PCCN EXAM PREP PRACTICE QUESTIONS WITH
CORRECT ANSWERS
1. A 49-year-old male was recently admitted with an inferior wall
xc xc xc xc xc xc xc xc xc xc
MI resulting from 100% occlusion of the right coronary artery
xc xc xc xc xc xc xc xc xc
(RCA). The 12-Lead ECG reveals ST elevation in leads II, Ill, and avF.
xc xc xc xc xc xc xc xc xc xc xc xc
You would expect to see reciprocal changes in which leads?
xc xc xc xc xc xc xc xc xc
A. I, aVR xc xc
B. V, V2 xc xc
C. V, VA xc xc
D I, aVL - ans-xc xc xc xc
1. D. I, aVI. The RCA perfuses the inferior wall and the mirror image or reciprocal change wil
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
l be seen in the high latera wall, which is reflected in leads I, and aVL, on the 12-
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate With
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
the anterior area of the heart. The aVR lead does not provide much diagnostic value as all e
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
nergy is depolarizing away from this lead. xc xc xc xc xc xc
You are summoned to the room of a 30-year-
xc xc xc xc xc xc xc xc
old female who is experiencing sustained tonic-
xc xc xc xc xc xc
clonic convulsions while sitting in a chair. A family member states: "She was just talking to u
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
s and suddenly she let out a shriek and started flopping like a fish out of water." What is your
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
initial priority of care? xc xc xc
A. Call for help and safely guide the patient to the floor
xc xc xc xc xc xc xc xc xc xc xc
B. Call for help and administer a prescribed antiepileptic
xc xc xc xc xc xc xc xc
C. Call for help and administer a prescribed benzodiazepine
xc xc xc xc xc xc xc xc
D. Call for help and monitor the course of the seizure - ans-
xc xc xc xc xc xc xc xc xc xc xc xc
A. Call for help and safely guide the patient to the floor
xc xc xc xc xc xc xc xc xc xc xc
Patient Safety is priority
xc xc xc xc
A 46-year-old patient presents with pneumonia and sepsis.
xc xc xc xc xc xc xc
He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath and
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
is now on 100% FiO, via non-re-
xc xc xc xc xc xc
breather mask. You obtain an ABG with the following results: pH 7.20 / PaCO, 68/
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
PaO, 102/ HCO, 28. A chest x-
xc xc xc xc xc xc xc
ray reveals bilateral pulmonary infiltrates. The patient is likely developing:
xc xc xc xc xc xc xc xc xc
A. Worsening pneumonia
xc xc
B. Acute Respiratory Distress Syndrome
xc xc xc xc
C. Pulmonary embolusxc xc
D. Atelectasis - ans-B. Acute Respiratory Distress Syndrome
xc xc xc xc xc xc xc
A 56-year- xc
old male is admitted to the PCU with a hypertensive crisis. His blood pressure is now 205/1
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
,25 mm Hg and he is complaining of a headache with nausea. He reports he ran out of blood
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
pressure medication three days ago, but also appears to be confused to the date and situati
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
on. What is the most appropriate treatment approach?
xc xc xc xc xc xc xc
A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication, th
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
en gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medicati
xc xc xc xc xc xc xc xc xc xc xc xc xc
ons
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications, t
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
hen switch to oral antihypertensive medications for maintenance
xc xc xc xc xc xc xc
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications,
xc xc xc xc xc xc xc xc xc xc xc xc xc x
then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihyperten
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
sive medications xc
D. Slowly lower the diastolic pressure to 85 mm - ans-
xc xc xc xc xc xc xc xc xc xc
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications,
xc xc xc xc xc xc xc xc xc xc xc xc xc x
then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihyperten
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
sive medication xc
5. Which of the following labs must be closely monitored when administering Lisinopril to a
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
patient with systolic heart failure? xc xc xc xc
A. Sodium xc
B. Phosphate xc
C. Magnesium xc
D Potassium - ans-D. Potassium
xc xc xc xc
Patients taking angiotensin converting enzyme inhibitors may experience hyperkalemia. A
xc xc xc xc xc xc xc xc xc
CE inhibitors block angiotensin II, which may lead to decreased aldosterone. Aldosterone i
xc xc xc xc xc xc xc xc xc xc xc xc
s responsible forexcreting potassium from the kidneys. Therefore, ACE inhibitors can caus
xc xc xc xc xc xc xc xc xc xc xc
e potassium retension and potassium levels should be monitored closely. In addition, renal
xc xc xc xc xc xc xc xc xc xc xc xc xc
labs such as BUN and creatinine should be monitored. If the patient develops more than a 2
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
0% increase in the creatinine, the medication should be discontinued.
xc xc xc xc xc xc xc xc xc
A 57-year-
xc
old man was admitted with an acute myocardial infarction and is rapidly deteriorating. He h
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
as a BP of 86/42
xc xc xc xc
(57), heart rate of 110, weak, thready pulses, and mottled skin-
xc xc xc xc xc xc xc xc xc xc
especially at the knees. He has had minimal urine output the past 8 hours. A Rapid Respon
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
se is activated. Which of the following medications would be the best option to increase the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
patient's cardiac output? xc xc
A Dobutamine
xc
B Norepinephrine
xc
C Amiodarone
xc
D Phenylephrine - ans-
xc xc xc
A Dobutamine. Dobutamine is a positive inotropic medication used to improve myocardial d
xc xc xc xc xc xc xc xc xc xc xc xc
ysfunction on patients with a low cardiac index and elevated afterload. It will improve contra
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ctility and reduce afterload. Milrinone, which is a phosphodiesterase inhibitor could also be
xc xc xc xc xc xc xc xc xc xc xc xc xc
, used as an alternative to dobutamine, in the setting of decompensated heart failure. It is us
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ed cautiously in patients experiencing cardiogiogenic shock as one of the main side effects
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
of Milrinone is hypotension. The half life of Milrinone is about 6 hours. Norepinephrine and
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Phenylephrine cause vasoconstriction, which would increase the SVR and may compromi xc xc xc xc xc xc xc xc xc xc
se cardiac output.
xc xc
You are caring for a patient post gastric bypass. Which of the following parameters should y
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ou closely monitor after surgery?
xc xc xc xc
A* HR, RR, temperature, WBC & MAP
xc xc xc xc xc xc
B* Protein levels and vitamin B12
xc xc xc xc xc
C* Albumin and pre-albumin levels
xc xc xc xc
D* Signs of dumping syndrome - ans-A* HR, RR, temperature, WBC & MAP
xc xc xc xc xc xc xc xc xc xc xc xc
You are caring for a patient admitted after a ground level fall. The patient has decreased lev
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
el of consciousness. On admission the patient is ordered to be a full code. The family arrive
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
s with advanced directives stating the patient wishes not to have CPR performed or life sust
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
aining treatment continued. The nurse approaches the provider about this discrepancy and
xc xc xc xc xc xc xc xc xc xc xc x
the provider states "I am aware of the advanced directive, but the daughter wants everythin
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
g done."
xc
What is the appropriate next step by the nurse?
xc xc xc xc xc xc xc xc
A* Ask the daughter why she wants everything done
xc xc xc xc xc xc xc xc
B* Collaborate with the provider and social worker to schedule a family meeting
xc xc xc xc xc xc xc xc xc xc xc xc
C* Tell the doctor we have to follow the patient's wishes
xc xc xc xc xc xc xc xc xc xc
* Discuss the situation with the nurse manager - ans-
xc xc xc xc xc xc xc xc xc
B* Collaborate with the provider and social worker to schedule a family meeting
xc xc xc xc xc xc xc xc xc xc xc xc
Which is the best intervention to promote safety of the patient receiving hemodialysis?
xc xc xc xc xc xc xc xc xc xc xc xc
A* Direct visualization of the connection between the machine and the access device
xc xc xc xc xc xc xc xc xc xc xc xc
B* Strict intake and output monitoring
xc xc xc xc xc
C* Strict bedrest
xc xc
D* Electrolyte assessment q 4 hours - ans-
xc xc xc xc xc xc xc
A* Direct visualization of the connection between the machine and the access device
xc xc xc xc xc xc xc xc xc xc xc xc
The nurse must be able to visualize the junction of the central venous access and the dialysi
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
s unit at all times. Disconnection can result in exsanguination within minutes.
xc xc xc xc xc xc xc xc xc xc xc
Four hours after starting an insulin infusion in a patient admitted with diabetic ketoacidosis,
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
the patient's blood glucose is 235 mg/
xc xc xc xc xc xc
dL. Which of the following fluids should be administered at this point?
xc xc xc xc xc xc xc xc xc xc xc
A Hypertonic solution to hydrate the cell
xc xc xc xc xc xc
CORRECT ANSWERS
1. A 49-year-old male was recently admitted with an inferior wall
xc xc xc xc xc xc xc xc xc xc
MI resulting from 100% occlusion of the right coronary artery
xc xc xc xc xc xc xc xc xc
(RCA). The 12-Lead ECG reveals ST elevation in leads II, Ill, and avF.
xc xc xc xc xc xc xc xc xc xc xc xc
You would expect to see reciprocal changes in which leads?
xc xc xc xc xc xc xc xc xc
A. I, aVR xc xc
B. V, V2 xc xc
C. V, VA xc xc
D I, aVL - ans-xc xc xc xc
1. D. I, aVI. The RCA perfuses the inferior wall and the mirror image or reciprocal change wil
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
l be seen in the high latera wall, which is reflected in leads I, and aVL, on the 12-
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate With
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
the anterior area of the heart. The aVR lead does not provide much diagnostic value as all e
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
nergy is depolarizing away from this lead. xc xc xc xc xc xc
You are summoned to the room of a 30-year-
xc xc xc xc xc xc xc xc
old female who is experiencing sustained tonic-
xc xc xc xc xc xc
clonic convulsions while sitting in a chair. A family member states: "She was just talking to u
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
s and suddenly she let out a shriek and started flopping like a fish out of water." What is your
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
initial priority of care? xc xc xc
A. Call for help and safely guide the patient to the floor
xc xc xc xc xc xc xc xc xc xc xc
B. Call for help and administer a prescribed antiepileptic
xc xc xc xc xc xc xc xc
C. Call for help and administer a prescribed benzodiazepine
xc xc xc xc xc xc xc xc
D. Call for help and monitor the course of the seizure - ans-
xc xc xc xc xc xc xc xc xc xc xc xc
A. Call for help and safely guide the patient to the floor
xc xc xc xc xc xc xc xc xc xc xc
Patient Safety is priority
xc xc xc xc
A 46-year-old patient presents with pneumonia and sepsis.
xc xc xc xc xc xc xc
He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath and
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
is now on 100% FiO, via non-re-
xc xc xc xc xc xc
breather mask. You obtain an ABG with the following results: pH 7.20 / PaCO, 68/
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
PaO, 102/ HCO, 28. A chest x-
xc xc xc xc xc xc xc
ray reveals bilateral pulmonary infiltrates. The patient is likely developing:
xc xc xc xc xc xc xc xc xc
A. Worsening pneumonia
xc xc
B. Acute Respiratory Distress Syndrome
xc xc xc xc
C. Pulmonary embolusxc xc
D. Atelectasis - ans-B. Acute Respiratory Distress Syndrome
xc xc xc xc xc xc xc
A 56-year- xc
old male is admitted to the PCU with a hypertensive crisis. His blood pressure is now 205/1
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
,25 mm Hg and he is complaining of a headache with nausea. He reports he ran out of blood
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
pressure medication three days ago, but also appears to be confused to the date and situati
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
on. What is the most appropriate treatment approach?
xc xc xc xc xc xc xc
A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication, th
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
en gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive medicati
xc xc xc xc xc xc xc xc xc xc xc xc xc
ons
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications, t
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
hen switch to oral antihypertensive medications for maintenance
xc xc xc xc xc xc xc
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications,
xc xc xc xc xc xc xc xc xc xc xc xc xc x
then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihyperten
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
sive medications xc
D. Slowly lower the diastolic pressure to 85 mm - ans-
xc xc xc xc xc xc xc xc xc xc
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications,
xc xc xc xc xc xc xc xc xc xc xc xc xc x
then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral antihyperten
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
sive medication xc
5. Which of the following labs must be closely monitored when administering Lisinopril to a
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
patient with systolic heart failure? xc xc xc xc
A. Sodium xc
B. Phosphate xc
C. Magnesium xc
D Potassium - ans-D. Potassium
xc xc xc xc
Patients taking angiotensin converting enzyme inhibitors may experience hyperkalemia. A
xc xc xc xc xc xc xc xc xc
CE inhibitors block angiotensin II, which may lead to decreased aldosterone. Aldosterone i
xc xc xc xc xc xc xc xc xc xc xc xc
s responsible forexcreting potassium from the kidneys. Therefore, ACE inhibitors can caus
xc xc xc xc xc xc xc xc xc xc xc
e potassium retension and potassium levels should be monitored closely. In addition, renal
xc xc xc xc xc xc xc xc xc xc xc xc xc
labs such as BUN and creatinine should be monitored. If the patient develops more than a 2
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
0% increase in the creatinine, the medication should be discontinued.
xc xc xc xc xc xc xc xc xc
A 57-year-
xc
old man was admitted with an acute myocardial infarction and is rapidly deteriorating. He h
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
as a BP of 86/42
xc xc xc xc
(57), heart rate of 110, weak, thready pulses, and mottled skin-
xc xc xc xc xc xc xc xc xc xc
especially at the knees. He has had minimal urine output the past 8 hours. A Rapid Respon
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
se is activated. Which of the following medications would be the best option to increase the
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
patient's cardiac output? xc xc
A Dobutamine
xc
B Norepinephrine
xc
C Amiodarone
xc
D Phenylephrine - ans-
xc xc xc
A Dobutamine. Dobutamine is a positive inotropic medication used to improve myocardial d
xc xc xc xc xc xc xc xc xc xc xc xc
ysfunction on patients with a low cardiac index and elevated afterload. It will improve contra
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ctility and reduce afterload. Milrinone, which is a phosphodiesterase inhibitor could also be
xc xc xc xc xc xc xc xc xc xc xc xc xc
, used as an alternative to dobutamine, in the setting of decompensated heart failure. It is us
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ed cautiously in patients experiencing cardiogiogenic shock as one of the main side effects
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
of Milrinone is hypotension. The half life of Milrinone is about 6 hours. Norepinephrine and
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
Phenylephrine cause vasoconstriction, which would increase the SVR and may compromi xc xc xc xc xc xc xc xc xc xc
se cardiac output.
xc xc
You are caring for a patient post gastric bypass. Which of the following parameters should y
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
ou closely monitor after surgery?
xc xc xc xc
A* HR, RR, temperature, WBC & MAP
xc xc xc xc xc xc
B* Protein levels and vitamin B12
xc xc xc xc xc
C* Albumin and pre-albumin levels
xc xc xc xc
D* Signs of dumping syndrome - ans-A* HR, RR, temperature, WBC & MAP
xc xc xc xc xc xc xc xc xc xc xc xc
You are caring for a patient admitted after a ground level fall. The patient has decreased lev
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
el of consciousness. On admission the patient is ordered to be a full code. The family arrive
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
s with advanced directives stating the patient wishes not to have CPR performed or life sust
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
aining treatment continued. The nurse approaches the provider about this discrepancy and
xc xc xc xc xc xc xc xc xc xc xc x
the provider states "I am aware of the advanced directive, but the daughter wants everythin
c xc xc xc xc xc xc xc xc xc xc xc xc xc xc
g done."
xc
What is the appropriate next step by the nurse?
xc xc xc xc xc xc xc xc
A* Ask the daughter why she wants everything done
xc xc xc xc xc xc xc xc
B* Collaborate with the provider and social worker to schedule a family meeting
xc xc xc xc xc xc xc xc xc xc xc xc
C* Tell the doctor we have to follow the patient's wishes
xc xc xc xc xc xc xc xc xc xc
* Discuss the situation with the nurse manager - ans-
xc xc xc xc xc xc xc xc xc
B* Collaborate with the provider and social worker to schedule a family meeting
xc xc xc xc xc xc xc xc xc xc xc xc
Which is the best intervention to promote safety of the patient receiving hemodialysis?
xc xc xc xc xc xc xc xc xc xc xc xc
A* Direct visualization of the connection between the machine and the access device
xc xc xc xc xc xc xc xc xc xc xc xc
B* Strict intake and output monitoring
xc xc xc xc xc
C* Strict bedrest
xc xc
D* Electrolyte assessment q 4 hours - ans-
xc xc xc xc xc xc xc
A* Direct visualization of the connection between the machine and the access device
xc xc xc xc xc xc xc xc xc xc xc xc
The nurse must be able to visualize the junction of the central venous access and the dialysi
xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc xc
s unit at all times. Disconnection can result in exsanguination within minutes.
xc xc xc xc xc xc xc xc xc xc xc
Four hours after starting an insulin infusion in a patient admitted with diabetic ketoacidosis,
xc xc xc xc xc xc xc xc xc xc xc xc xc xc
the patient's blood glucose is 235 mg/
xc xc xc xc xc xc
dL. Which of the following fluids should be administered at this point?
xc xc xc xc xc xc xc xc xc xc xc
A Hypertonic solution to hydrate the cell
xc xc xc xc xc xc
