Free PCCN Practice Questions

Question 1

A 68-year-old patient is 24 hours post-PCI for an inferior STEMI. Vital signs are BP 92/58 mmHg, HR 110 bpm (sinus), RR 24/min, SpO2 94% on room air, temperature 37.1°C. The provider asks the nurse to report the mean arterial pressure (MAP). Which action is most appropriate?

Accepted Answer

Report a MAP of 69 mmHg and notify the provider that the pressure is below the usual 65 mmHg threshold.

Answer

Report a MAP of 69 mmHg and continue routine telemetry monitoring.

Answer

Report a MAP of 75 mmHg and encourage oral fluids.

Answer

Report a MAP of 62 mmHg and initiate a vasoactive infusion per protocol.

Question 2

A telemetry nurse notes a regular narrow-complex rhythm at 150 bpm. There are no discernible P waves, and the QRS duration is narrow. The patient is awake, oriented, and talking. BP is 118/76 mmHg, RR 20/min, and SpO2 is 96% on room air. What is the most appropriate first step?

Accepted Answer

Attempt vagal maneuvers and notify the provider per unit protocol.

Answer

Call a code and prepare for immediate defibrillation.

Answer

Give a loading dose of intravenous metoprolol without further assessment.

Answer

Place the patient in Trendelenburg position and apply supplemental oxygen.

Question 3

A patient with HFrEF reports worsening shortness of breath over the past 24 hours. Assessment reveals bilateral crackles halfway up the lung fields, +2 jugular venous distension, 3+ pitting edema of the lower extremities, and a weight gain of 3 lb (1.4 kg) since yesterday. SpO2 is 88% on room air. What is the priority nursing action?

Accepted Answer

Apply supplemental oxygen, sit the patient upright, and notify the provider immediately.

Answer

Administer the scheduled oral diuretic and reassess in 4 hours.

Answer

Encourage the patient to lie flat to improve venous return.

Answer

Give a PRN anxiolytic because the dyspnea is likely anxiety-related.

Question 4

A patient with a history of atrial fibrillation has an irregularly irregular rhythm on telemetry at 140–160 bpm. There are no distinct P waves. The patient is diaphoretic, confused to place, and BP is 82/54 mmHg. What is the most appropriate immediate action?

Accepted Answer

Activate the rapid response team and prepare for synchronized cardioversion per protocol.

Answer

Administer scheduled metoprolol PO to slow the ventricular rate.

Answer

Have the patient perform a Valsalva maneuver.

Answer

Continue monitoring and obtain a 12-lead ECG in 30 minutes.

Question 5

A patient is 1 day post laparoscopic colectomy and is receiving 2 L/min nasal cannula oxygen. Before walking in the hall, SpO2 was 93%. Midway through the walk the patient becomes dyspneic, RR increases to 28/min, accessory muscles are in use, and SpO2 falls to 86%. What is the nurse’s best first action?

Accepted Answer

Stop the activity, increase supplemental oxygen per protocol, and reassess; notify the provider if SpO2 does not improve.

Answer

Tell the patient to stop walking and take slow breaths while continuing the same 2 L/min flow.

Answer

Switch immediately to a non-rebreather mask at 15 L/min and continue ambulation.

Answer

Obtain an arterial blood gas before making any oxygen changes.

Question 6

An arterial blood gas is obtained from a patient with COPD who is somnolent after receiving additional opioid medication for pain. The results are: pH 7.32, PaCO2 55 mmHg, HCO3 28 mEq/L, PaO2 68 mmHg. Which interpretation is most accurate?

Accepted Answer

Respiratory acidosis with metabolic compensation.

Answer

Respiratory alkalosis with metabolic compensation.

Answer

Metabolic acidosis with respiratory compensation.

Answer

Normal ABG values for a patient with COPD.

Question 7

A 71-year-old patient with a urinary tract infection has the following findings: temperature 38.9°C, heart rate 118 bpm, respiratory rate 26/min, blood pressure 94/62 mmHg, altered mental status (new confusion), and lactate 3.2 mmol/L. WBC is 16,200/µL. What is the priority nursing action?

Accepted Answer

Initiate the sepsis bundle: notify the provider, obtain cultures, begin ordered IV fluids and antibiotics, and monitor closely.

Answer

Give acetaminophen for the fever and reassess vital signs in 2 hours.

Answer

Insert an indwelling urinary catheter to monitor output before any other action.

Answer

Administer a 1 L fluid bolus independently because the patient is hypotensive.

Question 8

A patient with acute kidney injury has a serum potassium of 6.2 mEq/L. The telemetry monitor shows peaked T waves, and the patient reports new palpitations and mild paresthesias. Which action is most appropriate for the progressive-care nurse?

Accepted Answer

Notify the provider immediately, obtain a 12-lead ECG, stop potassium-containing infusions and foods, and prepare for ordered treatment such as calcium gluconate.

Answer

Recheck the potassium in 1 hour and continue routine monitoring.

Answer

Administer oral sodium polystyrene sulfonate and reassess in 4 hours.

Answer

Start emergent hemodialysis at the bedside.

Question 9

A patient with type 2 diabetes is alert and cooperative but reports shakiness and sweating. A point-of-care glucose reading is 54 mg/dL. The patient can swallow safely. What is the most appropriate first treatment?

Accepted Answer

Give 15 g of fast-acting carbohydrate, then recheck the glucose in 15 minutes.

Answer

Administer 1 mg glucagon intramuscularly.

Answer

Give 50 mL of 50% dextrose intravenously.

Answer

Give a high-protein snack and recheck the glucose in 1 hour.

Question 10

A 22-year-old patient with type 1 diabetes is admitted with 2 days of vomiting and abdominal pain. Laboratory results include glucose 432 mg/dL, pH 7.26, bicarbonate 16 mEq/L, anion gap 22, and serum ketones positive. Potassium is 3.4 mEq/L. Which statement best reflects the priority nursing consideration at this stage?

Accepted Answer

DKA is present; insulin therapy will likely be ordered with close potassium monitoring because insulin drives potassium into cells.

Answer

The low potassium must be aggressively repleted before any insulin is given.

Answer

This is hyperosmolar hyperglycemic state; give subcutaneous insulin and oral fluids.

Answer

The anion gap is normal, so ketoacidosis is unlikely; monitor only.

Question 11

A 64-year-old patient is found with sudden onset of left-sided facial droop, left arm weakness, and slurred speech. The time the patient was last known well was 90 minutes ago. The patient is alert and vital signs are stable. What is the priority nursing action?

Accepted Answer

Activate the stroke protocol immediately, keep the patient NPO, and prepare for urgent imaging and provider evaluation.

Answer

Give aspirin 325 mg immediately because stroke protocols require antiplatelet therapy.

Answer

Offer the patient a sip of water to assess swallowing ability.

Answer

Place the patient in Trendelenburg to improve cerebral perfusion.

Question 12

A patient with a history of peptic ulcer disease reports several episodes of black, tarry stools today. Vital signs are HR 112 bpm, BP 96/64 mmHg, RR 22/min, and SpO2 95% on room air. Hemoglobin is 8.2 g/dL, down from 11.5 g/dL yesterday. Which action is most appropriate?

Accepted Answer

Notify the provider, establish or maintain large-bore IV access, send type and screen/crossmatch, keep the patient NPO, and prepare for possible transfusion.

Answer

Send the patient home with a proton-pump inhibitor and instructions to return if bleeding worsens.

Answer

Administer an oral iron supplement to correct the anemia.

Answer

Insert a nasogastric tube at the bedside to confirm bleeding before notifying the provider.

Question 13

A provider writes an order for a sedative injection for an alert, oriented patient who has clearly stated they do not want the medication. The family also states the patient does not want it. The provider says it is needed so the patient will sleep. What is the nurse’s most appropriate action?

Accepted Answer

Clarify the order with the provider, advocate for the patient’s autonomy, and document the patient’s refusal if the medication is declined.

Answer

Administer the medication because the provider’s order takes priority over the patient’s stated preference.

Answer

Ask a colleague to give the medication so the patient does not associate the refusal with the primary nurse.

Answer

Tell the patient they must take the medication because the family agrees with the provider.

Question 14

A patient is scheduled for an elective synchronized cardioversion. The nurse brings the consent form, and the patient says, “I just need you to tell me what they’re going to do — I didn’t really understand the doctor.” What is the nurse’s best response?

Accepted Answer

Notify the provider that the patient needs further explanation before giving informed consent, and do not have the patient sign until questions are answered.

Answer

Sign the form now; the doctor will explain again right before the procedure.

Answer

Ask the patient’s spouse to sign because the patient seems uncertain.

Answer

Tell the patient that cardioversion is routine and there is nothing to worry about.

Question 15

The family of a patient recovering from sepsis repeatedly enters the nurses’ station demanding updates every 20–30 minutes and has begun speaking loudly to staff. The patient is stable and has asked that updates be shared with the family. Which response is most appropriate?

Accepted Answer

Set a structured update plan, communicate it to the family, involve the charge nurse or social work if needed, and maintain a calm, professional tone.

Answer

Ban the family from the unit because their behavior is disruptive.

Answer

Give the family the patient’s full medical record so they can review it themselves.

Answer

Ignore the family and hope they calm down on their own.

Question 16

A progressive-care nurse is using qSOFA as a bedside sepsis screening tool. Which set of findings defines an abnormal qSOFA score?

Accepted Answer

Systolic blood pressure ≤100 mmHg, respiratory rate ≥22/min, altered mentation.

Answer

Systolic blood pressure ≤100 mmHg, respiratory rate ≥20/min, Glasgow Coma Scale score ≤14.

Answer

Temperature >38.3°C, heart rate >90 bpm, white blood cell count >12,000/µL.

Answer

Lactate >2 mmol/L, creatinine >1.5 mg/dL, platelets <100,000/µL.

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