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PCCN (Adult) Cheat Sheet

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Cardiovascular

  • 20% of exam
  • Hemodynamic Values ACS Recognition Heart Failure Dysrhythmias & ECG Vasoactive & Antiarrhythmic Meds

Respiratory

  • 14% of exam
  • ABG Interpretation Respiratory Failure & Ventilation NIV Support Chest Tube Basics

Endo, Heme, Neuro, GI, Renal

  • 27% of exam
  • Endocrine Emergencies Insulin & Glycemic Meds Neuro & Stroke GI & Hepatic Renal & Electrolytes Heme, Immune & Onc

MSK, Multisystem, Behavioral

  • 20% of exam
  • Sepsis & MODS DVT/PE & Mobility Behavioral & Withdrawal Compartment Syndrome

Professional Caring & Ethics

  • 20% of exam
  • Synergy Model Advocacy Collaboration Systems Thinking Clinical Inquiry

Quick Facts

  • Credential PCCN (Adult)
  • Items 150 (125 scored)
  • Time 3 hours
  • Pass 82 of 125
  • Format Multiple choice
  • Fee $260 or $375
  • Framework Judgment 80%, Caring 20%
  • Body AACN Certification
  • Valid 3 years

MONA for ACS Review CA

  • Morphine, Oxygen, Nitrates, Aspirin; not all routine
  • Aspirin: give unless allergy Oxygen: only if hypoxic Nitrates: avoid if hypotensive Morphine: caution, may mask ischemia

STEMI vs NSTEMI CA

STEMI

  • ST elevation on ECG
  • Full-thickness occlusion
  • Immediate cath lab

NSTEMI

  • ST depression or T change
  • Partial occlusion
  • Serial troponin, urgent workup
  • Elevation vs depression

Chest Pain / Rhythm to Action CA

  • ST elevation → Activate cath lab ( STEMI )
  • ST depression, T change → Serial troponin ( NSTEMI )
  • Pulseless VF or VT → Defibrillate ( Unsynchronized )
  • Unstable tachycardia, pulse → Synchronized cardioversion
  • Torsades de pointes → Magnesium
  • Symptomatic bradycardia → Atropine, then pace
  • Asystole or PEA → CPR and epinephrine ( No shock )

Hemodynamic Values CA

  • CVP 2-6 mmHg, preload
  • PAWP 8-12 mmHg, left preload
  • CO 4-8 L/min
  • CI 2.5-4; shock under 2.2
  • SVR 800-1200; afterload
  • MAP 70-100; target over 65
  • SvO2 60-80% oxygen delivery
  • PA pressure Systolic 15-25 mmHg

Afib vs Aflutter CA

Atrial fib

  • Irregularly irregular
  • No discrete P waves
  • Rate control or cardiovert

Atrial flutter

  • Regular sawtooth waves
  • Often 2:1 conduction
  • Ablation curative option
  • Chaotic vs sawtooth

ACS Recognition CA

  • STEMI ST elevation; activate cath lab
  • NSTEMI ST depression or T-wave change
  • Unstable angina Ischemic symptoms, negative troponin
  • Troponin trend Rises 3-6 hours after injury
  • New LBBB Treat as STEMI equivalent
  • RV involvement Right-sided ECG, inferior MI
  • Post-cath bleed Flank pain plus falling hemoglobin

Mobitz I vs Mobitz II CA

Mobitz I

  • PR progressively lengthens
  • Then dropped beat
  • Usually benign

Mobitz II

  • PR stays constant
  • Sudden dropped beat
  • May need pacing
  • Gradual vs sudden

Heart Failure CA

  • Preload Volume returning to heart
  • Afterload Resistance heart pumps against
  • BNP Rises with volume overload
  • Orthopnea trend Worsening signals congestion
  • Weight gain 2-3 lb/day flags retention
  • Diuretic response Track urine output, weight
  • Cardiogenic shock Hypotension, cold extremities, low output

Dysrhythmias & ECG CA

  • Atrial fib Irregular, no P waves
  • Atrial flutter Sawtooth flutter waves
  • SVT Narrow, fast, regular
  • V-tach Wide QRS over 100
  • V-fib Chaotic; defibrillate immediately
  • Torsades Polymorphic VT; give magnesium
  • 1st-degree block PR over 0.20 seconds
  • Mobitz I PR lengthens, drops beat
  • Mobitz II Constant PR, sudden drop
  • 3rd-degree block AV dissociation; may pace

Vasoactive & Antiarrhythmic Meds CA

  • Norepinephrine Alpha vasopressor; septic first-line
  • Vasopressin Non-adrenergic; septic add-on
  • Dopamine Dose-dependent adrenergic effects
  • Dobutamine Beta inotrope; raises output
  • Nitroglycerin Venodilator; lowers preload
  • Adenosine Rapid push; terminates SVT
  • Amiodarone Broad-spectrum antiarrhythmic
  • Diltiazem Rate control, afib/flutter
  • Digoxin Narrow therapeutic index

ROME for ABGs RE

  • Respiratory Opposite, Metabolic Equal
  • Resp: pH and CO2 opposite Metab: pH and HCO3 same

Respiratory vs Metabolic Acidosis RE

Respiratory

  • CO2 up, pH down
  • Hypoventilation cause
  • Fix ventilation

Metabolic

  • HCO3 down, pH down
  • DKA, lactate, toxins
  • Fix underlying cause
  • CO2 driver vs HCO3 driver

ABG Acid-Base Picker RE

  • pH down, CO2 up → Respiratory acidosis
  • pH up, CO2 down → Respiratory alkalosis
  • pH down, HCO3 down → Metabolic acidosis
  • pH up, HCO3 up → Metabolic alkalosis
  • High anion gap → DKA, lactate, toxins
  • Normal anion gap → GI or renal bicarb loss

ABG Interpretation RE

  • pH 7.35-7.45 normal range
  • PaCO2 35-45 mmHg; respiratory
  • HCO3 22-26 mEq/L; metabolic
  • PaO2 80-100 mmHg oxygenation
  • Resp acidosis pH down, CO2 up
  • Resp alkalosis pH up, CO2 down
  • Metabolic acidosis pH down, HCO3 down
  • Metabolic alkalosis pH up, HCO3 up
  • Anion gap High: DKA, lactate, toxins

Respiratory Failure & Ventilation RE

  • Type I failure Low PaO2, hypoxemic
  • Type II failure High PaCO2, hypercapnic
  • BiPAP Two pressures, awake patient
  • CPAP One pressure, keeps alveoli open
  • NIV caution Avoid if airway unprotected
  • Failure to wean Tachypnea, accessory muscle use
  • ARDS pattern Bilateral infiltrates, normal wedge
  • Continuous bubbling Chest-tube air leak sign

Cushing Triad MU

  • Rising ICP: up BP, down pulse
  • Widening pulse pressure Bradycardia Irregular breathing

DKA vs HHS MU

DKA

  • Ketoacidosis
  • pH under 7.3
  • Younger, type 1

HHS

  • No ketoacidosis
  • Glucose over 600
  • Older, type 2
  • Acidosis vs hyperosmolar

Endocrine Emergencies MU

  • DKA Acidosis, ketones; usually type 1
  • HHS Very high glucose, minimal ketones
  • SIADH Dilute serum, concentrated urine
  • Diabetes insipidus Dilute urine; give desmopressin
  • Thyroid storm Fever, tachycardia, agitation
  • Hyperglycemia Sustained over 180-200 mg/dL
  • Hypoglycemia Under 70 mg/dL; treat now

Delirium vs Dementia MU

Delirium

  • Acute onset
  • Fluctuating attention
  • Often reversible cause

Dementia

  • Gradual onset
  • Stable attention
  • Progressive, not reversible
  • Acute vs chronic

Insulin & Glycemic Meds MU

  • Regular insulin IV DKA and HHS drip
  • Insulin timing Hold if potassium low
  • Potassium first Replace before, with insulin
  • Dextrose 50% Treats severe hypoglycemia
  • Glucagon IM option, no IV access
  • Glucose recheck Retest 15 minutes after treatment

Neuro & Stroke MU

  • GCS Eye, verbal, motor; 3-15
  • Pupil check Unequal or nonreactive urgent
  • NIHSS Scores stroke severity
  • Alteplase window Ischemic stroke within 4.5h
  • Hemorrhagic stroke CT before any thrombolytic
  • ICP Treat over 20-22 mmHg
  • Delirium CAM-ICU; fluctuating attention
  • Seizure priority Airway, then benzodiazepine

GI & Hepatic MU

  • Upper GI bleed Hematemesis, melena
  • Lower GI bleed Hematochezia
  • GI bleed priority Airway, IV access, type/cross
  • Pancreatitis labs Elevated lipase, amylase
  • Cirrhosis complication Varices, ascites, encephalopathy
  • Hepatic encephalopathy Lactulose lowers ammonia
  • C. diff Contact isolation, soap wash
  • Ischemic bowel Pain out of proportion

Renal & Electrolytes MU

  • Pre-renal AKI Perfusion loss; fluid responsive
  • Intrinsic AKI ATN; muddy brown casts
  • Post-renal AKI Obstruction; relieve it
  • Hyperkalemia Peaked T waves on ECG
  • Hypokalemia Dysrhythmia, muscle weakness risk
  • CKD/ESRD Dialysis-dependent baseline
  • Electrolyte panel Trend with renal function

Heme, Immune & Onc MU

  • HIT Platelets drop; stop heparin
  • Anemia trend Falling H&H; assess source
  • Coagulopathy Warfarin, heparin, antiplatelet-induced
  • Autoimmune flare Lupus, Guillain-Barre, MS
  • Neutropenic precaution Protect from infection exposure

6 Ps of Compartment Syndrome MU

  • Pain, pallor, paresthesia, paralysis, pulselessness, poikilothermia
  • Pain out of proportion Pulselessness is late sign Escalate before paralysis

Hypovolemic vs Cardiogenic Shock MU

Hypovolemic

  • Low preload, low wedge
  • High SVR
  • Needs fluids

Cardiogenic

  • High wedge pressure
  • Low cardiac output
  • Needs inotropes
  • Volume vs pump

Shock Type Picker MU

  • Low CVP, high SVR → Hypovolemic ( Give fluids )
  • High wedge, low output → Cardiogenic ( Inotropes )
  • Low SVR, warm skin → Distributive ( Pressors plus source )
  • Equal diastolic pressures → Tamponade ( Drain pericardium )
  • Fluid-refractory, high lactate → Septic shock ( Norepinephrine )

Sepsis & MODS MU

  • Sepsis-3 Infection plus organ dysfunction
  • qSOFA Altered, low BP, tachypnea
  • Septic shock Pressors plus lactate over 2
  • Hour-1 bundle Cultures, lactate, antibiotics, fluids
  • Initial fluids 30 mL/kg crystalloid
  • First pressor Norepinephrine, then vasopressin
  • MODS Two or more organs fail
  • CAUTI/CLABSI Device-associated infection prevention
  • Pressure injury Stage by tissue depth

DVT/PE & Mobility MU

  • DVT sign Unilateral swelling, warmth, pain
  • PE presentation Sudden dyspnea, pleuritic pain
  • Massive PE Obstructive shock risk
  • Anticoagulation Heparin or DOAC protocol
  • Compartment syndrome 6 Ps warning signs
  • Immobility risk Pressure injury plus VTE
  • Early mobility Lowers delirium, VTE risk

Behavioral & Withdrawal MU

  • CIWA Scores alcohol withdrawal severity
  • Withdrawal timeline Seizure, DT risk window
  • Benzodiazepines First-line for withdrawal seizures
  • Agitation workup Rule out hypoxia, pain first
  • De-escalation Try before restraint use
  • Restraints Least restrictive, time-limited

8 Nurse Competencies PR

  • Judgment, Advocacy, Caring, Collaboration, Systems, Inquiry, Learning, Diversity
  • 8 nurse competencies 8 patient characteristics Match equals synergy

Professional Caring & Ethics PR

  • Advocacy Moral agency for the patient
  • Caring practices Vigilance, engagement with families
  • Response to diversity Culturally responsive nursing care
  • Facilitation of learning Teach patients, families, staff
  • Collaboration Intra- and interdisciplinary teamwork
  • Systems thinking Navigate resources across settings
  • Clinical inquiry Question and evaluate practice
  • Synergy premise Match nurse skill to need

Common Traps

SpO2 vs ventilation

  • SpO2 reflects oxygenation only ≠ Trend CO2 for hypoventilation

First pressor choice

  • Norepinephrine first-line ≠ Not dopamine in septic shock

DKA potassium order

  • Hold insulin if K+ low ≠ Replace potassium first

HIT platelets

  • Stop all heparin sources ≠ Do not give platelets routinely

Mobitz I vs II

  • Progressive PR is benign ≠ Fixed PR sudden drop concerning

ARDS wedge pressure

  • ARDS wedge is normal ≠ High wedge is cardiogenic

qSOFA purpose

  • Bedside screen only ≠ Not a diagnostic criterion

Chest-tube bubbling

  • Continuous bubbling signals leak ≠ Do not clamp routinely

Last Minute

  • 1. 150 items: 125 scored, 25 unscored
  • 2. Pass = 82 correct of 125 scored
  • 3. 3-hour testing appointment
  • 4. Judgment 80%, Professional Caring 20%
  • 5. Cardiovascular is the largest domain, 20%
  • 6. ROME reads the ABG
  • 7. Norepinephrine first in septic shock
  • 8. DKA: replace potassium before insulin
  • 9. HIT: stop all heparin sources
  • 10. Continuous chest-tube bubbling means air leak
  • 11. qSOFA screens; it does not diagnose
  • 12. Synergy Model matches nurse to patient

PCCN Progressive Care Certified Nurse

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