lonely PCCN

5 Apr

I need a pacemaker STAT

If you click on the image of this artwork you will be morphed to the artist of this fine idea, found on deviantART. The title of the piece is “Cardiac insufficiency” by Mariix.  I doubt the artist is a nurse, or a doctor, but she has the right idea: the heart needs juice, electrical juice that is.

Somebody plug me in please. I am a lonely student in my studies for PCCN certification. I need some joules.

Here I am studying for PCCN again. My test date is April 21, so I can not be lazy anymore.  Since it has been so long since I have really studied, I am starting back with cardiovascular, which is 46% of the exam equals 45 questions.

Some of the sample questions seem easy, some of the study material seems hard.

I have an undying opinion that telemetry nurses are special, and not just because I am one of them silly!  Of course I get tired of spinning tele packs, especially when the acuity is high and the ratio is just as high. I still have the energy to do it, so I keep on measuring the QTc.

So here are the first 10 easy sample questions, and I will summarize rationales. The answers are underlined and highlighted in red for  cardio-LOVE.

1. Which of the following variables affects the cardiac output directly?

a. Preload

b. Stroke Volume

c. Afterload

d. Resistance

*All the answers may affect the CO but only the SV does so directly. The way to increase the CO is to manipulate the SV (too much or too little venous return to the heart) and manipulate the HR (is it too fast or too slow?) I am obsessed with the manipulation of the heart.

2. Coronary artery perfusion is dependent upon

a. Diastolic pressure

b. Systolic pressure

c. Afterload

d. SVR

*Coronary arteries fill during diastole

3. The patient is short of breath with chest pain. The heart rate is irregular at 170 beats per minute and the blood pressure is low at 80/60.  Anticipate and get ready for the following:

a. Atropine 0.5mg IV

b. Labetolol 25mg IV

c. Cardioversion 100J

d. Lidocaine 75mg IV

* Atrial Fibrillation with a rapid ventricular response that is hemodynamically unstable. Conversion is either electrically or chemically but none of the other answers include drugs that could chemically convert rapid A fib, so the answer is cardioversion with 100J. I just did this last week at the bedside for an unstable situation and believe me: IT HURTS! The patient went into NSR and screamed: “Don’t ever do that again!”  Next time I will advocate for some Versed instead of just the Fentanyl.

4. Chest pain that is NOT relieved by rest and nitroglycerine is called:

a. Variant angina

b. Stable angina

c. Unstable angina

d. Prinzmetal’s angina

*No explanation, it is easy.

5. The nurse administering tPA for acute myocardial infarctions should monitor the patient for all these EXCEPT:

a. Peripheral thrombosis

b. Myocardial reperfusion

c. Bleeding complications

d. Coronary reocclusion

* self-explanatory: thrombosis will not occur in the periphery after tPA

6. Which finding would indicate coronary reperfusion during tPA infusion?

a. Drop in arterial blood pressure

b. Elevation of the ST segment

c. Ventricular fibrillation

d. Dramatic reduction in chest pain.

*although there is a chance of reperfusion arrhythmia it does not indicate reperfusion.

7. The patient is admitted with acute pulmonary edema. The pO2 is 48, pCO2 is 57, the blood pressure is 160/90, pulse 122, respiratory rate is 36. The most appropriate initial intervention:

a. bi-level positive airway pressure (BiPAP)

b. Continuous positive airway pressure (CPAP)

c. Pressure control ventilation

d. Inverse ratio ventilation

*Lots of experience on telemetry with this for those CHFers and Acute on Chronic COPDers. We just have to remember that for BiPAP the patient must be able to maintain own airway and that the duration is for less than 48 hours. Usually that is enough time anyway to turn things around with some Lasix and Dig. 🙂

8. The pathologic changes found on a 12 lead EKG to indicate myocardial ischemia are:

a. ST elevation

b. ST segment depression and T wave elevation

c. Q wave formation

d. ST segment depression and T wave inversion

* ST elevation shows injury. Q wave formation indicates necrosis. The keyword is ischemia for this question.

9. Failure to capture is a complication of pacemakers that might be caused by:

a. Lead maturation

b. Lead displacement

c. Dead battery

d. Open circuit

* Failure to capture is the pacer is firing and you see the spike, but there is no qrs following it. Open circuit is a broken lead wire. Lead maturation is normal.

10. Automatic implantable cardio-defibrillators-AICDs- might be initiated in the treatment of:

a. Frequent PVCs

b. Atrial fibrillation

c. Narrow complex SVT

d. Symptomatic VT

*Those at risk for sudden cardiac death, cardiomyopathy.

Hopefully I did not bore the internet with this, but who wants to study alone? Not me!

Apparently these are the easy questions. It has to get harder, right?


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8 Responses to “lonely PCCN”

  1. birdy April 5, 2010 at 22:35 #

    I’m studying, too! But I don’t have a test date yet. Study hard! I can’t wait to read all about it.

    • seejanenurse April 5, 2010 at 22:58 #

      Good I do not want to be alone. I figured out that if I did not choose a test date, I would never study.

  2. ccu_rn June 9, 2010 at 14:18 #

    hey how did it go? did you pass? i am thinking of taking the pccn exam. i was on a cardiac step down unit for 2 and a half years and now in the cardiac icu since january. but this summer i’m kind of bored-since i’m on break from np school and i’m thinking hey maybe i will study and take the exam by august. what do you think will help me the most? i have the core essentials book for progressive care nursing, and lots of other materials i’ve acquired over the years of schooling and critical care courses i’ve taken at my facility.

    thanks !

    shan =)

    • seejanenurse June 15, 2010 at 01:35 #

      I did pass! 🙂 I studied from a program that the hospital funded by ED4Nurses.com I only used that material, and I passed. I am sure you can do it, check out the website.

      Good luck!

  3. niki August 25, 2010 at 00:56 #

    congratulations!! i am taking it next month. i am nervous 😦

  4. Debbie September 30, 2010 at 03:00 #

    I am starting to study for the PCCN. Did you pass? I hope so.

  5. Susie May 10, 2013 at 16:59 #

    need some reinforcement here!!!!!!!! I’ll be 60 6 days after my PCCN exam in 10 days; been studying ALOT!!!!!!!!!!! I PLAN TO PASS!!!!!!!!!

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