PCCN Practice Exam Questions and
Answers
with Rationales
1. A patient with hypertensive crisis has become increasingly
confused and pulls out the IV. In order to avoid the complication of
hypertensive encephalopathy, the nurse should expect to include
monitoring for
A. decreasing pulse pressure MAP.
B. signs of HF.
C. bruising from restraints.
D. hyperglycemia.: B. signs of HF.
Patients with hypertensive crisis should be monitored for signs of HF, widening pulse pressure, and
seizures which are all signs of hypertensive encephalopathy. Restraints should be avoided as they
increase intracranial pressure and BP contributing to worsening hypertensive crisis.
2. A patient with mitral stenosis is admitted. Which dysrhythmias
should be of GREATEST concern to the nurse?
A. Wolff-Parkinson-White syndrome
B. afib
1/
123
,C. torsades de pointes
D. monomorphic vtach: B. afib
Mitral stenosis is characterized by a narrowing of the valve orifice and enlargement of the left atrium due
to obstruction of flow into the left ventricle. The left atrial hypertrophy causes changes in depolarization and
repolarization and increas- es the risk for atrial fibrillation. The most common cause of monomorphic vtach
(VT) is AMI, not mitral stenosis. Other causes of monomorphic VT are hypomagnesemia, hypokalemia,
and dilated cardiomyopathy. Woltt-Parkinson-White (WPW) syndrome is characterized by a short PR
interval, delta wave and tachycardia greater than 200 beats per minute. WPW syndrome is causes by
early activation of the ventricles via an accessory pathway and is not associated with mitral stenosis.
Torsades de pointes is a polymorphic ventricular tachycardia associated with a long QT interval. It is
pause-dependent and commonly associated with drug-induced QT prolongation, not mitral stenosis.
3. A patient with HF is on a diuretic and fluid restriction. The
assessment indi- cates atrial tachycardia with a rate of 130, presence
of crackles in all lung fields, an S3 at the left apex and BP of 90/40
(previously 130/60). The patient reports feeling SOB. The nurse
should anticipate the administration of
A. a fluid bolus to enhance preload
B. dopamine (Inotropic) to support BP
C. dobutamine (Dobutrex) to augment CO
D. adenosine (Adenocard) to reverse the tachcardia: C. dobutamine (Dobutrex)
to augment CO
In patients w/ decompensated HF, the use of IV inotropic agents such as dobutamine may be indicated
2/
123
,to support cardiac function and cardiac output. Dobutamine has beta-2 effects (in addition to beta-1)
which results in mild vasodilation. It is especially useful for afterload reduction in HF patients that cannot
tolerate vasodilator therapy. The administration of a fluid bolus will make the patient's condition worse.
Dopamine does not provide afterload reduction and may worsen the patient's tachycardia. Adenosine is
not indicated as the HR is less than 150 and the goal is to treat the underlying cause of the
tachycardia.
4. A patient with a hx of HF and ACS is admitted following an
episode of syncope. Two hours later, the assessment reveals,
shallow breaths and bilateral clear lung sounds. Data are: BP 134/64
(supine); 90/60 standing; RR 32; UO 30 mL over past 2 hours. The
nurse should anticipate:
A. IV fluids
B. nesiritide (Natrecor)
C. dopamine
D. mannitol: A. IV fluids
Although this pt has a hx of HF, data suggest orthostatic hypotension and hypovolemia which should
initially be treated with fluids. While HF may be of concern, the patient's breath sounds are clear at
present. Careful monitoring of patient tolerance is needed during the administration of a fluid challenge.
Nesiritide is used for short-term tx of decompensated CHF. It vasodilates both veins and arteries and
increases diuresis and natriuresis which would worsen orthostasis. The use of an osmotic diuretic is not
indicated and may cause further hypovolemia. Dopamine augments CO by improving contractility and
3/
123
, tissue perfusion. It will increase BP but the patient's underlying hypovolemia needs to be corrected
first.
5. A patient who was admitted with uncontrolled HTN is scheduled
for dis- charge. Which education is a PRIORITY for the nurse during
discharge instruc- tions?
A. relaxation and stress management techniques
B. multidrug regimens and consequences if not followed
C. BP monitoring along with alcohol and caffeine changes
D. lifestyle modifications for cessation of vaping, dietary and
exercise adjust- ments: B. multidrug regimens and consequences if not followed
Multidrug regimens with two or three medications of different drug classes are almost always required
to achieve recommended BP goals. Insufficient time for patient engagement as well as multidrug
burden, prescription drug costs, and medication side effects are primary contributors to medication
noncompliance. The primary prevention of hypertension requires large-scale societal changes, including
further efforts to influence the food industry to reduce salt in processed foods, efforts to increase
exercise, and availability of fresh fruits and vegetables. After a person's BP rises to hypertensive or even
pre-hypertensive levels, lifestyle modification alone is almost never enough to return it to normal, and
recidivism is typical. Lifestyle modifications are difficult to sustain long-term and thus, are a secondary
focus in patient education.
6. A patient presents with CP, dyspnea, orthopnea, and a systolic
4/
123
Answers
with Rationales
1. A patient with hypertensive crisis has become increasingly
confused and pulls out the IV. In order to avoid the complication of
hypertensive encephalopathy, the nurse should expect to include
monitoring for
A. decreasing pulse pressure MAP.
B. signs of HF.
C. bruising from restraints.
D. hyperglycemia.: B. signs of HF.
Patients with hypertensive crisis should be monitored for signs of HF, widening pulse pressure, and
seizures which are all signs of hypertensive encephalopathy. Restraints should be avoided as they
increase intracranial pressure and BP contributing to worsening hypertensive crisis.
2. A patient with mitral stenosis is admitted. Which dysrhythmias
should be of GREATEST concern to the nurse?
A. Wolff-Parkinson-White syndrome
B. afib
1/
123
,C. torsades de pointes
D. monomorphic vtach: B. afib
Mitral stenosis is characterized by a narrowing of the valve orifice and enlargement of the left atrium due
to obstruction of flow into the left ventricle. The left atrial hypertrophy causes changes in depolarization and
repolarization and increas- es the risk for atrial fibrillation. The most common cause of monomorphic vtach
(VT) is AMI, not mitral stenosis. Other causes of monomorphic VT are hypomagnesemia, hypokalemia,
and dilated cardiomyopathy. Woltt-Parkinson-White (WPW) syndrome is characterized by a short PR
interval, delta wave and tachycardia greater than 200 beats per minute. WPW syndrome is causes by
early activation of the ventricles via an accessory pathway and is not associated with mitral stenosis.
Torsades de pointes is a polymorphic ventricular tachycardia associated with a long QT interval. It is
pause-dependent and commonly associated with drug-induced QT prolongation, not mitral stenosis.
3. A patient with HF is on a diuretic and fluid restriction. The
assessment indi- cates atrial tachycardia with a rate of 130, presence
of crackles in all lung fields, an S3 at the left apex and BP of 90/40
(previously 130/60). The patient reports feeling SOB. The nurse
should anticipate the administration of
A. a fluid bolus to enhance preload
B. dopamine (Inotropic) to support BP
C. dobutamine (Dobutrex) to augment CO
D. adenosine (Adenocard) to reverse the tachcardia: C. dobutamine (Dobutrex)
to augment CO
In patients w/ decompensated HF, the use of IV inotropic agents such as dobutamine may be indicated
2/
123
,to support cardiac function and cardiac output. Dobutamine has beta-2 effects (in addition to beta-1)
which results in mild vasodilation. It is especially useful for afterload reduction in HF patients that cannot
tolerate vasodilator therapy. The administration of a fluid bolus will make the patient's condition worse.
Dopamine does not provide afterload reduction and may worsen the patient's tachycardia. Adenosine is
not indicated as the HR is less than 150 and the goal is to treat the underlying cause of the
tachycardia.
4. A patient with a hx of HF and ACS is admitted following an
episode of syncope. Two hours later, the assessment reveals,
shallow breaths and bilateral clear lung sounds. Data are: BP 134/64
(supine); 90/60 standing; RR 32; UO 30 mL over past 2 hours. The
nurse should anticipate:
A. IV fluids
B. nesiritide (Natrecor)
C. dopamine
D. mannitol: A. IV fluids
Although this pt has a hx of HF, data suggest orthostatic hypotension and hypovolemia which should
initially be treated with fluids. While HF may be of concern, the patient's breath sounds are clear at
present. Careful monitoring of patient tolerance is needed during the administration of a fluid challenge.
Nesiritide is used for short-term tx of decompensated CHF. It vasodilates both veins and arteries and
increases diuresis and natriuresis which would worsen orthostasis. The use of an osmotic diuretic is not
indicated and may cause further hypovolemia. Dopamine augments CO by improving contractility and
3/
123
, tissue perfusion. It will increase BP but the patient's underlying hypovolemia needs to be corrected
first.
5. A patient who was admitted with uncontrolled HTN is scheduled
for dis- charge. Which education is a PRIORITY for the nurse during
discharge instruc- tions?
A. relaxation and stress management techniques
B. multidrug regimens and consequences if not followed
C. BP monitoring along with alcohol and caffeine changes
D. lifestyle modifications for cessation of vaping, dietary and
exercise adjust- ments: B. multidrug regimens and consequences if not followed
Multidrug regimens with two or three medications of different drug classes are almost always required
to achieve recommended BP goals. Insufficient time for patient engagement as well as multidrug
burden, prescription drug costs, and medication side effects are primary contributors to medication
noncompliance. The primary prevention of hypertension requires large-scale societal changes, including
further efforts to influence the food industry to reduce salt in processed foods, efforts to increase
exercise, and availability of fresh fruits and vegetables. After a person's BP rises to hypertensive or even
pre-hypertensive levels, lifestyle modification alone is almost never enough to return it to normal, and
recidivism is typical. Lifestyle modifications are difficult to sustain long-term and thus, are a secondary
focus in patient education.
6. A patient presents with CP, dyspnea, orthopnea, and a systolic
4/
123
