PCCN STANDARD 2027 EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔The prevention of pulmonary emboli is geared toward prevention of:
A. abdominal compartment syndrome
B. deep vein thrombus formation
C. hyperglycemia
D. hyperthermia - ✔✔B. deep vein thrombus formation
Over 90% of pulmonary emboli in the hospitalized patient originate from DVT, usually in
the leg. Prevention of DVT has become of great importance and is an outcome goal.
Abdominal compartment syndrome, hyperglycemia and hyperthermia are all
complications that may occur in the postoperative patient, but do not have primary
relationships to DVT and pulmonary emboli.
✔✔One major complication of pulmonary embolus is:
A. pulmonary infarction
B. gastrointestinal infarction
C. liver failure
D. leg edema - ✔✔A. pulmonary infarction
A pulmonary embolus is a venous embolus originating most commonly from a DVT from
the leg. This travels into the pulmonary artery and occludes a small pulmonary artery.
Distal to the occlusion, there will be no further circulation and infarction may occur in a
segment of the lung; the size of infarct is dependent on the size of the embolus. Liver
and gastrointestinal infarctions are not related to pulmonary emboli. Leg edema is not a
complication of pulmonary emboli, but may result from DVT.
✔✔The most common cardiac complication of post-thoracic (lung) surgery is:
A. fluid overload
B. pneumonia
C. renal failure
D. atrial fibrillation - ✔✔D. atrial fibrillation
Because of the lung resection process, pulmonary pressure are elevated after lung
surgery and may cause acute elevations in intrathoracic pressure, putting a stretch
across the atria. This increase in pressure and stretch causes premature atrial
complexes and the development of atrial fibrillation. Pneumonia is a complication of any
,surgery, but is not the most common in the postoperative lung surgery patient. Fluid
overload is a complication of post lung surgery, but not the most common cardiac
complication, nor is renal failure a cardiac complication.
✔✔Which of the following parameters is used as an estimate of alveolar ventilation?
A. PaO2
B. PaCO2
C. pH
D. alveolar-arterial oxygen gradient - ✔✔B. PaCO2
A good estimate of alveolar ventilation is the patient's PaCO2 level. With good alveolar
ventilation, the patient is washing out the CO2. With ventilatory failure, the PaCO2
increases. Remember:
alveolar ventilation=tidal vol - dead space x frequency
PaO2 reflects the oxygen in the blood, pH is the measure of acid/base of the blood and
alveolar-arterial oxygen gradient is a measure of how much oxygen is transported from
the alveolus to the arterial blood. The other answers are incorrect.
✔✔At which level of FiO2 support is oxygen toxicity thought to develop?
A. 30-40% for longer than 48 hrs
B. 40-50% for longer than 2 hrs
C. more than 50% for longer than 24-28 hrs
D. FiO2 does not cause oxygen toxicity - ✔✔C. more than 50% for longer than 24-28
hrs
Oxygen toxicity does occur in adults and is related to the amount of FiO2 over time.
FiO2 at more than 50% for more than 24 hrs can cause toxicity. Toxicity is seen as
increasing atelectasis due to decreased surfactant production. Inspired oxygen at levels
less than 50% will not cause toxicity.
✔✔Which of the following is a goal for positive end expiratory pressure (PEEP)
therapy?
A. to improve CO2 elimination
B. to treat a metabolic acidosis
C. to reduce postoperative abdominal bleeding
D. to allow reduction in FiO2 support - ✔✔D. to allow reduction in FiO2 support
PEEP therapy is used for improving oxygenation and for alveolar recruitment. Improving
oxygenation would allow the practioner to decrease FiO2 support. PEEP does not help
to eliminate CO2; increasing respiratory rate will lower CO2. Metabolic acidosis is
corrected with treatment of the cause of acidosis such as: increased lactic acid, renal
failure and/or diabetic ketoacidosis (DKA). For the postoperative cardiothoracic surgery
patient who has chest bleeding, increasing the PEEP on the ventilator may reduce
chest bleeding by tamponading the bleeder; this is not a common practice with other
types of bleeding
✔✔Which of the following is a complication of mechanical ventilation and positive end
expiratory pressure (PEEP) therapy?
,A. atelectasis
B. oxygen toxicity
C. reduced cardiac output
D. acute respiratory distress syndrome (ARDS) - ✔✔C. reduced cardiac output
Because positive pressure ventilation increases intrathoracic pressures, this may cause
a reduction in venous return and therefore a reduction in cardiac output. Reduced
cardiac output is the most common complication of mechanical ventilation and the use
of PEEP. PEEP therapy may reduce the FiO2 on the ventilator, and therefore decrease
the complication of oxygen toxicity. Atelectasis and ARDS are treated mainly with
increased PEEP; they are not complications of this treatment methodology.
✔✔Pulmonary emboli produce all of the following physiologic changes except:
A. pulmonary hypertension
B. arterial hypoxemia
C. hypocarbia
D. left ventricular failure - ✔✔D. left ventricular failure
With pulmonary emboli, the pulmonary pressures become elevated and may cause
acute right ventricular failure. The left ventricle has no increase in afterload. A patient
who becomes hypoxemic will increase his or her respiratory rate causing a lowered
PaCO2 (hypocarbia). With pulmonary emboli, the patient typically has hypoxemia due to
the decrease in alveolar perfusion.
✔✔A patient just admitted to your floor from the PACU is agitated and has tingling of the
fingers. ABG on room air reveals:
pH 7.49 PaCO2 25 PaO2 95 HCO3 24
Which of the following is correct?
A. normal acid-base balance
B. compensated respiratory alkalosis
C. uncompensated respiratory alkalosis
D. uncompensated metabolic alkalosis - ✔✔C. uncompensated respiratory alkalosis
The patient has an alkalosis (pH high), from a respiratory parameter of PaCO2 25. The
patient is breathing fast and blowing off CO2. This is uncompensated since the pH is
abnormal. The patient may be in pain, thus causing an increased respiratory rate.
✔✔In preparation for assisting a physician doing a thoracentesis, the patient should be
positioned in which of the following manners:
A. lying on the affected side with head of the bed flat
B. lying on the affected side with head of the bed elevated 15 degrees
C. lying on the opposite side with head of the bed flat
D. patient upright and slightly bent forward - ✔✔D. patient upright and slightly bent
forward
Positioning the patient properly before a thoracentesis is a nursing responsibility.
Upright and slightly bent forward is the most optimal position, allowing a posterior
drainage approach. If the upright position is not possible and the patient must lie in bed,
then the preferred position is decubitus with the side of the chest containing the effusion
, down. Patient comfort is important as well, having the head of the bed upright will allow
the patient to breathe easier and allow for the fluid to flow to the posterior of the lung.
✔✔Which of the following is a complication after a bedside thoracentesis?
A. acute bleeding for puncture site
B. pneumothorax
C. hemothorax
D. all of the above - ✔✔D. all of the above
Bedside thoracentesis has been replaced by ultrasound-guided thoracentesis due to the
complication of pneumothorax. Patient coagulation studies are done before the
procedure to eliminate the possibility of bleeding from the site, as well as causing a
hemothorax, although these complications may still occur.
✔✔Which of the following indicates an active pleural air leak for a patient with a chest
tube attached to a pleural drainage system?
A. bubbling in the water-seal chamber
B. bubbling in the suction control chamber
C. fluctuation of water level in the water-seal chamber with respiration
D. no fluctuation of water level in the water-seal chamber with respiration - ✔✔A.
bubbling in the water-seal chamber
An active air leak is noticeable in the chest tube drainage system by the presence of
bubbling in the water-seal chamber. Air bubbles result from a leakage of air from the
lung parenchyma into the pleural space. If an air leak is present, the chest tube should
not be removed or the leaking air will be trapped, resulting in a pneumothorax.
✔✔Which type of condition can lead to a tension pneumothorax?
A. closed pneumothorax
B. open pneumothorax
C. subcutaneous emphysema
D. pneumomediastinum - ✔✔A. closed pneumothorax
The only way a tension pneumothorax can occur is within a closed chest wall. A tension
pneumothorax denotes an opening in the pleural space where air is trapped inside the
chest between the collapsed pleural wall and the chest wall. Eventually enough air will
be trapped to push the mediastinum to the opposite wall, compressing the heart and
causing vascular collapse and death.
✔✔A patient is one day following surgery for peripheral vascular disease. She is
increasingly short of breath and develops a low-grade fever, hiccoughs, dyspnea,
cough, tachycardia and chest pain. Which of the following diagnoses is the most likely?
A. atelectasis
B. myocardial infarction
C. pulmonary embolism
D. pneumonitis - ✔✔C. pulmonary embolism
The patient is exhibiting signs of pulmonary embolism. While clinical manifestations may
vary according to size and position of the embolus, common symptoms include dyspnea
QUESTIONS SET A+
✔✔The prevention of pulmonary emboli is geared toward prevention of:
A. abdominal compartment syndrome
B. deep vein thrombus formation
C. hyperglycemia
D. hyperthermia - ✔✔B. deep vein thrombus formation
Over 90% of pulmonary emboli in the hospitalized patient originate from DVT, usually in
the leg. Prevention of DVT has become of great importance and is an outcome goal.
Abdominal compartment syndrome, hyperglycemia and hyperthermia are all
complications that may occur in the postoperative patient, but do not have primary
relationships to DVT and pulmonary emboli.
✔✔One major complication of pulmonary embolus is:
A. pulmonary infarction
B. gastrointestinal infarction
C. liver failure
D. leg edema - ✔✔A. pulmonary infarction
A pulmonary embolus is a venous embolus originating most commonly from a DVT from
the leg. This travels into the pulmonary artery and occludes a small pulmonary artery.
Distal to the occlusion, there will be no further circulation and infarction may occur in a
segment of the lung; the size of infarct is dependent on the size of the embolus. Liver
and gastrointestinal infarctions are not related to pulmonary emboli. Leg edema is not a
complication of pulmonary emboli, but may result from DVT.
✔✔The most common cardiac complication of post-thoracic (lung) surgery is:
A. fluid overload
B. pneumonia
C. renal failure
D. atrial fibrillation - ✔✔D. atrial fibrillation
Because of the lung resection process, pulmonary pressure are elevated after lung
surgery and may cause acute elevations in intrathoracic pressure, putting a stretch
across the atria. This increase in pressure and stretch causes premature atrial
complexes and the development of atrial fibrillation. Pneumonia is a complication of any
,surgery, but is not the most common in the postoperative lung surgery patient. Fluid
overload is a complication of post lung surgery, but not the most common cardiac
complication, nor is renal failure a cardiac complication.
✔✔Which of the following parameters is used as an estimate of alveolar ventilation?
A. PaO2
B. PaCO2
C. pH
D. alveolar-arterial oxygen gradient - ✔✔B. PaCO2
A good estimate of alveolar ventilation is the patient's PaCO2 level. With good alveolar
ventilation, the patient is washing out the CO2. With ventilatory failure, the PaCO2
increases. Remember:
alveolar ventilation=tidal vol - dead space x frequency
PaO2 reflects the oxygen in the blood, pH is the measure of acid/base of the blood and
alveolar-arterial oxygen gradient is a measure of how much oxygen is transported from
the alveolus to the arterial blood. The other answers are incorrect.
✔✔At which level of FiO2 support is oxygen toxicity thought to develop?
A. 30-40% for longer than 48 hrs
B. 40-50% for longer than 2 hrs
C. more than 50% for longer than 24-28 hrs
D. FiO2 does not cause oxygen toxicity - ✔✔C. more than 50% for longer than 24-28
hrs
Oxygen toxicity does occur in adults and is related to the amount of FiO2 over time.
FiO2 at more than 50% for more than 24 hrs can cause toxicity. Toxicity is seen as
increasing atelectasis due to decreased surfactant production. Inspired oxygen at levels
less than 50% will not cause toxicity.
✔✔Which of the following is a goal for positive end expiratory pressure (PEEP)
therapy?
A. to improve CO2 elimination
B. to treat a metabolic acidosis
C. to reduce postoperative abdominal bleeding
D. to allow reduction in FiO2 support - ✔✔D. to allow reduction in FiO2 support
PEEP therapy is used for improving oxygenation and for alveolar recruitment. Improving
oxygenation would allow the practioner to decrease FiO2 support. PEEP does not help
to eliminate CO2; increasing respiratory rate will lower CO2. Metabolic acidosis is
corrected with treatment of the cause of acidosis such as: increased lactic acid, renal
failure and/or diabetic ketoacidosis (DKA). For the postoperative cardiothoracic surgery
patient who has chest bleeding, increasing the PEEP on the ventilator may reduce
chest bleeding by tamponading the bleeder; this is not a common practice with other
types of bleeding
✔✔Which of the following is a complication of mechanical ventilation and positive end
expiratory pressure (PEEP) therapy?
,A. atelectasis
B. oxygen toxicity
C. reduced cardiac output
D. acute respiratory distress syndrome (ARDS) - ✔✔C. reduced cardiac output
Because positive pressure ventilation increases intrathoracic pressures, this may cause
a reduction in venous return and therefore a reduction in cardiac output. Reduced
cardiac output is the most common complication of mechanical ventilation and the use
of PEEP. PEEP therapy may reduce the FiO2 on the ventilator, and therefore decrease
the complication of oxygen toxicity. Atelectasis and ARDS are treated mainly with
increased PEEP; they are not complications of this treatment methodology.
✔✔Pulmonary emboli produce all of the following physiologic changes except:
A. pulmonary hypertension
B. arterial hypoxemia
C. hypocarbia
D. left ventricular failure - ✔✔D. left ventricular failure
With pulmonary emboli, the pulmonary pressures become elevated and may cause
acute right ventricular failure. The left ventricle has no increase in afterload. A patient
who becomes hypoxemic will increase his or her respiratory rate causing a lowered
PaCO2 (hypocarbia). With pulmonary emboli, the patient typically has hypoxemia due to
the decrease in alveolar perfusion.
✔✔A patient just admitted to your floor from the PACU is agitated and has tingling of the
fingers. ABG on room air reveals:
pH 7.49 PaCO2 25 PaO2 95 HCO3 24
Which of the following is correct?
A. normal acid-base balance
B. compensated respiratory alkalosis
C. uncompensated respiratory alkalosis
D. uncompensated metabolic alkalosis - ✔✔C. uncompensated respiratory alkalosis
The patient has an alkalosis (pH high), from a respiratory parameter of PaCO2 25. The
patient is breathing fast and blowing off CO2. This is uncompensated since the pH is
abnormal. The patient may be in pain, thus causing an increased respiratory rate.
✔✔In preparation for assisting a physician doing a thoracentesis, the patient should be
positioned in which of the following manners:
A. lying on the affected side with head of the bed flat
B. lying on the affected side with head of the bed elevated 15 degrees
C. lying on the opposite side with head of the bed flat
D. patient upright and slightly bent forward - ✔✔D. patient upright and slightly bent
forward
Positioning the patient properly before a thoracentesis is a nursing responsibility.
Upright and slightly bent forward is the most optimal position, allowing a posterior
drainage approach. If the upright position is not possible and the patient must lie in bed,
then the preferred position is decubitus with the side of the chest containing the effusion
, down. Patient comfort is important as well, having the head of the bed upright will allow
the patient to breathe easier and allow for the fluid to flow to the posterior of the lung.
✔✔Which of the following is a complication after a bedside thoracentesis?
A. acute bleeding for puncture site
B. pneumothorax
C. hemothorax
D. all of the above - ✔✔D. all of the above
Bedside thoracentesis has been replaced by ultrasound-guided thoracentesis due to the
complication of pneumothorax. Patient coagulation studies are done before the
procedure to eliminate the possibility of bleeding from the site, as well as causing a
hemothorax, although these complications may still occur.
✔✔Which of the following indicates an active pleural air leak for a patient with a chest
tube attached to a pleural drainage system?
A. bubbling in the water-seal chamber
B. bubbling in the suction control chamber
C. fluctuation of water level in the water-seal chamber with respiration
D. no fluctuation of water level in the water-seal chamber with respiration - ✔✔A.
bubbling in the water-seal chamber
An active air leak is noticeable in the chest tube drainage system by the presence of
bubbling in the water-seal chamber. Air bubbles result from a leakage of air from the
lung parenchyma into the pleural space. If an air leak is present, the chest tube should
not be removed or the leaking air will be trapped, resulting in a pneumothorax.
✔✔Which type of condition can lead to a tension pneumothorax?
A. closed pneumothorax
B. open pneumothorax
C. subcutaneous emphysema
D. pneumomediastinum - ✔✔A. closed pneumothorax
The only way a tension pneumothorax can occur is within a closed chest wall. A tension
pneumothorax denotes an opening in the pleural space where air is trapped inside the
chest between the collapsed pleural wall and the chest wall. Eventually enough air will
be trapped to push the mediastinum to the opposite wall, compressing the heart and
causing vascular collapse and death.
✔✔A patient is one day following surgery for peripheral vascular disease. She is
increasingly short of breath and develops a low-grade fever, hiccoughs, dyspnea,
cough, tachycardia and chest pain. Which of the following diagnoses is the most likely?
A. atelectasis
B. myocardial infarction
C. pulmonary embolism
D. pneumonitis - ✔✔C. pulmonary embolism
The patient is exhibiting signs of pulmonary embolism. While clinical manifestations may
vary according to size and position of the embolus, common symptoms include dyspnea
