PCCN (Adult) case studies
PCCN (Adult) · Put your knowledge to work in context.
PCCN® (Adult) is a specialty certification from AACN Certification Corporation for nurses who care for acutely ill adult patients. The credential is accepted by the Magnet Recognition Program®. Two eligibility pathways exist. The Direct Care Eligibility Pathway is for nurses who provide direct care to acutely ill adult patients regardless of physical location; typical areas include intermediate care, stepdown, telemetry, direct observation, transitional care and emergency departments. Topics on this exam: Clinical Judgment and Professional Caring and Ethical Practice. The PCCN (Adult) case studies are 5 cases and about 3,143 words.
1Rapid Atrial Fibrillation in a Patient With Reduced Ejection Fraction
R, 72, has heart failure with reduced ejection fraction (EF 30%) and was admitted two days ago with pneumonia. At 0700 he is alert but says he feels "fluttering and lightheaded." Telemetry shows atrial fibrillation with a ventricular rate of 138–146. BP 104/68, RR 24, SpO2 92% on 2 L nasal cannula, temp 38.1°C. Bibasilar crackles, JVP 10 cm, 2+ pitting edema to mid-shin, weight up 2.4 kg since admission.
661 words, about 3 min2Oxygen-Induced Hypercapnia in a COPD Exacerbation
L, 74, is admitted with a COPD exacerbation. Her baseline is 2 L nasal cannula at home with SpO2 88–92%. Overnight the RN titrates oxygen to 6 L to keep SpO2 above 94%. At 0600 she is drowsy and difficult to arouse, RR 10 and shallow, HR 112, BP 138/76.
628 words, about 3 min3Opioid-Induced Respiratory Depression on Postoperative Day One
K, 58, is postoperative day 1 after open reduction and internal fixation of a femur fracture. He has a hydromorphone PCA: 0.2 mg demand, 8-minute lockout, 0.2 mg/hr basal. Home medications include extended-release morphine 30 mg BID and gabapentin 600 mg TID; he also received lorazepam 1 mg for sleep at 2200. At 0230 the RN finds him snoring loudly and minimally responsive to a sternal rub.
579 words, about 3 min4DNI Status, Noninvasive Ventilation, and a Family That Says "No Machines"
B, 78, has advanced COPD with three admissions in six months. She has a signed DNR/DNI order and her daughter is her healthcare proxy. At 1900 she is in respiratory distress: RR 34, accessory muscle use, SpO2 82% on a nonrebreather, ABG pH 7.20, PaCO2 80 mm Hg. She is alert enough to say, "I can't breathe - help me." The oncoming nurse says, "She's a DNI, so there's nothing to do except morphine." The resident asks whether BiPAP is "even allowed." The daughter is at the bedside and says, "Do everything, but no machines.".
657 words, about 3 min5Charge Nurse Assignment With an Unfamiliar Float and a Supratherapeutic aPTT
You are the charge nurse on a 24-bed progressive care unit at 1900. Two night RNs have called out. The house supervisor sends a float RN from the orthopedic unit who has not managed titratable cardiac infusions in two years. Your staff also includes an RN who has been off orientation for six weeks and a float UAP.
618 words, about 3 min