Click Study Flashcards above to open the flashcard hub — hundreds of PCCN cards you can flip, match, type, or quiz yourself on. Every card is drawn from the AACN test-plan domains and written to the progressive-care level, so you study exactly what the PCCN certification exam tests.[1] Pair them with our free practice questions and study guide.
PCCN Flashcard Study Modes
Flip mode moves front to back at your own pace for first-pass study. Match is a timed pairing game that puts terms against their definitions. Type shows the definition and makes you produce the term, so a card like Takotsubo has to come back spelled correctly, not just recognized. Quiz builds multiple-choice questions from the same 295 cards when you want exam-style pressure.
Why Flashcards Work for the PCCN
Cardiovascular is the biggest block at 55 cards, which lines up with the 20% weight AACN gives it. The fronts run from core syndrome and biomarker recall such as ACS, NSTEMI, and Troponin to sharper distinctions like STEMI ECG, Takotsubo, and DAPT, plus drug cards including Diltiazem and BNP interpretation.
Professional practice carries another 20%, and the deck splits it across Synergy Model with 16 cards and Ethics & Professional Practice with 12. The Synergy cards drill the patient and nurse characteristics one at a time, including Resiliency, Predictability, and Systems Thinking. The ethics set covers principle definitions and communication structure, with fronts like Autonomy, Nonmaleficence, Moral distress, and SBAR.
Musculoskeletal / Multisystem / Psychosocial holds 39 cards and absorbs the multisystem, behavioral, and musculoskeletal weights, leaning heavily on sepsis recognition and safety scoring through qSOFA/SOFA, Lactate, MAP goal, Braden scale, and Unstageable. Pulmonary / Respiratory adds 45 cards at 14%, mixing acid-base and device recall in fronts such as ROME, SBT, HFNC, ARDS, and BiPAP.
The organ-system middle of the deck stacks up next. Neurology has 32 cards for assessment tools and acute management, including NIHSS, CAM/CAM-ICU, Mannitol, and Normal ICP. Renal & Electrolytes has 24 cards on Prerenal AKI, Oliguria, and Hyponatremia. Endocrine has 22, with SIADH, Anion gap, and DKA glucose. Gastrointestinal has 20, including Melena, Ascites, and Cullen’s sign.
Two smaller sets round it out. Hematology / Immunology gives you 15 cards on heparin-induced thrombocytopenia and neuromuscular disease, with fronts like 4Ts score, HIT action, and GBS treatment. Exam Logistics & Framework adds 15 cards on the test itself, including PCCN total items, PCCN time limit, and PCCN vs CCRN.
That matters on the PCCN, where facts like Beck’s triad, the sepsis Hour-1 bundle, hyperkalemia treatment, and drip parameters must be instantly available. Used alongside our practice questions and study guide, flashcards turn review time into measurable progress.
PCCN Flashcards by Topic
The cards are organized by the AACN test-plan domains. Weight your study toward the heaviest ones — Cardiovascular (the largest single domain at 20%) and Multisystem (15%) together are 35% of the exam, and the Professional Caring category is a full 20%:[1]
| AACN test-plan domain | Weight |
|---|---|
| Cardiovascular | 20% |
| Professional Caring & Ethical Practice (Synergy Model) | 20% |
| Multisystem | 15% |
| Respiratory | 14% |
| Neurology | 7% |
| Gastrointestinal | 7% |
| Endocrine | 6% |
| Renal | 4% |
| Hematology / Immunology / Oncology | 3% |
| Behavioral / Psychosocial | 3% |
| Musculoskeletal | 2% |
How to Get the Most Out of These Flashcards
- Start with Cardiovascular. It is both the heaviest domain at 20% and the largest at 55 cards, so early Flip passes there pay off the most.
- Type-drill the look-alikes. Cards like NSTEMI, Prerenal AKI, and Anion gap reward exact recall, and typing exposes the ones you only half recognize in multiple choice.
- Use Match for the definition sets. The 16 Synergy Model characteristics and the 12 ethics principles, such as Beneficence and Fidelity/Veracity, sort fastest as timed pairs.
- Switch to the practice test once Quiz feels easy. When Cardiovascular and Pulmonary / Respiratory stop producing misses, move to full-length questions and use the study guide on weak domains.
- Keep the cadence small and repeated. Work one or two domains a session across the 295 cards, then re-Flip yesterday’s misses before starting anything new.
PCCN Flashcards FAQ
Hundreds of free PCCN flashcards, organized across the AACN test-plan domains tested on the Progressive Care Certified Nurse exam — from cardiovascular and respiratory through the Synergy Model. They're free to use with no account required.
Yes. Flashcards use active recall — retrieving an answer from memory — which research shows is one of the most effective ways to make information stick, especially in short sessions spread over several days. That matters for facts like Beck's triad, the sepsis bundle, and drip parameters.
Every AACN domain: Cardiovascular (the largest at 20%), Respiratory, Multisystem (sepsis, shock, HAIs), the combined Endocrine/Hematology/Neurology/GI/Renal block, Musculoskeletal and Psychosocial, plus the 20% Professional Caring and Ethical Practice category tested through the Synergy Model and exam logistics.
Yes. Every card is written to the progressive-care, step-down, and telemetry level the PCCN actually tests — moderately stable adults at elevated risk of instability — emphasizing early recognition and escalation rather than ICU/CCRN-level independent management.
Mix the modes: flip to learn, type to test recall, match for speed, and quiz to check yourself. Spend the most time on Cardiovascular (20%) and Multisystem (15%) — together they are 35% of the exam — and don't skip the 20% Synergy Model category.
Yes — 100% free, all four study modes, no paywall.
PCCN flashcard bank
All 295 cards, by topic
A reference copy of every card in this deck. Each answer stays hidden until you choose to show it. To study with Flip, Match, Type and Quiz modes and track what you have mastered, use Study Flashcards at the top of the page.
Exam Logistics & Framework (15)
- PCCN
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Progressive Care Certified Nurse; AACN certification for nurses caring for acutely ill, moderately stable adults at elevated risk of instability.
- Certifying body
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AACN Certification Corporation (American Association of Critical-Care Nurses); ABSNC-accredited.
- PCCN total items
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150 multiple-choice (125 scored + 25 unscored pretest).
- PCCN time limit
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3 hours.
- PCCN passing score
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Criterion-referenced cut score set by modified Angoff; no fixed percentage.
- PCCN delivery
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PSI computer-based; testing center or Live Remote Proctoring.
- PCCN patient population
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Adults only.
- Clinical Judgment weight
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80% of the exam (body-system clinical content).
- Professional Caring & Ethical Practice weight
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20% (Synergy Model competencies).
- Largest single domain
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Cardiovascular (20%).
- Second-largest domain
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Multisystem (15%).
- Direct Care eligibility (2-yr)
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1,750 hours in 2 years, 875 in the most recent year.
- Knowledge Professional eligibility
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1,040 hours in 2 years, 260 in the most recent year.
- PCCN renewal
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Every 3 years; 100 Synergy CERPs (Cat A/B/C) or renewal by exam, plus practice hours.
- PCCN vs CCRN
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PCCN = progressive/step-down/telemetry (moderately stable); CCRN = ICU (critically ill).
Synergy Model (16)
- Synergy Model premise
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Optimal outcomes when nurse competencies match patient characteristics.
- Resiliency
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Patient's capacity to bounce back after an insult.
- Vulnerability
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Susceptibility to stressors affecting outcomes.
- Stability
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Ability to maintain steady-state equilibrium.
- Complexity
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Entanglement of two or more systems (body/family/therapies).
- Resource Availability
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Resources the patient/family/community brings.
- Predictability
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Expecting a certain course of illness.
- Clinical Judgment (competency)
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Clinical reasoning + decision-making + critical thinking + global grasp.
- Advocacy/Moral Agency
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Acting on patient's behalf; resolving ethical concerns.
- Caring Practices
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Compassionate, therapeutic, vigilant environment.
- Collaboration
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Working with the interdisciplinary team toward shared goals.
- Systems Thinking
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Managing system/environmental resources.
- Response to Diversity
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Incorporating differences into care.
- Facilitation of Learning
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Educating patients/families/staff.
- Clinical Inquiry
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Evidence-based questioning/evaluation of practice.
- Benner's competent stage
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3rd stage; the level PCCN certifies.
Ethics & Professional Practice (12)
- Autonomy
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Patient's right to self-determination.
- Beneficence
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Acting to benefit the patient.
- Nonmaleficence
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Do no harm.
- Justice
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Fair, equitable care.
- Fidelity/Veracity
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Faithfulness/truthfulness.
- ANA Code of Ethics
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Foundational ethical framework AACN bases certification on.
- Informed consent
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Provider obtains; nurse witnesses/verifies understanding.
- Advance directive
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Document stating care wishes if patient can't decide.
- DPOA for health care
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Surrogate decision-maker designation.
- Moral distress
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Knowing the right action but being constrained from taking it.
- SBAR
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Situation, Background, Assessment, Recommendation (structured communication).
- Two patient identifiers
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Required before any care/medication.
Cardiovascular (55)
- Beck's triad
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Hypotension + JVD + muffled heart sounds = cardiac tamponade.
- ACS
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Acute coronary syndrome spectrum: unstable angina, NSTEMI, STEMI.
- STEMI ECG
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ST elevation mm in contiguous leads (or new LBBB).
- NSTEMI
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Elevated troponin without persistent ST elevation.
- Unstable angina
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Ischemic chest pain with normal troponin.
- Inferior MI leads
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II, III, aVF (right coronary artery).
- Anterior MI leads
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V1–V4 (LAD).
- Lateral MI leads
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I, aVL, V5–V6 (circumflex).
- RV infarct caution
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Preload-dependent; avoid nitroglycerin (causes hypotension).
- Door-to-balloon
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Goal min for primary PCI in STEMI.
- Door-to-needle
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Fibrinolytics within 30 min if PCI unavailable.
- Troponin
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Most specific cardiac biomarker for MI.
- DAPT
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Dual antiplatelet therapy: aspirin + P2Y12 inhibitor (ticagrelor/clopidogrel).
- Pericarditis
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Pleuritic chest pain relieved by sitting forward; friction rub; diffuse ST elevation + PR depression.
- Myocarditis
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Inflammation (often viral) → HF, dysrhythmias, ↑troponin without occlusion.
- Endocarditis signs
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Janeway lesions, Osler nodes, splinter hemorrhages, Roth spots; new murmur + fever.
- Aortic dissection
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Tearing chest/back pain, BP differential between arms; lower HR/BP first (beta-blocker before vasodilator).
- Pulsus paradoxus
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SBP drop >10 mmHg on inspiration (tamponade).
- Tamponade treatment
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Pericardiocentesis.
- Cardiogenic shock
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Pump failure; cold/clammy, hypotension, pulmonary congestion, rising lactate.
- Inotropes for cardiogenic shock
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Dobutamine, milrinone.
- Dilated cardiomyopathy
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Enlarged weak ventricle, ↓EF, systolic HF.
- Hypertrophic cardiomyopathy
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Thick septum, outflow obstruction; sudden death risk; avoid dehydration/excess preload reduction.
- Restrictive cardiomyopathy
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Stiff ventricle, diastolic dysfunction.
- Takotsubo
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Stress cardiomyopathy; apical ballooning; mimics STEMI with clean coronaries; reversible.
- Atrial fibrillation
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Irregularly irregular, no P waves; stroke + RVR risk.
- CHA2DS2-VASc
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Stroke risk score guiding AF anticoagulation.
- SVT treatment
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Vagal maneuvers, then adenosine.
- Adenosine administration
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Rapid IV push + fast flush; transient asystole expected.
- VT (pulseless)/VF
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Defibrillate.
- Torsades de pointes
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Polymorphic VT with prolonged QT; treat IV magnesium.
- Complete (3rd-degree) heart block
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AV dissociation; needs pacing.
- Symptomatic bradycardia
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Atropine, then transcutaneous pacing.
- Acute decompensated HF
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Dyspnea, crackles, pink frothy sputum, ↑BNP, S3.
- HF acute treatment
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Upright position, O2/NIV, IV loop diuretic, nitroglycerin.
- Left-sided HF
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Pulmonary congestion (crackles, dyspnea).
- Right-sided HF
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Systemic congestion (JVD, edema, hepatomegaly).
- BNP
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Elevated in heart failure.
- HF daily weight alert
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Report >2–3 lb/day or >5 lb/week gain.
- GDMT for HF
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ACE-I/ARB/ARNI, beta-blocker, MRA, SGLT2 inhibitor, diuretic.
- Hypertensive urgency
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Severe BP without end-organ damage; oral lowering.
- Hypertensive emergency
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Severe BP WITH end-organ damage; IV titratable agents.
- HTN emergency BP goal
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Lower ~10–20% in first hour, then gradually.
- IV antihypertensives
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Nicardipine, clevidipine, labetalol, nitroprusside.
- TAVR complication
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New conduction block (may need pacemaker), vascular bleeding, stroke.
- Aortic stenosis triad
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Syncope, Angina, Dyspnea (SAD); avoid aggressive preload/afterload reduction.
- Acute limb ischemia (6 P's)
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Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia.
- Nitroglycerin
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Vasodilator; hold if SBP <90, RV infarct, recent PDE-5 inhibitor.
- Diltiazem
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CCB for AF rate control; avoid in decompensated HF.
- Amiodarone
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Antiarrhythmic; hypotension/bradycardia; long-term lung/thyroid/liver toxicity.
- Furosemide
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Loop diuretic; monitor K+, renal function, daily weight.
- Norepinephrine
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First-line vasopressor for septic/distributive shock; maintains MAP.
- Post-cath site care
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Assess bleeding/hematoma, distal pulses, contrast nephropathy, retroperitoneal bleed.
- Contrast-induced nephropathy
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Prevent with hydration; monitor creatinine post-cath.
- Electrical alternans
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Beat-to-beat QRS amplitude variation; seen in tamponade.
Pulmonary / Respiratory (45)
- Normal ABG
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pH 7.35–7.45, PaCO2 35–45, HCO3 22–26, PaO2 80–100.
- Respiratory acidosis
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↓pH, ↑PaCO2 (hypoventilation).
- Respiratory alkalosis
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↑pH, ↓PaCO2 (hyperventilation).
- Metabolic acidosis
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↓pH, ↓HCO3.
- Metabolic alkalosis
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↑pH, ↑HCO3.
- ROME
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Respiratory Opposite, Metabolic Equal (pH vs value direction).
- ARDS
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Refractory hypoxemia + bilateral infiltrates not from cardiac failure.
- Lung-protective ventilation
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Low tidal volume ~6 mL/kg IBW, PEEP, plateau <30, permissive hypercapnia.
- Severe asthma silent chest
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Ominous sign of no air movement → impending failure.
- Asthma severe treatment
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SABA + ipratropium, systemic steroids, magnesium.
- COPD O2 target
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SpO2 88–92% (avoid over-oxygenation).
- COPD exacerbation NIV
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BiPAP first-line for hypercapnic respiratory failure.
- OSA treatment
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CPAP; risk of post-sedation respiratory depression.
- Central sleep apnea
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No respiratory effort; linked to HF, stroke, opioids.
- Tension pneumothorax
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Tracheal deviation away, hypotension, JVD → needle decompression.
- Hemothorax
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Blood in pleural space.
- Empyema
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Pus in pleural space.
- Chylothorax
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Lymph in pleural space.
- Chest tube air leak
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Continuous bubbling in water-seal chamber.
- Chest tube tidaling
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Normal fluctuation with respiration.
- PE signs
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Sudden dyspnea, pleuritic pain, tachycardia, hypoxia.
- PE diagnostic
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CT pulmonary angiography; D-dimer sensitive not specific.
- PE ECG
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S1Q3T3 with RV strain.
- Massive PE
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Obstructive shock; thrombolytics/embolectomy.
- Pulmonary fibrosis
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Restrictive scarring, chronic hypoxemia, clubbing.
- Pulmonary hypertension
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↑PA pressure → RV strain → cor pulmonale, loud P2.
- Sarcoidosis
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Granulomatous connective tissue disorder; steroid-responsive.
- Opioid-induced respiratory depression
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Monitor capnography/SpO2; reverse with naloxone.
- Type I respiratory failure
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Hypoxemic (PaO2 <60).
- Type II respiratory failure
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Hypercapnic (PaCO2 >50 + acidosis).
- Failure to wean
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Inability to liberate from ventilator; assess RSBI, secretions, strength, nutrition.
- SBT
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Spontaneous breathing trial to assess extubation readiness.
- VAP prevention
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HOB 30–45°, oral care, sedation interruption, readiness-to-extubate.
- Pneumonia signs
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Fever, productive cough, consolidation, hypoxia, leukocytosis.
- Pneumonectomy
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No chest tube to suction; cautious fluids (one lung).
- Lobectomy
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Chest tube to re-expand remaining lobes; pulmonary hygiene.
- VATS
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Video-assisted minimally-invasive thoracic surgery.
- Venturi mask
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Delivers precise FiO2; useful in COPD.
- Non-rebreather mask
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High-concentration O2 delivery.
- HFNC
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High-flow nasal cannula; bridges before NIV/intubation.
- CPAP
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Continuous positive airway pressure (one level).
- BiPAP
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Bilevel positive airway pressure (inspiratory + expiratory).
- Rising PaCO2 in fatigued patient
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Red flag for impending respiratory failure.
- Naloxone
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Opioid reversal agent.
- Capnography (EtCO2)
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Monitors ventilation/early respiratory depression.
Endocrine (22)
- Hypoglycemia (<70)
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Shakiness, diaphoresis, confusion; rule of 15, D50/glucagon if unconscious.
- DKA glucose
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>250 mg/dL with ketosis and anion-gap acidosis (pH <7.3).
- DKA breathing
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Kussmaul respirations + fruity breath.
- HHS glucose
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>600 mg/dL (often >1000), minimal ketosis, osmolality >320.
- DKA/HHS first treatment
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IV fluids first, then insulin infusion.
- DKA insulin + potassium
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Insulin shifts K+ into cells; don't start insulin if K+ <3.3.
- DKA dextrose timing
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Add dextrose when glucose ~200 to prevent hypoglycemia/cerebral edema.
- SIADH
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Too much ADH → water retention, concentrated urine, hyponatremia.
- SIADH treatment
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Fluid restriction; hypertonic saline if severe.
- Diabetes insipidus
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Too little ADH → polyuria, dilute urine, hypernatremia.
- DI treatment
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Fluid replacement + desmopressin (DDAVP).
- Sodium correction rule
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Correct slowly to avoid osmotic demyelination/cerebral edema.
- Thyroid storm
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Fever, tachy/AF, agitation; beta-blocker + antithyroid + cooling.
- Myxedema coma
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Hypothermia, hypotension, ↓LOC; IV levothyroxine.
- Insulin drip
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Continuous IV insulin for DKA/HHS; hourly glucose monitoring.
- Glucagon
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Reverses severe hypoglycemia if no IV access.
- Hyperglycemia complications
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Risk of DKA/HHS; treat cause + insulin.
- Anion gap
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Elevated in DKA (metabolic acidosis).
- Cerebral edema risk
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From too-rapid glucose/osmolality correction.
- Thiamine before glucose
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Prevents Wernicke encephalopathy (esp. alcohol use).
- DDAVP
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Desmopressin; synthetic ADH for diabetes insipidus.
- Serum osmolality (HHS)
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Markedly elevated (>320 mOsm/kg).
Hematology / Immunology (15)
- Anemia
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↓O2-carrying capacity; fatigue, pallor, tachycardia, dyspnea.
- Warfarin monitoring
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INR.
- Warfarin reversal
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Vitamin K, PCC/FFP.
- HIT
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Heparin-induced thrombocytopenia; platelets drop % + paradoxical clotting ~5–10 days in.
- HIT action
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Stop ALL heparin; start non-heparin anticoagulant (argatroban/bivalirudin/fondaparinux).
- HIT — avoid
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Platelet transfusions and warfarin until platelets recover.
- 4Ts score
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Pretest probability tool for HIT.
- Heparin monitoring
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aPTT or anti-Xa.
- Platelet inhibitors
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Aspirin, clopidogrel, ticagrelor; bleeding risk.
- Guillain-Barré
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Ascending paralysis post-infection; monitor vital capacity (respiratory failure risk).
- GBS treatment
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IVIG or plasmapheresis.
- Myasthenia gravis
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Fluctuating weakness; myasthenic vs cholinergic crisis.
- Multiple sclerosis
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Demyelinating autoimmune disorder.
- ALS
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Progressive motor neuron disease; respiratory monitoring.
- Lupus (SLE)
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Multisystem autoimmune disorder.
Neurology (32)
- Ischemic stroke
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~87% of strokes; clot-caused.
- Hemorrhagic stroke
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Bleed; BP control, reverse anticoagulation.
- FAST/BE-FAST
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Stroke recognition (Balance, Eyes, Face, Arm, Speech, Time).
- NIHSS
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Standardized stroke severity scale.
- tPA/alteplase
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Thrombolytic for eligible ischemic stroke within window.
- Thrombectomy
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Mechanical clot removal for large-vessel occlusion.
- Post-tPA precautions
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Frequent neuro/BP checks, bleeding precautions, no invasive lines 24h.
- Dysphagia screen
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Before any PO intake post-stroke (aspiration risk).
- Normal ICP
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5–15 mmHg.
- Cushing's triad
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Hypertension (widened pulse pressure) + bradycardia + irregular respirations = late ↑ICP.
- ICP management
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HOB 30°, head midline, normocapnia, osmotic therapy.
- Mannitol
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Osmotic diuretic to reduce ICP.
- Status epilepticus
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Seizure min or recurrent without recovery; emergency.
- Status epilepticus first-line
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Benzodiazepine (lorazepam/midazolam).
- Seizure precautions
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Padded rails, suction/O2 at bedside, nothing in mouth, side-lying after.
- TBI
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Monitor for rising ICP, herniation, seizures.
- Subdural hematoma
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Venous bleed; slower onset.
- Epidural hematoma
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Arterial bleed; lucid interval then decline.
- Hepatic encephalopathy
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↑ammonia → confusion; treat lactulose/rifaximin.
- Delirium
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Acute, fluctuating, often reversible confusion; treat the cause.
- Dementia
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Gradual, progressive, irreversible cognitive decline.
- CAM/CAM-ICU
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Delirium assessment tool.
- Delirium management
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Reorient, treat cause, minimize sedatives/restraints, sleep/mobility.
- Encephalopathy types
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Hypoxic-ischemic, metabolic, infectious, hepatic.
- Space-occupying lesion
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Tumor/hematoma/abscess causing mass effect.
- Altered mental status causes
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Infection, hypoxia, electrolytes, meds, withdrawal.
- Glasgow Coma Scale
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Eye/verbal/motor; suggests need to protect airway.
- Cerebral perfusion
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Maintain by avoiding hypotension/hypoxia in brain injury.
- Levetiracetam
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Common antiepileptic.
- Wernicke encephalopathy
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Thiamine deficiency; give thiamine before glucose.
- Stroke BP management
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Don't over-lower in ischemic; tighter control in hemorrhagic.
- Pupillary changes
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Asymmetry/fixed dilation suggests herniation.
Gastrointestinal (20)
- Upper GI bleed
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Hematemesis/coffee-ground emesis, melena; ulcer/varices.
- Lower GI bleed
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Hematochezia (bright red); diverticular/malignancy.
- Variceal bleed
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Octreotide, urgent endoscopy + band ligation; possible balloon tamponade.
- GI bleed nursing
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Large-bore IV, fluids/blood, NPO, type & cross, monitor Hgb.
- Melena
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Black tarry stool (upper GI bleed).
- PPI
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Suppresses acid; used in upper GI ulcer bleed.
- Pancreatitis labs
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Elevated lipase and amylase.
- Cullen's sign
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Periumbilical bruising (hemorrhagic pancreatitis).
- Grey Turner's sign
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Flank bruising (hemorrhagic pancreatitis).
- Pancreatitis care
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NPO/bowel rest, fluids, pain control; watch SIRS, hypocalcemia.
- Bowel obstruction
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Distension, vomiting, abnormal bowel sounds; NG decompression.
- Ileus
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Functional bowel motility failure.
- C. difficile
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Contact precautions + soap-and-water (alcohol doesn't kill spores).
- Cirrhosis complications
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Varices, ascites, encephalopathy, coagulopathy, hepatorenal syndrome.
- Ascites
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Fluid accumulation from portal hypertension.
- Ischemic bowel
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Pain out of proportion + lactate↑; emergency.
- Refeeding syndrome
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Watch phosphate/K/Mg when restarting nutrition in malnourished.
- Bariatric surgery complications
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Anastomotic leak, dumping syndrome.
- Esophageal varices
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Dilated veins from portal hypertension; high bleed risk.
- Dumping syndrome
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Rapid gastric emptying post-GI surgery.
Renal & Electrolytes (24)
- Prerenal AKI
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↓perfusion (hypovolemia, hypotension, HF); often reversible.
- Intrarenal AKI
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Direct damage (ATN, nephrotoxins, contrast).
- Postrenal AKI
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Obstruction (stones, BPH, tumor).
- Oliguria
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Urine output <0.5 mL/kg/hr.
- AKI monitoring
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BUN/creatinine, urine output, electrolytes; avoid nephrotoxins.
- CKD
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Progressive irreversible kidney damage.
- ESRD
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Requires dialysis.
- AV fistula care
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No BP/blood draws/IV in that arm; assess thrill/bruit.
- Hyperkalemia ECG
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Peaked T → widened QRS → loss of P → sine wave → arrest.
- Hyperkalemia first step
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Calcium gluconate to stabilize myocardium.
- Hyperkalemia shift therapy
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Insulin + glucose, beta-agonist, bicarbonate.
- Hyperkalemia removal
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Diuretics, GI binders, dialysis.
- Hypokalemia ECG
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U waves, flattened T waves, arrhythmias.
- K+ replacement rule
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Never IV push; check magnesium too.
- Hyponatremia
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Correct slowly (osmotic demyelination risk); seizures if severe.
- Hypernatremia
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Correct slowly (cerebral edema risk).
- Hypocalcemia
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Chvostek/Trousseau signs, tetany, prolonged QT.
- Hypercalcemia
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Stones, bones, groans, psychiatric overtones.
- Hypomagnesemia
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Torsades, refractory hypokalemia.
- Hyperphosphatemia
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Common in CKD; binds calcium.
- Uremia
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Toxin buildup in renal failure; encephalopathy, pericarditis.
- Erythropoietin
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Reduced in CKD → anemia.
- Metabolic acidosis (renal)
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Common in renal failure.
- Contrast nephropathy prevention
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Hydration; avoid nephrotoxins.
Musculoskeletal / Multisystem / Psychosocial (39)
- Compartment syndrome
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↑compartment pressure → ischemia; 6 P's; emergency fasciotomy.
- Compartment syndrome don't
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Do NOT elevate above heart or ice (worsens perfusion).
- Immobility complications
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VTE, pressure injury, pneumonia, deconditioning.
- Falls prevention
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Risk assessment, bed alarms, call-light reach, med review.
- Sepsis
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Life-threatening organ dysfunction from dysregulated infection response.
- Septic shock
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Sepsis + vasopressors for MAP + lactate >2 despite fluids.
- qSOFA/SOFA
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Sepsis screening/severity tools.
- Sepsis Hour-1 bundle
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Lactate, cultures before antibiotics, antibiotics, 30 mL/kg fluid, vasopressors.
- Sepsis fluids
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30 mL/kg crystalloid for hypotension or lactate .
- Sepsis first vasopressor
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Norepinephrine.
- Lactate
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Marker of tissue hypoperfusion in sepsis/shock.
- MAP goal
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mmHg in shock.
- Hypovolemic shock
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Volume loss; tachycardia, hypotension, cool/clammy → fluids/blood.
- Anaphylactic shock
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Distributive; urticaria, angioedema, bronchospasm → epinephrine IM first.
- Epinephrine (anaphylaxis)
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First-line, IM.
- Distributive shock
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Vasodilation (septic, anaphylactic, neurogenic).
- Obstructive shock
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Mechanical (tamponade, tension PTX, massive PE).
- CLABSI prevention
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Sterile insertion, chlorhexidine, daily line review, scrub the hub.
- CAUTI prevention
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Insert only when indicated, aseptic, closed system, remove early.
- SSI prevention
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Timed prophylactic antibiotics, glucose control, normothermia.
- MRSA/VRE precautions
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Contact (gown + gloves).
- Airborne precautions
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N95 + negative-pressure room (TB, measles, varicella).
- Droplet precautions
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Surgical mask (influenza, pertussis).
- Pressure injury Stage 1
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Non-blanchable erythema, intact skin.
- Pressure injury Stage 2
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Partial-thickness loss, exposed dermis.
- Pressure injury Stage 3
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Full-thickness skin loss (fat visible).
- Pressure injury Stage 4
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Full-thickness skin + tissue loss (muscle/bone).
- Deep tissue pressure injury
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Persistent non-blanchable deep red/maroon/purple.
- Unstageable
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Base obscured by slough/eschar; depth unknown.
- Braden scale
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Pressure-injury risk assessment.
- Rhabdomyolysis
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Muscle breakdown → myoglobin → AKI; ↑CK, dark urine.
- Rhabdomyolysis treatment
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Aggressive IV fluids; monitor K+/renal/cardiac.
- Alcohol withdrawal CIWA-Ar
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Scale guiding symptom-triggered benzodiazepine treatment.
- Delirium tremens (DTs)
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48–96h: autonomic instability, hallucinations; potentially fatal.
- Acetaminophen overdose antidote
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N-acetylcysteine.
- Palliative care
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Symptom relief at any disease stage.
- Restraints
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Last resort; ordered, monitored, time-limited, least-restrictive.
- De-escalation
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First-line response to agitation/aggression.
- Two identifiers + med reconciliation
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Core patient-safety practices at every transition.
References
- 1.AACN Certification Corporation. “PCCN Exam Handbook & Test Plan (effective Feb 6, 2024).” AACN.org. ↑
- 2.American Association of Critical-Care Nurses. “AACN Synergy Model for Patient Care.” AACN.org. ↑
- 3.Society of Critical Care Medicine. “Surviving Sepsis Campaign Guidelines.” SCCM.org. ↑
- 4.Centers for Disease Control and Prevention (CDC). “MRSA & Isolation Precautions.” CDC.gov. ↑
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