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AACN PCCN (Progressive Care Certified Nursing) Certification Exam is a specialized certification exam designed for nurses who work in progressive care units. PCCN exam is administered by the American Association of Critical-Care Nurses (AACN) and is intended to demonstrate a nurse’s knowledge and competence in providing progressive care to patients who require complex monitoring and interventions.
NEW QUESTION # 270
A variation of a nonrebreathing mask without the one-way valves is a:
- A. Peak-flow mask
- B. Partial rebreathing mask
- C. Venturi mask
- D. Cannulated mask
Answer: B
Explanation:
Correct answer: Partial rebreathing mask
Oxygen should always be supplied to maintain the reservoir bag at least one-third to one-half full on inspiration. At a flow of 6 to 10 liters per minute, the system can provide 40% to 70% oxygen.
A Venturi mask is an example of a high-flow oxygen delivery system.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 114.
NEW QUESTION # 271
All the following will help in relieving the pain and discomfort caused by Pericarditis except:
- A. Use of analgesics
- B. Use of corticosteroids
- C. Use of anti-inflammatory drugs like ibuprofen, etc.
- D. Use of nitroglycerines
Answer: D
Explanation:
Explanation: All the following will help in relieving the pain and discomfort caused by Pericarditis except use of nitroglycerines. Nitroglycerines have no role in relieving the pain and discomfort of treating Pericarditis. However, analgesics will relieve pain from Pericarditis, anti-inflammatory drugs will decrease inflammation, thus relieving discomfort and improving the rate of fluid reabsorption. Steroids also have an anti-inflammatory component.
NEW QUESTION # 272
To help prevent hospital-acquired pneumonia in a ventilated patient, which of the following is recommended?
- A. If a suction catheter is to be used for reentry into the patient's lower respiratory tract, use clean fluid to remove secretions from the catheter
- B. Perform tracheostomy care and suctioning under clean conditions
- C. Avoid supine positioning and, unless medically contraindicated, keep the head of the bed elevated at
45 to 60 degrees at all times - D. Implement a comprehensive oral hygiene program that includes teeth brushing and the use of oral
0.12% chlorhexidine gluconate for ventilator patients
Answer: D
Explanation:
Correct answer: Implement a comprehensive oral hygiene program that includes teeth brushing and the use of oral 0.12% chlorhexidine gluconate for ventilator patients The development and implementation of an oral hygiene program is one of the evidence-based practice guidelines for the prevention of ventilator-associated pneumonia (VAP).
The head of the bed should be kept elevated at 30 to 45 degrees unless medically contraindicated to prevent VAP. Tracheostomy care should always be performed under aseptic conditions. If a suction catheter is to be used for reentry into the patient's lower respiratory tract, use only sterile fluid to remove secretions from the catheter.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 270.
NEW QUESTION # 273
The following are signs and symptoms of respiratory depression associated with opioid use:
- A. Altered level of consciousness, constriction of the pupils, hypercarbia
- B. Increased depth of respirations, slowed respiratory rate, constricted pupils
- C. Increased level of sedation, hypocarbia, tachypnea
- D. Dilated pupils, increased level of sedation, hypoxemia
Answer: A
Explanation:
Correct answer: Altered level of consciousness, constriction of the pupils, hypercarbia Signs and symptoms of respiratory depression associated with opioid use include altered level of consciousness, decreased depth of respirations, slowed respiratory rate, constriction of the pupils, hypoxemia, and hypercarbia.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 148.
NEW QUESTION # 274
Which of the following explanations best describes the mechanism of hepatic encephalopathy?
- A. Increased level of ammonia in the blood which crosses blood brain barrier and is absorbed in blood cells.
- B. Increased level of uric acid in the blood
- C. Increased level of bacteria in the blood
- D. Increase level of viral agents in the blood
Answer: A
Explanation:
Explanation: Increased level of ammonia in the blood which crosses blood brain barrier and is absorbed in blood cells best describes the mechanism of hepatic encephalopathy. Hepatic failure is a state in which the liver is no longer be able to perform normal function due to different factors. Hepato-renal syndrome and Hepatic encephalopathy are the parts of syndrome of hepatic failure. An increased level of ammonia is responsible for an altered level of consciousness, stupor or coma in hepatic encephalopathy.
NEW QUESTION # 275
Interventions to help prevent disagreement between staff and family perspectives about the type or priorities of family needs include all of the following except:
- A. Identification of a family spokesman or contact person
- B. Relying on nurses to fulfill all family needs
- C. Establishing methods to contact and communicate with the patient's family
- D. Providing information according to family needs
Answer: B
Explanation:
Correct answer: Relying on nurses to fulfill all family needs
Families need support in maintaining their strength and having needs met to be able to function as a positive influence for the patient rather than having a negative impact. However, relying on nurses to fulfill all family needs while caring for patients creates tension and frustration. Hospital resources must also be utilized and the family can also be assessed for resources they have which can be maximized.
Interventions to help prevent disagreement between staff and family perspectives about the type or priorities of family needs include: Establishing methods to contact and communicate with the patient's family, identification of a family spokesman or contact person, and providing information according to family needs.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 29.
NEW QUESTION # 276
Acute ischemic heart disease is most often caused by:
- A. Fixed obstructions
- B. Spasm of the smooth wall of the coronary arteries
- C. Thrombus formation at a site of atherosclerotic plaque rupture within a coronary artery
- D. Coronary artery spasm
Answer: C
Explanation:
Correct answer: Thrombus formation at a site of atherosclerotic plaque rupture within a coronary artery The lack of adequate blood supply to the heart is most often caused by intracoronary thrombus formation.
Pre-existing atherosclerosis and spasm of the smooth muscle wall of the coronary arteries, termed fixed obstructions, may also contribute to reduced blood flow. In some situations, coronary artery spasm may play a major role, unrelated to underlying atherosclerosis.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 218.
NEW QUESTION # 277
A 30-year-old man presented to medical OPD with complaints of polyuria and polydipsia of short duration. Patient is also obese. Blood glucose levels are high. What is the likely diagnosis?
- A. Type 2 diabetes mellitus
- B. None of the above
- C. Diabetes insipidus
- D. Type 1 diabetes mellitus
Answer: D
Explanation:
Explanation: The likely diagnosis for this patient is Type 1 Diabetes Mellitus because it usually occurs in an individual under age 40 who is overweight and has blood glucose levels that are high. There is also a short history of polyuria and polydipsia.
NEW QUESTION # 278
Caution must be taken not to diurese a heart failure patient too fast, as rapid loss of fluid can lead to:
- A. Pulsus alternans
- B. Stimulation of the Frank-Starling response
- C. Disseminated intravascular coagulation
- D. Activation of the renin-angiotensin system
Answer: D
Explanation:
Correct answer: Activation of the renin-angiotensin system
In the management of fluid volume overload, caution must be taken not to diurese the patient too quickly, as the rapid loss of fluids can lead to activation of the renin-angiotensin system.
Diuretics should be initiated according to the severity of the patient's signs and symptoms. More severe symptoms require IV therapy in addition to loop diuretics; loop diuretics may adequately manage less severe symptoms. If there is inadequate response to loop diuretics, thiazide diuretics may be added later.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 233.
NEW QUESTION # 279
All of the following statements related to stimulation threshold testing are true except:
- A. After the stimulus threshold is determined, the output should be set 2 to 3 times higher than the threshold
- B. The pacing rate may need to be temporarily decreased to override an intrinsic rhythm
- C. The monitor much continuously be monitored during stimulation threshold testing
- D. The stimulus threshold is determined by first decreasing the output until the pacing stimulus no longer captures the heart, and then slowly increasing the output until 1:1 capture resumes
Answer: B
Explanation:
Correct answer: The pacing rate may need to be temporarily decreased to override an intrinsic rhythm The pacing rate may need to be temporarily increased, not decreased, to override an intrinsic rhythm.
When the placing lead is first placed, the stimulation threshold is usually very low.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 460.
NEW QUESTION # 280
Angiotensin-converting enzyme (ACE) inhibitors are indicated in the management of heart failure and hypertension. Which of the following statements is true about these agents?
- A. These agents decrease the availability of bradykinin and increase plasma aldosterone concentrations
- B. Hypokalemia is a possible complication of ACE inhibitor therapy
- C. Drug-induced angioedema associated with these agents most often affects the tongue, lips, face, and upper airway
- D. These agents selectively block the binding of angiotensin II to the receptors in various tissues (i.e., the adrenal gland and vascular smooth muscle)
Answer: C
Explanation:
Correct answer: Drug-induced angioedema associated with these agents most often affects the tongue, lips, face, and upper airway Adverse effects associated with angiotensin-converting enzyme (ACE) inhibitors include cough, rash, and taste disturbances. Drug-induced angioedema may also occur and only rarely is associated with abdominal symptoms.
Angiotensin receptor blockers, not ACE inhibitors, selectively block the binding of angiotensin II to receptors in various tissues. ACE inhibitors increase the availability of bradykinin and various other vasodilatory prostaglandins and decrease plasma aldosterone concentrations. Hyperkalemia, not hypokalemia, is a possible complication of ACE inhibitor therapy.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 173.
NEW QUESTION # 281
The progressive care environment can be anxiety-provoking for patients. Which of the following statements is most correct related to sedation and delirium in the progressive care unit?
- A. The use of sedatives decreases the risk of delirium in acutely ill patients as sedatives induce the stages of sleep that provide a restorative state
- B. Lorazepam, a benzodiazepine, has a rapid onset of action and a short duration of effect
- C. Sedative-induced amnesia protects patients from the psychological stress associated with the progressive care environment and sedation infusions must not be interrupted
- D. In clinical trials, oral quetiapine has been shown to reduce the duration of delirium
Answer: D
Explanation:
Correct answer: In clinical trials, oral quetiapine has been shown to reduce the duration of delirium The use of atypical antipsychotics as possible alternatives to haloperidol to manage delirium in acutely ill patients has increased over the past several years. To this point, quetiapine has been the most well- studied. Sedation is quetiapine's most commonly associated side effect, and it can only be administered orally.
Acutely ill patients are especially at risk for delirium if they have been on sedatives; especially per infusion for longer than 24 hours. Daily interruptions in the administration of sedatives have been associated with better outcomes and do not appear to increase psychological stress. Lorazepam, the most common benzodiazepine, is an intermediate-term sedative; it has an intermediate onset of action and duration of effect.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 154-156, 165-166.
NEW QUESTION # 282
All of the following are signs and symptoms of cardiac tamponade except:
- A. Hypertension
- B. Muffled heart sounds
- C. Sinus tachycardia
- D. Pulsus paradoxus
Answer: A
Explanation:
Correct answer: Hypertension
Signs and symptoms of cardiac tamponade include decreased blood pressure (hypotension), tachycardia, shortness of breath, anxiety/decreased level of consciousness, pulsus paradoxus, sinus tachycardia, decreased mediastinal tube drainage, diastolic plateau, muffled heart sounds, and decreased cardiac output.
Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium).
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 226, 413.
NEW QUESTION # 283
Identifying the problem, gathering data, and clarifying who should make the final decision are steps in which phase of the process of ethical analysis?
- A. Planning
- B. Assessment
- C. Implementation
- D. Evaluation
Answer: B
Explanation:
Correct answer: Assessment
Identifying the problem, gathering data, clarifying who should make the final decision are steps in the assessment phase of the process of ethical analysis. The assessment phase of the process of ethical analysis involves clarification of the problem, distinguishing the morally relevant facts, and identifying the individuals involved in the problem.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 199.
NEW QUESTION # 284
Which of the following statements is true related to encephalitis?
- A. The most common type of encephalitis seen in the United States is caused by West Nile virus
- B. Pending specialized testing of the cerebrospinal fluid, diagnosis is often presumed and empiric treatment initiated with intravenous vancomycin
- C. Encephalitis caused by the herpes simplex virus is extremely rare
- D. It is inflammation of the brain parenchyma
Answer: D
Explanation:
Correct answer: It is inflammation of the brain parenchyma
Encephalitis is inflammation of the brain parenchyma. There are many causes, including arboviruses such as West Nile, but the most common type seen in the United States is encephalitis due to the herpes simplex virus (HSV).
The most common cause of encephalitis is a viral infection and empirical treatment is most often initiated with an antiviral agent pending testing of the cerebrospinal fluid.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 318.
NEW QUESTION # 285
Distributive shock is also known as:
- A. Cardiogenic shock
- B. Relative hypovolemic shock
- C. Hypovolemic shock
- D. Vascular shock
Answer: B
Explanation:
Correct answer: Relative hypovolemic shock
In distributive shock, the total volume of blood and the pumping function of the heart are normal, but the blood is not appropriately distributed throughout the vascular bed. For various reasons, including sepsis and anaphylaxis, massive vasodilation occurs, increasing the size of the vascular bed. In this enlarged bed, the normal volume of circulating blood can no longer fill the vascular space, causing a drop in blood pressure and inadequate tissue perfusion.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 236.
NEW QUESTION # 286
A 49 year old male patient has experienced a myocardial infarction with an approximate 55% damage to his ventricle. What interventions would most likely NOT be performed for this patient to avoid the complication of cardiogenic shock?
- A. Chest tube insertion
- B. Intraaortic balloon pump
- C. Angioplasty
- D. Bypass surgery
Answer: A
Explanation:
Explanation: The interventions that would most likely NOT be performed for this patient is insertion of a chest tube. All treatments are aimed with the goal of restoring blood flow and oxygenation early and quickly to avoid organ damage.
NEW QUESTION # 287
Which of the following statements is true?
- A. The most frequent fatal complication of liver failure is hepatic encephalopathy
- B. Serum ammonia is the cerebral toxin most often implicated in hepatic encephalopathy
- C. Ammonia is produced in the liver
- D. Pruritis occurs in liver failure due to increased levels of serum ammonia
Answer: B
Explanation:
Correct answer: Serum ammonia is the cerebral toxin most often implicated in hepatic encephalopathy Ammonia is produced by bacteria in the bowel, and in the liver, it is converted to urea for excretion via the kidneys. Pruritis is associated with jaundice and is a result of bile salt accumulation. The most frequent fatal complication of liver failure is hepatorenal syndrome, which is a form of severe liver disease. This syndrome occurs in up to 40% of patients with advanced cirrhosis and, without liver transplantation, it is often fatal.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 350-351.
NEW QUESTION # 288
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