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NEW QUESTION # 78
In a positive-pressure ventilator, which mode of ventilation ensures that a predetermined number of breaths at a selected Vt are delivered each minute, and any additional breaths initiated by the patient, while allowed, are not delivered by the ventilator?
- A. Assist-control ventilation
- B. Synchronized intermittent mandatory ventilation
- C. Control ventilation
- D. Spontaneous ventilation
Answer: B
Explanation:
Correct answer: Synchronized intermittent mandatory ventilation
The synchronized intermittent mandatory ventilation (SIMV) mode of ventilation ensures that a predetermined number of breaths at a selected Vt are delivered each minute. Any additional breaths initiated by the patient are allowed but these breaths are not delivered by the ventilator.
The patient is allowed to spontaneously breathe at the depth and rate desired until it is time for the next mandatory breath. Mandatory breaths are synchronized with the patient's inspiratory effort, if present, to optimize patient-ventilator synchrony.
Additional breaths initiated by the patient are not delivered by the ventilator. This is in contrast to the assist-control mode where these breaths are delivered by the ventilator.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 121.
NEW QUESTION # 79
A patient who is scheduled for coronary angiography states, "I want to be asleep during my procedure. I can't stand any kind of pain." Of the following, the best response for the nurse to make to this patient is:
- A. "You have to stay awake, but the procedure is painless."
- B. "Don't worry. You will be given medicine to make you very sleepy and you won't remember anything."
- C. "You will have to be awake during the procedure so you can control your breathing."
- D. "It sounds like you're feeling anxious. What has your doctor told you about your procedure?"
Answer: D
Explanation:
Correct answer: "It sounds like you're feeling anxious. What has your doctor told you about your procedure?" It is most therapeutic to acknowledge the patient's feelings, find out what they have been told, and not to minimize fear. Typically, patients remain awake during the procedure, allowing them to facilitate the catheterization process by controlling respiratory patterns. An anxiolytic agent, such as diazepam, is frequently administered during the procedure to decrease anxiety.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 213-214.
NEW QUESTION # 80
A complex patient is transitioning to a skilled nursing facility from the progressive care unit. Which of the following statements is true regarding the transition to the next stage of care for this patient?
- A. The patient's family should be told to anticipate that fewer staff members will be available to monitor for patient changes at the new facility and provide them with the progressive care unit's phone number to use if concerns arise
- B. Complex patients require extensive preplanning to achieve a successful transition to the next stage of care
- C. Planning for this patient's transition of care began when the physician wrote the order for transfer
- D. Family visits to the new facility prior to the patient's arrival on that unit should not be encouraged as this will increase patient anxiety
Answer: B
Explanation:
Correct answer: Complex patients require extensive preplanning to achieve a successful transition to the next stage of care A successful transition to the next stage of care requires extensive preplanning in the case of complex patients, and this process begins soon after the patient is admitted to the progressive care unit.
Because the thought of leaving the hospital can be frightening as it is perceived as moving to a place in which there is less staff to monitor patients, the positive aspects of the transition should be reinforced.
Family visits to the new facility should be encouraged, as this may help reduce the patient's anxiety about the transfer.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 34.
NEW QUESTION # 81
All of the following are types of synthetic insulin except:
- A. NPH
- B. Regular
- C. Humalog (lispro H)
- D. Intralente
Answer: D
Explanation:
Explanation: All of the following are types of synthetic insulin except intralente. There are different types of insulin with varying action times which help in maintiaing the levels of glucose in the body.
Duration of action of insulin depends on the individual's metabolic rates, intake, and level of activity.
Intralente is not a type of insulin; rather Ultralente is the correct name of a type of insulin.
NEW QUESTION # 82
Mrs. Smith, a 54-year-old housewife, was encouraged to exercise and role from side to side frequently while she was admitted in hospital. She was being given IV fluids and naso-gastric aspiration was done.
Moreover, she was nil per oral. What is she suffering from?
- A. All of the above
- B. Acute appendicitis
- C. Paralytic ileus
- D. Acute cholecystitis
Answer: C
Explanation:
Explanation: She is suffering from paralytic ileus because in this condition exercises and rolling from side to side help in increasing the bowel activity. Nasogastric aspiration helps in clearing the stomach of gastric contents and thus will help relieving the pressure.
NEW QUESTION # 83
The following statements regarding the use of nitroglycerin to manage acute hypertensive episodes are true except:
- A. Rate of IV administration of nitroglycerin for acute hypertensive episode is 5 to 100 mcg/min.
- B. Nitroglycerin dilates veins more than arterioles
- C. Nitroglycerin dilates arterioles more than veins
- D. For IV administration, 100 mg nitroglycerin is mixed in 100 mL NS or D5
Answer: C
Explanation:
Correct answer: Nitroglycerin dilates arterioles more than veins
Nitroglycerin dilates veins more than arterioles.
Nitroglycerin is a medication commonly used to treat acute hypertensive episodes. The onset of blood pressure reduction after starting a nitroglycerin infusion is approximately 1 to 3 minutes, with duration of action of less than 10 minutes.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 171, 241.
NEW QUESTION # 84
Which is the key quality concept below?
- A. Accessibility
- B. Coordination
- C. Respect
- D. All the above
Answer: D
Explanation:
Explanation: All the qualities listed are part of the key quality concept. All the key concepts related to quality must be communicated to the members of the organization through workshops, newsletters, fact sheets, general meetings.
NEW QUESTION # 85
A 50 year old female a known case of HIV/AIDS, presented to medical OPD with general weight loss, night sweats, general debility, fever, productive cough and hemoptysis. What is she suffering from?
- A. Bronchiectasis
- B. Pneumonia
- C. Tuberculosis
- D. Emphysema
Answer: C
Explanation:
Explanation: She is suffering from tuberculosis because in tuberculosis there is weight loss, general debility, night sweats, fever and hemoptysis. Moreover AIDS is responsible for the immunocompromised state of the patient. Immunocompromised patients are prone to have tuberculosis.
NEW QUESTION # 86
A potentially life-threatening complication of bariatric surgery that may be difficult to detect, but which can lead to overwhelming sepsis is:
- A. Aspiration pneumonia
- B. Anastomotic leakage
- C. Dehydration
- D. Pulmonary embolism
Answer: B
Explanation:
Correct answer: Anastomotic leakage
If not recognized and treated early, leakage of gastric contents at the site of anastomosis following bariatric surgery can quickly lead to sepsis and become life-threatening. Some patients with an anastomotic leak may experience fever, left shoulder pain, or abdominal pain but, sometimes, the only sign of a leak may be unexplained tachycardia (faster than normal heart rate at rest).
While a pulmonary embolism is potentially life-threatening, it does not usually quickly lead to sepsis.
Aspiration pneumonia is not a common complication of bariatric surgery, and the signs and symptoms are not typically difficult to detect. Dehydration is usually not a complication of bariatric surgery, and it is usually not difficult to detect.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 361.
NEW QUESTION # 87
The most common cause of dilated cardiomyopathy is:
- A. Aortic stenosis
- B. Myocardial fibrosis
- C. Coronary artery disease
- D. Infection
Answer: C
Explanation:
Correct answer: Coronary artery disease
Coronary artery disease is the most common cause of dilated cardiomyopathy.
Aortic stenosis is a cause of hypertrophic cardiomyopathy, and myocardial fibrosis can cause restrictive cardiomyopathy. While viral, bacterial, or fungal infections can cause dilated cardiomyopathy, infection is not the most common cause.
Reference:
Bu
rns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 467-468.
NEW QUESTION # 88
Occlusion of circumflex coronary artery results in:
- A. Posterior wall infarction
- B. Anterior MI
- C. Left Lateral MI
- D. Inferior MI
Answer: C
Explanation:
Explanation: Occlusion of circumflex coronary artery results in Left Lateral MI. The Myocardial Infarction most commonly damages the left ventricle and its associated septum. Right ventricle damage is only if there is any occlusion of the supplying vessel. Occlusion of circumflex coronary artery results in Left Lateral MI because circumflex artery supplies left lateral wall of the heart. This also causes damage to the anterior wall of the heart.
NEW QUESTION # 89
What would be identified on the arterial blood gas results as a reflection of acute respiratory distress syndrome?
- A. Increased HcO3
- B. Low PaO2 levels
- C. Decreased PaCO2
- D. High PaO2 levels
Answer: B
Explanation:
Explanation: The result of the arterial blood gas that would reflect the presence of acute respiratory distress syndrome would be a low PaO2 level. The paCO2 will initially decrease but increase as the patient becomes more fatigued.
NEW QUESTION # 90
If the patient is unable to furrow his forehead or smile and puff out his cheeks, then in which nerve is a lesion most commonly suspected?
- A. Trigeminal nerve
- B. Occulomotor nerve
- C. Facial nerve
- D. Abducens nerve
Answer: C
Explanation:
Explanation: If the patient is unable to furrow the forehead or smile and puff out the cheeks, then a lesion in the facial nerve is most commonly suspected, because the motor component of facial nerves is responsible for controlling all the muscles of the face.
NEW QUESTION # 91
Bleeding located between the dura and the skull is a(n):
- A. Subarachnoid hemorrhage
- B. Brain contusion
- C. Epidural hematoma
- D. Subdural hematoma
Answer: C
Explanation:
Correct answer: Epidural hematoma
Bleeding located between the dura and the skull (above the dura) is an epidural hematoma.
An epidural hematoma is a primary brain injury and is often associated with skull fractures that lacerate an underlying artery. It is most common in the temporal region due to tearing of the middle meningeal artery.
A contusion is a cortical bruise caused when the brain impacts the inside of the skull. A subdural hematoma describes bleeding that accumulates below the dura. A subarachnoid hemorrhage describes bleeding into the subarachnoid space; these can result from trauma, aneurysm, or other vascular malformations.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 495, 500-501.
NEW QUESTION # 92
Which of the following terms indicates prolonged or recurring seizures without a return to baseline mental status?
- A. Tonic-clonic seizure
- B. Myoclonic seizure
- C. Drop attacks
- D. Status epilepticus
Answer: D
Explanation:
Correct answer: Status epilepticus
The classic definition of status epilepticus is a seizure or series of seizures lasting longer than 30 minutes, but treatment is most often instituted much sooner. Recent guidelines suggest a definition of seizure activity which lasts longer than five minutes.
Myoclonic seizures are described as a sudden, brief muscle jerking of one or more muscle groups and are commonly associated with metabolic, degenerative, and hypoxic causes. Atonic seizures are characterized by the sudden loss of muscle tone and are also called "drop attacks." In tonic-clonic seizures, muscle activity varies between jerking and sustained muscle contractions.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 316-317.
NEW QUESTION # 93
The most common cause of respiratory failure in acutely ill patients is:
- A. Pulmonary hypertension
- B. Chronic obstructive pulmonary disease
- C. Pneumonia
- D. Asthma
Answer: C
Explanation:
Correct answer: Pneumonia
The most common cause of respiratory failure in acutely ill patients is pneumonia.
Pneumonia is the most common respiratory infection and the most common cause of respiratory failure in acutely ill patients.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 267.
NEW QUESTION # 94
Ketones accumulate in the blood when which of the following are being broken down faster than they can be metabolized?
- A. Triglycerides
- B. Complex carbohydrates
- C. Proteins
- D. Fats
Answer: D
Explanation:
Correct answer: Fats
Ketones accumulate in the blood when fats are being broken down faster than they can be metabolized.
When insulin is not available, glucose cannot enter cells. This triggers a mobilization of stored glucose via the breakdown of protein and fat and the release of stored glucose from the liver. Ketones are given off when fat is broken down for energy. If the ketogenic pathway is overwhelmed, ketone acids accumulate in the bloodstream where hydrogen ions (H+) dissociate, leading to a profound metabolic acidosis.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 389.
NEW QUESTION # 95
A patient is diagnosed with hypertrophic cardiomyopathy. Treatment will most likely include:
- A. Administration of beta-blockers
- B. Administration of nitroprusside
- C. Administration of dobutamine
- D. Administration of diuretics
Answer: A
Explanation:
Correct answer: Administration of beta-blockers
A patient with hypertrophic cardiomyopathy would most likely be treated with beta-blockers to decrease the heart rate, contractility, and myocardial oxygen consumption.
Diuretics, inotropes, and vasodilators are usually contraindicated in patients with hypertrophic cardiomyopathy.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 471.
NEW QUESTION # 96
A patient presented to medical OPD with all the signs and symptoms of heart failure. His echocardiography showed increased right ventricle workload, right ventricle hypertrophy, displaced interventricular septum and tricuspid regurgitation. What is the most important test to confirm the diagnosis in this regard?
- A. ECG
- B. Chest x-ray
- C. Right-sided cardiac catheterization
- D. Echocardiography (already done)
Answer: C
Explanation:
Explanation: The most important test for patient presenting with symptoms of heart failure is right- sided cardiac catheterization because this will tell about the blood pressure in the right side of heart and will confirm the diagnosis of Pulmonary Hypertension which is responsible for all these changes in heart structure and function.
NEW QUESTION # 97
Violent behavior, hallucinations, rhabdomyolysis, and hypertensive crisis are signs and symptoms of an overdose of:
- A. LSD
- B. Phencyclidine
- C. Cocaine
- D. Barbiturates
Answer: B
Explanation:
Correct answer: Phencyclidine
Signs and symptoms of phencyclidine (PCP) overdose include:
* Violent behavior
* Hallucinations
* Seizures
* Rhabdomyolysis (the rapid breakdown of muscle fibers)
* Hypertensive crisis
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 288.
NEW QUESTION # 98
......
AACN PCCN (Progressive Care Certified Nursing) Exam is a certification exam designed for nurses who work in progressive care units. PCCN exam is developed and administered by the American Association of Critical-Care Nurses (AACN), which is a professional organization dedicated to advancing the care of critically ill patients. The PCCN certification is nationally recognized and demonstrates a nurse’s expertise in caring for acutely ill adult patients.
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