PCCN Questions with Correct Answers

A pt with history of taking gentamicin (Garamycin) is admitted with oliguria, confusion, lethargy, nausea and vomiting. Lab data are as follows BUN 26 Cr 1.6 Na 130 K 4.9 Calcium 7.8 Which of the following should the nurse suspect A. dehydration B. acute tubular necrosis C. GI infection D. chronic renal failure Correct Answer B. This pt has received a nephrotoxic agent, which puts the pt at risk for development of ATN. Lab data support this diagnosis with an elevated BUN, creatinine and potassium. Calcium and sodium levels will be decreased. After a STEMI, a pt suddenly experiences a decreased level consciousness, a weak and thready pulse and posterior crackles in the lower half of the lung fields bilaterally. Data are as follows BP 76/43 HR 139 RR 24 UO 5 ml for the past hour O2 sat 88% on 2 L via nasal (from 97%) The nurse should suspect which of the ff causes A. CVA B. cardiogenic shock c. pulmonary embolus D. ARDS Correct Answer B. This pt has a primary risk factor (STEMI) and signs of cardiogenic shock. The hypotension is caused by a decrease in contractility of cardiac muscle. Compensatory mechanisms of tachycardia and tachypnea result. A decrease in urine output, decreased level of consciousness, crackles and a weak and thready pulse result from hypoperfusion associated with the condition. A frail, elderly pt recovering from an exploratory laparotomy was extubated following a prolonged period of mechanical ventilation and IV sedation. She continues to receive PRN opioids for pain. Today, the nurse notes occasional combativeness, fluctuating lethargy and poor short-term memory. Data are as follows BP 104/60 HR 87 RR 24 O2 sat 95% on 2L via NC The nurse should recognize that A. mobilization should be limited to prevent injury B. the RASS scale should guide medication administration C. the use of Haldol is associated with lethal dysrhythmias D. moving the pt to a room with a window is a useful distraction technique Correct Answer C. The most current guidelines advise cautious use of antipsychotic meds to manage delirium, as risk versus benefits data remain unclear. Another choice may be a short-term trial of an atypical antipsychotic such as Quetiapine (Seroquel) The physician gave metoprolol (Lopressor) to a patient with rapid afib 5 minutes ago without effect for rate control and is currently administering IV diltiazem (Cardizem); BP is 94/60. Which of the following should the nurse anticipate. A. calcium chloride B. synchronized cardioversion C. digoxin D. transcutaneous pacing Correct Answer D. A beta-blocker and calcium channel blocker combination should be used with caution. When drugs from these 2 classes are given together, the additive effect is the potent suppression of the AV node. Having transcutaneous pacing nearby can help the pt be treated early if this complication develops. A pt with HF is on a diuretic and fluid restriction. Assessment indicated atrial tachycardia with a rate of 130, presence of crackles in all lung fields, an S3 at the left apex and BP of 90/40 (previously 130/60). The patient reports feeling SOB. The nurse should anticipate administration of A. a fluid bolus to enhace preload B. dopamine to support BP C. dobutamine to augment cardiac output D. adenosine to reverse tachycardia Correct Answer C. In pt with decompensated heart failure, use of intravenous inotropic agents such as dobutamine may be indicated to support cardiac function and cardiac output. The dysrhythmia most commonly associated with mitral stenosis is A. 2nd degree AB block type II B. idioventricular rhythm C. sinus bradycardia D. afib Correct Answer D. Mitral stenosis increases the risk of developing atrial fibrillation because of high pressures in the left atrium that will stimulate left atrial remodeling and enlargement. A pt with an elevated BMI is having fluctuations in BP, HR and oxygen saturation, and reports feeling sleepy and fatigued despite intershift report of the pt sleeping. The nurse noted periods of irritability and memory deficits. Which of the ff interventions is indicated A. monitoring for hypotension B. administering small doses of benzodiazepines C. performing a mini-mental status exam D. collaborating with the physician for use of a CPAP mask Correct AnswerD. This pt has primary risk factor (obesity) and symptoms of obstructive sleep apnea. Continuous positive airway pressure (CPAP) may be initiated if the pt CO2 level is stable and acceptable.