Free PCCN Exam - Direct Care Eligibility Pathway Practice Questions

Sample Practice Questions

Try these 10 sample questions from the PCCN Exam - Direct Care Eligibility Pathway practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1An adult in progressive care has a stable, regular monomorphic wide-complex tachycardia of uncertain mechanism. Which intravenous drug may be used to help diagnose the rhythm while treating it?

   1. A. Adenosine
   2. B. Procainamide
   3. C. Amiodarone
   4. D. Lidocaine

   Answer: A

   Explanation: The AHA states, "In hemodynamically stable adult patients with regular monomorphic wide-complex tachycardia, IV adenosine may be considered for treatment or aiding rhythm diagnosis when the cause of the rhythm cannot be determined." Adenosine has this diagnostic role in the specified stable rhythm; the other antiarrhythmics are treatments for particular tachyarrhythmias but are not the cited diagnostic intervention.

   Reference: 2025 AHA Adult Advanced Life Support Guidelines — Wide-Complex Tachycardia, management recommendations table

2. 2An adult with a documented do-not-resuscitate order develops treatable pain and nausea. Which interpretation of the order should the nurse apply to these nonresuscitation treatments?

   1. A. Continue indicated symptom care despite the DNR order
   2. B. Continue symptom care only after canceling the DNR order
   3. C. Suspend symptom care until code status is discussed again
   4. D. Replace symptom care with monitoring because of the DNR

   Answer: A

   Explanation: ANA states, "Care for patients with do-not-resuscitate orders is no different from care for any other patient, including respect and advocacy for the patients’ preferences and values, promotion of well-being, and alleviation of suffering." The DNR does not itself limit indicated pain and nausea relief.

   Reference: ANA Nursing Care and Do-not-resuscitate Decisions — Statement of ANA Position, page 1

3. 3A monitored adult develops sustained monomorphic wide-complex tachycardia with new hypotension and confusion. Which electrical treatment is indicated for this unstable rhythm?

   1. A. Immediate synchronized cardioversion
   2. B. Immediate unsynchronized defibrillation
   3. C. Immediate overdrive pacing
   4. D. Immediate transcutaneous pacing

   Answer: A

   Explanation: The guideline states, "Synchronized cardioversion is recommended for acute treatment of adult patients with hemodynamically unstable wide-complex tachycardia." The rhythm is monomorphic and has a pulse but is causing poor perfusion, so synchronized cardioversion is the indicated electrical therapy.

   Reference: 2025 AHA Adult Advanced Life Support Guidelines — Wide-Complex Tachycardia, management recommendations table

4. 4An adult with decision-making capacity declines resuscitation, while family members ask the nurse to disregard the patient's choice. Whose refusal should the nurse give priority in advocating for the care plan?

   1. A. The capable patient's current expressed refusal
   2. B. An authorized surrogate's contrary preference
   3. C. A prior advance directive that conflicts with current wishes
   4. D. A family majority favoring resuscitation

   Answer: A

   Explanation: ANA states, "Nurses recognize that the resuscitation refusal by the patient with decision-making capacity should be given highest priority, even when these wishes conflict with those of the health care team and/or family." A current capable refusal outranks the competing surrogate, family, or prior direction in this scenario.

   Reference: ANA Nursing Care and Do-not-resuscitate Decisions — Advocacy, policies, and guidelines, page 4

5. 5An adult on telemetry develops sustained polymorphic ventricular tachycardia. Which immediate electrical treatment should the nurse prepare for?

   1. A. An immediate unsynchronized shock
   2. B. An immediate synchronized shock
   3. C. Immediate transcutaneous pacing
   4. D. Immediate transvenous pacing

   Answer: A

   Explanation: The AHA guideline says, "Immediate unsynchronized shock is recommended for adults with sustained polymorphic ventricular tachycardia." The changing QRS morphology prevents reliable synchronization, making an unsynchronized shock the appropriate immediate treatment.

   Reference: 2025 AHA Adult Advanced Life Support Guidelines — Polymorphic Ventricular Tachycardia, treatment recommendations table

6. 6Before an invasive procedure, an adult accurately explains the expected benefits and available alternatives but cannot explain any material risks. Which part of informed consent should the nurse arrange to be discussed again?

   1. A. The material risks of the planned procedure
   2. B. The expected benefits of the planned procedure
   3. C. The available alternatives to the procedure
   4. D. The administrative timing of the procedure

   Answer: A

   Explanation: AHRQ explains that informed consent ensures patients understand "the risks, benefits, and alternatives to treatment." This patient can explain benefits and alternatives but not risks, so the risk discussion is the missing part.

   Reference: Joint Commission Safe Informed Care — Rationale, informed consent

7. 7An adult has recurrent episodes of polymorphic ventricular tachycardia with a prolonged QT interval after an initial shock. Which medication may help suppress further episodes?

   1. A. Intravenous magnesium
   2. B. Intravenous lidocaine
   3. C. Intravenous amiodarone
   4. D. Intravenous procainamide

   Answer: A

   Explanation: The guideline states, "Magnesium may be considered for treatment of adults with recurrences of polymorphic ventricular tachycardia associated with a long QT interval (torsades de pointes)." This patient's prolonged QT and recurrent polymorphic VT identify torsades, for which magnesium is the medication considered here.

   Reference: 2025 AHA Adult Advanced Life Support Guidelines — Polymorphic Ventricular Tachycardia, treatment recommendations table

8. 8A patient with limited English proficiency needs to discuss a new treatment plan and a teenage family member offers to interpret. Which resource should the nurse arrange to support an accurate conversation?

   1. A. A competent language-assistance interpreter
   2. B. The available minor family member alone
   3. C. Written English instructions without interpretation
   4. D. A staff member with unverified language proficiency

   Answer: A

   Explanation: HHS CLAS standards call for competent language assistance and state that "the use of untrained individuals and/or minors as interpreters should be avoided and discouraged." A competent interpreter supports the patient's own decisions.

   Reference: HHS National CLAS Standards — Communication and Language Assistance, interpreter competence

9. 9An adult in progressive care is pulseless, and the monitor shows ventricular fibrillation. Which electrical therapy is indicated?

   1. A. Immediate unsynchronized defibrillation
   2. B. Immediate synchronized cardioversion
   3. C. Immediate overdrive pacing
   4. D. Immediate temporary transvenous pacing

   Answer: A

   Explanation: The AHA guideline states, "In adult patients with cardiac arrest, defibrillators (using biphasic or monophasic waveforms) are recommended to treat tachyarrhythmias requiring a shock such as ventricular fibrillation or pulseless ventricular tachycardia." Pulseless VF is a shockable arrest rhythm, so immediate defibrillation is indicated.

   Reference: 2025 AHA Adult Advanced Life Support Guidelines — Section 5, Defibrillation, recommendation 1

10. 10After teaching an adult how to manage a new medication schedule at home, which question best checks whether the nurse communicated the instructions clearly?

    1. A. Can you explain in your own words how you will take it?
    2. B. Do you understand the medication directions I gave you?
    3. C. Would you like the same instructions repeated again?
    4. D. Can you sign that the medication teaching occurred?

    Answer: A

    Explanation: AHRQ defines teach-back as asking the patient "to explain the information they need to know or actions they need to take, in their own words." A yes/no understanding question or signed form does not demonstrate comprehension.

    Reference: AHRQ TeamSTEPPS Tool: Teach-Back — Tool: Teach-Back, method definition