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PCCN CERT AACN PRACTICE EXAM VERIFIED
Q&A LATEST 2022/2023
Which artery or arteries are responsible for anterior circulation to the brain?
A. External carotid
B. Internal carotid
C. Basilar
D. Vertebral (correct answers)B. Internal carotid
The brain is supplied with oxygenated blood from two arterial systems: the anterior circulation
originating with the carotid arteries and the posterior circulation, which originates with the vertebral
arteries. The common carotid arteries bifurcate, forming the external and internal carotid arteries.
A 51 year old man is in the PCU with a diagnosis of acute respiratory failure, possibly secondary to
sepsis. His last VS and labs were as follows: BP 108/60, NSR 70, Temp 38.8C, SPO2 99%, pH 7.52, PaCO2
29, PsO2 109, HCO3 29.
Based on the above ABGs, what is your interpretation of this patient's condition?
A. Uncompensated respiratory alkalosis
B. Respiratory acidosis with a compensating metabolic alkalosis
C. Compensated metabolic alkalosis
D. Uncompensated respiratory acidosis (correct answers)A. Uncompensated respiratory alkalosis
The pH is alkalotic at 7.52, the PaCO2 is low at 29 indicating the alkalosis is due to respiratory issue.
When the pH and the PCO2 move in opposite directions, the primary problem is often respiratory in
origin.
The upper airway serves three of the key functions listed below. Select the one function that is NOT
served by the upper airway.
A. Humidification of air
B. Removal of particles
C. Warming of inspired air
,D. Participation in gas exchange (correct answers)D. Participation in gas exchange
Gas exchange takes place in the lower airways, in the alveoli.
Which part of the trachea is relatively avascular, allowing for emergency placement of artificial airways
in this area?
A. Thyroid cartilage
B. Cricothyroid cartilage
C. Laryngopharynx
D. Glottis (correct answers)B. Cricothyroid cartilage
The cricothyroid cartilage is a complete ring located just below the thyroid cartilage where the vocal
cords are located. The cricothyroid membrane is an avascular structure that connects the thyroid and
cricoid cartilages. It is through this membrane that an airway may be established in an emergency. In
this way, the posterior wall of the larynx and vocal cords are not injured.
The left and right mainstem bronchi divide from the trachea at which of the following locations?
A. Carina
B. Sternoclavicular junction
C. Lingula
D. Larynx (correct answers)A. Carina
The trachea divides into the right and left main-stem bronchi at the carina, located at the angle of Louis
at the sternomanubrial junction, at about the second intercostal space.
Right main stem bronchus intubations are more likely to be performed than left bronchus intubations
for which of the following reasons?
A. The right mainstem bronchus has more ciliary clearance of mucus, facilitating passage of the
endotracheal tube.
B. The left mainstem bronchus is located several inches lower than the right
C. The left mainstem bronchus, although wider than the right, sits posterior to the right mainstem
bronchus
D. The right mainstem bronchus is wider and has less angulation than the left (correct answers)D. The
right mainstem bronchus is wider and has less angulation than the left
,The right mainstem bronchus comes off the trachea in almost a straight line, while the left mainstem
bronchus comes off the trachea at an angle of approximately 40 degrees. The right mainstem bronchus
is wider in diameter than the left.
A 69 year old woman is admitted at 0700 with persistent right-sided chest pain that is not affected by
respiration or position. She had a V/Q scan at 0900 that showed intermediate probability for a
pulmonary embolism. The pain fluctuates and is now not very severe. She has crackles in her right
middle lobe. Her ECG shows no signs of ischemia. She is not intubated but is on a 35% high-humidity
face mask. She has the following vital signs and ABGs: BP 94/56, ST 108, RR 26, Temp 36.7, SPO2 98%,
pH 7.26, PaCO2 30, PaO2 98, HCO3 18, Lactate 4.8.
The patient's physician has told you that he would call at about 1600. The current time is 1100. You are
to call him only if her physical or laboratory values are SIGNIFICANTLY abnormal.
Based on the above information, interpret the ABGs.
A. Respiratory alkalosis with a compensating metabolic acidosis
B. Metabolic acidosis with a compensating respiratory alkalosis
C. Uncompensated respiratory alkalosis
D. Uncompensated metabolic acidosis (correct answers)B. Metabolic acidosis with a compensating
respiratory alkalosis
The pH is acidotic at 7.26 and the HCO3 is low at 18, indicating a metabolic acidosis. The lungs try to
compensate by increasing respirations to rid the body of acid, CO2, resulting in a PaCO2 that is low at
30, thus creating a partially compensating degree of respiratory alkalosis.
A 69 year old woman is admitted at 0700 with persistent right-sided chest pain that is not affected by
respiration or position. She had a V/Q scan at 0900 that showed intermediate probability for a
pulmonary embolism. The pain fluctuates and is now not very severe. She has crackles in her right
middle lobe. Her ECG shows no signs of ischemia. She is not intubated but is on a 35% high-humidity
face mask. She has the following vital signs and ABGs: BP 94/56, ST 108, RR 26, Temp 36.7, SPO2 98%,
pH 7.26, PaCO2 30, PaO2 98, HCO3 18, Lactate 4.8.
The patient's physician has told you that he would call at about 1600. The current time is 1100. You are
to call him only if her physical or laboratory values are SIGNIFICANTLY abnormal.
Based on the abnormal information, what is your interpretation of her oxygenation status?
A. She shows signs of poor tissue oxygenation based on the elevated lactate, low HCO3 and pH.
, B. Her oxygenation is adequate at present based on the normal SPO2 and PaO2.
C. Her oxygenation is inadequate based on the FiO2 of 0.35, generating a PaO2 of only 98.
D. Her oxygenation is adequate at present based on the FiO2 of 0.35, generating a PaO2 of only 98 and
an SPO2 of 98%. (correct answers)A. She shows signs of poor tissue oxygenation based on the elevated
lactate, low HCO3 and pH.
The body's cells require oxygen for energy production. When perfusion/oxygenation is inadequate, the
cells begin anaerobic metabolism, which produces lactate. Lactate is one of the most common causes of
metabolic acidosis and is an acid causing the HCO3 and subsequently the pH to decrease.
A 69 year old woman is admitted at 0700 with persistent right-sided chest pain that is not affected by
respiration or position. She had a V/Q scan at 0900 that showed intermediate probability for a
pulmonary embolism. The pain fluctuates and is now not very severe. She has crackles in her right
middle lobe. Her ECG shows no signs of ischemia. She is not intubated but is on a 35% high-humidity
face mask. She has the following vital signs and ABGs: BP 94/56, ST 108, RR 26, Temp 36.7, SPO2 98%,
pH 7.26, PaCO2 30, PaO2 98, HCO3 18, Lactate 4.8.
The patient's physician has told you that he would call at about 1600. The current time is 1100. You are
to call him only if her physical or laboratory values are SIGNIFICANTLY abnormal.
What intervention should you make at this time?
A. Do not notify the physician but increase the FiO2 per standing orders.
B. Notify the physician because of significantly abnormal values.
C. Wait until the physician calls at 1600 to report because while some values are abnormal, they are not
significantly abnormal.
D. Continue to monitor the patient but make no changes in her current therapy. (correct answers)B.
Notify the physician because of significantly abnormal values.
An elevated lactate level of >4 mmol/L is a critical finding. It indicates poor perfusion or a shock state. It
is important to find and correct the source of the acid/lactate as quickly as possible to prevent
deterioration of the patient's condition.
What is the name of the lipoprotein secreted by alveolar type II cells that promotes alveolar expansion
by increasing the surface tension of the alveoli?
A. Surfactant
B. Phagocytes
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