Page 1 of 350
AACN PCCN - Progressive Care Certified Nurse 800
QUESTIONS TESTBANK AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
AACN PCCN - Progressive Care Certified Nurse
Q ; A patient presents in acute distress with rales halfway up bilaterally; cool and clammy
extremities; elevated jugular venous distention (JVD); oxygen saturations at 95%, down from
99%; and complaints of shortness of breath. Which of the following findings correspond to
the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion
D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary edema, causing
pulmonary congestion. Pneumonia can also cause fluid in the alveolar sacs. The patient is
complaining of shortness of breath, and the oxygen saturations are lowering, also indicating
that the patient has pulmonary congestion. The patient's skin is cool and clammy, indicating
that the skin is poorly perfused. Skin does not require oxygen and shunts blood away in
decreased cardiac function; therefore, this patient has pulmonary congestion and low perfusion
state. The other answers are incorrect.
ALL THE BEST CHAMP!!
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When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction
A. the beginning of ventricular systole
The heart sound of S1 indicates the opening of the aortic and pulmonic valves and marks the
beginning of ventricular systole or ejection. The beginning of diastole is after S2, propulsion of
blood into a noncompliant chamber is S4, and blood going in the wrong direction will cause a
murmur.
A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure
A. increased thickness of the alveolar capillary membrane
With increasing left ventricular pressures, blood moves back into the left atrium, then to the
pulmonary veins. When the pressure in the pulmonary veins increases, capillary function
decreases, and fluid then shifts to the interstitial space, causing interstitial edema, thereby,
increasing the thickness of the space oxygen must travel. When left ventricular pressures
increase, the fluid then shifts to the alveolar space, causing pulmonary edema. This fluid acts as
ALL THE BEST CHAMP!!
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a deterrent to oxygen diffusion. Retention of CO2 does not impair diffusion. An elevated body
temperature associated with pulmonary edema is not causing a diffusion abnormality;
increased temperature shifts the oxyhemoglobin curve to the right, more quickly releasing
oxygen to the tissues. Low barometric pressure has no effect on diffusion of gases in the lung.
A patient with an anterior-wall STEMI is in cardiogenic shock. What would be the
hemodynamic profile assessment?
A. decreased cardiac index, increased preload, increased afterload
B. decreased cardiac index, decreased preload, increased afterload
C. decreased cardiac index, decreased preload, decreased afterload
D. increased cardiac index, decreased preload, decreased afterload
A. decreased cardiac index, increased preload, increased afterload
In a patient with cardiogenic shock, both preload and afterload are increased due to severe
vasoconstriction on both the venous and arterial side. Arterial vasoconstriction increases
afterload and therefore lowers cardiac index. Because the ventricle is failing and contractility is
also low, the left ventricular pressures increase and cause blood to increase in the pulmonary
bed, resulting in increased right ventricular pressures and preload. In heart failure, there is an
increase in preload and afterload with a decrease in cardiac index and contractility. The other
answers are incorrect.
A patient is discharged with the diagnosis of severe peripheral vascular disease (PVD). In
addition to medication and a walking regime, if applicable, which of the following is essential
education at time of discharge?
ALL THE BEST CHAMP!!
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, Page 4 of 350
A. nutritional counseling
B. smoking cessation counseling
C. social work consult
D. speech therapy consult
B. smoking cessation counseling
Cessation of tobacco use is the most important non-pharmacological intervention that can be
done to improve signs and symptoms of peripheral bvascular disease. Social work consult and
speech therapy may not be indicated in this patient. All patients may benefit from nutrition
counseling; however, this is not a primary concern for this patient.
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic pressure
(LVEDP), the pressure exerted on the ventricular muscle at the end of diastole when the
ventricle is full. This enables blood to flow from a higher pressure through open arteries to a
lower pressure, a pressure gradient known as coronary artery prefusion pressure. As diastolic
pressure drops, there is a decrease in coronary artery blood flow. Coronary artery perfusion is
ALL THE BEST CHAMP!!
4
AACN PCCN - Progressive Care Certified Nurse 800
QUESTIONS TESTBANK AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
AACN PCCN - Progressive Care Certified Nurse
Q ; A patient presents in acute distress with rales halfway up bilaterally; cool and clammy
extremities; elevated jugular venous distention (JVD); oxygen saturations at 95%, down from
99%; and complaints of shortness of breath. Which of the following findings correspond to
the patient's cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion
D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary edema, causing
pulmonary congestion. Pneumonia can also cause fluid in the alveolar sacs. The patient is
complaining of shortness of breath, and the oxygen saturations are lowering, also indicating
that the patient has pulmonary congestion. The patient's skin is cool and clammy, indicating
that the skin is poorly perfused. Skin does not require oxygen and shunts blood away in
decreased cardiac function; therefore, this patient has pulmonary congestion and low perfusion
state. The other answers are incorrect.
ALL THE BEST CHAMP!!
1
,Page 2 of 350
When listening to heart sounds, S1 signifies which of the following?
A. the beginning of ventricular systole
B. the beginning of ventricular diastole
C. the propulsion of blood into a non-compliant ventricle
D. the blood going in the wrong direction
A. the beginning of ventricular systole
The heart sound of S1 indicates the opening of the aortic and pulmonic valves and marks the
beginning of ventricular systole or ejection. The beginning of diastole is after S2, propulsion of
blood into a noncompliant chamber is S4, and blood going in the wrong direction will cause a
murmur.
A patient with pulmonary edema has impaired diffusion due to:
A. increased thickness of the alveolar capillary membrane
B. retaining CO2
C. an elevated body temperature associated with pulmonary edema
D. low barometric pressure
A. increased thickness of the alveolar capillary membrane
With increasing left ventricular pressures, blood moves back into the left atrium, then to the
pulmonary veins. When the pressure in the pulmonary veins increases, capillary function
decreases, and fluid then shifts to the interstitial space, causing interstitial edema, thereby,
increasing the thickness of the space oxygen must travel. When left ventricular pressures
increase, the fluid then shifts to the alveolar space, causing pulmonary edema. This fluid acts as
ALL THE BEST CHAMP!!
2
,Page 3 of 350
a deterrent to oxygen diffusion. Retention of CO2 does not impair diffusion. An elevated body
temperature associated with pulmonary edema is not causing a diffusion abnormality;
increased temperature shifts the oxyhemoglobin curve to the right, more quickly releasing
oxygen to the tissues. Low barometric pressure has no effect on diffusion of gases in the lung.
A patient with an anterior-wall STEMI is in cardiogenic shock. What would be the
hemodynamic profile assessment?
A. decreased cardiac index, increased preload, increased afterload
B. decreased cardiac index, decreased preload, increased afterload
C. decreased cardiac index, decreased preload, decreased afterload
D. increased cardiac index, decreased preload, decreased afterload
A. decreased cardiac index, increased preload, increased afterload
In a patient with cardiogenic shock, both preload and afterload are increased due to severe
vasoconstriction on both the venous and arterial side. Arterial vasoconstriction increases
afterload and therefore lowers cardiac index. Because the ventricle is failing and contractility is
also low, the left ventricular pressures increase and cause blood to increase in the pulmonary
bed, resulting in increased right ventricular pressures and preload. In heart failure, there is an
increase in preload and afterload with a decrease in cardiac index and contractility. The other
answers are incorrect.
A patient is discharged with the diagnosis of severe peripheral vascular disease (PVD). In
addition to medication and a walking regime, if applicable, which of the following is essential
education at time of discharge?
ALL THE BEST CHAMP!!
3
, Page 4 of 350
A. nutritional counseling
B. smoking cessation counseling
C. social work consult
D. speech therapy consult
B. smoking cessation counseling
Cessation of tobacco use is the most important non-pharmacological intervention that can be
done to improve signs and symptoms of peripheral bvascular disease. Social work consult and
speech therapy may not be indicated in this patient. All patients may benefit from nutrition
counseling; however, this is not a primary concern for this patient.
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic pressure
(LVEDP), the pressure exerted on the ventricular muscle at the end of diastole when the
ventricle is full. This enables blood to flow from a higher pressure through open arteries to a
lower pressure, a pressure gradient known as coronary artery prefusion pressure. As diastolic
pressure drops, there is a decrease in coronary artery blood flow. Coronary artery perfusion is
ALL THE BEST CHAMP!!
4
