PCCN REVIEW EXAM WITH ALL NEEDED
TO PASS
A vnurse vis vcaring vfor va v71-year-old vfemale vpatient vwith vend-stage vchronic
vobstructive vpulmonary vdisease v(COPD) vwho vis vexperiencing vcardiac vischemia
vwith vincreased vshortness vof vbreath. vThe vMOST vappropriate vgoal vof voxygen
vtherapy vfor vthis vpatient vwould vbe vto:
A. vLimit vsupplemental voxygen vto vlower vthe vrisk vof vreducing vrespiratory vdrive
B. vMaintain voxygen vsaturations vbetween v86% vand v89%
,C. vAdminister voxygen vuntil voxygen vsaturations vare vgreater vthan v95% vin vorder vto
vrelieve vischemia v
D. vMaintain voxygen vsaturations vbetween v90% vand v92% v- vcorrect vanswers v-D.
vMaintain voxygen vsaturations vbetween v90% vand v92%
Feedback
Maintaining voxygen vsaturations vbetween v90% vand v92% vwill vserve vthe vpurpose vof
vproviding venough voxygen vto vrelieve vcardiac vischemia vwhile vreducing vthe vrisk vof
vrespiratory vdepression vin va vpatient vwith vCOPD.
Laboratory vstudies vfrom va v22-year-old vmale vclient vwith vType vI vdiabetes vmellitus
vare vevaluated vduring van vadmission vfor vsevere vpneumonia. vWhich vof vthe
vfollowing vlaboratory vresults vshould vthe vnurse vreport vto vthe vphysician? v
A. vGlycosylated vhemoglobin v(HbA1c), v9.8% v
B. vLow-density vlipoprotein v(LDL), v
C. v94 vmg/dLHematocrit v(Hct), v53% v
D. vUrine vspecific vgravity, v1.250 v- vcorrect vanswers v-A. vGlycosylated vhemoglobin
v(HbA1c), v9.8%
Feedback
Glycosylated vhemoglobin vmeasures vthe vaverage vblood vsugar vlevels vover va v2 vto
v3 vmonth vtime vperiod. vClients vwith vpreviously vdiagnosed vdiabetes vmellitus vshould
vaim vto vkeep vtheir vHbA1c vlevels vbelow v7%.CONTENT vAREA: vClinical vJudgement:
vEndocrine/Hematology/Neurology/GI/Renal
The vnurse vis vassessing va v68 vyear vold vfemale vpatient vwith va vhistory vof vchronic
vobstructive vpulmonary vdisease v(COPD). vThe vpatient vpresents vwith vcomplaints vof
vrecent vconfusion, vincreased vfatigue, vand vsyncopal vepisodes vwhen vwalking. vThe
vnurse vassesses vS3 vand vS4 vsounds von vauscultation, vjugular vvein vdistention, vand
v+3 vpitting vedema vof vthe vankles vand vfeet. vWhich vof vthe vfollowing vcomplications
vof vCOPD vdoes vthe vnurse vsuspect vthe vpatient vis vmost vlikely vexperiencing? v
A. vAcute vrespiratory vdistress vsyndrome v(ARDS) v
B. vBronchiectasis v
C. vHeart vfailure v
D. vCor vpulmonale v- vcorrect vanswers v-D. vCor vpulmonale
Feedback
The vnurse vshould vrecognize vthat va vhistory vof vCOPD vtogether vwith vthe vsigns vand
vsymptoms vlisted vhere vare vsuggestive vof vcor vpulmonale. vThe vpatient vrequires
vfurther vworkup vto vconfirm vthis vdiagnosis.
A v42-year-old vmale vwith vMarfan vsyndrome vand vcomplaint vof vdizziness vis
vadmitted vto vthe vtelemetry vunit vfor vmonitoring. vWhich vof vthe vfollowing
vaccompanying vsymptoms vmay vindicate vthe vneed vfor vimmediate vsurgical
vattention?
A. vCough vwith vvocal vhoarseness
B. vLimited vrotation vof vthe vleft vshoulder
C.Headache vthat vresolved vafter vbreakfast, vbut vhas vreturned
,D. vSudden vstabbing vpain vin vthe vright velbow v- vcorrect vanswers v-A. vCough vwith
vvocal vhoarseness
Feedback
Patients vdiagnosed vwith vMarfan vsyndrome vare vat vhigher vrisk vfor vaortic
vaneurysms. vChanges vin vvocal vquality vaccompanied vby va vcough vor vdysphagia
v(difficulty vswallowing) vmay vindicate vthat va vthoracic vaortic vaneurysm vis vbecoming
vmore venlarged.
The vnurse vis vassessing va v74 vyear vold vfemale vpatient vwho vhas vpresented vwith
vthe vfollowing vsymptoms: vcool, vclammy vskin; vfaint, virregular vperipheral vpulses,
vand v+3 vpitting vedema vin vher vbilateral vlower vextremities. vHer vpartner vtells vthe
vnurse vthe vpatient vhas va vhistory vof vheart vfailure vwith va vrecent vLVEF vof v20%, vas
vwell vas vtype v2 vdiabetes. vThe vpatient's vHR vis v132, vBP vis v79/48, vand vblood
vglucose vis v349. vWhich vof vthe vfollowing vconditions vdoes vthe vnurse vsuspect?
A. vCardiogenic vshock
B. vDiabetic vketoacidosis
C. vFluid voverload
D. vObstructive vshock v- vcorrect vanswers v-A. vCardiogenic vshock
Feedback
The vnurse vshould videntify vthat vcardiogenic vshock vis van vemergency vthat vhas
vextremely vhigh vmortality vrates vwithout vtimely vintervention. vThe vpatient's vhistory vof
vheart vfailure vtogether vwith vher vacute vsymptoms vof vweak vpulses, vedema, vand
vhypotension vall vpoint vto vcardiogenic vshock.
The vnurse vis vcaring vfor va vpatient vwith vstage v5 vchronic vkidney vdisease vwho
vnormally vreceives vhemodialysis vthree vtimes va vweek von vMonday, vWednesday,
vand vFriday. vIt vis vnow vSunday vand vthe vpatient vstates vthey vhave vmissed vtheir
vlast vtwo vdialysis vsessions. vThe vpatient vis vcomplaining vof vshortness vof vbreath
vand vfatigue, vand vtheir vlabs vshow va vcreatinine vof v3.9 vand vpotassium vof v6.8.
vWhat vis vthe vBEST vtreatment vfor vthis vpatient v?
A. v80 vmg vIV vpush vfurosemide vfollowed vby vrechecking vthe vpotassium vlevel, vwith
vmore vIV vfurosemide vas vneeded
B. v15 vg vkayexalate vPO vtwice vdaily
C. vIntravenous vcalcium vinfusion
D. vUrgent vhemodialysis v- vcorrect vanswers v-D. vUrgent vhemodialysis
Feedback
The vnurse vshould vrecognize vthat vdialysis vis vthe vbest voption vfor vthis vpatient vsince
vthey vare valready va vregular vdialysis vpatient vand vare va vlikely vcandidate vto vreceive
vurgent vdialysis vdue vto vtheir vmissed vdialysis vsessions, vshortness vof vbreath, vand
vcritical vpotassium vlevel.
A v17-year-old vmale vclient vis vrecovering vfrom vidiopathic vinfective vendocarditis. vThe
vnurse vshould vinclude vwhich vof vthe vfollowing vteaching vpoints vin vthe vdischarge
vcare vplan vfor vthis vclient?
A. vTaking vprophylactic vantibiotics vbefore vdental vprocedures
B. vDrinking vno vmore vthan v1 vliter vof vfluid vper vday
, C. vStrictly vavoiding vcaffeine vor vother vstimulants
D. vEncouraging va vhealthy vlow-fat vdiet vthat vincludes vat vleast v2 vgrams vof vsodium
vintake vper vday v- vcorrect vanswers v-A. vTaking vprophylactic vantibiotics vbefore
vdental vprocedures
Feedback
Client vwith va vhistory vof vinfective vendocarditis vshould vtake vprophylactic vantibiotics
vbefore vdental vprocedures vand vsome vsurgical vprocedures.
The vnurse vis vcaring vfor va v21 vyear vold vfemale vwho vis vbeing vtreated vwith vIV
vmagnesium vfor vpre-eclampsia. vUpon vassessment, vthe vnurse vnotes vthat vthe
vpatient's vskin vis vflushed, vher vblood vpressure vis v88/56, vand vher vrespiratory vrate
vis v12. vThe vnurse vchecks vthe vpatient's vmagnesium vlevel vand vfinds vthat vit vis v7.2
vmg/dL. vWhich vof vthe vfollowing vactions vdoes vthe vnurse vanticipate vtaking vnext?
A. vAdministering vintravenous vcalcium vgluconate
B. vIncreasing vthe vrate vof vthe vmagnesium vinfusion
C. vPlacing vthe vpatient vin vTrendelenburg vand vadministering va vbolus vof vIV vfluid
D.Preparing vthe vpatient vfor va vbedside vcardioversion. v- vcorrect vanswers v-A.
vAdministering vintravenous vcalcium vgluconate
Feedback
The vnurse vshould videntify vthat vthe vsigns vand vsymptoms vhere vare vreflective vof va
vcritically vhigh vmagnesium vlevel, vreflected vby vthe vlab vlevel vof v7.2 vmg/dL, vand
vthat vthe vcorrect vtreatment vis van vinfusion vof vcalcium vgluconate.
A v22-year-old vmale vpatient vis vadmitted vfor vobservation vfollowing va vlinear vtemporal
vskull vfracture vfrom va vskiing vaccident. vUpon vadmission vat v2 vpm, vthe vpatient vwas
valert vand voriented, vand vreports vthat vhe v"passed vout vfor va vsecond" vimmediately
vafter vhis vaccident. vAt v4 vpm, vthe vnurse vnotes vthat vthe vpatient's vGlasgow vComa
vScale v(GCS) vis v8. vThe vnurse vshould:
A. vContinue vto vmonitor vfor vchanges
B. vPlace vthe vpatient vin vTrendelenburg vposition
C. vPrepare vthe vpatient vfor vburr vhole vplacement vwith vclot vevacuation
D. vPrepare vto vadminister vtissue vplasminogen vactivator v(tPA) vto vreverse vocclusive
vstroke v- vcorrect vanswers v-C. vPrepare vthe vpatient vfor vburr vhole vplacement vwith
vclot vevacuation
Feedback
This vpatient vis vexhibiting vclassic vsigns vand vsymptoms vof van vepidural vhematoma.
vSurgical vintervention vto vremove vthe vhematoma vand vrelieve vpressure von vthe
vbrain vshould vbe vperformed vas vsoon vas vpossible.
A v71-year-old vfemale vpatient vis vadmitted vafter vevaluation vin vthe vemergency
vdepartment v(ED) vfor vsuspected vcoronary vsyndrome vinvolving vthe vinferior vwall.
vWhich vof vthe vfollowing vchanges vwould vthe vnurse vanticipate vseeing von va v12-lead
vECG vfor van vinferior vwall vmyocardial vinfarction v(MI)?
A. vST velevation, vQ vwaves, vand vinverted vT vwaves vin vleads vII, vIII, vand vaVF
B. vST velevation, vQ vwaves, vand vinverted vT vwaves vin vleads vI vand vaVL
C. vST vdepression, vQ vwaves, vand vspiked vT vwaves vin vleads vII, vIII, vand vaVF
TO PASS
A vnurse vis vcaring vfor va v71-year-old vfemale vpatient vwith vend-stage vchronic
vobstructive vpulmonary vdisease v(COPD) vwho vis vexperiencing vcardiac vischemia
vwith vincreased vshortness vof vbreath. vThe vMOST vappropriate vgoal vof voxygen
vtherapy vfor vthis vpatient vwould vbe vto:
A. vLimit vsupplemental voxygen vto vlower vthe vrisk vof vreducing vrespiratory vdrive
B. vMaintain voxygen vsaturations vbetween v86% vand v89%
,C. vAdminister voxygen vuntil voxygen vsaturations vare vgreater vthan v95% vin vorder vto
vrelieve vischemia v
D. vMaintain voxygen vsaturations vbetween v90% vand v92% v- vcorrect vanswers v-D.
vMaintain voxygen vsaturations vbetween v90% vand v92%
Feedback
Maintaining voxygen vsaturations vbetween v90% vand v92% vwill vserve vthe vpurpose vof
vproviding venough voxygen vto vrelieve vcardiac vischemia vwhile vreducing vthe vrisk vof
vrespiratory vdepression vin va vpatient vwith vCOPD.
Laboratory vstudies vfrom va v22-year-old vmale vclient vwith vType vI vdiabetes vmellitus
vare vevaluated vduring van vadmission vfor vsevere vpneumonia. vWhich vof vthe
vfollowing vlaboratory vresults vshould vthe vnurse vreport vto vthe vphysician? v
A. vGlycosylated vhemoglobin v(HbA1c), v9.8% v
B. vLow-density vlipoprotein v(LDL), v
C. v94 vmg/dLHematocrit v(Hct), v53% v
D. vUrine vspecific vgravity, v1.250 v- vcorrect vanswers v-A. vGlycosylated vhemoglobin
v(HbA1c), v9.8%
Feedback
Glycosylated vhemoglobin vmeasures vthe vaverage vblood vsugar vlevels vover va v2 vto
v3 vmonth vtime vperiod. vClients vwith vpreviously vdiagnosed vdiabetes vmellitus vshould
vaim vto vkeep vtheir vHbA1c vlevels vbelow v7%.CONTENT vAREA: vClinical vJudgement:
vEndocrine/Hematology/Neurology/GI/Renal
The vnurse vis vassessing va v68 vyear vold vfemale vpatient vwith va vhistory vof vchronic
vobstructive vpulmonary vdisease v(COPD). vThe vpatient vpresents vwith vcomplaints vof
vrecent vconfusion, vincreased vfatigue, vand vsyncopal vepisodes vwhen vwalking. vThe
vnurse vassesses vS3 vand vS4 vsounds von vauscultation, vjugular vvein vdistention, vand
v+3 vpitting vedema vof vthe vankles vand vfeet. vWhich vof vthe vfollowing vcomplications
vof vCOPD vdoes vthe vnurse vsuspect vthe vpatient vis vmost vlikely vexperiencing? v
A. vAcute vrespiratory vdistress vsyndrome v(ARDS) v
B. vBronchiectasis v
C. vHeart vfailure v
D. vCor vpulmonale v- vcorrect vanswers v-D. vCor vpulmonale
Feedback
The vnurse vshould vrecognize vthat va vhistory vof vCOPD vtogether vwith vthe vsigns vand
vsymptoms vlisted vhere vare vsuggestive vof vcor vpulmonale. vThe vpatient vrequires
vfurther vworkup vto vconfirm vthis vdiagnosis.
A v42-year-old vmale vwith vMarfan vsyndrome vand vcomplaint vof vdizziness vis
vadmitted vto vthe vtelemetry vunit vfor vmonitoring. vWhich vof vthe vfollowing
vaccompanying vsymptoms vmay vindicate vthe vneed vfor vimmediate vsurgical
vattention?
A. vCough vwith vvocal vhoarseness
B. vLimited vrotation vof vthe vleft vshoulder
C.Headache vthat vresolved vafter vbreakfast, vbut vhas vreturned
,D. vSudden vstabbing vpain vin vthe vright velbow v- vcorrect vanswers v-A. vCough vwith
vvocal vhoarseness
Feedback
Patients vdiagnosed vwith vMarfan vsyndrome vare vat vhigher vrisk vfor vaortic
vaneurysms. vChanges vin vvocal vquality vaccompanied vby va vcough vor vdysphagia
v(difficulty vswallowing) vmay vindicate vthat va vthoracic vaortic vaneurysm vis vbecoming
vmore venlarged.
The vnurse vis vassessing va v74 vyear vold vfemale vpatient vwho vhas vpresented vwith
vthe vfollowing vsymptoms: vcool, vclammy vskin; vfaint, virregular vperipheral vpulses,
vand v+3 vpitting vedema vin vher vbilateral vlower vextremities. vHer vpartner vtells vthe
vnurse vthe vpatient vhas va vhistory vof vheart vfailure vwith va vrecent vLVEF vof v20%, vas
vwell vas vtype v2 vdiabetes. vThe vpatient's vHR vis v132, vBP vis v79/48, vand vblood
vglucose vis v349. vWhich vof vthe vfollowing vconditions vdoes vthe vnurse vsuspect?
A. vCardiogenic vshock
B. vDiabetic vketoacidosis
C. vFluid voverload
D. vObstructive vshock v- vcorrect vanswers v-A. vCardiogenic vshock
Feedback
The vnurse vshould videntify vthat vcardiogenic vshock vis van vemergency vthat vhas
vextremely vhigh vmortality vrates vwithout vtimely vintervention. vThe vpatient's vhistory vof
vheart vfailure vtogether vwith vher vacute vsymptoms vof vweak vpulses, vedema, vand
vhypotension vall vpoint vto vcardiogenic vshock.
The vnurse vis vcaring vfor va vpatient vwith vstage v5 vchronic vkidney vdisease vwho
vnormally vreceives vhemodialysis vthree vtimes va vweek von vMonday, vWednesday,
vand vFriday. vIt vis vnow vSunday vand vthe vpatient vstates vthey vhave vmissed vtheir
vlast vtwo vdialysis vsessions. vThe vpatient vis vcomplaining vof vshortness vof vbreath
vand vfatigue, vand vtheir vlabs vshow va vcreatinine vof v3.9 vand vpotassium vof v6.8.
vWhat vis vthe vBEST vtreatment vfor vthis vpatient v?
A. v80 vmg vIV vpush vfurosemide vfollowed vby vrechecking vthe vpotassium vlevel, vwith
vmore vIV vfurosemide vas vneeded
B. v15 vg vkayexalate vPO vtwice vdaily
C. vIntravenous vcalcium vinfusion
D. vUrgent vhemodialysis v- vcorrect vanswers v-D. vUrgent vhemodialysis
Feedback
The vnurse vshould vrecognize vthat vdialysis vis vthe vbest voption vfor vthis vpatient vsince
vthey vare valready va vregular vdialysis vpatient vand vare va vlikely vcandidate vto vreceive
vurgent vdialysis vdue vto vtheir vmissed vdialysis vsessions, vshortness vof vbreath, vand
vcritical vpotassium vlevel.
A v17-year-old vmale vclient vis vrecovering vfrom vidiopathic vinfective vendocarditis. vThe
vnurse vshould vinclude vwhich vof vthe vfollowing vteaching vpoints vin vthe vdischarge
vcare vplan vfor vthis vclient?
A. vTaking vprophylactic vantibiotics vbefore vdental vprocedures
B. vDrinking vno vmore vthan v1 vliter vof vfluid vper vday
, C. vStrictly vavoiding vcaffeine vor vother vstimulants
D. vEncouraging va vhealthy vlow-fat vdiet vthat vincludes vat vleast v2 vgrams vof vsodium
vintake vper vday v- vcorrect vanswers v-A. vTaking vprophylactic vantibiotics vbefore
vdental vprocedures
Feedback
Client vwith va vhistory vof vinfective vendocarditis vshould vtake vprophylactic vantibiotics
vbefore vdental vprocedures vand vsome vsurgical vprocedures.
The vnurse vis vcaring vfor va v21 vyear vold vfemale vwho vis vbeing vtreated vwith vIV
vmagnesium vfor vpre-eclampsia. vUpon vassessment, vthe vnurse vnotes vthat vthe
vpatient's vskin vis vflushed, vher vblood vpressure vis v88/56, vand vher vrespiratory vrate
vis v12. vThe vnurse vchecks vthe vpatient's vmagnesium vlevel vand vfinds vthat vit vis v7.2
vmg/dL. vWhich vof vthe vfollowing vactions vdoes vthe vnurse vanticipate vtaking vnext?
A. vAdministering vintravenous vcalcium vgluconate
B. vIncreasing vthe vrate vof vthe vmagnesium vinfusion
C. vPlacing vthe vpatient vin vTrendelenburg vand vadministering va vbolus vof vIV vfluid
D.Preparing vthe vpatient vfor va vbedside vcardioversion. v- vcorrect vanswers v-A.
vAdministering vintravenous vcalcium vgluconate
Feedback
The vnurse vshould videntify vthat vthe vsigns vand vsymptoms vhere vare vreflective vof va
vcritically vhigh vmagnesium vlevel, vreflected vby vthe vlab vlevel vof v7.2 vmg/dL, vand
vthat vthe vcorrect vtreatment vis van vinfusion vof vcalcium vgluconate.
A v22-year-old vmale vpatient vis vadmitted vfor vobservation vfollowing va vlinear vtemporal
vskull vfracture vfrom va vskiing vaccident. vUpon vadmission vat v2 vpm, vthe vpatient vwas
valert vand voriented, vand vreports vthat vhe v"passed vout vfor va vsecond" vimmediately
vafter vhis vaccident. vAt v4 vpm, vthe vnurse vnotes vthat vthe vpatient's vGlasgow vComa
vScale v(GCS) vis v8. vThe vnurse vshould:
A. vContinue vto vmonitor vfor vchanges
B. vPlace vthe vpatient vin vTrendelenburg vposition
C. vPrepare vthe vpatient vfor vburr vhole vplacement vwith vclot vevacuation
D. vPrepare vto vadminister vtissue vplasminogen vactivator v(tPA) vto vreverse vocclusive
vstroke v- vcorrect vanswers v-C. vPrepare vthe vpatient vfor vburr vhole vplacement vwith
vclot vevacuation
Feedback
This vpatient vis vexhibiting vclassic vsigns vand vsymptoms vof van vepidural vhematoma.
vSurgical vintervention vto vremove vthe vhematoma vand vrelieve vpressure von vthe
vbrain vshould vbe vperformed vas vsoon vas vpossible.
A v71-year-old vfemale vpatient vis vadmitted vafter vevaluation vin vthe vemergency
vdepartment v(ED) vfor vsuspected vcoronary vsyndrome vinvolving vthe vinferior vwall.
vWhich vof vthe vfollowing vchanges vwould vthe vnurse vanticipate vseeing von va v12-lead
vECG vfor van vinferior vwall vmyocardial vinfarction v(MI)?
A. vST velevation, vQ vwaves, vand vinverted vT vwaves vin vleads vII, vIII, vand vaVF
B. vST velevation, vQ vwaves, vand vinverted vT vwaves vin vleads vI vand vaVL
C. vST vdepression, vQ vwaves, vand vspiked vT vwaves vin vleads vII, vIII, vand vaVF
