PCCN Questions And Answers With Complete
And Latest Test
Two days following a near-drowning accident, a pt is dyspneic, using accessory muscles,
expectorating large amounts of secretions and reporting feeling of impending death. Changes to the
assessment data include
RR- 24 TO 36
CXR clear to bilateral diffuse infiltrates
ABG 40% face mask or 100% non-rebreather mask
pO2 120 mm Hg to 56 mm Hg
pCO2 33 mmHg to 56 mmHg
pH 7.42 to 7.35
HCO3 24 meq/L to 27 mEq/L
Which of the ff do these changes most likely represent
A. aspiration pneumonia
B. pulmonary embolism
C. interstitial pneumonitis
D. ARDS Correct Answer: D. The onset of symptoms occurred within 48 hours of the incident. The
bilateral diffuse infiltrates and ABG results indicating hypoxemia and CO2 retention are all consistent
with ARDS.
Aspiration pneumonia should include hypoxemia, respiratory alkalosis. The CXR results would reveal
an area of opacity with aspiration pneumonia rather than diffuse infiltrates.
Interstitial lung disease involves an inflammation of supportive tissue between the air sacs rather than
inflammation in the air sacs themselves. Symptoms would be SOB and a dry cough.
A pt reports chest pain that is sharp, constant, worse when lying down and alleviated with sitting up
and leaning forward. The most likely cause of these findings is
A. ACS
B. pericarditis
C. PE
D. AAA Correct Answer: B Pericarditis is inflammation of the pericardial sac. The damaged
epicardium becomes rough and inflamed and irritates the pericardium lying adjacent to it,
precipitating pericarditis. Pain is the most common symptom of pericarditis. THe pain is sharp,
constant and is alleviated when sitting up and leaning forward.
A pt tells a nurse, "I don't know how I'm going to pay for this hospitalization." The nurse should
A. arrange a meeting with hospital social services staff
B. Notify the business office so a payment plan can be designed
C. redirect the pt toward meeting psychologic needs
D. give the pt applications for public assistance medical coverage Correct Answer: A. Collaboration
with a social worker is indicated in this case the social worker can assist the pt in identifying ways to
address the financial implications of this hospitalization and help identify methods of payments.
A cardiac pt with DNR status is being managed medically. The nurse notes a new cough, thick yellow
sputum and a temperature of 101.4 (38.4) Coarse crackles are present in the right upper field. The
nurse should most immediately anticipate
A. blood and sputum cultures followed by a broad spectrum abx
,B. mucolytics and judicious IV fluid administration
C. an antyipyretic and conservative management
D. NPO status and encouragement of frequent activity Correct Answer: A. This pt symptoms are
consistent with pneumonia. Management should include abx therapy, oxygen therapy for hypoxemia,
mechanical ventilation if acute respiratory failure develops, fluid management for hydration, nutritional
support, and treatment of associated medical problems and complications.
Which of the ff findings is most indicative of a ruptured aortic aneurysm
A. Back pain
B. bounding peripheral pulses
C. intermittent claudication
D. warm, flushed skin Correct Answer: A. An aneurysm is the localized dilation of an artery. Should
an aneurysm rupture, blood will build up under pressure in the tissues surrounding the aorta, which
can result in acute pain and tenderness in theses areas. This is particularly the case if the aneurysm
leaks from the back of the aorta. Ruptured AAA presents with a classic triad of pain in the flank or
back, hypotension and a pulsatile abdominal mass; however, only about half of the full triad. The pt
will complain of the pain and may feel cold, sweaty and faint on standing. The pt may also report
abdominal pain. A small percentage may have vomiting
According to recommendations based on research findings, pain assessment should occur
A. based on changes in vital signs
B. only when the pt movements indicate the pt is seeking attention
C. routinely, regardless of physical findings
D. only when the presence of pain can be validated Correct Answer: C. Pain is considered the fifth
vital sign and must be assessed regularly. Presence of physical findings may be part of the
comprehensive assessment of pain. However, physical findings may not be present in all patients
with pain
A pt with a tracheostomy requires frequent suctioning for thick sputum, A nurse finds a colleague
instilling saline in the endotracheal tube prior to suctioning. The most appropriate response by the
nurse would be to
A. report the colleague to the charge nurse or manager
B. noted the practice on the pt chart to ensure consistency of suctioning techniques
C. ask the attending physician to review the suctioning policy.
D. collaborate with the colleague to review the evidence about this practice. Correct Answer: D. In
addition to an unappreciable increase in sputum recovery, use of NS adversely affects arterial and
global tissue oxygenation and dislodges bacterial colonies, thus contributing to lower airway
contamination. Other harmful pt outcomes have been reported in the nursing literature, including
delays in return to baseline vital signs, Spo2 and intracranial pressure. Because no solid scientifically
based benefits for routine use of normal saline have been shown, it is highly recommended that this
potentially harmful practice be abandoned. Instead, treatment considerations should center on ways
to prevent the development of thick tenacious secretions. A review of these data should take place
with the colleague to help mitigate continuation of this dangerous practice
Upon admission to the PCU, you screen a pt to determine whether to administer an influenza
vaccine. Which of the following is a contraindication to the vaccine?
A. Guillian-Barre syndrome
B. chronic renal failure
C. COPD
, D. cirrhosis Correct Answer: A. Persons who developed Guillain-Barre syndrome after receiving an
influenza vaccine should not receive the influenza vaccine without checking with their provider
Emergency treatment of ventricular dysrhythmias for the pt who has an ICD pacemaker includes
which of the following
A. If a pt develops vfib, the nurse should not defibrillate with external paddles
B. if the ICD is firing correctly and the pt does not have pulse, CPR is not indicated
C. when preparing for external defibrillation, avoid placing the paddle directly over the ICD pulse
generator
D. when you need to turn off all functions of the ICD or pacemaker, apply a magnet Correct Answer:
C. Defibrillation has been known to cause malfunction of an ICD or pacemaker. Care should be taken
to ensure the defibrillation paddle/ pads are applied at least 4-finger breaths away from the device.
The anterior-lateral and anterior-posterior positions for paddle/pad placement are acceptable in a pt
with a permanent ICD or pacemaker. The pads may also be placed safely away from the ICD with 1
pad at the apex left mid-axillary, 5th ICS., and the other pad right of the sternum just below the
clavicle.
Based on the device implanted and the manufacturer, application of a magnet may turn device off or
reset to the default settings.
A pt is admitted following mitral valve replacement. Which of the following should most likely be
included in the patent's plan of care
A. positive inotropic agent
B. anticoagulant
C. prophylactic antibiotic
D. ACE inhibitor Correct Answer: B. Anticoagulatn therapy recommendations are based on the valve
apparatus and the pt risk factors (afib, LV dyfunction, previous thromboembolism, and
hypercoagulable condition). Mechanical valve replacement require lifelong anticoagulant therapy,
while most pt with bioprosthetic valve replacement require short term anti-coagulation (3 months). In
pt with NSR and no risk factors for thrombus, only aspirin therapy is recommended after bioprosthetic
valve replacement.
A pt with multiple rib fractures sustained in a motor vehicle collision 4 days ago reports sudden chest
pain and difficulty breathing. Chest xray reveals a right hemothorax. The pt appears anxious and has
decreased breath sounds on the affected side. Which of the ff procedures should the nurse anticipate
A. needle decompression, 2nd ICS at midclavicular line
B. bronchoscopy with broncial lavage
C. placement of a right-side chest tube in the 6th ICS at the posterior axillary line
D. CT scan for further evaluation and diagnosis Correct Answer: C. Blunt or penetrating thoracic
trauma can cause bleeding into the pleural space, resulting in a hemothorax. This life-threatening
condition must be treated immediately. Resuscitation with intravenous fluids is initiated to treat the
hypovolemic shock. A chest tube is placed on the affected side to allow drainage of the affected side
to allow drainage of blood.
A pt with which of the ff is at greatest risk for torsades de pointes
A. depressed ST segment
B. development of peaked T waves
C. prolonged QT interval
D. development of a U wave Correct Answer: C. The normal QTc is less than 0.46 second (460
msec) in women and less than 0.45 second (450 msec) in men. A prolonged QT interval is significant
because it can predispose the pt to the development of polymorphic VT, also known as torsades de
And Latest Test
Two days following a near-drowning accident, a pt is dyspneic, using accessory muscles,
expectorating large amounts of secretions and reporting feeling of impending death. Changes to the
assessment data include
RR- 24 TO 36
CXR clear to bilateral diffuse infiltrates
ABG 40% face mask or 100% non-rebreather mask
pO2 120 mm Hg to 56 mm Hg
pCO2 33 mmHg to 56 mmHg
pH 7.42 to 7.35
HCO3 24 meq/L to 27 mEq/L
Which of the ff do these changes most likely represent
A. aspiration pneumonia
B. pulmonary embolism
C. interstitial pneumonitis
D. ARDS Correct Answer: D. The onset of symptoms occurred within 48 hours of the incident. The
bilateral diffuse infiltrates and ABG results indicating hypoxemia and CO2 retention are all consistent
with ARDS.
Aspiration pneumonia should include hypoxemia, respiratory alkalosis. The CXR results would reveal
an area of opacity with aspiration pneumonia rather than diffuse infiltrates.
Interstitial lung disease involves an inflammation of supportive tissue between the air sacs rather than
inflammation in the air sacs themselves. Symptoms would be SOB and a dry cough.
A pt reports chest pain that is sharp, constant, worse when lying down and alleviated with sitting up
and leaning forward. The most likely cause of these findings is
A. ACS
B. pericarditis
C. PE
D. AAA Correct Answer: B Pericarditis is inflammation of the pericardial sac. The damaged
epicardium becomes rough and inflamed and irritates the pericardium lying adjacent to it,
precipitating pericarditis. Pain is the most common symptom of pericarditis. THe pain is sharp,
constant and is alleviated when sitting up and leaning forward.
A pt tells a nurse, "I don't know how I'm going to pay for this hospitalization." The nurse should
A. arrange a meeting with hospital social services staff
B. Notify the business office so a payment plan can be designed
C. redirect the pt toward meeting psychologic needs
D. give the pt applications for public assistance medical coverage Correct Answer: A. Collaboration
with a social worker is indicated in this case the social worker can assist the pt in identifying ways to
address the financial implications of this hospitalization and help identify methods of payments.
A cardiac pt with DNR status is being managed medically. The nurse notes a new cough, thick yellow
sputum and a temperature of 101.4 (38.4) Coarse crackles are present in the right upper field. The
nurse should most immediately anticipate
A. blood and sputum cultures followed by a broad spectrum abx
,B. mucolytics and judicious IV fluid administration
C. an antyipyretic and conservative management
D. NPO status and encouragement of frequent activity Correct Answer: A. This pt symptoms are
consistent with pneumonia. Management should include abx therapy, oxygen therapy for hypoxemia,
mechanical ventilation if acute respiratory failure develops, fluid management for hydration, nutritional
support, and treatment of associated medical problems and complications.
Which of the ff findings is most indicative of a ruptured aortic aneurysm
A. Back pain
B. bounding peripheral pulses
C. intermittent claudication
D. warm, flushed skin Correct Answer: A. An aneurysm is the localized dilation of an artery. Should
an aneurysm rupture, blood will build up under pressure in the tissues surrounding the aorta, which
can result in acute pain and tenderness in theses areas. This is particularly the case if the aneurysm
leaks from the back of the aorta. Ruptured AAA presents with a classic triad of pain in the flank or
back, hypotension and a pulsatile abdominal mass; however, only about half of the full triad. The pt
will complain of the pain and may feel cold, sweaty and faint on standing. The pt may also report
abdominal pain. A small percentage may have vomiting
According to recommendations based on research findings, pain assessment should occur
A. based on changes in vital signs
B. only when the pt movements indicate the pt is seeking attention
C. routinely, regardless of physical findings
D. only when the presence of pain can be validated Correct Answer: C. Pain is considered the fifth
vital sign and must be assessed regularly. Presence of physical findings may be part of the
comprehensive assessment of pain. However, physical findings may not be present in all patients
with pain
A pt with a tracheostomy requires frequent suctioning for thick sputum, A nurse finds a colleague
instilling saline in the endotracheal tube prior to suctioning. The most appropriate response by the
nurse would be to
A. report the colleague to the charge nurse or manager
B. noted the practice on the pt chart to ensure consistency of suctioning techniques
C. ask the attending physician to review the suctioning policy.
D. collaborate with the colleague to review the evidence about this practice. Correct Answer: D. In
addition to an unappreciable increase in sputum recovery, use of NS adversely affects arterial and
global tissue oxygenation and dislodges bacterial colonies, thus contributing to lower airway
contamination. Other harmful pt outcomes have been reported in the nursing literature, including
delays in return to baseline vital signs, Spo2 and intracranial pressure. Because no solid scientifically
based benefits for routine use of normal saline have been shown, it is highly recommended that this
potentially harmful practice be abandoned. Instead, treatment considerations should center on ways
to prevent the development of thick tenacious secretions. A review of these data should take place
with the colleague to help mitigate continuation of this dangerous practice
Upon admission to the PCU, you screen a pt to determine whether to administer an influenza
vaccine. Which of the following is a contraindication to the vaccine?
A. Guillian-Barre syndrome
B. chronic renal failure
C. COPD
, D. cirrhosis Correct Answer: A. Persons who developed Guillain-Barre syndrome after receiving an
influenza vaccine should not receive the influenza vaccine without checking with their provider
Emergency treatment of ventricular dysrhythmias for the pt who has an ICD pacemaker includes
which of the following
A. If a pt develops vfib, the nurse should not defibrillate with external paddles
B. if the ICD is firing correctly and the pt does not have pulse, CPR is not indicated
C. when preparing for external defibrillation, avoid placing the paddle directly over the ICD pulse
generator
D. when you need to turn off all functions of the ICD or pacemaker, apply a magnet Correct Answer:
C. Defibrillation has been known to cause malfunction of an ICD or pacemaker. Care should be taken
to ensure the defibrillation paddle/ pads are applied at least 4-finger breaths away from the device.
The anterior-lateral and anterior-posterior positions for paddle/pad placement are acceptable in a pt
with a permanent ICD or pacemaker. The pads may also be placed safely away from the ICD with 1
pad at the apex left mid-axillary, 5th ICS., and the other pad right of the sternum just below the
clavicle.
Based on the device implanted and the manufacturer, application of a magnet may turn device off or
reset to the default settings.
A pt is admitted following mitral valve replacement. Which of the following should most likely be
included in the patent's plan of care
A. positive inotropic agent
B. anticoagulant
C. prophylactic antibiotic
D. ACE inhibitor Correct Answer: B. Anticoagulatn therapy recommendations are based on the valve
apparatus and the pt risk factors (afib, LV dyfunction, previous thromboembolism, and
hypercoagulable condition). Mechanical valve replacement require lifelong anticoagulant therapy,
while most pt with bioprosthetic valve replacement require short term anti-coagulation (3 months). In
pt with NSR and no risk factors for thrombus, only aspirin therapy is recommended after bioprosthetic
valve replacement.
A pt with multiple rib fractures sustained in a motor vehicle collision 4 days ago reports sudden chest
pain and difficulty breathing. Chest xray reveals a right hemothorax. The pt appears anxious and has
decreased breath sounds on the affected side. Which of the ff procedures should the nurse anticipate
A. needle decompression, 2nd ICS at midclavicular line
B. bronchoscopy with broncial lavage
C. placement of a right-side chest tube in the 6th ICS at the posterior axillary line
D. CT scan for further evaluation and diagnosis Correct Answer: C. Blunt or penetrating thoracic
trauma can cause bleeding into the pleural space, resulting in a hemothorax. This life-threatening
condition must be treated immediately. Resuscitation with intravenous fluids is initiated to treat the
hypovolemic shock. A chest tube is placed on the affected side to allow drainage of the affected side
to allow drainage of blood.
A pt with which of the ff is at greatest risk for torsades de pointes
A. depressed ST segment
B. development of peaked T waves
C. prolonged QT interval
D. development of a U wave Correct Answer: C. The normal QTc is less than 0.46 second (460
msec) in women and less than 0.45 second (450 msec) in men. A prolonged QT interval is significant
because it can predispose the pt to the development of polymorphic VT, also known as torsades de
