PCCN EXAMINATION 2027 ANSWERS AND
QUESTIONS SET A+
✔✔In the oliguric phase of acute renal failure, the:
A. urine output is less than 400 ml per day
B. urine output is greater than 500 ml per day
C. urine output totally ceases
D. urine output is not measured - ✔✔A. urine output is less than 400 ml per day
If the urine output is less than 400 ml per day, the patient is said to be oliguric. Anuria is
defined as producing less than 100 ml per day of urine.
✔✔Which of the following laboratory findings would be congruent with metabolic
alkalosis?
A. pH 7.48 PaCO2 42 mmHg potassium 3.0 mEq/L
B. pH 7.40 PaCO2 40 mmHg potassium 4.0 mEq/L
C. pH 7.44 PaCO2 38 mmHg potassium 6.0 mEq/L
D. pH 7.30 PaCO2 44 mmHg potassium 3.5 mEq/L - ✔✔A. pH 7.48 PaCO2 42 mmHg
potassium 3.0 mEq/L
The question si asking which is consistent with metabolic alkalosis. First, find the ABG
that is alkalotic then look at CO2; it should be normal. Then find a measure of metabolic
function. Potassium is an indicator. Low potassium would cause an alkalosis. The pH is
alkalotic. The PaCO2 is normal. The potassium is very low. A very low potassium level
can cause metabolic alkalosis.
✔✔Which of the following drugs removes potassium from the body in hyperkalemic
patients in acute renal failure?
A. sodium bicarbonate
B. calcium chloride
C. glucose and insulin infusion
D. sodium polystyrene sulfonate (Kayexalate) - ✔✔D. sodium polystyrene sulfonate
(Kayexalate)
As the resin passes along the intestine or is retained in the colon after administration by
enema, the sodium ions are partially released and are replaced by potassium ions. For
the most part, this action occurs in the large intestine, which excretes potassium ions to
a greater degree than does the small intestine. Sodium bicarbonate, glucose and insulin
,actually shift the potassium from the intravascular compartment back into the cell.
Insulin and sodium bicarbonate do not remove the potassium from the body. They only
shift the potassium intracellularly.
✔✔The distal convoluted tubules in the kidney are influenced by an antidiuretic
hormone (ADH) to:
A. concentrate the urine
B. reabsorb potassium
C. dilute the urine
D. increase sodium loss in the urine - ✔✔A. concentrate the urine
ADH's effect on the kidney is to decrease urine output and conserve water for the body.
Its effect is to reabsorb sodium and water and reduce urine output to maintain
intravascular volume. ADH does not affect potassium.
✔✔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 - ✔✔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.
✔✔Acetaminophen (Tylenol) overdose causes acute liver failure. What is the antidote
for this type of overdose?
A. hemodialysis
B. acetylcysteine (Acetadote)
C. fluid resuscitation
D. there is no antidote for acetaminophen overdose - ✔✔B. acetylcysteine (Acetadote)
The only antidote for acetaminophen overdose is acetylcysteine, which is now available
in IV form called acetylcysteine (Acetadote). The other choices are incorrect.
✔✔The primary treatment of hypovolemia due to blood loss is:
A. stop the blood loss
B. fluid resuscitation
C. use of blood products
D. all of the above - ✔✔D. all of the above
The treatment of hypovolemia due to blood loss is: stop the volume loss if possible;
fluid-resuscitate the patient using an isotonic crystalloid solution; give blood products as
indicated. Inotropes are utilized only when fluid resuscitation is complete.
✔✔In anaphylactic shock, the nurse should:
A. stop the offending agent if known
B. Restrict fluid intake due to fluid overload
, C. Manage hypertension with vasodilators
D. No drugs are known to be helpful with allergic reactions of this magnitude - ✔✔A.
stop the offending agent if known
A patient with anaphylaxis is having an acute allergic reaction to an offending agent. If
the agent is known, stop the drug treatment or remove the agent. With an allergic
reaction, histamine is released and a systemic inflammatory response occurs with
massive vasodilation. This vasodilation requires aggressive volume resuscitation and
drugs such as epinephrine, diphenhydramine (Benadryl) and IV steroids such as
hydrocortisone sodium succinate (Solu-Cortef) for treatment. The patient may also have
airway obstruction and require airway control.
✔✔The definition of sepsis is:
A. high fever with no white blood cell change, no documented infection
B. temperature more than 100.4F (38C) or less than 96.8F (36C); WBC less than 4,000
or greater than 12,000 with documented infection
C. change in mental status
D. decreased urine output - ✔✔B. temperature more than 100.4F (38C) or less than
96.8F (36C); WBC less than 4,000 or greater than 12,000 with documented infection
The definition of sepsis, a condition in which individuals both meet criteria for systemic
inflammatory response syndrome (SIRS) and have a known or highly suspected
infection, is exact: A WBC count greater than 12,000 or less than 4,000 with
temperature more than 100.4F (38C) or less than 96.8F (36C) and a documented
infection process. There may be a change in mental status, but that is not the definition,
nor is decreased urine output. Other criteria of SIRS include: a heart rate greater than
90, a respiratory rate greater than 20 or pCO2 less than 32 mm Hg. Mental status
change is the earliest sign of tissue hypoperfusion, followed by decreased urinary
output, but neither of those signs defines sepsis.
✔✔A complete assessment of a patient with a wound includes which of the following:
A. a detailed description of the wound and vascular assessment
B. a nutrition assessment
C. laboratory findings, including hematology, microbiology and chemistries
D. all of the above - ✔✔D. all of the above
Accurate wound assessment on admission includes: detailed description of the wound,
including wound location, length, width, depth and the presence and position of
undermining, presence of cellulitis and drainage. Calculation of wound area of volume
should be performed and documented at each patient visit. A nutrition assessment is
key. Vascular assessment is also essential, especially if a patient presents with a
chronic wound. A thorough vascular exam should be performed, including palpation of
radial, femoral and pedal pulses. Signs of arterial obstruction include lack of peripheral
pulses with poor capillary refill, think atrophic skin and hypertrophic deformed nails.
Laboratory assessment to include hematology, complete blood count and differential,
chemistries including metabolic panel, liver function tests, albumin, prealbumin,
hemoglobin A1C, and microbiology, including previous cultures and pathology.
✔✔Neurogenic shock has the following presentation:
QUESTIONS SET A+
✔✔In the oliguric phase of acute renal failure, the:
A. urine output is less than 400 ml per day
B. urine output is greater than 500 ml per day
C. urine output totally ceases
D. urine output is not measured - ✔✔A. urine output is less than 400 ml per day
If the urine output is less than 400 ml per day, the patient is said to be oliguric. Anuria is
defined as producing less than 100 ml per day of urine.
✔✔Which of the following laboratory findings would be congruent with metabolic
alkalosis?
A. pH 7.48 PaCO2 42 mmHg potassium 3.0 mEq/L
B. pH 7.40 PaCO2 40 mmHg potassium 4.0 mEq/L
C. pH 7.44 PaCO2 38 mmHg potassium 6.0 mEq/L
D. pH 7.30 PaCO2 44 mmHg potassium 3.5 mEq/L - ✔✔A. pH 7.48 PaCO2 42 mmHg
potassium 3.0 mEq/L
The question si asking which is consistent with metabolic alkalosis. First, find the ABG
that is alkalotic then look at CO2; it should be normal. Then find a measure of metabolic
function. Potassium is an indicator. Low potassium would cause an alkalosis. The pH is
alkalotic. The PaCO2 is normal. The potassium is very low. A very low potassium level
can cause metabolic alkalosis.
✔✔Which of the following drugs removes potassium from the body in hyperkalemic
patients in acute renal failure?
A. sodium bicarbonate
B. calcium chloride
C. glucose and insulin infusion
D. sodium polystyrene sulfonate (Kayexalate) - ✔✔D. sodium polystyrene sulfonate
(Kayexalate)
As the resin passes along the intestine or is retained in the colon after administration by
enema, the sodium ions are partially released and are replaced by potassium ions. For
the most part, this action occurs in the large intestine, which excretes potassium ions to
a greater degree than does the small intestine. Sodium bicarbonate, glucose and insulin
,actually shift the potassium from the intravascular compartment back into the cell.
Insulin and sodium bicarbonate do not remove the potassium from the body. They only
shift the potassium intracellularly.
✔✔The distal convoluted tubules in the kidney are influenced by an antidiuretic
hormone (ADH) to:
A. concentrate the urine
B. reabsorb potassium
C. dilute the urine
D. increase sodium loss in the urine - ✔✔A. concentrate the urine
ADH's effect on the kidney is to decrease urine output and conserve water for the body.
Its effect is to reabsorb sodium and water and reduce urine output to maintain
intravascular volume. ADH does not affect potassium.
✔✔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 - ✔✔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.
✔✔Acetaminophen (Tylenol) overdose causes acute liver failure. What is the antidote
for this type of overdose?
A. hemodialysis
B. acetylcysteine (Acetadote)
C. fluid resuscitation
D. there is no antidote for acetaminophen overdose - ✔✔B. acetylcysteine (Acetadote)
The only antidote for acetaminophen overdose is acetylcysteine, which is now available
in IV form called acetylcysteine (Acetadote). The other choices are incorrect.
✔✔The primary treatment of hypovolemia due to blood loss is:
A. stop the blood loss
B. fluid resuscitation
C. use of blood products
D. all of the above - ✔✔D. all of the above
The treatment of hypovolemia due to blood loss is: stop the volume loss if possible;
fluid-resuscitate the patient using an isotonic crystalloid solution; give blood products as
indicated. Inotropes are utilized only when fluid resuscitation is complete.
✔✔In anaphylactic shock, the nurse should:
A. stop the offending agent if known
B. Restrict fluid intake due to fluid overload
, C. Manage hypertension with vasodilators
D. No drugs are known to be helpful with allergic reactions of this magnitude - ✔✔A.
stop the offending agent if known
A patient with anaphylaxis is having an acute allergic reaction to an offending agent. If
the agent is known, stop the drug treatment or remove the agent. With an allergic
reaction, histamine is released and a systemic inflammatory response occurs with
massive vasodilation. This vasodilation requires aggressive volume resuscitation and
drugs such as epinephrine, diphenhydramine (Benadryl) and IV steroids such as
hydrocortisone sodium succinate (Solu-Cortef) for treatment. The patient may also have
airway obstruction and require airway control.
✔✔The definition of sepsis is:
A. high fever with no white blood cell change, no documented infection
B. temperature more than 100.4F (38C) or less than 96.8F (36C); WBC less than 4,000
or greater than 12,000 with documented infection
C. change in mental status
D. decreased urine output - ✔✔B. temperature more than 100.4F (38C) or less than
96.8F (36C); WBC less than 4,000 or greater than 12,000 with documented infection
The definition of sepsis, a condition in which individuals both meet criteria for systemic
inflammatory response syndrome (SIRS) and have a known or highly suspected
infection, is exact: A WBC count greater than 12,000 or less than 4,000 with
temperature more than 100.4F (38C) or less than 96.8F (36C) and a documented
infection process. There may be a change in mental status, but that is not the definition,
nor is decreased urine output. Other criteria of SIRS include: a heart rate greater than
90, a respiratory rate greater than 20 or pCO2 less than 32 mm Hg. Mental status
change is the earliest sign of tissue hypoperfusion, followed by decreased urinary
output, but neither of those signs defines sepsis.
✔✔A complete assessment of a patient with a wound includes which of the following:
A. a detailed description of the wound and vascular assessment
B. a nutrition assessment
C. laboratory findings, including hematology, microbiology and chemistries
D. all of the above - ✔✔D. all of the above
Accurate wound assessment on admission includes: detailed description of the wound,
including wound location, length, width, depth and the presence and position of
undermining, presence of cellulitis and drainage. Calculation of wound area of volume
should be performed and documented at each patient visit. A nutrition assessment is
key. Vascular assessment is also essential, especially if a patient presents with a
chronic wound. A thorough vascular exam should be performed, including palpation of
radial, femoral and pedal pulses. Signs of arterial obstruction include lack of peripheral
pulses with poor capillary refill, think atrophic skin and hypertrophic deformed nails.
Laboratory assessment to include hematology, complete blood count and differential,
chemistries including metabolic panel, liver function tests, albumin, prealbumin,
hemoglobin A1C, and microbiology, including previous cultures and pathology.
✔✔Neurogenic shock has the following presentation:
