PCCN practice exam notes 2024 with Complete Solutions
Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizzi-
ness, recent K+ lvl is 3.4. What action would you do first?
a. emergent defib
C
b. amio 300mg IVP
c. emergent cardioversion
d. hang 10 mEq KCL/50mL D5W
C.
The nurse notes the following when analyzing a patient's teleme-
try strip: HR, 65/min and regular; PR interval, 0.22 seconds; QRS QT measurements reflect the duration of ventricular repolar-
complex, 0.10 seconds; QTc, 0.52 seconds. Which of the following ization. Lengthening of QT interval is associated with arrhyth-
dysrhythmias is the patient at risk for? mias, adverse cardiac events, and increased mortality because a
longer QT duration places the vulnerable ventricular repolarization
A. Atrial fibrillation because the PR interval is wide phase close to the next depolarization, increasing the likelihood of
B. Sinus arrhythmia because the QRS complex is narrow R-on-T. The most common arrhythmia that occurs with prolonged
C. Torsades de pointes because the QTc is wide QTc is torsades de pointes. Atrial fibrillation, sinus bradycardia,
D. Third-degree heart block because the PR interval is narrow and third-degree heart block are not typically associated with
prolonged ventricular repolarization (QTc >0.50 seconds).
A patient with chronic obstructive pulmonary disease (COPD) is
admitted for worsening dyspnea and possible pneumonia. The
B.
current ABG results are pH, 7.19; PaO2, 52 mm Hg; PaCO2, 68
mm Hg; HCO3 - , 32 mmol/L. The nurse would interpret these
Based on the ABG analysis, the patient is experiencing a respira-
results as
tory acidosis with hypoxemia most likely due to the pneumonia. A
A. Metabolic acidosis with hypoxemia
pH of 7.19 indicates acidosis; a PaCO2 of 68 mm Hg is elevated
B. Respiratory acidosis with hypoxemia
and a cause of acidosis; an HCO3 - of 32 mmol/L indicates renal
C. Respiratory alkalosis with typical oxygenation for a COPD
compensation; a PaO2 of 52 mm Hg indicates hypoxemia
patient
D. Metabolic alkalosis with typical oxygenation for a COPD patient
76-year-old patient is receiving gentamicin and linezolid for an B.
infection. Which of the following potential complications is the most
important for the nurse to monitor this patient for? Gentamicin is a nephrotoxic agent that places patients at risk for
A. Acute delirium acute kidney injury, and this risk is increased in older patients.
B. Acute kidney injury Acute delirium (A), liver failure (C), and sepsis (D) are all com-
C. Acute hepatic failure plications that could occur in an older adult with an infection but
D. Sepsis would not be caused by the administration of an antibiotic.
D.
An older patient is experiencing delirium 24 hours following hip
replacement. Which intervention might worsen the patient's con- Older patients are at increased risk for delirium during acute
dition? hospitalization. Interventions to manage acute delirium include
A. Removing any unnecessary tubes and equipment from the removing or camouflaging tubes, removing unnecessary equip-
room ment, frequently reorienting the patient, and ensuring that the
B. Assessing and treating the patient's pain every 2 hours call bell is consistently within reach, assessing and treating pain
C. Ensuring that the patient has the means to call for help effectively, and encouraging mobility and involvement in activities
D. Loosely applying soft restraints of daily living. Restraining the patient is contraindicated in the care
of patients with delirium.
C.
A patient shows a new slight facial droop and the patient's right
arm is weaker than the left. A priority intervention would be to
The stroke protocol should be activated as soon as signs of stroke
A. Obtain a serum glucose level
are identified in a patient. Initial signs of stroke include facial droop,
B. Obtain a full set of vital signs
arm down drift, and garbled speech. For best outcomes, the time
C. Initiate the stroke protocol
elapsed between initials signs of stroke and treatment must be as
D. Initiate the code response team
short as possible.
elevated glucose, lipase, amylase, BUN/Cr, triglycerides, and
bilirubin (know your lab values)
low calcium, mag and potassium
Which of the following lab results shows acute pancreatitis?
tx: fluids, rest pancreas, pain management, monitor and replace
electrolytes, nutrition, surgery (first line if hemorrhagic/necrotizing)
Post-op gastric bypass c/o tachycardia, tachypnea, diaphoresis,
fever and reveals clean, dry, closed abd staple line and large firm suspect anastomosis leak and possible peritonitis
abdomen.
1/6
, PCCN practice exam notes 2024 with Complete Solutions
Discharge education for (diet) post cholecystitis low-fat diet
LBO - lower abdominal pain, distention, NO vomiting
SBO - high-pitched bowel sounds, n/v, acute pain
Assessment findings for large bowel obstruction vs small bowel
Liver failure - ascites, rebound tenderness, jaundice
obstruction
pancreatitis/gallstones - low-grade fever, steatorrhea, no bowel
sounds
CO = HR X SV
Determinants of cardiac output:
(preload + afterload + contractility)
cardiac: tachycardic, weak pulse, jvd, s3, displaced pmi, car-
diomegaly, valvular abnormalities, peripheral edema, + hepato-
s/s heart failure jugular reflux
pulmonary: bibasilar rales, pnd, dyspnea
neurologic: fatigue, dizziness, change LOC, impending doom
HFrEF (HF with reduced EF) EF: <40
HFpEF (HF with preserved EF) EF: >50
a patient with hypertrophic cardiomyopathy was just admitted to
PCU. you are reviewing the admission order. which one concern
you? d. dig and lasix daily
a. oxygen 2L nc, continuous tele
b. beta-blocker and amiodarone be careful for + inotropes and diuretics for pt with cardiomyopathy
c. chest xray and 2-d echo
d. dig and lasix daily
which assessment data would be most consistent with pt diag-
nosed with dilated cardiomyopathy?
a. tachycardia, with peaked t waves, htn, weak distal pulses
b. 2nd degree hb, left bbb, htn, cool extremities c.
c. afib with rvr, hypotension, pulmonary congestion
d. bradycardia, diffuse st changes, wide aortic space arch on xray,
flat jugular veins
patient with HFrEF develops sudden onset of sob with b/l rales
and pink frothy sputum. BP 110/60, HR 132, RR 28, 88% 2L nc.
what is the best initial action?
a. apply BiPAP and advocate for diuretic a
b. prepare intubation and d/c ace inhibitors
c. start neb tx and request atb
d. deliver o2 via NRB mask and give nitro
the monitor shows this rhythm (wide complex tachycardia) for a pt
with AICD who is alert and oriented and bp of 110/70. the nurse
prepares to administer: b.
a. sedative to help pt tolerate ICD shock
b. amiodarone bolus of 150 mg over 10 mins no need to cardiovert patient is alert and stable
c. synchronized cardioversion
d. adenosine 6mg rapid IV push
HF, MI, valvular disorders, cardiac tamponade, htn crisis, tachy
dysrhythmias
EKG = tachycardia, acute st segment and t wave
Echo = MI, wall motion abnormalities, v dysfunctio - valve disease,
LVH
cardiogenic pulmonary edema
ABG = low o2 sat, respiratory alkalosis, refractory hypoxemia
CXRAY = changes day to day or after tx
TX: afterload reduction if SBP >100
vasoconstriction if hypotensive
DIRECT AND INDIRECT INJURY TO LUNGS
noncardiogenic pulmonary edema
XRAY = ARDS
2/6
Pt on Vtach, HR 135, RR 32, BP 90/48, conscious but c/o dizzi-
ness, recent K+ lvl is 3.4. What action would you do first?
a. emergent defib
C
b. amio 300mg IVP
c. emergent cardioversion
d. hang 10 mEq KCL/50mL D5W
C.
The nurse notes the following when analyzing a patient's teleme-
try strip: HR, 65/min and regular; PR interval, 0.22 seconds; QRS QT measurements reflect the duration of ventricular repolar-
complex, 0.10 seconds; QTc, 0.52 seconds. Which of the following ization. Lengthening of QT interval is associated with arrhyth-
dysrhythmias is the patient at risk for? mias, adverse cardiac events, and increased mortality because a
longer QT duration places the vulnerable ventricular repolarization
A. Atrial fibrillation because the PR interval is wide phase close to the next depolarization, increasing the likelihood of
B. Sinus arrhythmia because the QRS complex is narrow R-on-T. The most common arrhythmia that occurs with prolonged
C. Torsades de pointes because the QTc is wide QTc is torsades de pointes. Atrial fibrillation, sinus bradycardia,
D. Third-degree heart block because the PR interval is narrow and third-degree heart block are not typically associated with
prolonged ventricular repolarization (QTc >0.50 seconds).
A patient with chronic obstructive pulmonary disease (COPD) is
admitted for worsening dyspnea and possible pneumonia. The
B.
current ABG results are pH, 7.19; PaO2, 52 mm Hg; PaCO2, 68
mm Hg; HCO3 - , 32 mmol/L. The nurse would interpret these
Based on the ABG analysis, the patient is experiencing a respira-
results as
tory acidosis with hypoxemia most likely due to the pneumonia. A
A. Metabolic acidosis with hypoxemia
pH of 7.19 indicates acidosis; a PaCO2 of 68 mm Hg is elevated
B. Respiratory acidosis with hypoxemia
and a cause of acidosis; an HCO3 - of 32 mmol/L indicates renal
C. Respiratory alkalosis with typical oxygenation for a COPD
compensation; a PaO2 of 52 mm Hg indicates hypoxemia
patient
D. Metabolic alkalosis with typical oxygenation for a COPD patient
76-year-old patient is receiving gentamicin and linezolid for an B.
infection. Which of the following potential complications is the most
important for the nurse to monitor this patient for? Gentamicin is a nephrotoxic agent that places patients at risk for
A. Acute delirium acute kidney injury, and this risk is increased in older patients.
B. Acute kidney injury Acute delirium (A), liver failure (C), and sepsis (D) are all com-
C. Acute hepatic failure plications that could occur in an older adult with an infection but
D. Sepsis would not be caused by the administration of an antibiotic.
D.
An older patient is experiencing delirium 24 hours following hip
replacement. Which intervention might worsen the patient's con- Older patients are at increased risk for delirium during acute
dition? hospitalization. Interventions to manage acute delirium include
A. Removing any unnecessary tubes and equipment from the removing or camouflaging tubes, removing unnecessary equip-
room ment, frequently reorienting the patient, and ensuring that the
B. Assessing and treating the patient's pain every 2 hours call bell is consistently within reach, assessing and treating pain
C. Ensuring that the patient has the means to call for help effectively, and encouraging mobility and involvement in activities
D. Loosely applying soft restraints of daily living. Restraining the patient is contraindicated in the care
of patients with delirium.
C.
A patient shows a new slight facial droop and the patient's right
arm is weaker than the left. A priority intervention would be to
The stroke protocol should be activated as soon as signs of stroke
A. Obtain a serum glucose level
are identified in a patient. Initial signs of stroke include facial droop,
B. Obtain a full set of vital signs
arm down drift, and garbled speech. For best outcomes, the time
C. Initiate the stroke protocol
elapsed between initials signs of stroke and treatment must be as
D. Initiate the code response team
short as possible.
elevated glucose, lipase, amylase, BUN/Cr, triglycerides, and
bilirubin (know your lab values)
low calcium, mag and potassium
Which of the following lab results shows acute pancreatitis?
tx: fluids, rest pancreas, pain management, monitor and replace
electrolytes, nutrition, surgery (first line if hemorrhagic/necrotizing)
Post-op gastric bypass c/o tachycardia, tachypnea, diaphoresis,
fever and reveals clean, dry, closed abd staple line and large firm suspect anastomosis leak and possible peritonitis
abdomen.
1/6
, PCCN practice exam notes 2024 with Complete Solutions
Discharge education for (diet) post cholecystitis low-fat diet
LBO - lower abdominal pain, distention, NO vomiting
SBO - high-pitched bowel sounds, n/v, acute pain
Assessment findings for large bowel obstruction vs small bowel
Liver failure - ascites, rebound tenderness, jaundice
obstruction
pancreatitis/gallstones - low-grade fever, steatorrhea, no bowel
sounds
CO = HR X SV
Determinants of cardiac output:
(preload + afterload + contractility)
cardiac: tachycardic, weak pulse, jvd, s3, displaced pmi, car-
diomegaly, valvular abnormalities, peripheral edema, + hepato-
s/s heart failure jugular reflux
pulmonary: bibasilar rales, pnd, dyspnea
neurologic: fatigue, dizziness, change LOC, impending doom
HFrEF (HF with reduced EF) EF: <40
HFpEF (HF with preserved EF) EF: >50
a patient with hypertrophic cardiomyopathy was just admitted to
PCU. you are reviewing the admission order. which one concern
you? d. dig and lasix daily
a. oxygen 2L nc, continuous tele
b. beta-blocker and amiodarone be careful for + inotropes and diuretics for pt with cardiomyopathy
c. chest xray and 2-d echo
d. dig and lasix daily
which assessment data would be most consistent with pt diag-
nosed with dilated cardiomyopathy?
a. tachycardia, with peaked t waves, htn, weak distal pulses
b. 2nd degree hb, left bbb, htn, cool extremities c.
c. afib with rvr, hypotension, pulmonary congestion
d. bradycardia, diffuse st changes, wide aortic space arch on xray,
flat jugular veins
patient with HFrEF develops sudden onset of sob with b/l rales
and pink frothy sputum. BP 110/60, HR 132, RR 28, 88% 2L nc.
what is the best initial action?
a. apply BiPAP and advocate for diuretic a
b. prepare intubation and d/c ace inhibitors
c. start neb tx and request atb
d. deliver o2 via NRB mask and give nitro
the monitor shows this rhythm (wide complex tachycardia) for a pt
with AICD who is alert and oriented and bp of 110/70. the nurse
prepares to administer: b.
a. sedative to help pt tolerate ICD shock
b. amiodarone bolus of 150 mg over 10 mins no need to cardiovert patient is alert and stable
c. synchronized cardioversion
d. adenosine 6mg rapid IV push
HF, MI, valvular disorders, cardiac tamponade, htn crisis, tachy
dysrhythmias
EKG = tachycardia, acute st segment and t wave
Echo = MI, wall motion abnormalities, v dysfunctio - valve disease,
LVH
cardiogenic pulmonary edema
ABG = low o2 sat, respiratory alkalosis, refractory hypoxemia
CXRAY = changes day to day or after tx
TX: afterload reduction if SBP >100
vasoconstriction if hypotensive
DIRECT AND INDIRECT INJURY TO LUNGS
noncardiogenic pulmonary edema
XRAY = ARDS
2/6
