PCCN Review
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: -
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? -
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? -
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
1|Page
,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? -
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 ? -
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? -
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? -
2|Page
, 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: -
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)? -
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 bottle of Tylenol "to
end my pain forever." What is the MOST appropriate intervention for the nurse to take? -
Ensure that the patient's physical environment is safe and free of objects that could be used
to harm herself
Feedback
The nurse should identify that the most important thing when working with a patient who is
expressing suicidal ideology is patient safety; this begins with the patient's physical environment and
ensuring that there is nothing that the patient can access that can be used to harm themselves.
A telemetry nurse is caring for a 59-year-old male patient who is being evaluated for non-specific
cardiac symptoms. Just after the nurse arrives in the patient's room to administer the morning
3|Page
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: -
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? -
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? -
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
1|Page
,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? -
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 ? -
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? -
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? -
2|Page
, 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: -
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)? -
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 bottle of Tylenol "to
end my pain forever." What is the MOST appropriate intervention for the nurse to take? -
Ensure that the patient's physical environment is safe and free of objects that could be used
to harm herself
Feedback
The nurse should identify that the most important thing when working with a patient who is
expressing suicidal ideology is patient safety; this begins with the patient's physical environment and
ensuring that there is nothing that the patient can access that can be used to harm themselves.
A telemetry nurse is caring for a 59-year-old male patient who is being evaluated for non-specific
cardiac symptoms. Just after the nurse arrives in the patient's room to administer the morning
3|Page
