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PCCN Questions And Answers With Complete Test 2022
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PCCN Questions And Answers With CompleteTest 2022
What type of WBC increases with anaphylaxis Correct Answers: basophils
What type of WBC increases with allergic reaction or parasite? Correct Answers: eosinophils
What are mature neutrophils? Correct Answers: segs
What are immature neutrophils? Correct Answers: bands
What are types of granulocytes? Correct Answers: neutrophils, eosinophils, and basophils
What are types of agranulocytes? Correct Answers: monocytes, lymphocytes (T and B lymphocytes)
What type of WBC "starts the war" or triggers an immune response? Correct Answers: monocytes
What is a shift to the left with neutrophils? Correct Answers: an increase in immature neutrophils
(bands). If bands > 10% start thinking infection or inflammation
What do basophils become when they leave the vessels and enter tissues for response? Correct
Answers: mast cells
What are common stress responses? Correct Answers: PE, pneumonia, GI bleed
Normal platelet count Correct Answers: 150,000-400,000
What is reversal agent for heparin? Correct Answers: protamine sulfate
What is reversal agent for coumadin? Correct Answers: vitamin K or FFP
What are causes of DIC? Correct Answers: sepsis, blood or immuno disease, if greater than 4 units
prbcs received in 24 hours, solid organ transplant, trauma
What is DIC? Correct Answers: unpredictable clotting, some progress to bleeding bc used up all of
clotting factors, always secondary diagnosis to something else
What are s/s of DIC? Correct Answers: dusky fingers/toes (clotting in capillaries), bleeding (gums,
oozing of IV sites), unexplained petechiae/bruising
Lab changes in DIC Correct Answers: -decreased platelets < 100,000
-increased coags (PTT, INR, PT)
-decreased fibrinogen levels (protein precursor to fibrin which is essential to make the clot)
-increased fsps (things that make the clot)
-increased D dimer
How to treat DIC Correct Answers: treat clotting phase with heparin
,Treat bleeding phase with cyroprecipitate - blood product of choice for hemorrhage related to DIC -
gives pt back clotting factors AND fibrinogen
What is HIT? Correct Answers: Heparin Induced Thrombocytopenia. Platelets decrease 5-14 days
after receiving heparin. More likely to be caused by low molecular weight heparin (SQ). See
unpredictable clotting, more common in venous.
What is HIT treatment? Correct Answers: stop all heparin! Including heparin flushes. Stop coumadin!
Don't want to give platelets because it will cause more clotting.
What is most common reason patients reject an organ/blood? Correct Answers: they develop
antibodies
What are s/s of hypoglycemia? Correct Answers: pale, sweaty, cool/clammy, shaky, confusion, vision
changes (blurred or seeing spots)
What do cells start to break down when they dont have glucose for energy? What does this produce?
Correct Answers: proteins and fats, ketones
What is DKA? Correct Answers: more commonly in type one diabetics who produce little to no insulin.
As glucose in blood increases, it causes osmotic diuresis and patient excretes large volumes of urine.
Patient may become hypovolemic. Patient will develop ketoacidosis and lactic acidosis.
What s/s of DKA? Correct Answers: blood sugar 250-800
Sweet, fruity breath
Postural hypotension
Kusmol respirations (deep + labored) to decrease CO2 to attempt to normalize ph
Nausea/vomiting
What are the hallmarks of DKA? Correct Answers: high blood sugars
Ketones in urine and blood
Acidosis with low bicarb
What is treatment for DKA? Correct Answers: fluid volume resusitation and insulin drip
What kills DKA patient? Correct Answers: hypokalemia
When can you stop insulin drip with DKA? Correct Answers: when no more ketones in urine
What is HHS? Correct Answers: hyperosmolar hyperglycemic state. More common in type two
diabetics. Relative lack of insulin that leads to increase glucose production
What kills an HHS patient? Correct Answers: severe dehydration
What are s/s of HHS? Correct Answers: three Ps: polydipsia, polyurea, polyphasia
Normal HHS blood sugar: 600-1200 (higher than DKA)
Tongue looks like shoe leather
Tenting of tissues
Tachycardia
Hypotensive
, Rapid and shallow rrs
What is treatment for HHS? Correct Answers: fluid volume resusitation (8-12 L in first 24 hours) and
insulin drip with no bolus
What is diabetes insipidus? Correct Answers: complete or relative lack of antidiuretic hormone aka
vasopressin
What are causes of diabetes insipidus? Correct Answers: renal or neuro:
Nephrogenic DI where renal tubules are desensitized to effects of ADH
Central DI where ADH not being produced by posterior pituitary gland
Most commonly caused by trauma (typically head) or pituitary tumor
What is the response of DI? Correct Answers: inability to concentrate urine, large urine volume
THINK DI = DRY
What are the s/s of DI? Correct Answers: thirsty, polyuria, dehydration, tenting, dry mucus
membranes, tachycardia, hypotension, increased plasma osmolality, decreased urine osmolality,
increased sodium levels d/t dehydration, decreased specific gravity of the urine
How to treat DI? Correct Answers: give vasopressin AKA ADH then fluid volume replacement
Watch Is/Os and electrolytes
What is SIADH? Correct Answers: making too much ADH causing decreased urine production and
increased urine concentration
SIADH = sodium swimming in water
Untreated can lead to water intoxication and death
S/s of SIADH? Correct Answers: decreased sodium levels
Decreased blood osmolality
Dark, concentrated urine
Increased urine osmolality
Late s/s: decreased LOC, seizure, coma
What causes SIADH? Correct Answers: CNS dysfunction, head trauma, lung CA, patients taking high
doses of nsaids, chemo, big surgical patients
How to treat SIADH? Correct Answers: free water restriction, loop diuretics (lasix, bumex),
tetracycline abx or lithium (increased urine water excretion), 3% saline infusion to replace sodium
Watch Is/Os and sodium levels
What is a normal GFR? Correct Answers: 90-120 ml/min
What kind of dysrythmia is more common with posterior MI? Correct Answers: atrial dysrythmia
What type of dysrhythmia commonly occurs with LAD MI? Correct Answers: Second Degree Type II
What is the equation for Cardiac Output? Correct Answers: CO = HR x SV (stroke volume)
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