PCCN FINAL AND PRACTICE EXAM
2024 WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED
DETAILED RATIONALES ANSWERS
|FREQUENTLY TESTED QUESTIONS
AND SOLUTIONS|ALREADY GRADED
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The authority of a surrogate speak for a pt should be based on which of the ff conditions
A. the surrogate is a family member and has recently lived with the pt
B. the family has designated the surrogate as the most knowledgeable person regarding the pt wishes
C. the pt has specifically conveyed wishes to the surrogate regarding current or similar circumstances
D. the pt indicates to the nursing staff that the surrogate should speak on the pt behalf
C. The main difference between a medical power of attorney and a healthcare surrogate is that pt
appoint a medical POA to make healthcare decisions for them when they become unable to make
them for themselves. Pt can specify what healthcare decisions they want their medical power of
attorney to make. A healthcare surrogate, on the other hand, is appointed to make healthcare
decisions for pt if they become unable to make them themselves. pt have no say in who becomes
their healthcare surrogate. They can avoid having a healthcare surrogate appointed if they have
appointed a medical power of attorney representative and that representative is still willing and able
to serve.
The nurse needs to perform a physical and gather history data on a pt who speaks only mandarin. The pt
is accompanied by a visitor representing herself as the daughter, who offers to interpret. When the
nurse responds that there will be an interpreter, the visitor become upset and wants to know why that
is necessary. The nurse's best response is
A. "Since the pt doesn't speak english, I can't be sure you are really her daughter, and the interpreter
can tell me that."
B. "Our policy states that an interpreter must be used at all times in this hospital when communicating
with a person who does not speak english."
C. "In discussing medical medical issues, a professional interpreter can help to ensure complete
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,understanding of all information. You may also participate, with permission from the pt."
D. "I'm not sure that you will understand the medical terminology well enough to translate it correctly
into mandarin."
C. This response is consistent with caring practices in the synergy model. In order to maintain
confidentiality, ensure accurate communication and support patient- and family- centered care
principles, family members, friends or other unqualified interpreters should not be used as
interpreters except in emergent situations. As an advocate and moral agent for the pt, staff should
use qualified interpreters to ensure effective communication
A 16 year old is admitted following a syncopal episdoe while on a basketball court. The pt reports having
had syncopal episodes in the past, generally while in the midst of sports events. The nurse notes the pt
is in SB with a rate of 55, PR interval of 0.16, QRS of 0.10, QT interval of 0.50, and a slightly peaked T
wave. The nurse should anticipate
A. cardiac cath the following morning
B. performance of an echo
C. serum and urine toxicology screens
D. CBC and trop levels
B. This pt has signs and symptoms of long QT syndrome. This condiition is a congenital disorder
characterized by a prolongation of the QT interval on ECG and propensity for ventricular
tachyarrhythmias, which may lead to syncope, cardiac arrest or sudden death, Imaging studies, such
as echocardiography, may help to exclude other potential reasons for arrhythmic events or associated
congenital heart diseases. ANy young person with syncope that occurs during exercise or in any other
circumstance in which a surge of adrenaline levels was likely to have been present should have long
QT syndrome specifically ruled out
A pt who sustained a fall reports a headache and, soon after, develops acute confusion. The nurse notes
ST segment depression on the pt ECG. Which of the following should the nurse suspect is the most likely
cause
A. hypokalemia
B. cerebral hemorrhage
C. alcohol intoxication
D. ischemia
B. This pt has risk factors (fall) and symptoms of cerebral hemorrhage. Pt with a cerebral hemorrhage
may have ST segment depression or QT prolongation.
In addition to positive blood cultures, which of the following are indicative of septic shock
BP HR RR T WBC
A. 108/86 94 26 100.6 13
B. 92/72 128 36 101.2 21
C. 85/58 136 36 96 38
D. 126/69 96 24 102.8 14
C. This pt has sign of septic shock: the pt is hypotensive, tachycardic, tachypneic, and has subnormal
temperature and elevated WBC
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,A pt who is in initial DKA will present with
A. increased potassium and decreased sodium
B. decreased plasma osmolality and ketones in urine
C. hyperphosphatemia and hyperglycemia
D. hypophosphatemia and acidosis
A. Initially, pt with DKA will have a sodium level that is normal or low. potassium levels are falsely
elevated due to the presence of acidosis (loss of hydrogen ions).
A pt was recently diagnosed with hypertrophic cardiomyopathy. Nursing instructions to the pt should
include
A. avoidance of strenous exercise or extreme physical exertion
B. no need for genetic testing
C. the need for periodic used of a temporary pacemaker being likely in the future
D. a low-sodium diet
A. Pt with hypertrophic cardiomyopathy must abstain from highly strenous competitive activity and
highly strenous physical exertion due to the high risk of arrhythmogenic sudden death.
A pt post heart transplant develops second degree heart block, type II. Vital signs are BP 86/40, HR 42,
RR 24. Assessment reveals mild onset of chest pain rated 2 out of 10, warm and dry skin, and clear
breath sounds. The pt denies SOB. The nurse should initially
A. anticipate transcutaneous pacing
B. administer 0.5 mg IV atropine
C. draw blood to help determine if the pt is rejecting his organ
D. reassure the patient that this rhythm is common following a heart transplant
B. This pt has an unstable bradycardia. Current recommendations by AHA include administration of
0.5 mg of atropine, although this initial treatment may not be effective because the transplanted
heart lacks vagal innervation
A pt with chronic alcohol abuse has lab data that reveal a phosphorous level of 0.8. Given the pt history
and current condition, which of the following is the pt at risk of developing
A. hyperventilation
B. increase glucose production
C. bacterial infection
D. decreased deep tendon reflex
C. Since phosphorous assists in cellular immunity (resistance to infectious diseases), the pt with low
phosphorous levels is at increased risk of developing a bacterial infection.
A postoperative African-american pt with a history of heart failure is being prepared for discharge. The
pt continues to report pain as 5 to 6 on a 0 to 10 scale. The physician wrote a prescription for ibuprofen
to be taken 3 times a day. The pt expresses concern about the prescription. The physician states
"opioids are inappropriate for her acute pain." Which of the following is indicated
A. instruct the pt to fill the prescription and call the physician if pain goes unrelieved.
B. realize women complain of pain more frequently than men do, and the prescription is realistic.
C. explain to the pt that African-Americans are at greater risk for opioid abuse than Caucasians and that
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, the prescription is appropriate.
D. collaborate with the physician to determine if race impacted the pain management decision
D. Racial and ethnic disparities in pain are well documented in the literature. As an advocate and
moral agents for this pt and consistent with caring practices in the synergy model, collaboration with
the physician prior to pt discharge is indicated to determine if any biases contributed to the pain
regimen prescribed for this patient.
A pt with acute arterial occlusion is being prepared for discharge. Which of the following should be
included in pt teaching
A. walk 35 to 50 minutes on a treadmill or track 3 to 4 times/week
B. keep the legs at heart level
C. for pain relief at night, keep the head of bead flat
D. initiate cold remedies upon early onset of cold symptoms
A. This exercise is an important but underused treatment. It can increase symptoms-free walking
distance and improve quality of life. Mechanisms probably include increased collateral circulation,
improved endothelial function with microvascular vasodilation, decreased blood viscosity and
decreased ischemia-induced inflammation.
A pt develops a rapid heart rate of 168 and BP if 82/48. The pt reports light headedness and shortness of
breath. Which of the following is indicated
A. diltiazem 5 mg IV bolus
B. synchronized cardioversion
C. amiodarone 300 mg IV bolus
D overdrive pacing
B. This patient has symptomatic SVT as evidenced by the presence of hypotension, lightheadedness
and shortness of breath. Synchronized cardioversion is indicated at this time.
A pt reports of sudden pain and change in color of the leg. Assessment reveals one lower extremity is
mottled and cold. Superficial veins are collapsed, and a pulse deficit is noted. The nurse should
A. elevate the affected extremity
B. instruct the pt that, if needed, to only take cold remedies with pseudephedirne
C. anticipate initiation of aniplatelet therapy
D. perform very gentle removal of calluses from feet
C. This pt is exhibiting symptoms of PAD. Management includes administration of antiplatelet therapy
to reduce the risk of MI and stroke
A pt who was in the ICU has been weaned after 2 weeks of mechanical ventilation and a continuous
midazolam (versed) infusion. In the PCU, the pt is experiencing episodes of agitation and anxiety during
the day and reports inability to sleep during the night. Which of the following interventions is indicated
A. place the pt in a private room away from the nurses' station
B collaborate with the physician to obtain an order for a sleeping aid
C. perform all care for the pt until the episodes of agitation and anxiety decrease
D. perform a delirium screen
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