PCCN FINAL AACN PRACTICE TEST
(2022/2023 FINAL Progressive Care Certified Nurse
AACN TEST)
A 49yo male was recently admitted with an inferior wall MI resulting from 100% occlusion of the RCA.
The 12 lead EKG reveals ST elevation in leads II, III, and aVF. You would expect to see reciprocal changes
in which leads?
a. I, aVR
b. V1 and V2
c. V3 and V4
d. I, aVL (correct answers)D. The RCA perfuses the inferior wall and the mirror image or reciprocal
change will be seen in the high lateral wall, which is reflected in leads I, and aVL on the 12 lead EKG.
Leads with the anterior area of the heart. The aVR lead does not provide much diagnostic value as all
energy is depolarizing away from this lead.
You are summoned to the room of a 30yo female who is experiencing sustained tonic-clonic convulsions
while sitting in a chair. A family member states, "she was just talking to us and suddenly she let out a
shriek and started flopping like a fish out of water." what is your initial priority of care?
a. Call for help and safely guide the patient to the floor.
b. Call for help and administer a prescribed antiepileptic.
c. Call for help and administer a prescribed benzodiazepine.
d. Call for help and monitor the course of the seizure. (correct answers)A. Patient safety is the first
priority. Once the patient is safe from immediate harm or injury, the seizure activity must be
terminated. Seizure abatement is accomplished by the administration of a benzodiazepine. Antiepileptic
medications are useful in the prevention of seizure activity.
A 46yo patient presents with pneumonia and sepsis. He was treated with 4 days of antibiotics and IV
fluids. He is increasingly short of breath and is now on 100% FiO2 via non-rebreather mask. You obtain
an ABG that says: pH 7.2 / PaCO2 68 / PaO2 102 / HCO3 28. A chest x-ray reveals bilateral pulmonary
infiltrates. The patient is likely developing:
a. worsening pneumonia
b. acute respiratory distress syndrome
, c. pulmonary embolus
d. atelectasis (correct answers)B. Criteria for ARDS include bilateral pulmonary infiltrates on chest X-ray
and a P/F ratio </= 300; it is further rated as mild-mod-severe ARDS based on the /F ratio. To calculate
the P/F ratio, divide the PaO2 from an ABG by the FiO2. In this case 102 [pO2]/ 1.0 [FiO2] = 102, making
it borderline severe ARDS. other criteria fore ARDS include decreased compliance, refractory hypoxemia
and low expired minute volume. The patient needs to be transferred to the ICU and will likely require
intubation and mechanical ventilation.
A 56yo male is admitted to the PCU with a hypertensive crisis. His BP is now 205/125 and he is
complaining of a headache with nausea. He reports he ran out of his BP medication three days ago, but
also appears to be confused to the date and situation. What is the most appropriate treatment
approach?
a. Rapidly lower the systolic pressure to 100 with IV antihypertensives, then gradually reduce the
diastolic pressure to 85 with oral antihypertensive medications.
b. Slowly lower the systolic pressure to 120 with IV antihypertensive medications, the switch to oral
antihypertensive medications for maintenance.
c. Rapidly lower the diastolic pressure to 100 with IV antihypertensive medications, then continue to
gradually reduce the diastolic pressure to 85 with oral antihypertensive medications
d. Slowly lower the diastolic pressure to 85 with oral antihypertensive medications, then adjust dose for
maintenance (correct answers)C. The patient is experiencing a hypertensive crisis with associated
hypertensive encephalopathy. This requires emergent treatment by rapid decreasing the diastolic blood
pressure to around 100 using IV antihypertensive medication. The maximum initial decrease should be
no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can
lead to cerebral edema or renal failure. The initial decrease should take place over 2-6H. Once the BP is
controlled and symptoms have resolved the patient should be transitioned to oral antihypertensive
medications with a goal to reduce the diastolic pressure gradually to 85 over the next 2-3 months.
Which of the following labs must be closely monitored when administering Lisinopril to a patient with
systolic heart failure?
a. sodium
b. phosphate
c. magnesium
d. potassium (correct answers)D. Patients taking ACE inhibitors may experience hyperkalemia. ACE
inhibitors block angiotensin II, which may lead to decreased aldosterone. Aldosterone is responsible for
excreting potassium from the kidneys. Therefore, ACE inhibitors can cause potassium retention and
potassium levels should be monitored closely. In addition, renal labs such as BUN and Cr should be
(2022/2023 FINAL Progressive Care Certified Nurse
AACN TEST)
A 49yo male was recently admitted with an inferior wall MI resulting from 100% occlusion of the RCA.
The 12 lead EKG reveals ST elevation in leads II, III, and aVF. You would expect to see reciprocal changes
in which leads?
a. I, aVR
b. V1 and V2
c. V3 and V4
d. I, aVL (correct answers)D. The RCA perfuses the inferior wall and the mirror image or reciprocal
change will be seen in the high lateral wall, which is reflected in leads I, and aVL on the 12 lead EKG.
Leads with the anterior area of the heart. The aVR lead does not provide much diagnostic value as all
energy is depolarizing away from this lead.
You are summoned to the room of a 30yo female who is experiencing sustained tonic-clonic convulsions
while sitting in a chair. A family member states, "she was just talking to us and suddenly she let out a
shriek and started flopping like a fish out of water." what is your initial priority of care?
a. Call for help and safely guide the patient to the floor.
b. Call for help and administer a prescribed antiepileptic.
c. Call for help and administer a prescribed benzodiazepine.
d. Call for help and monitor the course of the seizure. (correct answers)A. Patient safety is the first
priority. Once the patient is safe from immediate harm or injury, the seizure activity must be
terminated. Seizure abatement is accomplished by the administration of a benzodiazepine. Antiepileptic
medications are useful in the prevention of seizure activity.
A 46yo patient presents with pneumonia and sepsis. He was treated with 4 days of antibiotics and IV
fluids. He is increasingly short of breath and is now on 100% FiO2 via non-rebreather mask. You obtain
an ABG that says: pH 7.2 / PaCO2 68 / PaO2 102 / HCO3 28. A chest x-ray reveals bilateral pulmonary
infiltrates. The patient is likely developing:
a. worsening pneumonia
b. acute respiratory distress syndrome
, c. pulmonary embolus
d. atelectasis (correct answers)B. Criteria for ARDS include bilateral pulmonary infiltrates on chest X-ray
and a P/F ratio </= 300; it is further rated as mild-mod-severe ARDS based on the /F ratio. To calculate
the P/F ratio, divide the PaO2 from an ABG by the FiO2. In this case 102 [pO2]/ 1.0 [FiO2] = 102, making
it borderline severe ARDS. other criteria fore ARDS include decreased compliance, refractory hypoxemia
and low expired minute volume. The patient needs to be transferred to the ICU and will likely require
intubation and mechanical ventilation.
A 56yo male is admitted to the PCU with a hypertensive crisis. His BP is now 205/125 and he is
complaining of a headache with nausea. He reports he ran out of his BP medication three days ago, but
also appears to be confused to the date and situation. What is the most appropriate treatment
approach?
a. Rapidly lower the systolic pressure to 100 with IV antihypertensives, then gradually reduce the
diastolic pressure to 85 with oral antihypertensive medications.
b. Slowly lower the systolic pressure to 120 with IV antihypertensive medications, the switch to oral
antihypertensive medications for maintenance.
c. Rapidly lower the diastolic pressure to 100 with IV antihypertensive medications, then continue to
gradually reduce the diastolic pressure to 85 with oral antihypertensive medications
d. Slowly lower the diastolic pressure to 85 with oral antihypertensive medications, then adjust dose for
maintenance (correct answers)C. The patient is experiencing a hypertensive crisis with associated
hypertensive encephalopathy. This requires emergent treatment by rapid decreasing the diastolic blood
pressure to around 100 using IV antihypertensive medication. The maximum initial decrease should be
no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can
lead to cerebral edema or renal failure. The initial decrease should take place over 2-6H. Once the BP is
controlled and symptoms have resolved the patient should be transitioned to oral antihypertensive
medications with a goal to reduce the diastolic pressure gradually to 85 over the next 2-3 months.
Which of the following labs must be closely monitored when administering Lisinopril to a patient with
systolic heart failure?
a. sodium
b. phosphate
c. magnesium
d. potassium (correct answers)D. Patients taking ACE inhibitors may experience hyperkalemia. ACE
inhibitors block angiotensin II, which may lead to decreased aldosterone. Aldosterone is responsible for
excreting potassium from the kidneys. Therefore, ACE inhibitors can cause potassium retention and
potassium levels should be monitored closely. In addition, renal labs such as BUN and Cr should be
