PCCN FINAL EXAM WITH REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS / GUARANTEED PASS / ALREADY GRADED A+ / LATEST 2024/2025 / PCCN
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Course
PCCN
Institution
PCCN
PCCN FINAL EXAM WITH REAL EXAM
QUESTIONS AND CORRECT DETAILED
ANSWERS / GUARANTEED PASS / ALREADY
GRADED A+ / LATEST 2024/2025 / PCCN
A patient just admitted to your floor from the PACU is agitated and has tingling of
the fingers. ABG on room air reveals:
pH 7.49 PaCO2 25 PaO2 95 HCO3 2...
PCCN FINAL EXAM WITH REAL EXAM
QUESTIONS AND CORRECT DETAILED
ANSWERS / GUARANTEED PASS / ALREADY
GRADED A+ / LATEST 2024/2025 / PCCN
A patient just admitted to your floor from the PACU is agitated and has tingling of
the fingers. ABG on room air reveals:
pH 7.49 PaCO2 25 PaO2 95 HCO3 24
Which of the following is correct?
A. normal acid-base balance
B. compensated respiratory alkalosis
C. uncompensated respiratory alkalosis
D. uncompensated metabolic alkalosis - ANSWER-C. uncompensated respiratory
alkalosis
The patient has an alkalosis (pH high), from a respiratory parameter of PaCO2 25.
The patient is breathing fast and blowing off CO2. This is uncompensated since the
pH is abnormal. The patient may be in pain, thus causing an increased respiratory
rate.
In preparation for assisting a physician doing a thoracentesis, the patient should be
positioned in which of the following manners:
A. lying on the affected side with head of the bed flat
B. lying on the affected side with head of the bed elevated 15 degrees
,C. lying on the opposite side with head of the bed flat
D. patient upright and slightly bent forward - ANSWER-D. patient upright and
slightly bent forward
Positioning the patient properly before a thoracentesis is a nursing responsibility.
Upright and slightly bent forward is the most optimal position, allowing a posterior
drainage approach. If the upright position is not possible and the patient must lie in
bed, then the preferred position is decubitus with the side of the chest containing
the effusion down. Patient comfort is important as well, having the head of the bed
upright will allow the patient to breathe easier and allow for the fluid to flow to the
posterior of the lung.
Which of the following is a complication after a bedside thoracentesis?
A. acute bleeding for puncture site
B. pneumothorax
C. hemothorax
D. all of the above - ANSWER-D. all of the above
Bedside thoracentesis has been replaced by ultrasound-guided thoracentesis due to
the complication of pneumothorax. Patient coagulation studies are done before the
procedure to eliminate the possibility of bleeding from the site, as well as causing a
hemothorax, although these complications may still occur.
Which of the following indicates an active pleural air leak for a patient with a chest
tube attached to a pleural drainage system?
A. bubbling in the water-seal chamber
B. bubbling in the suction control chamber
C. fluctuation of water level in the water-seal chamber with respiration
D. no fluctuation of water level in the water-seal chamber with respiration -
ANSWER-A. bubbling in the water-seal chamber
An active air leak is noticeable in the chest tube drainage system by the presence of
bubbling in the water-seal chamber. Air bubbles result from a leakage of air from
,the lung parenchyma into the pleural space. If an air leak is present, the chest tube
should not be removed or the leaking air will be trapped, resulting in a
pneumothorax.
Which type of condition can lead to a tension pneumothorax?
A. closed pneumothorax
B. open pneumothorax
C. subcutaneous emphysema
D. pneumomediastinum - ANSWER-A. closed pneumothorax
The only way a tension pneumothorax can occur is within a closed chest wall. A
tension pneumothorax denotes an opening in the pleural space where air is trapped
inside the chest between the collapsed pleural wall and the chest wall. Eventually
enough air will be trapped to push the mediastinum to the opposite wall,
compressing the heart and causing vascular collapse and death.
Dehydration in hyperosmolar hyperglycemia syndrome (HHS) is primary due to
which event?
A. lack of anti-diuretic hormone (ADH)
B. inability of the kidneys to concentrate urine
C. nausea and vomiting
D. osmotic diuresis from very high blood glucose - ANSWER-D. osmotic diuresis
from very high blood glucose
In HHS, the patient's blood sugar is extremely high, causing a severe fluid deficit.
This dehydration is significant. Mortality is approximately 15% and its typically
associated with a concurrent catastrophic illness such as a MI or sepsis or
complications such as arrhinias or cerebral edemas.
In hyperosmolar hyperglycemic syndrome (HHS) the patient has an initial
hypokalemia. The nurse should:
, A. check the patient's potassium level before giving insulin
B. monitor the heart rate before giving insulin
C. monitor the patient's level of pain before administration of insulin
D. no precautions are necessary - ANSWER-A. check the patient's potassium level
before giving insulin
The patient in HHS will have low potassium initially and may require electrolyte
replacement therapy before insulin is started. Insulin drives potassium out of the
serum and into the cells. The resulting serum hypokalemia can lead to cardiac
arrhythmias. Once insulin is given and a drip is started, close monitoring of
potassium is required. The patient with HHS will have cardiac monitoring, and all
patients will have close heart rate and rhythm monitoring, however, insulin does
not require a heart rate requirement before administration. Monitoring the patient's
level of pain is listed as a distracter.
Which of the following laboratory diagnostic findings will most likely be seen in a
disseminated intravascular coagulation (DIC)?
A. PT and PTT prolonged
B. fibrinogen increased
C. platelet count increased
D. D-dimer within normal limits - ANSWER-A. PT and PTT prolonged
In DIC, the patient has used up all his or her coagulation factors in making
thrombus, so the PT and PTT are prolonged. Fibrinogen will be decreased (the
body is using up all the clotting factors), platelet count is also decreased (must be
below 100,00) and the D-dimer is elevated due to the thrombus formation in the
microvascular space.
What blood product would correct the patient with a fibrinogen deficiency?
A. packed red blood cells
B. fresh frozen plasma
C. platelets
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