PCCN REVIEW QUESTIONS AND ANSWERS
A nurse is caring for a 71-year-old female patient with end-stage chronic obstructive
pulmonary disease (COPD) who is experiencing cardiac ischemia with increased
shortness of breath. The MOST appropriate goal of oxygen therapy for this patient
would be to:
A. Limit supplemental oxygen to lower the risk of reducing respiratory drive
B. Maintain oxygen saturations between 86% and 89%
C. Administer oxygen until oxygen saturations are greater than 95% in order to relieve
ischemia
D. Maintain oxygen saturations between 90% and 92% - Answers -D. Maintain oxygen
saturations between 90% and 92%
Feedback
Maintaining oxygen saturations between 90% and 92% will serve the purpose of
providing enough oxygen to relieve cardiac ischemia while reducing the risk of
respiratory depression in a patient with COPD.
Laboratory studies from a 22-year-old male client with Type I diabetes mellitus are
evaluated during an admission for severe pneumonia. Which of the following laboratory
results should the nurse report to the physician?
A. Glycosylated hemoglobin (HbA1c), 9.8%
B. Low-density lipoprotein (LDL),
C. 94 mg/dLHematocrit (Hct), 53%
D. Urine specific gravity, 1.250 - Answers -A. Glycosylated hemoglobin (HbA1c), 9.8%
Feedback
Glycosylated hemoglobin measures the average blood sugar levels over a 2 to 3 month
time period. Clients with previously diagnosed diabetes mellitus should aim to keep their
HbA1c levels below 7%.CONTENT AREA: Clinical Judgement:
Endocrine/Hematology/Neurology/GI/Renal
The nurse is assessing a 68 year old female patient with a history of chronic obstructive
pulmonary disease (COPD). The patient presents with complaints of recent confusion,
increased fatigue, and syncopal episodes when walking. The nurse assesses S3 and
S4 sounds on auscultation, jugular vein distention, and +3 pitting edema of the ankles
and feet. Which of the following complications of COPD does the nurse suspect the
patient is most likely experiencing?
A. Acute respiratory distress syndrome (ARDS)
B. Bronchiectasis
C. Heart failure
D. Cor pulmonale - Answers -D. Cor pulmonale
Feedback
,The nurse should recognize that a history of COPD together with the signs and
symptoms listed here are suggestive of cor pulmonale. The patient requires further
workup to confirm this diagnosis.
A 42-year-old male with Marfan syndrome and complaint of dizziness is admitted to the
telemetry unit for monitoring. Which of the following accompanying symptoms may
indicate the need for immediate surgical attention?
A. Cough with vocal hoarseness
B. Limited rotation of the left shoulder
C.Headache that resolved after breakfast, but has returned
D. Sudden stabbing pain in the right elbow - Answers -A. Cough with vocal hoarseness
Feedback
Patients diagnosed with Marfan syndrome are at higher risk for aortic aneurysms.
Changes in vocal quality accompanied by a cough or dysphagia (difficulty swallowing)
may indicate that a thoracic aortic aneurysm is becoming more enlarged.
The nurse is assessing a 74 year old female patient who has presented with the
following symptoms: cool, clammy skin; faint, irregular peripheral pulses, and +3 pitting
edema in her bilateral lower extremities. Her partner tells the nurse the patient has a
history of heart failure with a recent LVEF of 20%, as well as type 2 diabetes. The
patient's HR is 132, BP is 79/48, and blood glucose is 349. Which of the following
conditions does the nurse suspect?
A. Cardiogenic shock
B. Diabetic ketoacidosis
C. Fluid overload
D. Obstructive shock - Answers -A. Cardiogenic shock
Feedback
The nurse should identify that cardiogenic shock is an emergency that has extremely
high mortality rates without timely intervention. The patient's history of heart failure
together with her acute symptoms of weak pulses, edema, and hypotension all point to
cardiogenic shock.
The nurse is caring for a patient with stage 5 chronic kidney disease who normally
receives hemodialysis three times a week on Monday, Wednesday, and Friday. It is
now Sunday and the patient states they have missed their last two dialysis sessions.
The patient is complaining of shortness of breath and fatigue, and their labs show a
creatinine of 3.9 and potassium of 6.8. What is the BEST treatment for this patient ?
A. 80 mg IV push furosemide followed by rechecking the potassium level, with more IV
furosemide as needed
B. 15 g kayexalate PO twice daily
C. Intravenous calcium infusion
D. Urgent hemodialysis - Answers -D. Urgent hemodialysis
Feedback
The nurse should recognize that dialysis is the best option for this patient since they are
already a regular dialysis patient and are a likely candidate to receive urgent dialysis
due to their missed dialysis sessions, shortness of breath, and critical potassium level.
,A 17-year-old male client is recovering from idiopathic infective endocarditis. The nurse
should include which of the following teaching points in the discharge care plan for this
client?
A. Taking prophylactic antibiotics before dental procedures
B. Drinking no more than 1 liter of fluid per day
C. Strictly avoiding caffeine or other stimulants
D. Encouraging a healthy low-fat diet that includes at least 2 grams of sodium intake per
day - Answers -A. Taking prophylactic antibiotics before dental procedures
Feedback
Client with a history of infective endocarditis should take prophylactic antibiotics before
dental procedures and some surgical procedures.
The nurse is caring for a 21 year old female who is being treated with IV magnesium for
pre-eclampsia. Upon assessment, the nurse notes that the patient's skin is flushed, her
blood pressure is 88/56, and her respiratory rate is 12. The nurse checks the patient's
magnesium level and finds that it is 7.2 mg/dL. Which of the following actions does the
nurse anticipate taking next?
A. Administering intravenous calcium gluconate
B. Increasing the rate of the magnesium infusion
C. Placing the patient in Trendelenburg and administering a bolus of IV fluid
D.Preparing the patient for a bedside cardioversion. - Answers -A. Administering
intravenous calcium gluconate
Feedback
The nurse should identify that the signs and symptoms here are reflective of a critically
high magnesium level, reflected by the lab level of 7.2 mg/dL, and that the correct
treatment is an infusion of calcium gluconate.
A 22-year-old male patient is admitted for observation following a linear temporal skull
fracture from a skiing accident. Upon admission at 2 pm, the patient was alert and
oriented, and reports that he "passed out for a second" immediately after his accident.
At 4 pm, the nurse notes that the patient's Glasgow Coma Scale (GCS) is 8. The nurse
should:
A. Continue to monitor for changes
B. Place the patient in Trendelenburg position
C. Prepare the patient for burr hole placement with clot evacuation
D. Prepare to administer tissue plasminogen activator (tPA) to reverse occlusive stroke
- Answers -C. Prepare the patient for burr hole placement with clot evacuation
Feedback
This patient is exhibiting classic signs and symptoms of an epidural hematoma. Surgical
intervention to remove the hematoma and relieve pressure on the brain should be
performed as soon as possible.
A 71-year-old female patient is admitted after evaluation in the emergency department
(ED) for suspected coronary syndrome involving the inferior wall. Which of the following
, changes would the nurse anticipate seeing on a 12-lead ECG for an inferior wall
myocardial infarction (MI)?
A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
B. ST elevation, Q waves, and inverted T waves in leads I and aVL
C. ST depression, Q waves, and spiked T waves in leads II, III, and aVF
D. ST elevation and inverted T waves in all precordial leads - Answers -A. ST elevation,
Q waves, and inverted T waves in leads II, III, and aVF
Feedback
Acute coronary syndromes involving the inferior cardiac wall will most often manifest as
ST elevation and inverted T waves in leads II, III, and aVF. Q waves may appear during
the acute phases of the syndrome, or may appear as an infarction heals (more
common).
The nurse has a 32 year old female patient with a diagnosis of major depressive
disorder. The patient tells the nurse that she wishes every night that she could go to
sleep and never wake up. She also tells the nurse that she has been thinking that it
would be easy to take a whole bottle of Tylenol "to end my pain forever." What is the
MOST appropriate intervention for the nurse to take?
A. Encourage the patient to engage in psychotherapy when she is ready to talk about
her feelings.
B. Ensure that the patient's physical environment is safe and free of objects that could
be used to harm herself
C. Remind the patient to take her scheduled medications
D. Tell the patient to take some time alone to process her thoughts and feelings -
Answers -B. Ensure that the patient's physical environment is safe and free of objects
that could be used to harm herself
Feedback
The nurse should identify that the most important thing when working with a patient who
is expressing suicidal ideology is patient safety; this begins with the patient's physical
environment and ensuring that there is nothing that the patient can access that can be
used to harm themselves.
A telemetry nurse is caring for a 59-year-old male patient who is being evaluated for
non-specific cardiac symptoms. Just after the nurse arrives in the patient's room to
administer the morning medications, the patient loses consciousness. The cardiac
monitor reveals third-degree AV heart block with ventricular escape beats at 38 beats
per minute (bpm). The nurse should:
A. Prepare to initiate transcutaneous pacing
B. Administer atropine 0.5 mg IV
C. Prepare the patient for cardioversion
D. Administer adenosine (Adenocard) 6 mg rapid IV push - Answers -A. Prepare to
initiate transcutaneous pacing
Feedback
Third-degree heart block with a slow ventricular escape rhythm that is not sufficient to
keep a patient alert should be immediately addressed by transcutaneous pacing to
A nurse is caring for a 71-year-old female patient with end-stage chronic obstructive
pulmonary disease (COPD) who is experiencing cardiac ischemia with increased
shortness of breath. The MOST appropriate goal of oxygen therapy for this patient
would be to:
A. Limit supplemental oxygen to lower the risk of reducing respiratory drive
B. Maintain oxygen saturations between 86% and 89%
C. Administer oxygen until oxygen saturations are greater than 95% in order to relieve
ischemia
D. Maintain oxygen saturations between 90% and 92% - Answers -D. Maintain oxygen
saturations between 90% and 92%
Feedback
Maintaining oxygen saturations between 90% and 92% will serve the purpose of
providing enough oxygen to relieve cardiac ischemia while reducing the risk of
respiratory depression in a patient with COPD.
Laboratory studies from a 22-year-old male client with Type I diabetes mellitus are
evaluated during an admission for severe pneumonia. Which of the following laboratory
results should the nurse report to the physician?
A. Glycosylated hemoglobin (HbA1c), 9.8%
B. Low-density lipoprotein (LDL),
C. 94 mg/dLHematocrit (Hct), 53%
D. Urine specific gravity, 1.250 - Answers -A. Glycosylated hemoglobin (HbA1c), 9.8%
Feedback
Glycosylated hemoglobin measures the average blood sugar levels over a 2 to 3 month
time period. Clients with previously diagnosed diabetes mellitus should aim to keep their
HbA1c levels below 7%.CONTENT AREA: Clinical Judgement:
Endocrine/Hematology/Neurology/GI/Renal
The nurse is assessing a 68 year old female patient with a history of chronic obstructive
pulmonary disease (COPD). The patient presents with complaints of recent confusion,
increased fatigue, and syncopal episodes when walking. The nurse assesses S3 and
S4 sounds on auscultation, jugular vein distention, and +3 pitting edema of the ankles
and feet. Which of the following complications of COPD does the nurse suspect the
patient is most likely experiencing?
A. Acute respiratory distress syndrome (ARDS)
B. Bronchiectasis
C. Heart failure
D. Cor pulmonale - Answers -D. Cor pulmonale
Feedback
,The nurse should recognize that a history of COPD together with the signs and
symptoms listed here are suggestive of cor pulmonale. The patient requires further
workup to confirm this diagnosis.
A 42-year-old male with Marfan syndrome and complaint of dizziness is admitted to the
telemetry unit for monitoring. Which of the following accompanying symptoms may
indicate the need for immediate surgical attention?
A. Cough with vocal hoarseness
B. Limited rotation of the left shoulder
C.Headache that resolved after breakfast, but has returned
D. Sudden stabbing pain in the right elbow - Answers -A. Cough with vocal hoarseness
Feedback
Patients diagnosed with Marfan syndrome are at higher risk for aortic aneurysms.
Changes in vocal quality accompanied by a cough or dysphagia (difficulty swallowing)
may indicate that a thoracic aortic aneurysm is becoming more enlarged.
The nurse is assessing a 74 year old female patient who has presented with the
following symptoms: cool, clammy skin; faint, irregular peripheral pulses, and +3 pitting
edema in her bilateral lower extremities. Her partner tells the nurse the patient has a
history of heart failure with a recent LVEF of 20%, as well as type 2 diabetes. The
patient's HR is 132, BP is 79/48, and blood glucose is 349. Which of the following
conditions does the nurse suspect?
A. Cardiogenic shock
B. Diabetic ketoacidosis
C. Fluid overload
D. Obstructive shock - Answers -A. Cardiogenic shock
Feedback
The nurse should identify that cardiogenic shock is an emergency that has extremely
high mortality rates without timely intervention. The patient's history of heart failure
together with her acute symptoms of weak pulses, edema, and hypotension all point to
cardiogenic shock.
The nurse is caring for a patient with stage 5 chronic kidney disease who normally
receives hemodialysis three times a week on Monday, Wednesday, and Friday. It is
now Sunday and the patient states they have missed their last two dialysis sessions.
The patient is complaining of shortness of breath and fatigue, and their labs show a
creatinine of 3.9 and potassium of 6.8. What is the BEST treatment for this patient ?
A. 80 mg IV push furosemide followed by rechecking the potassium level, with more IV
furosemide as needed
B. 15 g kayexalate PO twice daily
C. Intravenous calcium infusion
D. Urgent hemodialysis - Answers -D. Urgent hemodialysis
Feedback
The nurse should recognize that dialysis is the best option for this patient since they are
already a regular dialysis patient and are a likely candidate to receive urgent dialysis
due to their missed dialysis sessions, shortness of breath, and critical potassium level.
,A 17-year-old male client is recovering from idiopathic infective endocarditis. The nurse
should include which of the following teaching points in the discharge care plan for this
client?
A. Taking prophylactic antibiotics before dental procedures
B. Drinking no more than 1 liter of fluid per day
C. Strictly avoiding caffeine or other stimulants
D. Encouraging a healthy low-fat diet that includes at least 2 grams of sodium intake per
day - Answers -A. Taking prophylactic antibiotics before dental procedures
Feedback
Client with a history of infective endocarditis should take prophylactic antibiotics before
dental procedures and some surgical procedures.
The nurse is caring for a 21 year old female who is being treated with IV magnesium for
pre-eclampsia. Upon assessment, the nurse notes that the patient's skin is flushed, her
blood pressure is 88/56, and her respiratory rate is 12. The nurse checks the patient's
magnesium level and finds that it is 7.2 mg/dL. Which of the following actions does the
nurse anticipate taking next?
A. Administering intravenous calcium gluconate
B. Increasing the rate of the magnesium infusion
C. Placing the patient in Trendelenburg and administering a bolus of IV fluid
D.Preparing the patient for a bedside cardioversion. - Answers -A. Administering
intravenous calcium gluconate
Feedback
The nurse should identify that the signs and symptoms here are reflective of a critically
high magnesium level, reflected by the lab level of 7.2 mg/dL, and that the correct
treatment is an infusion of calcium gluconate.
A 22-year-old male patient is admitted for observation following a linear temporal skull
fracture from a skiing accident. Upon admission at 2 pm, the patient was alert and
oriented, and reports that he "passed out for a second" immediately after his accident.
At 4 pm, the nurse notes that the patient's Glasgow Coma Scale (GCS) is 8. The nurse
should:
A. Continue to monitor for changes
B. Place the patient in Trendelenburg position
C. Prepare the patient for burr hole placement with clot evacuation
D. Prepare to administer tissue plasminogen activator (tPA) to reverse occlusive stroke
- Answers -C. Prepare the patient for burr hole placement with clot evacuation
Feedback
This patient is exhibiting classic signs and symptoms of an epidural hematoma. Surgical
intervention to remove the hematoma and relieve pressure on the brain should be
performed as soon as possible.
A 71-year-old female patient is admitted after evaluation in the emergency department
(ED) for suspected coronary syndrome involving the inferior wall. Which of the following
, changes would the nurse anticipate seeing on a 12-lead ECG for an inferior wall
myocardial infarction (MI)?
A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
B. ST elevation, Q waves, and inverted T waves in leads I and aVL
C. ST depression, Q waves, and spiked T waves in leads II, III, and aVF
D. ST elevation and inverted T waves in all precordial leads - Answers -A. ST elevation,
Q waves, and inverted T waves in leads II, III, and aVF
Feedback
Acute coronary syndromes involving the inferior cardiac wall will most often manifest as
ST elevation and inverted T waves in leads II, III, and aVF. Q waves may appear during
the acute phases of the syndrome, or may appear as an infarction heals (more
common).
The nurse has a 32 year old female patient with a diagnosis of major depressive
disorder. The patient tells the nurse that she wishes every night that she could go to
sleep and never wake up. She also tells the nurse that she has been thinking that it
would be easy to take a whole bottle of Tylenol "to end my pain forever." What is the
MOST appropriate intervention for the nurse to take?
A. Encourage the patient to engage in psychotherapy when she is ready to talk about
her feelings.
B. Ensure that the patient's physical environment is safe and free of objects that could
be used to harm herself
C. Remind the patient to take her scheduled medications
D. Tell the patient to take some time alone to process her thoughts and feelings -
Answers -B. Ensure that the patient's physical environment is safe and free of objects
that could be used to harm herself
Feedback
The nurse should identify that the most important thing when working with a patient who
is expressing suicidal ideology is patient safety; this begins with the patient's physical
environment and ensuring that there is nothing that the patient can access that can be
used to harm themselves.
A telemetry nurse is caring for a 59-year-old male patient who is being evaluated for
non-specific cardiac symptoms. Just after the nurse arrives in the patient's room to
administer the morning medications, the patient loses consciousness. The cardiac
monitor reveals third-degree AV heart block with ventricular escape beats at 38 beats
per minute (bpm). The nurse should:
A. Prepare to initiate transcutaneous pacing
B. Administer atropine 0.5 mg IV
C. Prepare the patient for cardioversion
D. Administer adenosine (Adenocard) 6 mg rapid IV push - Answers -A. Prepare to
initiate transcutaneous pacing
Feedback
Third-degree heart block with a slow ventricular escape rhythm that is not sufficient to
keep a patient alert should be immediately addressed by transcutaneous pacing to
