PCCN Exam Questions and Answers (Latest Update 2023/2024), Exams of Nursing

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Coronary artery perfusion is dependent upon: A. diastolic pressure B. systolic pressure C. afterload D. systemic vascular resistance (SVR) - Correct Answers ✅A. diastolic pressure Diastolic pressure in the aortic root is higher than left ventricular end- diastolic pressure (LVEDP), the pressure exerted on the ventricular muscle at the end of diastole when the ventricle is full. This enables blood to flow from a higher pressure through open arteries to a lower pressure, a pressure gradient known as coronary artery prefusion pressure. As diastolic pressure drops, there is a decrease in coronary artery blood flow. Coronary artery perfusion is not affected by systolic pressure, afterload or SVR, but they all increase the demand of oxygen in the heart. A post-STEMI (ST elevation myocardial infarction) patient is started on an angiotensin-converting enzyme (ACE) inhibitor during his hospital stay. Which of the following is the most common serious side effect that may occur? A. a nonproductive cough

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B. pedal edema C. swelling of the tongue and face D. rhinorrhea - Correct Answers ✅C. swelling of the tongue and face Although all of the answers may occur, swelling og the tongue and face is the most serious and may require intervention. Patients should be instructed to seek medical attention immediately for any signs of swelling in the tongue or throat. Which of the following best describes the fourth heart sound (S4): A. It occurs after ventricular contraction B. It is best heard with the diaphragm of the stethoscope C. It is a normal finding in children D. It occurs during late diastole when the atria contracts - Correct Answers ✅D. It occurs during late diastole when the atria contracts The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left ventricle. An S4 is also called an atrial heart sound since it occurs at the end of diastolic filling when the atria contracts and fully fills the left ventricle. Known as "atrial kick", this filling is important to cardiac output. The increased end-diastolic volume in the ventricle improves cardiac output. When the left ventricle is stiff (decreased compliance with long term hypertension, aortic stenosis or with acute STEMI), the atrium has to pump

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harder to move blood from the atrium to the ventricle, causing a turbulent blood flow and extra heart sound. This heart sound is always pathologic. It occurs before ventricular contraction, is best heard with the bell of the stethoscope and is never a normal heart sound, even in children. Which pathologic changes found on the 12-lead ECG indicate myocardial ischemia? A. ST-segment elevation B. ST-segment depression and T-wave elevation C. Q-wave formation D. ST-segment depression and T-wave inversion - Correct Answers ✅D. ST segment depression and T wave inversion Myocardial ischemia changes the repolarization of the ventricular muscle. That change is seen on the 12 lead ECG as ST-segment depression and T wave inversion, which demonstrate subendocardial ischemia -- the innermost layer of muscle in the myocardium. ST-segment elevation indicates acute injury or infarction, ST segment depression and T wave elevation may indicate an electrolyte abnormality, while Q wave formation indicates total infarction.

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Positive inotropic agents are used to: A. improve cardiac output and tissue perfusion B. decrease water loss through the kidneys C. increase heart rate D. vasodilate vessels - Correct Answers ✅A. improve cardiac output and tissue perfusion The term "inotropic" refers to affecting the force of myocardial contraction. Improvement of cardiac muscle contraction leads to improved cardiac output and tissue perfusion. A patient in the ED is now being admitted to telemetry bwith complaint of chest pain and has been judged to be a possible candidate for therapy with alteplase (Activase). Which of the following is not considered a contraindication for the use of this medication? A. current antibiotic use B. recent abdominal surgery C. recent gastrointestinal bleed D. recent intracranial bleed - Correct Answers ✅A. current antibiotic use

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Use of antibiotics is not a contraindication for the use of alteplase. All the other answers -- recent abdominal surgery, recent gastrointestinal bleeding and a recent intracranial bleed -- are contraindications for the use of any fibrinolytic. The two major components that determine blood pressure are: A. systemic vascular resistance (SVR) (afterload) and cardiac output B. contractility and SVR (afterload) C. preload and SVR (afterload) D. contractility and SVR (afterload) - Correct Answers ✅A. SVR (afterload) and cardiac output The equation for BP is: BP = SVR x cardiac output. BP is determined by resistance of the arterial bed and the cardiac output. If the SVR (afterload) is high and the cardiac output low, the patient may still have a normal BP. the pulse pressure will be lower, but this is a compensatory response by the heart to maintain BP. If the SVR (afterload) is low (as in early septic shock), the cardiac output is very high, thereby trying to support BP.

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The layer of the arterial vessel wall responsible for changes in the diameter of the artery is the: A. media B. intima C. externa D. adventitia - Correct Answers ✅A. media The media layer of the arterial wall contains vascular smooth muscle cells and is responsible for arterial tone. Vasoactive substances released in response to the sympathetic nervous system and/or the renin-angiotensin system determine arterial tone. Intima, externa and adventitia are incorrect. A patient presents in acute distress with rales halfway up bilaterally; cool and clammy extremities; elevated jugular venous distention (JVD); oxygen saturations at 95%, down from 99%; and complaints of shortness of breath. Which of the following findings correspond to the patient's cardiac status? A. no pulmonary congestion, normal perfusion B. no pulmonary congestion, low perfusion C. pulmonary congestion, normal perfusion D. pulmonary congestion, low perfusion - Correct Answers ✅D. pulmonary congestion, low perfusion

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Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary edema, causing pulmonary congestion. Pneumonia can also cause fluid in the alveolar sacs. The patient is complaining of shortness of breath, and the oxygen saturations are lowering, also indicating that the patient has pulmonary congestion. The patient's skin is cool and clammy, indicating that the skin is poorly perfused. Skin does not require oxygen and shunts blood away in decreased cardiac function; therefore, this patient has pulmonary congestion and low perfusion state. The other answers are incorrect. When listening to heart sounds, S1 signifies which of the following? A. the beginning of ventricular systole B. the beginning of ventricular diastole C. the propulsion of blood into a non-compliant ventricle D. the blood going in the wrong direction - Correct Answers ✅A. the beginning of ventricular systole The heart sound of S1 indicates the opening of the aortic and pulmonic valves and marks the beginning of ventricular systole or ejection. The beginning of diastole is after S2, propulsion of blood into a noncompliant chamber is S4, and blood going in the wrong direction will cause a murmur.

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A patient with pulmonary edema has impaired diffusion due to: A. increased thickness of the alveolar capillary membrane B. retaining CO C. an elevated body temperature associated with pulmonary edema D. low barometric pressure - Correct Answers ✅A. increased thickness of the alveolar capillary membrane With increasing left ventricular pressures, blood moves back into the left atrium, then to the pulmonary veins. When the pressure in the pulmonary veins increases, capillary function decreases, and fluid then shifts to the interstitial space, causing interstitial edema, thereby, increasing the thickness of the space oxygen must travel. When left ventricular pressures increase, the fluid then shifts to the alveolar space, causing pulmonary edema. This fluid acts as a deterrent to oxygen diffusion. Retention of CO does not impair diffusion. An elevated body temperature associated with pulmonary edema is not causing a diffusion abnormality; increased temperature shifts the oxyhemoglobin curve to the right, more quickly releasing oxygen to the tissues. Low barometric pressure has no effect on diffusion of gases in the lung. A patient with an anterior-wall STEMI is in cardiogenic shock. What would be the hemodynamic profile assessment?

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A. decreased cardiac index, increased preload, increased afterload B. decreased cardiac index, decreased preload, increased afterload C. decreased cardiac index, decreased preload, decreased afterload D. increased cardiac index, decreased preload, decreased afterload - Correct Answers ✅A. decreased cardiac index, increased preload, increased afterload In a patient with cardiogenic shock, both preload and afterload are increased due to severe vasoconstriction on both the venous and arterial side. Arterial vasoconstriction increases afterload and therefore lowers cardiac index. Because the ventricle is failing and contractility is also low, the left ventricular pressures increase and cause blood to increase in the pulmonary bed, resulting in increased right ventricular pressures and preload. In heart failure, there is an increase in preload and afterload with a decrease in cardiac index and contractility. The other answers are incorrect. A patient is discharged with the diagnosis of severe peripheral vascular disease (PVD). In addition to medication and a walking regime, if applicable, which of the following is essential education at time of discharge? A. nutritional counseling B. smoking cessation counseling C. social work consult

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D. speech therapy consult - Correct Answers ✅B. smoking cessation counseling Cessation of tobacco use is the most important non-pharmacological intervention that can be done to improve signs and symptoms of peripheral bvascular disease. Social work consult and speech therapy may not be indicated in this patient. All patients may benefit from nutrition counseling; however, this is not a primary concern for this patient. A medication that dilates both the venous and arterial beds will cause which of the following results? A. increased preload, decreased afterload B. increased preload, increased afterload C. decreased preload, decreased afterload D. decreased preload, increased afterload - Correct Answers ✅C. decreased preload, decreased afterload When both the venous and arterial beds are dilated, there will be less venous return, causing a decreased preload (ex. nitroglycerin). With arterial vasodilation, the afterload will decrease (ex nitroprusside, ACE-I). Afterload in this case is resistant to LV pumping.

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Stable angina is best defined as: A. pain that increases in severity B. pain that is new C. pain that occurs at rest D. pain that has a predictable pattern over time - Correct Answers ✅D. pain that has a predictable pattern over time Stable angina is predictable -- the patient can describe the pain and how it is initiated accurately each time -- and occurs with exertion. Ex: The patient knows every time he or she climbs stairs, it will be accompanied by chest pain. The pain is relieved with rest and nitroglycerin (Nitrolingual). Pain that is new or occurs at rest is not stable angina. If the pain increases in severity, it is no longer stable. The gold standard diagnostic tool for the identification, location of disease and severity of coronary artery disease is: A. a stress test B. an echocardiography C. cardiac catheterization D. a spiral computer tomography (CT scan) - Correct Answers ✅C. cardiac catheterization

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The gold standard, or best diagnostic tool, for the diagnosis, location and severity of coronary artery disease is the cardiac catheterization performed in the cath laboratory. Echocardiography is excellent in revealing structure changes, but not coronary artery disease. A stress test may be a good screening tool, but again, is not the gold standard, nor is CT scanning The most common complication after a STEMI is: A. heart failure B. dysrhythmia C. ventricular septal rupture D. ventricular wall rupture - Correct Answers ✅B. dysrhythmia The most common complication after a STEMI is dysrhthmia due to irritability of the ischemic myocardium and the dead myocardium that does not transmit electrical stimuli. With interior-wall STEMI, the most common dysrhythmia is bradycardia and heart block. With anterior-wall STEMI, tachydysrhythmias such as ventricular tachycardia and/or ventricular fibrillation are most common. Heart failure, ventricular septal wall rupture and ventricular rupture are infrequent complications after STEMI and carry a very poor prognosis.

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The most common cause of heart failure in the US is: A. valvular disease B. ischemic heart disease C. renal failure D. hepatitis - Correct Answers ✅B. ischemic heart disease In the US, the most common cause of heart failure is ischemic heart disease. After STEMI or NSTEMI with damage to the myocardium, ventricular failure may result secondary to decreased ejection fraction. Each insult to the myocardium may make the heart failure worse. For many years, valvular disease, caused by untreated strep throat, was one of the most common causes of heart failure. However, that has changed since the newer strep tests provide rapid results, preventing delayed treatments. Renal failure and hepatitis are serious illnesses but are not common causes of heart failure. Systolic left ventricular dysfunction is best defined as: A. the impaired ability of the left ventricle to contract and effectively eject blood B. the impaired ability of the left ventricle to fill and relax C. heart failure with an elevated systolic blood pressure

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D. heart failure in which the heart stops beating - Correct Answers ✅A. the impaired ability of the left ventricle to contract and effectively eject blood Systolic failure occurs when the ventricle has lower contractility and produces a lower ejection fraction and cardiac output. The ventricle dilates and loses the ability to contract as a unit. Depending on the severity of the dysfunction, the patient may present in cardiogenic shock. Impaired ability to fill the ventricle is a problem with diastolic dysfunction; heart failure with an elevated systolic pressure may more often cause diastolic dysfunction by causing a thickened ventricle that cannot fill properly. Heart failure caused by asystole is not heart failure but electrical standstill. Neurohormonal response in heart failure with long-term consequences include: A. increased liver release of glycogen stores B. increased activation of the sympathetic nervous system and the renin- angiotensin system C. increased production of hemoglobin D. increased production of cholesterol to make hormones - Correct Answers ✅B. increased activation of the sympathetic nervous system and the renin- angiotensin system

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With continued heart failure, the body compensates for the low cardiac output by stimulating the sympathetic nervous system and the renin- angiotensin system. This increases preload and afterload in an already poorly functioning heart. Neurohormonal blockers are the treatment. Activation of increased liver release of glycogen stores increases blood sugar, but not heart failure. Increased production of hemoglobin is a response to hypoxia, and increased production of cholesterol does not have a relation to the neurohormonal response to heart failure. Medications commonly used in the treatment of heart failure include: A. ACE inhibitors, beta blockers B. calcium channel blockers C. nitrates D. calcium channel blockers and digoxin (Lanoxicaps) - Correct Answers ✅A. ACE inhibitors, beta blockers The most effective and evidence-based practice treatment of heart failure is neurohormonal blockade. These medications include beta blockers and ACE inhibitors. They reduce preload and afterload as well as controlling heart rate and BP. Calcium channel blockers are not used in heart failure since they tend to increase the absorption of sodium and water. Nitrates are used for treatment in conjunction with other drugs. Beta blockers are ACE-I are the

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foundation of treatments. Digoxin is also used but only after the beta blockers and ACE-I are started. The heart's primary compensatory response to chronic aortic stenosis includes: A. left arterial hypertrophy B. left ventricular hypertrophy C. left ventricular dilation D. right ventricular dysfunction - Correct Answers ✅B. left ventricular hypertrophy With chronic aortic stenosis, the left ventricle hypertrophies over time due to the increased workload of pumping blood through a narrowed opening. This leads to diastolic dysfunction as well as hypertrophy. The left atrium will enlarge over time, but the primary result is left ventricular hypertrophy, not dilation. The right ventricle remains normal for a period of time. Patients with pericardial effusions should be assessed for the development of which of the following complications: A. thrombocytopenia B. tamponade

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C. low hemoglobin and hematocrit D. endocarditis - Correct Answers ✅B. tamponade Any patient with a pericardial effusion should be assessed for cardiac tamponade physiology. Any accumulation of fluid in the pericardial sac can compress the myocardium, producing tamponade signs and symptoms. All patients are assessed for thrombocytopenia, low H+H and endocarditis; they are not the focus of complications with effusions but could be additional signs of tamponade (low H+H and thrombocytopenia). Nursing interventions in the patient with pericarditis include all the following except: A. providing comfort by administering pain medications and proper positioning B. auscultating heart sounds to assess for muffled heart sounds C. administering anticoagulants to prevent thrombus in the pericardium D. monitoring for jugular venous distention (JVD) and hypotension - Correct Answers ✅C. administering anticoagulants to prevent thrombus in the pericardium A patient with pericarditis should have pain-relief medication. The nurse should auscultate heart sounds and assess if they are muffled (a sign of

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possible tamponade), and monitor for JVD and hypotension (more signs of tamponade physiology). Do not give anticoagulants to the patient since they may cause bloody pericardial effusions and tamponade. Epinephrine is indicated as the first-line drug for any pulseless condition because it has the following actions: A. inotropic and selectively shunts blood to brain and heart B. converts ventricular fibrillation to sinus rhythm C. slows the heart rate and improves contractility D. causes decreased contractility, - Correct Answers ✅A. inotropic and selectively shunts blood to brain and heart Epinephrine is a pure catecholamine that increases contractility and causes vasoconstriction that shunts blood to the heart, brain, and diaphragm. According to ACLS, it is the drug of choice for any pulseless arrest. Epinephrine does not convert VF to any rhythm, slow heart rates or cause decreased contractility. The most common postoperative complication of coronary artery bypass (CABG) surgery is: A. bleeding

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B. stroke C. atrial fibrillation D. ventricular fibrillation - Correct Answers ✅C. atrial fibrillation The most common complication after CABG is the dysrhythmia atrial fibrillation. In approximately 33% of all patients who have atrial fibrillation, the mechanism is not completely understood. Postoperative myocardial edema may cause an atrial stretch, facilitating electrophysiological abnormalities. Other complications include bleeding, stroke, and ventricular fibrillation, but they are not the most common. An NSTEMI is differentiated from an unstable angina by: A. location of chest pain B. cardiac biomarker elevation C. ECG changes D. extent of cardiac history - Correct Answers ✅B. cardiac biomarker elevation In the NSTEMI vs unstable angina patient, the location of pain may be the same. Regarding ECG changes, both may have ST-Twave depression in the associated leads. The history of a patient with myocardial ischemia may not be pertinent. In an unstable angina, the patient may have ECG changes, but

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no cardiac enzyme changes. In NSTEMI, the patient will have cardiac enzyme elevation. The nurse auscultates an S3 on a patient just admitted with NSTEMI. What does that indicate? A. normal heart sounds B. mitral valve stenosis C. fluid overload D. increased afterload - Correct Answers ✅C. fluid overload The auscultation of an S3 is always abnormal in the adult patient. It indicates an overfilled left ventricle at the beginning of ventricular diastole and is a marker of poor ventricular function as well as fluid overload. S3 does not reflect mitral valve stenosis (diastolic murmur) or increased afterload The primary function of beta blocker therapy in heart failure is to: A. increase BP B. block compensatory vasoconstriction and increase heart rate C. increase urine output

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D. decrease preload - Correct Answers ✅B. block compensatory vasoconstriction and increase heart rate The treatment of heart failure is to reduce the actions of the sympathetic nervous system and the renin-angiotensin system. Beta blockers block the SNS and reduce afterload, slightly reduce contractility and improve heart rate regulation. These decrease the demands of oxygen for the patient with reduced ventricular function. Beta blockers do not increase heart rate, nor do they increase urine output or change preload in any way. Early symptoms of fluid overload and pulmonary edema are: A. rales and hypoxia B. S3 heart sound and tachycardia C. complaint of shortness of breath and orthopnea D. ST segment elevation in the chest leads - Correct Answers ✅C. complaint of shortness of breath and orthopnea Remember that symptoms are what the patient complains of, not signs that the nurse measures. Rales and hypoxia, S3 and tachycardia are signs that are measured at the bedside. ST segment elevation is a sign of cardiac injury/infarction. A complaint of shortness of breath and the inability to lie down are symptoms of early left-ventricular failure.

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An elderly patient is admitted and placed on warfarin (Coumadin) for arterial fibrillation. What is a therapeutic range for anticoagulation for this patient? A. international normalized ration (INR) less than 1.0 B. INR between 1.0 and 1.5 C. INR between 2.5 and 3.5 D. INR between 4.5 and 6.0 - Correct Answers ✅C. INR between 2.5 and 3.5 The therapeutic range of INR for any patient with atrial fibrillation is 2.5-3.5, no matter what their age. A normal INR is 1.0, and 4.5-6.0 is a high INR. After cardiac transplantation, the patient is placed on cyclosporine modified (Gengraf). In assessing this patient, the nurse should monitor: A. Blood glucose B. serum creatinine C. serum amylase D. serum magnesium - Correct Answers ✅B. serum creatinine When a patient is on cyclosporine for antirejection, serum creatinine should be followed closely. Cyclosporine is eliminated via the kidneys and can cause renal injury and failure. Of course, blood glucose should be monitored;

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however, this questions is looking for the consequence of a drug on renal function. Serum amylase is affected by liver disease or pancreatitis, and serum magnesium should always be monitored; however, it is not affected by cyclosporine. An elderly patient on warfarin (Coumadin) therapy has been admitted with an INR of 6.0. What is the antidote that can be used to counteract the effects of warfarin and decrease the risk of bleeding? A. vitamin A B. vitamin B12 C. vitamin C D. vitamin K - Correct Answers ✅D. vitamin K Vitamin K is the antidote for warfarin overdose. None of the other vitamins are antagonists of warfarin. A physiologic reason for sinus tachycardia is: A. elevated serum potassium B. elevated creatinine C. decreased urine output

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D. tissue hypoxia - Correct Answers ✅D. tissue hypoxia Sinus tachycardia is generally a compensatory mechanism for decreased tissue oxygenation. Fever, pain, anxiety, hypovolemia and decreased blood pressure all are reasons for tachycardia. The physiology in all is the lack of oxygen delivery at the tissue level. Elevated potassium does not increase heart rate, but if it is high enough, causes sinus bradycardia. Elevated creatinine is a marker of renal failure, and increased potassium would cause sinus bradycardia. Decreased urine output may or may not affect heart rate. A patient is admitted with decompensated heart failure. The patient is receiving furosemide (Lasix), digoxin (Lanoxin), metoprolol (Lopressor) and lisinopril (Zestril) at home. What drug can be added to reduce preload? A. spironolactone (Aldactone) b. verapamil (Calan) c. dabigatran etexilate (Pradaza) d. No other drugs are essential - Correct Answers ✅A. spironolactone (Aldactone) When the heart failure patient continues to have volume overload on appropriate medications, an aldosterone inhibitor such as spironolactone or eplerenone (Inspera) should be added. Aldosterone inhibition will decrease sodium reabsorption from the kidneys and therefore decrease intravascular

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volume. The nurse would carefully monitor potassium since aldosterone blockers are potassium-sparing diuretics. Remember not to use verapamil in heart failure; it will increase sodium and water retention. Dabigatran etexilate is an anticoagulant used only for non-vascular atrial fibrillation. Which condition would stimulate renin production? A. increased blood supply to the renal tubules B. decreased blood pressure C. decreased sympathetic output D. increased sodium concentration - Correct Answers ✅B. decreased blood pressure Renin secretion is regulated by blood flow to the juxtaglomerular apparatus. Decreased blood pressure would be identified, and renin secretion would occur. This begins a compensatory mechanism that causes vasoconstriction with increased blood pressure as well as sodium and water reabsorption in the kidneys, thereby effectively increasing blood pressure. Increased blood flow would maintain normal renin production. Decreased sympathetic output would not affect renin secretion from the kidneys (it is stimulated by low renal blood flow). Low serum sodium concentrations would stimulate renin production due to decreased osmolality.

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