PCCN

PCCN DKA Overview

Pathophysiology

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.  DKA happens predominantly in those with Type 1 diabetes, but it can occur in those with Type 2 diabetes under certain circumstances.  This condition develops when you body can't produce enough insulin.  Insulin normally plays a key role in helping sugar (glucose) - a major source of energy for your muscles and other tissues - enter your cells.  Without enough insulin, your body begins to break down fat as fuel.  This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.   DKA is medical emergency, and without treatment it can lead to death.

Signs & Symptoms of DKA

DKA s/s often develop quickly, sometimes within 24 hours.  For some, these s/s may be the first indication of having diabetes.

• Excessive thirst
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Weakness or fatigue
• Fruity scented breath
• Confusion

Causes of DKA

Sugar is a main source of energy for the cells that make up your muscles and other tissues.  Normally, insulin helps sugar enter your cells.  Without enough insulin, your body can't use sugar properly for energy.  This prompts the release of hormones that break down fat as fuel, which produces acids known as ketones.  Excess ketones build up in the blood and eventually spill over into the urine.

• DKA is usually triggered by
• An illness - an infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol.
• A problem with insulin therapy - missed insulin treatments or inadequate insulin therapy can leave you with too little insulin in your system, triggering DKA.
• Physical or emotional trauma
• Heart attack
• Alcohol or drug abuse, particularly cocaine
• Corticosteroids and some diuretics

Risk Factors of DKA

• Have Type 1 diabetes
• Frequently miss insulin doses
• May occur in Type 2 diabetes (uncommon)

Complications

DKA is treated with fluids, electrolytes such as sodium, potassium, and chloride and insulin.  Perhaps surprisingly, the most common complications of DKA are related to this lifesaving treatments. Treatment complications include

• Low blood sugar (hypoglycemia)
• Low potassium (hypokalemia)
• Swelling in the brain (cerebral edema)

Treatment of DKA

• Fluid replacement
• Electrolyte replacement
• Insulin therapy

Prevention of DKA

• Commit to managing your diabetes
• Monitor your blood sugar level
• Adjust your insulin dosage as needed
• Check your ketone levels

 

PCCN Renal Exam Overview 

The PCCN Exam covers a wide range of topics.  This particular article will focus primarily on the Renal section of the PCCN Exam.  The Renal portion of the PCCN Exam will cover the following content areas, Anatomy and Physiology, Fluid Balance Concepts, Acute Renal Failure, Acute Tubular Necrosis, Chronic Renal Failure and Dialysis, Electrolyte Imbalance, and Renal Trauma.  The Renal section is a very small portion of the overall PCCN Exam.  This section will contribute perhaps 5 to 8 questions on the exam.  Listed below are a few examples of some PCCN Renal practice questions that will help prepare you for the PCCN Exam.

Renal System Overview

The urinary system, also known as the renal system, consists of the kidneys, ureters, bladder, and the urethra.  Each kidney consists of millions of functional units called nephrons.  The purpose of the renal system is to eliminate wastes from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH.  The kidneys have extensive blood supply via the renal arteries which leave the kidneys via the renal vein.  Following filtration of blood and further processing, wastes (in the form of urine) exit the kidney via the ureters, where it is stored and subsequently expelled from the body by urination (voiding).  The female and male urinary system are very similar, differing only in the length of the urethra.  The urinary system is regulated by the endocrine system and hormones such as antidiuretic hormone, aldosterone, and parathyroid hormone.

Renal System Function

• Removal of waste products from the body (mainly urea and uric acid).
• Regulation of electrolyte balance (sodium, potassium and calcium).
• Regulation of acid base homeostasis
• Controlling blood volume and maintaining blood pressure

Urine Formation

Average urine production in adult humans is about 1-2 L/day, depending on state of hydration, activity level, environmental factors, weight, and the individual's health.

• Polyuria is urine production > 2.5 L/day
• Oliguria is urine production < 400 mL/day
• Anuria is urine production < 100 mL/day

The first step in urine formation is the filtration of blood in the kidneys.  In a healthy human the kidney receives between 12 and 30% of the cardiac output, but it averages about 20% or about 1.25 L/min.

Regulation of Concentration and Volume

The urinary system is under influence of circulatory system, nervous system and endocrine system.  Aldosterone plays a central role regulating blood pressure through its effects on the kidney.  It acts on the distal tubules and collecting ducts of the nephron and increases reabsorption of sodium from the glomerular filtrate.  Reabsorption of sodium results in retention of water, which increases blood pressure and blood volume.

• Antidiuretic hormone (ADH) is a neurohypophysial hormone and its primary function is to retain water in the body and to constrict blood vessels.
• Vasopressin regulates the body's retention of water by increasing water reabsorption in the collecting ducts of the kidney nephron.

PCCN Renal Exam - Practice Questions 

1) 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

2) Approximately 4 minutes after the first CRRT treatment is begun, a patient complains of severe back pain and itching. The patient's VS are BP 85/45 mm Hg, HR 120 bpm, RR 28 bpm. The nurse's initial intervention for this patient would be to

A) Administer 100 mL NS fluid bolus B) Check for bleeding at the access site C) Administer Benadryl 12.5 mg IV D) Disconnect the patient from the machine

3) A patient is receiving high dose diuretic therapy for fluid overload secondary to heart failure. The patient's ECG demonstrated prolonged PR and QT intervals, broad flat T waves, and multifocal PVC's. The initial management of this patient needs to include administration of

A) Magnesium B) Hypertonic saline C) Potassium D) Acetazolamide

4) An ESRD patient receiving hemodialysis three times per week is admitted with an acute anterior wall MI. The patient's BP is 105/48, HR 64 bpm, and RR 22 bpm. The nurse should anticipate that this patient's dialysis will be managed by

A) Slow continuous ultrafiltration B) Continuous venovenous hemodialysis C) Hemodialysis D) Peritoneal dialysis

5) Which of the following patient descriptions suggests a late complication of renal injury?

A) Blunt trauma to the flank region with absent bowel sounds B) A gunshot wound to the flank region with a WBC count of 16,000 C) A laceration of the right ureter with a serum creatinine of 6 D) A stab wound to the left flank with a BP of 185/87 mm Hg

PCCN Renal Exam - Practice Questions Answer with Rationale

1) 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.

2) Correct Answer - D) Disconnect the patient from the machine

• Rationale - The patient should be immediately disconnected from the circuit and machine because these findings suggest that the patient is experiencing a dialyzer or hemofilter reaction. Signs of this reaction include hypotension, pruritis, back pain, angioedema, and/or anaphylaxis. Once removed from the treatment, the patient is reassessed, and the symptoms are managed.

3) Correct Answer - A) Magnesium

• Rationale - Magnesium needs to be administered because this patient is exhibiting ECG evidence that suggests hypomagnesemia. Although the patient may be hypokalemic and/or hypocalcemic owing to diuretic therapy, the patient's ECG changes are consistent with hypomagnesemia. Hypertonic saline is used for SIADH, potassium administered for hypokalemia, and acetazolamide for hyperphosphatemia.

4) Correct Answer - C) Hemodialysis

• Rationale - The patient is currently on hemodialysis, and it would be continued. Hemodialysis is the most effective of all of the renal replacement therapies and is considered the gold standard for the treatment of acute and chronic renal failure. Hemodialysis is contraindicated in patients with hemodynamic instability, hypovolemia, coagulation disorders, or vascular access problems.

5) Correct Answer - D) A stab wound to the left flank with a BP of 185/87 mm Hg

• Rationale - Late complication of renal injury include: hypertension, hydronephrosis, chronic pyelonephritis, calculus formation, and intrarenal calcification. Early complication include ileus, sepsis, shock, impairment or loss of renal function, perinephric or renal abscess, and fistula formation.

 

Strategies For Success On The PCCN Exam!!

Congratulations on your recent accomplishment.  You have finally become eligible to sit and take the PCCN National Exam.  The PCCN Exam was designed for those nurses who provide care for acutely ill adult patients who are moderately stable with an elevated risk on instability.  Specialty nurses interested in the PCCN Certification may work in areas such as intermediate care, direct observation, step-down, telemetry and transitional care units.  The PCCN Exam is a very tough exam to pass; so we have put together some strategies that we feel will help increase your chances of passing this exam on the first time.

Strategy One:  Purchase A Review Course

Now I know what you are thinking, but before you jump to conclusions, read a little further.  We definitely recommend you purchasing a PCCN Exam Review Course.  A good solid review course will cover all of the content currently listed on the PCCN Exam in addition to some practice questions.  Be sure to select a course that will give you a thorough overview of content.  If you do not have any study materials, we highly recommend purchasing a review course.  If you do not currently have one in mind, we offer an online study course that will definitely help prepare you for taking the exam.  If not our course, then do a google search.  Be sure and find a review course that offers some sort of guarantee for passing.

Strategy Two:  Multiple Choice Practice Questions

Currently the PCCN Exam consists of 125 multiple choice practice questions (AACN.org).  Although this number changes from time to time, it will not deviate that much.  We believe the learning curve for this exam is somewhere between 1500 to 2000 practice questions.  In other words, in order to be successful the first time, you need to answer at least 1500 multiple choice questions prior to exam day.  Please be sure an answer 125 questions in one sitting prior to exam day.  Most people fail this exam due to fatigue so you need to be able to go the distance of the exam.  Although we offer some review questions, there are tons of books on the market that offer questions as well.  Ideally you want to purchase an online question bank because this method mimics what you will see on exam day; computerized format.

Strategy Three:  Study Habits

You must develop good study habits prior to taking the exam.  The last thing you want to do is cram towards the end.  Cramming doesn't work very well for this type of exam.  Sit down and map out a study plan, leaving time for rest and relaxation as well.  Be sure to include a day where you don't do any studying at all.  Burn out can lead to test failure.  Please do not study or answer any test questions on the day prior to the exam because this method tends to raise your anxiety level.  Just relax the day prior to the exam and get a good nights rest, preferably 8+ hours.

Conclusion

In order to be successful on passing the PCCN Exam on your first attempt, you must have a strategy.  Develop a good plan prior to purchasing the actual exam from AACN.org.  Once you purchase the exam, you only have so many days before you have to take the exam.  Be sure to study all parts of the exam outline and practice at least 1500 multiple choice questions prior to your exam.  Good luck on your exam..... If you are interested in some of the courses we offer, click on the links below for more information....  

PCCN Exam Course: Study The Smart Way!

PCCN Certification Exam

If you are reading this post, then you are somewhat familiar with the PCCN exam or at least interested in taking the exam.  Allow me to give you a modest breakdown of the PCCN exam.  This exam is administered by American Association of Critical Care Nursing (AACN) organization which is based in California.  This exam is primarily for those nurses that work on Telemetry units, and/or Step-down units, etc.  This test has a total of 125 questions and you will be allotted approximately 2 hrs to complete the exam.  100 of the questions are scored, and the other 25 questions are used to gather statistical analysis for future PCCN Certification Exams.  You must master a minimum of 70% of the exam in order to pass.  Preparation is the key to success on this exam.  You must practice as many questions as you can and review all of the core content listed on the exam according to AACN.

Study The Smart Way

Studying for the PCCN Exam has become a very tedious task for a lot of nurses who have decided to take the PCCN certification plunge.  The good part about it is, it doesn't have too.  You can leverage today's technology and make wiser use of your time and money.  Making wiser use of your time and money allows you the opportunity to spend more time with your family and not feel so stressed out about taking the exam in the first place.  When preparing to study for the PCCN exam, it is imperative that you do your research on all of the available online and classroom lecture options available.  Here at Elite Reviews, we have designed all of our courses with the learner in mind.  We have a wide range of course options that is catered to today's working professional.  Listed below is a detailed list of some of the courses we have to offer.  The good thing about the courses are, they are all available online and mobile compatible.  Take a look at the options below under the PCCN Review Courses heading.

PCCN Practice Questions

This part seems to be where the most questions are asked.  A lot of nurses who plan to take the PCCN exam often have questions about what is on the exam.  AACN has a done a great job in outlining exactly whats on the PCCN Certification Exam.  Here at Elite Reviews, we have tried to put the learner's mind at ease in terms of practice questions.  We have included all of the practice questions your mind can stand within our PCCN Review Courses.  We did our very best to stick with the outline set forth by AACN when writing the questions within the review courses and practice exams.  We covered all of the subject areas in great detail and then some.  For those of you looking for the learning curve in terms of questions, you should strive to practice answering greater then 2000 PCCN practice questions prior to exam day.  This will give you more than enough practice to be successful on the national exam.

PCCN Review Courses

Here at Elite Reviews, we pride ourselves on offering a superb customer experience.  We not only want you to enjoy and learn from our products, we want you to pass your exam as well.  We have a wide array of products for you to choose from.  If you are trying to decide which of the following PCCN Courses is best for you, take our PCCN Predictor Exam first.  The PCCN Predictor Exam will give you a baseline of where you currently stand in your studies.  One of the best features of the PCCN Predictor Exam is, you can take it multiple times within the allotted subscription time frame and it's reasonably priced.  Listed below are some of the PCCN Review Courses we have to offer. Whether you purchase one of our courses or not, we wish you all the success in the world on passing you PCCN Certification Exam.  Please visit us or call us at any time during the course of your studies should you need further assistance........ Best Wishes  

 

PCCN Exam Questions

PCCN Certification Overview

The PCCN certification was introduced in 2004 for registered nurses providing direct care to patients in several areas.  Nurses interested in this certification may work in any of the following areas such as intermediate care, direct observation, step-down, telemetry, transitional care or emergency departments.  In order to be successful on the PCCN Exam, you must dedicate some time to studying on a daily basis.  In times past, the most beneficial has been to find a really good review course that offers at least 1500 to 2000 PCCN Exam Questions and a detailed overview of content.

PCCN Questions

The PCCN Exam is a 2.5-hour test that contains 125 test items.  100 items are scored and 25 are used to gather statistical data on item performance for future exams (AACN.org).  The items are based on the AACN Synergy Model for Patient Care, with 80% focusing on clinical judgment and 20% focusing on Professional Caring and ethical practice.   In order to be successful on your first attempt, you must score greater than a 70% on the exam.  If you want to be successful on your first attempt, you must answer at least 2000+ PCCN style exam questions prior to test day with an 85% or greater.  We have designed several courses that we feel will aid in your studies.  Some of the courses that we have to offer are listed below…                      

PCCN Test Plan

The content of the PCCN Exams is described in the test plans on AACN.org.  Candidates are tested on a variety of patient care problems that are organized under major categories.  Listed below is a detailed list of the content areas. Cardiovascular (33%) Pulmonary (14%) Neurology, Multisystem, Behavioral (15%) Gastrointestinal, Endocrine, Renal, Hematology (18%) Professional Caring/Ethical Practice (20%)  

PCCN Cardiovascular Questions

A patient is in the bed, with the HOB elevated at 45 degrees.  Using a ruler, you measure the distance between the sternal angle and the point at which you see jugular venous pulsation cease.  This distance measures 6 cm and indicates A)  A normal finding B)  Hypovolemia C)  Right Ventricular Failure D)  Left Ventricular Failure Answer:  Correct response is (C) Right Ventricular Failure Rationale:  Jugular venous pressure more than 3 to 4 cm above the sternal angle is considered elevated.  Right heart failure is the most frequent cause of abnormally increased venous pressures.  RVF may be preceded by Left ventricular failure.