PCCN Practice Exam Notes Questions with Correct Solutions, Rated A+

Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizziness, recent K+ lvl is 3.4. What action would you do first? a. emergent defib b. amio 300mg IVP c. emergent cardioversion d. hang 10 mEq KCL/50mL D5W - cORRECT sOLUTION C Upon analyzing a patient's telemetry strip, the nurse observes the following: heart rate of 65 beats per minute, regular rhythm, PR interval of 0.22 seconds, QRS complex duration of 0.10 seconds, and QTc interval of 0.52 seconds. What dysrhythmias should the patient be concerned about? A. Atrial fibrillation due to the widened PR interval. B. Sinus arrhythmia due to the narrow QRS complex. C. Torsades de pointes due to the prolonged QTc interval D. Third-degree heart block due to the narrow PR interval - CORRECT SOLUTION C. QT measurements provide information about the duration of ventricular repolarization. The prolongation of the QT interval is linked to the development of arrhythmias, negative cardiac events, and higher mortality rates. This is due to the fact that a longer QT duration brings the vulnerable ventricular repolarization phase closer to the next depolarization, which in turn increases the chances of R-on-T occurring. Torsades de pointes is a frequently observed arrhythmia that occurs with prolonged QTc. It is uncommon for atrial fibrillation, sinus bradycardia, and third-degree heart block to be linked with prolonged ventricular repolarization (QTc 0.50 seconds). A patient with chronic obstructive pulmonary disease (COPD) is admitted for worsening dyspnea and potential pneumonia. The current ABG results show a pH of 7.19, a PaO2 of 52 mm Hg, a PaCO2 of 68 mm Hg, and an HCO3- level of 32 mmol/L. The nurse would interpret these findings as A. Acidosis of the metabolism accompanied by low oxygen levels. B. Respiratory acidosis with hypoxemia C. Respiratory alkalosis with normal oxygenation levels for a COPD patient D. Metabolic alkalosis with typical oxygenation for a COPD patient - the correct solution is B. The nurse notes the following when analyzing a patient's telemetry strip: HR, 65/min and regular; PR interval, 0.22 seconds; QRS complex, 0.10 seconds; QTc, 0.52 seconds. Which of the following dysrhythmias is the patient at risk for? A. Atrial fibrillation because the PR interval is wide B. Sinus arrhythmia because the QRS complex is narrow C. Torsades de pointes because the QTc is wide D. Third-degree heart block because the PR interval is narrow - cORRECT sOLUTION C. Based on the ABG analysis, the patient is experiencing a respiratory acidosis with hypoxemia most likely due to the pneumonia. A pH of 7.19 indicates acidosis; a PaCO2 of 68 mm Hg is elevated and a cause of acidosis; an HCO3 - of 32 mmol/L indicates renal compensation; a PaO2 of 52 mm Hg indicates hypoxemia 76-year-old patient is receiving gentamicin and linezolid for an infection. Which of the following potential complications is the most important for the nurse to monitor this patient for? A. Acute delirium B. Acute kidney injury C. Acute hepatic failure D. Sepsis - cORRECT sOLUTION B. Gentamicin is a nephrotoxic agent that places patients at risk for acute kidney injury, and this risk is increased in older patients. Acute delirium (A), liver failure (C), and sepsis (D) are all complications that could occur in an older adult with an infection but would not be caused by the administration of an antibiotic. An older patient is experiencing delirium 24 hours following hip replacement. Which intervention might worsen the patient's condition? A. Removing any unnecessary tubes and equipment from the room B. Assessing and treating the patient's pain every 2 hours C. Ensuring that the patient has the means to call for help D. Loosely applying soft restraints - cORRECT sOLUTION D. Older patients are at increased risk for delirium during acute hospitalization. Interventions to manage acute delirium include removing or camouflaging tubes, removing unnecessary equipment, frequently reorienting the patient, and ensuring that the call bell is consistently within reach, assessing and treating pain effectively, and encouraging mobility and involvement in activities of daily living. Restraining the patient is contraindicated in the care of patients with delirium. A patient shows a new slight facial droop and the patient's right arm is weaker than the left. A priority intervention would be to A. Obtain a serum glucose level B. Obtain a full set of vital signs C. Initiate the stroke protocol D. Initiate the code response team - cORRECT sOLUTION C.