should take place with the colleague to help mitigate continuation of this dangerous practice Upon admission to the PCU, you screen a pt to determine whether to administer an influenza vaccine. Which of the following is a contraindication to the vaccine? A. Guillian-Barre syndrome B. chronic renal failure C. COPD D. cirrhosis - correct answer A. Persons who developed Guillain-Barre syndrome after receiving an influenza vaccine should not receive the influenza vaccine without checking with their provider

Emergency treatment of ventricular dysrhythmias for the pt who has an ICD pacemaker includes which of the following A. If a pt develops vfib, the nurse should not defibrillate with external paddles B. if the ICD is firing correctly and the pt does not have pulse, CPR is not indicated C. when preparing for external defibrillation, avoid placing the paddle directly over the ICD pulse generator D. when you need to turn off all functions of the ICD or pacemaker, apply a magnet - correct answer C. Defibrillation has been known to cause malfunction of an ICD or pacemaker. Care should be taken to ensure the defibrillation paddle/ pads are applied at least 4-finger breaths away from the device. The anterior-lateral and anterior-posterior positions for paddle/pad placement are acceptable in a pt with a permanent ICD or pacemaker. The pads may also be placed safely away from the ICD with 1 pad at the apex left mid-axillary, 5th ICS., and the other pad right of the sternum just below the clavicle. Based on the device implanted and the manufacturer, application of a magnet may turn device off or reset to the default settings. A pt is admitted following mitral valve replacement. Which of the following should most likely be included in the patent's plan of care A. positive inotropic agent B. anticoagulant C. prophylactic antibiotic D. ACE inhibitor - correct answer B. Anticoagulatn therapy recommendations are based on the valve apparatus and the pt risk factors (afib, LV dyfunction, previous thromboembolism, and hypercoagulable condition). Mechanical valve replacement require lifelong anticoagulant therapy, while most pt with bioprosthetic valve replacement require short term anti-coagulation (3 months). In pt with NSR and no risk factors for thrombus, only aspirin therapy is recommended after bioprosthetic valve replacement. A pt with multiple rib fractures sustained in a motor vehicle collision 4 days ago reports sudden chest pain and difficulty breathing. Chest xray reveals a right hemothorax. The pt appears anxious and has decreased breath sounds on the affected side. Which of the ff procedures should the nurse anticipate A. needle decompression, 2nd ICS at midclavicular line B. bronchoscopy with broncial lavage C. placement of a right-side chest tube in the 6th ICS at the posterior axillary line

D. CT scan for further evaluation and diagnosis - correct answer C. Blunt or penetrating thoracic trauma can cause bleeding into the pleural space, resulting in a hemothorax. This life-threatening condition must be treated immediately. Resuscitation with intravenous fluids is initiated to treat the hypovolemic shock. A chest tube is placed on the affected side to allow drainage of the affected side to allow drainage of blood. A pt with which of the ff is at greatest risk for torsades de pointes A. depressed ST segment B. development of peaked T waves C. prolonged QT interval D. development of a U wave - correct answer C. The normal QTc is less than 0.46 second (460 msec) in women and less than 0.45 second (450 msec) in men. A prolonged QT interval is significant because it can predispose the pt to the development of polymorphic VT, also known as torsades de pointes. When drugs associated with a high risk of torsades de pointes are started, it is important to record the QT and QTc interval and to continue to monitor the QT and QTc interval during treatment. Prolongation of the absolute QT interval beyond 0.5 second (500 msec) increases the risk of polymorphic VT. A pt is confused about time and place, despite frequent reorientation. For the pt safety, the nurse should initially A. put a vest restraint on the pt B. ask a family member to stay with the pt C. administer a mild sedative D. increase the frequency of pt observation - correct answer D. Pt have a right to receive safe care in a safe environment. However, the use of restraints is inherently risky. THe decision to use a restrain or seclusion is not driven by diagnosis, but by a comprehensive patient assessment. FOr a given pt at a particular point in time, this assessment determines whether the use of less restrictive measures poses a greater risk than the risk of using a restraint. Increasing the frequency of observation may be all that is required to keep this pt safe. The comprehensive assessment to identify medical problems that may be causing behavior changes in the pt. For example, temperature elevations, hypoxia, hypoglycemia, electrolyte imbalances, drug interactions and adverse effects may cause confusion, agitation and combative behavior. Addressing these medical issues may eliminate or minimize the need for restraint. A pt with ACS who has undergone cardiac surgery 2 days ago develops new onset of JVD, muffled heart tones, palpitations, difficulty breathing and chest pain that worsens with coughing. Decreased peripheral pulses are noted. Vital signs are as follows BP 110/60 to 90/

HR 96 to 134 RR 20 to 28 Which of the following should the nurse anticipate A. needle decompression B. echocardiogram C. administration of dopamine D. spiral Ct - correct answer B. This pt is at risk for and is demonstrating signs of cardiac tamponade. Cardiac tamponade may occur after surgery if blood accumulates in the mediastinal space, impairing the heart's ability to pump. Signs of tamponade include elevated and equalized filling pressures (CVP, PADP, PAOP), decreased cardiac output, respiratory rate, jugular venous distention, pulsus paradoxus, and muffled heart sounds. Transesophageal or transthoracic echocardiography may be used to diagnose or confirm cardiac tamponade. A pt is admitted with a severe headache, nausea and vomiting. BP on arrival is 280/140 mm Hg. The nurse should anticipate immediate administration of A. atniemetics B. labetalol C. mannitol D. analgesics - correct answer B. Hypertensive urgencies may be treated with rapid-acting oral antihypertensive agents. There are many drug categories available, including ACEIs, ARBs, calcium channel blockers and beta-blockers. Labetalol is an example of a beta-blocker that may be used in this situation. A pt who is extubated following 3 days of mechanical ventilation is noted to have hot and flushed skin and is expectorating thick yellow sputum. Auscultation reveals bilateral crackles halfway up posterior. Data are as follows BP 112/ HR 138 RR 30 T 102 (38.9) o2 SAT 93% ON 2 l nc Which of the ff orders should the nurse anticipate A. lasix 40 mg ivp and increase 02 to 4 L/min

B. albuterol inhaler and methylprednisolone 125 mg IVP C. serum BNP and HCTZ D. blood culture and IV antibiotics - correct answer D. This pt is demonstrating symptoms of pneumonia. Rapid administration of antibiotics contributes to improved outcomes. Obtaining blood cultures will help the provider determine the appropriateness of selected antibiotics. When caring for a 15 year old pt, The nurse should A. answer questions with simple and practical information B. dispel fantasies and encourage questions C. encourage pt to talk about life experiences D. allow the pt peers to visit - correct answer D. Teens want to be with people their own age- their peers. Peers are often more accepting of the feelings, thoughts and actions associated with the teen's search for self-identity. The influence of peers- whether positive or negative- is critical importance in an adolescent's life. A pt with a history of heroin and alcohol abuse is admitted for treatment of cellulitis. The pt has flushed, slightly moist skin and is slow to respond to verbal stimuli. The affected arm is edematous and hard to the touch, with yellow exudate noted from puncture wounds on the skin. Vital signs are BP 88/ HR 120 RR 26 T 102 (38.9) The nurse should anticipate orders for which of the ff A. abx and crystalloid administration B. antipyretic and dopamine administration C. CT scan of the head and a drug screen D. colloid followed by norepineprhine administration - correct answer A. This pt has risk factors and is exhibiting signs of sepsis. The main goals are to control infection and provide immediate resuscitation of the hypoperfused state. Early goal-directed therapy during the first 6 hours of resuscitation improves survival. This they includes aggressive fluid resuscitation to augment intravascular volume and increase preload until a CVP of 8 to 12 mm Hg. (12 to 15 mm Hg in mechanically ventilated pt). is acheived. Crystalloids or colloids may be used. A fluid challenge for hypovolemia should be initiated.

A pt with HTN, dyslipidemia and CAD has leg pain and decreased skin temperature in the legs and feet. The pt legs have pallor and decreased pulses that become fainter when the legs are elevated. The nurse should suspect. A. DVT B. chronic venous insufficiency C. acute arterial occlusion D. PAD - correct answer D. The symptoms described in this scenario are consistent with PAD. This pt also has risk factors for PAD. Risk factors for PAD include DM and impaired glucose tolerance, smoking, hypertension, hyperlipidemia and hyperhocysteinemia A pt with history of COPD and anterior wall MI that occurred 1 year ago is now SOB and expectorating pink frothy sputum. The pt has a rapid, irregular heart-beat with an O2 sat of 89%. The most likely cause of these S/S is A. pulmonary edema B. cardiac tamponade C. pneumococcal pneumonia D. ARDS - correct answer A. History and current symptoms are consistent for pulmonary edema Which of the ff patients in the PCU should be further evaluated for malnutrition? The pt with A. a third episode of ARF and poor pulmonary function tests B. hypoactive bowel sounds and normal albumin levels C. sepsis who hasa 10 kg water weight gain and is receiving diuretics D. elevated BMI and Hgb of 14.6 - correct answer A. Malnutrition and respiratory failure are closely lined. Critically ill pt with respiratory failure are vulnerable to complication of underfeeding or overfeeding. A pt with ESRD and HF is receiving HD through an AV graft. VS are BP 190/94, HR 104, RR 26. The pt has crackles bilaterally and is bleeding from the graft site. The nurse should A. asses for bruit and thrill every 30 min for 2 hours and reasses B. notify the interventional radiologist C. ask the nephrologist to insert a temp catheter into the contralateral arm

D. collaborate with the nephrologists regarding not using heparin during dialysis treatment - correct answer B. If the bleeding is not controlled following application of direct pressure to the site, repair by an interventional radiologist is indicated. A pt presents with a temperature of 105.6 F (40.9) and nuchal rigidity. A nurse obtains blood culture and administers antibiotics. The patient remains febrile, and the family questions the adequacy of the interventions. The nurse's best response should be to A. arrange a social service consult B. assure the family that everything will be explained later. C suggest that the family discuss their concerns with the physician D. acknowledge the family's concerns while explaining rationales for the interventions - correct answer D. The nurse demonstrating high levels of caring practices and facilitation of learning will acknowledge and address the family's learning A pt who is newly admitted is hemodynamically stable, had sustained a stroke and had been on mechanical ventilation via tracheostomy tube, a continuous sedation infusion and enteral feedings in the ICU for several days. The pt is now off sedation and receiving O2 via a trach collar. Gastric residual volumes of 250 ml every 6 hours over the past 3 days have been noted. Upon collaborating with the nutritionist and physician, the nurse should anticipate which of the ff A. dilution of the enteral feeds by 50% with water B. administration of a prokinetic agent C. decreasing the rate of enteral feedings by 50% D. initiation of pernteral nutrition - correct answer B. In a studr of 206 critically ill pt, 2 or more GRVs of at least 200 mL and 1 or more GRVs of at least 250 mL were found significantly more often in pt who experienced frequent aspiration. Prokinetics have been advocated to improve gastric emptying. Which of the ff electrolye abnormalities should the PCU nurse anticipate in caring for a pt with chronic alcohol abuse A. hypomagnesemia B. hyperphosphatemia C. hypercalcemia D. hyponatremia - correct answer A. Pt with chronic alcohol abuse are at risk of reasons (1) their diet is typically low in magnesium, (2) alcohol diuresis pulls magnesium out of the body, and (3) there is associated poor GI absorption of dietary magnesium in chronic alcohol abuse.

A pt develops SVT hypotension and chest pain. The goal of therapy will be to A. reduce HR to increase diastolic filling time B. produce arteriolar constriction to increase perfusion pressure C. dilate coronary arteries to increase myocardial O2 delivery D. promote venous constriction to increase preload - correct answer A. Rapid heart rates can lead to hemodynamic instability, because the fast rate prevents adequate ventricular filling during diastole and increases myocardial oxygen demand, while decreasing time available for coronary artery filling Which of the following would be the most important immediate concern when managing a pt with an acute ischemic stroke A. preventing pressure ulcers from limited mobility related to hemiparesis B. avoiding HTN while maintaining adequate cerebral perfusion C. performing a CT scan to evaluate for bleeding form tPA infusion D. intubation and mechanical ventilation for airway protection - correct answer B. The main goals for managing the pt with acute ischemic stroke are twofold: (1) enhancement of cerebral blood flow and (2) neuroprotection, with the aim to reduce the intrinsic vulnerability of brain tissue to ischemia A pt with history of taking gentamicin (Garamycin) is admitted with oliguria, confusion, lethargy, nausea and vomiting. Lab data are as follows BUN 26 Cr 1. Na 130 K 4. Calcium 7. Which of the following should the nurse suspect A. dehydration B. acute tubular necrosis C. GI infection D. chronic renal failure - correct answer B. This pt has received a nephrotoxic agent, which puts the pt at risk for development of ATN. Lab data support this diagnosis with an elevated BUN, creatinine and potassium. Calcium and sodium levels will be decreased.

After a STEMI, a pt suddenly experiences a decreased level consciousness, a weak and thready pulse and posterior crackles in the lower half of the lung fields bilaterally. Data are as follows BP 76/ HR 139 RR 24 UO 5 ml for the past hour O2 sat 88% on 2 L via nasal (from 97%) The nurse should suspect which of the ff causes A. CVA B. cardiogenic shock c. pulmonary embolus D. ARDS - correct answer B. This pt has a primary risk factor (STEMI) and signs of cardiogenic shock. The hypotension is caused by a decrease in contractility of cardiac muscle. Compensatory mechanisms of tachycardia and tachypnea result. A decrease in urine output, decreased level of consciousness, crackles and a weak and thready pulse result from hypoperfusion associated with the condition. A frail, elderly pt recovering from an exploratory laparotomy was extubated following a prolonged period of mechanical ventilation and IV sedation. She continues to receive PRN opioids for pain. Today, the nurse notes occasional combativeness, fluctuating lethargy and poor short-term memory. Data are as follows BP 104/ HR 87 RR 24 O2 sat 95% on 2L via NC The nurse should recognize that A. mobilization should be limited to prevent injury B. the RASS scale should guide medication administration C. the use of Haldol is associated with lethal dysrhythmias D. moving the pt to a room with a window is a useful distraction technique - correct answer C. The most current guidelines advise cautious use of antipsychotic meds to manage delirium, as risk versus benefits

data remain unclear. Another choice may be a short-term trial of an atypical antipsychotic such as Quetiapine (Seroquel) The physician gave metoprolol (Lopressor) to a patient with rapid afib 5 minutes ago without effect for rate control and is currently administering IV diltiazem (Cardizem); BP is 94/60. Which of the following should the nurse anticipate. A. calcium chloride B. synchronized cardioversion C. digoxin D. transcutaneous pacing - correct answer D. A beta-blocker and calcium channel blocker combination should be used with caution. When drugs from these 2 classes are given together, the additive effect is the potent suppression of the AV node. Having transcutaneous pacing nearby can help the pt be treated early if this complication develops. A pt with HF is on a diuretic and fluid restriction. Assessment indicated atrial tachycardia with a rate of 130, presence of crackles in all lung fields, an S3 at the left apex and BP of 90/40 (previously 130/60). The patient reports feeling SOB. The nurse should anticipate administration of A. a fluid bolus to enhace preload B. dopamine to support BP C. dobutamine to augment cardiac output D. adenosine to reverse tachycardia - correct answer C. In pt with decompensated heart failure, use of intravenous inotropic agents such as dobutamine may be indicated to support cardiac function and cardiac output. The dysrhythmia most commonly associated with mitral stenosis is A. 2nd degree AB block type II B. idioventricular rhythm C. sinus bradycardia D. afib - correct answer D. Mitral stenosis increases the risk of developing atrial fibrillation because of high pressures in the left atrium that will stimulate left atrial remodeling and enlargement.

A pt with an elevated BMI is having fluctuations in BP, HR and oxygen saturation, and reports feeling sleepy and fatigued despite intershift report of the pt sleeping. The nurse noted periods of irritability and memory deficits. Which of the ff interventions is indicated A. monitoring for hypotension B. administering small doses of benzodiazepines C. performing a mini-mental status exam D. collaborating with the physician for use of a CPAP mask - correct answer D. This pt has primary risk factor (obesity) and symptoms of obstructive sleep apnea. Continuous positive airway pressure (CPAP) may be initiated if the pt CO2 level is stable and acceptable. A pt with suspected pulmonary hypertension should be prepared for which of the ff tests to confirm the diagnosis A. angiography B. echocardiography C. electrocardiography D. cardiac catheterization - correct answer D. RIght heart catheterization is required to confirm a diagnosis of pulmonary hypertension, to assess the severity of the hemodynamic impairment and to test the vasoreactivity of the pulmonary circulation A pt with sepsis has the ff lab data PT 12. aPTT 58. Fibrinogen elevated Fibrin split products elevated Which of the ff is indicated A. PLT B. cryoprecitpitate C. Vitamin K D. FFP - correct answer D. The pt aPTT is elevated, indicating an alteration with the intrinsic pathway or common pathway of the clotting cascade. FFP is needed to help correct this abnormality. What is the recommended initial position to improve oxygenation for a pt with unilateral pneumonia

A. prone B. high-fowler's C. side-lying on unaffected side D. supine - correct answer C. With the affected side uppermost, the lower lung is better ventilated and better pefused. Thise improves V/Q matching and gas exchange A pt with a history of diabetes and hypertension reports onset of numbness in her hands, unusual fatigue, loss of appetite, indigestion and a cough. Which of the following response by the PCU nurse is indicated A. Your doctor will likely order a CT scan without contrast B. I will call the dietitian to review your meal selections and intake with you C. How have you been sleeping the last couple of nights D. I will call the physician to obtain an order for an electrocardiogram - correct answer D. This pt has risk factors for and is demonstrating symptoms of possible ACS. An ECG will help diagnose this condition. A pt with a history of IV drug abuse is admitted with a fever and a grade III/VI systolic murmur. The patient develops sudden dyspnea and anxiety. Chest auscultation reveals a loud holosystolic murmur and crackles. Which of the ff is the most likely cause A. Mitral valve insufficiency B. ventricular aneurysm formation C. Heart failure D. hemopericardium with tamponade - correct answer A. This pt has a risk factor (IV drug abuse) and symptoms of endocarditis, which is common in IV drug abusers because of the nonsterile injection into the nervous system. While the tricuspid valve is most typically affected, involvement of the mitral and aortic valves can occur. A pt with history of COPD is receiving 28% oxygen via face mask and has the following ABG values. pH. 7. pCO2 48 pO2 62 HCO3 26 O2 sat 89

Which of the ff is indicated at this time A. continue ongoing therapy and monitoring B. increase the dead space of the oxygen tubing C. increase the FIO D. administer 1 meq/kg of sodium bicarbonate - correct answer A. Pt with COPD usually present with very high levels of carbon dioxide and lower oxygen levels. The ABG results of the patient in this scenario are within acceptable ranges for a pt with COPD. No intervention is indicated at this time. A pt with a history of hyperlipidemia and alcohol abuse reports left upper quadrant abdominal pain. vital signs are BP 85/ HR 110 RR 24 T 101 (38.3) Which of the following lab values should the nurse anticipate A. decreased sedimentation rate and elevated calcium level B. decreased serum amylase level and increased WBC count C. decreased LDH and increased SGOT (AST) D. decreased Hct and increased lipase level - correct answer D. This pt is demonstrating signs, symptoms and risk factors of pancreatitis. A decrease in Hct and an increase in lipase levels are consistent with this condition. A pt with systolic heart failure has slight dyspnea at rest. The nurse should anticipate management to include A. metoprolol B. milrinone C. lisinopril D. diltiazem - correct answer C. Use of an oral afterload reducer is indicated at this time to manage systolic heart failure. Decreasing heart workload may alleviate symptoms. A pt is admitted with a history of end-stage renal disease (ESRD), diarrhea, nausea, vomiting, prolonged QT interval, hyperreflexia and paresthesia of the fingers. Which lab value should the nurse monitor

A. calcium B. potassium C. magnesium D. sodium - correct answer A. This pt is demonstrating signs of hypocalcemia. The kidneys reabsorb up to 98% of filtered calcium, with less than 25 excreted in the urine. Patients with ESRD are usually hypocalcemic, because of the inability to reabsorb filtered calcium, along with decreased production of vitamin D3 in the nonfunctioning kidney. A pt with hepatic failure related to hepatitis B is being admitted. Lab data include PT >50 seconds, aPTT 59 seconds, bilirubin 18 mg/dL. Which of the following interventions should be anticipated A. arterial blood gas monitoring BID and preparing pt for a CT of the head B. checking blood sugar TID and hourly mental status assessment C. assessing ammonia levels BID and phosphorous levels daily D. preparing pt for a liver biopsy and transfusing FFP BID - correct answer B. This pt has a risk factor (hepatic failure) and symptoms of potential fulminant hepatic failure (FHF). Complication of FHF include encepalopathy, cerebral edema and hypoglycemia. Monitoring blood sugar and mental status are indicated for this pt. Which action is best to help reduce anxiety in a pt who has been hospitalized for suspected peptic ulcer disease A. ask all members of the team to reassure the pt about quality of care provided by the staff B. assigned the pt to a room with a talkative optimistic roommate C. explain to the pt what to expect during the hospitalization D. visit the pt frequently, and encourage discussion about pleasant future plans. - correct answer C. This pt is anxious about being hospitalized. Explaining what can be anticipated during the hospitalization is consistent with caring practices and will likely to help decrease the pt anxiety. A pt is admitted with GI bleeding and a 3 day history of melena. The pt is unresponsive but is breathing spontaneously. Urine output is 15 ml in 8 hours, and skin is cool to the touch. Assessment data include BP 86/54, HR 138, RR 30, T 99.3 (37.3) CVP 3 The nurse should anticipate immediate administration of which of the following A. adenosine B. aggressive fluid resuscitation

C. 3 units PRBCs D. dopamine (intropin) - correct answer B. This pt has risk factors, signs and symptoms of hypovolemic shock. Aggressive fluid resuscita is indicated at this time. An adult pt is admitted with status asmaticus. ABGs are pH 7.45, pCO2 29, pO2 60, HCO3 24. She is given 02 at 6 l per nasal cannula, epinephrine and albuterol (ventolin) treatments. Which of the ff ABG results are most indicative her condition is worsening pH pCO2 pO2 HCO A. 7.50 24 64 23 B. 7.34 47 59 21 C. 7.44 27 72 25 D. 7.43 39 69 24 - correct answer B. These arterial blood gases reveal a low pO2 and high pCO2 (stage 4 of blood gas progression in pt with status asmaticus, the most serious) which occurs with respiratory muscle insufficiency; this is an even more serious sign that stage 3, and mandates intubation and ventilatory support. The primary goal of thrombolytic therapy for ACS is A. troponin release B. chest pain relief C. myocardial reperfusion D. ectopy prevention - correct answer C. Thrombolytic therapy is administered to establish and maintain the patency of coronary arteries, thus improving myocardial perfusion. A patient with dilated cardiomyopathy is admitted with dyspnea, cough, palpitations and decreased level of consciousness. The patient is in sinus tach with no ectopy. The nurse should anticipate management to include A. administration of captopril (Capoten) B. insertion of a temporary left ventricular assist device C. loading the pt with digoxin D. preparation for dynamic cardiomyopathy procedure - correct answer A. This pt is showing symptoms of heart failure related to dilated cardiomyopathy. ACE inhibitors have been effective in improving both symptoms and survival in these pt. Most pt will tolerate ACE inhibitor therapy as well.

Apatient is admitted with acute respiratory failure, left lobar pneumonia and COPD. Physical examination reveals severe fatigue, coarse inspiratory crackles and expiratory wheezing. Data also include HR 132, RR 35, T 102.6 (38.9), pH 7.28, pCO2 72, pO2 48, HCO3 36 Based on this information, the nurse should anticipate which of the following additional clinical findings A. purulent sputum B. mediastinal shift to the right C. bradypnea D. intermittent apneic periods - correct answer A. Pneumonia is common in pt with COPD. Sputum becomes purulent over time in pt with pneumonia. A pt with end-stage renal disease asks the nurse why is anemic. The nurse explains the anemia is caused by A. blood loss in the urine B. renal insensitivity to vitamin A C. inadequate production of erythropoietin D. inability of the kidney to retain iron. - correct answer C. As chronic kidney disease progresses to stage 2 and 3, erythropoietin production decreases and anemia may become clinically evident A pt is receiving milrinone therapy should be assessed for which of the following side effects A. hyperkalemia B. chest pain C. thrombocytopenia D. decreased urination - correct answer B. Chest pain, ventricular dysrhthmias and hypotension are potential side effects of milrinone administration. Thrombocytopenia is a side effect of inamnirone, another PDI but not milrinone. Which of the ff ABG results should the PCU nurse anticipate in caring for a pt. with chronic alcohol abuse pH pCO2HCO A. 7.35 36 18 B. 7.30 50 23 C. 7.50 30 25

D. 7.48 47 32 - correct answer A. Pt with chronic alcohol abuse are at risk for developing metabolic acidosis, which is reflected with these ABG. This condition has been termed alcoholic ketoacidosis (AKA) as a distinct syndrome. AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels and a normal or low glucose concentration A patient reports severe nonradiating substernal chest pain. ECG reveals a 2 mm ST segment elevation in the precordial leads. After pain relief is achieved with nitroglycerin, the ECG returns to normal. Which of the following data is most useful in the acute management of this patient. A. troponin I B. serum electrolytes C. coagulation studies D. lipid profile - correct answer A. This pt is demonstrating symptoms of ACS. In order to determine if cardiac damage has occurred, troponin levels are obtain. When myocardial cells become damaged, troponin levels will begin to rise in the bloodstream. Determination of the presence of myocardial damage will help guide pt care management. Which electrolyte imbalance most commonly accompanies acute tubular necrosis A. hyponatremia B. hypokalemia C. hypophosphatemia D. hypouricemia - correct answer A. ATN is characterized by the kidneys' inability to conserve sodium, so pt will be hyponatremic A pt is admitted for evaluation of exercise intolerance, increasing short of breath and a new-onset mitral murmur. Assessment reveals a QT segment of 0.46 second. The nurse should recognize that the pt is at most risk for development of A. atrial fib B. 2nd degree HB II C. ventricular dysrhythmia D. paroxysmal atrial tachycardia - correct answer C. Pt with QT prolongation are at risk for development of torsades de pointes or polymorphic vtach. This pt QT interval is prolonged.

A patient develops chest pain, shortness of breath and coughing 3 days after STEMI. The nurse should suspect A. Pneumothorax B. aortic dissection C. Pulmonary embolism D. Pericarditis - correct answer C. This pt is exhibiting symptoms of PE A patient admitted following an episode of new onset sepsis. assessment reveals new onset dyspnea, intercostal retractions and crackles in all lung fields, pt is placed on oxygen via NC at 4Lpm which criteria ABG results should the nurse anticipate. pH pCO2 pO2 O2sat HCO A. 7.5 30 59 89 23 B. 7.3 51 49 81 18 C. 7.26 32 63 91 14 D. 7.48 46 52 85 28 - correct answer A. As the pt is dyspneic, the initial change in arterial blood gases will be respiratory alkalosis. This will be reflected in a decrease in CO2 and corresponding increase in pH. Pt w/ a hx of heart failure and ACS is admitted following episode of syncope. 2 hours later assessment reveals BP 134/64 (supine) 90/60 sitting HR 115 w weak thready pulse (supine) 130 (sitting RR 32 shallow BS clear UO 30 ml of past 2 hours The nurse should initiate A IV fluids B Nesiritide (natrecor) C. Mannitol (Osmitrol) D. Digoxin (Lanoxin) - correct answer A. Although this pt has a history of heart failure, data suggest orthostatic hypotension and hypovolemia, which should initially be treated with fluids. While heart failure may be of concern, this pt breath sounds are clear at present.

A pt is being discharged and continuing on amiodarone therapy. pt teaching will include monitoring for which of the following long-term complications. A tachyarrhythmias B. renal insuff C. pulmonary fibrosis D. hyperkalemia - correct answer C. A well-documented side effect of amiodarone after long-term use is pulmonary fibrosis Which of the following dysrhythmias should the RN watch for in a patient following lung resection surgery? A S.V.T. B Sinus bradycardia C V.Fib D P.V.C. - correct answer A. Post operative cardiac arrhythmia are common after thoracic surgery. Pt undergoing pulmonary resections have postoperative SVT with a frequency and severity proportional to their age and their magnitude of the procedure. Many factors contribute to these dysrhythmias, including underlying cardiac disease, degree of surgical trauma, intraopreative cardiac manipulation, stimulation of the sympathetic nervous system by pain, reduced vascular effects of anesthesia, cardioactive drugs and metabolic abnormalitites. A pt w resp infection sustained blunt trauma in MVA. Pt is on O2 via face mask and is hemodynamically stable. The RN should anticipate which of the following interventions to prevent development of acute resp distress syndrome. A. Prophylactic mechanical ventilation w/ large tidal volumes B. minimizing transfusion of packed red blood cells C. measures to keep pt pH 7.25-7.35 D. withholding antibiotic therapy until definitive identification of the organism is made. - correct answer B. Studies suggest that minimizing transfusions decreases the likelihood of developing ARDS Which of the ff is the most appropriate treatment for COPD, resp distress and an O2 sat of 85% A immediate intubation and mech vent B. 100% NRB and steroid administration

C. 02 via NC 2l and brochodilators D. CXR, Bld cx and abx - correct answer C. COPD is a progressive disease characterized by irrevesible expiratory airflow obstruction. Treatment focuses on relief of symptoms and slowing the progression of the disease. Therapies include oxygen therapy and bronchodilators. A pt is admitted with sepsis. Pt does not desire intubation, vasopressors or resuscitation in the event of cardiac arrest but will accept conservative treatment, including IV fluids, antibiotics and blood products, if needed. In assessing this pt, the nurse notes 2 blood sugar readings are greater than 180 consecutively. The nurse should anticipate A. no treatment, and elevated blood sugar is expected in elderly patients with sepsis B. administration of insulin to maintain a blood sugar of less that or equal to 180 C. monitoring the blood sugar unless it increases to greater than 200 D. no treatment; to avoid increased mortality associated with rebound hyperglycemia - correct answer B. Administration of insulin is consistent with the pt wishes. Tight glycemic control does not improve outcomes in critical care pt who are septic. A target range of less than or equal to 180 and avoidance of hypoglycemia and highly variable blood glucose values is the evidence-based approach to glycemic control in this population. Which of the ff are signs and symptoms of cardiac tamponade A. HTN, CP, palpitations B. tachypnea, tachycardia, hypotension C. bradypnea, bounding pulses, drowsiness D. bradycardia, anxiety, palpitations - correct answer B. Pt with cardiac tamponade will present with these symptoms A post op CABG pt questions why he is receiving an insulin drip. The nurse explains the rationale is A. prevent the development of DM B. reduce the risk of infection C. prevent the development of intestinal ischemia D. reduce the risk of acute renal failure - correct answer B. Good glycemic control helps prevent the risk of postoperative infections

A pt has undergone vascular surgery for PAD. To prevent future exacerbation, the nurse should include which of the ff discharge teaching A. modify diet to include low fat and high simple carbohydrates B. avoid all alcoholic beverages C. exercise no more than 30 minutes a day D. avoid secondhand smoke. - correct answer D. PAD is associated with an increased risk for atherosclerotic adverse events. Modification or elimination of risk factors, especially smoking, is included in the treatment goals. A pt is being discharged is tearful and states, "Medication costs are overwhelming, and i have to come back to the hospital when my condition flares up when I have no medications. THe social workers give me phone numbers and websites, but i don't have a computer or know what to say to those people." This is the patient's third admission. The doctor has written 5 necessary prescriptions for the pt heart condition. THe next action for the nurse should be to A. perform medication reconciliation to determine generic equivalents for the prescriptions B. review previously provided information and assist the pt in contacting assistance programs before discharge C call the physician and request enough samples to fill the prescription D. help the pt prioritize which medications are necessary and which she could do without. - correct answer B. Assisting the pt to contact assistance programs (e.g., from the pharmaceutical companies) may help the pt afford the prescribed medications Which of the ff are symptoms of hypoglycemia A. bradycardia and diaphoresis B. flushed dry skin and tachycardia C. anxiety and flushed dry skin D. tachycardia and trembling - correct answer D. Pt with hypoglycemia will present with diaphoresis A pt with hepatic failure and end stage renal disease is hemodynamically stable but disoriented. The family is trying to make end of life decisions but is expressing frustration, because "every doctor who comes in tells us something different." The most appropriate action for the nurse would be to A. review the physicians' progress note with the family members B. contact the physicians individually, explain the issue and ask them to speak once more with the family

C. ask the clinical nurse specialist to help coordinate a family conference with as many physicians as possible D. request that an ethics committee intervene and review the case. - correct answer C. Having all providers together will allow for sharing of perspectives and possibly consensus-building surrounding the pt's condition Twelve hours after sustaining a pelvic fracture, a pt reports chest pain, hemoptysis and severe shortness of breath. Respiratory rate is 34. ABG on 02 at 4l via NC are: pH 7.48, pCO2 28, p02 68. The nurse should suspect that the patient has developed. A. tension pneumothorax B. a pulmonary embolism C. post-intubation laryngeal edema D. respiratory failure - correct answer B. This pt is at risk for developing a PE (postoperative status) and has symptoms of this condition A pt is admitted with hypertrophic cardiomyopathy. For which of the ff dysrhytmias is this patient at risk A. SB B. PAC C. SVT D. asystole - correct answer C. Hypertrophic cardiomyopathy is distinguished by a hypertrophied, non- dilated left ventricle. A trial dilation results in atrial fibrillation and SVT A nurse caring for a 76 year old patient in the PCU. Which of the ff age related cardiac changes should the nurse anticipate. A. decreased response to catecholamines B. increased myocardial complaince C. decreased audibility of S1 D. increased resting heart rate - correct answer A. Aging is associated with a decreased response to catecholamines. It is also associated with decrease in myocardial compliance. It is also associated with an increased audibility of S1 because of increased rigidity of the ventricular wall. It is associated with a decrease in resting HR.

A pt with type II diabetes and recent pneumonia is admitted with a serum glucose level of 590. The pt is alert and oriented, denies nausea or vomiting and reports being very thirsty with frequent urination. Data are as follows BP 112/58, HR 114, RR 18, T 100 (37.8), O2 sat 92% on 2 L via NC Which of the ff lab findings should the nruse anticipate Urine ketones Arterial pH A. negative 7.42 B. positive 7.24 C. negative 7.35 D. positive 7.50 - correct answer B. This pt is demonstrating signs and symptoms of DKA. DKA is associated with an elevated blood sugar, ketonuria and decrease in pH associated with a metabolic acidosis. Which of the ff is initially indicated for a pt diagnosed with an ischemic stroke 2 hours prior to admission to the PCU A. clopidogrel (Plavix) B. heparin C. argatroban (Acova) D. TPA (activase) - correct answer D. TPA are used to dissolve clots. TPA dissolves the clots and permits reperfusion of the brain tissue. It should be used as soon as possible after onset of symptoms. The maximum time has been expanded to 4.5 hours or less from the onset of symptoms Three days following STEMI and cardiac catheterization with stent insertion, a pt develops sudden-onset diffuse crackles and a new loud murmur heard most prominently at the 5th ICS mid-clavicular line. The nurse should recognize that this may represent A. mitral regurgitation B left sided heart failure C. stent occlusion D. cardiogenic shock - correct answer A. The pt has a risk factor (STEMI) and symptoms of mitral regurgitation. The murmur is located at the 5th intercostal space mid-clavicular line A pt with a history of ACS involving the anterior wall develops chest pain, dyspnea, wheezing, diaphoresis, and restlessness. The most likely cause of these findings is