2023年最新の有効なPCCN試験最新問題で2023年最新の学習ガイド
PCCN認定で究極のガイド [2023年更新]
質問 # 113
What is the first step of problem solving?
- A. identify concepts
- B. define the issue
- C. consider reason for action
- D. collect data
正解：B
解説：
Explanation: Defining the issue is the first step in problem solving. Problem solving for satisfaction of patient/family involves forming a hypothesis, testing, and assessing data to determine if the hypothesis holds true.
質問 # 114
The American Association of Critical-Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments identifies six standards which are needed in the workplace to promote the effective resolution of ethical dilemmas. Which of the following is not included as one of these standards?
- A. True collaboration
- B. Appropriate staffing
- C. Meaningful relationships
- D. Authentic leadership
正解：C
解説：
Correct answer: Meaningful relationships
The six standards identified by AACN needed in the environment to promote effective resolution of ethical problems include:
* Authentic leadership
* Meaningful recognition
* Appropriate staffing
* Effective decision-making
* True collaboration
* Skilled communication
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 207.
質問 # 115
Which of the following is the preferred route of medication administration in the acutely ill patient?
- A. Intramuscular
- B. Oral
- C. Intravenous
- D. Subcutaneous
正解：C
解説：
Correct answer: Intravenous
In acutely ill patients, the intravenous route is the preferred method of medication administration because it permits reliable, complete delivery.
The subcutaneous (SC) or intramuscular (IM) routes of medication administration are rarely used in the acutely ill for several reasons including:
* Delayed onset of action
* Unreliable absorption due to decreased tissue perfusion
* Decreased subcutaneous fat or inadequate muscle tissue
* Unpredictable, incomplete, or erratic drug absorption
* Bleeding complications or hematomas in compromised patients
Medication administration via the SC or IM routes may also be painful for these patients. The oral (PO) route of medication administration in the acutely ill may also result in incomplete, unpredictable, or erratic drug absorption.
Reference:
Burns,
Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 162.
質問 # 116
Which of the following terms describes the obligation to be faithful to commitments and promises?
- A. Veracity
- B. Justice
- C. Autonomy
- D. Fidelity
正解：D
解説：
Correct answer: Fidelity
Fidelity is the obligation to be faithful to commitments and to promises, and uphold the implicit and explicit commitments to patients, colleagues, and employers.
Veracity is the obligation to be truthful. Justice is defined as fairness. Autonomy affirms the right of a person to make choices based on his or her values or beliefs.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 195-196.
質問 # 117
Which of the following statements is true regarding positive end-expiratory pressure (PEEP)?
- A. The application of positive pressure to the airways during expiration may keep alveoli open and prevent early closure during exhalation in conjunction with any of the ventilator modes
- B. PEEP may decrease intracranial pressure and increase renal perfusion
- C. PEEP may decrease hepatic congestion
- D. Use of PEEP may decrease the risk of barotrauma due to lower mean and peak airway pressures during ventilation
正解：A
解説：
Correct answer: The application of positive pressure to the airways during expiration may keep alveoli open and prevent early closure during exhalation in conjunction with any of the ventilator modes Lung compliance and ventilation-perfusion matching are often improved by prevention of early alveolar closure.
Use of PEEP may increase, not decrease, the risk of barotrauma due to higher mean and peak airway pressures during ventilation. Use of PEEP may increase intracranial pressure and decrease renal perfusion and lead to hepatic congestion. PEEP may increase hepatic congestion.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 122.
質問 # 118
Which of the following is an antiarrhythmic medication with a class IIa recommendation for pharmacological cardioversion of atrial fibrillation?
- A. Ibutilide
- B. Amiodarone
- C. Propafenone
- D. Flecainide
正解：B
解説：
Correct answer: Amiodarone
Amiodarone has a class IIa recommendation in the pharmacological cardioversion of atrial fibrillation (benefit > > risk).
Ibutilide, propafenone, and flecainide are antiarrhythmics used in the pharmacological cardioversion of atrial fibrillation and carry a class I recommendation (benefit > > > risk).
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 51-52.
質問 # 119
A 50-year-old man is suspected to have paralytic ileus. All of the following symptoms are of paralytic ileus except:
- A. Nausea and vomiting
- B. Large number of bowel sounds in abdomen
- C. Constipation and lack of flatulence
- D. Abdominal distention
正解：B
解説：
Explanation: All of the above symptoms are of paralytic ileus except large number of bowel sounds in abdomen. The lack of bowel sounds is characteristic of paralytic ileus. Paralytic ileus is obstruction of the intestine due to paralysis of the intestinal muscles. The paralysis does not need to be complete to cause ileus, but the intestinal muscles must be so inactive that it prevents the passage of food and leads to a functional blockage of the intestine.
質問 # 120
Which cranial nerve is the trigeminal nerve?
- A. III
- B. V
- C. IX
- D. VI
正解：B
解説：
Correct answer: V
Cranial nerve V controls facial sensation, including the cornea, nasal mucosa, and oral mucosa; muscles of chewing and mastication.
* Olfactory Nerve - I
* Optic Nerve - II
* Oculomotor Nerve - III
* Trochlear Nerve - IV
* Trigeminal Nerve - V
* Abducens Nerve - VI
* Facial Nerve - VII
* Vestibulocochlear (Auditory) Nerve - VIII
* Glossopharyngeal Nerve - IX
* Vagus Nerve - X
* Accessory Nerve - XI
* Hypoglossal Nerve - XII
An illustration of the human brain highlights the 12 cranial nerves:
1. The olfactory nerve is located within the nasal cavity below the frontal lobe.
2. The optic nerve emerges from the optic disk in the forebrain.
3. The oculomotor nerve originates from the midbrain of the brainstem.
4. The trochlear nerve originates from the medial midbrain.
5. The trigeminal nerve emerges from the semilunar ganglion near the apex of the temporal bone.
6. The abducens is located on the floor of the fourth ventricle in pons.
7. The facial nerve emerges from pons.
8. The vestibulocochlear nerve is located in pons of the brainstem.
9. The glossopharyngeal nerve emerges from the medulla oblongata.
10. The vagus nerve arises from medulla oblongata.
11. The hypoglossal nerve originates near the top of the spinal cord at the base of the brain.
12. The accessory nerve arises from the cervical spinal cord and caudal medulla.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 302.
質問 # 121
Openness and recognition of issues and willingness to act is called:
- A. Moral agency
- B. None of the above
- C. Advocacy
- D. Agency
正解：D
解説：
Explanation: Openness and recognition of issues and willingness to act is called agency. Under the ACCN synergy model, Nurse Competencies include advocacy, agency, moral agency. Agency is the term used to describe openness, recognition of issues and willingness to act to resolve problem.
質問 # 122
Which of the following terms refers to the use of one's own skills and knowledge to promote the interests of another?
- A. Nonmaleficence
- B. Paternalism
- C. Fidelity
- D. Advocacy
正解：D
解説：
Correct answer: Advocacy
Patient advocacy is an essential role of the nurse. The nurse is able to understand the impact of disease and interpret health care information in a unique way, then acts as a patient advocate by applying this understanding to ensure the patient's values and beliefs guide the plan of care.
Paternalism refers to circumstances in which the principle of doing good (beneficence) overrides that of autonomy. Nonmaleficence is the principle that imposes the duty to do no harm. Fidelity describes the obligation to be faithful to promises and commitments.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 198.
質問 # 123
The nurse is assessing a patient using the Full Outline of Unresponsive (FOUR) score tool. The patient she is assessing is not intubated, and his respirations are even and easy at rest. He opens his eyes on command, and his pupils are equal and reactive to light. He gives the nurse a "thumbs up" when asked.
What is this patient's FOUR score?
- A. 0
- B. 1
- C. 2
- D. 3
正解：C
解説：
Correct answer: 16
The FOUR score is a tool used in the assessment of neurological patients that assigns a value of 0 through 4 in each of four categories: eyes, motor, brain stem reflexes, and respirations. The scores are added for a total score. This patient is given a score of 4 in each category, indicating no impairment detected by the tool in these areas at the time of the assessment.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 297-298.
質問 # 124
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. All of the above
- B. Glycemic control
- C. Appropriate laboratory testing and history
- D. Diabetes self management education
正解：A
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 # 125
Which of the following statements is true regarding artificial airways?
- A. More nutrition options are available to patients with endotracheal tubes than with tracheostomy tubes
- B. A fenestration is necessary to be able to talk with a tracheostomy tube
- C. Following the insertion of a tracheostomy or endotracheal tube, the cuff of the tube is inflated so that the pressure is maintained at less than 25 mm Hg
- D. More communication options are available to patients with endotracheal tubes than with tracheostomy tubes
正解：C
解説：
Correct answer: Following the insertion of a tracheostomy or endotracheal tube, the cuff of the tube is inflated so that the pressure is maintained at less than 25 mm Hg Cuff pressure is maintained at less than 25 mm Hg; it is inflated with just enough air to create an effective seal. Overinflation can lead to obstruction of the distal airway as well as tracheal ischemia, necrosis, and erosion.
Some tracheostomy tubes have an additional opening along the outer tube cannula which is known as a fenestration. This facilitates vocalization by allowing the upward flow of air through the vocal cords, but it is not necessary to be able to talk with a tracheostomy tube. More communication and nutrition options are available to patients with tracheostomy tubes than with endotracheal tubes.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 110, 111.
質問 # 126
Of all the electrolyte disorders, the one which can be fatal due to the alterations it causes in the conduction of electrical impulses, particularly in muscle and cardiac tissue is:
- A. Hypo-osmolar disorders
- B. Hyperkalemia
- C. Hyperosmolar disorders
- D. Hypocalcemia
正解：B
解説：
Correct answer: Hyperkalemia
Hyperkalemia is a condition in which the potassium level in the blood is higher than normal. Because the tissue of the heart is sensitive to potassium levels, increased levels alter the conduction of electrical impulses traveling through the cardiac tissue. These abnormalities can lead to serious arrhythmias and death. Blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L). A level higher than 7.0 mmol/L requires immediate treatment.
Hyperosmolar disorders are not considered to be as critical as hyperkalemia, but care must be taken to correct the sodium and osmolality level gradually. Hypo-osmolality disorders are very common in acutely ill patients, most often related to the use of D-5-W IV solutions. They can be very serious but are not as critical as hyperkalemia and do not result primarily in life-threatening arrhythmias. While calcium is critical to normal cell function, membrane stability, blood coagulation, and neural transmission, low levels do not typically lead to fatal cardiac arrhythmias.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 377-378.
質問 # 127
A 50-year-old male chronic drinker, presented in medical OPD with intermittent fever, epistaxis, ankle edema, indigestion, abdominal pain and palmar erythema. What is he suffering from based on clinical findings?
- A. Acute fulminant hepatitis
- B. Compensated cirrhosis
- C. Cholecystitis
- D. Decompensated cirrhosis
正解：B
解説：
Explanation: According to the symptoms presented, he is suffering from compensated cirrhosis because alcohol is the cause of cirrhosis. Other features of compensated cirrhosis are intermittent fever, epistaxis, ankle edema, palmar erythema.
質問 # 128
Which of the following terms indicates prolonged or recurring seizures without a return to baseline mental status?
- A. Drop attacks
- B. Status epilepticus
- C. Tonic-clonic seizure
- D. Myoclonic seizure
正解：B
解説：
Correct answer: Status epilepticus
The classic definition of status epilepticus is a seizure or series of seizures lasting longer than 30 minutes, but treatment is most often instituted much sooner. Recent guidelines suggest a definition of seizure activity which lasts longer than five minutes.
Myoclonic seizures are described as a sudden, brief muscle jerking of one or more muscle groups and are commonly associated with metabolic, degenerative, and hypoxic causes. Atonic seizures are characterized by the sudden loss of muscle tone and are also called "drop attacks." In tonic-clonic seizures, muscle activity varies between jerking and sustained muscle contractions.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 316-317.
質問 # 129
On a positive-pressure ventilator, which mode of ventilation ensures that patients receive a predetermined number and volume of breaths each minute and no deviations from the respiratory rate or Vt settings are delivered?
- A. Synchronized intermittent mandatory ventilation
- B. Spontaneous breathing
- C. Assist-control ventilation
- D. Control ventilation
正解：D
解説：
Correct answer: Control ventilation
Control ventilation ensures that patients receive a predetermined number and volume of breaths each minute. No deviations from the respiratory rate or Vt settings are delivered with control ventilation.
Generally, in control ventilation, the patient is heavily sedated and may be paralyzed with neuromuscular blocking agents. This mode is most often used in the ICU or operating room and might be used in patients who are paralyzed due to spinal cord injuries or who have a neuromuscular condition that precludes spontaneous breathing but who are otherwise physiologically stable.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 120-121.
質問 # 130
A patient with severe variceal bleeding is to undergo a percutaneous transjugular intrahepatic portosystemic shunt. The nurse is explaining the procedure to the patient's family. She tells the family:
- A. A common side effect of this procedure is dumping syndrome
- B. This is a painless procedure
- C. Another name for this procedure is the Billroth II
- D. The advantage of this procedure is that it is not as invasive as surgery
正解：D
解説：
Correct answer: The advantage of this procedure is that it is not as invasive as surgery The advantage of this procedure, which is also called the TIPS procedure, is that it is not as invasive as surgery as portal circulation is accessed by way of the right jugular vein. To decrease pressure in the portal vein (and therefore, decreased portal pressure), a stent is used to create a shunt between a branch of the portal vein and the hepatic vein. Decreasing portal pressure decreases pressure on the varices to prevent rupture and hemorrhage.
Dumping syndrome is associated with the Billroth I procedure, not with the TIPS procedure. Also called rapid gastric emptying, dumping syndrome occurs when the undigested contents of the stomach move too rapidly into the small bowel. The Billroth II is a surgical gastric resection procedure. It is often indicated in refractory peptic ulcer disease and gastric adenocarcinoma. Parts of the TIPS procedure can be painful, such as the balloon dilation of the intrahepatic tract. Pain medication and IV sedation are administered during the procedure.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 347-348.
質問 # 131
A patient presented in neurology OPD with CT angiogram of the brain vessels, and an aneurysm, saccular in shape, was seen at bifurcation of the artery. Moreover, the aneurysm was thought to be congenital. Which is the most likely type of aneurysm in this case?
- A. Fusiform
- B. Dissecting
- C. Berry aneurysm
- D. Mycotic
正解：C
解説：
Explanation: Berry aneurysm the most likely type of aneurysm in this case. The most likely type of aneurysm in this case is the berry aneurysm, because it is congenital, saccular in shape and is seen at bifurcation of basilar artery.
質問 # 132
A patient has developed Acute Respiratory Acidosis, with a pH of 7.25 and a PaCO2 of 55. What is the underlying cause of Respiratory Acidosis?
- A. There are elevated levels of aldosterone present.
- B. The lungs are working excessively resulting in "over breathing."
- C. The lungs are not sufficiently ventilating.
- D. There is an underlying gastric disorder.
正解：C
解説：
Explanation: The underlying cause of respiratory acidosis is that the lungs are not sufficiently ventilating.
Acute Respiratory Acidosis is a sudden collapse of the body's ventilation system often resulting from central nervous system disease, drugs or toxins or Chronic Obstructive Pulmonary Disease (COPD).
質問 # 133
Aneurysm development is initiated in which layer of the aorta?
- A. Intima
- B. Fusiform
- C. Medial
- D. Tunica adventitia
正解：C
解説：
Correct answer: Medial
Aneurysm development is initiated in the medial layer of the aorta.
The aorta is composed of three layers: Intima, media, and tunica adventitia. Aneurysm development is initiated by the breakdown of elastic tissue and smooth muscle cells in the medial layer of the aorta.
"Fusiform" is not one of the layers of the aorta. A fusiform aneurysm is characterized by bulging of the entire circumference of the affected portion of the aorta.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 480-481.
質問 # 134
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