• PCCN EXAM 09/12/2026
PCCN EXAM 3 NEW 2025/ 2026 ACTUAL EXAM
TEST BANK| 2 VERSIONS (VERSION A & B) WITH
COMPLETE 650 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+| PROGRESSIVE
CARE CERTIFIED NURSE EXAM PREP (MOST
RECENT!!)
.
The most common causative organism of antibiotic-associated colitis is
A. Clostridium difficile.
P 1
, • PCCN EXAM 09/12/2026
B. Staphylococcus aureus.
C. Salmonella.
D. Escherichia coli. –
Correct Answer :A.
Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that causes antibiotic-
associated colitis. It colonizes the human intestinal tract after the normal gut flora have been altered by
antibiotic therapy. It produces exotoxins that lead to inflammation and diarrhea. Antibiotic use is the most
common risk factor for C. difficile-associated diarrhea (CDAD). Other risk factors include advanced age,
hospitalization, and severe illness. The antibiotics most frequently implicated in CDAD include fluoroquinolones
(e.g., ciprofloxacin), clindamycin, broad-spectrum penicillins, and cephalosporins. Symptoms of CDAD include
watery diarrhea (up to 10 or 15 times daily), lower abdominal pain and cramping, low grade fever, and
leukocytosis. C difficile is highly transmissible and can be cultured from nearly any surface, including items in
patient rooms as well as the hands, clothing, and stethoscopes of health care workers. Infection is easily
transmitted between patients and between healthcare workers and patients. Treatment includes stopping the
causative antibiotic; infection control practices, including contact precautions and hand washing with soap and
water (not alcohol based hand cleaners); and administration of metronidazole or vancomycin.
Staphylococcus aureus is a leading cause of both community-acquired and healthcare-acquired bacteremia. A
methicillin resistant form (MRSA) commonly manifests as skin and soft tissue infections (including wound
infections), bacteremia, or pneumonia. Risk factors for MRSA include hospitalization or residence in a long term
care facility, recent antibiotic therapy, HIV infection, injection drug use, hemodialysis, sharing of needles, and
sharing of sports equipment.
Treatment includes antibiotics: clindamycin, trimethoprim-sulfamethoxazole (Bactrim,
Esophageal varices are caused by:
A. Portal vein atrophy from diminished blood flow.
B. Congenital esophageal aneurysms.
C. A high level of alcohol content in the esophagus.
D. Obstruction of and hypertension within the portal vein with resultant shunting of blood to the esophageal
veins.
- Correct Answer :D.
Although esophageal varices can be seen as a complication of alcoholism, they are not related to any alcohol in
the esophagus. Esophageal varices are caused by liver disease (often the result of chronic alcoholism). Liver
disease increases pressure within the portal vein that is transmitted back into the veins that drain from the
P 2
, • PCCN EXAM 09/12/2026
gastrointestinal tract including those from the esophagus. The increased backward pressure from the portal vein
causes the esophageal veins to dilate.
A patient with hepatic failure demonstrates deterioration in handwriting and when asked on exam to hold his
arm and hand out like a stop sign, involuntary flapping of the hand (asterixis) is observed. These symptoms are
most likely due to:
A. Intracranial hemorrhage.
B. Sub clinical seizure.
C. Alcohol withdrawal.
D. Encephalopathy.
- Correct Answer :D. Encephalopathy is an anticipated complication of hepatic failure and is caused by high
ammonia levels, which cause neurotoxicity. In failure, the liver loses its ability to normally metabolize and
detoxify substances. Ammonia is produced by bacteria in the bowel and is a byproduct of protein metabolism.
Normally, the liver metabolizes ammonia into urea for excretion. In liver failure, ammonia levels rise.
When assessing the abdomen of a patient, the correct order of assessment techniques is:
A. Palpation, percussion, auscultation, inspection.
B. Inspection, palpation, percussion, auscultation.
C. Inspection, auscultation, percussion, palpation.
D. Percussion, palpation, auscultation, inspection. –
Correct Answer :C. When assessing the abdomen it is important to auscultate before performing percussion or
palpation. The performance of palpation or percussion if done first can interfere with the auscultatory
assessment.
Stress ulceration in the stomach is common in critically ill patients. Stress ulcer prophylaxis is indicated in which
of the following patients at highest risk for GI bleeding:
Choose one
A. Mechanical ventilation for more than 48 hours.
B. History of GI ulceration or bleeding in the past year.
P 3
, • PCCN EXAM 09/12/2026
C. ICU stay longer than 1 week.
D. Coagulopathy.
E. All of the above. –
Correct Answer :E. Two major risk factors for clinically important GI bleeding are mechanical ventilation for more
than 48 hours and coagulopathy (defined as a platelet count <50,000, INR >1.5, or aPTT >2 times the control
value). In addition, guidelines recommend stress ulcer prophylaxis in patients with a history of GI ulceration or
bleeding within the past year, and two or more of the following risk factors: sepsis, ICU admission lasting >1
week, occult GI bleeding lasting ≥6 days, and glucocorticoid therapy.
Drugs used to prevent GI bleeding in critically ill patients include which of the following:
A. Beta blockers and calcium channel blockers.
B. Aldosterone blockers and beta blockers.
C. Proton pump inhibitors (PPI) and histamine-2 receptor blockers (H2 blockers).
D. ACE inhibitors and angiotensin receptor blockers (ARBs). –
Correct Answer :C. H2 blockers and PPI reduce gastric acid secretion. Examples of H2 blockers include
cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepsid), and nizatidine (Axid). Examples of PPI include
omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), and pantoprazole (Protonix). Other
drugs that can be used include sucralfate (Carafate) which coats and protects the gastric mucosa without
altering gastric acid secretion, and antacids which neutralize gastric acid to protect the gastric mucosa.
ACE inhibitors prevent conversion of angiotensin I to angiotensin II and ARBs block angiotensin II at its receptor
site. Both are used to treat heart failure and hypertension.
Aldosterone blockers are used in heart failure to block aldosterone's effect on Na+ and water reabsorption by
the kidney.
Beta blockers and calcium channel blockers can be used to treat hypertension and angina. Beta blockers are
indicated in heart failure as well.
You are caring for a 44 year old male who is being admitted with acute upper GI bleeding. He is vomiting bright
red blood, his skin is cold and clammy, BP is 86/52, heart rate is 120. You know that the main priority in his care
right now is:
A. Inserting an NG tube to decompress the stomach and assess rate of bleeding.
B. Administering crystalloid IV fluids and/or blood products to prevent or treat hypovolemic shock.
P 4
PCCN EXAM 3 NEW 2025/ 2026 ACTUAL EXAM
TEST BANK| 2 VERSIONS (VERSION A & B) WITH
COMPLETE 650 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+| PROGRESSIVE
CARE CERTIFIED NURSE EXAM PREP (MOST
RECENT!!)
.
The most common causative organism of antibiotic-associated colitis is
A. Clostridium difficile.
P 1
, • PCCN EXAM 09/12/2026
B. Staphylococcus aureus.
C. Salmonella.
D. Escherichia coli. –
Correct Answer :A.
Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that causes antibiotic-
associated colitis. It colonizes the human intestinal tract after the normal gut flora have been altered by
antibiotic therapy. It produces exotoxins that lead to inflammation and diarrhea. Antibiotic use is the most
common risk factor for C. difficile-associated diarrhea (CDAD). Other risk factors include advanced age,
hospitalization, and severe illness. The antibiotics most frequently implicated in CDAD include fluoroquinolones
(e.g., ciprofloxacin), clindamycin, broad-spectrum penicillins, and cephalosporins. Symptoms of CDAD include
watery diarrhea (up to 10 or 15 times daily), lower abdominal pain and cramping, low grade fever, and
leukocytosis. C difficile is highly transmissible and can be cultured from nearly any surface, including items in
patient rooms as well as the hands, clothing, and stethoscopes of health care workers. Infection is easily
transmitted between patients and between healthcare workers and patients. Treatment includes stopping the
causative antibiotic; infection control practices, including contact precautions and hand washing with soap and
water (not alcohol based hand cleaners); and administration of metronidazole or vancomycin.
Staphylococcus aureus is a leading cause of both community-acquired and healthcare-acquired bacteremia. A
methicillin resistant form (MRSA) commonly manifests as skin and soft tissue infections (including wound
infections), bacteremia, or pneumonia. Risk factors for MRSA include hospitalization or residence in a long term
care facility, recent antibiotic therapy, HIV infection, injection drug use, hemodialysis, sharing of needles, and
sharing of sports equipment.
Treatment includes antibiotics: clindamycin, trimethoprim-sulfamethoxazole (Bactrim,
Esophageal varices are caused by:
A. Portal vein atrophy from diminished blood flow.
B. Congenital esophageal aneurysms.
C. A high level of alcohol content in the esophagus.
D. Obstruction of and hypertension within the portal vein with resultant shunting of blood to the esophageal
veins.
- Correct Answer :D.
Although esophageal varices can be seen as a complication of alcoholism, they are not related to any alcohol in
the esophagus. Esophageal varices are caused by liver disease (often the result of chronic alcoholism). Liver
disease increases pressure within the portal vein that is transmitted back into the veins that drain from the
P 2
, • PCCN EXAM 09/12/2026
gastrointestinal tract including those from the esophagus. The increased backward pressure from the portal vein
causes the esophageal veins to dilate.
A patient with hepatic failure demonstrates deterioration in handwriting and when asked on exam to hold his
arm and hand out like a stop sign, involuntary flapping of the hand (asterixis) is observed. These symptoms are
most likely due to:
A. Intracranial hemorrhage.
B. Sub clinical seizure.
C. Alcohol withdrawal.
D. Encephalopathy.
- Correct Answer :D. Encephalopathy is an anticipated complication of hepatic failure and is caused by high
ammonia levels, which cause neurotoxicity. In failure, the liver loses its ability to normally metabolize and
detoxify substances. Ammonia is produced by bacteria in the bowel and is a byproduct of protein metabolism.
Normally, the liver metabolizes ammonia into urea for excretion. In liver failure, ammonia levels rise.
When assessing the abdomen of a patient, the correct order of assessment techniques is:
A. Palpation, percussion, auscultation, inspection.
B. Inspection, palpation, percussion, auscultation.
C. Inspection, auscultation, percussion, palpation.
D. Percussion, palpation, auscultation, inspection. –
Correct Answer :C. When assessing the abdomen it is important to auscultate before performing percussion or
palpation. The performance of palpation or percussion if done first can interfere with the auscultatory
assessment.
Stress ulceration in the stomach is common in critically ill patients. Stress ulcer prophylaxis is indicated in which
of the following patients at highest risk for GI bleeding:
Choose one
A. Mechanical ventilation for more than 48 hours.
B. History of GI ulceration or bleeding in the past year.
P 3
, • PCCN EXAM 09/12/2026
C. ICU stay longer than 1 week.
D. Coagulopathy.
E. All of the above. –
Correct Answer :E. Two major risk factors for clinically important GI bleeding are mechanical ventilation for more
than 48 hours and coagulopathy (defined as a platelet count <50,000, INR >1.5, or aPTT >2 times the control
value). In addition, guidelines recommend stress ulcer prophylaxis in patients with a history of GI ulceration or
bleeding within the past year, and two or more of the following risk factors: sepsis, ICU admission lasting >1
week, occult GI bleeding lasting ≥6 days, and glucocorticoid therapy.
Drugs used to prevent GI bleeding in critically ill patients include which of the following:
A. Beta blockers and calcium channel blockers.
B. Aldosterone blockers and beta blockers.
C. Proton pump inhibitors (PPI) and histamine-2 receptor blockers (H2 blockers).
D. ACE inhibitors and angiotensin receptor blockers (ARBs). –
Correct Answer :C. H2 blockers and PPI reduce gastric acid secretion. Examples of H2 blockers include
cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepsid), and nizatidine (Axid). Examples of PPI include
omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), and pantoprazole (Protonix). Other
drugs that can be used include sucralfate (Carafate) which coats and protects the gastric mucosa without
altering gastric acid secretion, and antacids which neutralize gastric acid to protect the gastric mucosa.
ACE inhibitors prevent conversion of angiotensin I to angiotensin II and ARBs block angiotensin II at its receptor
site. Both are used to treat heart failure and hypertension.
Aldosterone blockers are used in heart failure to block aldosterone's effect on Na+ and water reabsorption by
the kidney.
Beta blockers and calcium channel blockers can be used to treat hypertension and angina. Beta blockers are
indicated in heart failure as well.
You are caring for a 44 year old male who is being admitted with acute upper GI bleeding. He is vomiting bright
red blood, his skin is cold and clammy, BP is 86/52, heart rate is 120. You know that the main priority in his care
right now is:
A. Inserting an NG tube to decompress the stomach and assess rate of bleeding.
B. Administering crystalloid IV fluids and/or blood products to prevent or treat hypovolemic shock.
P 4
