Progressive Care Certified
Nurse Review Exam (PCCN)
Questions and Answers Exam
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% - ANSWER>>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.
Laboratory studies from a 22-year-old male client with Type I diabetes mellitus are evaluated
during an admission for severe pneumonia. Which of the following laboratory results should
the 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 - ANSWER>>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
,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 - ANSWER>>D. Cor pulmonale
Feedback
The nurse should recognize that a history of COPD together with the signs and symptoms listed
here are suggestive of cor pulmonale. The patient requires further workup to confirm this
diagnosis.
A 42-year-old male with Marfan syndrome and complaint of dizziness is admitted to the
telemetry unit for monitoring. Which of the following accompanying 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 - ANSWER>>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.
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
D. Obstructive shock - ANSWER>>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.
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 - ANSWER>>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.
A 17-year-old male client is recovering from idiopathic infective endocarditis. The nurse should
include which of the following teaching points in the discharge care plan for this client?
A. Taking prophylactic antibiotics before dental procedures
B. Drinking no more than 1 liter of fluid per day
C. Strictly avoiding caffeine or other stimulants
D. Encouraging a healthy low-fat diet that includes at least 2 grams of sodium intake per day -
ANSWER>>A. Taking prophylactic antibiotics before dental procedures
Feedback
Client with a history of infective endocarditis should take prophylactic antibiotics before dental
procedures and some surgical procedures.
The nurse is caring for a 21 year old female who is being treated with IV magnesium for pre-
eclampsia. Upon assessment, the nurse notes that the patient's skin is flushed, her blood
pressure is 88/56, and her respiratory rate is 12. The nurse checks the patient's magnesium
level and finds that it is 7.2 mg/dL. Which of the following actions does the nurse anticipate
taking next?
A. Administering intravenous calcium gluconate
B. Increasing the rate of the magnesium infusion
C. Placing the patient in Trendelenburg and administering a bolus of IV fluid
, D.Preparing the patient for a bedside cardioversion. - ANSWER>>A. Administering intravenous
calcium gluconate
Feedback
The nurse should identify that the signs and symptoms here are reflective of a critically high
magnesium level, reflected by the lab level of 7.2 mg/dL, and that the correct treatment is an
infusion of calcium gluconate.
A 22-year-old male patient is admitted for observation following a linear temporal skull fracture
from a skiing accident. Upon admission at 2 pm, the patient was alert and oriented, and reports
that he "passed out for a second" immediately after his accident. At 4 pm, the nurse notes that
the patient's Glasgow Coma Scale (GCS) is 8. The nurse should:
A. Continue to monitor for changes
B. Place the patient in Trendelenburg position
C. Prepare the patient for burr hole placement with clot evacuation
D. Prepare to administer tissue plasminogen activator (tPA) to reverse occlusive stroke -
ANSWER>>C. Prepare the patient for burr hole placement with clot evacuation
Feedback
This patient is exhibiting classic signs and symptoms of an epidural hematoma. Surgical
intervention to remove the hematoma and relieve pressure on the brain should be performed
as soon as possible.
A 71-year-old female patient is admitted after evaluation in the emergency department (ED) for
suspected coronary syndrome involving the inferior wall. Which of the following changes would
the nurse anticipate seeing on a 12-lead ECG for an inferior wall myocardial infarction (MI)?
A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
B. ST elevation, Q waves, and inverted T waves in leads I and aVL
C. ST depression, Q waves, and spiked T waves in leads II, III, and aVF
D. ST elevation and inverted T waves in all precordial leads - ANSWER>>A. ST elevation, Q
waves, and inverted T waves in leads II, III, and aVF
Feedback
Acute coronary syndromes involving the inferior cardiac wall will most often manifest as ST
elevation and inverted T waves in leads II, III, and aVF. Q waves may appear during the acute
phases of the syndrome, or may appear as an infarction heals (more common).
The nurse has a 32 year old female patient with a diagnosis of major depressive disorder. The
patient tells the nurse that she wishes every night that she could go to sleep and never wake
up. She also tells the nurse that she has been thinking that it would be easy to take a whole
Nurse Review Exam (PCCN)
Questions and Answers Exam
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% - ANSWER>>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.
Laboratory studies from a 22-year-old male client with Type I diabetes mellitus are evaluated
during an admission for severe pneumonia. Which of the following laboratory results should
the 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 - ANSWER>>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
,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 - ANSWER>>D. Cor pulmonale
Feedback
The nurse should recognize that a history of COPD together with the signs and symptoms listed
here are suggestive of cor pulmonale. The patient requires further workup to confirm this
diagnosis.
A 42-year-old male with Marfan syndrome and complaint of dizziness is admitted to the
telemetry unit for monitoring. Which of the following accompanying 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 - ANSWER>>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.
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
D. Obstructive shock - ANSWER>>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.
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 - ANSWER>>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.
A 17-year-old male client is recovering from idiopathic infective endocarditis. The nurse should
include which of the following teaching points in the discharge care plan for this client?
A. Taking prophylactic antibiotics before dental procedures
B. Drinking no more than 1 liter of fluid per day
C. Strictly avoiding caffeine or other stimulants
D. Encouraging a healthy low-fat diet that includes at least 2 grams of sodium intake per day -
ANSWER>>A. Taking prophylactic antibiotics before dental procedures
Feedback
Client with a history of infective endocarditis should take prophylactic antibiotics before dental
procedures and some surgical procedures.
The nurse is caring for a 21 year old female who is being treated with IV magnesium for pre-
eclampsia. Upon assessment, the nurse notes that the patient's skin is flushed, her blood
pressure is 88/56, and her respiratory rate is 12. The nurse checks the patient's magnesium
level and finds that it is 7.2 mg/dL. Which of the following actions does the nurse anticipate
taking next?
A. Administering intravenous calcium gluconate
B. Increasing the rate of the magnesium infusion
C. Placing the patient in Trendelenburg and administering a bolus of IV fluid
, D.Preparing the patient for a bedside cardioversion. - ANSWER>>A. Administering intravenous
calcium gluconate
Feedback
The nurse should identify that the signs and symptoms here are reflective of a critically high
magnesium level, reflected by the lab level of 7.2 mg/dL, and that the correct treatment is an
infusion of calcium gluconate.
A 22-year-old male patient is admitted for observation following a linear temporal skull fracture
from a skiing accident. Upon admission at 2 pm, the patient was alert and oriented, and reports
that he "passed out for a second" immediately after his accident. At 4 pm, the nurse notes that
the patient's Glasgow Coma Scale (GCS) is 8. The nurse should:
A. Continue to monitor for changes
B. Place the patient in Trendelenburg position
C. Prepare the patient for burr hole placement with clot evacuation
D. Prepare to administer tissue plasminogen activator (tPA) to reverse occlusive stroke -
ANSWER>>C. Prepare the patient for burr hole placement with clot evacuation
Feedback
This patient is exhibiting classic signs and symptoms of an epidural hematoma. Surgical
intervention to remove the hematoma and relieve pressure on the brain should be performed
as soon as possible.
A 71-year-old female patient is admitted after evaluation in the emergency department (ED) for
suspected coronary syndrome involving the inferior wall. Which of the following changes would
the nurse anticipate seeing on a 12-lead ECG for an inferior wall myocardial infarction (MI)?
A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
B. ST elevation, Q waves, and inverted T waves in leads I and aVL
C. ST depression, Q waves, and spiked T waves in leads II, III, and aVF
D. ST elevation and inverted T waves in all precordial leads - ANSWER>>A. ST elevation, Q
waves, and inverted T waves in leads II, III, and aVF
Feedback
Acute coronary syndromes involving the inferior cardiac wall will most often manifest as ST
elevation and inverted T waves in leads II, III, and aVF. Q waves may appear during the acute
phases of the syndrome, or may appear as an infarction heals (more common).
The nurse has a 32 year old female patient with a diagnosis of major depressive disorder. The
patient tells the nurse that she wishes every night that she could go to sleep and never wake
up. She also tells the nurse that she has been thinking that it would be easy to take a whole
