PCCN UPDATED MAIN ANSWERS AND QUESTIONS
SET A+
✔✔Why is calcium required for clot formation?
A. Calcium reacts with factor Xa to begin the common pathway of clot formation.
B. Calcium is necessary for contraction of vascular smooth muscle.
C. Calcium is necessary for bone conservation
D. Calcium is a by-product of glucose metabolism - ✔✔A. Calcium reacts with factor Xa
to begin the common pathway of clot formation.
There is an intrinsic and extrinsic pathway for clot formation. As they combine to form
the final common pathway at factor Xa, calcium must be present at a sufficient level for
clot formation to occur. Calcium is necessary for contraction of smooth muscle;
however, this is not the mechanism for clot formation. Calcium is required for bone
conservation; again, not a mechanism of clot formation. Many blood products lower the
available serum calcium levels, thereby reducing the ability to make normal clots.
Glucose metabolism has nothing to do with clot formation.
✔✔An elevated serum D-dimer indicates the presence of?
A. coagulopathy
B. fibrin clot formation
C. low calcium
D. heart failure - ✔✔B. fibrin clot formation
The D-Dimer is effective in demonstrating that fibrin clot formation has occurred within
the body. An elevated D-dimer is highly sensitive for the recognition of clot formation,
but nor sensitive enough to distinguish the location of the clot. The term "coagulopathy"
indicates a bleeding disorder. Not all disorders are thrombus forming, but rather indicate
the inability to make clots (decreased clotting factors such as liver failure). Low calcium
levels may trigger a coagulopathy since calcium is required to make clots, but does not
change the D-dimer value since no clot is made. Heart failure may cause alterations in
the microvascular space, but does not elevate the D-dimer value. The three most
common causes of elevation of the D-dimer are pulmonary embolus, DVT formation and
disseminated intravascular coagulation. Any postoperative patient that has made clots
will have an elevated D-dimer.
,✔✔A patient is admitted with disorientation 3 weeks after gastrostomy-tube placement
following a diagnosis of malabsorption syndrome. The family has been irrigating the G-
tube and aspirating after each feeding. This may produce which abnormality?
A. metabolic acidosis
B. metabolic alkalosis
C. respiratory acidosis
D. respiratory alkalosis - ✔✔B. metabolic alkalosis
Metabolic alkalosis is caused by the removal of hydrochloric acid from the stomach.
Vomiting and diarrhea are other causes of metabolic alkalosis. Metabolic acidosis is
caused primarily in the ICU from renal failure, lactate acidosis and diabetic ketoacidosis
(DKA). respiratory acidosis or alkalosis are caused by patient's tidal volume and/or
respiratory rate.
✔✔What is the main cause of esophageal varices?
A. esophageal ulceration
B. portal hypertension
C. gastric ulcerations
D. venous malformations - ✔✔B. portal hypertension
The main cause of esophageal varices is portal hypertension caused by cirrhosis of the
liver. The portal vein must accommodate increasing pressure in the liver, and does so
by building collateral circulation. These collaterals are present in the rectum
(hemorrhoids) and the esophagus (esophageal varices). These veins are under
increased pressure and become tortuous and bulging. Esophageal ulceration may lead
to bleeding, but is not the cause of variceal formation. Gastric ulcerations, again, may
cause gastric bleeding but do not form esophageal varices. Venous malformations (an
abnormal connection between an artery and a vein) also may cause severe
gastrointestinal bleeding but are not the cause of varices.
✔✔Bruising in the flank and groin due to retropertioneal bleeding is called?
A. Grey-Turner's sign
B. Cullen's sign
C. Kernig's sign
D. Welch's sign - ✔✔A. Grey-Turner's sign
Grey-Turner's sign is characterized by ecchymosis along the flank area and groin while
Cullen's sign is ecchymosis around the umbilicus. Kernig's sign consists of painful
movement of the leg secondary to meningitis, and Welch's sign is not a medical term.
✔✔Patient assessment findings indicative of bowel ischemia would include?
A. increased serum lactate levels
B. acute onset abdominal pain
C. urgent bowel movements, sometimes bloody
D. all of the above - ✔✔D. all of the above
When the patient has bowel ischemia, anaerobic metabolism occurs and the patient's
serum lactate level will increase. The patient will have ischemic-like abdominal pain with
, general tenderness and pain throughout the abdomen, and may have diarrhea, melena,
vomiting or abdominal bleeding
✔✔In acute pancreatitis, the patient may have electrolyte abnormalities. Which of the
following may occur?
A. increased calcium
B. decreased calcium
C. decreased phosphorus
D. decreased glucose - ✔✔B. decreased calcium
Hypocalcemia in acute pancreatitis results from multiple factors including
hypoalbuminemia. In the patient with acute pancreatitis, the calcium is lowered
secondary to the rapid rise in serum phosphorus. Additionally, calcium binds with fatty
acids liberated by lipase, forming calcium soaps. This effectively lowers serum calcium
levels. Glucose is also increased to gluconeogenesis, resulting from increased adrenal
cortisol secretion. The other answers are incorrect.
✔✔The 56 year old patient with pancreatitis develops fine tremors, agitation and
tachycardia 48 hrs after admission. These signs may indicate:
A. alcohol withdrawal
B. adverse reaction to medication
C. ICU psychosis
D. generalized tonic-clonic seizure - ✔✔A. alcohol withdrawal
The first signs of alcohol withdrawal are tachycardia, tremors, and agitation or
hallucinations. The primary etiology of acute pancreatitis in the U.S. is alcoholism.
Adverse reactions to medications may include tachycardia and possibly fine tremors
with some neuro-psychiatric medications, but do not generally include agitation. ICU
psychosis generally occurs two to three days after admission and appears as a sudden
change in level of consciousness and agitation, not fine tremors. Generalized seizure
activity begins with muscular tonic-clonic contractions and loss of consciousness.
✔✔The most common type of gastrointestinal bleeding is:
A. lower gastrointestinal bleeding
B. upper gastrointestinal bleeding
C. pancreatic bleeding
D. ruptured spleen - ✔✔B. upper gastrointestinal bleeding
Typically 85 percent of gastrointestinal bleeding is from the upper gastrointestinal tract.
Lower gastrointestinal bleeding is much less frequent. Pancreatic bleeding is infrequent,
and ruptured spleen secondary to trauma is not a common site of gastrointestinal
bleeding.
✔✔All of the following can cause gastrointestinal perforation, but which is the most
common cause?
A. bowel obstruction
B. ruptured appendicitis
C. colonic ulcers
SET A+
✔✔Why is calcium required for clot formation?
A. Calcium reacts with factor Xa to begin the common pathway of clot formation.
B. Calcium is necessary for contraction of vascular smooth muscle.
C. Calcium is necessary for bone conservation
D. Calcium is a by-product of glucose metabolism - ✔✔A. Calcium reacts with factor Xa
to begin the common pathway of clot formation.
There is an intrinsic and extrinsic pathway for clot formation. As they combine to form
the final common pathway at factor Xa, calcium must be present at a sufficient level for
clot formation to occur. Calcium is necessary for contraction of smooth muscle;
however, this is not the mechanism for clot formation. Calcium is required for bone
conservation; again, not a mechanism of clot formation. Many blood products lower the
available serum calcium levels, thereby reducing the ability to make normal clots.
Glucose metabolism has nothing to do with clot formation.
✔✔An elevated serum D-dimer indicates the presence of?
A. coagulopathy
B. fibrin clot formation
C. low calcium
D. heart failure - ✔✔B. fibrin clot formation
The D-Dimer is effective in demonstrating that fibrin clot formation has occurred within
the body. An elevated D-dimer is highly sensitive for the recognition of clot formation,
but nor sensitive enough to distinguish the location of the clot. The term "coagulopathy"
indicates a bleeding disorder. Not all disorders are thrombus forming, but rather indicate
the inability to make clots (decreased clotting factors such as liver failure). Low calcium
levels may trigger a coagulopathy since calcium is required to make clots, but does not
change the D-dimer value since no clot is made. Heart failure may cause alterations in
the microvascular space, but does not elevate the D-dimer value. The three most
common causes of elevation of the D-dimer are pulmonary embolus, DVT formation and
disseminated intravascular coagulation. Any postoperative patient that has made clots
will have an elevated D-dimer.
,✔✔A patient is admitted with disorientation 3 weeks after gastrostomy-tube placement
following a diagnosis of malabsorption syndrome. The family has been irrigating the G-
tube and aspirating after each feeding. This may produce which abnormality?
A. metabolic acidosis
B. metabolic alkalosis
C. respiratory acidosis
D. respiratory alkalosis - ✔✔B. metabolic alkalosis
Metabolic alkalosis is caused by the removal of hydrochloric acid from the stomach.
Vomiting and diarrhea are other causes of metabolic alkalosis. Metabolic acidosis is
caused primarily in the ICU from renal failure, lactate acidosis and diabetic ketoacidosis
(DKA). respiratory acidosis or alkalosis are caused by patient's tidal volume and/or
respiratory rate.
✔✔What is the main cause of esophageal varices?
A. esophageal ulceration
B. portal hypertension
C. gastric ulcerations
D. venous malformations - ✔✔B. portal hypertension
The main cause of esophageal varices is portal hypertension caused by cirrhosis of the
liver. The portal vein must accommodate increasing pressure in the liver, and does so
by building collateral circulation. These collaterals are present in the rectum
(hemorrhoids) and the esophagus (esophageal varices). These veins are under
increased pressure and become tortuous and bulging. Esophageal ulceration may lead
to bleeding, but is not the cause of variceal formation. Gastric ulcerations, again, may
cause gastric bleeding but do not form esophageal varices. Venous malformations (an
abnormal connection between an artery and a vein) also may cause severe
gastrointestinal bleeding but are not the cause of varices.
✔✔Bruising in the flank and groin due to retropertioneal bleeding is called?
A. Grey-Turner's sign
B. Cullen's sign
C. Kernig's sign
D. Welch's sign - ✔✔A. Grey-Turner's sign
Grey-Turner's sign is characterized by ecchymosis along the flank area and groin while
Cullen's sign is ecchymosis around the umbilicus. Kernig's sign consists of painful
movement of the leg secondary to meningitis, and Welch's sign is not a medical term.
✔✔Patient assessment findings indicative of bowel ischemia would include?
A. increased serum lactate levels
B. acute onset abdominal pain
C. urgent bowel movements, sometimes bloody
D. all of the above - ✔✔D. all of the above
When the patient has bowel ischemia, anaerobic metabolism occurs and the patient's
serum lactate level will increase. The patient will have ischemic-like abdominal pain with
, general tenderness and pain throughout the abdomen, and may have diarrhea, melena,
vomiting or abdominal bleeding
✔✔In acute pancreatitis, the patient may have electrolyte abnormalities. Which of the
following may occur?
A. increased calcium
B. decreased calcium
C. decreased phosphorus
D. decreased glucose - ✔✔B. decreased calcium
Hypocalcemia in acute pancreatitis results from multiple factors including
hypoalbuminemia. In the patient with acute pancreatitis, the calcium is lowered
secondary to the rapid rise in serum phosphorus. Additionally, calcium binds with fatty
acids liberated by lipase, forming calcium soaps. This effectively lowers serum calcium
levels. Glucose is also increased to gluconeogenesis, resulting from increased adrenal
cortisol secretion. The other answers are incorrect.
✔✔The 56 year old patient with pancreatitis develops fine tremors, agitation and
tachycardia 48 hrs after admission. These signs may indicate:
A. alcohol withdrawal
B. adverse reaction to medication
C. ICU psychosis
D. generalized tonic-clonic seizure - ✔✔A. alcohol withdrawal
The first signs of alcohol withdrawal are tachycardia, tremors, and agitation or
hallucinations. The primary etiology of acute pancreatitis in the U.S. is alcoholism.
Adverse reactions to medications may include tachycardia and possibly fine tremors
with some neuro-psychiatric medications, but do not generally include agitation. ICU
psychosis generally occurs two to three days after admission and appears as a sudden
change in level of consciousness and agitation, not fine tremors. Generalized seizure
activity begins with muscular tonic-clonic contractions and loss of consciousness.
✔✔The most common type of gastrointestinal bleeding is:
A. lower gastrointestinal bleeding
B. upper gastrointestinal bleeding
C. pancreatic bleeding
D. ruptured spleen - ✔✔B. upper gastrointestinal bleeding
Typically 85 percent of gastrointestinal bleeding is from the upper gastrointestinal tract.
Lower gastrointestinal bleeding is much less frequent. Pancreatic bleeding is infrequent,
and ruptured spleen secondary to trauma is not a common site of gastrointestinal
bleeding.
✔✔All of the following can cause gastrointestinal perforation, but which is the most
common cause?
A. bowel obstruction
B. ruptured appendicitis
C. colonic ulcers
