PCCN Review 2024 NK Review Latest version
with RATIONALES
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%
** 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
** 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
** 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
** 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
** 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
** 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-
a1
old male client is recovering from idiopathic infective endocarditis. The nurse should include which of the
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
following teaching points in the discharge care plan for this client?
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A. Taking prophylactic antibiotics before dental procedures
a1 a1 a1 a1 a1 a1
B. Drinking no more than 1 liter of fluid per day
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
C. Strictly avoiding caffeine or other stimulants
a1 a1 a1 a1 a1 a1
D. Encouraging a healthy low-fat diet that includes at least 2 grams of sodium intake per day
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1a1
** A. Taking prophylactic antibiotics before dental procedures
a1 a1 a1 a1 a1 a1 a1 a1
Feedback
Client with a history of infective endocarditis should take prophylactic antibiotics before dental procedur
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
es and some surgical procedures.
a1 a1 a1 a1
The nurse is caring for a 21 year old female who is being treated with IV magnesium for pre-
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
eclampsia. Upon assessment, the nurse notes that the patient's skin is flushed, her blood pressure is 88/5
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
, 6, and her respiratory rate is 12. The nurse checks the patient's magnesium level and finds that it is 7.2 mg/
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
dL. Which of the following actions does the nurse anticipate taking next?
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A. Administering intravenous calcium gluconate
a1 a1 a1 a1
B. Increasing the rate of the magnesium infusion
a1 a1 a1 a1 a1 a1 a1
C. Placing the patient in Trendelenburg and administering a bolus of IV fluid
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
D.Preparing the patient for a bedside cardioversion. a1 a1 a1 a1 a1 a1 a1a1
a1 ** A. Administering intravenous calcium gluconate
a1 a1 a1 a1 a1
Feedback
The nurse should identify that the signs and symptoms here are reflective of a critically high magnesium le
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
vel, reflected by the lab level of 7.2 mg/
a1 a1 a1 a1 a1 a1 a1 a1
dL, and that the correct treatment is an infusion of calcium gluconate.
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A 22-year-
a1
old male patient is admitted for observation following a linear temporal skull fracture from a skiing accide
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
nt. Upon admission at 2 pm, the patient was alert and oriented, and reports that he "passed out for a secon
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
d" immediately after his accident. At 4 pm, the nurse notes that the patient's Glasgow Coma Scale (GCS) is
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
8. The nurse should:
a1 a1 a1
A. Continue to monitor for changes
a1 a1 a1 a1 a1
B. Place the patient in Trendelenburg position
a1 a1 a1 a1 a1 a1
C. Prepare the patient for burr hole placement with clot evacuation
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
D. Prepare to administer tissue plasminogen activator (tPA) to reverse occlusive stroke
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1a1
a1 ** C. Prepare the patient for burr hole placement with clot evacuation
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
Feedback
This patient is exhibiting classic signs and symptoms of an epidural hematoma. Surgical intervention to re
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
move the hematoma and relieve pressure on the brain should be performed as soon as possible.
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A 71-year-
a1
old female patient is admitted after evaluation in the emergency department (ED) for suspected coronary
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a
syndrome involving the inferior wall. Which of the following changes would the nurse anticipate seeing o
1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
n a 12-lead ECG for an inferior wall myocardial infarction (MI)?
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
B. ST elevation, Q waves, and inverted T waves in leads I and aVL
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
C. ST depression, Q waves, and spiked T waves in leads II, III, and aVF
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
D. ST elevation and inverted T waves in all precordial leads
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1a1
a1 ** A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
with RATIONALES
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%
** 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
** 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
** 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
** 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
** 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
** 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-
a1
old male client is recovering from idiopathic infective endocarditis. The nurse should include which of the
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
following teaching points in the discharge care plan for this client?
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A. Taking prophylactic antibiotics before dental procedures
a1 a1 a1 a1 a1 a1
B. Drinking no more than 1 liter of fluid per day
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
C. Strictly avoiding caffeine or other stimulants
a1 a1 a1 a1 a1 a1
D. Encouraging a healthy low-fat diet that includes at least 2 grams of sodium intake per day
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1a1
** A. Taking prophylactic antibiotics before dental procedures
a1 a1 a1 a1 a1 a1 a1 a1
Feedback
Client with a history of infective endocarditis should take prophylactic antibiotics before dental procedur
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
es and some surgical procedures.
a1 a1 a1 a1
The nurse is caring for a 21 year old female who is being treated with IV magnesium for pre-
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
eclampsia. Upon assessment, the nurse notes that the patient's skin is flushed, her blood pressure is 88/5
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
, 6, and her respiratory rate is 12. The nurse checks the patient's magnesium level and finds that it is 7.2 mg/
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
dL. Which of the following actions does the nurse anticipate taking next?
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A. Administering intravenous calcium gluconate
a1 a1 a1 a1
B. Increasing the rate of the magnesium infusion
a1 a1 a1 a1 a1 a1 a1
C. Placing the patient in Trendelenburg and administering a bolus of IV fluid
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
D.Preparing the patient for a bedside cardioversion. a1 a1 a1 a1 a1 a1 a1a1
a1 ** A. Administering intravenous calcium gluconate
a1 a1 a1 a1 a1
Feedback
The nurse should identify that the signs and symptoms here are reflective of a critically high magnesium le
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
vel, reflected by the lab level of 7.2 mg/
a1 a1 a1 a1 a1 a1 a1 a1
dL, and that the correct treatment is an infusion of calcium gluconate.
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A 22-year-
a1
old male patient is admitted for observation following a linear temporal skull fracture from a skiing accide
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
nt. Upon admission at 2 pm, the patient was alert and oriented, and reports that he "passed out for a secon
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
d" immediately after his accident. At 4 pm, the nurse notes that the patient's Glasgow Coma Scale (GCS) is
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
8. The nurse should:
a1 a1 a1
A. Continue to monitor for changes
a1 a1 a1 a1 a1
B. Place the patient in Trendelenburg position
a1 a1 a1 a1 a1 a1
C. Prepare the patient for burr hole placement with clot evacuation
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
D. Prepare to administer tissue plasminogen activator (tPA) to reverse occlusive stroke
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1a1
a1 ** C. Prepare the patient for burr hole placement with clot evacuation
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
Feedback
This patient is exhibiting classic signs and symptoms of an epidural hematoma. Surgical intervention to re
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
move the hematoma and relieve pressure on the brain should be performed as soon as possible.
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A 71-year-
a1
old female patient is admitted after evaluation in the emergency department (ED) for suspected coronary
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a
syndrome involving the inferior wall. Which of the following changes would the nurse anticipate seeing o
1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
n a 12-lead ECG for an inferior wall myocardial infarction (MI)?
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
B. ST elevation, Q waves, and inverted T waves in leads I and aVL
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
C. ST depression, Q waves, and spiked T waves in leads II, III, and aVF
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
D. ST elevation and inverted T waves in all precordial leads
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1a1
a1 ** A. ST elevation, Q waves, and inverted T waves in leads II, III, and aVF
a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1 a1
