PCCN Review Exam Questions and
Answers
1. A nurse is caring for a 71-year-old female patient with end-stage
chronic obstructive pulmonary disease (COPD) who is experiencing
cardiac ischemia with increased shortness of breath.
The MOST appropriate goal of oxygen therapy for this patient
would be to:
A. Limit supplemental oxygen to lower the risk of reducing respiratory
drive
B. Maintain oxygen saturations between 86% and 89%
C. Administer oxygen until oxygen saturations are greater than 95%
in order to relieve ischemia
D. Maintain oxygen saturations between 90% and 92%: D. Maintain oxygen
saturations between 90% and 92%
Feedback
Maintaining oxygen saturations between 90% and 92% will serve the purpose of providing enough
oxygen to relieve cardiac ischemia while reducing the risk of respiratory depression in a patient with
COPD.
2. Laboratory studies from a 22-year-old male client with Type I
diabetes mel- litus are evaluated during an admission for severe
pneumonia. Which of the following laboratory results should the
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,nurse report to the physician?
A. Glycosylated hemoglobin (HbA1c), 9.8%
B. Low-density lipoprotein (LDL),
C. 94 mg/dLHematocrit (Hct), 53%
D. Urine specific gravity, 1.250: A. Glycosylated hemoglobin
(HbA1c), 9.8% Feedback
Glycosylated hemoglobin measures the average blood sugar levels over a 2 to 3 month time period.
Clients with previously diagnosed diabetes mellitus should aim to keep their HbA1c levels below
7%.CONTENT AREA: Clinical Judgement: Endocrine/Hematology/Neurology/GI/Renal
3. The nurse is assessing a 68 year old female patient with a history
of chronic obstructive pulmonary disease (COPD). The patient presents
with complaints of recent confusion, increased fatigue, and syncopal
episodes when walking. The nurse assesses S3 and S4 sounds on
auscultation, jugular vein distention, and
+3 pitting edema of the ankles and feet. Which of the following
complications of COPD does the nurse suspect the patient is most
likely experiencing?
A. Acute respiratory distress syndrome (ARDS)
B. Bronchiectasis
C. Heart failure
D. Cor pulmonale: D. Cor
pulmonale Feedback
The nurse should recognize that a history of COPD together with the signs and symptoms listed here
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76
,are suggestive of cor pulmonale. The patient requires further workup to confirm this diagnosis.
4. A 42-year-old male with Marfan syndrome and complaint of
dizziness is admitted to the telemetry unit for monitoring. Which
of the following accom- panying symptoms may indicate the
need for immediate surgical attention?
A. Cough with vocal hoarseness
B. Limited rotation of the left shoulder
C. Headache that resolved after breakfast, but has returned
D. Sudden stabbing pain in the right elbow: A. Cough with vocal
hoarseness Feedback
Patients diagnosed with Marfan syndrome are at higher risk for aortic aneurysms. Changes in vocal
quality accompanied by a cough or dysphagia (difficulty swallowing) may indicate that a thoracic aortic
aneurysm is becoming more enlarged.
5. The nurse is assessing a 74 year old female patient who has
presented with the following symptoms: cool, clammy skin; faint,
irregular peripheral pulses, and +3 pitting edema in her bilateral
lower extremities. Her partner tells the nurse the patient has a
history of heart failure with a recent LVEF of 20%, as well as type 2
diabetes. The patient's HR is 132, BP is 79/48, and blood glucose is
349. Which of the following conditions does the nurse suspect?
A. Cardiogenic shock
B. Diabetic ketoacidosis
C. Fluid overload
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76
, D. Obstructive shock: A. Cardiogenic
shock Feedback
The nurse should identify that cardiogenic shock is an emergency that has extremely high mortality
rates without timely intervention. The patient's history of heart failure together with her acute symptoms
of weak pulses, edema, and hypotension all point to cardiogenic shock.
6. The nurse is caring for a patient with stage 5 chronic kidney
disease who normally receives hemodialysis three times a week on
Monday, Wednesday,
and Friday. It is now Sunday and the patient states they have missed
their last two dialysis sessions. The patient is complaining of
shortness of breath and fatigue, and their labs show a creatinine of
3.9 and potassium of 6.8. What is the BEST treatment for this patient
?
A. 80 mg IV push furosemide followed by rechecking the potassium
level, with more IV furosemide as needed
B. 15 g kayexalate PO twice daily
C. Intravenous calcium infusion
D. Urgent hemodialysis: D. Urgent
hemodialysis Feedback
The nurse should recognize that dialysis is the best option for this patient since they are already a
regular dialysis patient and are a likely candidate to receive urgent dialysis due to their missed dialysis
sessions, shortness of breath, and critical potassium level.
7. A 17-year-old male client is recovering from idiopathic infective
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76
Answers
1. A nurse is caring for a 71-year-old female patient with end-stage
chronic obstructive pulmonary disease (COPD) who is experiencing
cardiac ischemia with increased shortness of breath.
The MOST appropriate goal of oxygen therapy for this patient
would be to:
A. Limit supplemental oxygen to lower the risk of reducing respiratory
drive
B. Maintain oxygen saturations between 86% and 89%
C. Administer oxygen until oxygen saturations are greater than 95%
in order to relieve ischemia
D. Maintain oxygen saturations between 90% and 92%: D. Maintain oxygen
saturations between 90% and 92%
Feedback
Maintaining oxygen saturations between 90% and 92% will serve the purpose of providing enough
oxygen to relieve cardiac ischemia while reducing the risk of respiratory depression in a patient with
COPD.
2. Laboratory studies from a 22-year-old male client with Type I
diabetes mel- litus are evaluated during an admission for severe
pneumonia. Which of the following laboratory results should the
1/
76
,nurse report to the physician?
A. Glycosylated hemoglobin (HbA1c), 9.8%
B. Low-density lipoprotein (LDL),
C. 94 mg/dLHematocrit (Hct), 53%
D. Urine specific gravity, 1.250: A. Glycosylated hemoglobin
(HbA1c), 9.8% Feedback
Glycosylated hemoglobin measures the average blood sugar levels over a 2 to 3 month time period.
Clients with previously diagnosed diabetes mellitus should aim to keep their HbA1c levels below
7%.CONTENT AREA: Clinical Judgement: Endocrine/Hematology/Neurology/GI/Renal
3. The nurse is assessing a 68 year old female patient with a history
of chronic obstructive pulmonary disease (COPD). The patient presents
with complaints of recent confusion, increased fatigue, and syncopal
episodes when walking. The nurse assesses S3 and S4 sounds on
auscultation, jugular vein distention, and
+3 pitting edema of the ankles and feet. Which of the following
complications of COPD does the nurse suspect the patient is most
likely experiencing?
A. Acute respiratory distress syndrome (ARDS)
B. Bronchiectasis
C. Heart failure
D. Cor pulmonale: D. Cor
pulmonale Feedback
The nurse should recognize that a history of COPD together with the signs and symptoms listed here
2/
76
,are suggestive of cor pulmonale. The patient requires further workup to confirm this diagnosis.
4. A 42-year-old male with Marfan syndrome and complaint of
dizziness is admitted to the telemetry unit for monitoring. Which
of the following accom- panying symptoms may indicate the
need for immediate surgical attention?
A. Cough with vocal hoarseness
B. Limited rotation of the left shoulder
C. Headache that resolved after breakfast, but has returned
D. Sudden stabbing pain in the right elbow: A. Cough with vocal
hoarseness Feedback
Patients diagnosed with Marfan syndrome are at higher risk for aortic aneurysms. Changes in vocal
quality accompanied by a cough or dysphagia (difficulty swallowing) may indicate that a thoracic aortic
aneurysm is becoming more enlarged.
5. The nurse is assessing a 74 year old female patient who has
presented with the following symptoms: cool, clammy skin; faint,
irregular peripheral pulses, and +3 pitting edema in her bilateral
lower extremities. Her partner tells the nurse the patient has a
history of heart failure with a recent LVEF of 20%, as well as type 2
diabetes. The patient's HR is 132, BP is 79/48, and blood glucose is
349. Which of the following conditions does the nurse suspect?
A. Cardiogenic shock
B. Diabetic ketoacidosis
C. Fluid overload
3/
76
, D. Obstructive shock: A. Cardiogenic
shock Feedback
The nurse should identify that cardiogenic shock is an emergency that has extremely high mortality
rates without timely intervention. The patient's history of heart failure together with her acute symptoms
of weak pulses, edema, and hypotension all point to cardiogenic shock.
6. The nurse is caring for a patient with stage 5 chronic kidney
disease who normally receives hemodialysis three times a week on
Monday, Wednesday,
and Friday. It is now Sunday and the patient states they have missed
their last two dialysis sessions. The patient is complaining of
shortness of breath and fatigue, and their labs show a creatinine of
3.9 and potassium of 6.8. What is the BEST treatment for this patient
?
A. 80 mg IV push furosemide followed by rechecking the potassium
level, with more IV furosemide as needed
B. 15 g kayexalate PO twice daily
C. Intravenous calcium infusion
D. Urgent hemodialysis: D. Urgent
hemodialysis Feedback
The nurse should recognize that dialysis is the best option for this patient since they are already a
regular dialysis patient and are a likely candidate to receive urgent dialysis due to their missed dialysis
sessions, shortness of breath, and critical potassium level.
7. A 17-year-old male client is recovering from idiopathic infective
4/
76
