PCCN Exam Questions with Correct Answers Latest
Updates Questions With Complete Solution
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
D. The onset of symptoms occured 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 hypoxxemia, respiratory alkalosis. The CXR
results would reveal an area of opacity with aspiration pneumonia rather than diffuse
infiltrates.
Interstitial lung disease invlolves 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
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
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 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
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
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
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.
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
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
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
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
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
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
pointes. When drugs associated with a high risk of torsades de pointes are started, it is
important to record the QT and QTc interval and to continue to monitor the QT and QTc
Updates Questions With Complete Solution
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
D. The onset of symptoms occured 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 hypoxxemia, respiratory alkalosis. The CXR
results would reveal an area of opacity with aspiration pneumonia rather than diffuse
infiltrates.
Interstitial lung disease invlolves 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
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
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 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
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
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
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.
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
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
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
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
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
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
pointes. When drugs associated with a high risk of torsades de pointes are started, it is
important to record the QT and QTc interval and to continue to monitor the QT and QTc
