Free PCCN Practice Test: 50 Questions With Rationales

Correct answer: C. Synchronized cardioversion

Low blood pressure plus new confusion means this tachycardia is unstable. For hemodynamically unstable regular narrow-complex tachycardia with a pulse, the 2025 AHA guidance calls for immediate synchronized cardioversion. Synchronizing times the shock to the QRS complex so it isn't delivered during the vulnerable T wave.

Why the other options are wrong:

• A. An IV diltiazem infusion — Diltiazem can lower blood pressure further and delays the electrical therapy this unstable patient needs.
• B. Transcutaneous pacing — Pacing treats symptomatic bradycardia. It has no role in stopping a rapid rhythm like this one.
• D. An unsynchronized high-energy shock — Unsynchronized shocks are for pulseless VF/VT and polymorphic VT, which can't be synchronized. This unstable regular narrow-complex tachycardia should be cardioverted with synchronization.

Takeaway: Decide on rhythm, pulse, and stability together. Unstable regular narrow-complex tachycardia with a pulse points to synchronized cardioversion.

Source: AHA 2025 Guidelines, Part 9: Adult Advanced Life Support, section 17, Regular Narrow-Complex Tachycardia: hemodynamically unstable tachycardia and synchronized cardioversion. · Item PCCN-FREE-001 · AACN test plan 1A.9

Correct answer: A. Acute-on-chronic hypercapnic respiratory acidosis; anticipate bilevel NIV

The pH is below 7.35 and the PaCO2 is high, so this is respiratory acidosis. The documented baseline hypercapnia and raised bicarbonate support an acute-on-chronic process, but the patient is still acidemic, so it is not fully compensated. The ERS/ATS guideline recommends bilevel NIV for COPD exacerbations with acute or acute-on-chronic hypercapnic respiratory failure. This patient is alert and protecting the airway, which makes NIV appropriate.

Why the other options are wrong:

• B. Metabolic alkalosis; increase the oxygen to 6 L/min by nasal cannula — The pH is acidemic, not alkalemic. Uncontrolled oxygen can also worsen hypercapnia.
• C. Fully compensated respiratory acidosis; continue the current therapy — Full compensation would bring the pH near normal. A pH of 7.28 is not fully compensated.
• D. Primary metabolic acidosis; anticipate an IV sodium bicarbonate infusion — A high bicarbonate and a high PaCO2 point to a respiratory problem, not a metabolic acidosis.

Takeaway: In a COPD exacerbation, a pH below 7.35 with a high PaCO2 in an alert patient points to bilevel NIV.

Source: ERS/ATS Clinical Practice Guideline: Noninvasive Ventilation for Acute Respiratory Failure (2017), recommendations for COPD exacerbation with acute or acute-on-chronic hypercapnic respiratory failure. · Item PCCN-FREE-011 · AACN test plan 2A.3

Correct answer: B. Replace potassium and hold insulin until potassium is above 3.5 mmol/L

Insulin drives potassium into cells and can cause dangerous hypokalemia. The 2024 hyperglycemic crises consensus report says that when potassium is below 3.5 mmol/L, replacement should begin and insulin should be postponed until potassium rises above 3.5 mmol/L. The nurse starts replacement per orders and confirms the plan with the provider.

Why the other options are wrong:

• A. Start the insulin infusion now; potassium will rise as acidosis corrects — Insulin lowers serum potassium. Starting it at 3.2 mmol/L risks arrhythmias.
• C. Give an IV insulin bolus to clear the ketones faster — Any insulin at this potassium level carries the same hypokalemia risk.
• D. Give IV sodium bicarbonate before any other treatment — The consensus doesn't recommend routine bicarbonate. It's considered only for severe acidosis, pH below 7.0.

Takeaway: In DKA, check potassium before insulin. Below 3.5 mmol/L, replace first.

Source: Hyperglycemic Crises in Adults With Diabetes: A Consensus Report (Diabetes Care, 2024), Potassium and Bicarbonate subsections: delay insulin while K+ <3.5 mmol/L until K+ >3.5 mmol/L; consider bicarbonate for pH <7.0. · Item PCCN-FREE-018 · AACN test plan 3A.2

Correct answer: C. Use NEWS, MEWS, or SIRS rather than qSOFA as the single tool

The 2026 Surviving Sepsis guideline makes a strong recommendation to use NEWS, NEWS2, MEWS, or SIRS over qSOFA as a single screening tool for acutely ill hospitalized patients. It also states that sepsis is a clinical diagnosis that no single biomarker can rule in or out.

Why the other options are wrong:

• A. Use qSOFA alone as the unit's single screening tool — The guideline recommends against qSOFA as the single screening tool.
• B. Screen every acutely ill patient with a single procalcitonin level — No single biomarker should rule sepsis in or out.
• D. Check a lactate level only after hypotension develops — Waiting for hypotension misses the early window that screening is meant to catch.

Takeaway: For hospital sepsis screening, the 2026 guidance favors NEWS, MEWS, or SIRS over qSOFA alone.

Source: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026, Screening recommendations. · Item PCCN-FREE-032 · AACN test plan 4B.9

Correct answer: C. Raise her stated priority in the discussion and support her in voicing it

In AACN's Synergy Model, advocacy and moral agency mean working on another's behalf and representing the patient's concerns. The patient's priorities belong in the planning discussion, and a capable patient should be supported to speak for herself.

Why the other options are wrong:

• A. Stay quiet, because placement is ultimately the team's decision — This leaves out the patient's own priorities, which advocacy exists to bring forward.
• B. Tell her afterward that the facility is required for safety — This overrides a capable patient's input without discussing options.
• D. Ask her family to decide on placement on her behalf — A capable patient makes her own decisions. Family involvement doesn't replace her voice.

Takeaway: Advocacy means making sure the patient's priorities are heard in the room where decisions are made.

Source: AACN PCCN Exam Handbook – Direct Care (July 2026), page 9, AACN Synergy Model nurse characteristics (Advocacy/Moral Agency). · Item PCCN-FREE-041 · AACN test plan 5A

Correct answer: C. Transcutaneous pacing

This is persistent symptomatic bradycardia that didn't respond to atropine. Transcutaneous pacing is the electrical option that raises the heart rate while the team arranges further treatment, such as transvenous pacing. A beta-adrenergic infusion is another accepted option, but the question asks for an electrical bridge.

Why the other options are wrong:

• A. Synchronized cardioversion — Cardioversion ends tachyarrhythmias. It won't raise a slow rate.
• B. Unsynchronized defibrillation — Defibrillation doesn't treat this slow organized rhythm.
• D. A vagal maneuver — Vagal maneuvers slow AV conduction, which would make this bradycardia worse.

Takeaway: When symptomatic bradycardia doesn't respond to atropine, the electrical bridge is pacing, not a shock.

Source: AHA 2025 Guidelines, Part 9: Adult Advanced Life Support, section 19, Initial Management of Bradycardia: atropine-unresponsive bradycardia, pacing and adrenergic infusion options. · Item PCCN-FREE-002 · AACN test plan 1A.9

Correct answer: D. CPAP or bilevel noninvasive ventilation

For acute respiratory failure from cardiogenic pulmonary edema, the ERS/ATS guideline recommends noninvasive positive-pressure ventilation (bilevel or CPAP) for patients like this one; cardiogenic shock and acute coronary syndrome were excluded from the evidence underlying that recommendation. Positive pressure improves oxygenation and reduces preload and work of breathing.

Why the other options are wrong:

• A. Continue the nonrebreather alone and recheck in an hour — The patient is already hypoxemic and working hard on high-flow mask oxygen. Waiting postpones effective support.
• B. Immediate intubation — An alert, cooperative patient who isn't in shock is an NIV candidate. Intubation is for failure or contraindications.
• C. Incentive spirometry every hour — Incentive spirometry doesn't provide the ventilatory support needed for this acute respiratory failure.

Takeaway: Cardiogenic pulmonary edema without shock or ACS: think CPAP or bilevel early.

Source: ERS/ATS Clinical Practice Guideline: Noninvasive Ventilation for Acute Respiratory Failure (2017), recommendation for acute respiratory failure due to cardiogenic pulmonary edema, including stated exclusions. · Item PCCN-FREE-012 · AACN test plan 2A.12a

Correct answer: A. Stop all heparin, including flushes, and anticipate a non-heparin anticoagulant

HIT is a prothrombotic immune reaction, and the new leg swelling suggests thrombosis. The ASH algorithm for high-probability suspected HIT is to stop every heparin exposure and start a non-heparin anticoagulant. Stopping anticoagulation altogether would leave the clotting process untreated.

Why the other options are wrong:

• B. Switch the heparin infusion to low-molecular-weight heparin injections — Low-molecular-weight heparin cross-reacts with HIT antibodies and must also be avoided.
• C. Stop all anticoagulation until the platelet count recovers — HIT carries a high thrombosis risk. It needs a non-heparin anticoagulant, not none.
• D. Request a platelet transfusion to correct the thrombocytopenia — Routine platelet transfusion is not recommended for acute HIT at average bleeding risk; the priority here is stopping heparin and arranging appropriate anticoagulation.

Takeaway: Acute HIT means no heparin in any form, but it still needs anticoagulation with a different drug.

Source: American Society of Hematology 2018 HIT Guideline – Pocket Guide, p. 2: high-probability 4Ts pathway; p. 4: Platelet Transfusion recommendations. · Item PCCN-FREE-021 · AACN test plan 3B.2

Correct answer: B. Keep the patient NPO and request a formal swallowing assessment

A wet or gurgly voice after swallowing is a sign of possible aspiration, and aspiration can happen with no cough at all (silent aspiration). ASHA distinguishes a screen, which identifies risk, from a full assessment, which defines swallow safety. This patient needs the assessment before any oral intake, including medications.

Why the other options are wrong:

• A. The patient passed the screen because there was no cough; start a regular diet — A lack of coughing isn't proof of a safe swallow.
• C. Give the oral medications crushed in applesauce with supervision — A failed screen has not established that food or oral medications can be swallowed safely; changing the texture doesn't substitute for assessment.
• D. Allow thin liquids today and repeat the screen in 24 hours — Swallow safety has not been established. Allowing thin liquids while delaying assessment ignores the warning sign.

Takeaway: Screen, don't assume. A wet voice is a warning sign even without a cough.

Source: ASHA Practice Portal: Adult Dysphagia, Signs and Symptoms; Assessment – Screening. · Item PCCN-FREE-023 · AACN test plan 3C.3

Correct answer: B. Ask the provider whether monitoring can safely be reduced, and cluster care

The Synergy Model describes caring practices as creating a compassionate, supportive environment that promotes comfort and prevents unnecessary suffering, while keeping up vigilance. Adjusting monitoring through the proper channel does both.

Why the other options are wrong:

• A. Continue hourly checks without discussion, since they are ordered — Vigilance matters, but so does asking whether the care plan can better balance rest with monitoring.
• C. Skip the overnight checks without telling anyone so the patient can sleep — Changing monitoring without an order or communication isn't safe practice.
• D. Give a sleep medication and keep the hourly checks unchanged — This treats the symptom and leaves the cause in place.

Takeaway: Caring practice balances comfort with vigilance, and changes go through the team.

Source: AACN PCCN Exam Handbook – Direct Care (July 2026), page 9, AACN Synergy Model nurse characteristics (Caring Practices). · Item PCCN-FREE-042 · AACN test plan 5B

Correct answer: A. Coach the patient through a vagal maneuver on the monitor

The patient is stable, and the rhythm is a regular narrow-complex tachycardia. The 2025 AHA guidance supports vagal maneuvers, such as a modified Valsalva, for initial management of regular narrow-complex tachycardia. Adenosine is usually the next step if the maneuver fails, but the question asked for a nonpharmacologic option.

Why the other options are wrong:

• B. Prepare the patient for synchronized cardioversion — Cardioversion is for unstable patients or when vagal maneuvers and drugs fail. This patient is stable.
• C. Give a 1-liter normal saline bolus over 30 minutes — A fluid bolus doesn't interrupt a reentrant rhythm, and nothing here suggests hypovolemia.
• D. Apply oxygen by nonrebreather mask at 15 L/min — SpO2 is normal, and oxygen won't terminate the tachycardia.

Takeaway: Stable regular narrow-complex tachycardia: try vagal maneuvers first, then adenosine. Save electricity for instability or failure.

Source: AHA 2025 Guidelines, Part 9: Adult Advanced Life Support, section 17, Regular Narrow-Complex Tachycardia: vagal maneuvers in stable patients. · Item PCCN-FREE-003 · AACN test plan 1A.9

Correct answer: B. Early favorable response; continue NIV and monitor closely

Falling PaCO2, rising pH, a lower respiratory rate, and less work of breathing all point the same way: the patient is responding. The ERS/ATS guideline emphasizes close monitoring during an NIV trial, because early trends help separate responders from patients who are failing.

Why the other options are wrong:

• A. NIV is failing; prepare the patient for intubation — Every trend is improving. Nothing here suggests failure.
• C. Remove NIV because the pH is still below 7.35 — Improvement doesn't have to be complete at one hour. Stopping now risks losing the gains.
• D. Increase the oxygen to reach an SpO2 of 98% — In hypercapnic COPD, aiming for high saturations risks worsening CO2 retention.

Takeaway: Judge NIV by the direction of pH, PaCO2, respiratory rate, and effort, not by whether the numbers are normal yet.

Source: ERS/ATS Clinical Practice Guideline: Noninvasive Ventilation for Acute Respiratory Failure (2017), implementation considerations and monitoring during NIV. · Item PCCN-FREE-013 · AACN test plan 2A.12a

Correct answer: C. Start contact precautions now while the result is pending

CDC guidance calls for contact precautions for patients with suspected or confirmed C. difficile infection. Waiting for the result allows spread in the meantime. C. difficile spores resist alcohol, but CDC still prefers alcohol-based hand sanitizer in most clinical situations when hands are not visibly soiled, including CDI care. Soap and water are used for visibly soiled hands and encouraged as an additional precaution during outbreaks; gloves, gowns, and hand hygiene remain essential.

Why the other options are wrong:

• A. Wait for the test result before starting any precautions — Waiting for confirmation leaves a patient with suspected infection without the recommended contact precautions.
• B. Use standard precautions and alcohol-based hand rub only — Standard precautions alone aren't enough. Hand hygiene does not replace the gown and gloves required for contact precautions.
• D. Start airborne precautions with an N95 respirator — C. difficile spreads by contact, not through the air.

Takeaway: Suspected C. diff: start contact precautions now, with gown, gloves, and appropriate hand hygiene.

Source: CDC: Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, Isolate and initiate contact precautions for suspected or confirmed CDI; CDC: Clinical Safety — Hand Hygiene for Healthcare Workers, Follow specific recommendations when treating confirmed or suspected C. difficile infection; additional soap-and-water precaution during outbreaks. · Item PCCN-FREE-026 · AACN test plan 3D.3

Correct answer: D. About 0.36 mL/kg/hour, which meets the KDIGO urine-output criterion for AKI; report it

25 ÷ 70 = 0.357, or about 0.36 mL/kg/hour. KDIGO defines AKI to include urine output below 0.5 mL/kg/hour for 6 hours. This patient meets that definition, which calls for prompt reporting and evaluation of the cause.

Why the other options are wrong:

• A. About 0.36 mL/kg/hour, which is above the 0.3 threshold, so no report is needed — A rate below 0.3 mL/kg/hour belongs to KDIGO's more severe staging (sustained 24 hours or longer). The diagnostic threshold is 0.5.
• B. About 2.8 mL/kg/hour, which is normal — This inverts the division (70 ÷ 25). The unit math doesn't work.
• C. About 0.6 mL/kg/hour, which is normal — The arithmetic is wrong. 25 ÷ 70 is about 0.36.

Takeaway: Urine output below 0.5 mL/kg/hour for 6 hours meets the AKI definition. Divide by weight in kilograms.

Source: KDIGO Clinical Practice Guideline for Acute Kidney Injury (2012), printed p. 19 (PDF page 22), recommendation 2.1.1 and Table 2: urine-output definition and staging. · Item PCCN-FREE-029 · AACN test plan 3E.1

Correct answer: A. Ask the patient how she wants to receive information and who to include

In the Synergy Model, response to diversity means recognizing and incorporating individual differences. That starts with this patient's own preferences, not assumptions about a group.

Why the other options are wrong:

• B. Follow the colleague's suggestion and speak with the son first — This rests on a stereotype and bypasses the patient's own wishes.
• C. Avoid discussing the prognosis with anyone in the family — Withholding information can leave the patient unable to make her own decisions.
• D. Ask the son privately what his mother would want to know — The patient can answer this herself. Ask her first.

Takeaway: Culture informs the questions you ask. It doesn't answer them for the patient.

Source: AACN PCCN Exam Handbook – Direct Care (July 2026), page 9, AACN Synergy Model nurse characteristics (Response to Diversity). · Item PCCN-FREE-043 · AACN test plan 5C

Correct answer: A. An unsynchronized high-energy shock (defibrillation)

Changing QRS shapes mean polymorphic VT. The 2025 AHA guidance treats polymorphic VT as unstable and calls for immediate shock delivery. The defibrillator can't reliably sync to QRS complexes that keep changing, so the shock is delivered unsynchronized at high energy. Magnesium may be considered for recurrent torsades de pointes associated with a long QT interval, but it doesn't replace the shock.

Why the other options are wrong:

• B. Synchronized cardioversion — The device may fail to sync to a changing QRS, which delays a shock the patient needs now.
• C. Transcutaneous pacing — Pacing is not the immediate treatment for sustained polymorphic VT.
• D. Obtain a 12-lead ECG before any electrical therapy — This delays the immediate shock recommended for sustained polymorphic VT. Diagnostic detail comes after treatment.

Takeaway: Unstable monomorphic VT with a pulse gets synchronized cardioversion. Sustained polymorphic VT gets an unsynchronized shock.

Source: AHA 2025 Guidelines, Part 9: Adult Advanced Life Support, section 16, Polymorphic Ventricular Tachycardia: immediate unsynchronized shock; long-QT recurrent torsades. · Item PCCN-FREE-004 · AACN test plan 1A.9

Correct answer: D. Titrate oxygen to an SpO2 of 88–92%

In COPD exacerbations with a risk of hypercapnia, titrating oxygen to 88–92% improves outcomes compared with untitrated high-flow oxygen. Excess oxygen can worsen CO2 retention, but the saturation alone does not establish why this patient is drowsy. The pending ABG and the change in mental status still need prompt follow-up.

Why the other options are wrong:

• A. Keep the SpO2 at 94–98% — This target suits patients who aren't at risk of hypercapnia. It's too high for this patient.
• B. Raise the oxygen to keep the SpO2 at 99% or higher for reserve — Increasing oxygen further risks worsening hypercapnia; the drowsiness needs urgent assessment, not a higher saturation target.
• C. Stop oxygen entirely until the ABG results — Removing oxygen risks dangerous hypoxemia. The goal is titration, not withdrawal.

Takeaway: A hypercapnic COPD patient on oxygen should be titrated to 88–92%, not maximized.

Source: ERS/ATS Clinical Practice Guideline: Noninvasive Ventilation for Acute Respiratory Failure (2017), Question 1a, p. 4: oxygen targeted to 88–92% during COPD exacerbation; Question 1b: close monitoring of hypercapnic respiratory failure. · Item PCCN-FREE-014 · AACN test plan 2A.3

Correct answer: A. Not resolved; continue insulin with dextrose per protocol

Glucose falls faster than ketosis clears. The 2024 consensus defines DKA resolution as ketones below 0.6 mmol/L plus a venous pH of at least 7.3 or bicarbonate of at least 18 mmol/L. This patient meets none of those. Dextrose is added as glucose falls so insulin can continue until the ketosis clears.

Why the other options are wrong:

• B. Resolved, because the glucose is now below 200 mg/dL — Glucose alone doesn't define resolution. The ketones and acid-base values are still abnormal.
• C. Stop the infusion and switch to correctional (sliding-scale) insulin — Stopping IV insulin before resolution risks rebound ketoacidosis.
• D. Stop the dextrose because the glucose is now controlled — Dextrose is what allows insulin to continue safely while the ketones clear.

Takeaway: DKA is over when the ketones and acidosis resolve, not when the glucose drops.

Source: Hyperglycemic Crises in Adults With Diabetes: A Consensus Report (Diabetes Care, 2024), Insulin and Criteria for Resolution of DKA and HHS: ketones <0.6 mmol/L and (venous pH ≥7.3 or bicarbonate ≥18 mmol/L). · Item PCCN-FREE-019 · AACN test plan 3A.2

Correct answer: B. Draw blood cultures now, then give antimicrobials immediately

The 2026 guideline recommends collecting blood cultures as soon as possible and ideally before antimicrobials. For septic shock, it recommends giving antimicrobials immediately, ideally within 1 hour of recognition. A few minutes to collect cultures is acceptable, but a meaningful delay in antibiotics is not.

Why the other options are wrong:

• A. Wait for the culture results before choosing an antimicrobial — Waiting for culture results delays treatment. Septic shock needs empiric antimicrobials now.
• C. Wait for a procalcitonin result before starting antimicrobials — The guideline suggests clinical evaluation alone, not procalcitonin, to decide whether to start antimicrobials.
• D. Hold antimicrobials until a repeat lactate confirms shock — Shock is already recognized. Waiting costs time the guideline says not to lose.

Takeaway: In septic shock, draw cultures quickly and give antimicrobials immediately, ideally within 1 hour of recognition.

Source: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026, Blood culture and Antibiotic initiation recommendations. · Item PCCN-FREE-033 · AACN test plan 4B.9

Correct answer: B. Ask him to explain the plan in his own words, then reteach gaps

AHRQ's teach-back method asks patients to explain in their own words, which tests how clear the teaching was, not how smart the patient is. Any gaps are retaught until the explanation is correct.

Why the other options are wrong:

• A. Ask him, "Do you understand what to do?" — A yes/no question invites a polite "yes" and doesn't show understanding.
• C. Give him a handout and document that teaching was done — Handing out material doesn't confirm comprehension.
• D. Have him repeat the definition of heart failure back to you — Reciting a definition doesn't show he can act on the plan.

Takeaway: Teach-back: "Tell me in your own words what you'll do."

Source: AHRQ Health Literacy Toolkit: Tool 5, Use the Teach-Back Method, Overview and actions. · Item PCCN-FREE-044 · AACN test plan 5D

Correct answer: A. About 550 ms; report it, check K+ and Mg2+, anticipate holding the drug

√0.64 = 0.8, and 440 ÷ 0.8 = 550 ms, a 100 ms rise from the supplied baseline. AHA's 2025 guidance identifies increased torsades risk with QTc above 500 ms and recognizes medication- and electrolyte-related causes. Report the finding promptly so the team can review the ECG, the medication, and potassium and magnesium results before deciding whether to hold the next dose. The calculation answers the formula given; it doesn't by itself establish a diagnosis or a medication order.

Why the other options are wrong:

• B. 440 ms, which is acceptable; continue routine QTc monitoring — 440 ms is the uncorrected QT. At a rate of 94/min it has to be corrected for heart rate.
• C. About 688 ms; begin chest compressions and call for help — Dividing by the RR interval instead of its square root gives a wrong number. And this adult with a perfusing sinus rhythm does not need chest compressions.
• D. About 550 ms, an expected drug effect; recheck at the next routine interval — The math is right, but waiting ignores a torsades risk that needs reporting and correction now.

Takeaway: Take the square root of RR before you divide, with RR in seconds. A newly prolonged QTc needs prompt ECG, medication, and electrolyte review.

Source: AHA 2025 Guidelines, Part 9: Adult Advanced Life Support, section 16, Polymorphic Ventricular Tachycardia: long QT, medication/electrolyte causes, and risk above QTc 500 ms; arithmetic derived from the formula supplied in this item. · Item PCCN-FREE-005 · AACN test plan 1A.9

Correct answer: B. Support breathing with bag-mask ventilation and give naloxone per protocol

The patient has a pulse but isn't breathing adequately, so ventilation comes first. The 2025 AHA guidance supports giving naloxone for suspected opioid overdose, but ventilation must not wait for the drug to work. The PCA should also be stopped.

Why the other options are wrong:

• A. Give naloxone, then wait to see whether breathing improves before ventilating — Hypoxemia continues while you wait. Naloxone is given alongside ventilatory support, not instead of it.
• C. Begin chest compressions — A pulse is present. Compressions are for cardiac arrest.
• D. Apply a nonrebreather mask at 15 L/min and reassess in 5 minutes — A nonrebreather mask alone doesn't correct severe hypoventilation. Ventilation is required.

Takeaway: A pulse with inadequate breathing means ventilate first. Naloxone helps, but it doesn't replace breaths.

Source: AHA 2025 Guidelines, Part 10: Adult and Pediatric Special Circumstances of Resuscitation, section on opioid-associated emergencies. · Item PCCN-FREE-015 · AACN test plan 2A.11

Correct answer: B. His hemoglobin is above the usual 7 g/dL threshold for stable adults

The 2023 international AABB guideline recommends considering transfusion when hemoglobin is below 7 g/dL for most hemodynamically stable hospitalized adults. The team keeps monitoring, and a change such as bleeding or cardiac symptoms would change the decision.

Why the other options are wrong:

• A. Transfusion is standard whenever hemoglobin falls below 10 g/dL — This is a liberal threshold that current guidance doesn't support for stable patients like this one.
• C. Blood is only given when hemoglobin falls below 5 g/dL — This is inaccurate and could delay a transfusion that's actually indicated.
• D. Blood transfusions are reserved for surgical patients — Transfusion decisions depend on clinical need, not on whether the patient had surgery.

Takeaway: For stable adults, think restrictive: about 7 g/dL, adjusted for bleeding, cardiac disease, and symptoms.

Source: ISBT: International AABB Guideline on Red Blood Cell Transfusion (2023) announcement, Recommendations for most hemodynamically stable hospitalized adult patients; individual context and cardiovascular exceptions. · Item PCCN-FREE-022 · AACN test plan 3B.1

Correct answer: D. A multicomponent plan: sensory aids, reorientation, sleep, mobility, family

The SCCM PADIS guideline supports multicomponent nonpharmacologic strategies for reducing delirium. These include reorientation, sensory aids, sleep protection, and mobility. Any new change in mental status still needs evaluation for a cause.

Why the other options are wrong:

• A. Scheduled routine antipsychotic doses to prevent recurrence — The 2018 PADIS guideline advises against routine antipsychotic prevention. The 2025 update found insufficient evidence to recommend for or against antipsychotics for treatment; that is not support for scheduled doses to prevent recurrence.
• B. Soft wrist restraints at night to prevent line removal — Restraints are associated with worsening agitation and injury, and they aren't a delirium prevention strategy.
• C. Lights and TV left on overnight to keep the patient oriented — This disrupts sleep, which is itself a delirium risk factor.

Takeaway: Evaluate causes of delirium and support orientation, sensory aids, sleep, mobility, and familiar people.

Source: SCCM PADIS Guideline (2018), Delirium: multicomponent nonpharmacologic intervention and antipsychotic prevention recommendations; adult ICU scope; SCCM Focused Update to the PADIS Guideline (2025), Antipsychotics for treatment of delirium: unable to issue a recommendation for or against; adult ICU scope. · Item PCCN-FREE-024 · AACN test plan 3C.7

Correct answer: B. Have the patient demonstrate, correct errors, and demonstrate again

For skills, AHRQ's teach-back tool describes a "show me" approach: the patient demonstrates, and the nurse corrects and has them repeat until the technique is right.

Why the other options are wrong:

• A. Have the patient watch a video about inhaler technique — Watching doesn't confirm the patient can do it.
• C. Demonstrate the technique twice while the patient watches — The nurse doing it proves the nurse can do it.
• D. Ask the patient to rate their confidence from 1 to 10 — Confidence isn't the same as correct technique.

Takeaway: For a skill, the patient shows you. Watching isn't the same as doing.

Source: AHRQ Health Literacy Toolkit: Tool 5, Use the Teach-Back Method, Show me – demonstration. · Item PCCN-FREE-045 · AACN test plan 5D

Correct answer: C. Lower daily weight, net negative fluid balance, less orthopnea, and fewer crackles

Decongestion is judged from several trends that agree with each other, such as body weight, intake and output, symptoms, and exam findings. The heart failure guideline calls for resolving clinical evidence of congestion; AHA also identifies weight change and worsening orthopnea as findings to track. In this question, the combined trend is stronger evidence than one isolated reading.

Why the other options are wrong:

• A. Urine output of 400 mL in the hour after the first dose — One brisk hour shows the drug is acting. It doesn't show that the fluid overload is resolving.
• B. SpO2 rose from 89% to 95% after oxygen was increased from 2 to 6 L/min — A higher saturation after increasing oxygen doesn't by itself demonstrate decongestion.
• D. Blood pressure rose from 118/70 to 136/82 mm Hg — A rising blood pressure isn't a marker of successful diuresis.

Takeaway: Judge decongestion from trends that agree: weight, net balance, symptoms, and exam. A single number doesn't settle it.

Source: 2022 AHA/ACC/HFSA Heart Failure Guideline – official slide set, slide 142, decongestion strategy in hospitalized patients; American Heart Association: Managing Heart Failure Symptoms, Which symptoms should I track? — weight change, shortness of breath and orthopnea. · Item PCCN-FREE-006 · AACN test plan 1A.10a

Correct answer: D. Continue close monitoring for recurrent respiratory depression

Naloxone can wear off before the opioid does, especially with long-acting or extended-release products, and respiratory depression can return. The 2025 AHA guidance emphasizes continued observation after a successful response. The provider also needs to know so the pain plan can be revised.

Why the other options are wrong:

• A. Restart the PCA at the prior settings now that the patient is awake — That reintroduces the cause before the plan has been reassessed.
• B. Stop monitoring because the reversal is complete — Reversal can be temporary. Stopping monitoring is exactly the wrong move.
• C. Give a second naloxone dose now to prevent a recurrence — Extra naloxone in an awake patient can cause abrupt withdrawal and severe pain. Further doses depend on reassessment.

Takeaway: Naloxone may run out before the opioid does. Keep watching.

Source: AHA 2025 Guidelines, Part 10: Adult and Pediatric Special Circumstances of Resuscitation, care following a successful response to opioid overdose. · Item PCCN-FREE-016 · AACN test plan 2A.11

Correct answer: D. Explain that a test of cure isn't recommended if symptoms are gone

CDC guidance advises against a "test of cure." Patients can stay test-positive after clinical recovery, so a positive result wouldn't mean treatment failed and could lead to unnecessary treatment. New diarrhea would still need evaluation.

Why the other options are wrong:

• A. Send a stool toxin test before discharge to confirm the cure — This is the test of cure CDC advises against.
• B. Repeat stool testing weekly for a month to be safe — Routine repeat testing without symptoms isn't recommended.
• C. Start a probiotic, which prevents any recurrence of infection — Nothing guarantees against recurrence, and the question is about testing.

Takeaway: Symptoms guide C. diff testing. Routine testing for cure is not recommended.

Source: CDC: Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities, confirming CDI in patients – no test of cure. · Item PCCN-FREE-027 · AACN test plan 3D.3

Correct answer: D. Notify the provider urgently and loosen any constricting dressing

Pain out of proportion to the injury, and pain with passive stretch, are key early signs of acute compartment syndrome, which AAOS describes as a surgical emergency. The nurse escalates urgently and removes anything constricting the limb. These pain findings already warrant urgent assessment; do not wait for the pulse to disappear.

Why the other options are wrong:

• A. A palpable pulse rules it out; give analgesia and recheck in 2 hours — Waiting for pulses to disappear delays treatment.
• B. Apply a snug compression wrap to reduce the swelling — External compression raises compartment pressure further.
• C. Apply warm compresses and reassess at the next shift — This delays emergency evaluation.

Takeaway: Escalating pain plus pain on passive stretch: escalate now, even with a pulse.

Source: AAOS OrthoInfo: Compartment Syndrome, Acute compartment syndrome: pain on stretch, surgical emergency and loosening constriction; British Orthopaedic Association: Diagnosis and Management of Compartment Syndrome of the Extremities (July 2025), Background; Standards 7–9: release circumferential dressings, urgent assessment and decompression after diagnosis. · Item PCCN-FREE-031 · AACN test plan 4A.2

Correct answer: C. Arrange a qualified medical interpreter by phone, video, or in person

The National CLAS Standards call for competent language assistance and advise against using untrained individuals or minors as interpreters. Consent needs accurate, complete interpretation, and it shouldn't put a child in that role.

Why the other options are wrong:

• A. Accept the granddaughter's help so the procedure isn't delayed — A minor isn't an appropriate interpreter for a consent discussion.
• B. Use the nurse's basic phrases and a translation app — This isn't competent interpretation for consent.
• D. Proceed in English, speaking slowly and clearly — Slower English doesn't give a patient with limited English proficiency meaningful access.

Takeaway: For this consent discussion, use a qualified interpreter rather than a child or untrained family member.

Source: HHS Office of Minority Health: National CLAS Standards, Communication and Language Assistance, Standards 5–7. · Item PCCN-FREE-046 · AACN test plan 5C

Correct answer: D. Serum potassium and renal function

Spironolactone is a mineralocorticoid receptor antagonist (MRA). Its most important risks are hyperkalemia and worsening kidney function, and the ACE inhibitor adds to the potassium risk. The guideline ties safe MRA use to checking potassium and renal function.

Why the other options are wrong:

• A. Liver enzymes and bilirubin — Liver injury isn't the main safety concern with spironolactone.
• B. Platelet count and INR — Bleeding and clotting tests aren't the priority when starting an MRA.
• C. Thyroid-stimulating hormone — Thyroid function isn't affected in a way that needs routine monitoring when an MRA is started.

Takeaway: MRA plus ACE inhibitor, ARB, or ARNI: watch potassium and creatinine.

Source: 2022 AHA/ACC/HFSA Heart Failure Guideline – official slide set, slide 75: mineralocorticoid receptor antagonists, potassium and renal-function monitoring. · Item PCCN-FREE-007 · AACN test plan 1A.10b

Correct answer: D. Escalate urgently for invasive airway management

Worsening acidosis, a falling level of consciousness, and an inability to protect the airway or clear secretions mean the NIV trial is failing. The ERS/ATS guideline warns against continuing NIV when a patient is deteriorating, and calls for close monitoring with rapid access to intubation when the patient is not improving.

Why the other options are wrong:

• A. Increase FiO2 and recheck the ABG in 2 hours — More oxygen doesn't fix ventilatory failure, and two more hours is a dangerous delay.
• B. Switch to nasal cannula so the patient can cough — Removing ventilatory support from a failing patient speeds the decline.
• C. Give a sedative to improve mask tolerance — Sedating a patient who is already obtunded and hypercapnic further depresses breathing and airway protection.

Takeaway: Declining consciousness plus worsening pH on NIV means escalate now. Don't extend a failing trial.

Source: ERS/ATS Clinical Practice Guideline: Noninvasive Ventilation for Acute Respiratory Failure (2017), implementation considerations: monitoring for and responding to NIV failure. · Item PCCN-FREE-017 · AACN test plan 2A.12a

Correct answer: A. Give 15 g of fast-acting carbohydrate; recheck in 15 minutes

The ADA's 15-15 rule applies to an alert person who can swallow: take 15 g of fast-acting carbohydrate, recheck in 15 minutes, and repeat if the glucose is still low. There is no need to delay oral treatment while establishing IV access.

Why the other options are wrong:

• B. Give intramuscular glucagon per the hypoglycemia protocol — Glucagon is for severe hypoglycemia when the patient can't safely take anything by mouth.
• C. Give peanut butter crackers and recheck in 30 minutes — Fat slows glucose absorption. A snack can follow once the glucose recovers, but it isn't the first treatment.
• D. Start an IV and give dextrose once access is placed — This patient can swallow, so oral carbohydrate treats the low faster without a delay for IV access.

Takeaway: Alert and able to swallow: 15 grams, 15 minutes, recheck.

Source: American Diabetes Association: Hypoglycemia – Symptoms and Treatment, treatment section, the 15-15 rule. · Item PCCN-FREE-020 · AACN test plan 3A.7

Correct answer: A. Stroke volume or pulse pressure change with a passive leg raise

The 2026 guideline suggests using dynamic measures to guide fluid resuscitation instead of physical examination or static measures alone. Examples include the response to a passive leg raise or a fluid challenge, measured by stroke volume or pulse pressure.

Why the other options are wrong:

• B. A single central venous pressure reading after the fluids — A static pressure doesn't reliably predict whether more fluid will raise cardiac output.
• C. The absence of crackles on the lung examination — Clear lungs don't show that fluid will help. Physical exam alone isn't recommended.
• D. One lactate value drawn after the initial fluid bolus — Lactate trends help guide resuscitation, but one value doesn't predict fluid responsiveness.

Takeaway: To predict fluid responsiveness, test the response dynamically, for example with a passive leg raise, rather than relying on one static number.

Source: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026, Resuscitation – dynamic measures recommendation. · Item PCCN-FREE-034 · AACN test plan 4B.9

Correct answer: C. Bring the disciplines and the patient together to agree on one plan

The Synergy Model describes collaboration as working with others, including patients, families, and interdisciplinary colleagues, toward realistic shared goals. Conflicting instructions are a collaboration problem to solve, not a choice to hand to the patient.

Why the other options are wrong:

• A. Tell the patient to follow whichever advice feels right to him — This hands an unresolved safety question to the patient.
• B. Write your own device recommendation into the instructions — This bypasses the disciplines responsible for the assessment.
• D. Document the discrepancy and discharge the patient as planned — Documentation without resolution leaves the risk in place.

Takeaway: Conflicting plans get resolved together, with the patient included, before discharge.

Source: AACN PCCN Exam Handbook – Direct Care (July 2026), page 9, AACN Synergy Model nurse characteristics (Collaboration). · Item PCCN-FREE-047 · AACN test plan 6A

Correct answer: A. An IV loop diuretic

This patient is congested ("wet") with adequate perfusion ("warm"). For patients hospitalized with significant fluid overload, the heart failure guideline recommends prompt IV loop diuretics to relieve congestion.

Why the other options are wrong:

• B. A 500-mL normal saline bolus to protect the kidneys — Adding volume would worsen the pulmonary congestion.
• C. A milrinone infusion — Inotropes are for low-output states with poor perfusion. This patient is warm with a normal lactate.
• D. The patient's usual oral loop diuretic dose — Significant fluid overload in a hospitalized patient calls for prompt IV loop diuretics, rather than simply resuming the usual oral dose.

Takeaway: Warm and wet heart failure gets IV loop diuretics. Save inotropes for signs of low output.

Source: 2022 AHA/ACC/HFSA Heart Failure Guideline – official slide set, slide 142: prompt IV loop diuretics for hospitalized heart failure with significant fluid overload. · Item PCCN-FREE-008 · AACN test plan 1A.10a

Correct answer: C. Activate the stroke response team now and report last known well

Sudden facial droop, arm weakness, and speech trouble are classic stroke warning signs. Hypoglycemia, a common mimic, has been ruled out. Treatment options depend on how quickly the team evaluates the patient, and the last-known-well time is central to those decisions.

Why the other options are wrong:

• A. Give aspirin by mouth, then recheck the neurologic status — Aspirin is not the first response to an undifferentiated stroke: it could worsen a hemorrhagic stroke. Activate the stroke pathway rather than giving oral medication and waiting.
• B. Recheck the neurologic status in 1 hour — Waiting burns treatment time.
• D. Notify the primary provider at morning rounds — This delays a time-critical emergency.

Takeaway: New focal deficit: activate the stroke team now and give the exact last-known-well time.

Source: CDC: Signs and Symptoms of Stroke, Signs and Symptoms: sudden focal deficits and immediate action; AHA: 2026 Acute Ischemic Stroke Guideline – Top Things to Know, 2026 guideline summary: early recognition and timely stroke treatment; American Heart Association: Aspirin and Dual Antiplatelet Therapy, Should I take aspirin during a heart attack or stroke? — bleeding-stroke warning. · Item PCCN-FREE-025 · AACN test plan 3C.3

Correct answer: B. Early oral feeding as tolerated, usually a low-fat solid diet

The 2024 ACG guideline supports early oral feeding, within 24–48 hours as tolerated, in mild acute pancreatitis. It doesn't require waiting for lipase to normalize or starting with clear liquids.

Why the other options are wrong:

• A. Keep the patient NPO until the lipase level normalizes — Lipase levels don't determine when to feed, and prolonged NPO offers no benefit here.
• C. Start parenteral nutrition through a central line — The gut works. Parenteral nutrition adds risk without a clear indication.
• D. Clear liquids for 5 days before any solid food — Staged advancement isn't required once the patient is tolerating intake.

Takeaway: Mild pancreatitis and hungry: feed early. A normal lipase isn't the gate.

Source: ACG Clinical Guideline Highlights: Acute Pancreatitis (2024), Management – Feeding. · Item PCCN-FREE-028 · AACN test plan 3D.9

Correct answer: C. Remove the catheter under the protocol and explain why

CDC recommendations limit indwelling catheters to appropriate indications and call for removing them as soon as they're no longer needed. They also support nurse-driven removal protocols. Convenience isn't an indication, and each extra day raises infection risk.

Why the other options are wrong:

• A. Keep the catheter until discharge to honor the family's wish — Convenience isn't an appropriate indication for an indwelling catheter.
• B. Replace it with a new catheter to lower infection risk — Routine fixed-interval replacement isn't recommended. Removing an unnecessary catheter reduces catheter exposure.
• D. Send a routine urinalysis and culture before removing it — Routine screening cultures in patients without symptoms aren't recommended.

Takeaway: No indication means the catheter comes out. Protocols let nurses act on that.

Source: CDC: CAUTI Prevention Guideline – Summary of Recommendations, Appropriate urinary catheter use; quality-improvement programs. · Item PCCN-FREE-035 · AACN test plan 4B.2a

Correct answer: B. Work with the prescriber, pharmacy, and case management on access

The Synergy Model describes systems thinking as using the resources available within and across systems to meet the patient's needs. A prescription the patient can't get is a gap in the plan that needs solving before discharge.

Why the other options are wrong:

• A. Discharge him and advise him to call his insurer tomorrow — This risks a gap in anticoagulation at a vulnerable time.
• C. Send leftover inpatient doses home with him — This sends medication home without a coordinated dispensing plan and doesn't solve ongoing access.
• D. Delay discharge without telling the team why — The problem needs coordinated solving, not a silent delay.

Takeaway: A plan the patient can't access isn't a plan. Solve it across the system before discharge.

Source: AACN PCCN Exam Handbook – Direct Care (July 2026), page 9, AACN Synergy Model nurse characteristics (Systems Thinking). · Item PCCN-FREE-048 · AACN test plan 6B

Correct answer: D. Ask the prescriber whether high-intensity statin therapy is intended

The 2025 ACS guideline recommends high-intensity statin therapy after acute coronary syndrome for patients without a contraindication. The nurse doesn't change the order. The nurse raises the discrepancy so the prescriber can confirm the plan.

Why the other options are wrong:

• A. Hold the statin until an outpatient cholesterol level is checked — Stopping statin therapy after ACS removes a recommended secondary-prevention treatment.
• B. Take no action, because statin intensity doesn't matter after ACS — Intensity matters. The guideline recommends high-intensity therapy.
• C. Suggest an over-the-counter cholesterol supplement instead — A supplement isn't the guideline-recommended substitute for high-intensity statin therapy after ACS.

Takeaway: After ACS, a missing statin or less-than-high-intensity therapy without a documented reason is worth a clarifying call.

Source: AHA: 2025 Acute Coronary Syndromes Guideline – Top Things to Know, point 3: high-intensity statin therapy after ACS. · Item PCCN-FREE-009 · AACN test plan 1A.1

Correct answer: C. IV calcium gluconate

With ECG changes, the first priority is protecting the heart. The UK Kidney Association guideline gives IV calcium first to stabilize the myocardium. Calcium works within minutes but doesn't lower potassium. Insulin-dextrose promptly shifts potassium into cells, and binders and dialysis remove it.

Why the other options are wrong:

• A. The oral potassium binder — Binders remove potassium too slowly to protect the heart right now.
• B. IV furosemide — A patient with end-stage kidney disease may make little urine, and diuretics are slow and unreliable here.
• D. Insulin with dextrose — This is an important early step, but it shifts potassium rather than immediately stabilizing the myocardium. With ECG changes, calcium comes first.

Takeaway: Hyperkalemia with ECG changes: protect the heart with calcium while promptly arranging potassium shifting and removal.

Source: UK Kidney Association: Clinical Practice Guideline – Treatment of Acute Hyperkalaemia in Adults (October 2023), Guidelines 16.2 (IV calcium for ECG changes), 16.3 (insulin-glucose) and 18.2 (dialysis patient: calcium even when dialysis is immediately available). · Item PCCN-FREE-030 · AACN test plan 3E.3

Correct answer: D. Scrub the connector with antiseptic and use a sterile access device

CDC recommendations call for minimizing contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone-iodine, an iodophor, or 70% alcohol) and accessing it only with sterile devices.

Why the other options are wrong:

• A. Wipe the connector with dry sterile gauze before access — Dry gauze doesn't disinfect the surface.
• B. Flush the line first, then clean the connector — Flushing first can introduce surface contamination into the line.
• C. Remove the connector and inject directly into the catheter hub — This opens the system and adds contamination risk without a reason.

Takeaway: Scrub the hub every time, and use only sterile devices.

Source: CDC: Intravascular Catheter-Related Infection Prevention – Summary of Recommendations, Needleless intravascular catheter systems. · Item PCCN-FREE-036 · AACN test plan 4B.2b

Correct answer: A. Keep the patient under constant observation and escalate urgently

Current suicidal thoughts call for immediate safety measures: stay with the patient or arrange constant observation, remove potential means within reach, and promptly notify the provider for urgent evaluation by a qualified clinician. NIMH's adult inpatient guide centers on asking about current thoughts and escalating promptly. The nurse's role is safety and escalation, not an independent decision about disposition.

Why the other options are wrong:

• B. Leave the room briefly to find the provider in person — Leaving the patient alone removes the most important safety measure.
• C. Ask the patient to sign a no-harm contract for tonight — A contract doesn't make the patient safer and isn't a substitute for observation and evaluation.
• D. Reassure the patient the feeling will pass and redirect — This dismisses a disclosure that needs action.

Takeaway: Current suicidal thoughts: don't leave the patient, remove means, escalate now.

Source: NIMH: Adult Inpatient Brief Suicide Safety Assessment Guide, current suicidal thoughts; next steps. · Item PCCN-FREE-039 · AACN test plan 4C (testable action: suicidal ideation)

Correct answer: B. Frame a focused question and appraise the evidence and policy

The Synergy Model describes clinical inquiry as questioning and evaluating practice and creating change through evidence-based practice. The first step is a well-formed question and an honest look at the evidence, not an individual workaround.

Why the other options are wrong:

• A. Stop doing 04:00 checks on your own stable patients — Changing practice on your own bypasses policy and may put patients at risk.
• C. Change the unit policy based on one recent article — One study rarely justifies a practice change without appraisal.
• D. Keep the practice because it has always been done — Tradition isn't evidence. Inquiry means asking the question.

Takeaway: Clinical inquiry: question, appraise the evidence, then propose a change through the right channel.

Source: AACN PCCN Exam Handbook – Direct Care (July 2026), page 9, AACN Synergy Model nurse characteristics (Clinical Inquiry). · Item PCCN-FREE-049 · AACN test plan 6C

Correct answer: A. Explain that rehab is recommended after a heart attack and arrange referral

The 2025 ACS guideline recommends referral to cardiac rehabilitation after ACS. Rehab provides supervised exercise, risk-factor education, and support, and feeling well doesn't remove the benefit. The nursing role is to explain why it matters and make the referral happen.

Why the other options are wrong:

• B. Explain that rehab is only for patients who develop heart failure after MI — This is incorrect. Referral is recommended for patients after ACS in general, not only those with heart failure.
• C. Suggest waiting and starting rehab only if symptoms return — Waiting for symptoms defeats the purpose of secondary prevention.
• D. Encourage a return to usual heavy exercise right away instead — Unsupervised heavy exertion right after MI isn't a substitute for a structured program.

Takeaway: After ACS, feeling fine isn't a reason to skip cardiac rehab referral.

Source: AHA: 2025 Acute Coronary Syndromes Guideline – Top Things to Know, point 9: cardiac rehabilitation referral after ACS. · Item PCCN-FREE-010 · AACN test plan 1A.1

Correct answer: C. Assess the suspected pressure injury, relieve pressure, and document it now

AHRQ's hospital toolkit separates risk assessment from comprehensive skin assessment. A reassuring score doesn't cancel what the skin exam shows. Non-blanchable redness over a bony prominence is concerning for pressure injury and needs action and documentation.

Why the other options are wrong:

• A. Take no action, because the Braden score is reassuring — A risk score predicts future risk. It doesn't override an existing finding.
• B. Recalculate the Braden score in 24 hours before acting — This delays care for an abnormal skin finding that's already present.
• D. Document the redness only if it is still present at discharge — Present-on-admission findings need prompt documentation and care.

Takeaway: A risk score and a skin assessment answer different questions. Do both, and act on the skin.

Source: AHRQ: Preventing Pressure Ulcers in Hospitals – Section 3, Best Practices, Sections 3.2 and 3.3: comprehensive skin assessment and risk assessment with clinical judgment; AHRQ: Pressure Ulcer Toolkit — Tools 3B and 3D, Tool 3B: skin color and nonblanching changes; Tool 3D: Braden scores and clinical assessment. · Item PCCN-FREE-037 · AACN test plan 4B.7

Correct answer: B. It can be given alongside heart failure treatment, at any stage

The WHO describes palliative care as appropriate early in serious illness and across conditions including cardiovascular disease. The National Institute on Aging explicitly includes care alongside disease-directed treatment. It addresses symptoms and family distress. This is different from hospice eligibility.

Why the other options are wrong:

• A. It means you would need to stop your heart failure treatment — Palliative care is compatible with disease-directed therapy.
• C. It is only for patients who have been diagnosed with cancer — The WHO explicitly includes non-cancer conditions such as heart failure.
• D. It starts only in the final days of life, after treatment ends — It is most useful early, not only at the very end.

Takeaway: Palliative care isn't the same as hospice. It can start early, alongside treatment.

Source: World Health Organization: Palliative Care fact sheet, Early palliative care and conditions including cardiovascular disease; National Institute on Aging: What Are Palliative Care and Hospice Care?, What is palliative care? and Who can benefit? — alongside disease-directed treatment, including heart failure. · Item PCCN-FREE-038 · AACN test plan 4B.5

Correct answer: D. Help the patient build a written safety plan in their own words

NIMH's inpatient guide directs clinicians to make a safety plan with the patient. The plan should be developed with the patient and identify specific coping strategies and contacts.

Why the other options are wrong:

• A. Have the patient sign a no-suicide contract before discharge — Contracts aren't safety plans and don't give the patient concrete steps.
• B. Hand the patient a general crisis pamphlet at discharge — Generic information without a personalized plan leaves the patient without specific steps.
• C. Write the safety plan for the patient to save time — Writing the plan for the patient omits the collaboration the guide calls for.

Takeaway: Build the safety plan with the patient. A no-suicide contract isn't a substitute.

Source: NIMH: Adult Inpatient Brief Suicide Safety Assessment Guide, Make a safety plan with the patient. · Item PCCN-FREE-040 · AACN test plan 4C (testable action: suicidal ideation)

Correct answer: C. Report the events and bring the pattern to unit leaders

A recurring failure is a system problem. The Synergy Model's systems thinking looks at processes across settings. Reporting creates the data needed to redesign the process.

Why the other options are wrong:

• A. Quietly fix each reconciliation as the patients arrive — Silent workarounds leave the system unchanged and the next patient at risk.
• B. Post a complaint about the ICU nurses in the team chat — Blame doesn't fix a process and damages collaboration.
• D. Ask future patients to bring their own medication lists — This shifts a hospital process failure onto patients.

Takeaway: A repeated failure is a system problem. Report it and fix the process.

Source: AACN PCCN Exam Handbook – Direct Care (July 2026), page 9, AACN Synergy Model nurse characteristics (Systems Thinking). · Item PCCN-FREE-050 · AACN test plan 6B