PCCN Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

Vasovagal reaction to sheath removal: A vasovagal reaction causes hypotension with bradycardia, usually during or right after sheath removal. This patient is tachycardic hours later.

Retroperitoneal hemorrhage: Correct. Back or flank pain with tachycardia and hypotension after femoral access, without a visible hematoma, suggests bleeding into the retroperitoneal space. Notify the provider, give fluids, hold anticoagulants as ordered and expect a CT.

Pseudoaneurysm at the femoral access site: A pseudoaneurysm presents as a pulsatile groin mass with a bruit. It does not usually cause back pain with hemodynamic collapse.

Acute thrombosis of the new coronary stent: Stent thrombosis causes recurrent chest pain and new ST changes, not flank pain with a soft groin.

After femoral PCI, a soft groin with no hematoma does not rule out bleeding. Back or flank pain plus tachycardia and hypotension means retroperitoneal hemorrhage until proven otherwise.

Answer: D

Metabolic alkalosis, uncompensated: Metabolic alkalosis requires a pH above 7.45. The pH here is acidotic.

Respiratory acidosis, fully compensated: Full compensation would bring the pH back into the normal range (7.35-7.45). At 7.30 it has not.

Respiratory acidosis, uncompensated (acute): Uncompensated means HCO3- is still normal (22-26 mEq/L). Here HCO3- is elevated, showing renal compensation is under way.

Respiratory acidosis, partially compensated: Correct. pH is low with a high PaCO2 (respiratory cause), and HCO3- is elevated in the compensating direction but has not normalized the pH. This is typical of acute-on-chronic hypercapnia in COPD.

ABG steps: pH (acid or base), PaCO2 vs HCO3- (which matches the pH), then compensation: none (other value normal), partial (other value abnormal, pH abnormal) or full (pH normal).

Answer: D

Oral N-acetylcysteine twice daily beforehand: Large trials (such as PRESERVE) found no benefit of N-acetylcysteine for preventing contrast-associated AKI.

IV furosemide just before the contrast load: Diuretics before contrast can cause volume depletion and have been associated with more kidney injury, not less.

Fluid restriction for 12 hours before the test: Volume depletion increases contrast nephrotoxicity, so restricting fluids raises risk.

IV isotonic fluids before and after the procedure: Correct. Isotonic IV hydration around the procedure, plus using the lowest contrast volume and holding nephrotoxins when possible, is the recommended protective strategy.

Renal protection for contrast procedures: hydrate with isotonic fluid, minimize contrast, avoid nephrotoxins. N-acetylcysteine and diuretics do not help.

Answer: C

Request a psychiatric consult for tomorrow morning: Psychiatric evaluation is needed, but it does not provide immediate safety for a patient voicing intent now.

Ask family to bring in home medications for review: Bringing medications into the room adds means. Reviewing home medications is not the immediate safety priority.

Start continuous 1:1 observation and remove hazards: Correct. A stated intent to repeat the attempt indicates high, imminent risk. Continuous observation and an environment free of ligature points, sharps and medications come first, then urgent psychiatric evaluation.

Reassure the patient that things will get better: False reassurance dismisses the patient's feelings and does nothing to reduce immediate risk.

Voiced intent after an attempt = high risk: ensure immediate safety (1:1 observation, environmental safety), then a structured risk assessment and psychiatric evaluation.

Answer: A

Notify the provider; confirm informed refusal: Correct. A patient with capacity may refuse care. The nurse involves the provider, makes sure the risks and alternatives are understood, offers safer options (such as oral medication and follow-up), and documents the discussion.

Apply soft restraints until the provider arrives: Restraining a competent adult to prevent departure is false imprisonment and violates restraint standards.

Tell him insurance will refuse to pay if he leaves: This is a common myth and a coercive misstatement. It does not respect informed decision-making.

Remove the IV and let him leave without any notice: Leaving without provider involvement, risk discussion or follow-up planning fails the nurse's duty to advocate and ensure safety.

Advocacy is not the same as control: respect informed decisions by capable patients while reducing harm through explanation, alternatives and follow-up.

Answer: C

'He was admitted yesterday with community-acquired pneumonia.': Admission diagnosis and history are Background.

'I'm calling about Mr. J. in room 12, who is newly short of breath.': Who the patient is and the immediate problem make up the Situation.

'I think he may be developing sepsis, and he is getting worse.': Correct. Assessment is the nurse's clinical interpretation of the problem based on the data gathered.

'I would like you to come and evaluate him within 15 minutes.': A specific request for action is the Recommendation.

SBAR: Situation (what is happening), Background (context), Assessment (what I think the problem is), Recommendation (what I need you to do, and by when).