PCCN EXAM TEST BANK | PROGRESSIVE CARE
CERTIFIED NURSE EXAM | QUESTIONS AND
CORRECT ANSWERS WITH EXPLANATIONS |
GRADED A+ | VERIFIED ANSWERS | ALREADY
GRADED A+ | STUDY THIS ONE!
The layer of the arterial vessel wall responsible for changes in the diameter
of the artery is the:
A. media
B. intima
C. externa
D. adventitia ---------CORRECT ANSWER-----------------A. media
The media layer of the arterial wall contains vascular smooth muscle
cells and is responsible for arterial tone. Vasoactive substances
released in response to the sympathetic nervous system and/or the
renin-angiotensin system determine arterial tone. Intima, externa and
adventitia are incorrect.
A patient presents in acute distress with rales halfway up bilaterally; cool
and clammy extremities; elevated jugular venous distention (JVD); oxygen
saturations at 95%, down from 99%; and complaints of shortness of breath.
Which of the following findings correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion ---------CORRECT ANSWER--------
---------D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to
pulmonary edema, causing pulmonary congestion. Pneumonia can
also cause fluid in the alveolar sacs. The patient is complaining of
shortness of breath, and the oxygen saturations are lowering, also
indicating that the patient has pulmonary congestion. The patient's
skin is cool and clammy, indicating that the skin is poorly perfused.
Skin does not require oxygen and shunts blood away in decreased
cardiac function; therefore, this patient has pulmonary congestion
and low perfusion state. The other answers are incorrect.
,When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction ---------CORRECT ANSWER-------
----------A. the beginning of ventricular systole
The heart sound of S1 indicates the opening of the aortic and
pulmonic valves and marks the beginning of ventricular systole or
ejection. The beginning of diastole is after S2, propulsion of blood
into a noncompliant chamber is S4, and blood going in the wrong
direction will cause a murmur.
A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure ---------CORRECT ANSWER-----------------A.
increased thickness of the alveolar capillary membrane
With increasing left ventricular pressures, blood moves back into the
left atrium, then to the pulmonary veins. When the pressure in the
pulmonary veins increases, capillary function decreases, and fluid
then shifts to the interstitial space, causing interstitial edema,
thereby, increasing the thickness of the space oxygen must travel.
When left ventricular pressures increase, the fluid then shifts to the
alveolar space, causing pulmonary edema. This fluid acts as a
deterrent to oxygen diffusion. Retention of CO2 does not impair
diffusion. An elevated body temperature associated with pulmonary
edema is not causing a diffusion abnormality; increased temperature
shifts the oxyhemoglobin curve to the right, more quickly releasing
oxygen to the tissues. Low barometric pressure has no effect on
diffusion of gases in the lung.
,A patient with an anterior-wall STEMI is in cardiogenic shock. What would
be the hemodynamic profile assessment?
A. decreased cardiac index, increased preload, increased afterload
B. decreased cardiac index, decreased preload, increased afterload
C. decreased cardiac index, decreased preload, decreased afterload
D. increased cardiac index, decreased preload, decreased afterload ---------
CORRECT ANSWER-----------------A. decreased cardiac index,
increased preload, increased afterload
In a patient with cardiogenic shock, both preload and afterload are
increased due to severe vasoconstriction on both the venous and
arterial side. Arterial vasoconstriction increases afterload and
therefore lowers cardiac index. Because the ventricle is failing and
contractility is also low, the left ventricular pressures increase and
cause blood to increase in the pulmonary bed, resulting in increased
right ventricular pressures and preload. In heart failure, there is an
increase in preload and afterload with a decrease in cardiac index and
contractility. The other answers are incorrect.
A patient is discharged with the diagnosis of severe peripheral vascular
disease (PVD). In addition to medication and a walking regime, if
applicable, which of the following is essential education at time of
discharge?
A. nutritional counseling
B. smoking cessation counseling
C. social work consult
D. speech therapy consult ---------CORRECT ANSWER-----------------B.
smoking cessation counseling
Cessation of tobacco use is the most important non-pharmacological
intervention that can be done to improve signs and symptoms of
peripheral bvascular disease. Social work consult and speech therapy
may not be indicated in this patient. All patients may benefit from
nutrition counseling; however, this is not a primary concern for this
patient.
A medication that dilates both the venous and arterial beds will cause
which of the following results?
, A. increased preload, decreased afterload
B. increased preload, increased afterload
C. decreased preload, decreased afterload
D. decreased preload, increased afterload ---------CORRECT ANSWER-----
------------C. decreased preload, decreased afterload
When both the venous and arterial beds are dilated, there will be less
venous return, causing a decreased preload (ex. nitroglycerin). With
arterial vasodilation, the afterload will decrease (ex nitroprusside,
ACE-I). Afterload in this case is resistant to LV pumping.
Stable angina is best defined as:
A. pain that increases in severity
B. pain that is new
C. pain that occurs at rest
D. pain that has a predictable pattern over time ---------CORRECT
ANSWER-----------------D. pain that has a predictable pattern over time
Stable angina is predictable -- the patient can describe the pain and
how it is initiated accurately each time -- and occurs with exertion. Ex:
The patient knows every time he or she climbs stairs, it will be
accompanied by chest pain. The pain is relieved with rest and
nitroglycerin (Nitrolingual). Pain that is new or occurs at rest is not
stable angina. If the pain increases in severity, it is no longer stable.
The gold standard diagnostic tool for the identification, location of disease
and severity of coronary artery disease is:
A. a stress test
B. an echocardiography
C. cardiac catheterization
D. a spiral computer tomography (CT scan) ---------CORRECT ANSWER---
--------------C. cardiac catheterization
The gold standard, or best diagnostic tool, for the diagnosis, location
and severity of coronary artery disease is the cardiac catheterization
performed in the cath laboratory. Echocardiography is excellent in
revealing structure changes, but not coronary artery disease. A stress
test may be a good screening tool, but again, is not the gold standard,
nor is CT scanning
