PCCN REVIEW 2024 WITH
ELABORATED 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% - 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 - 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 - 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 - 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 - 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 - 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 - 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. - 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 - C. Prepare the
patient for burr hole placement with clot evacuation
Feedback
ELABORATED 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% - 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 - 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 - 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 - 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 - 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 - 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 - 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. - 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 - C. Prepare the
patient for burr hole placement with clot evacuation
Feedback
