PROGRESSIVE CARE CERTIFIED
NURSE(PCCN) REVIEWED QUESTIONS AND
ANSWERS LATEST FULL REVIEW 2022/2023
A 58-year-old male with a history of alcohol abuse is a heavy smoker. He complains of pain in his chest in
the afternoons when he is sitting and watching TV. ECG shows elevation of ST segments.
The most likely diagnosis is:
a. Unstable angina.
b. Variant/Prinzmetal's angina.
c. Stable angina.
d. Gastroesophageal reflux disease. (correct answers)B: Variant angina (also known as Prinzmetal's
angina) results from spasms of the coronary arteries associated with or without atherosclerotic plaques;
and is often related to smoking, alcohol, or illicit stimulants. Elevation of ST segments typically occurs
with variant angina, which frequently occurs cyclically at the same time each day and often while the
person is at rest. Stable angina occurs regularly with activity. Unstable angina occurs when there is a
change in the pattern of stable angina. GERD pain may be mistaken for angina.
Metabolic syndrome is characterized by:
a. Abdominal obesity, decreased triglyceride level, increased HDL level, and hypertension.
b. Hypertension, abdominal obesity, and increased HDL level.
c. Abdominal obesity, increased triglyceride level, decreased HDL level, and increased fasting blood
glucose level.
d. Hypotension, decreased fasting blood glucose level, increased triglyceride level, and decreased HDL
level. (correct answers)C: Metabolic syndrome (insulin resistance) puts people at risk for the
development of diabetes mellitus and cardiovascular disease, and is characterized by abdominal obesity
(>35 inches in women and >40 inches in men), increased triglycerides (150), decreased HDL level (<40
, mm Hg in men and <50 mm Hg in women), elevation of blood pressure (130/ 85 mm Hg), and increased
fasting glucose ( 110 mg/dL). Other indicators include elevation of C-reactive protein (evidence of a
proinflammatory state) and high levels of fibrinogen (evidence of a prothrombotic state).
Parenteral nutrition with a total nutrient admixture that includes lipids has been ordered for a burn
patient for administration throughout a 24-hour period. When preparing to administer the solution, the
nurse observes that the oil has separated, forming an obvious layer. Which of the following options is
the correct action to take?
a. Administer the solution, as oil separation is normal.
b. Mix the solution by shaking the bag until no oil separation is noticeable.
c. Discard the solution.
d. Return the solution to the pharmacy for the addition of added emulsifier. (correct answers)C: The
total nutrient admixture should be discarded if there is "cracking" of the lipid emulsion and the oil
separates into a layer. With TNA, all the components of parenteral nutrition and lipids are admixed
together in one container to create a 3-in-1 formula. Components of parenteral nutrition generally
include proteins, carbohydrates, fats, electrolytes, vitamins, sterile water, and trace vitamins. While
most postoperative patients need 1500 calories per day to prevent protein breakdown, those with fever,
burns, major surgery, trauma, or hypermetabolic disease may need up to 10,000 more calories daily.
A 30-year-old patient complains of post-operative pain at 8 on a 1-to-10 scale 12 hours after surgery,
but is not moaning, grimacing, or exhibiting any standard physical signs of pain. The patient last received
pain medication 6 hours earlier, and has orders for morphine every 4 hours as needed and ibuprofen
every 6 hours as needed. Which is the most appropriate action?
a. Administer ibuprofen.
b. Administer morphine.
c. Administer ibuprofen, and if the patient does not feel relief after one hour post-dose, then administer
morphine.
d. Question present family members about the patient's pain tolerance before making a decision.
(correct answers)B: The nurse should give morphine, as 8 on a 1 to 10 scale is representative of severe
pain, not uncommon in the first 24 hours after surgery. Patients have a right to pain control, and the
nurse should trust that the pain is what the patient says it is. Patients may show very different behavior
when they are in pain. Some may cry and moan with minor pain, and others may exhibit little difference
in behavior when truly suffering. Thus, judging pain by behavior can lead to the wrong conclusions.
Questioning family members is not appropriate.
NURSE(PCCN) REVIEWED QUESTIONS AND
ANSWERS LATEST FULL REVIEW 2022/2023
A 58-year-old male with a history of alcohol abuse is a heavy smoker. He complains of pain in his chest in
the afternoons when he is sitting and watching TV. ECG shows elevation of ST segments.
The most likely diagnosis is:
a. Unstable angina.
b. Variant/Prinzmetal's angina.
c. Stable angina.
d. Gastroesophageal reflux disease. (correct answers)B: Variant angina (also known as Prinzmetal's
angina) results from spasms of the coronary arteries associated with or without atherosclerotic plaques;
and is often related to smoking, alcohol, or illicit stimulants. Elevation of ST segments typically occurs
with variant angina, which frequently occurs cyclically at the same time each day and often while the
person is at rest. Stable angina occurs regularly with activity. Unstable angina occurs when there is a
change in the pattern of stable angina. GERD pain may be mistaken for angina.
Metabolic syndrome is characterized by:
a. Abdominal obesity, decreased triglyceride level, increased HDL level, and hypertension.
b. Hypertension, abdominal obesity, and increased HDL level.
c. Abdominal obesity, increased triglyceride level, decreased HDL level, and increased fasting blood
glucose level.
d. Hypotension, decreased fasting blood glucose level, increased triglyceride level, and decreased HDL
level. (correct answers)C: Metabolic syndrome (insulin resistance) puts people at risk for the
development of diabetes mellitus and cardiovascular disease, and is characterized by abdominal obesity
(>35 inches in women and >40 inches in men), increased triglycerides (150), decreased HDL level (<40
, mm Hg in men and <50 mm Hg in women), elevation of blood pressure (130/ 85 mm Hg), and increased
fasting glucose ( 110 mg/dL). Other indicators include elevation of C-reactive protein (evidence of a
proinflammatory state) and high levels of fibrinogen (evidence of a prothrombotic state).
Parenteral nutrition with a total nutrient admixture that includes lipids has been ordered for a burn
patient for administration throughout a 24-hour period. When preparing to administer the solution, the
nurse observes that the oil has separated, forming an obvious layer. Which of the following options is
the correct action to take?
a. Administer the solution, as oil separation is normal.
b. Mix the solution by shaking the bag until no oil separation is noticeable.
c. Discard the solution.
d. Return the solution to the pharmacy for the addition of added emulsifier. (correct answers)C: The
total nutrient admixture should be discarded if there is "cracking" of the lipid emulsion and the oil
separates into a layer. With TNA, all the components of parenteral nutrition and lipids are admixed
together in one container to create a 3-in-1 formula. Components of parenteral nutrition generally
include proteins, carbohydrates, fats, electrolytes, vitamins, sterile water, and trace vitamins. While
most postoperative patients need 1500 calories per day to prevent protein breakdown, those with fever,
burns, major surgery, trauma, or hypermetabolic disease may need up to 10,000 more calories daily.
A 30-year-old patient complains of post-operative pain at 8 on a 1-to-10 scale 12 hours after surgery,
but is not moaning, grimacing, or exhibiting any standard physical signs of pain. The patient last received
pain medication 6 hours earlier, and has orders for morphine every 4 hours as needed and ibuprofen
every 6 hours as needed. Which is the most appropriate action?
a. Administer ibuprofen.
b. Administer morphine.
c. Administer ibuprofen, and if the patient does not feel relief after one hour post-dose, then administer
morphine.
d. Question present family members about the patient's pain tolerance before making a decision.
(correct answers)B: The nurse should give morphine, as 8 on a 1 to 10 scale is representative of severe
pain, not uncommon in the first 24 hours after surgery. Patients have a right to pain control, and the
nurse should trust that the pain is what the patient says it is. Patients may show very different behavior
when they are in pain. Some may cry and moan with minor pain, and others may exhibit little difference
in behavior when truly suffering. Thus, judging pain by behavior can lead to the wrong conclusions.
Questioning family members is not appropriate.
