TEST BANK FOR PCCN EXAM | ALL QUESTIONS
AND CORRECT ANSWERS WITH
EXPLANATIONS | ALREADY GRADED A+ |
VERIFIED ANSWERS | ALREADY GRADED A+ |
JUST RELEASED
A 58-year-old male with a history of alcohol abuse is a heavy smoker. He
complains of pain in his chest in the afternoons when he is sitting and
watching TV. ECG shows elevation of ST segments.
The most likely diagnosis is:
a. Unstable angina.
b. Variant/Prinzmetal's angina.
c. Stable angina.
d. Gastroesophageal reflux disease. ---------CORRECT ANSWER-------------
----B: Variant angina (also known as Prinzmetal's angina) results from
spasms of the coronary arteries associated with or without
atherosclerotic plaques; and is often related to smoking, alcohol, or
illicit stimulants. Elevation of ST segments typically occurs with
variant angina, which frequently occurs cyclically at the same time
each day and often while the person is at rest. Stable angina occurs
regularly with activity. Unstable angina occurs when there is a change
in the pattern of stable angina. GERD pain may be mistaken for
angina.
Metabolic syndrome is characterized by:
a. Abdominal obesity, decreased triglyceride level, increased HDL level,
and hypertension.
b. Hypertension, abdominal obesity, and increased HDL level.
c. Abdominal obesity, increased triglyceride level, decreased HDL level,
and increased fasting blood glucose level.
d. Hypotension, decreased fasting blood glucose level, increased
triglyceride level, and decreased HDL level. ---------CORRECT ANSWER---
--------------C: Metabolic syndrome (insulin resistance) puts people at
,risk for the development of diabetes mellitus and cardiovascular
disease, and is characterized by abdominal obesity (>35 inches in
women and >40 inches in men), increased triglycerides (150),
decreased HDL level (<40 mm Hg in men and <50 mm Hg in women),
elevation of blood pressure (130/ 85 mm Hg), and increased fasting
glucose ( 110 mg/dL). Other indicators include elevation of C-reactive
protein (evidence of a proinflammatory state) and high levels of
fibrinogen (evidence of a prothrombotic state).
Parenteral nutrition with a total nutrient admixture that includes lipids has
been ordered for a burn patient for administration throughout a 24-hour
period. When preparing to administer the solution, the nurse observes that
the oil has separated, forming an obvious layer. Which of the following
options is the correct action to take?
a. Administer the solution, as oil separation is normal.
b. Mix the solution by shaking the bag until no oil separation is noticeable.
c. Discard the solution.
d. Return the solution to the pharmacy for the addition of added emulsifier.
---------CORRECT ANSWER-----------------C: The total nutrient admixture
should be discarded if there is "cracking" of the lipid emulsion and
the oil separates into a layer. With TNA, all the components of
parenteral nutrition and lipids are admixed together in one container
to create a 3-in-1 formula. Components of parenteral nutrition
generally include proteins, carbohydrates, fats, electrolytes, vitamins,
sterile water, and trace vitamins. While most postoperative patients
need 1500 calories per day to prevent protein breakdown, those with
fever, burns, major surgery, trauma, or hypermetabolic disease may
need up to 10,000 more calories daily.
A 30-year-old patient complains of post-operative pain at 8 on a 1-to-10
scale 12 hours after surgery, but is not moaning, grimacing, or exhibiting
any standard physical signs of pain. The patient last received pain
medication 6 hours earlier, and has orders for morphine every 4 hours as
needed and ibuprofen every 6 hours as needed. Which is the most
appropriate action?
,a. Administer ibuprofen.
b. Administer morphine.
c. Administer ibuprofen, and if the patient does not feel relief after one hour
post-dose, then administer morphine.
d. Question present family members about the patient's pain tolerance
before making a decision. ---------CORRECT ANSWER-----------------B: The
nurse should give morphine, as 8 on a 1 to 10 scale is representative
of severe pain, not uncommon in the first 24 hours after surgery.
Patients have a right to pain control, and the nurse should trust that
the pain is what the patient says it is. Patients may show very
different behavior when they are in pain. Some may cry and moan
with minor pain, and others may exhibit little difference in behavior
when truly suffering. Thus, judging pain by behavior can lead to the
wrong conclusions. Questioning family members is not appropriate.
Q-wave myocardial infarction is characterized by:
a. ST-T wave changes with ST depression that reverses within a few days.
b. Small infarct size-due to spontaneous reperfusion.
c. Peak CK levels in 12 to 13 hours.
d. Complete coronary occlusion in 80% to 90% of patients. ---------
CORRECT ANSWER-----------------D: Q-wave myocardial infarction is
characterized by complete coronary occlusion in 80% to 90% of
patients. Abnormal Q waves (wider and deeper) are especially
common in the morning. Infarction is usually prolonged, resulting in
transmural necrosis. Peak CK levels occur in approximately 27 hours.
Non-Q-wave myocardial infarction is characterized by ST changes
with ST depression. Infarct is typically non-transmural and small with
coronary occlusion in only 20% to 30% of patients. Peak CK levels
occur in approximately 12 to 13 hours.
A nursing team leader delegates a task to an unlicensed assistive member
of the personnel. Who is responsible for patient outcomes?
a. The unlicensed person who completes the task
, b. Both the team leader and the unlicensed person who completes the task
c. The team leader who delegates the task
d. The administrative staff ---------CORRECT ANSWER-----------------C: The
nurse who delegates remains accountable for patient outcomes and
for supervision of the person to whom the task was delegated. The
scope of nursing includes delegation of tasks to unlicensed assistive
personnel, providing those personnel have adequate training and
knowledge. Delegation can be used to manage the workload and to
provide adequate and safe care. Delegation should be done in a
manner that reduces liability by providing adequate communication.
A patient with acute lung injury has crackling, tachypnea, and cyanosis.
Oxygen therapy is instituted to maintain oxygen saturation at:
a. 85%
b. >90%
c. >95%
d. 98% ---------CORRECT ANSWER-----------------B: Acute lung injury
results in severely compromised lungs with crackling and wheezing,
decreased pulmonary compliance, and cyanosis, so oxygen therapy
is provided to maintain oxygen saturation >90%. Oxygen should be
administered at 100% because of the mismatch between ventilation
(V) and perfusion (Q), which can result in hypoxia upon change in
positioning. Endotracheal intubation may be needed if oxygen
saturation falls or carbon dioxide levels rise.
The normal blood, urea, nitrogen (BUN)/creatinine ratio is:
a. 5:1
b. 8:1
c. 10:1
d. 20:1 ---------CORRECT ANSWER-----------------C: The normal
BUN/creatinine ratio is 10:1. Normal serum creatinine is 0.6 to 1.2
mg/dL) and increases with impaired renal function, urinary tract
obstruction, and nephritis. Levels should remain stable with normal
functioning. Normal blood urea nitrogen (BUN) is 7 to 8 mg/dL for
