Page 1 of 337
AACN PCCN (Progressive Care Certified Nurse)
ACTUAL EXAM ALL 700 Questions and Verified
Solutions Latest Update This Year
AACN PCCN TEST 1
Q; A patient in the ED is now being admitted to telemetry bwith complaint of chest pain and has been
judged to be a possible candidate for therapy with alteplase (Activase). Which of the following is not
considered a contraindication for the use of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed
A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other answers -- recent
abdominal surgery, recent gastrointestinal bleeding and a recent intracranial bleed -- are
contraindications for the use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload)
, Page 2 of 337
A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the SVR (afterload) is high
and the cardiac output low, the patient may still have a normal BP. the pulse pressure will be lower, but
this is a compensatory response by the heart to maintain BP. If the SVR (afterload) is low (as in early
septic shock), the cardiac output is very high, thereby trying to support BP.
The layer of the arterial vessel wall responsible for changes in the diameter of the artery is the:
A. media
B. intima
C. externa
D. adventitia
A. media
The media layer of the arterial wall contains vascular smooth muscle cells and is responsible for arterial
tone. Vasoactive substances released in response to the sympathetic nervous system and/or the renin-
angiotensin system determine arterial tone. Intima, externa and adventitia are incorrect.
A patient presents in acute distress with rales halfway up bilaterally; cool and clammy extremities;
elevated jugular venous distention (JVD); oxygen saturations at 95%, down from 99%; and complaints
of shortness of breath. Which of the following findings correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion
, Page 3 of 337
D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary edema, causing pulmonary
congestion. Pneumonia can also cause fluid in the alveolar sacs. The patient is complaining of shortness
of breath, and the oxygen saturations are lowering, also indicating that the patient has pulmonary
congestion. The patient's skin is cool and clammy, indicating that the skin is poorly perfused. Skin does
not require oxygen and shunts blood away in decreased cardiac function; therefore, this patient has
pulmonary congestion and low perfusion state. The other answers are incorrect.
When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction
A. the beginning of ventricular systole
The heart sound of S1 indicates the opening of the aortic and pulmonic valves and marks the beginning
of ventricular systole or ejection. The beginning of diastole is after S2, propulsion of blood into a
noncompliant chamber is S4, and blood going in the wrong direction will cause a murmur.
A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure
, Page 4 of 337
A. increased thickness of the alveolar capillary membrane
With increasing left ventricular pressures, blood moves back into the left atrium, then to the pulmonary
veins. When the pressure in the pulmonary veins increases, capillary function decreases, and fluid then
shifts to the interstitial space, causing interstitial edema, thereby, increasing the thickness of the space
oxygen must travel. When left ventricular pressures increase, the fluid then shifts to the alveolar space,
causing pulmonary edema. This fluid acts as a deterrent to oxygen diffusion. Retention of CO2 does not
impair diffusion. An elevated body temperature associated with pulmonary edema is not causing a
diffusion abnormality; increased temperature shifts the oxyhemoglobin curve to the right, more quickly
releasing oxygen to the tissues. Low barometric pressure has no effect on diffusion of gases in the lung.
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic pressure (LVEDP), the
pressure exerted on the ventricular muscle at the end of diastole when the ventricle is full. This enables
blood to flow from a higher pressure through open arteries to a lower pressure, a pressure gradient
known as coronary artery prefusion pressure. As diastolic pressure drops, there is a decrease in coronary
artery blood flow. Coronary artery perfusion is not affected by systolic pressure, afterload or SVR, but
they all increase the demand of oxygen in the heart.
A post-STEMI (ST elevation myocardial infarction) patient is started on an angiotensin-converting
enzyme (ACE) inhibitor during his hospital stay. Which of the following is the most common serious
AACN PCCN (Progressive Care Certified Nurse)
ACTUAL EXAM ALL 700 Questions and Verified
Solutions Latest Update This Year
AACN PCCN TEST 1
Q; A patient in the ED is now being admitted to telemetry bwith complaint of chest pain and has been
judged to be a possible candidate for therapy with alteplase (Activase). Which of the following is not
considered a contraindication for the use of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed
A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other answers -- recent
abdominal surgery, recent gastrointestinal bleeding and a recent intracranial bleed -- are
contraindications for the use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload)
, Page 2 of 337
A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the SVR (afterload) is high
and the cardiac output low, the patient may still have a normal BP. the pulse pressure will be lower, but
this is a compensatory response by the heart to maintain BP. If the SVR (afterload) is low (as in early
septic shock), the cardiac output is very high, thereby trying to support BP.
The layer of the arterial vessel wall responsible for changes in the diameter of the artery is the:
A. media
B. intima
C. externa
D. adventitia
A. media
The media layer of the arterial wall contains vascular smooth muscle cells and is responsible for arterial
tone. Vasoactive substances released in response to the sympathetic nervous system and/or the renin-
angiotensin system determine arterial tone. Intima, externa and adventitia are incorrect.
A patient presents in acute distress with rales halfway up bilaterally; cool and clammy extremities;
elevated jugular venous distention (JVD); oxygen saturations at 95%, down from 99%; and complaints
of shortness of breath. Which of the following findings correspond to the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion
, Page 3 of 337
D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary edema, causing pulmonary
congestion. Pneumonia can also cause fluid in the alveolar sacs. The patient is complaining of shortness
of breath, and the oxygen saturations are lowering, also indicating that the patient has pulmonary
congestion. The patient's skin is cool and clammy, indicating that the skin is poorly perfused. Skin does
not require oxygen and shunts blood away in decreased cardiac function; therefore, this patient has
pulmonary congestion and low perfusion state. The other answers are incorrect.
When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction
A. the beginning of ventricular systole
The heart sound of S1 indicates the opening of the aortic and pulmonic valves and marks the beginning
of ventricular systole or ejection. The beginning of diastole is after S2, propulsion of blood into a
noncompliant chamber is S4, and blood going in the wrong direction will cause a murmur.
A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure
, Page 4 of 337
A. increased thickness of the alveolar capillary membrane
With increasing left ventricular pressures, blood moves back into the left atrium, then to the pulmonary
veins. When the pressure in the pulmonary veins increases, capillary function decreases, and fluid then
shifts to the interstitial space, causing interstitial edema, thereby, increasing the thickness of the space
oxygen must travel. When left ventricular pressures increase, the fluid then shifts to the alveolar space,
causing pulmonary edema. This fluid acts as a deterrent to oxygen diffusion. Retention of CO2 does not
impair diffusion. An elevated body temperature associated with pulmonary edema is not causing a
diffusion abnormality; increased temperature shifts the oxyhemoglobin curve to the right, more quickly
releasing oxygen to the tissues. Low barometric pressure has no effect on diffusion of gases in the lung.
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic pressure (LVEDP), the
pressure exerted on the ventricular muscle at the end of diastole when the ventricle is full. This enables
blood to flow from a higher pressure through open arteries to a lower pressure, a pressure gradient
known as coronary artery prefusion pressure. As diastolic pressure drops, there is a decrease in coronary
artery blood flow. Coronary artery perfusion is not affected by systolic pressure, afterload or SVR, but
they all increase the demand of oxygen in the heart.
A post-STEMI (ST elevation myocardial infarction) patient is started on an angiotensin-converting
enzyme (ACE) inhibitor during his hospital stay. Which of the following is the most common serious
