PCCN EXAMINATION 2024|GUARANTEED QUESTIONS WITH ACCURATE ACUAL ANSWERS

A 45-year old woman is admitted with type 1 diabetic mellitus. She is hyperventilating, has signs of dehydration (increased urine output and increased thirst), and is tachycardic. Initial treatment would include: A. Diazoxide (Hyperstat) to inhibit the release of insulin B. glucose for hypoglycemia C. insulin therapy for ketoacidosis, fluid and electrolyte replacement D. intravenous fluids for dehydration and glucose for hypoglycemia - Accurate AnswerC. insulin therapy for ketoacidosis, fluid and electrolyte replacement The patient is exhibiting the signs and symptoms of diabetic ketoacidosis (DKA). Signs of dehydration, such as polydipsia and polyphagia, are due to large urine output, increased thirst is secondary to dehydration and tachycardia is due to sympathetic nervous system stimulation from an increased glucose level and ketosis. Initial treatment would include insulin therapy, re-hydration with fluids and electrolyte replacement. Diazoxide would not be used since it inhibits insulin release (this patient requires insulin to lower glucose). The patient is not hypoglycemia. Signs and symptoms of hypoglycemia are similar; tachycardia, change in behavior (irritability) or level of consciousness, sweating and shaking. A 45-year-old female with history of bipolar disorder is one-day postoperative following abdominal surgery. The patient slept only one or two hours during the night and is speaking rapidly, throwing her belongings at the nurses and insists she is going to leave the hospital. The nurse should: A. Notify the mental health crisis team B. Notify social services C. Notify the nursing supervisor D. Notify the patient's husband - Accurate AnswerA. Notify the mental health crisis team In many hospitals, this can be the rapid response team. Not all hospitals have access to mental health professionals so the rapid response team answers these calls. The mental health crisis team is comprised of mental health professionals who can assess the mental status of the patients as well as the medical-surgical assessment. After the complete assessment is made, the decision of how to treat this possible exacerbation of her bipolar disorder may be made. The patient is at risk for hurting herself and others and may need continuing assessment of mental and surgical status beyond the rapid response team. Decisions will be made with the attending physician. Social services may help with placement, but not during an acute situation. The nursing supervisor may be notified as the rapid response team is notified; this is a great strategy; however, the supervisor may not have the ability to assess this complex patient. The supervisor is more able to delegate care and request more help to the area if needed. The patient's husband will need to be called after the immediate assessment is made. A 55 year old male postoperative patient is demonstrating signs of pain; tachycardia, hypertension, abdominal guarding and increased respiratory rate. The patient refuses pain medication because he believes he will become addicted to the narcotics. What is the nurse's best response? A. Acknowledge that the patient is entitled to refuse pain medications B. Tell the patient that opioids have a low addiction rate when used for postoperative pain while in the hospital C. Admire the patient's stoicism D. Acknowledge opioid addiction potential, and offer a back rub - Accurate AnswerB. Tell the patient that opioids have a low addiction rate when used for postoperative pain while in the hospital Many people are concerned about addiction rates of narcotics; however, the use of narcotics for postoperative pain while in the hospital has a very low addiction rate. The risk for abuse increases when patients go home with narcotics. Explaining to the patient that limited use in the hospital will increase his recovery and reduce inflammation is the correct response. Any patient may refuse medications after an explanation of the facts are given. A back rub or alternative care is a way to treat the patient if they absolutely refuse medications; however, the best answer is to correct the patient's misinformation about the use of narcotics during the immediate postoperative period. A 55-year old male is admitt