PCCN Certification Exam Questions with
Verified Answers
Question 1
A patient who is postoperative day 2 after a pancreatic resection for hemorrhagic
pancreatitis is now complaining of acute shortness of breath with rales bilaterally and
increasing oxygen requirements. This could be the beginning of:
A. acute respiratory distress syndrome
B. asthma
C. postoperative pain syndrome
D. gastric bleed
Correct Answer
A. acute respiratory distress syndrome
Any patient with an inflammatory disorder (such as postoperative abdominal
surgery) can develop acute respiratory distress syndrome approximately 24-36 hrs
post event. The signs and symptoms include acute shortness of breath, rales
bilaterally, diffuse bilateral ground-glass appearance, or white-out, on chest x-ray
and increased requirements for oxygen. Asthma would include wheezing.
Postoperative pain would not likely cause rales. A gastric bleed would not cause
rales.
Page 1 of 100
,Question 2
The nurse is teaching a patient to manage tracheostomy care. The nurse has prepared
written directions and a video, but the patient ignores them and picks up the pieces
of equipment and looks at them trying to figure out the parts. The patient's learning
style is most likely:
A. auditory
B. visual
C. kinesthetic
D. mixed
Correct Answer
C. kinesthetic
Kinesthetic learners learn best by handling, doing and practicing the objective.
These learners should be allowed to handle supplies or equipment at their pace,
with little interruptions. They do benefit from written directions, videos and
diagrams. Auditory learners learn best by listening and talking, so procedures
should be explained during presentations. Auditory learners benefit from
audiotapes and extra time for questions.
Question 3
You are caring for a patient recently admitted with an inferior wall MI. Which of the
following 12-lead ECG findings would you anticipate?
A. T wave inversion in leads I and aVL
B. Q wave formation and ST segment elevation in leads II, III, and aVF
C. QRS duration greater than 0.01 in all leads
D. R wave taller in V6
Correct Answer
B. Q wave formation and ST segment elevation in leads II, III, and aVF
With STEMI, the patient will have ST segment elevation. The inferior leads are II, III,
and aVF. T wave inversion in leads I and aVL indicate ischemia in the anterior leads.
QRS duration that is prolonged may indicate an intraventricular conduction defect,
and an R wave taller in V6 is a bundle branch block.
Page 2 of 100
,Question 4
Why is calcium required for clot formation?
A. Calcium reacts with factor Xa to begin the common pathway of clot formation.
B. Calcium is necessary for contraction of vascular smooth muscle.
C. Calcium is necessary for bone conservation
D. Calcium is a by-product of glucose metabolism
Correct Answer
A. Calcium reacts with factor Xa to begin the common pathway of clot formation.
There is an intrinsic and extrinsic pathway for clot formation. As they combine to
form the final common pathway at factor Xa, calcium must be present at a sufficient
level for clot formation to occur. Calcium is necessary for contraction of smooth
muscle; however, this is not the mechanism for clot formation. Calcium is required
for bone conservation; again, not a mechanism of clot formation. Many blood
products lower the available serum calcium levels, thereby reducing the ability to
make normal clots. Glucose metabolism has nothing to do with clot formation.
Question 5
A patient with chronic obstructive lung disease now has respiratory failure with a
PaCO2 of 65 and a pH of 7.30. The patient has dyspnea and is experiencing cardiac
dysrhythmias, confusion and hypotension. These findings are consistent with:
A. respiratory alkalosis
B. respiratory acidosis
C. metabolic alkalosis
D. metabolic acidosis
Correct Answer
B. respiratory acidosis
To evaluate an arterial blood gas in a patient with chronic disease, address the pH
first. In this case, the pH is abnormal. It is 7.30, which is acidotic, and an acute
finding. The PaCO2 is also elevated, meaning that this is a respiratory acidosis. This
finding is important and the patient requires immediate care. Respiratory alkalosis
would include a pH greater than 7.45; metabolic acidosis would require a base
deficit (less than -2.2) or a bicarbonate of less than 22; metabolic alkalosis would
require a base excess (greater than +2.2) or a bicarbonate of greater than 26.
Page 3 of 100
, Question 6
In sepsis, endotoxins stimulate production of tumor necrosis factor. This stimulates:
A. neutrophil activation and platelet aggregation
B. parathyroid hormone production
C. increased CO2 levels
D. increased intracranial pressure
Correct Answer
A. neutrophil activation and platelet aggregation
Endotoxins stimulate multiple actions within the vessel; these include neutrophil
activation causing capillary leakage and platelet activation and coagulation cascade.
Parathyroid hormone, CO2 levels and increased intracranial pressure are not results
of tumor necrosis factor release.
Question 7
An ICU patient is 4 days postoperative. For the past three days, the patient has been
disengaged and quiet. Now he is becoming restless, argumentative and now hostile
saying the nursing staff is trying to kill him and is asking for the police. All vital signs
and labs are within normal limits. What pharmacologic agent would be appropriate?
A. midazolam (Versed)
B. Haloperidol (Haldol)
C. propofol (Diprivan)
D. sertraline (Zoloft)
Correct Answer
B. Haloperidol (Haldol)
The patient's change in behavior with no other physiological factors indicates
possible delirium. The drug of choice is haloperidol. Midazolam is not the drug of
choice since it is a tranquilizer. Propofol is an anesthetic agent, and the patient is
not intubated. Sertraline is a SSRI for depression.
Page 4 of 100
Verified Answers
Question 1
A patient who is postoperative day 2 after a pancreatic resection for hemorrhagic
pancreatitis is now complaining of acute shortness of breath with rales bilaterally and
increasing oxygen requirements. This could be the beginning of:
A. acute respiratory distress syndrome
B. asthma
C. postoperative pain syndrome
D. gastric bleed
Correct Answer
A. acute respiratory distress syndrome
Any patient with an inflammatory disorder (such as postoperative abdominal
surgery) can develop acute respiratory distress syndrome approximately 24-36 hrs
post event. The signs and symptoms include acute shortness of breath, rales
bilaterally, diffuse bilateral ground-glass appearance, or white-out, on chest x-ray
and increased requirements for oxygen. Asthma would include wheezing.
Postoperative pain would not likely cause rales. A gastric bleed would not cause
rales.
Page 1 of 100
,Question 2
The nurse is teaching a patient to manage tracheostomy care. The nurse has prepared
written directions and a video, but the patient ignores them and picks up the pieces
of equipment and looks at them trying to figure out the parts. The patient's learning
style is most likely:
A. auditory
B. visual
C. kinesthetic
D. mixed
Correct Answer
C. kinesthetic
Kinesthetic learners learn best by handling, doing and practicing the objective.
These learners should be allowed to handle supplies or equipment at their pace,
with little interruptions. They do benefit from written directions, videos and
diagrams. Auditory learners learn best by listening and talking, so procedures
should be explained during presentations. Auditory learners benefit from
audiotapes and extra time for questions.
Question 3
You are caring for a patient recently admitted with an inferior wall MI. Which of the
following 12-lead ECG findings would you anticipate?
A. T wave inversion in leads I and aVL
B. Q wave formation and ST segment elevation in leads II, III, and aVF
C. QRS duration greater than 0.01 in all leads
D. R wave taller in V6
Correct Answer
B. Q wave formation and ST segment elevation in leads II, III, and aVF
With STEMI, the patient will have ST segment elevation. The inferior leads are II, III,
and aVF. T wave inversion in leads I and aVL indicate ischemia in the anterior leads.
QRS duration that is prolonged may indicate an intraventricular conduction defect,
and an R wave taller in V6 is a bundle branch block.
Page 2 of 100
,Question 4
Why is calcium required for clot formation?
A. Calcium reacts with factor Xa to begin the common pathway of clot formation.
B. Calcium is necessary for contraction of vascular smooth muscle.
C. Calcium is necessary for bone conservation
D. Calcium is a by-product of glucose metabolism
Correct Answer
A. Calcium reacts with factor Xa to begin the common pathway of clot formation.
There is an intrinsic and extrinsic pathway for clot formation. As they combine to
form the final common pathway at factor Xa, calcium must be present at a sufficient
level for clot formation to occur. Calcium is necessary for contraction of smooth
muscle; however, this is not the mechanism for clot formation. Calcium is required
for bone conservation; again, not a mechanism of clot formation. Many blood
products lower the available serum calcium levels, thereby reducing the ability to
make normal clots. Glucose metabolism has nothing to do with clot formation.
Question 5
A patient with chronic obstructive lung disease now has respiratory failure with a
PaCO2 of 65 and a pH of 7.30. The patient has dyspnea and is experiencing cardiac
dysrhythmias, confusion and hypotension. These findings are consistent with:
A. respiratory alkalosis
B. respiratory acidosis
C. metabolic alkalosis
D. metabolic acidosis
Correct Answer
B. respiratory acidosis
To evaluate an arterial blood gas in a patient with chronic disease, address the pH
first. In this case, the pH is abnormal. It is 7.30, which is acidotic, and an acute
finding. The PaCO2 is also elevated, meaning that this is a respiratory acidosis. This
finding is important and the patient requires immediate care. Respiratory alkalosis
would include a pH greater than 7.45; metabolic acidosis would require a base
deficit (less than -2.2) or a bicarbonate of less than 22; metabolic alkalosis would
require a base excess (greater than +2.2) or a bicarbonate of greater than 26.
Page 3 of 100
, Question 6
In sepsis, endotoxins stimulate production of tumor necrosis factor. This stimulates:
A. neutrophil activation and platelet aggregation
B. parathyroid hormone production
C. increased CO2 levels
D. increased intracranial pressure
Correct Answer
A. neutrophil activation and platelet aggregation
Endotoxins stimulate multiple actions within the vessel; these include neutrophil
activation causing capillary leakage and platelet activation and coagulation cascade.
Parathyroid hormone, CO2 levels and increased intracranial pressure are not results
of tumor necrosis factor release.
Question 7
An ICU patient is 4 days postoperative. For the past three days, the patient has been
disengaged and quiet. Now he is becoming restless, argumentative and now hostile
saying the nursing staff is trying to kill him and is asking for the police. All vital signs
and labs are within normal limits. What pharmacologic agent would be appropriate?
A. midazolam (Versed)
B. Haloperidol (Haldol)
C. propofol (Diprivan)
D. sertraline (Zoloft)
Correct Answer
B. Haloperidol (Haldol)
The patient's change in behavior with no other physiological factors indicates
possible delirium. The drug of choice is haloperidol. Midazolam is not the drug of
choice since it is a tranquilizer. Propofol is an anesthetic agent, and the patient is
not intubated. Sertraline is a SSRI for depression.
Page 4 of 100
