AACN PCCN Practice Test

AACN PCCN Practice Test 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: fo ...

AACN PCCN Practice Test 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 are the causes of afib in post-cardiac surgery patients? - ✔✔advanced age, pre-existing medical or cardiac conditions, electrolyte abnormalities, conduction disturbances that wil likely resolve, and pre-existing atrial or valve conditions that contribute to the development of this arrythmia what is a life threatening condition that most commonly occurs with renal dysfunction? - ✔✔hyperkalemia what medication is contraindicated in RV infarct? - ✔✔nitro bc it will reduce preload, and patients with RV infarct are preload dependent what are the manifestations of hepatic encephalopathy? - ✔✔changes in mental state, behavior, personality, decreased self-care ability, deterioration of handwriting, or loss of other small movements, and asterixis ("liver flaps") what are the manifestations of cerebral edema? - ✔✔decreased LOC, bradycardia, HTN, bradypnea, posturing, unequal pupils, decreased pupillary reaction to light what are impending delirium tremens manifested by? - ✔✔tremors, irritability, n/v, hallucinations (auditory, visual, or olfactory), confusion, delusions, and severe agitation what is impending azotemia manifested by? - ✔✔tachycardia, hypotension, and signs of dehydration what is hyponatremia associated with? - ✔✔SIADH what are neuro complications of hyponatremia? - ✔✔HA, nausea, vomiting, lethargy, coma, seizure 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 what happens with ARDS? - ✔✔most often seen as part of a systemic inflammatory process, particularly systemic sepsis, where there is a widespread destruction of the capillary endothelium, extravasation of protein-rich fluid, and interstitial edema. in addition, the alveolar basement membrane is damaged, and fluid seeps into the airspaces, stiffening the lungs and causing ventilation-perfusion mismatch what does R sided HF cause? - ✔✔JVD, dependent peripheral edema, ascites what does endocarditis cause? - ✔✔damage to heart valves that usually manifests in regurgitant murmor what does pulmonary HTN cause - ✔✔a systolic murmur, dyspnea, and tachycardia occurs over period of time, not acutely why is morphine administered in acute HF? - ✔✔decrease preload with vasodilation may also decrease afterload what is an absolute contraindication of t-Pa - ✔✔history of hemorrhagic stroke, AV malformation, or aneurysm within 3 months what is the recommended initial position to improve oxygenation for a patient with unilateral pneumonia? - ✔✔sidelying on unaffected side to optimize perfusion to the healthy lung what is implied consent? - ✔✔refers to following a patient's wishes/requests that were made known prior to the patient becoming incapacitated and unable to make his preferences known 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 s/s of pneumothorax - ✔✔cough, sharp CP, abnormal or absent movement of chest wall on affected side what arrhythmia may be associated with valvular surgery? - ✔✔complete heart block what does pneumonia typically produce? - ✔✔fever, chills, a productive cough, purulent sputum, and crackles when would a mediastinal shift occur? - ✔✔pneumothorax due to large pleural effusion as CO2 levels rise, patient exhibits... - ✔✔somnolence, could result in apnea patients with hyperkalemia and associated diabetes will likely develop... - ✔✔depressed ST segments prominent U waves will be present with... - ✔✔hypokalemia in non-cardiac patients undergoing surgical procedures, which lead is valuable for identifying ACS? - ✔✔V5 what are common complications of aortic valve disease? - ✔✔arrhythmia and HF what is the drug of choice to treat MI associated pericarditis? - ✔✔NSAIDs 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