PCCN CERTIFICATION PRACTICE EXAM COMPLETE QUESTION BANK COMPLETE WITH 100% VERIFIED ANSWERS

PCCN CERTIFICATION PRACTICE EXAM COMPLETE QUESTION BANK COMPLETE WITH 100% VERIFIED ANSWERS Question 1 A patient with acute decompensated heart failure is receiving dobutamine. Which assessment finding indicates the medication is having the desired therapeutic effect? A. Decreased urine output B. Increased cardiac output with improved peripheral perfusion C. Decreased blood pressure D. Increased pulmonary capillary wedge pressure (PCWP) Answer: B. Increased cardiac output with improved peripheral perfusion Rationale: Dobutamine is a beta-1 adrenergic agonist that increases cardiac contractility and stroke volume, leading to increased cardiac output and improved tissue perfusion. The desired effect is improved peripheral perfusion (warm, pink extremities, adequate urine output) and hemodynamic improvement (increased cardiac output, decreased PCWP). Decreased urine output and decreased blood pressure would indicate inadequate response or adverse effects. ________________________________________ Question 2 A patient with an acute myocardial infarction (AMI) develops a new systolic murmur heard best at the apex, along with hypotension and pulmonary edema. These findings are most consistent with which complication? A. Ventricular septal rupture B. Papillary muscle rupture C. Left ventricular free wall rupture D. Pericarditis Answer: B. Papillary muscle rupture Rationale: Acute papillary muscle rupture is a life-threatening complication of myocardial infarction that causes acute mitral regurgitation. The murmur is heard best at the apex and radiates to the axilla (holosystolic murmur). The abrupt onset of severe mitral regurgitation causes acute pulmonary edema and cardiogenic shock. Ventricular septal rupture causes a harsh holosystolic murmur heard best at the left lower sternal border. ________________________________________ Question 3 A patient is 2 days post-cardiac catheterization via the femoral approach. The nurse notes a 2-cm pulsatile mass with a bruit in the right groin. What is the most appropriate initial nursing action? A. Apply a warm compress to the area B. Apply firm manual pressure above the site C. Notify the healthcare provider immediately D. Continue to monitor the site Answer: C. Notify the healthcare provider immediately Rationale: This patient has developed a femoral artery pseudoaneurysm, characterized by a pulsatile mass with a bruit. This is a serious complication requiring immediate notification of the healthcare provider. The provider will likely order a duplex ultrasound to confirm the diagnosis and determine the need for ultrasound-guided compression, thrombin injection, or surgical repair. ________________________________________ Question 4 A patient with a history of heart failure is prescribed digoxin. Which laboratory value should be monitored closely due to the risk of digoxin toxicity? A. Sodium B. Potassium C. Magnesium D. Calcium Answer: B. Potassium Rationale: Digoxin toxicity is more likely to occur in patients with hypokalemia, as low serum potassium increases the binding of digoxin to cardiac sodium-potassium ATPase pumps. Therapeutic digoxin level is 0.8-2.0 ng/mL. Signs of toxicity include nausea, vomiting, visual disturbances (yellow-green halos), and cardiac arrhythmias (bradycardia, heart block, ventricular tachycardia). ________________________________________ Question 5 A patient is being evaluated for Takotsubo cardiomyopathy (stress-induced cardiomyopathy). Which of the following clinical features would be most consistent with this diagnosis? A. ST-segment elevation in multiple coronary distributions on ECG B. Presence of significant coronary artery obstruction on angiography C. Decreased left ventricular ejection fraction with apical ballooning D. History of typical angina with exercise Answer: C. Decreased left ventricular ejection fraction with apical ballooning Rationale: Takotsubo cardiomyopathy is a transient left ventricular dysfunction triggered by emotional or physical stress. The hallmark is apical ballooning with basal hyperkinesis on echocardiography or ventriculography, with the left ventricle resembling a Japanese takotsubo pot. Coronary angiography typically shows no significant obstructive coronary artery disease. Patients present with chest pain, ECG changes, and elevated cardiac biomarkers mimicking acute coronary syndrome. ________________________________________ Question 6 A patient with a history of hypertension presents with a sudden, severe chest or back pain described as "ripping" or "tearing." The pain is worst at onset and does not change with position. Which diagnosis should be suspected? A. Pulmonary embolism B. Acute coronary syndrome C. Aortic dissection D. Pericarditis Answer: C. Aortic dissection Rationale: Aortic dissection is a life-threatening emergency characterized by sudden, severe, "ripping" or "tearing" chest or back pain. The pain is typically maximal at onset. It is often associated with a history of hypertension and may involve the ascending aorta (Stanford Type A) or descending aorta (Stanford Type B). Immediate surgical consultation is required for Type A dissections. ________________________________________ Question 7 A patient with heart failure is receiving furosemide. Which laboratory value requires the most immediate nursing intervention? A. Serum sodium of 135 mEq/L B. Serum potassium of 3.0 mEq/L C. Serum creatinine of 1.2 mg/dL D. Serum magnesium of 2.0 mEq/L Answer: B. Serum potassium of 3.0 mEq/L Rationale: Furosemide is a loop diuretic that can cause hypokalemia. A serum potassium of 3.0 mEq/L is significantly low and increases the risk of cardiac arrhythmias, especially in patients with heart failure who may also be on digoxin. The nurse should notify the provider and prepare to administer potassium replacement. Normal potassium is 3.5-5.0 mEq/L. ________________________________________ Question 8