PCCN CARDIAC EXAM 2024 WITH
ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED RATIONALES
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Robert suffered an MI but is now in stable condition in the PCU. Seven family members arrive at the unit
demanding to see the pt. Your best response would be:
-Notify social services
-Identify the responsible family spokesperson and contact him or her
-Refuse to admit more than one person]
-Call security to remove the visitors.
Identify the responsible family spokesperson and contact him or her.
Visitation policies cary by institution. However, it is best to identify one person as the point of
contact. HIPAA regulations require limitations on the release of any medical information be set by the
patient if the patient is able to communicate his or her wishes. If the patient is unable to make this
decision, the next of kin can act as a contact person.
Robert suffered an MI but is now in stable contition in the PCU. After you have identified his significant
other, his estranged wife arrives. Robert tells you that he does not want contact with her. He even
writes a note to the effect to be placed on his chart. He also states he wants no information given to his
estranged wife. She becomes belligerent when told of Robert's wishes and threatens the staff with a
lawsuit. The most appropriate nursing action would be :
-Request an ethics/ multidisciplinary care conference to discuss communication and dissemination of
the patient's medical status and to review the visitation policy
-Immediately call the hospial's attorney to speak to the estranged wife
-Give the wife any information she wants, but do not inform Robert that you have done so
-Request that the patient's physician write a non-visitation order for the wife.
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,Request an ethics/ multidisciplinary care conference to discuss communication and dissemination of the
patient's medical status and to review the visitation policy
The best response would be to collaborate and interact with other professionals.
Rebecca, who is a Jehovah's Witness, has just undergone a cardiac surgical procedure. Her Hgb and Hct
levels have been falling and are now 6.5 and 24. Her chest tubes have drained 1750 ml in the last 4
hours. The anticipated treatment would be to administer:
-One unit type specific whole blood
-500 ml albumin
-250 ml FFP
-Continuous-circuit auto-transfusion
Continuous-Circuit Auto-transfusion
The religious preference of the patient must be respected. The only acceptable form of transfusion is
this case is via auto-transfusion.
The major advantage of using an internal mammary artery for cardiac bypass would be:
-Greater ease of harvesting
-Better postsurgical patency
-A lowered infection rate
-A lowered rate of reperfusion rhythms
Better postsurgical patency
Utilizing the internal mammary artery means grafts do not have to come from the saphenous veins in
the legs, minimizing the risk for infection from another site.
In the graft procedure, the internal mammary artery is seperated at only one end and reanastomosed
to the affected coronary artery distal to the affected area. The patency of the resulting graft is
generally quite good. After 10 years, approximately 90% of the grafts are still patent.
Your patient just underwent a percutaneous intervention for stent placement, after which he was
returned to your tele unit. You note a rash over the patient's trunk and arms. This is probably due to
_____.
-An allergic reaction to contrast dye
-Petechiae from a fat emolism
-A reaction to the indwelling stent
-A rash secondary to a Candida infection
An allergic reaction to contrast dye.
Iodine dye is used and will cause a rash, itching, swelling and can also lead to laryngospasm and
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,anaphylaxis in some patients. It is imperative to determine whether the patient is allergic to iodine,
shellfish, or horses prior to initiating the procedure.
A sign of necrosis on an EKG would include:
-Acute ST elevation
-A Right BBB
-A Left BBB
-A Q wave in lead III
Acute ST elevation.
Along with acute ST elevation, another indicator of necrosis would be an abnormal Q wave. If the Q
wave appears within about 6 hours of a transmural MI, it is an ominous sign. If the Q wave is more
than 0.04 seconds long, it is a sign of necrosis. In an inferior MI, the Q wave should not exceed 0.03
seconds or it is indicative of necrosis.
Holly recieved 4 mg Morphine IV. She is now unresponsive and her RR and depth are diminished. The
antidote for morphine is:
-Regitine
-Bicarbonate
-Naloxone
-Atropine
Naloxone
The antagonist for morphine and other opiods is Narcan (naloxone). Generally, the naloxone dose is
0.4 mg IV. This dose can be repeated about every 3 to 4 minutes for a total of 3 times. When you give
Narcan, you must always be alert for the patient to relapse once the dose wears off. Administering
multiple follow-up doses is not uncommon.
Complications associated with ventricular assist devices (VADs) include:
-Thromboembolism
-Thrombocytopenia
-Dissection of the aorta
-Septicemia
Thromboembolism
Additional complications that are commonly seen with VADs are infection and bleeding.
Thrombocytopenia, aortic dissection and septicemia are complications of an intra-aortic balloon pump
(IAPB).
Other indications for use of VAD include use as a bridge to transplant, treatment of cardiogenic shock,
and inability to wean from cardiopulmonary bypass. Always be aware of the possibility of device
failure.
Prolonged cardiac arrest, especially with neuroligical damage is a contraindication for use of a VAD.
Extensive organ damage is another contraindication. Dysrhythmias are not indications for use.
The most common infection in patients with VADs is:
PNA secondary to immobility is the primary reason for infection with VADs. There may also exist a
need for some type of ventilatory support. Jst the fact that tubes are placed into the body is a
potential source of infection, but this is usually minimized by good hand washing and aseptic
technique.
The most common type of VAD is the
-RVAD
-VAD
-BIVAD
-LVAD
LVAD
The left ventricular assist device is the most commonly used because left heart failure is more
common and usually precedes right venticular failure.
The most common major impediment to family education regarding placement of a ventricular assist
device is:
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