**The Progressive Care Nursing (PCCN) Certification
Review: Intermediate Medical-Surgical and Telemetry
Concepts**
1. A nurse is caring for a client with an acute exacerbation of heart failure. The client has crackles in the
lung bases, an oxygen saturation of 88% on room air, and a heart rate of 110 bpm. What is the priority
action?
A. Place the client in a high Fowler's position.
B. Administer furosemide (Lasix) IV.
C. Apply oxygen via nasal cannula at 2 L/min.
D. Obtain a stat chest x-ray.
💫RATIONALE✔️✔️: High Fowler's position reduces venous return and improves breathing, which is the
first non-pharmacologic intervention for pulmonary edema.
💫ANSWER✔️✔️: A. Place the client in a high Fowler's position.
---
2. A client with chronic obstructive pulmonary disease (COPD) has a new prescription for home oxygen
at 2 L/min via nasal cannula. Which statement by the client indicates understanding?
A. "I will increase my oxygen to 4 L/min if I feel short of breath."
B. "I will check my oxygen saturation every 4 hours while awake."
C. "I can smoke as long as I am at least 10 feet away from the tank."
D. "I will store my oxygen tank upright in a well-ventilated closet."
💫RATIONALE✔️✔️: Monitoring oxygen saturation guides therapy and prevents over-oxygenation,
which can cause hypercapnia in COPD. Smoking near oxygen is strictly forbidden.
💫ANSWER✔️✔️: B. "I will check my oxygen saturation every 4 hours while awake."
---
,3. A nurse is assessing a client with a pulmonary embolism who is receiving a heparin infusion. The
client's aPTT is 110 seconds (control 30 seconds). The client has no signs of bleeding. What is the priority
action?
A. Continue the infusion at the same rate.
B. Decrease the infusion rate and notify the provider.
C. Stop the infusion and administer protamine sulfate.
D. Administer vitamin K.
💫RATIONALE✔️✔️: An aPTT of 110 seconds is >3.5x control (supratherapeutic). The infusion rate
should be decreased per protocol, and the provider notified. Protamine is for life-threatening bleeding.
💫ANSWER✔️✔️: B. Decrease the infusion rate and notify the provider.
---
4. A client with diabetes mellitus is admitted with a blood glucose of 450 mg/dL, serum potassium of 5.8
mEq/L, and an anion gap of 22. The nurse suspects:
A. Diabetic ketoacidosis (DKA)
B. Hyperosmolar hyperglycemic state (HHS)
C. Lactic acidosis
D. Hypoglycemia
💫RATIONALE✔️✔️: DKA presents with hyperglycemia, anion gap metabolic acidosis, and often
hyperkalemia (from acidosis shifting potassium out of cells). HHS has less acidosis.
💫ANSWER✔️✔️: A. Diabetic ketoacidosis (DKA)
---
5. A client with DKA is receiving an insulin infusion. The nurse notes that the serum glucose is decreasing
by 25 mg/dL per hour. What is the priority action?
A. Continue the infusion at the same rate.
B. Increase the insulin infusion rate.
C. Decrease the insulin infusion rate.
D. Add dextrose to the IV fluids.
💫RATIONALE✔️✔️: A safe and effective rate of glucose decline in DKA is 50-75 mg/dL per hour. 25
mg/dL per hour is too slow; the insulin rate should be increased.
, 💫ANSWER✔️✔️: B. Increase the insulin infusion rate.
---
6. A client with hyperosmolar hyperglycemic state (HHS) has a serum sodium of 155 mEq/L. The nurse
should anticipate an order for:
A. 0.45% normal saline (half-normal saline)
B. 0.9% normal saline
C. 3% normal saline
D. Lactated Ringer's solution
💫RATIONALE✔️✔️: In HHS with hypernatremia, 0.45% normal saline (hypotonic) is used to correct
hyperosmolality after initial volume resuscitation with 0.9% NS.
💫ANSWER✔️✔️: A. 0.45% normal saline (half-normal saline)
---
7. A nurse is caring for a client with a new diagnosis of atrial fibrillation. The client has a heart rate of
140 bpm and is asymptomatic. Which medication should the nurse anticipate to control the ventricular
rate?
A. Diltiazem (Cardizem) IV
B. Digoxin (Lanoxin) IV
C. Amiodarone (Cordarone) IV
D. Warfarin (Coumadin) PO
💫RATIONALE✔️✔️: Rate control in stable atrial fibrillation is achieved with diltiazem (calcium channel
blocker) or metoprolol (beta-blocker). Digoxin is second-line.
💫ANSWER✔️✔️: A. Diltiazem (Cardizem) IV
---
8. A client with atrial fibrillation has a new prescription for warfarin (Coumadin). The nurse teaches the
client that warfarin is used to:
A. Convert atrial fibrillation to normal sinus rhythm
B. Control the ventricular rate
C. Prevent stroke by reducing thrombus formation
, D. Decrease the frequency of episodes
💫RATIONALE✔️✔️: Warfarin is an anticoagulant used to prevent thromboembolic events (stroke) in
atrial fibrillation. It does not affect rate or rhythm.
💫ANSWER✔️✔️: C. Prevent stroke by reducing thrombus formation
---
9. A client with heart failure has a serum potassium level of 3.2 mEq/L. The nurse is reviewing
medications. Which medication places the client at highest risk for arrhythmia?
A. Furosemide (Lasix)
B. Metoprolol (Lopressor)
C. Digoxin (Lanoxin)
D. Lisinopril (Zestril)
💫RATIONALE✔️✔️: Hypokalemia potentiates digoxin toxicity by increasing binding of digoxin to cardiac
muscle, leading to ventricular arrhythmias.
💫ANSWER✔️✔️: C. Digoxin (Lanoxin)
---
10. A client with cirrhosis has an elevated ammonia level and is confused. Which dietary intervention is
most appropriate?
A. High-protein diet to promote healing.
B. Low-protein diet with vegetable proteins.
C. No protein restriction until encephalopathy develops.
D. High-carbohydrate, high-fat diet.
💫RATIONALE✔️✔️: For cirrhosis with hyperammonemia and hepatic encephalopathy, protein is often
restricted (or switched to vegetable/dairy proteins) because protein breakdown produces ammonia.
💫ANSWER✔️✔️: B. Low-protein diet with vegetable proteins.
---
11. A nurse is caring for a client with a new diagnosis of acute pancreatitis. Which laboratory finding is
most specific?
Review: Intermediate Medical-Surgical and Telemetry
Concepts**
1. A nurse is caring for a client with an acute exacerbation of heart failure. The client has crackles in the
lung bases, an oxygen saturation of 88% on room air, and a heart rate of 110 bpm. What is the priority
action?
A. Place the client in a high Fowler's position.
B. Administer furosemide (Lasix) IV.
C. Apply oxygen via nasal cannula at 2 L/min.
D. Obtain a stat chest x-ray.
💫RATIONALE✔️✔️: High Fowler's position reduces venous return and improves breathing, which is the
first non-pharmacologic intervention for pulmonary edema.
💫ANSWER✔️✔️: A. Place the client in a high Fowler's position.
---
2. A client with chronic obstructive pulmonary disease (COPD) has a new prescription for home oxygen
at 2 L/min via nasal cannula. Which statement by the client indicates understanding?
A. "I will increase my oxygen to 4 L/min if I feel short of breath."
B. "I will check my oxygen saturation every 4 hours while awake."
C. "I can smoke as long as I am at least 10 feet away from the tank."
D. "I will store my oxygen tank upright in a well-ventilated closet."
💫RATIONALE✔️✔️: Monitoring oxygen saturation guides therapy and prevents over-oxygenation,
which can cause hypercapnia in COPD. Smoking near oxygen is strictly forbidden.
💫ANSWER✔️✔️: B. "I will check my oxygen saturation every 4 hours while awake."
---
,3. A nurse is assessing a client with a pulmonary embolism who is receiving a heparin infusion. The
client's aPTT is 110 seconds (control 30 seconds). The client has no signs of bleeding. What is the priority
action?
A. Continue the infusion at the same rate.
B. Decrease the infusion rate and notify the provider.
C. Stop the infusion and administer protamine sulfate.
D. Administer vitamin K.
💫RATIONALE✔️✔️: An aPTT of 110 seconds is >3.5x control (supratherapeutic). The infusion rate
should be decreased per protocol, and the provider notified. Protamine is for life-threatening bleeding.
💫ANSWER✔️✔️: B. Decrease the infusion rate and notify the provider.
---
4. A client with diabetes mellitus is admitted with a blood glucose of 450 mg/dL, serum potassium of 5.8
mEq/L, and an anion gap of 22. The nurse suspects:
A. Diabetic ketoacidosis (DKA)
B. Hyperosmolar hyperglycemic state (HHS)
C. Lactic acidosis
D. Hypoglycemia
💫RATIONALE✔️✔️: DKA presents with hyperglycemia, anion gap metabolic acidosis, and often
hyperkalemia (from acidosis shifting potassium out of cells). HHS has less acidosis.
💫ANSWER✔️✔️: A. Diabetic ketoacidosis (DKA)
---
5. A client with DKA is receiving an insulin infusion. The nurse notes that the serum glucose is decreasing
by 25 mg/dL per hour. What is the priority action?
A. Continue the infusion at the same rate.
B. Increase the insulin infusion rate.
C. Decrease the insulin infusion rate.
D. Add dextrose to the IV fluids.
💫RATIONALE✔️✔️: A safe and effective rate of glucose decline in DKA is 50-75 mg/dL per hour. 25
mg/dL per hour is too slow; the insulin rate should be increased.
, 💫ANSWER✔️✔️: B. Increase the insulin infusion rate.
---
6. A client with hyperosmolar hyperglycemic state (HHS) has a serum sodium of 155 mEq/L. The nurse
should anticipate an order for:
A. 0.45% normal saline (half-normal saline)
B. 0.9% normal saline
C. 3% normal saline
D. Lactated Ringer's solution
💫RATIONALE✔️✔️: In HHS with hypernatremia, 0.45% normal saline (hypotonic) is used to correct
hyperosmolality after initial volume resuscitation with 0.9% NS.
💫ANSWER✔️✔️: A. 0.45% normal saline (half-normal saline)
---
7. A nurse is caring for a client with a new diagnosis of atrial fibrillation. The client has a heart rate of
140 bpm and is asymptomatic. Which medication should the nurse anticipate to control the ventricular
rate?
A. Diltiazem (Cardizem) IV
B. Digoxin (Lanoxin) IV
C. Amiodarone (Cordarone) IV
D. Warfarin (Coumadin) PO
💫RATIONALE✔️✔️: Rate control in stable atrial fibrillation is achieved with diltiazem (calcium channel
blocker) or metoprolol (beta-blocker). Digoxin is second-line.
💫ANSWER✔️✔️: A. Diltiazem (Cardizem) IV
---
8. A client with atrial fibrillation has a new prescription for warfarin (Coumadin). The nurse teaches the
client that warfarin is used to:
A. Convert atrial fibrillation to normal sinus rhythm
B. Control the ventricular rate
C. Prevent stroke by reducing thrombus formation
, D. Decrease the frequency of episodes
💫RATIONALE✔️✔️: Warfarin is an anticoagulant used to prevent thromboembolic events (stroke) in
atrial fibrillation. It does not affect rate or rhythm.
💫ANSWER✔️✔️: C. Prevent stroke by reducing thrombus formation
---
9. A client with heart failure has a serum potassium level of 3.2 mEq/L. The nurse is reviewing
medications. Which medication places the client at highest risk for arrhythmia?
A. Furosemide (Lasix)
B. Metoprolol (Lopressor)
C. Digoxin (Lanoxin)
D. Lisinopril (Zestril)
💫RATIONALE✔️✔️: Hypokalemia potentiates digoxin toxicity by increasing binding of digoxin to cardiac
muscle, leading to ventricular arrhythmias.
💫ANSWER✔️✔️: C. Digoxin (Lanoxin)
---
10. A client with cirrhosis has an elevated ammonia level and is confused. Which dietary intervention is
most appropriate?
A. High-protein diet to promote healing.
B. Low-protein diet with vegetable proteins.
C. No protein restriction until encephalopathy develops.
D. High-carbohydrate, high-fat diet.
💫RATIONALE✔️✔️: For cirrhosis with hyperammonemia and hepatic encephalopathy, protein is often
restricted (or switched to vegetable/dairy proteins) because protein breakdown produces ammonia.
💫ANSWER✔️✔️: B. Low-protein diet with vegetable proteins.
---
11. A nurse is caring for a client with a new diagnosis of acute pancreatitis. Which laboratory finding is
most specific?
