PCCN Practice Exam Questions and
Answers
1. Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizziness,
recent K+ lvl is 3.4.
What action would you do first?
a. emergent defib
b. amio 300mg IVP
c. emergent cardioversion
d. hang 10 mEq KCL/50mL D5W: C
2. The nurse notes the following when analyzing a patient's
telemetry strip:
HR, 65/min and regular; PR interval, 0.22 seconds; QRS complex, 0.10
seconds;
QTc, 0.52 seconds.
Which of the following dysrhythmias is the patient at risk for?
A. Atrial fibrillation because the PR interval is wide
B. Sinus arrhythmia because the QRS complex is narrow
C. Torsades de pointes because the QTc is wide
D. Third-degree heart block because the PR interval is narrow: C.
,QT measurements reflect the duration of ventricular repolarization. Lengthening of QT interval is
associated with arrhythmias, adverse cardiac events, and increased mortality because a longer QT
duration places the vulnerable ventricular repolarization phase close to the next depolarization, increasing
the likelihood of R-on-T. The most common arrhythmia that occurs with prolonged QTc is torsades de pointes.
Atrial fibrillation, sinus bradycardia, and third-degree heart block are not typically associated with
prolonged ventricular repolarization (QTc >0.50 seconds).
3. A patient with chronic obstructive pulmonary disease (COPD) is
admitted for worsening dyspnea and possible pneumonia. The current
ABG results are pH,
7.19; PaO2, 52 mm Hg; PaCO2, 68 mm Hg; HCO3 - , 32 mmol/L. The
nurse would interpret these results as
A. Metabolic acidosis with hypoxemia
B. Respiratory acidosis with hypoxemia
C. Respiratory alkalosis with typical oxygenation for a COPD patient
D. Metabolic alkalosis with typical oxygenation for a COPD patient: B.
Based on the ABG analysis, the patient is experiencing a respiratory acidosis with hypoxemia most likely
due to the pneumonia. A pH of 7.19 indicates acidosis; a PaCO2 of 68 mm Hg is elevated and a cause of
acidosis; an HCO3 - of 32 mmol/L indicates renal compensation; a PaO2 of 52 mm Hg indicates
hypoxemia
4. 76-year-old patient is receiving gentamicin and linezolid for
, an infection. Which of the following potential complications is
the most important for the nurse to monitor this patient for?
A. Acute delirium
B. Acute kidney injury
C. Acute hepatic failure
D. Sepsis: B.
Gentamicin is a nephrotoxic agent that places patients at risk for acute kidney injury, and this risk is
increased in older patients. Acute delirium (A), liver failure (C), and sepsis (D) are all complications that
could occur in an older adult with an infection but would not be caused by the administration of an
antibiotic.
5. An older patient is experiencing delirium 24 hours following hip
replacement. Which intervention might worsen the patient's
condition?
A. Removing any unnecessary tubes and equipment from the room
B. Assessing and treating the patient's pain every 2 hours
C. Ensuring that the patient has the means to call for help
D. Loosely applying soft restraints: D.
Older patients are at increased risk for delirium during acute hospitalization. Interventions to manage
acute delirium include removing or camouflaging tubes, removing unnecessary equipment, frequently
reorienting the patient, and ensuring that the call bell is consistently within reach, assessing and treating
pain ettectively, and encouraging mobility and involvement in activities of daily living. Restraining the patient
Answers
1. Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizziness,
recent K+ lvl is 3.4.
What action would you do first?
a. emergent defib
b. amio 300mg IVP
c. emergent cardioversion
d. hang 10 mEq KCL/50mL D5W: C
2. The nurse notes the following when analyzing a patient's
telemetry strip:
HR, 65/min and regular; PR interval, 0.22 seconds; QRS complex, 0.10
seconds;
QTc, 0.52 seconds.
Which of the following dysrhythmias is the patient at risk for?
A. Atrial fibrillation because the PR interval is wide
B. Sinus arrhythmia because the QRS complex is narrow
C. Torsades de pointes because the QTc is wide
D. Third-degree heart block because the PR interval is narrow: C.
,QT measurements reflect the duration of ventricular repolarization. Lengthening of QT interval is
associated with arrhythmias, adverse cardiac events, and increased mortality because a longer QT
duration places the vulnerable ventricular repolarization phase close to the next depolarization, increasing
the likelihood of R-on-T. The most common arrhythmia that occurs with prolonged QTc is torsades de pointes.
Atrial fibrillation, sinus bradycardia, and third-degree heart block are not typically associated with
prolonged ventricular repolarization (QTc >0.50 seconds).
3. A patient with chronic obstructive pulmonary disease (COPD) is
admitted for worsening dyspnea and possible pneumonia. The current
ABG results are pH,
7.19; PaO2, 52 mm Hg; PaCO2, 68 mm Hg; HCO3 - , 32 mmol/L. The
nurse would interpret these results as
A. Metabolic acidosis with hypoxemia
B. Respiratory acidosis with hypoxemia
C. Respiratory alkalosis with typical oxygenation for a COPD patient
D. Metabolic alkalosis with typical oxygenation for a COPD patient: B.
Based on the ABG analysis, the patient is experiencing a respiratory acidosis with hypoxemia most likely
due to the pneumonia. A pH of 7.19 indicates acidosis; a PaCO2 of 68 mm Hg is elevated and a cause of
acidosis; an HCO3 - of 32 mmol/L indicates renal compensation; a PaO2 of 52 mm Hg indicates
hypoxemia
4. 76-year-old patient is receiving gentamicin and linezolid for
, an infection. Which of the following potential complications is
the most important for the nurse to monitor this patient for?
A. Acute delirium
B. Acute kidney injury
C. Acute hepatic failure
D. Sepsis: B.
Gentamicin is a nephrotoxic agent that places patients at risk for acute kidney injury, and this risk is
increased in older patients. Acute delirium (A), liver failure (C), and sepsis (D) are all complications that
could occur in an older adult with an infection but would not be caused by the administration of an
antibiotic.
5. An older patient is experiencing delirium 24 hours following hip
replacement. Which intervention might worsen the patient's
condition?
A. Removing any unnecessary tubes and equipment from the room
B. Assessing and treating the patient's pain every 2 hours
C. Ensuring that the patient has the means to call for help
D. Loosely applying soft restraints: D.
Older patients are at increased risk for delirium during acute hospitalization. Interventions to manage
acute delirium include removing or camouflaging tubes, removing unnecessary equipment, frequently
reorienting the patient, and ensuring that the call bell is consistently within reach, assessing and treating
pain ettectively, and encouraging mobility and involvement in activities of daily living. Restraining the patient
