PCCN CORRECT STUDY ANSWERS AND QUESTIONS
SET A+
✔✔The first 24 hours after stroke, the patient is at high risk for multiple complications.
One complication that the nurse can protect the patient from is:
A. bleeding
B. decreased level of consciousness
C. aspiration
D. speech abnormality - ✔✔C. aspiration
The post-stroke patient is most risk for aspiration since he or she may have swallow
abnormalities. Patients who are poststroke should have a swallow evaluation before the
reinstitution of feeding. Aspiration precautions should be initiated after stroke and
continued until a complete swallow evaluation is done. The nurse cannot prevent
bleeding, changes in consciousness or the presence of a speech abnormality; however,
the nurse can assess and monitor these changes.
✔✔A patient with a known seizure disorder falls to the floor having a generalized grand
mal seizure. Which of the following options is most appropriate nursing action?
A. position the patient flat on his or her back and loosen clothing
B. place a tongue blade between his or her teeth
C. do not touch the patient until the seizure subsides
D. position the patient on his or her side with head flexed forward - ✔✔D. position the
patient on his or her side with head flexed forward
If a patient is having a generalized grand mal seizure, the priority is to first maintain an
open airway. Placing the patient on his side with his head flexed forward will keep his
tongue forward and prevent aspiration. Placing the patient flat on his back will not
prevent aspiration. The patient should never be restrained or anything placed in his
mouth. The answer to most medical-surgical questions should be the first priority care:
airway, breathing, circulation and drugs.
✔✔When plasma glucose falls to 250 mg/dL in acute diabetic ketoacidosis (DKA), IV
fluids should be changed to D5 1/2NS to prevent which of the following?
A. hyperglycemia
B. hyperkalemia
C. cerebral edema
,D. the Somogyl effect - ✔✔C. cerebral edema
When lowering blood sugar in DKA, the patient is also fluid-depleted secondary to
hyperosmolar diuresis. In that hypovolemic state with lowered blood sugar, the brain
requiresfluid replacement. Dropping blood sufar too quickly without fluid replacement
will cause severe cerebral edema. Hypotonic solutions will only cause cerebral edema
to worsen because fluid moves from the vasculature to the interstitial space.
Hyperglycemia doesnot occyur. The Somogyi effect is the rapid raise of blood sugar
early in the morning after blood-sugar levels have dropped in the late evening because
of too high of an insulin level during the late evening and early morning.
✔✔In diabetic ketoacidosis (DKA), the patient has an increased serum osmolality. In the
initial state of DKA, what are the other dangerous electrolyte abnormalities?
A. hypernatremia
B. hyponatremia
C. hypocalcemia
D. hyperkalemia - ✔✔D. hyperkalemia
Initially, the patient has high serum potassium to the metabolic acidosis present from
the ketones. This acidosis pulls potassium from the cell, making the patient
hyperkalemic. As soon as insulin is given, however, potassium re-enters the cell and the
ketosis stops. The initial sodium level in DKA is normal, as is calcium.
✔✔Normal serum osmolality is within the range of:
A. 145-155 mOsm/L
B. 200-250 mOsm/L
C. 275-295 mOsm/L
D. 325-375 mOsm/L - ✔✔C. 275-295 mOsm/L
Normal serum osmolality is 275-295 mOsm/L. Typically, if the osmolality is increased, it
indicates intravascular dehydration. If the osmolality is low, that usually indicates
intravascular fluid overload. In many endocrine abnormalities, intravascular volume is
altered and requires daily monitoring.
✔✔Symptoms of hypoglycemia include:
A. decreased deep tendon reflexes, hypertension and difficulty swallowing
B. increased DTRs, hypertension and slow heart rate
C. increased heart rate, increased irritability, nausea
D. there are no early signs of hypoglycemia - ✔✔C. increased heart rate, increased
irritability, nausea
DTRs, hypertension, and difficulty swallowing are signs of sympathetic nervous system
discharge secondary to the compensatory mechanisms of hypoglycemia. DTRs are
generally not changed with hypoglycemia unless the blood sugar is exceedingly low,
causing severe neurological disruption and seizures. Hypertension is not a complication
of hypogluycemia.
✔✔Blood-sugar elevation in the critically ill adult is common. Which of the following
mechanisms explain this increase in blood sugar in the non-diabetic patient?
, A. medications such as epinephrine
B. shivering
C. temperature elevation
D. change in position - ✔✔A. medications such as epinephrine
Epinephrine is a pure catecholamine. This activates the sympathetic nervous system
thereby increasing blood sugar by the fight or flight mechanism. Shivering, temperature
elevation and changes in position may cause drops in serum glucose as the patient is
utilizing energy.
✔✔A 45-year old woman is admitted with type 1 diabetic mellitus. She is
hyperventilating, has signs of dehydration (increased urine output and increased thirst),
and is tachycardic. Initial treatment would include:
A. Diazoxide (Hyperstat) to inhibit the release of insulin
B. glucose for hypoglycemia
C. insulin therapy for ketoacidosis, fluid and electrolyte replacement
D. intravenous fluids for dehydration and glucose for hypoglycemia - ✔✔C. insulin
therapy for ketoacidosis, fluid and electrolyte replacement
The patient is exhibiting the signs and symptoms of diabetic ketoacidosis (DKA). Signs
of dehydration, such as polydipsia and polyphagia, are due to large urine output,
increased thirst is secondary to dehydration and tachycardia is due to sympathetic
nervous system stimulation from an increased glucose level and ketosis. Initial
treatment would include insulin therapy, re-hydration with fluids and electrolyte
replacement. Diazoxide would not be used since it inhibits insulin release (this patient
requires insulin to lower glucose). The patient is not hypoglycemia. Signs and
symptoms of hypoglycemia are similar; tachycardia, change in behavior (irritability) or
level of consciousness, sweating and shaking.
✔✔To evaluate the outcomes of nutritional intervention for a patient with type 2 diabetes
with a dating blood sugar of 130 mg/dL three months ago, which laboratory result would
best indicate dietary compliance?
A. fasting blood sugar of 106 mg/dL or less
B. hemoglobin A1C of 6.6%
C. hemoglobin A1C of 1.5%
D. fasting blood sugar of 150 mg/dL - ✔✔B. hemoglobin A1C of 6.6%
Hemoglobin A1C best describes the patient's blood sugars over a 3 month period.
Hemoglobin A1C comprises hemoglobin A with a glucose molecule: because
hemoglobin holds onto excess blood glucose, it demonstrates the average blood
glucose levels over a 3 month period and between describes diet and medication
compliance over time. Fasting blood sugar only demonstrates the patient's last 12 hour
dietary discretion.
✔✔The criteria for the diagnosis of metabolic syndrome include:
A. hyperglycemia, hypertension, increased abdominal fat
B. low blood sugar, obesity, history of STEMI
C. low blood sugar, increased triglycerides, normal lipid panel
SET A+
✔✔The first 24 hours after stroke, the patient is at high risk for multiple complications.
One complication that the nurse can protect the patient from is:
A. bleeding
B. decreased level of consciousness
C. aspiration
D. speech abnormality - ✔✔C. aspiration
The post-stroke patient is most risk for aspiration since he or she may have swallow
abnormalities. Patients who are poststroke should have a swallow evaluation before the
reinstitution of feeding. Aspiration precautions should be initiated after stroke and
continued until a complete swallow evaluation is done. The nurse cannot prevent
bleeding, changes in consciousness or the presence of a speech abnormality; however,
the nurse can assess and monitor these changes.
✔✔A patient with a known seizure disorder falls to the floor having a generalized grand
mal seizure. Which of the following options is most appropriate nursing action?
A. position the patient flat on his or her back and loosen clothing
B. place a tongue blade between his or her teeth
C. do not touch the patient until the seizure subsides
D. position the patient on his or her side with head flexed forward - ✔✔D. position the
patient on his or her side with head flexed forward
If a patient is having a generalized grand mal seizure, the priority is to first maintain an
open airway. Placing the patient on his side with his head flexed forward will keep his
tongue forward and prevent aspiration. Placing the patient flat on his back will not
prevent aspiration. The patient should never be restrained or anything placed in his
mouth. The answer to most medical-surgical questions should be the first priority care:
airway, breathing, circulation and drugs.
✔✔When plasma glucose falls to 250 mg/dL in acute diabetic ketoacidosis (DKA), IV
fluids should be changed to D5 1/2NS to prevent which of the following?
A. hyperglycemia
B. hyperkalemia
C. cerebral edema
,D. the Somogyl effect - ✔✔C. cerebral edema
When lowering blood sugar in DKA, the patient is also fluid-depleted secondary to
hyperosmolar diuresis. In that hypovolemic state with lowered blood sugar, the brain
requiresfluid replacement. Dropping blood sufar too quickly without fluid replacement
will cause severe cerebral edema. Hypotonic solutions will only cause cerebral edema
to worsen because fluid moves from the vasculature to the interstitial space.
Hyperglycemia doesnot occyur. The Somogyi effect is the rapid raise of blood sugar
early in the morning after blood-sugar levels have dropped in the late evening because
of too high of an insulin level during the late evening and early morning.
✔✔In diabetic ketoacidosis (DKA), the patient has an increased serum osmolality. In the
initial state of DKA, what are the other dangerous electrolyte abnormalities?
A. hypernatremia
B. hyponatremia
C. hypocalcemia
D. hyperkalemia - ✔✔D. hyperkalemia
Initially, the patient has high serum potassium to the metabolic acidosis present from
the ketones. This acidosis pulls potassium from the cell, making the patient
hyperkalemic. As soon as insulin is given, however, potassium re-enters the cell and the
ketosis stops. The initial sodium level in DKA is normal, as is calcium.
✔✔Normal serum osmolality is within the range of:
A. 145-155 mOsm/L
B. 200-250 mOsm/L
C. 275-295 mOsm/L
D. 325-375 mOsm/L - ✔✔C. 275-295 mOsm/L
Normal serum osmolality is 275-295 mOsm/L. Typically, if the osmolality is increased, it
indicates intravascular dehydration. If the osmolality is low, that usually indicates
intravascular fluid overload. In many endocrine abnormalities, intravascular volume is
altered and requires daily monitoring.
✔✔Symptoms of hypoglycemia include:
A. decreased deep tendon reflexes, hypertension and difficulty swallowing
B. increased DTRs, hypertension and slow heart rate
C. increased heart rate, increased irritability, nausea
D. there are no early signs of hypoglycemia - ✔✔C. increased heart rate, increased
irritability, nausea
DTRs, hypertension, and difficulty swallowing are signs of sympathetic nervous system
discharge secondary to the compensatory mechanisms of hypoglycemia. DTRs are
generally not changed with hypoglycemia unless the blood sugar is exceedingly low,
causing severe neurological disruption and seizures. Hypertension is not a complication
of hypogluycemia.
✔✔Blood-sugar elevation in the critically ill adult is common. Which of the following
mechanisms explain this increase in blood sugar in the non-diabetic patient?
, A. medications such as epinephrine
B. shivering
C. temperature elevation
D. change in position - ✔✔A. medications such as epinephrine
Epinephrine is a pure catecholamine. This activates the sympathetic nervous system
thereby increasing blood sugar by the fight or flight mechanism. Shivering, temperature
elevation and changes in position may cause drops in serum glucose as the patient is
utilizing energy.
✔✔A 45-year old woman is admitted with type 1 diabetic mellitus. She is
hyperventilating, has signs of dehydration (increased urine output and increased thirst),
and is tachycardic. Initial treatment would include:
A. Diazoxide (Hyperstat) to inhibit the release of insulin
B. glucose for hypoglycemia
C. insulin therapy for ketoacidosis, fluid and electrolyte replacement
D. intravenous fluids for dehydration and glucose for hypoglycemia - ✔✔C. insulin
therapy for ketoacidosis, fluid and electrolyte replacement
The patient is exhibiting the signs and symptoms of diabetic ketoacidosis (DKA). Signs
of dehydration, such as polydipsia and polyphagia, are due to large urine output,
increased thirst is secondary to dehydration and tachycardia is due to sympathetic
nervous system stimulation from an increased glucose level and ketosis. Initial
treatment would include insulin therapy, re-hydration with fluids and electrolyte
replacement. Diazoxide would not be used since it inhibits insulin release (this patient
requires insulin to lower glucose). The patient is not hypoglycemia. Signs and
symptoms of hypoglycemia are similar; tachycardia, change in behavior (irritability) or
level of consciousness, sweating and shaking.
✔✔To evaluate the outcomes of nutritional intervention for a patient with type 2 diabetes
with a dating blood sugar of 130 mg/dL three months ago, which laboratory result would
best indicate dietary compliance?
A. fasting blood sugar of 106 mg/dL or less
B. hemoglobin A1C of 6.6%
C. hemoglobin A1C of 1.5%
D. fasting blood sugar of 150 mg/dL - ✔✔B. hemoglobin A1C of 6.6%
Hemoglobin A1C best describes the patient's blood sugars over a 3 month period.
Hemoglobin A1C comprises hemoglobin A with a glucose molecule: because
hemoglobin holds onto excess blood glucose, it demonstrates the average blood
glucose levels over a 3 month period and between describes diet and medication
compliance over time. Fasting blood sugar only demonstrates the patient's last 12 hour
dietary discretion.
✔✔The criteria for the diagnosis of metabolic syndrome include:
A. hyperglycemia, hypertension, increased abdominal fat
B. low blood sugar, obesity, history of STEMI
C. low blood sugar, increased triglycerides, normal lipid panel
