The PCCN Exam is a comprehensive and challenging assessment for nurses seeking qualification to work with moderately stable patients. In order to take the test, candidates must have a current registered nurse licensure in the United States and must have completed 1,750 hours of direct bedside care of acutely ill adult patients. At least 875 of those hours must have been completed during the year before application for the test.
Eighty percent of the PCCN Exam relates to clinical judgment, while 20 percent evaluates professional caring and ethical practice. The clinical judgment section covers a number of body systems, including cardiovascular (37 percent of the exam), pulmonary (13 percent), endocrine (4 percent), hematology/immunology (5 percent), neurology (4 percent), gastrointestinal (5 percent), renal (6 percent), and multisystem (6 percent).
The professional caring and ethical practice domain addresses: advocacy/moral agency (2 percent), caring practices (4 percent), collaboration (4 percent), systems thinking (2 percent), response to diversity (2 percent), clinical inquiry (2 percent), and the facilitation of learning (4 percent).
The PCCN Exam takes two-and-a-half hours to complete and consists of 125 multiple-choice questions. In most cases, the exam is administered on a computer, though a paper version is also available.
PCCN Exam Practice Questions
1. A patient with gastroenteritis has been diagnosed with severe dehydration (>15% fluid loss). Typical symptoms include:
a. Dry mouth and increased thirst
b. Dizziness, lethargy, reduced skin turgor, and orthostatic hypotension
c. Resting hypotension, confusion, tachycardia, and oliguria
d. Hypotension and anuria in addition to other symptoms
2. Neurogenic shock is often characterized by:
3. Which of the following is an example of therapeutic communication?
a. “Don’t worry. Everything will be fine.”
b. “You should listen to your doctor.”
c. “Why are you upset?”
d. “Is there anything you’d like to discuss?”
4. A patient with chronic ventilatory failure has PCO2>50 and pH <7.35 with dyspnea, cardiac arrhythmias, confusion, hyperkalemia, and hypotension: These findings are consistent with:
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
5. The best time to initiate conflict resolution is:
a. When those in conflict have had time to resolve their differences
b. When conflict interferes with function
c. When those involved ask for conflict resolution
d. At the initial emergence of conflict
1. D: Severe dehydration is fluid loss >15% and occurs when total body water decreases but sodium does not. It is characterized by marked hypotension and anuria as well as symptoms associated with lesser dehydration. Mild dehydration (5% loss) is characterized by dizziness, lethargy, reduced skin turgor, dry mucous membranes, and orthostatic hypotension. Moderate dehydration (10% loss) is characterized by confusion, resting hypotension, tachycardia, and oliguria/anuria. Dehydration may result from inadequate fluids, excess water loss, NG suctioning, drugs, diarrhea, vomiting, and fever.
2. C: Neurogenic shock is often characterized by bradycardia, hypotension, and warm dry skin related to lack of vascular tone that results in hypothermia from loss of cutaneous heat. Neurogenic shock can occur when spinal cord injury, neurological disease, drugs, or anesthesia impairs the autonomic nervous system that controls the cardiovascular system.
3. D: Open-ended questions, such as “Is there anything you’d like to discuss?” encourage patients to express feelings. Nurses should avoid meaningless clichés, such as “Don’t worry. Everything will be fine,” as this may not be true, and should avoid providing direct advice with “You should…” or “The best thing to do is…,” but should provide facts and encourage patients to make decisions. “Why are you upset?” questions behavior that may not directly relate to care and requires analysis of feelings.
4. A: Patients with chronic ventilatory failure cannot compensate for hypercapnia and the pH falls, resulting in respiratory acidosis. Symptoms include increasing dyspnea with tachypnea, gasping respirations, and use of accessory muscles. Patients may become confused as hypercapnia causes increased intracranial pressure. If pH is <7.2, cardiac arrhythmias, hyperkalemia, and hypotension can occur as pulmonary arteries constrict and the peripheral vascular system dilates. ABGs are consistent with respiratory acidosis (PCO2 >50 and pH<7.35). 5. D: The best time to initiate conflict resolution is when conflict first emerges, but before open conflict and hardening of positions. Steps include: Allowing both parties to present their sides without bias. Encouraging operation through negotiation and compromise. Maintaining focus and avoiding arguments. Evaluating the need for renegotiation, formal resolution process, or third party. Utilizing humor and empathy to diffuse tension. Summarizing and outlining key arguments. Avoiding forcing resolution if possible.