PCCN : AACN Progressive Critical Care Nursing 2025 Exam

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Nursing
PCCN
AACN Progressive Critical Care Nursing 2025
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stion: 528
is the primary mechanism of action of corticosteroids in the manage ute respiratory distress syndrome (ARDS)?
asoconstriction nti-inflammatory ronchodilation
urfactant production wer: B
anation: The primary mechanism of action of corticosteroids in the agement of acute respiratory distress syndrome (ARDS) is their anti- mmatory effect. ARDS is characterized by widespread inflammation a ased permeability of the alveolar-capillary membrane, leading to onary edema and impaired gas exchange. Corticosteroids help to sup xcessive inflammatory response, which can improve lung function an
Que
What ment
of ac
1. V
2. A
3. B
4. S
Ans Expl
man
infla nd
incre
pulm press
this e d
facilitate recovery in ARDS patients.
Question: 529
A patient with severe sepsis has a lactate level of 5 mmol/L. Which of the following is the next appropriate step in management?
1. Administration of broad-spectrum antibiotics
2. Initiation of fluid resuscitation
3. Vasopressor therapy
4. Measurement of central venous oxygen saturation
Answer: D
perfusion and is an indication for early goal-directed therapy, which des measurement of central venous oxygen saturation to guide fluid a pressor administration.
stion: 530
tient with a history of atrial fibrillation is admitted with chest pain an ness of breath. The nurse should prioritize obtaining which of the wing diagnostic tests?
lectrocardiogram (ECG) hest X-ray
roponin level ll of the above
wer: D
Explanation: In severe sepsis, a lactate level > 4 mmol/L indicates tissue hypo
inclu nd
vaso
Que
A pa d
short follo
1. E
2. C
3. T
4. A
Ans
Explanation: In a patient with atrial fibrillation and new-onset chest pain and shortness of breath, the nurse should prioritize obtaining an electrocardiogram, a chest X-ray, and a troponin level. These diagnostic tests can help determine the underlying cause of the patient's symptoms, such as myocardial infarction, pulmonary embolism, or other cardiac-related issues.
Question: 531
Which of the following is the most appropriate initial management for a patient with status epilepticus?
henytoin evetiracetam oth A and B
wer: D
anation: The most appropriate initial management for a patient with st pticus is the administration of benzodiazepines (e.g., lorazepam or epam) followed by a long-acting antiseizure medication such as pheny
ombination helps terminate the seizure and prevent recurrence.
stion: 532
-year-old man with a history of coronary artery disease and hypertens ents to the emergency department with chest pain, shortness of breath, ting. His vital signs are: blood pressure 90/60 mmHg, heart rate 110 b
Benzodiazepines
P
L
B
Ans
Expl atus
epile
diaz toin.
This c
Que
A 55 ion
pres and
swea pm,
respiratory rate 24 breaths/min, and oxygen saturation 88% on room air. An ECG shows ST-segment elevation in the inferior leads. What is the most appropriate immediate management?
1. Administer aspirin and nitroglycerin
2. Perform emergent coronary angiography and percutaneous coronary intervention
3. Administer thrombolytic therapy
4. Provide supplemental oxygen and obtain urgent cardiology consultation Answer: C
f the heart. The most appropriate immediate management in this sce dminister thrombolytic therapy, which can help dissolve the coronar thrombus and restore blood flow to the affected myocardium. Emer
nary angiography and percutaneous coronary intervention are also opriate, but thrombolytics can be initiated more rapidly in the emerge rtment. Supplemental oxygen and cardiology consultation are also rtant, but should not delay initiation of thrombolytic therapy.
stion: 533
ent with acute renal failure is placed on continuous renal replacement py (CRRT). Which of the following is the most important nursing vention to prevent complications?
losely monitor fluid balance dminister anticoagulants
Explanation: The clinical presentation of chest pain, shortness of breath, hypotension, tachycardia, and ST-segment elevation on ECG is consistent with an acute ST-elevation myocardial infarction (STEMI) involving the inferior wall o nario
is to a y
artery gent
coro
appr ncy
depa impo
Que
A cli thera inter
1. C
2. A
3. Assess for bleeding
4. Maintain adequate blood flow Answer: D
Explanation: Maintaining adequate blood flow to the CRRT circuit is the most important nursing intervention to prevent complications, such as clotting or
filter failure. Closely monitoring fluid balance, administering anticoagulants, and assessing for bleeding are also important interventions, but maintaining adequate blood flow is the critical factor in preventing CRRT-related complications.
is the recommended strategy for preventing pressure injuries in a ally ill patient?
urning and repositioning se of specialty mattresses
kin assessment and moisture management ll of the above
wer: D
anation: The recommended strategy for preventing pressure injuries in ally ill patient includes a combination of turning and repositioning, us alty mattresses (e.g., air mattresses), and regular skin assessment with opriate moisture management. This comprehensive approach helps red isk of pressure injury development.
Question: 534
What critic
1. T
2. U
3. S
4. A
Ans
Expl a
critic e of
speci
appr uce
the r
Question: 535
A patient with a history of end-stage renal disease (ESRD) on hemodialysis presents with a fever, hypotension, and altered mental status. The nurse suspects which of the following complications?
1. Hyperkalemia
2. Uremic encephalopathy
3. Dialysis disequilibrium syndrome
4. Hemodialysis-associated hypotension Answer: C
ient with ESRD on hemodialysis are most likely indicative of dialysis quilibrium syndrome. This condition occurs due to the rapid removal o products and electrolytes during dialysis, which can lead to cerebral ma and neurological symptoms. Hyperkalemia, uremic encephalopathy odialysis-associated hypotension are other potential complications, but
ented symptoms are most characteristic of dialysis disequilibrium rome.
stion: 536
tient with a history of hypertension and type 2 diabetes mellitus is tted with new-onset atrial fibrillation. The physician orders amiodaro pixaban (Eliquis) for the patient. Which of the following is the most rtant nursing consideration?
onitoring the patient's thyroid function
Explanation: The symptoms of fever, hypotension, and altered mental status in a pat
dise f
waste
ede , and
hem the
pres synd
Que
A pa
admi ne
and a impo
1. M
2. Assessing for signs of bleeding
3. Checking the patient's serum potassium level
4. Educating the patient on the importance of medication adherence Answer: B
onset atrial fibrillation who is started on amiodarone and apixaban is assessing for signs of bleeding. Apixaban is an anticoagulant that increases the risk of bleeding, which requires close monitoring. Monitoring thyroid function and serum potassium level are important but less critical in the immediate management of this patient. Educating the patient on medication adherence is also important but should not be the top priority.
stion: 537
tient with a history of traumatic brain injury (TBI) develops a fever a ed mental status. Which of the following is the most likely cause of th
?
rinary tract infection
entilator-associated pneumonia entral nervous system infection epsis of unknown source
wer: C
anation: In a patient with a history of TBI who develops a fever and ed mental status, the most likely cause of the fever is a central nervou m (CNS) infection, such as meningitis or ventriculitis. Patients with T
increased risk of CNS infections due to the disruption of the blood-b
Que
A pa nd
alter e
fever
1. U
2. V
3. C
4. S
Ans Expl
alter s
syste BI
are at rain
barrier and the presence of foreign devices, such as ventricular catheters. Other possible causes, such as urinary tract infection, pneumonia, or sepsis, are also possible but less likely in this specific scenario.
A 50-year-old patient with a history of congestive heart failure presents with shortness of breath, edema, and fatigue. Arterial blood gas (ABG) analysis shows the following:
pH: 7.46
paCO2: 30 mmHg
pO2: 85 mmHg
is the most likely diagnosis? etabolic acidosis
espiratory acidosis etabolic alkalosis espiratory alkalosis
wer: D
anation: The given ABG results indicate respiratory alkalosis. The ased pH (7.46), decreased paCO2 (30 mmHg), and normal bicarbonat
/L) are characteristic of respiratory alkalosis.
tients with congestive heart failure, respiratory alkalosis can occur as pensatory mechanism to improve oxygenation and ventilation. The ness of breath, edema, and fatigue reported by the patient are commo ptoms associated with congestive heart failure and the resulting respira
HCO3-: 22 mEq/L
What
1. M
2. R
3. M
4. R
Ans Expl
incre e (22
mEq
In pa a
com
short n
sym tory
alkalosis.
The normal bicarbonate level suggests that the respiratory system is the primary driver of the acid-base imbalance, rather than a metabolic compensation.
Question: 539
A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation. The physician orders neuromuscular blocking agents (NMBAs) for the patient. Which of the following is the most appropriate nursing intervention?
dminister scheduled sedation to maintain the patient's Richmond Agit tion Scale (RASS) at -4 to -5.
nsure the patient receives physical therapy and early mobilization whi BAs.
onitor the patient's train-of-four (TOF) ratio to assess the depth of omuscular blockade.
wer: D
anation: The most appropriate nursing intervention for a patient with DS receiving NMBAs is to monitor the patient's train-of-four (TOF) ra
s the depth of neuromuscular blockade. Monitoring the TOF ratio hel re the appropriate level of blockade is maintained, which is critical for agement of ARDS. Performing spontaneous breathing trials, administe ion, and providing early mobilization are also important interventions toring the TOF ratio is the most appropriate in this scenario.
Perform daily spontaneous breathing trials to assess for extubation readiness.
A ation-
Seda
E le on
NM
M
neur Ans
Expl
AR tio to
asses ps
ensu the
man ring
sedat , but
moni
Question: 540
A patient with a history of chronic obstructive pulmonary disease (COPD) and cor pulmonale is admitted with an acute exacerbation. Which of the following is the most appropriate initial management?
1. Administer high-flow oxygen therapy
2. Initiate non-invasive ventilation (NIV)
3. Perform emergency intubation
4. Administer diuretic therapy Answer: B
exacerbation, the most appropriate initial management is to initiate n sive ventilation (NIV), such as bilevel positive airway pressure (BiPA nuous positive airway pressure (CPAP). NIV can help improve gas ange, reduce the work of breathing, and avoid the need for invasive hanical ventilation. High-flow oxygen therapy and diuretic therapy ma
e indicated, but NIV should be the first-line intervention.
stion: 541
ch of the following is the most appropriate initial antibiotic regimen fo nt with severe sepsis?
eftriaxone ancomycin
road-spectrum antibiotic combination argeted antibiotic based on culture results
Explanation: In a patient with COPD and cor pulmonale presenting with an acute on-
inva P) or
conti exch
mec y
also b
Que
Whi r a
patie
1. C
2. V
3. B
4. T
Answer: C
Explanation: The most appropriate initial antibiotic regimen for a patient with severe sepsis is a broad-spectrum antibiotic combination. This helps provide empiric coverage while awaiting culture results, which is crucial for improving outcomes.
Question: 542
agement?
iuretic therapy asodilator therapy otropic support
ll of the above wer: D
anation: The appropriate initial management for a patient with acute mpensated heart failure includes diuretic therapy to reduce fluid overl dilator therapy to decrease afterload and preload, and inotropic suppor ove cardiac contractility. This comprehensive approach is crucial in lizing the patient's hemodynamic status and managing the acute erbation of heart failure.
A 55-year-old patient with a history of chronic heart failure is admitted to the ICU with acute decompensation. The patient presents with severe dyspnea, pulmonary edema, and hypotension. What is the most appropriate initial
man
1. D
2. V
3. In
4. A
Ans Expl
deco oad,
vaso t to
impr stabi exac

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