Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you're allergic to, such as peanuts or bee stings.Anaphylaxis causes your immune system to release a flood of chemicals that can cause you to go into shock — your blood pressure drops suddenly and your airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting. Common triggers include certain foods, some medications, insect venom and latex.Anaphylaxis requires an injection of epinephrine and a follow-up trip to an emergency room. If you don't have epinephrine, you need to go to an emergency room immediately. If anaphylaxis isn't treated right away, it can be fatal.
Signs And Symptoms
Anaphylaxis symptoms usually occur within minutes of exposure to an allergen. Sometimes, however, it can occur a half-hour or longer after exposure. Signs and symptoms include:
Skin reactions, including hives and itching and flushed or pale skin
Low blood pressure (hypotension)
Constriction of your airways and a swollen tongue or throat, which can cause wheezing and trouble breathing
A weak and rapid pulse
Nausea or vomiting
Causes
The most common anaphylaxis triggers in children are food allergies, such as to peanuts, and tree nuts, fish, shellfish and milk. Besides allergy to peanuts, nuts, fish and shellfish, anaphylaxis triggers in adults include:
Certain medications, including antibiotics, aspirin and other over-the-counter pain relievers, and the intravenous (IV) contrast used in some imaging tests
Stings from bees, yellow jackets, wasps, hornets and fire ants
Latex
Treatment
During an anaphylactic attack, you might receive cardiopulmonary resuscitation (CPR) if you stop breathing or your heart stops beating. You might also be given medications, including:
Epinephrine (adrenaline) to reduce your body's allergic response
Oxygen, to help you breathe
Intravenous (IV) antihistamines and cortisone to reduce inflammation of your air passages and improve breathing
A beta-agonist (such as albuterol) to relieve breathing symptoms
Hypovolemic shock is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body’s blood or fluid supply. This severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood to your body. Hypovolemic shock can lead to organ failure. This condition requires immediate emergency medical attention.Hypovolemic shock is the most common type of shock, with very young children and older adults being the most susceptible.
Causes
Hypovolemic shock results from significant and sudden blood or fluid losses within your body. Blood loss of this magnitude can occur because of:
bleeding from serious cuts or wounds
bleeding from blunt traumatic injuries due to accidents
internal bleeding from abdominal organs or ruptured ectopic pregnancy
bleeding from the digestive tract
significant vaginal bleeding
Endometriosis
In addition to actual blood loss, the loss of body fluids can cause a decrease in blood volume. This can occur in cases of:
excessive or prolonged diarrhea
severe burns
protracted and excessive vomiting
excessive sweating
Blood carries oxygen and other essential substances to your organs and tissues. When heavy bleeding occurs, there is not enough blood in circulation for the heart to be an effective pump. Once your body loses these substances faster than it can replace them, organs in your body begin to shut down and the symptoms of shock occur. Blood pressure plummets, which can be life-threatening.
Signs and Symptoms
The symptoms of hypovolemic shock vary with the severity of the fluid or blood loss. However, all symptoms of shock are life-threatening and need emergency medical treatment. Internal bleeding symptoms may be hard to recognize until the symptoms of shock appear, but external bleeding will be visible. Symptoms of hemorrhagic shock may not appear immediately. Older adults may not experience these symptoms until the shock progresses significantly. Some symptoms are more urgent than others.
Mild symptoms can include:
headache
fatigue
nausea
profuse sweating
dizziness
Severe symptoms, which must be taken seriously and warrant emergency medical attention, include:
cold or clammy skin
pale skin
rapid, shallow breathing
rapid heart rate
little or no urine output
confusion
weakness
weak pulse
blue lips and fingernails
lightheadedness
loss of consciousness
Complications
A lack of blood and fluid in your body can lead to the following complications:
damage to organs such as your kidney or brain
gangrene of the arms or legs
heart attack
The effects of hypovolemic shock depend on the speed at which you’re losing blood or fluids and the amount of blood or fluids you are losing. The extent of your injuries can also determine your chances for survival. Chronic medical conditions such as diabetes, previous stroke, heart, lung, or kidney disease, or taking blood thinners like Coumadin or aspirin can increase the likelihood that you’ll experience more complications from hypovolemic shock.
Treatment
Once at a hospital, a person suspected of having hypovolemic shock will receive fluids or blood products via an intravenous line, to replenish the blood lost and improve circulation. Treatment revolves around controlling loss of fluid and blood, replacing what’s been lost, and stabilizing damage that both caused and resulted from the hypovolemic shock. This will also include treating the injury or illness that caused the shock, if possible.
These include:
blood plasma transfusion
platelet transfusion
red blood cell transfusion
intravenous crystalloids
Doctors may also administer medications that increase the heart’s pumping strength to improve circulation and get blood where it’s needed.
These include:
dopamine
dobutamine
epinephrine
norepinephrine
Antibiotics may be administered to prevent septic shock and bacterial infections.
Close cardiac monitoring will determine the effectiveness of the treatment you receive.
The pancreas is a large gland behind the stomach and next to the small intestine. The pancreas does two things: it releases powerful digestive enzymes into the small intestine to aid the digestion of food, and it releases the hormones insulin and glucagon into the bloodstream. These hormones help the body control how it uses food for energy.
Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage happens when the digestive enzymes are activated before they are released into the small intestine and begin attacking the pancreas. There are two forms of pancreatitis; acute and chronic.
Acute pancreatitis is a sudden inflammation that lasts for a short time. It may range from mild discomfort to a severe life threatening illness. Most people with acute pancreatitis recover completely after getting the right treatment. In severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation.
Chronic pancreatitis is long lasting inflammation of the pancreas. it most often happens after an episode of acute pancreatitis. Heavy alcohol consumption is another big cause.
Signs and Symptoms
Upper abdominal pain that radiates to the back; aggravated by eating, especially foods high in fat
Swollen and tender abdomen
Nausea and vomiting
Fever
Increased heart rate
Pancreatitis Etiology
Gallstones or heavy alcohol use
Medications, infections, trauma
Metabolic disorders and surgery
Treatment of Pancreatitis
Treat the s/s
IV fluids and pain meds
GI Sample Questions
1) Vasopressin may be used in the patients with GI bleeding. What is the mechanism of action of Vasopressin?
A) Increases mesenteric blood flow to reduce ischemia
B) Decreases portal venous blood flow to decrease bleeding
C) Causes sodium and water retention to replace volume
D) Blocks H2 receptors to inhibit hydrochloric acid secretion
2) A 39 y/o male is admitted with a history of chronic liver failure and ETOH abuse. He has ascites and severe peripheral edema. He is anorexic, vomiting, hypokalemic, and now has developed metabolic alkalosis. Which of the following would not be included in this patient's management?
A) Diuretics
B) Potassium supplements
C) Antiemetics
D) Diet high in protein
3) A 52 y/o male patient with acute pancreatitis develops agitation, fine tremors, and tachycardia about 48 hours after admission. Which of the following is the most likely cause of these signs and symptoms?
A) Pancreatic pseudocyst
B) Hypoglycemia
C) Alcohol withdrawal
D) Pancreatic abscess
GI Practice Questions Answer with Rationale
1) Correct Answer - B) Decreases portal venous blood flow to decrease bleeding
Rationale - Vasopressin slows blood loss by constricting the splanchnic arteriolar bed and decreasing portal venous pressure.
2) Correct Answer - A) Diuretics
Rationale - Diuretics would contribute to metabolic alkalosis and hypokalemia and would deplete the vascular bed rather than the third spaces.
3) Correct Answer - C) Alcohol withdrawal
Rationale - Alcoholism is a common cause of acute pancreatitis, and alcohol withdrawal is a complication that must be closely observed for within the first 24 - 72 hours after onset of abstinence.
A brain arteriovenous malformation (AVM) is a tangle of abnormal blood vessels connecting arteries and veins in the brain. The arteries are responsible for taking oxygen rich blood from the heart to the brain. Veins carry the oxygen depleted blood back to the lungs and heart. A brain AVM disrupts this vital process. An AVM can develop anywhere in your body but occurs most often in the brain or spine. Even so, brain AVM's are rare and affect less than 1% of the population. Some of the causes of brain AVM is unknown, but researchers believe most brain AVMs emerge during fetal development.
A brain AVM may not cause any signs or symptoms until the AVM ruptures, resulting in bleeding in the brain (hemorrhage). In about half of all brain AVMs, hemorrhage is the first sign. Some of the signs and symptoms are listed below...
Seizures
Headache
Muscle weakness or numbness in one part of the body
Vision loss
Difficulty speaking
Confusion
Severe unsteadiness
Risk Factors for AVM
Anyone can be born with a brain AVM, but these risk factors may include
Males - AVM's are more common in males
Family history
Complications
Bleeding in the brain (hemorrhage)
Reduced oxygen to brain tissue
Thin or weak blood vessels
Brain damage
Diagnosis
Cerebral arteriography
CT scan of the head
MRI of the brain
Treatment
Surgical removal (resection)
Endovascular embolization
Stereotactic Radiosurgery (SRS)
PCCN Exam - Practice Questions
1) A patient with a traumatic brain injury (TBI) has just been admitted after resuscitation in the emergency room department. Which of the following initial studies should the nurse anticipate in this patient?
A) Magnetic resonance imaging (MRI) of the brain
B) Computed tomography (CT) scan of the head
C) Lumbar puncture (LP)
D) Cerebral angiography
2) A patient presents with new-onset seizures. Diagnostic imaging reveals a 4 cm right posterior frontal arteriovenous malformation. In planning this patient's nursing care needs, which of the following conditions should the nurse anticipate?
A) Left-sided weakness
B) Receptive aphasia
C) Left homonymous hemianopsia
D) Sensory deficits on the right face and arm
3) A patient admitted last night with subarachnoid hemorrhage returned from the operating room 4 hours ago following aneurysm clipping. On admission, the patient was assessed as a Hunt and Hess Grade II. The patient now appears to be stuporous with significant left hemiparesis. The nurse should
A) Note that this is consistent with the Hunt and Hess appraisal at admission
B) Contact the neurosurgeon to communicate the examination findings
C) Adjust IV infusion rate because the aneurysm may have rebleed
D) Prepare for ventriculostomy insertion by the physician so hydrocephalus can be treated.
4) During report, the nurse is told that a patient with an intracranial hemorrhage has GCS values of 3 - 3 - 4. Evaluation of the patient's progress is based on the nurse's knowledge that this patient
A) Opens his eyes when spoke to
B) Follows simple commands
C) Makes no attempt to remove noxious stimuli
D) Makes no attempt to vocalize
5) A 25 y/o admitted patient has a generalized tonic clonic seizure. After the seizure has subsided, the nurse expects the patient to exhibit which of the following as a characteristic behavior after a seizure?
A) Restlessness
B) Lethargy
C) Automatisms
D) Incontinence
PCCN Practice Questions Answer with Rationale
1) Correct Answer - B) Computed tomography (CT) scan of the head
Rationale - CT scan of the head is useful for looking at bone and blood and is the best imaging study to view most intracranial processes, including trauma, intracerebral hemorrhage, and hydrocephalus.
2) Correct Answer - A) Left-sided weakness
Rationale - The location of the AVM suggests which deficit the nurse needs to anticipate. A lesion in the right frontal area would be expected to affect voluntary motor control on the left side of the body. Comprehension of spoken language.
3) Correct Answer - B) Contact the neurosurgeon to communicate the examination findings
Rationale - The patient is now a Hunt and Hess Grade IV, a substantial deterioration compared to the initial Grade II (Grades range from I to V, with Grade I identifying alert patients with mild headache and stiff neck and Grade V identifying patients in coma. The most appropriate action would be to notify the neurosurgeon, who may request a head CT scan or angiography.
4) Correct Answer - A) Opens his eyes when spoke to
Rationale - The GCS is an internationally recognized standardized assessment tool that evaluates level of consciousness, the most sensitive indicator of cerebral function. The patient's best responses in three areas, eye opening, motor response, and verbal response.
5) Correct Answer - B) Lethargy
Rationale - Typical postictal behavior includes confusion, lethargy, HA, and somnolence. The patient will usually sleep for an extended period following a seizure.
The Gastrointestinal section of the PCCN Certification will encompass a very small portion of the PCCN exam. This particular section will have approximately 5 to 8 questions on the exam. Although that is a very small portion in comparison to everything else on the exam, it is imperative that you get all of these questions correct. If you are able to answer all of the GI questions correct, you will have some latitude when answering other parts of the exam. In this article we will cover the Gastrointestinal outline of the PCCN exam, a broad overview of GI anatomy and physiology, and cover some GI practice questions.
Gastrointestinal Outline
Acute Abdominal Trauma
Acute GI Hemorrhage
Acute Abdomen
GI Surgeries
Hepatic Failure/Coma
Pancreatitis
Gastro-esophageal Reflux
GI Anatomy & Physiology
The human GI tract is an organ system responsible for transporting and digesting food, absorbing nutrients, and expelling waste. The GI tract consists of the stomach, and is divided into the upper and lower GI tracts and the small and large intestines. The GI tract includes all structures between the mouth and the anus, forming a continuous passageway that includes the main organs of digestion, namely the stomach, small intestine, and large intestine. The whole human GI tract is about 30 feet long at autopsy. It is considerably shorter in the living body because the intestines, which are tubes of smooth muscle tissue, maintaining a constant muscle tone.
Pancreatitis
The pancreas is a large gland behind the stomach and next to the small intestine. The pancreas does two things: it releases powerful digestive enzymes into the small intestine to aid the digestion of food, and it releases the hormones insulin and glucagon into the bloodstream. These hormones help the body control how it uses food for energy.
Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage happens when the digestive enzymes are activated before they are released into the small intestine and begin attacking the pancreas. There are two forms of pancreatitis; acute and chronic.
Acute pancreatitis is a sudden inflammation that lasts for a short time. It may range from mild discomfort to a severe life threatening illness. Most people with acute pancreatitis recover completely after getting the right treatment. In severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation.
Chronic pancreatitis is long lasting inflammation of the pancreas. it most often happens after an episode of acute pancreatitis. Heavy alcohol consumption is another big cause.
Signs and Symptoms
Upper abdominal pain that radiates to the back; aggravated by eating, especially foods high in fat
Swollen and tender abdomen
Nausea and vomiting
Fever
Increased heart rate
Pancreatitis Etiology
Gallstones or heavy alcohol use
Medications, infections, trauma
Metabolic disorders and surgery
Treatment of Pancreatitis
Treat the s/s
IV fluids and pain meds
PCCN GI Sample Questions
1) Vasopressin may be used in the patients with GI bleeding. What is the mechanism of action of Vasopressin?
A) Increases mesenteric blood flow to reduce ischemia
B) Decreases portal venous blood flow to decrease bleeding
C) Causes sodium and water retention to replace volume
D) Blocks H2 receptors to inhibit hydrochloric acid secretion
2) A 39 y/o male is admitted with a history of chronic liver failure and ETOH abuse. He has ascites and severe peripheral edema. He is anorexic, vomiting, hypokalemic, and now has developed metabolic alkalosis. Which of the following would not be included in this patient's management?
A) Diuretics
B) Potassium supplements
C) Antiemetics
D) Diet high in protein
3) A 52 y/o male patient with acute pancreatitis develops agitation, fine tremors, and tachycardia about 48 hours after admission. Which of the following is the most likely cause of these signs and symptoms?
A) Pancreatic pseudocyst
B) Hypoglycemia
C) Alcohol withdrawal
D) Pancreatic abscess
PCCN GI Practice Questions Answer with Rationale
1) Correct Answer - B) Decreases portal venous blood flow to decrease bleeding
Rationale - Vasopressin slows blood loss by constricting the splanchnic arteriolar bed and decreasing portal venous pressure.
2) Correct Answer - A) Diuretics
Rationale - Diuretics would contribute to metabolic alkalosis and hypokalemia and would deplete the vascular bed rather than the third spaces.
3) Correct Answer - C) Alcohol withdrawal
Rationale - Alcoholism is a common cause of acute pancreatitis, and alcohol withdrawal is a complication that must be closely observed for within the first 24 - 72 hours after onset of abstinence.
The Neurology portion of the PCCN exam will include roughly 20 questions or more. This is a fairly large portion of the exam. It is very important that you have a really good grasp on the particular section of the exam. The Cardiac, Pulmonary, and Neurology is the bulk of the PCCN exam. In this article, we will cover some of the content on the Neurology portion of the PCCN exam, Neurology Anatomy and Physiology, AV Malformation Overview and some of the PCCN Neurology practice questions that we have embedded in our PCCN Online Course and PCCN Question Bank.
PCCN Neurology Exam Outline
Aneurysm, AV Malformation
Encephalopathy
Head Trauma, Skull Fractures
Intracranial/Intraventricular Hemorrhage
Neurologic Infectious Diseases
Seizure Disorders, Stroke
Neurology Anatomy and Physiology
The nervous system is the part of an animal's body that coordinates its voluntary and involuntary actions and transmits signals to and from different parts of its body. The nervous system consists of 2 main parts; the central nervous system and the peripheral nervous system. The CNS contains the brain and spinal cord. The PNS consists mainly of nerves, which are enclosed bundles of the long fibers or axons, that connect the CNS to every other part of the body.
The autonomic nervous system is divided into the sympathetic (SNS) and parasympathetic nervous systems (PSNS). The SNS is activated in cases of emergencies to mobilize energy, while the PSNS is activated when organisms are in a related state. The enteric nervous system functions to control the gastrointestinal system. Both autonomic and enteric nervous systems function involuntarily. Nerves that exit from the cranium are called cranial nerves while those exiting from the spinal cord are called spinal nerves.
PCCN Neurology Exam Practice Questions
1) A patient with a traumatic brain injury (TBI) has just been admitted after resuscitation in the emergency room department. Which of the following initial studies should the nurse anticipate in this patient?
A) Magnetic resonance imaging (MRI) of the brain
B) Computed tomography (CT) scan of the head
C) Lumbar puncture (LP)
D) Cerebral angiography
2) A patient presents with new-onset seizures. Diagnostic imaging reveals a 4 cm right posterior frontal arteriovenous malformation. In planning this patient's nursing care needs, which of the following conditions should the nurse anticipate?
A) Left-sided weakness
B) Receptive aphasia
C) Left homonymous hemianopsia
D) Sensory deficits on the right face and arm
3) A patient admitted last night with subarachnoid hemorrhage returned from the operating room 4 hours ago following aneurysm clipping. On admission, the patient was assessed as a Hunt and Hess Grade II. The patient now appears to be stuporous with significant left hemiparesis. The nurse should
A) Note that this is consistent with the Hunt and Hess appraisal at admission
B) Contact the neurosurgeon to communicate the examination findings
C) Adjust IV infusion rate because the aneurysm may have rebleed
D) Prepare for ventriculostomy insertion by the physician so hydrocephalus can be treated.
4) During report, the nurse is told that a patient with an intracranial hemorrhage has GCS values of 3 - 3 - 4. Evaluation of the patient's progress is based on the nurse's knowledge that this patient
A) Opens his eyes when spoke to
B) Follows simple commands
C) Makes no attempt to remove noxious stimuli
D) Makes no attempt to vocalize
5) A 25 y/o admitted patient has a generalized tonic clonic seizure. After the seizure has subsided, the nurse expects the patient to exhibit which of the following as a characteristic behavior after a seizure?
A) Restlessness
B) Lethargy
C) Automatisms
D) Incontinence
PCCN Neurology Exam - Sample Questions Answer with Rationale
1) Correct Answer - B) Computed tomography (CT) scan of the head
Rationale - CT scan of the head is useful for looking at bone and blood and is the best imaging study to view most intracranial processes, including trauma, intracerebral hemorrhage, and hydrocephalus.
2) Correct Answer - A) Left-sided weakness
Rationale - The location of the AVM suggests which deficit the nurse needs to anticipate. A lesion in the right frontal area would be expected to affect voluntary motor control on the left side of the body. Comprehension of spoken language.
3) Correct Answer - B) Contact the neurosurgeon to communicate the examination findings
Rationale - The patient is now a Hunt and Hess Grade IV, a substantial deterioration compared to the initial Grade II (Grades range from I to V, with Grade I identifying alert patients with mild headache and stiff neck and Grade V identifying patients in coma. The most appropriate action would be to notify the neurosurgeon, who may request a head CT scan or angiography.
4) Correct Answer - A) Opens his eyes when spoke to
Rationale - The GCS is an internationally recognized standardized assessment tool that evaluates level of consciousness, the most sensitive indicator of cerebral function. The patient's best responses in three areas, eye opening, motor response, and verbal response.
5) Correct Answer - B) Lethargy
Rationale - Typical postictal behavior includes confusion, lethargy, HA, and somnolence. The patient will usually sleep for an extended period following a seizure.
The PCCN Exam outline includes a host of content that will be included on the national exam. Including but not limited to Hematology. The Hematology section of the PCCN exam will include roughly 5 to 8 questions. Although this section does not account for a large percentage of the exam, it would be wise to try and answer all of the questions in the section appropriately so as to give yourself a better chance in other areas. In this article we will cover the outline of the Hematology section, an overview of Hematology (broad), and some PCCN Hematology practice questions with rationales.
Hematology Outline
Blood Products and Plasma
HIV, AIDS, Neoplasms
Life Threatening Coagulopathies
Organ Transplantation
Sickle Cell Crisis (Trait, Anemia)
Hematology Overview
Hematology is the branch of medicine concerned with the study, diagnosis, treatment, and prevention of diseases related to blood. Hematology involves treating diseases that affect the production of blood and its components, such as blood cells, hemoglobin, blood proteins, bone marrow, platelets, blood vessels, spleen, and the mechanism of coagulation. Hematologists also conduct studies in oncology and work with oncologists.
Sickle Cell Anemia
Sickle Cell Anemia is an inherited form of anemia; a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout your body. Normally, your red blood cells are flexible and round, moving easily through your blood vessels. In sickle cell anemia, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block flow and oxygen to parts of the body. There's no cure for most people with sickle cell anemia. However, treatments can relieve pain and help prevent further problems associated with sickle cell anemia.
Sickle Cell Anemia S/S
Signs and symptoms of sickle cell anemia often don't appear until an infant is at least 4 months old and may include; anemia, episodes of pain, hand foot syndrome, frequent infections, delayed growth, and vision problems.
Sickle Cell Anemia Causes
Sickle cell anemia is caused by a mutation in the gene that tells your body to make hemoglobin; the red, iron rich compound that gives blood its red color. Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, and sticky. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and father must pass on the defective form of the gene for a child to be affected. With each pregnancy, two people with sickle cell traits have: a 25% chance of having an unaffected child with normal hemoglobin; a 50% chance of having a child who also is a carrier; and a 25 % chance of having a child with sickle cell anemia. The risk of inheriting sickle cell anemia comes down to genetics. For a baby to be born with sickle cell anemia, both parents must carry a sickle cell gene. Sickle cell anemia most commonly affects African Americans.
Sickle Cell Anemia Complications
Sickle cell anemia can lead to a host of complications, including; stroke, acute chest syndrome, pulmonary hypertension, organ damage, blindness, skin ulcers, gallstones and priapism. Treatment is aimed at treating the signs and symptoms.
PCCN Hematology Practice Questions
1) In the early stages of idiopathic thrombocytopenic purpura, (ITP), nursing interventions primarily focus on
A) Maintaining a patent airway
B) Controlling the respiratory rate
C) Replenishing circulating blood volume
D) Coping with alterations in body image
2) A patient with neutropenia has been placed in protective isolation. When providing care for this patient, it is important the nurse keeps in mind that the most common source of infection in immunocompromised patients is
A) Hospital equipment contaminated with pathogens
B) Poorly cleansed hands of health care workers
C) Normal flora and fauna from the patient's body
D) Family members coughing or sneezing on the patient
3) A patient experiencing renal transplantation has been having an unremarkable recovery over the previous 4 days. Which of the following findings would the nurse need to report to the physician immediately?
A) Abdominal discomfort and bladder distention
B) Increasing urinary output with decreasing serum creatinine
C) RUQ tenderness with elevated serum bilirubin
D) Elevated glucose and decreasing LOC
4) A patient about to receive a bone marrow transplant is in strict isolation and expressing feelings of anxiety. Nursing measures appropriate to this situation include
A) Playing music the patient enjoys and allowing photographs at the bedside
B) Allowing the patient's cat to visit for a pet therapy session
C) Encouraging the patient's school aged grandchildren to visit
D) Asking family members to bring in fresh produce as comfort food
5) A patient with HIV/AIDS is admitted complaining of weakness, weight loss of 25 pounds over the past month, fever, chills, and diarrhea. The patient's CD 4 count is 40. While taking the admission history, the nurse learns that the patient has two pet cats and a parrot. Which of the following opportunistic pathogens could be contributing to this patient's current clinical picture?
A) Pneumocystis carini
B) Cryptococcus
C) Toxoplasmosis
D) Mycobacterium avium
PCCN Hematology Practice Questions Answer with Rationale
1) Correct Answer - C) Replenishing circulating blood volume
Rationale - ITP is a deficiency of platelets with measurable amounts of antiplatelets antibodies resulting in bleeding into the skin and other organs. Acute ITP is generally a disease that affects children, while chronic ITP is generally experienced by adolescents and adults. Because of blood loss, replacing circulating blood volume is the primary goal when managing patients with ITP.
2) Correct Answer - C) Normal flora and fauna from the patient's body
Rationale - As the patient's natural immunity declines, his or her own normal body flora and fauna become the major source of opportunistic infections. While all of the other choices may contribute to the development of illness, they pose danger to the patient transiently and episodically rather than continually.
3) Correct Answer - A) Abdominal discomfort and bladder distention
Rationale - Abdominal discomfort and bladder distention indicate urinary tract obstruction, which could progress to renal transplant graft failure. An increase in urinary output and decreasing serum creatinine indicate improved renal function.
4) Correct Answer - A) Playing music the patient enjoys and allowing photographs at the bedside
Rationale - Allowing the patient to have things that make him or her feel more at home helps to reduce anxiety. Cats tend to carry many pathogens, owing to their bathing habits and litter box use, that could become opportunistic for this patient.
5) Correct Answer - D) Mycobacterium avium
Rationale - The symptoms evidenced (diarrhea, weight loss, fever with chills, and weakness) as well as contact with birds suggest the likelihood of Mycobacterium avium infection.
The Endocrine portion of the PCCN Exam will encompass roughly 5 to 8 questions on the national exam. In comparison to a lot of the other sections, this is a relatively small portion of the exam. Nevertheless, this is a significant portion in the event you get all of the Endocrine questions incorrect. It would be wise to put as much emphasis on this section as you do on the other sections of the exam. In this article, we will cover the PCCN Exam outline as it relates to the Endocrine section. We will also cover Diabetes Insipidus which is one of the areas of focus on the PCCN exam as well as some practice questions.
PCCN Exam Endocrine Outline
Endocrine Hormones
Diabetes Insipidus
Diabetic Ketoacidosis
Hyperglycemic Hyperosmolar Nonketotic Coma (HHNK)
Endocrine Anatomy & Physiology
The Endocrine system refers to the collection of glands of an organism that secrete hormones directly into the circulatory system to be carried towards distant target organs. The major endocrine glands include the pineal gland, pituitary gland, pancreas, ovaries, testes, thyroid gland, parathyroid gland, hypothalamus, gastrointestinal tract and adrenal glands. The endocrine system is in contrast to the exocrine system, which secretes its hormones to the outside of the body using ducts. Special features of endocrine glands are, in general, their ductless nature, their vascularity, and commonly the presence of intracellular vacuoles or granules that store their hormones. In contrast, exocrine glands, such as salivary glands, sweat glands, and glands within the GI tract, tend to be much less vascular and have ducts or a hollow lumen.
Diabetes Insipidus
DI is a condition characterized by excessive thirst and excretion of large amounts of severely dilute urine, with reduction of fluid intake having no effect on the concentration of urine. There are different types of DI, each with a different set of causes. The most common type is central DI, which involves a deficiency of vasopressin, also known as antidiuretic hormone (ADH). The second common type of DI is nephrogenic DI, which is due to kidney or nephron dysfunction caused by an insensitivity of the kidneys or nephrons to ADH. DI can also be gestational, or caused by alcohol or some types of drug abuse. DI should not be confused with nocturia.
Signs & Symptoms of DI
Excessive urination
Extreme thirst
Blurred vision
Diagnosis of DI
Water deprivation test
Urinalysis
MRI of brain
Genetic screening
Classification of DI
Neurogenic DI - more commonly known as central diabetes insipidus, is due to the lack of vasopressin production in the hypothalamus due to a range of causes. The underlying causes of central DI can include vascular, autoimmune, infection, sarcoidosis, some drugs, surgery, head trauma, benign or metastatic pituitary-hypothalamic tumor, although 50% of cases are found to be idiopathic.
Nephrogenic DI - is due to the inability of the kidney to respond normally to vasopressin.
Primary Polydipsia or Dipsogenic DI - results from excessive intake of fluids as opposed to deficiency of arginine vasopressin. It may be due to a defect or damage to the thirst mechanism, located in the hypothalamus, or due to mental illness. Treatment with DDAVP may lead to water intoxication.
Gestational DI - occurs only during pregnancy and the postpartum period. During pregnancy, women produce vasopressinase in the placenta, which breaks down ADH. Gestational DI is thought to occur with excessive production and/or impaired clearance of vasopressinase.
Treatment of DI
Central DI (Neurogenic) - because the cause of this form of DI is a lack of anti-diuretic hormone (ADH), treatment is usually with a synthetic hormone called desmopressin. You can take desmopressin as a nasal spray, as oral tablets or by injection.
Nephrogenic DI - this condition is the result of your kidneys not properly responding to ADH, so desmopressin is not a treatment option. Instead, your doctor may prescribe a low salt diet to help reduce the amount of urine your kidneys make. You'll also need to drink enough water to avoid dehydration.
Gestational DI - treatment for most cases of gestational DI is with the synthetic hormone desmopressin.
Primary polydipsia - there is no specific treatment for this form of DI, other than decreasing the amount of fluid intake. However, if the condition is caused by mental illness, treating the mental illness may relieve the symptoms.
PCCN Endocrine Practice Questions
1) Which of the following statements regarding fluid management is correct, regarding patients with diabetes insipidus?
A) Electrolyte levels must be monitored to determine the correct IV fluids to administer
B) If the diabetes insipidus is nephrogenic, vasopressin will need to be administered
C) If the diabetes insipidus is neurogenic, only fluids will need replacement
D) The patient's output must exceed his intake in order to prevent complications
2) The nurse is performing an admission health assessment on a newly diagnosed 54 year old male admitted with diabetes insipidus. Which of the following assessment findings would the nurse expect to see in a patient with that condition?
A) Elevated SBP, tachycardia, decreased urinary output
B) Elevated serum potassium, bradycardia, numbness in hands
C) Polyuria, extreme thirst, decreased urinary specific gravity
D) Widened pulse pressures, dilated pupils, decerebrate posturing
3) Which of the following signs are characteristic of diabetes insipidus?
A) Low urine output, low serum osmolality, hyponatremia, and low urine sodium
B) Elevated urine output, low serum osmolality, hyponatremia, and low urine sodium
C) Low urine output, low serum osmolality, hypernatremia, and elevated urine sodium
D) Elevated urine output, elevated serum osmolality, hypernatremia, and low urine sodium
PCCN Endocrine Practice Questions Answer with Rationale
1) Correct Answer - A) Electrolyte levels must be monitored to determine the correct IV fluids to administer
Rationale - Regardless of the cause or type of diabetes insipidus, the patients electrolyte values will govern appropriate treatment for this disorder. In nephrogenic diabetes insipidus, the kidney has been damaged and no longer responds to vasopressin, so aggressive replacement of fluids is required to sustain life.
2) Correct Answer - C) Polyuria, extreme thirst, decreased urinary specific gravity
Rationale - Patients with diabetes insipidus would be expected to be thirsty and produce large volumes of dilute urine. They will usually exhibit a decrease in BP and increase in HR related to hypovolemia.
The Cardiac portion of the PCCN exam covers the majority of the exam. The cardiac section will consist of roughly 20 to 25 questions on the PCCN exam. This is the majority of the exam so it is imperative that you focus a lot of your attention on this area. This post will give you a brief outline of what to expect from the cardiac portion of PCCN exam. We will briefly cover the cardiovascular system and some of its major components. Listed below is a detailed outline of what to expect from the cardiac portion of the PCCN exam followed by a brief overview of the cardiovascular system.
Cardiovascular
ACS, Angina, Acute MI
Acute Heart Failure/Pulmonary Edema
Acute Inflammatory Disease
Acute Peripheral Vascular Insufficiency
Cardiac Surgery and Trauma
Cardiac Tamponade
Cardiogenic Shock
Cardiomyopathies
Hypertensive Crisis
Hypovolemic Shock
Valvular Defects
Ruptured or Dissecting Aneurysms
ECG/Pacemakers, Pharmacology
PCCN Cardiovascular Exam
The circulatory system, also called the cardiovascular or vascular system, is an organ system that permits blood to circulate and transport nutrients, oxygen, carbon dioxide, hormones, and blood cells to and from the cells in the body to provide nourishment and help in fighting diseases, stabilize temperature and pH, and maintain homeostasis. The study of the blood flow is called hemodynamics. The study of the properties of the blood flow is called hemorrheology. Take a look at some of the cardiac practice questions below.
PCCN Cardiac Exam Prep Questions
1) Which of the following rhythm disturbances would be most likely to occur in a patient who has a serum potassium level of 8.1 mEq/L?
A) Second-degree heart block, Mobitz Type II, and asystole
B) PAC's and ventricular tachycardia
C) Right bundle-branch block
D) Paroxysmal atrial tachycardia
2) A 65 y/o patient admitted with CHF develops hypotension, tachycardia, decreasing UO, cool clammy skin, decreasing LOC, and tachypnea. Which of the following would be included in the patient's plan of care?
A) Positive inotropic agents, vasodilators, diuretics
B) ACE inhibitors, adenosine, beta-blockers
C) Beta-blockers, diuretics, calcium channel blockers
D) Negative inotropic agents, digoxin, antidysrhythmics
3) A 57 year old patient is experiencing insomnia and associated agitation. The patient prefers not to take a controlled substance as a sleep aid. In addition to reducing noise and interruptions, which of the following interventions has been shown to be both valuable and feasible in this situation?
A) Massage therapy
B) Aromatherapy
C) Alternative sedative
D) Progressive muscle relaxation
4) A 47 year old patient from the Mediterranean is admitted for unstable angina. The patient reports substernal chest pain 8/10, radiating down his left arm. VS are BP 134/76 mm Hg, HR 104 bpm, RR 22 bpm, Temp 98.4. Which of the following meds should be administered with caution to this patient?
A) Aspirin
B) Lopressor
C) Nitroglycerin
D) Morphine
5) The nurse is caring for a 39 y/o male patient who had a CABG 5 days ago. The patient has become increasingly anxious and irritable over the past 4 to 6 hrs. He sometimes holds his head and says it hurts but is unable to grade the pain on a scale of 1 to 10. He is oriented to person. Which of the following interventions should the nurse perform first?
A) Dipstick urine for specific gravity
B) Medicate with oral Tylenol
C) Measure capillary glucose levels
D) Apply soft limb restraints to wrists
PCCN Cardiac Exam Prep Questions Answer with Rationale
1) Correct Answer - A) Second-degree heart block, Mobitz Type II, and asystole
Rationale - Hyperkalemia causes depression in AV conduction and leads to heart block.
2) Correct Answer - A) Positive inotropic agents, vasodilators, diuretics
3) Correct Answer - A) Massage therapy
Rationale - Studies have demonstrated that massage, music therapy, and therapeutic touch promote relaxation and comfort to critically ill patients.
4) Correct Answer - A) Aspirin
Rationale - Many Mediterranean males have a glucose-6-phosphate dehydrogenase enzyme deficiency. This genetic variation increases the risk for hemolysis if the patient receives aspirin.
5) Correct Answer - C) Measure capillary glucose levels
Rationale - The patient is exhibiting anxiousness, irritability, and confusion, all of which could be a sign of hypoglycemia.
The Pulmonary AKA Respiratory system is a biological system consisting of specific organs and structures used for the process of respiration in an organism. The respiratory system is involved in the intake and exchange of oxygen and carbon dioxide between an organism and the environment.
Parts of the Respiratory System
As we breathe, oxygen enters the nose or mouth and passes the sinuses, which are hollow spaces in the skull. Sinuses help regulates the temperature and humidity of the air we breathe.
The trachea, also called the windpipe, filters the air that is inhaled, according to the American Lung Association. It branches into the bronchi, which are two tubes that carry air into each lung. The bronchial tubes are lined with tiny hairs called cilia. Cilia move back and forth, carrying mucus up and out. Mucus, a sticky fluid, collects dust, germs and other matter that has invaded the lungs. We expel mucus when we sneeze, cough, spit, or swallow.
The bronchial tubes lead to the lobes of the lungs. The right lung has three lobes; the left lung has two. The left lung is smaller to allow room for the heart. Lobes are filled with small, spongy sacs called alveoli, and this is where the exchange of oxygen and carbon dioxide occurs.
The alveolar walls are extremely thin. These walls are composed of a single layer of tissues called epithelial cells and tiny blood vessels called pulmonary capillaries.
Blood passes through the capillaries. The pulmonary artery carries blood containing carbon dioxide to the air sacs, where the gas moves from the blood to the air. Oxygenated blood goes to the heart through the pulmonary vein, and the heart pumps it throughout the body.
The diaphragm, a dome shaped muscle at the bottom of the lungs, controls breathing and separates the chest cavity from the abdominal cavity. When a breath is taken, it flattens out and pulls forward, making more space for the lungs. During exhalation, the diaphragm expands and forces air out.
Structures of the Pulmonary System
Airways
Blood vessels
Chest wall
Lungs
Lobes
Segments
Lobules
Conducting Airways
Upper Airways
Nasopharynx
Oropharynx
Larynx
Connects upper and lower airwars
Lower airways
Trachea
Bronchi
Terminal bronchioles
Pulmonary and Bronchial Circulation
Pulmonary circulation has a lower pressure than the systemic circulation
One third of pulmonary vessels are filled with blood at any given time
Pulmonary artery divides and enters the lung at the hilus
Each bronchus and bronchiole has an accompanying artery or arteriole
Chest Wall and Pleura
Chest Wall
Skin, ribs and intercostal muscles
Thoracic cavity
Pleura
Serous membrane
Parietal and visceral layers
Pleural space
Pleural fluid
Gas Transport
Four Steps
Ventilation of the lungs
Diffusion of oxygen from the alveoli into the capillary blood
Perfusion of systemic capillaries with oxygenated blood
Diffusion of oxygen from systemic capillaries into the cells
