Cardiovascular
20%of exam
Respiratory
14%of exam
Endo, Heme, Neuro, GI, Renal
27%of exam
MSK, Multisystem, Behavioral
20%of exam
Professional Caring & Ethics
20%of exam
Synergy ModelAdvocacyCollaborationSystems ThinkingClinical 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
Morphine, Oxygen, Nitrates, Aspirin; not all routine
Aspirin: give unless allergyOxygen: only if hypoxicNitrates: avoid if hypotensiveMorphine: caution, may mask ischemia
STEMI vs NSTEMI
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
- 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
- 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
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
- 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
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
- 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
- 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
- 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
Respiratory Opposite, Metabolic Equal
Resp: pH and CO2 oppositeMetab: pH and HCO3 same
Respiratory vs Metabolic Acidosis
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
- 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
- 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
- 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
Rising ICP: up BP, down pulse
Widening pulse pressureBradycardiaIrregular breathing
DKA vs HHS
DKA
- Ketoacidosis
- pH under 7.3
- Younger, type 1
HHS
- No ketoacidosis
- Glucose over 600
- Older, type 2
Acidosis vs hyperosmolar
Endocrine Emergencies
- 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
Delirium
- Acute onset
- Fluctuating attention
- Often reversible cause
Dementia
- Gradual onset
- Stable attention
- Progressive, not reversible
Acute vs chronic
Insulin & Glycemic Meds
- 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
- 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
- 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
- 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
- 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
Pain, pallor, paresthesia, paralysis, pulselessness, poikilothermia
Pain out of proportionPulselessness is late signEscalate before paralysis
Hypovolemic vs Cardiogenic Shock
Hypovolemic
- Low preload, low wedge
- High SVR
- Needs fluids
Cardiogenic
- High wedge pressure
- Low cardiac output
- Needs inotropes
Volume vs pump
Shock Type Picker
- 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
- 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
- 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
- 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
Judgment, Advocacy, Caring, Collaboration, Systems, Inquiry, Learning, Diversity
8 nurse competencies8 patient characteristicsMatch equals synergy
Professional Caring & Ethics
- 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
Buy on Amazon
Practice exams on ExamEdge
Online course on MometrixSame family resources
Explore More AACN Nursing Certifications
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
More From This Family
Videos and articles for deeper review.
VideoFREE CCRN Study Guide 2026: AACN Exam Plan + 10-Week ICU PlanArticlePCCN Pass Rate 2026: 70.10% (2025) + Free Study Plan13 min readArticleCCRN Hardest Topics Ranked: What to Study First + 8-Week Plan (2026)15 min readArticleFREE CCRN Study Guide 2026: AACN Exam Plan + 10-Week ICU Plan16 min readArticleFREE CCRN (Pediatric) Exam Guide 2026: Pass AACN PICU Cert26 min read