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PCCN Exam Questions with 100% vetted answers (2024-2025), Exams of Nursing

PCCN Exam Questions with 100% vetted answers (2024-2025)

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2024/2025

Available from 12/26/2024

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PCCN Exam Questions with correct answers
In pts with aortic insufficiency, the popliteal BP is often higher than the brachial BP by at least 40 mm
HG. This discrepancy between the measurements is known as? -
HILL'S SIGN
Hills's sign reflects the rapid rise in pulsation.
DeMusset's sign is also found in aortic insufficiency; it consists of the bobbing of the head in time with
the forceful pulse.
Holmes' and Rochelle's signs are not diagnostic signs.
Pulsus alternans is most often noted with? -
LV failure
Pulsus alternans occurs when a weakened myocardium cannot maintain an even pressure with each
contraction. The pulses alternate between strong and weak. This phenomenon is also seen in CHF.
A drug that will significantly decrease the INR would be? -
VITAMIN K
Vitamin K is considered the antidote for warfarin, but can actually lower the INR too much and increase
warfarin resistance, so careful monitoring is needed.
These cause SIGNIFICANT decrease in INR:
Rifampin (ABX)
Phenobarbital (barbiturate anticonvulsant)
Glutethimide (hypnotic sedative)
Those below cause a MODERATE decrease in INR:
Naficillin (narrow spectrum ABX)
High dose Vitamin C (cancer tx)
Cyclosporin (immunosuppressant)
Your pt has a temporary pacer and has been requiring adjustments to raise the energy output
(milliamps). This is probably due to?
Hyperkalemia
Necrotic tissue
Lidocaine toxicity
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PCCN Exam Questions with correct answers In pts with aortic insufficiency, the popliteal BP is often higher than the brachial BP by at least 40 mm HG. This discrepancy between the measurements is known as? - HILL'S SIGN Hills's sign reflects the rapid rise in pulsation. DeMusset's sign is also found in aortic insufficiency; it consists of the bobbing of the head in time with the forceful pulse. Holmes' and Rochelle's signs are not diagnostic signs. Pulsus alternans is most often noted with? - LV failure Pulsus alternans occurs when a weakened myocardium cannot maintain an even pressure with each contraction. The pulses alternate between strong and weak. This phenomenon is also seen in CHF.

A drug that will significantly decrease the INR would be? - VITAMIN K Vitamin K is considered the antidote for warfarin, but can actually lower the INR too much and increase warfarin resistance, so careful monitoring is needed. These cause SIGNIFICANT decrease in INR:

  • Rifampin (ABX)
  • Phenobarbital (barbiturate anticonvulsant)
  • Glutethimide (hypnotic sedative) Those below cause a MODERATE decrease in INR:
  • Naficillin (narrow spectrum ABX)
  • High dose Vitamin C (cancer tx)
  • Cyclosporin (immunosuppressant) Your pt has a temporary pacer and has been requiring adjustments to raise the energy output (milliamps). This is probably due to?
  • Hyperkalemia
  • Necrotic tissue
  • Lidocaine toxicity
  • An atrioventricular block -

The nurse observes that the patient's jugular veins distend in the semi-upright position to more than 5 cm above the sternal angle. This is an indication of: - fluid volume overload. what is normal Pulmonary artery occlusion pressure (PAOP)? - 5-12 mmHg The resistance against which the left ventricle must pump to eject its volume is: - systemic vascular resistance. When the tricuspid valve is open, central venous pressure reflects the filling pressure in the: - right ventricle. Tachycardia is dangerous for the patient with ischemic heart disease because of: - compromised cardiac output. During initial examination of a critical care patient, the nurse observes wide and convex nails and bulbous fingertips. This is evidence of: - central cyanosis. Priorities for palpation of the patient with cardiovascular disease include: -  estimating edema.  checking capillary refill  checking for DVT  arterial pulses By blocking the conversion of angiotensin I to angiotensin II, angiotensin-converting enzyme inhibitors produce: - b. vasodilation. The nurse has read that the cardiologist recommends the use of class IV drugs to depress sinus and atrioventricular node conduction and terminate supraventricular tachycardias in the patient at this time. The nurse will anticipate orders for which medications? - a. Verapamil, diltiazem, or amlodipine

The patient has markedly deep, rapid respirations with a fruity breath odor. Based on the patient's history, the nurse will: - perform a blood glucose measurement. The patient with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion will need to have the imbalance of which electrolyte corrected as soon as possible? - Sodium Which of the following conditions occurs when the renal tubules are unable to reabsorb excess glucose?

  • Glycosuria The patient has a waist measurement of 52 inches. His triglyceride level is 175 mg/dL, his high-density lipoprotein (HDL) cholesterol level is 32 mg/dL, and his fasting plasma glucose level is 224 mg/dL. His blood pressure readings are usually approximately 140/90 mm Hg. The nurse recognizes the characteristics of: - metabolic syndrome. To reverse the hyperglycemic hyperosmolar state, the nurse will first prepare to administer: - fluids The nurse is caring for a patient with central diabetes insipidus (DI). The nurse should anticipate orders for the administration of: - vasopressin In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiological effect is: - dilutional hyponatremia, reducing sodium concentration to critically low levels. Which assessment findings would indicate fluid volume excess? - edema, auscultation of a third heart sound, crackles in lungs, bounding pulses, AMS, olguria, HTN The report of a renal patient's laboratory results shows that the blood urea nitrogen (BUN) level is less than 25 mg/dL. To fully understand the patient's renal status, the nurse must consider this value along with: - c. creatinine level. To determine whether edema in a patient's hands is due to circulatory compromise or another cause, the nurse might: -

elevate the patient's extremities for 1 hour and observe the degree of edema still present. Hypovolemia causes tachycardia and : - hypotension. To avoid the complications that can result from administering furosemide (Lasix) to stimulate urinary output, the nurse will carefully monitor: - levels of electrolytes, especially potassium. Which dialysis method would be most appropriate for the hemodynamically stable patient in the anuric phase of acute kidney injury (AKI)? - Intermittent hemodialysis What are complications of continuous renal replacement therapy (CRRT)? - Air embolism, decreased inflow pressure, electrolyte imbalance Which electrolytes pose the most potential hazard if not within normal limits for the person with acute kidney failure? - Potassium and calcium peaked T-waves and a widening of the QRS interval in a pt with AKI are indicative of: - d. hyperkalemia. A patient presents with the following: HR, 120 beats/min; BP, 80/44 mm Hg; urine output averaging 20 mL/hr over the last 4 hours; afebrile; moist rales in the lungs bilaterally; BUN, 84 mg/dL; creatinine, 3. mg/dL. What is the probable cause of this patient's acute kidney injury (AKI)? - Left ventricular failure causing prerenal AKI An elderly patient is in a motor vehicle accident and incurs a significant internal hemorrhage. He is at greatest risk for which category of acute kidney injury (AKI)? - Prerenal A patient is admitted to the unit with the following laboratory values: urine specific gravity, 1.010; urine osmolality, 210 mOsm/kg; BUN/Cr ratio 10:1; urine sodium, 96 mEq/L. The urine output has been 60 mL since admission 2 hours ago. These values are most consistent with which of the following types of acute kidney injury (AKI)? - Intrarenal Percussing the patient's stomach produces a tympanic sound is a sign that: -

decreased. A vasopressin drip for a patient with bleeding esophagogastric varices would be contraindicated if the patient has a history of: - coronary artery disease What type of formula would be most appropriate for a patient with acute pancreatitis? - Low fat A person with a body mass index (BMI) of 32 would be considered: - obese Diet therapy for a hypertensive person 1 day after a myocardial infarction would include all the following except: - a fluid-restricted diet. Kwashiorkor malnutrition results in: - low levels of serum proteins, low lymphocyte count, and hair loss. Significant laboratory and clinical findings in the nutritional assessment of patient with cardiovascular disease include: - b. elevated low-density lipoprotein (LDL) cholesterol and decreased subcutaneous fat. Serum proteins serve the function of: - maintaining osmotic pressure. A patient on mechanical ventilation is receiving total parenteral nutrition (TPN). Why is appropriate caloric intake important? - Excessive calorie intake can cause an increase in PaCO2. A primary nutritional intervention for hypertension is: - limiting sodium An effect of malnutrition on respiratory function is: - decreased surfactant. What is the rationale for careful intake and output for the patient with pulmonary alterations? - Fluid volume excess can lead to right-sided heart failure.

To decrease portal hypertension, an interventional radiologist can: - perform a transjugular intrahepatic portosystemic shunt procedure. To decompress an obstructed gastrointestinal (GI) tract, the nurse will prepare to: - insert a nasogastric tube. When inserting a small-diameter feeding tube, the nurse will evaluate the placement into the: - stomach. The appropriate method of checking placement of a feeding tube is to: - use a portable x-ray device. Following surgery for liver transplantation, the nurse will recognize signs of hypovolemia, tachypnea, tachycardia, and poor peripheral oxygenation as evidence of: - blood loss. Accumulation of ammonia and other toxins normally detoxified by the liver can produce: - Hepatic encephalopathy Elevations in which lab test results to establish a diagnosis of acute liver failure? - Serum bilirubin and alkaline phosphatase levels The most useful test to evaluate the coagulation status of a patient with acute liver failure is prothrombin time. This is because prothrombin is: - markedly increased in the condition. The patient with spinal cord injury is at risk for disruption of the sympathetic nervous system. The nurse will be prepared to apply interventions for _____ shock. - neurogenic Shock syndrome can best be described as a: - generalized systemic response to inadequate tissue perfusion. The initial priority action in managing the patient in shock is to: - establish and maintain an airway. The nursing measure that can best enhance large volumes of fluid replacement in hypovolemic shock is:

In addition to having the usual host susceptibility to pathogens, the trauma patient is at risk for infection because of: - adverse effects of trauma on the immune system. How do you open the airway of an unresponsive trauma patient in the emergency department? - Chin lift/jaw thrust maneuver should be used. Tension pneumothorax is characterized by mediastinal shift that often results in? - Lung collapse on the injured side a. Verapamil

 Class and uses -  Antidysrhythmic

 used for angina, hypertension, supraventricular arrhythmia and atrial fibrillation or flutter, tardive dyskinesia  diltiazem

 Class and uses -  Antidysrhythmic

 used for angina, hypertension, supraventricular arrhythmia and atrial fibrillation or flutter, tardive dyskinesia  amlodipine

 class and uses -  Calcium channel blocker

HTN, angina more ____ ion resides in ICF and more ____ ion resides in ECF - potassium, sodium

electrical potential across membrane = ____ - -90mV

on an EKG, this portion shows atrial depolarization - P wave on an EKG, this portion shows ventricular depolarization - QRS complex on an EKG, this portion shows ventricular repolarization - T wave beginning of P -> beginning of QRS - PR interval: beginning of QRS -> end of T - QT interval: end of QRS -> beginning of T - ST segment: the delay in the __ region of the AV node allows the ventricle to fill - N each thick block on an EKG is ___ seconds -

each little block on an EKG is __ seconds -

15 little blocks = __ seconds - 3 hash marks at top of EKG = ___second intervals - 3

atrial fibrillation when the PR interval is lengthened beyond the normal interval, it is called a __ ___ ___ block - first degree AV when there is progressive prolongation of PR interval until QRS complex is dropped, this is called __ ___ ___ block (type ___) aka ____ phenomenon or ____ - second degree AV, I, wenchybock, mobitz (type I) when there is no correlation between what's happening in the atrium and the ventricle, nothing is getting through the AV node and the atrium and ventricle are firing on their own, this is called a ___ ___ ___ block - third degree AV as you double creatinine, you cut in half ____ - GFR normal BUN range - 8-20 mg/dl azotemia - increased BUN normal SCr range - 0.7-1.5 mg/dl normal sodium range - 136-145 meq/L normal osmolality range - 270-290 meq/L normal glucose range - 80-120 mg/dl normal serum potassium range - 3.5-5 meq/L intracellular potassium concentration -

140 meq/L normal magnesium range - 1.4-1.8 meq/L normal calcium range - 8.5-10.5 mg/dl normal phosphate range - 2.6-4.5 mg/dl anion gap calculation: - Na - (Cl + HCO3) total osmolality calculation: - (2xNa) + (glucose x10)/180 + (BUN x 10)/ total effective osmolality calculation - (2xNa) + (glucose x 10)/ normal anion gap range - 3-11 meq/L a patient w/significant Q waves and ST elevation present in leads V1-V4 is said to have: - acute anterior infarction a patient w/significant Q waves and ST elevation present in leads I and AVL is said to have: - acute lateral infarction a patient w/significant Q waves and ST elevation present in leads II, III and AVF is said to have: - acute inferior infarction Automaticity of cells in the SA node is a function of which phase of the action potential? - 4 the ___ node is located in the junctional tissue between atria and ventricles - AV

isotonic fluid losses from the body could lead to either - hypertonicity or hypotonicity

ST segment elevation indicates ____ injury - acute in the presence of an alkalosis, the ionized portion of serum calcium: - decreased the ______________ compartment will provide a disproportionately greater share of a hypotonic fluid loss from the body - extracellular Calculate the cardiac output for a pt with a HR of 70 and a SV of 65 ml. -  HR X SV=CO70 X 65= 45504.6 L/min Calculate the cardiac output for a pt with a HR of 70 and a SV of 65 ml. HR X SV=CO -  HR X SV=CO70 X 65= 45504.6 L/min What % of the cardiac cycle is provided by the atrial kick? - 20% What is Atrial Kick? - Atrial kick is a term that represents the amount of the total CO that is supplied via atrial contraction. If the pt has a condition or dysrhythmia that impairs or eliminates the atrial contraction, the pt may be compromised. A normal value for an EF would be? -

The EF should be more than 50%. It represents the amount of blood ejected from the left ventricle compared to the total amount available, expressed as a %. An EF of 35% or less indicates a problem with contractility, outflow or filling.

EXA: If the ventricle contains 90ml of blood and 50mls are ejected, the amount would be expressed as a %, in this case 55%. A pt presenting with chest pain that is more frequent, severe and prolonged than before has _____ angina. - UNSTABLE ANGINA

The change in quality, frequency, and duration indicates UNSTABLE ANGINA and may indicate that the pt is at increased risk for an MI. This pt should be closely monitored for EKG changes and rhythm disturbances. Pt/ family teaching should begin on how to identify an MI and basic CPR. Stroke Volume is comprised of which factors? - Contractility, preload and afterload A reflex tachycardia caused by the stretch of the right atrial receptors is known as the ____ - BAINBRIDGE REFLEX It is believed that this reflex exists to speed up the HR if the right side becomes overloaded, thereby helping equalize pressures on both sides

Diastole comprises what portion of time of the cardiac cycle? - 2/ The heart is virtually static during diastole. During this period, the cardiac vessels and chambers fill—a process that takes up 2/3s of the time necessary to complete the cardiac cycle

What is the MAP (mean arterial pressure) for pt:  BP 120/  HR 80 -

CI=CO/BSA -

 CI=CO/BSA

 CO=HR X SV

 CO=80 X 60

 CI=4800/2.

 CI=

 CI=2.4 L/min/m The resistance against which the right ventricle must work to eject its volume is known as: - Pulmonary Vascular Resistance This pressure represents a mean pressure in the systemic vasculature. The higher the resistance, the harder the heart has to work against it. EXA: Colder temperatures will cause vasoconstriction; the heart then has to pump harder to deliver blood through the narrowed vasculature. Approximately what % of coronary artery blockage is needed to cause angina? - 75% Anginal pain usually occurs when approximately 75% of the artery's diameter becomes occluded. Pain is usually more pronounced with exertion or emotional distress, when O2 demand by cardiac tissue cannot be met by O2 supply via the occluded arteries. The severity of the pain may be compounded with vasospams that further restrict blood flow through the coronary arteries. A heart murmur associated with acute valvular regurg would be? - SS1 and S2 are normal heart soundsS3 is associated with fluid statusS4 is associated with compliance.

Which is the best lead to monitor a RBBB? - Lead V Tall, peaked T waves on an EKG may be indicative of? - HYPERKALEMIA

The PR interval may become prolonged. Also, if the K is greater than 8, a wide-complex tachycardia may occur. Keep in mind that low levels of calcium or sodium may potentiate the cardiac effects, as can a low pH.

Administering vecuronium during theraputic hypothermic measures prevents: - PREVENT SHIVERING Vecuronium is a paralytic and will prevent shivering. If a pt shivers, her temperature will rise. Your pt was admitted for malaise, severe dyspnea and had a syncopal episode at work. He states he has a midline burning sensation in his chest that worsens when he is supine. You suspect? - MYOCARDITIS It can also present as inspiratory pain. The pain when supine is a cardinal sign of myocarditis. Other findings may include respiratory infection and an S3, S4, and pericardial friction rub. A definitive diagnosis of myocarditis can be made via? - ENDOMYOCARDIAL BIOPSY A biopsy is the ONLY definitive way to diagnose myocarditis.

The volume of fluid required to cause a pericardial tamponade is? - 50-75 ml of blood Although 50-75 mls is a small amount, the pressure in the intrapericardial space may equal or exceed atrial and vertricular pressures causing an acute tamponade.

Beck's triad is a combination of symptoms useful in diagnosing cardiac tamponade. They are? -  Distended neck veins  Muffled heart sounds  Hypotension

Tachycardia is an early sign of tamponade. A narrowed pulse pressure occurs, and fluid cannot be ejected from the heart. The muffled heart sounds occur because the fluid in the sac minimized the transmission of sound waves.