AACN PCCN July 2024 Exam Hanbook version 2.1.0 Exam Questions

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21.

You are caring for a 48-year-old male patient with a history of complete heart block. His pacemaker is set to a rate of 70 beats per minute. He is now presenting with lightheadedness and a pulse of 50 beats per minute. What should your FIRST intervention be? 

  • Check the pacemaker function with a magnet

  • Administer atropine

  • Increase the pacing threshold on the pacemaker

  • Call the cardiologist for an immediate consult

Correct answer: Check the pacemaker function with a magnet

The first action should be to check the pacemaker function with a magnet, which can help determine whether it is functioning correctly or has reverted to a backup mode.

Administering atropine is appropriate for bradycardia, but in a patient with a pacemaker, ensuring the device is functioning correctly should come first. Increasing the pacing threshold is a decision that should be made after confirming the pacemaker's function. Calling the cardiologist is important, but immediate assessment of the pacemaker’s function takes priority.

22.

The informed consent process is based on which bioethical principle?

  • Autonomy

  • Justice

  • Beneficence

  • Nonmaleficence

Correct answer: Autonomy

The principle of autonomy underpins the informed consent process. Autonomy respects the patient’s right to make informed decisions about their own healthcare, ensuring they have all necessary information to understand the risks, benefits, and alternatives before consenting to a procedure or treatment.

Justice is fairness in the distribution of resources and treatment. Beneficence involves acting in the best interest of the patient, promoting good and preventing harm. Nonmaleficence means "do no harm" and emphasizes the importance of not causing harm to the patient. While these principles are indirectly related to informed consent, the goal of the informed consent process is to empower the patient, which is based on autonomy.

23.

Congenital Long-QT Syndromes (LQTSs) involve mutations in several genes that control which of the following?

  • Potassium or sodium channels on cardiac cells

  • Potassium or chloride channels on cardiac cells

  • Chloride or sodium channels on cardiac cells

  • Chloride channels only on cardiac cells

Correct answer: Potassium or sodium channels on cardiac cells

LQTSs are primarily associated with mutations in genes that control potassium and sodium channels in cardiac cells. These ion channels are critical for the proper regulation of the heart's electrical activity. Potassium channels help in the repolarization phase of the cardiac action potential, while sodium channels are involved in the depolarization phase. Mutations in these channels can lead to prolonged QT intervals, increasing the risk of life-threatening arrhythmias.

Chloride channels are not typically associated with the pathophysiology of congenital long-QT syndromes. The most common mutations involve potassium and sodium channels.

24.

Which of the following is the MOST common method of correcting the measured QT interval for heart rate?

  • Bazett formula

  • Fridericia's method

  • Subject-specific correction method

  • Bonferroni formula

Correct answer: Bazett formula

The Bazett formula is the most common method of correcting the measured QT interval for heart rate: QTc = measured QT interval divided by the square root of the preceding R-R interval (all measurements in seconds).

Fridericia's method and the subject-specific correction method are other formulas (less commonly used) for QT interval rate correction. 

The Bonferroni formula is an adjustment made to P values when multiple statistical tests are being performed concurrently on a single data set. 

25.

Which of the following is a hallmark feature of Acute Respiratory Distress Syndrome (ARDS)?

 

  • Pulmonary edema without heart failure

  • Bronchospasm causing respiratory distress

  • Pulmonary hypertension leading to edema

  • Severe dyspnea and hypercapnia

Correct answer: Pulmonary edema without heart failure

ARDS is characterized by non-cardiogenic pulmonary edema, meaning the fluid in the lungs is not due to heart failure but to increased capillary permeability.

Bronchospasm is associated more with conditions like asthma or COPD, not ARDS. Pulmonary hypertension may occur but is not the hallmark feature of ARDS. Hypercapnia may occur late in the disease, but hypoxemia is the more prominent finding.

26.

You are caring for a 44-year-old female patient admitted with sudden onset of chest pain and dyspnea. Her vital signs are blood pressure 110/65 mmHg, heart rate 115 beats per minute, respiratory rate 26 breaths per minute, and SpO2 91%. Her EKG shows sinus tachycardia with peaked T waves. Laboratory results reveal hyperkalemia. 

Which of the following findings is MOST likely contributing to the patient’s dysrhythmia?

  • Acute kidney injury

  • Recent myocardial infarction

  • Uncontrolled hypertension

  • Hypothyroidism

Correct answer: Acute kidney injury

Hyperkalemia is most likely secondary to Acute Kidney Injury (AKI) since the kidneys are responsible for excreting potassium. In AKI, accumulation of potassium in the blood can lead to dysrhythmias, such as sinus tachycardia with peaked T waves.

A recent myocardial infarction can cause other arrhythmias but is not directly associated with hyperkalemia and peaked T waves. Uncontrolled hypertension may contribute to heart failure or other cardiac issues but is less likely to cause hyperkalemia. Hypothyroidism is associated with bradycardia, not tachycardia or peaked T waves.

27.

Cardiac Output (CO) measurements can be used to rapidly evaluate a patient's hemodynamic status. Which of the following conditions is MOST likely to contribute to an increase in CO?

  • Sepsis

  • Restrictive cardiomyopathy

  • Cardiac tamponade

  • Hypoglycemia

Correct answer: Sepsis

Sepsis often leads to a hyperdynamic state in which the body increases cardiac output as a compensatory mechanism to meet the metabolic demands of tissues due to infection and inflammation.

Restrictive cardiomyopathy restricts the heart's ability to fill properly, leading to decreased cardiac output. In cardiac tamponade, fluid accumulates in the pericardium, leading to compression of the heart and a subsequent decrease in cardiac output. Low blood sugar can impair the body's metabolic functions but is not directly associated with an increase in cardiac output.

28.

Of the following bronchodilators, which are examples of a combination Long-Acting Beta-2 Agonist (LABA) and a corticosteroid used in the treatment of Chronic Obstructive Pulmonary Disease (COPD)?

  • Salmeterol and fluticasone

  • Albuterol and ipratropium bromide

  • Salmeterol and formoterol

  • Albuterol and fluticasone

Correct answer: Salmeterol and fluticasone

Salmeterol and fluticasone are a combination of an LABA and a corticosteroid commonly used in the treatment of COPD. Salmeterol helps to relax the muscles around the airways, making breathing easier, while fluticasone reduces inflammation in the airways, improving symptoms and lung function.

Albuterol and ipratropium bromide are a combination used primarily for acute relief in COPD. Albuterol is a Short-Acting Beta-2 Agonist (SABA), and ipratropium is an anticholinergic agent.

Salmeterol and formoterol are both LABAs and are not combined with a corticosteroid. They are used for long-term control of COPD but not in combination with each other or a corticosteroid.

Albuterol and fluticasone are not a standard combination for COPD treatment. Albuterol is an SABA used for quick relief, while fluticasone is a corticosteroid. The combination of an LABA with a corticosteroid is preferred for long-term management of COPD.

29.

What is the MOST common cause of small bowel obstruction?

  • Adhesions

  • Hernias

  • Inflammatory bowel disease

  • Malignant tumors

Correct answer: Adhesions 

Adhesions are the leading cause of small bowel obstruction. These fibrous bands develop after abdominal surgeries and can cause sections of the intestine to adhere to each other, leading to a blockage. While other potential causes, such as hernias, tumors, and inflammatory conditions, can also result in a small bowel obstruction, adhesions are the most commonly seen in clinical settings.

 

30.

Which of the following is MOST commonly used to replace a stenotic aortic valve without open-heart surgery?

 

  • TAVR

  • Mitral clip

  • CABG

  • Endarterectomy

Correct answer: TAVR

TAVR (Transcatheter Aortic Valve Replacement) is a minimally invasive procedure used to replace a stenotic aortic valve, especially in patients who are not ideal candidates for open-heart surgery. The procedure is performed via a catheter, which avoids the need for open-chest surgery.

A mitral clip is a device used for treating mitral regurgitation, not aortic stenosis. Coronary Artery Bypass Grafting (CABG) is used for revascularization in patients with coronary artery disease, not for valve replacement. Endarterectomy is the removal of plaque from arteries, primarily for carotid artery stenosis, not for valve replacement.

31.

Which statement accurately describes the regulation of cerebral blood flow?

  • Vasodilation of cerebral vessels occurs in response to decreased blood pressure

  • Increased blood pressure results in vasodilation of cerebral vessels

  • An increase in arterial carbon dioxide pressure results in constriction of the cerebral vessels

  • A buildup of lactic acid in the bloodstream causes constriction of cerebral vessels

Correct answer: Vasodilation of cerebral vessels occurs in response to decreased blood pressure

Cerebral autoregulation allows the brain to maintain a constant blood flow despite changes in systemic blood pressure. When blood pressure decreases, cerebral vessels dilate to ensure adequate blood flow to the brain. This is a protective mechanism to prevent ischemia.

Increased blood pressure typically causes cerebral vessels to constrict, not dilate, as part of the autoregulatory mechanism to prevent excessive blood flow and potential damage to the brain.

An increase in arterial carbon dioxide pressure (PaCO2) results in cerebral vasodilation, not constriction. Elevated PaCO2 levels indicate hypercapnia, leading to increased cerebral blood flow to remove excess carbon dioxide.

A buildup of lactic acid in the bloodstream causes cerebral vasodilation, not constriction. Lactic acidosis can occur due to anaerobic metabolism, prompting cerebral vessels to dilate to increase blood flow and oxygen delivery to the brain.

32.

A 27-year-old male patient is brought to the emergency department by ambulance after falling from a ladder while working on a construction site. Witnesses state that he was climbing down when he lost his footing and fell approximately 10 feet, landing headfirst on the concrete pavement. The patient was wearing a helmet, but it came off during the fall. On arrival, he is confused and disoriented, with a Glasgow Coma Scale (GCS) score of 12. A visible contusion is noted on his forehead.

Based on the mechanism of injury, which of the following processes is MOST likely responsible for the brain injury this patient sustained when his head struck the pavement?

  • Deceleration

  • Acceleration

  • Blast injury

  • Penetrating trauma

Correct answer: Deceleration

When the head is moving and suddenly stops upon striking a stationary object (such as the pavement), the brain continues to move within the skull, causing it to collide with the inner surface of the skull. This process is known as deceleration, which is a common mechanism of injury in falls, motor vehicle collisions, and other similar trauma events.

Acceleration occurs when a stationary head is struck by a moving object, leading to the rapid movement of the brain within the skull. 

Blast injury is associated with exposure to an explosion, causing a pressure wave that can result in brain injury. 

Penetrating trauma occurs when an object pierces the skull and directly damages brain tissue, which does not apply to this scenario.

33.

Which of the following is a characteristic feature of dilated cardiomyopathy?

  • Enlarged heart chambers with decreased ejection fraction

  • Thickened heart muscle with reduced ventricular volume

  • Stiffened heart muscle that restricts ventricular filling

  • Inflammation of the heart muscle with no structural changes

Correct answer: Enlarged heart chambers with decreased ejection fraction

Dilated cardiomyopathy is characterized by the dilation of the heart chambers, particularly the left ventricle, and a reduced ability of the heart to pump blood, resulting in a decreased ejection fraction.

Thickened heart muscle with reduced ventricular volume is hypertrophic cardiomyopathy.

Stiffened heart muscle that restricts ventricular filling is characteristic of restrictive cardiomyopathy.

Myocarditis involves inflammation of the heart muscle without the typical structural changes seen in cardiomyopathies.

34.

In assessing the motor portion of the Glasgow Coma Scale (GCS), the response in each extremity is tested. Which of the following is used in calculating the total score for this category?

  • The best motor response observed in any one extremity

  • The motor response in the dominant extremity

  • The average motor response across all extremities

  • The motor response in the least responsive extremity

Correct answer: The best motor response observed in any one extremity

When assessing the motor portion of the GCS, the total score for this category is based on the best motor response observed in any one extremity. The GCS is designed to assess the level of consciousness and neurological functioning by evaluating eye-opening, verbal response, and motor response. The motor response component of the GCS is scored from 1 to 6, and 6 is the best possible score for obeying commands.

35.

A 72-year-old female patient is admitted with acute shortness of breath and severe hypoxemia. Her SpO2 is 85% despite oxygen therapy, and her ABG reveals a PaO2 of 52 mmHg. 

What is the MOST appropriate initial intervention?

  • Non-Invasive Positive Pressure Ventilation (NIPPV)

  • Endotracheal intubation

  • Increased oxygen flow via nasal cannula

  • Bronchodilators

Correct answer: Non-Invasive Positive Pressure Ventilation (NIPPV)

In patients with acute hypoxemia who are unresponsive to conventional oxygen therapy, NIPPV can rapidly improve oxygenation and reduce the work of breathing. NIPPV is a noninvasive option that helps avoid intubation in some cases.

Endotracheal intubation is considered when NIPPV fails or the patient’s condition deteriorates further.
Increasing the oxygen flow via nasal cannula would be insufficient for this level of hypoxemia. Bronchodilators may help with airway constriction but are not the primary intervention for acute respiratory failure.

36.

How can auto-Positive End-Expiratory Pressure (PEEP) be minimized in a ventilated patient?

  • Avoid overventilation

  • Decrease inspiratory flow rates

  • Use smaller-diameter endotracheal tubes

  • Auto-PEEP is intrinsic; there is no way to minimize its occurrence

Correct answer: Avoid overventilation

Auto-PEEP, also called intrinsic PEEP, happens when a breath is not fully exhaled before the next one begins, leading to gas trapping and increasing the risk of complications from PEEP. Patients on ventilators, especially those with COPD or high respiratory rates, are more likely to develop auto-PEEP. To reduce auto-PEEP, it's important to avoid overventilation.

Additionally, auto-PEEP can be minimized by lengthening the expiration time (such as by increasing inspiratory flow rates) and using larger-diameter endotracheal tubes to reduce obstructions to expiratory flow.

37.

Acute Respiratory Failure (ARF) can occur as a result of many abnormalities, but regardless of the specific underlying condition, the etiology of ARF in adults can be categorized into four main components: impaired ventilation, impaired gas exchange, airway obstruction, and ventilation-perfusion abnormalities. 

Which of the following conditions impairs gas exchange?

  • Pneumonia

  • Pleural effusion

  • Pulmonary embolism

  • Chronic Obstructive Pulmonary Disease (COPD)

Correct answer: Pneumonia

Pneumonia leads to impaired gas exchange because the infection causes inflammation and consolidation in the alveoli, preventing proper oxygenation of blood.

Pleural effusion primarily causes impaired ventilation due to fluid accumulation in the pleural space, preventing full lung expansion, rather than directly impairing gas exchange.

Pulmonary embolism causes ventilation-perfusion mismatching but does not directly impair gas exchange within the alveoli. 

While COPD can contribute to impaired ventilation and ventilation-perfusion mismatching, it primarily leads to obstructive airway issues rather than directly impairing gas exchange.

38.

You are caring for a 66-year-old male patient with a fever of 102.3°F, a respiratory rate of 22 breaths/min, and a recent diagnosis of Carbapenem-Resistant Enterobacteriaceae (CRE) pneumonia. The patient has been receiving treatment for 48 hours but remains febrile and tachypneic. 

Which of the following findings is LEAST likely to suggest treatment failure due to antibiotic resistance?

  • Growth of multiple organisms in the patient's sputum culture

  • Continued fever and respiratory symptoms after 48 hours of treatment

  • CRE identified as the primary pathogen in the culture

  • Increased white blood cell count despite antibiotic therapy

Correct answer: Growth of multiple organisms in the patient's sputum culture

The presence of multiple organisms in sputum culture could indicate colonization or secondary infection rather than directly pointing to antibiotic treatment failure for CRE pneumonia.

Continued fever and respiratory symptoms after 48 hours, identification of CRE as the pathogen, and increased white blood cell count despite antibiotics are more concerning signs of treatment failure due to resistance.

39.

Adequate closure of which of the following is important so that blood is ejected forward into the aorta, NOT backward into the left atrium, during ventricular systole?

  • Mitral valve

  • Tricuspid valve

  • Aortic valve

  • Pulmonary valve

Correct answer: Mitral valve

The mitral valve is situated between the left atrium and the left ventricle. During ventricular systole, the mitral valve must close properly to prevent the backflow of blood into the left atrium and ensure that blood is effectively ejected into the aorta through the aortic valve. If the mitral valve fails to close adequately, a condition known as mitral regurgitation may occur, in which blood leaks back into the left atrium, reducing cardiac output and increasing pressure in the pulmonary circulation.

The tricuspid valve is located between the right atrium and right ventricle and prevents backflow of blood into the right atrium during right ventricular systole. The aortic valve is located between the left ventricle and the aorta, and it must open properly to allow blood to flow into the aorta, but it does not prevent backflow into the left atrium. The pulmonary valve is located between the right ventricle and the pulmonary artery and functions similarly to the aortic valve, but it does not affect the left atrium or left ventricular ejection.

40.

Which of the following is the MOST common complication of hemodialysis?

 

  • Hypotension

  • Hypokalemia

  • Hypercalcemia

  • Hypertension

Correct answer: Hypotension

During dialysis, fluid is removed from the blood, which can decrease blood volume and result in hypotension. 

Hypokalemia can occur with dialysis, but it is not as common as hypotension. Hypertension is not a typical complication during the dialysis process itself but can be a concern in patients with chronic kidney disease. Hypercalcemia is not a common complication of hemodialysis; in fact, dialysis is more often associated with hypocalcemia if calcium is not adequately replaced.