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PCCN EXAM QUESTIONS AND ANSWERS 2024
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PCCN EXAM QUESTIONS AND ANSWERS 2024
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PCCN EXAMMannie is a 15 year old victim of a gunshot wound to his left chest and has a
pneumon-hemothorax. He has been stable all day with minimal chest drainage.
Over the last 4 hours, his O2 saturation has been decreasing. The doctor orders
mixed venous gases, and the results show SVO2 of 64%. What does this
information tell you?
-The amount of shunting that is occuring
-CO2 levels
-HCO3 levels
-PO2 levels - ANSWERS-The amount of shunting that is occuring
The SVO2 shows shunting. There is a normal 5% physiologic shung due to blood
loss in the bronchial , pleural and Thebesian veins. When there is an infection,
trauma or ARDS, blood is shunted at a higher rate which is seen as a lower SVO2
level.
Mannie is a 15 year old victim of a gunshot wound to his left chest and has a
pneumon-hemothorax. He has been stable all day with minimal chest drainage.
Over the last 4 hours, his O2 saturation has been decreasing. The doctor orders
mixed venous gases, and the results show SVO2 of 64%. One hour later, Mannie's
SVO2 is 22%. What does this indicate about his condition? - ANSWERS-His shunt is
worsening
,A CXR should also be done to assess his pneumon-hemothorax for possible
increase in size. His chest tube drainage sustem should be examined for the
possibility of blocks blocking drainage. The patient will probably be transferred to
ICU and placed on a ventilator.
Promethazine is contraindicated with fluroquinolone antibiotics for what reason?
- ANSWERS-This combination leads to QT prolongation and arrhythmias
Concomitant use of promethazine and fluoroquinolones is contraindicated
because their combination can produce prolongation of the QT interval and
increase the patient's risk of arrhythmias.
What is the infusion rate for Lasix (furosemide)? - ANSWERS--4 mg/min
The infusion rate should not exceed 4 mg/min. A rate faster than 4 mg per minute
may result in tinnitis or hearing loss.
Why is Lasix (furosemide) given slowly? - ANSWERS-Rapid infusion can lead to
hearing loss
A rate faster than 4 mg per minute may result in tinnitis or hearing loss.
Which hearbal remedies should be avoided while on Plavix? - ANSWERS-Dong
quai, gingko biloba, saw palmetto
,Dong quai, gingko biloba and ginseng can all increase bleeding times.
Saw palmetto decreases the effectiveness of Plavix.
What history should you know before starting Reo Pro (abciximab)? - ANSWERS-
Any bleeding history
Reo Pro, like any other anti-platelet, requires the patient to be carefully
questioned regarding any bleeding history.
Wargarin is indicated for which of the following conditions? - ANSWERS-DVT, A-
fib, heart valve replacement
DVT, A-fib, heart valve replacements and MI are conditions that REQUIRE the use
of warfarin. Patients with DVT, A-fib, and heart valve replacements will take
warfarin on a chronic basis. By comparison, MI patients may be weaned off
warfarin in 3 to 4 months.
Integrilin (eptifbatide) is indicated for which condition? - ANSWERS-ACS (acute
coronary syndrome)
Integrilin (eptifbatide) is used primarily for patients with acute coronary
syndrome to inhibit platelet aggrigation.
The pain associated with aortic stenosis is caused by: - ANSWERS-Decreased left
coronary artery flow
, Aortic stenosis is directly caused by decreased blood flow to the coronary arteries
during systole due to the stenotic valve. Prolonged resistance to blood flow via
the stenotic aortic valve results in left ventricular hypertrophy and left sided heart
failure. The pronosis is poor unless the aortic valve is replaced.
Mr B was admitted to the PCU to rule out MI two days ago. He has a history of
GERD and stomach ulcers. He is due to be discharged today on digoxin and oral
antacids. You review his morning labs prior to beginning your physical
assessment. Labs are:
WBC 1100/mm3 Sodium 140 mEq/L
RBCs 5.2 mil/mm3 Potassium 4.5 mEq/L
PLT 350000/mm3 Chloride 104 mEq/L
Hgb 13 g/bL Total Calcium 13.5 mg/dL
Hct 48 mL/dL Magnesium 1.87 mg/dL
You would probably expect to see whichsigns and symptoms during your
assessment of Mr. B.? - ANSWERS-Bradycardia, confusion, hypertension,
decreased grasp strength
Mr B would exhibit signs and symptoms of hypercalcemia, confirmed by his lab
value of 13.5 mg/dL. Signs and symptoms would include smooth muscle
relaxation, lethargy, confusion, shortened QT intervals, bradycardia, heart blocks,
bundle branch blocks, and hypertension.
Symptoms can be furthered compounded by the effects of digitalis and, possibly,
digitalis toxicity.
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