PCCN MASTER EXAM- 2024 WITH QUESTIONS AND 100% ALL CORRECT ANSWERS
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PCCN MASTER - 2024 WITH
PCCN MASTER EXAM- 2024 WITH QUESTIONS AND 100% ALL CORRECT ANSWERS
Hemodynamic status should be monitored closely with frequent vital signs and possibly invasive monitoring with a CVP or pulmonary artery catheter.An NG tube can be inserted to monitor bleeding and help remove blood from the sto...
PCCN MASTER EXAM- 2024 WITH
QUESTIONS AND 100% ALL CORRECT
ANSWERS
Hemodynamic status should be monitored closely with frequent vital signs and possibly
invasive monitoring with a CVP or pulmonary artery catheter.An NG tube can be
inserted to monitor bleeding and help remove blood from the stomach, but this is not the
first priority of care in this patient.An endoscopy is needed to identify the site of bleeding
as soon as possible, but stabilizing hemodynamics is the most immediate priority.H2
blockers are used to decrease gastric acid production and prevent ulcers. They are not
used as immediate therapy for GI bleeding.
Pharmacological treatment of bleeding gastric ulcers or gastritis can include all of the
following EXCEPT:
A. Nonsteroidal anti-inflammatory drugs (NSAIDS) to decrease gastric inflammation.
B. Antibiotics to treat H. pylori infections.
C. Histamine H2 blockers or proton pump inhibitors (PPI) to decrease acid production.
D. Antacids or sucralfate to protect stomach mucosa. - CORRECT ANSWERA.
Nonsteroidal anti-inflammatory drugs (NSAIDS) to decrease gastric inflammation.
Patients with gastric ulcers should avoid NSAIDs because they can contribute to
development of ulcers by inhibiting prostaglandins. Stomach or duodenal ulcers are
common side effects of long-term NSAID use.Histamine H2 blockers decrease
stimulation of H2 receptors in gastric cells that are responsible for secretion of
hydrochloric acid, resulting in a decrease in gastric acid secretion. PPIs totally block
stomach acid secretion and are the most powerful drugs for treating peptic ulcer
disease. Antacids neutralize stomach acid to decrease irritation and inflammation of
gastric mucosa. Sucralfate coats the gastric mucosa to reduce its exposure to stomach
acids. 80% to 90% of gastric ulcers are caused by infection with Heliobacter pylori (H.
pylori) bacteria. Antibiotics used to treat H. pylori infections include tetracycline,
amoxicillin, clarithromycin (Biaxin), and metronidazole (Flagyl).
When caring for a patient admitted to the critical care unit with an acute illness
accompanied by hypotension, the nurse recognizes the patient is at risk for developing
the following that may predispose the patient to a gastrointestinal (GI) bleed:
A. Stress ulcer.
B. AV malformation.
C. Mallory-Weiss tear.
D. Esophageal varices. - CORRECT ANSWERA. Stress ulcer.
,Upper GI bleed is more common than lower GI bleed. Approximately 20 to 25% percent
of patients who experience an upper GI bleed are already hospitalized. Ruptured
esophageal varices, AV malformation, and Mallory-Weiss tear (longitudinal tear of the
esophagus caused by forceful retching) can all cause upper GI bleeding. However, the
most common cause of upper GI bleeding is a peptic ulcer. Peptic ulcers include both
gastric and duodenal ulcers. Peptic ulcers occur when the normal protective
mechanisms fail to work. Stress ulcers have the same etiology as peptic ulcers although
they are typically limited to the stomach. They can develop within hours of admission to
the hospital. Contributing factors include decreased mucosal blood flow leading to
ischemia and degeneration of the mucosal lining. Once the protective lining is
penetrated, gastric secretions autodigest the layers of the stomach. This leads to
damage of the mucosal and submucosal layers. Damage can penetrate to the blood
vessels and result in hemorrhage.
The critically ill patient with no nutritional intake will develop nutritional deficiencies and
malnutrition. Inactivity of the GI tract can result in:
A. Profound diarrhea.
B. Bowel obstruction.
C. Increased rate of infection.
D. Gastrointestinal bleeding. - CORRECT ANSWERC. Increased rate of infection.
Normal bowel function prevents the millions of bacteria normally circulating In the GI
tract from colonizing. Lack of GI motility allows bacteria to accumulate. Critical illness
can result in the breakdown of the normal barriers in the gut. With normal defenses
down, the accumulated bacteria can translocate to the lymphatic system placing the
patient at a higher risk of infection.
A common culprit of recurrent peptic ulcer disease is:
A. Haemophilus influenza.
B. Klebsiella pneumoniea.
C. Streptococcus pneumoniae.
D. Helicobacter pylori. - CORRECT ANSWERD. Helicobacter pylori.
Helicobacter is the bacterial agent that is been identified as the most common cause of
recurrent peptic ulcer disease. Streptococcus pneumoniae is a very common cause of
community acquired pneumonia.Haemophilus influenza is a cause of community
acquired pneumonia often seen in smokers.Klebsiella pneumoniae is a cause of
community acquired pneumonia often seen in those with chronic alcoholism.
Strategies that can be used in the treatment of upper GI hemorrhage to help control
bleeding include of the following except:
A. Endoscopy with sclerotherapy.
B. Vasopressin.
C. Octreotide (sandostatin).
D. Gastric lavage. - CORRECT ANSWERD. Gastric lavage.
, D. The use of gastric lavage in upper GI bleeding is aimed at emptying the upper GI
tract of blood and to monitor the bleeding but is not beneficial in treating the bleeding.
Octreotide (Sandostatin) reduces splanchnic blood flow and also decreases the
secretion of gastric acid and reduces GI motility. Endoscopy is used for diagnosis of GI
bleeding. The use of sclerotherapy involves the injection of an agent around and into
the bleeding vessels. For this procedure epinephrine is often used. Vasopressin helps
control bleeding by causing vasoconstriction of the arterioles in the splanchnic bed. It
also decreases portal venous pressure.
A patient with acute liver failure is prone to all of the following complications except:
A. Infection and sepsis.
B. Ischemic stroke and bowel infarction.
C. Renal failure and GI bleeding.
D. Cerebral edema and increased intracranial pressure. - CORRECT ANSWERB.
Ischemic stroke and bowel infarction.
Ischemic stroke and bowel infarction would most likely occur as a result of thrombus
formation or embolization. In liver failure, coagulation proteins and clotting factors are
not produced by the liver, resulting in an increased risk of bleeding rather than a risk of
clotting. Patients with acute liver failure are susceptible to encephalopathy, cerebral
edema, renal failure, hypoglycemia, metabolic acidosis, sepsis, coagulopathy, and
multiorgan failure. Encephalopathy can result from increased ammonia levels and other
metabolic abnormalities that occur with liver failure. Hepatorenal syndrome is a form of
renal failure that occurs with severe liver disease and is thought to be due to portal
hypertension that causes renal vasoconstriction and decreased renal perfusion.
Patients with liver failure often develop coagulopathy and bleed due to the diminished
capacity of the liver to synthesize coagulation factors. The most common site of
bleeding is the gastrointestinal tract. An increase in blood-brain barrier permeability
occurs in severe liver failure for unknown reasons and can lead to exposure of the brain
to ammonia and other neurotoxic substances that can result in cerebral edema.
Cerebral edema often leads to an increase in ICP. Patients with liver failure are at
increased risk of infection and sepsis related to a variety of immunologic dysfunctions,
including complement deficiency, increased gut bacterial translocation, and white blood
cell dysfunction. The most common sites of infection are the respiratory and urinary
tracts and blood.
You are caring for a patient who had bariatric surgery. You know that these patients are
at particular risk for all of the following complications in the earlypost op period
EXCEPT:
A. Pulmonary embolus and DVT.
B. Airway obstruction and oxygenation issues.
C. Gastrointestinal leaks and sepsis.
D. Coagulopathies and DIC. - CORRECT ANSWERD. Coagulopathies and DIC.
Pulmonary embolism (PE) is the most common cause of mortality in the early post-op
period after weight-loss surgery and is responsible for more than 50 percent of deaths.
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