PCCN更新された試験問題集で[2023年最新] 練習有効な試験問題集
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AACN PCCN認定試験は、プログレッシブケア看護で少なくとも2年の経験がある看護師を対象としています。この認定試験では、中程度の病気であるが、一般的な医療外科ユニットの患者よりも集中的で警戒している監視が必要な患者のケアに関連する看護師の知識とスキルを評価します。この試験では、心臓および肺のケア、血行動態、神経学、腎臓および内分泌機能、薬理学など、さまざまなトピックをカバーしています。
質問 # 210
A nurse is caring for a client with congestive heart failure. The most recent laboratory test revealed that the client has a serum sodium level of 155 mEq/L and a serum potassium level of 3.1 mEq/L. The nurse would expect the physician to prescribe which medication for the client?
- A. Furosemide (Lasix)
- B. Spironolactone (Aldactone)
- C. Acetazolamide (Diamox)
- D. Bumetanide (Bumex)
正解：B
解説：
Explanation: Based on the laboratory findings, the nurse should expect the physician to prescribe a diuretic that excretes sodium and retains potassium. Spironolactone is the only diuretic from the list that may help achieve the treatment goals.
質問 # 211
Nurse Victoria gave active treatment like antibiotics and chemotherapy to a terminally ill patient. This act of hers has a disadvantage in that it:
- A. Increases cost of treatment
- B. Prolongs the dying process
- C. Uses expensive drugs
- D. None of the above
正解：B
解説：
Explanation: Her act prolongs the dying process. Healthcare providers and families of the terminally ill patient should follow ethics for such patients. Nurse has the responsibility to provide support and information to help parents/families to discuss the patient position with them. Prolonging the dying process is the disadvantage of this nurse's active treatment.
質問 # 212
View the supporting details to answer the following question.
Based on the patient's blood gas results provided, the nurse suspects which of the following?
A patient's blood gas results are as follows:
pH 7.21
PaCO2 51
HCO3 25
Base Excess -1
PaO2 63
SaO2 89
- A. Respiratory acidosis, full compensation, with hypoxemia
- B. Respiratory alkalosis, no compensation, with hypoxemia
- C. Respiratory acidosis, no compensation, with hypoxemia
- D. Metabolic acidosis, no compensation, without hypoxemia
正解：C
解説：
Correct answer: Respiratory acidosis, no compensation, with hypoxemia
Respiratory acidosis is evident due to a pH less than 7.35, the PaCO2 above 45. No kidney compensation is evident and hypoxemia is present with PaO2 of 63.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 102.
質問 # 213
A known diabetic presented in medical OPD with a history of altered level of consciousness, lethargy, poor feeding with vomiting, palpitations and anxiety. On examination, he had Tachycardia. His drug history revealed he is on intermediate insulin and has taken the dose in the morning. What would you like to do next with this patient?
- A. Check blood sugar level with glucometer
- B. Carry out ECG
- C. Send blood complete picture for test
- D. Will give glucose without checking blood sugar level
正解：A
解説：
Explanation: Check blood sugar levels with the rapid method using glucometer in this patient because all the symptoms and signs and the Tachycardia fit into hypoglycemia. This test should be done urgently because the brain can be damaged if this condition is prolonged.
質問 # 214
A former client calls the psychiatric unit and asks for the nurse who was assigned to care for him during his admission. The client is suicidal. The nurse would utilize which of the following techniques when speaking with the client on the phone?
- A. If the caller refuses further help, the nurse puts the phone down and refuses to speak with the caller until the caller agrees to suggested interventions
- B. If other staff members are available, the nurse asks them to call the police without the caller knowing about the plan
- C. Ask the caller for ideas about the possible immediate solutions to the current situation
- D. The nurse informs the caller that their nurse-client relationship has already been terminated and that any form of communication, including phone calls are not allowed
正解：C
解説：
Explanation: The nurse must ask the caller for ideas to resolve the current concerns. The caller's inputs should be assessed for their feasibility and appropriateness. The other options are not appropriate when dealing with a suicidal caller.
質問 # 215
All of the following statements are true concerning the QRS complex on electrocardiogram except:
- A. The width of the QRS complex represents intraventricular conduction time and is measured from the point at which it first leaves the baseline to the point at which the last wave ends
- B. An R wave is the first positive deflection from baseline
- C. A Q wave is an initial positive deflection from baseline
- D. An S wave is a negative deflection that follows an R wave
正解：C
解説：
Correct answer: A Q wave is an initial positive deflection from baseline A Q wave is an initial negative, rather than positive, deflection from baseline.
Normal QRS width is 0.04 to 0.10 second in an adult.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 39.
質問 # 216
A known diabetic is to be given advice about the best care of diabetes for him. Which of the following are the ADA (American Diabetes Association) guidelines for good management of diabetes?
- A. Glycemic control
- B. Diabetes self management education
- C. All of the above
- D. Appropriate laboratory testing and history
正解：C
解説：
Explanation: The American Diabetes Association Clinical Practice recommends few points to manage of diabetes are all the factors listed above. These are guidelines listed by the ADA for good management of diabetes. Appropriate laboratory testing and history, Glycemic control and Diabetes self management education are all the recommendation of ADA.
質問 # 217
All of the following factors can increase the level of glucose in the blood except:
- A. Hyperthyroidism
- B. Renal failure
- C. Stress
- D. Insulinoma
正解：D
解説：
Explanation: All of the following factors can increase the level of glucose in the blood except Inulinoma.
Different conditions can increase the levels of glucose in the body. Stress, renal failure, Cushing syndrome, hyperthyroidism, and pancreas disorders are one of the leading causes of high glucose levels in the body. Insulinoma, that causes blood glucose levels to be lowered, is a tumor of the pancreas where there is increased secretion of insulin.
質問 # 218
The syndrome of inappropriate antidiuretic hormone is:
- A. Characterized by an insensitivity of the renal tubules to antidiuretic hormone
- B. Characterized by the suppression of antidiuretic hormone
- C. Characterized by excessive release of antidiuretic hormone
- D. Distinguished by hypernatremia
正解：C
解説：
Correct answer: Characterized by excessive release of antidiuretic hormone The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone unrelated to the serum osmolality, or the concentration of electrolytes and other osmotically active particles.
SIADH is distinguished by hyponatremia (the opposite of hypernatremia). Water retention progresses to water intoxication. Nephrogenic diabetes insipidus is characterized by renal tubule insensitivity to antidiuretic hormone.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 398-399.
質問 # 219
Chest radiography provides visualization of the heart and lungs, making this an essential tool in respiratory assessment. Which of the following statements is correct related to chest radiography?
- A. On a normal chest x-ray, the diaphragm appears gray and dome-shaped with the left dome 1 to 3 cm higher than the right dome
- B. The skeletal thorax normally appears black on chest films
- C. Healthy lungs appear mostly white on chest films
- D. During an x-ray, only a few electromagnetic rays are absorbed by air; all rays are absorbed by bone or metal
正解：D
解説：
Correct answer: During an x-ray, only a few electromagnetic rays are absorbed by air; all rays are absorbed by bone or metal X-rays are a form of electromagnetic radiation utilized by x-ray imaging machines to create radiographic images. Only a few of these rays are absorbed by air, whereas all x-rays are absorbed by solid substances such as bone or metal. As the beam of the x-ray passes through the patient, the tissues which are denser absorb more of the beam. Less of the beam is absorbed by less-dense tissues.
Since the lungs are primarily sacs of gas or ar, healthy lungs appear mostly black on chest films. Since bone absorbs the most x-rays (is very dense), the skeletal thorax normally appears white on chest films.
The diaphragm appears dark or gray and is dome-shaped; however, the right dome is higher than the left.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 245-246.
質問 # 220
A nurse accidentally gave the wrong medication to a patient. Documenting the error in the form of an incident report demonstrates which of the following?
- A. The nurse's fidelity
- B. The nurse's autonomy
- C. The nurse's advocacy
- D. The nurse's veracity
正解：D
解説：
Correct action: The nurse's veracity
The nurse demonstrated veracity in telling the truth about her mistake. The rule of veracity is fundamental to relationships and society.
Fidelity refers to being faithful to commitments. Advocacy refers to the use of one's skill and knowledge to benefit another. Autonomy affirms the right of an individual to choose actions based on their values and beliefs.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 195-196.
質問 # 221
All of the following statements are true related to valvular heart disease except:
- A. An insufficient valve does not close properly
- B. Valves on the right side of the heart are more commonly affected
- C. Normally, when a heart valve opens, there are no pressure gradients between the chambers or vessels above and below the valve
- D. A stenotic valve has a narrowed opening
正解：B
解説：
Correct answer: Valves on the right side of the heart are more commonly affected Valves on the left side of the heart are more commonly affected in valvular heart disease as they are constantly exposed to higher pressures.
Under normal conditions, when a heart valve opens, no pressure gradients exist between the vessels or chambers below and above the valve. As valvular heart disease progresses, pressure gradients between the chambers or vessels develop.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 473.
質問 # 222
Which of the following drugs are used for treatment of Crohn's disease as immunomodulatory agents?
- A. Both a and b
- B. Methotrexate
- C. Cyclosporine
- D. None of the above
正解：A
解説：
Explanation: Cyclosporine and Methotrexate are used for treatment of Crohn's disease. Crohn's disease (also known as granulomatous, and colitis) is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms.
質問 # 223
Acute kidney injury (AKI) is characterized by three clinical phases, seen primarily due to intrarenal injury.
The first phase of AKI is characterized by:
- A. A significant rise in BUN and creatinine levels along with acute hypokalemia
- B. A significant rise in BUN and creatinine levels; common complications include fluid overload and acute hyperkalemia
- C. An increase in urine output
- D. A drop in BUN and creatinine levels
正解：B
解説：
Correct answer: A significant rise in BUN and creatinine levels; common complications include fluid overload and acute hyperkalemia In the first phase of acute kidney injury (AKI), the oliguric phase, the BUN and creatinine levels rise significantly. Common complications include fluid overload and acute hyperkalemia.
An increase in urine output occurs in the diuretic phase, which follows the oliguric phase. Hyperkalemia, rather than hypokalemia, is a common complication of the first phase of AKI. BUN and creatinine levels significantly rise, rather than drop, in the first phase of AKI.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 373.
質問 # 224
Which of the following types of generalized seizures is characterized by rhythmic muscle jerking?
- A. Clonic
- B. Tonic
- C. Atonic
- D. Tonic-clonic
正解：A
解説：
Correct answer: Clonic
Clonic seizures are characterized by rhythmic jerking of the muscles.
Atonic seizures are characterized by the sudden loss of muscle tone and are also known as drop attacks.
Tonic seizures are characterized by sustained muscle contractions. In tonic-clonic seizures, muscle activity varies between sustained muscle contraction and jerking.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 316.
質問 # 225
The ability to recognize needs and take action to influence the outcome of a conflict is called:
- A. Agency
- B. Justice
- C. Moral agency
- D. None of the above
正解：C
解説：
Explanation: The ability to recognize needs and take action to influence the outcome of a conflict is called moral agency. In ACCN synergy model of Nurse Competency, Moral agency is the ability to recognize needs and take action to influence the outcome of a conflict .The other two are advocacy and agency.
質問 # 226
All of the following statements related to hyperosmolar disorders are true except:
- A. Signs and symptoms may include tachycardia, restlessness, and seizures
- B. These disorders may be caused by conditions that result in an inhibition of antidiuretic hormone (ADH)
- C. They are the result of an excess of water
- D. Serum Na+ > 145 mEq/L
正解：C
解説：
Correct answer: They are the result of an excess of water
Hyperosmolar disorders are the result of a deficit of water, not an excess.
Signs and symptoms of hyperosmolar disorders may include tachycardia, restlessness, and seizures.
Hyperosmolality refers to high sodium levels, which may be indicative of water deficit. Serum Na+ is greater than 145 mEq/L in these conditions. Hyperosmolality disorders may be caused by conditions that result in an inhibition of antidiuretic hormone (ADH).
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 377.
質問 # 227
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