PCCN ACTUAL EXAM PAPER 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◉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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: A. Taking prophylactic antibiotics
before dental procedures
Feedback
QUESTIONS WITH SOLUTIONS GRADED A+
◉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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: A. Taking prophylactic antibiotics
before dental procedures
Feedback
