PCCN EXAM/PCCN CERIFICATION EXAM NEWEST
EXAM AND UPDATED STUDY GUIDE FULLY REVISED
EXAM WITH MOST TESTED EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS A NEW UPDATED
VERSION LATEST 2026-2027 (VERIFIED ANSWERS)
ALREADY GRADED A+
A 68-year-old patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with acute respiratory failure. An arterial blood gas (ABG) analysis reveals: pH 7.28,
PaCO2 68 mm Hg, HCO3- 28 mEq/L, and PaO2 55 mm Hg. How should the nurse interpret these
findings?
A. Uncompensated respiratory acidosis
B. Fully compensated respiratory acidosis
C. Partially compensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Correct Answer: C. Partially compensated respiratory acidosis
The ABG shows a primary respiratory acidosis (elevated PaCO2). The HCO3- is elevated,
indicating a metabolic compensatory response. Since the pH is still below normal, the
compensation is partial. Complete compensation would return the pH to a normal range.
A patient is receiving mechanical ventilation in the pressure support mode. Which assessment
finding would indicate to the nurse that the set pressure support is too low?
,A. The patient's respiratory rate is 28 breaths per minute.
B. The patient's exhaled tidal volume is 600 mL.
C. The patient is sleeping comfortably.
D. The arterial PaCO2 is 38 mm Hg.
Correct Answer: A. The patient's respiratory rate is 28 breaths per minute.
A respiratory rate of 28 breaths per minute indicates that the patient is tachypneic, likely
because the pressure support is insufficient to overcome airway resistance and the work of
breathing is too high. A low pressure support would lead to shallow, rapid breathing.
A nurse is caring for a patient with an endotracheal tube. What is the priority nursing action to
prevent ventilator-associated pneumonia (VAP)?
A. Suction the endotracheal tube every hour.
B. Maintain the head of the bed at 30 to 45 degrees.
C. Change the ventilator circuit daily.
D. Administer prophylactic antibiotics.
Correct Answer: B. Maintain the head of the bed at 30 to 45 degrees.
Maintaining the head of the bed elevated to 30-45 degrees is a key evidence-based
intervention to prevent VAP by reducing the risk of aspiration of gastric contents. Routine
circuit changes are not recommended, and prophylactic antibiotics are not a standard
preventative measure.
A patient with asthma is receiving treatment. The nurse notes that the patient's peak expiratory
flow rate is 40% of personal best, and the patient is now silent to auscultation. What is the
nurse's priority action?
A. Administer a nebulized bronchodilator treatment.
B. Prepare for immediate intubation.
C. Encourage the patient to use pursed-lip breathing.
D. Reassess breath sounds in 30 minutes.
,Correct Answer: B. Prepare for immediate intubation.
A silent chest in a patient with asthma is a critical sign indicating severe airway obstruction
with minimal air movement. This, combined with a peak flow of 40% of personal best,
suggests a life-threatening exacerbation requiring immediate intubation and mechanical
ventilation.
The nurse is caring for a patient with a pulmonary embolism (PE). The patient's vital signs are:
blood pressure 88/52 mm Hg, heart rate 118 bpm, respiratory rate 24 bpm, and SpO2 89% on 4
L nasal cannula. Which finding is most concerning and warrants immediate intervention?
A. The patient's heart rate of 118 bpm
B. The patient's SpO2 of 89%
C. The patient's blood pressure of 88/52 mm Hg
D. The patient's respiratory rate of 24 bpm
Correct Answer: C. The patient's blood pressure of 88/52 mm Hg
Hypotension (systolic BP < 90 mm Hg) in a patient with a PE indicates a massive PE causing
obstructive shock and right ventricular failure. This is a life-threatening emergency that
requires immediate intervention, such as thrombolytic therapy or embolectomy.
A patient is receiving continuous renal replacement therapy (CRRT). Which laboratory value
requires the most immediate intervention?
A. Serum potassium of 3.0 mEq/L
B. Serum phosphorus of 4.0 mg/dL
C. Serum sodium of 135 mEq/L
D. Serum ionized calcium of 0.8 mmol/L
Correct Answer: D. Serum ionized calcium of 0.8 mmol/L
A serum ionized calcium of 0.8 mmol/L is critically low (normal 1.1-1.3 mmol/L) and can cause
life-threatening cardiac arrhythmias, seizures, and hypotension. This requires immediate
calcium replacement. The other values are abnormal but not immediately life-threatening.
, A patient is admitted with diabetic ketoacidosis (DKA). The nurse reviews the orders. Which
order should the nurse question?
A. 0.9% normal saline at 250 mL/hr
B. Regular insulin IV bolus of 0.1 units/kg, then continuous infusion
C. 5% dextrose in 0.45% normal saline when blood glucose reaches 250 mg/dL
D. Potassium chloride 40 mEq IV push over 2 minutes
Correct Answer: D. Potassium chloride 40 mEq IV push over 2 minutes
Potassium chloride should never be given as an IV push due to the risk of fatal cardiac
arrhythmias. It must be diluted and infused over a specified time. The other orders are
standard for DKA treatment.
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of
118 mEq/L. The nurse assesses the patient. Which finding is most consistent with this diagnosis?
A. Dry mucous membranes and poor skin turgor
B. Increased urine output and thirst
C. Jugular vein distention and peripheral edema
D. Muscle twitching and hyperactive reflexes
Correct Answer: C. Jugular vein distention and peripheral edema
SIADH results in water retention and dilutional hyponatremia. This leads to fluid overload,
which can present as jugular vein distention (JVD) and peripheral edema. The other findings
are more consistent with hypernatremia or fluid volume deficit.
A patient is post-operative following a thyroidectomy. The nurse assesses the patient and notes
stridor. What is the priority nursing action?
A. Administer calcium gluconate IV.
B. Apply a tracheostomy tray at the bedside.
C. Place the patient in a high Fowler's position.
D. Encourage the patient to cough and deep breathe.
EXAM AND UPDATED STUDY GUIDE FULLY REVISED
EXAM WITH MOST TESTED EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS A NEW UPDATED
VERSION LATEST 2026-2027 (VERIFIED ANSWERS)
ALREADY GRADED A+
A 68-year-old patient with a history of chronic obstructive pulmonary disease (COPD) is
admitted with acute respiratory failure. An arterial blood gas (ABG) analysis reveals: pH 7.28,
PaCO2 68 mm Hg, HCO3- 28 mEq/L, and PaO2 55 mm Hg. How should the nurse interpret these
findings?
A. Uncompensated respiratory acidosis
B. Fully compensated respiratory acidosis
C. Partially compensated respiratory acidosis
D. Partially compensated metabolic alkalosis
Correct Answer: C. Partially compensated respiratory acidosis
The ABG shows a primary respiratory acidosis (elevated PaCO2). The HCO3- is elevated,
indicating a metabolic compensatory response. Since the pH is still below normal, the
compensation is partial. Complete compensation would return the pH to a normal range.
A patient is receiving mechanical ventilation in the pressure support mode. Which assessment
finding would indicate to the nurse that the set pressure support is too low?
,A. The patient's respiratory rate is 28 breaths per minute.
B. The patient's exhaled tidal volume is 600 mL.
C. The patient is sleeping comfortably.
D. The arterial PaCO2 is 38 mm Hg.
Correct Answer: A. The patient's respiratory rate is 28 breaths per minute.
A respiratory rate of 28 breaths per minute indicates that the patient is tachypneic, likely
because the pressure support is insufficient to overcome airway resistance and the work of
breathing is too high. A low pressure support would lead to shallow, rapid breathing.
A nurse is caring for a patient with an endotracheal tube. What is the priority nursing action to
prevent ventilator-associated pneumonia (VAP)?
A. Suction the endotracheal tube every hour.
B. Maintain the head of the bed at 30 to 45 degrees.
C. Change the ventilator circuit daily.
D. Administer prophylactic antibiotics.
Correct Answer: B. Maintain the head of the bed at 30 to 45 degrees.
Maintaining the head of the bed elevated to 30-45 degrees is a key evidence-based
intervention to prevent VAP by reducing the risk of aspiration of gastric contents. Routine
circuit changes are not recommended, and prophylactic antibiotics are not a standard
preventative measure.
A patient with asthma is receiving treatment. The nurse notes that the patient's peak expiratory
flow rate is 40% of personal best, and the patient is now silent to auscultation. What is the
nurse's priority action?
A. Administer a nebulized bronchodilator treatment.
B. Prepare for immediate intubation.
C. Encourage the patient to use pursed-lip breathing.
D. Reassess breath sounds in 30 minutes.
,Correct Answer: B. Prepare for immediate intubation.
A silent chest in a patient with asthma is a critical sign indicating severe airway obstruction
with minimal air movement. This, combined with a peak flow of 40% of personal best,
suggests a life-threatening exacerbation requiring immediate intubation and mechanical
ventilation.
The nurse is caring for a patient with a pulmonary embolism (PE). The patient's vital signs are:
blood pressure 88/52 mm Hg, heart rate 118 bpm, respiratory rate 24 bpm, and SpO2 89% on 4
L nasal cannula. Which finding is most concerning and warrants immediate intervention?
A. The patient's heart rate of 118 bpm
B. The patient's SpO2 of 89%
C. The patient's blood pressure of 88/52 mm Hg
D. The patient's respiratory rate of 24 bpm
Correct Answer: C. The patient's blood pressure of 88/52 mm Hg
Hypotension (systolic BP < 90 mm Hg) in a patient with a PE indicates a massive PE causing
obstructive shock and right ventricular failure. This is a life-threatening emergency that
requires immediate intervention, such as thrombolytic therapy or embolectomy.
A patient is receiving continuous renal replacement therapy (CRRT). Which laboratory value
requires the most immediate intervention?
A. Serum potassium of 3.0 mEq/L
B. Serum phosphorus of 4.0 mg/dL
C. Serum sodium of 135 mEq/L
D. Serum ionized calcium of 0.8 mmol/L
Correct Answer: D. Serum ionized calcium of 0.8 mmol/L
A serum ionized calcium of 0.8 mmol/L is critically low (normal 1.1-1.3 mmol/L) and can cause
life-threatening cardiac arrhythmias, seizures, and hypotension. This requires immediate
calcium replacement. The other values are abnormal but not immediately life-threatening.
, A patient is admitted with diabetic ketoacidosis (DKA). The nurse reviews the orders. Which
order should the nurse question?
A. 0.9% normal saline at 250 mL/hr
B. Regular insulin IV bolus of 0.1 units/kg, then continuous infusion
C. 5% dextrose in 0.45% normal saline when blood glucose reaches 250 mg/dL
D. Potassium chloride 40 mEq IV push over 2 minutes
Correct Answer: D. Potassium chloride 40 mEq IV push over 2 minutes
Potassium chloride should never be given as an IV push due to the risk of fatal cardiac
arrhythmias. It must be diluted and infused over a specified time. The other orders are
standard for DKA treatment.
A patient with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of
118 mEq/L. The nurse assesses the patient. Which finding is most consistent with this diagnosis?
A. Dry mucous membranes and poor skin turgor
B. Increased urine output and thirst
C. Jugular vein distention and peripheral edema
D. Muscle twitching and hyperactive reflexes
Correct Answer: C. Jugular vein distention and peripheral edema
SIADH results in water retention and dilutional hyponatremia. This leads to fluid overload,
which can present as jugular vein distention (JVD) and peripheral edema. The other findings
are more consistent with hypernatremia or fluid volume deficit.
A patient is post-operative following a thyroidectomy. The nurse assesses the patient and notes
stridor. What is the priority nursing action?
A. Administer calcium gluconate IV.
B. Apply a tracheostomy tray at the bedside.
C. Place the patient in a high Fowler's position.
D. Encourage the patient to cough and deep breathe.
