FREE PCCN Study Guide 2026: A Complete, AACN-Aligned Walkthrough

This free PCCN study guide walks through the highest-yield content the AACN Progressive Care Certified Nurse exam tests, organized by the body-system domains and the Synergy Model competencies that make up the official test plan.^[1]

It is interactive, not a wall of text: every domain has worked clinical scenarios, telemetry and lab tables, labeled diagrams, and built-in flashcards, taught at the progressive-care (telemetry / step-down) level the PCCN actually tests — recognizing deterioration early and escalating — not the ICU/CCRN level.

Read it domain by domain, then round out your prep with our practice questions and flashcards. The PCCN certifies the nurse who cares for acutely ill adults who are moderately stable with an elevated risk of instability.

PCCN Exam Snapshot

Clinical Judgment — the body-system clinical content — is 80% of the exam, and Cardiovascular (20%) plus Multisystem (15%) alone make up 35%. The remaining 20%, Professional Caring and Ethical Practice, is tested through the Synergy Model. Budget your study toward the heaviest domains first.^[1]

Percentages are set by an AACN study of practice and do not sum to exactly 100 due to rounding; the order of domains in the handbook does not reflect importance.^[1]

How the PCCN Is Built: the Synergy Model

Every AACN certification — including the PCCN — is organized by the AACN Synergy Model for Patient Care. Its central premise: optimal patient outcomes occur when the nurse’s competencies matchthe patient’s characteristics. The patient is at the center, and the nurse’s competencies are derived from the patient’s needs.^[3]

The model defines 8 patient characteristics (resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision-making, predictability) and 8 nurse competencies (clinical judgment, advocacy/moral agency, caring practices, collaboration, systems thinking, response to diversity, facilitation of learning, clinical inquiry). PCCN patients are typically moderately stable with an elevated risk of instability, so they sit in the middle of each continuum — the nurse must be ready to recognize a shift toward instability and respond.^[3]

The required practice level corresponds to the third stage of Benner’s Stages of Clinical Competence — “competent.” The PCCN does not certify an expert; it certifies the competent progressive-care nurse who can manage a typical assignment safely and escalate appropriately.

Cardiovascular

Cardiovascular is the largest single domain at 20% — about one in five scored items.^[1] Teach it at the telemetry/step-down level: continuous monitoring, serial troponins and ECGs, low-dose titratable drips, and early recognition of deterioration. Master the acute coronary syndromes, the lethal rhythms, and the heart-failure and shock patterns and you own the single biggest block of the exam.

Acute Coronary Syndromes

ACS is a spectrum from plaque rupture and thrombus. The three forms are distinguished by the ECG and troponin: unstable angina (ischemic pain, normal troponin), NSTEMI (elevated troponin, no persistent ST elevation), and STEMI (persistent ST elevation, full occlusion).

Localize the infarct: inferior leads are II, III, aVF (right coronary artery); anterior/septal are V1–V4 (LAD); lateral are I, aVL, V5–V6 (circumflex). For an inferior MI, check a right-sided ECG (V4R) — right-ventricular involvement makes the patient preload-dependent, so avoid nitroglycerin (it can cause profound hypotension).

Initial care: aspirin 162–325 mg chewed, oxygen only if SpO₂ <90%, nitroglycerin for ongoing ischemic pain (held for SBP <90, RV infarct, or recent PDE-5 inhibitor), and morphine for refractory pain. Ongoing: dual antiplatelet therapy, a beta-blocker, a high-intensity statin, and an ACE inhibitor.^[8][13]

Tamponade & Inflammatory Disease

Cardiac tamponade is pericardial fluid impairing ventricular filling. Recognize Beck’s triad — hypotension, jugular venous distension, and muffled heart sounds — plus pulsus paradoxus, a narrowed pulse pressure, and electrical alternans. Treatment is emergency pericardiocentesis; the nurse’s role is rapid recognition and escalation.

Pericarditis: sharp pleuritic pain relieved by sitting forward, a friction rub, and diffuse ST elevation with PR depression — watch for progression to effusion and tamponade. Myocarditis: often viral, with heart-failure symptoms and elevated troponin without coronary occlusion. Endocarditis: fever plus a new murmur, with Janeway lesions, Osler nodes, splinter hemorrhages, and Roth spots; draw blood cultures before antibiotics.

Dysrhythmias & Telemetry

Telemetry interpretation is the core PCCN skill. Atrial fibrillation is irregularly irregular with no P waves — anticoagulate by CHA₂DS₂-VASc and control rate (beta-blocker, diltiazem) or rhythm; new unstable AF with rapid response may need cardioversion.

SVT responds to vagal maneuvers then adenosine (rapid IV push with a fast flush; expect transient asystole). Pulseless VT and VF are defibrillated. Torsades de pointes — polymorphic VT with a prolonged QT — is treated with IV magnesium.

Electrolytes drive rhythm: hyperkalemia (peaked T → wide QRS → sine wave), hypokalemia (U waves, arrhythmia), and hypomagnesemia (torsades). A new lethal rhythm on the monitor is always an escalate-now event.

Heart Failure & Cardiogenic Shock

Acute decompensated heart failure and flash pulmonary edema present with dyspnea, orthopnea, crackles, pink frothy sputum, hypoxia, an elevated BNP/NT-proBNP, and an S3. Manage with upright positioning, oxygen or non-invasive ventilation, an IV loop diuretic (furosemide), and a vasodilator (nitroglycerin) to reduce preload and afterload.

Left-sided failure causes pulmonary congestion; right-sided failure causes systemic congestion (JVD, peripheral edema, hepatomegaly). Chronic therapy is guideline-directed medical therapy; teach daily weights and to report a gain over 2–3 lb/day or 5 lb/week.^[8]

Cardiogenic shock is pump failure — “cold and wet” skin, hypotension, pulmonary congestion, oliguria, and a rising lactate, often after a large MI. It is improved with inotropes (dobutamine, milrinone) and careful preload management, with possible mechanical support in the ICU. On step-down, the nursing priority is early recognition and escalation.

Hypertension, Valves & Vascular Disease

Distinguish hypertensive urgency (severe BP without end-organ damage → gradual oral lowering) from a hypertensive emergency (severe BP WITH end-organ damage → IV titratable agents such as nicardipine, clevidipine, or labetalol). Lower the pressure gradually — about 10–20% in the first hour — because too-rapid drops cause cerebral, coronary, and renal hypoperfusion.

Aortic dissection: tearing chest/back pain with a blood-pressure differential between arms — reduce shear force by lowering heart rate and BP, giving a beta-blocker before any vasodilator. Aortic stenosis presents with syncope, angina, and dyspnea; avoid aggressive preload/afterload reduction that drops cardiac output.

After TAVR or a structural procedure, watch for new conduction block (possible pacemaker), vascular bleeding, and stroke. Acute limb ischemia is the 6 P’s — pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia — and a vascular emergency.

Pulmonary / Respiratory

Respiratory is 14% of the exam.^[1] Progressive-care patients are on supplemental oxygen, non-invasive ventilation, or high-flow nasal cannula, or are weaning from the vent after an ICU stay. The recurring task is recognizing impending respiratory failure and escalating before an arrest.

ABG Interpretation

Normal ABG: pH 7.35–7.45, PaCO₂ 35–45, HCO₃ 22–26, PaO₂ 80–100. Read it in steps: is the pH acidotic or alkalotic? Which value matches the pH direction (CO₂ = respiratory, HCO₃ = metabolic)? Is the other value compensating? Use ROME — Respiratory Opposite, Metabolic Equal.

A rising PaCO₂ with a falling pH and increasing fatigue signals impending respiratory failure — escalate before the patient tires out and arrests.

ARDS & Respiratory Failure

ARDS is diffuse inflammatory lung injury causing refractory hypoxemia (a low PaO₂/FiO₂ ratio) and bilateral infiltrates not explained by cardiac failure; it is often driven by sepsis. Management is lung-protective ventilation — low tidal volume (~6 mL/kg ideal body weight), PEEP, plateau pressure <30, and permissive hypercapnia — with prone positioning for severe cases.

Classify respiratory failure as Type I (hypoxemic, PaO₂ <60) or Type II (hypercapnic, PaCO₂ >50 with acidosis). For failure to wean, assess the rapid-shallow-breathing index, secretions, strength, nutrition, and anxiety, and use spontaneous breathing trials.

Asthma, COPD & Sleep Apnea

Severe asthma / status asthmaticus: accessory-muscle use and — ominously — a silent chest (no air movement) with a rising PaCO₂ from fatigue. Treat with a short-acting beta-agonist plus ipratropium, systemic corticosteroids, and magnesium for severe cases. A normalizing or rising PaCO₂ in a tiring asthmatic is a red flag for failure.

COPD exacerbation: bronchodilators, corticosteroids, antibiotics if infectious, and controlled oxygen targeting SpO₂ 88–92% (over-oxygenation can worsen hypercapnia). BiPAP is first-line for hypercapnic respiratory failure and reduces the need for intubation. Obstructive sleep apnea is treated with CPAP; these patients are at risk for post-sedation respiratory depression.

Pleural Complications & Pulmonary Embolism

A tension pneumothorax adds tracheal deviation (away), hypotension, and JVD to absent breath sounds — an emergency needle decompression. Manage chest tubes: tidaling is normal, continuous bubbling in the water-seal chamber means an air leak, and never clamp a functioning chest tube without an order.

Pulmonary embolism causes sudden dyspnea, pleuritic pain, tachycardia, and hypoxia; CT pulmonary angiography is diagnostic, and the ECG may show S1Q3T3 with RV strain. Massive PE causes obstructive shock and is treated with thrombolytics or embolectomy; the rest get anticoagulation. Prevent VTE in every immobile patient.

Oxygen Escalation & Thoracic Surgery

Know the escalation ladder: nasal cannula → simple mask → venturi (precise FiO₂, good for COPD) → non-rebreather → high-flow nasal cannula → NIV (CPAP/BiPAP) → intubation. Step up for rising work of breathing, a falling SpO₂ despite oxygen, a rising CO₂ with acidosis, fatigue, or altered mental status.

Monitor at-risk patients (PCA pumps, post-sedation) with continuous SpO₂ and capnography, and reverse opioid-induced respiratory depression with naloxone. After a pneumonectomy, there is typically no chest tube to suction, and fluids are given cautiously (one lung).

Endocrine, Hematology, Neurology, GI & Renal

The handbook groups these five systems together; combined, they are 27% of the exam — Neurology and Gastrointestinal at 7% each, Endocrine 6%, Renal 4%, and Hematology/Immunology/Oncology 3%.^[1] A handful of high-yield emergencies dominate.

Endocrine Emergencies (DKA & HHS)

The flagship contrast is DKA vs HHS. DKA (glucose >250, ketones, anion-gap acidosis, Kussmaul breathing) tends to occur in type 1; HHS (glucose >600, often >1,000, markedly elevated osmolality, profound dehydration, minimal ketosis) occurs in older type 2 patients.

Treat both: IV fluids first, then an insulin infusion, then potassium replacement — insulin shifts potassium into cells, so do not start insulin if the potassium is below 3.3 mEq/L, and add dextrose as glucose falls (around 200 in DKA, 300 in HHS) to avoid hypoglycemia and cerebral edema.^[10]

SIADH (too much ADH → hyponatremia) is treated with fluid restriction, while diabetes insipidus (too little ADH → hypernatremia, polyuria) is treated with fluids and desmopressin. Correct sodium slowly either way. Hypoglycemia (<70 mg/dL) is the most acute danger — give fast carbs if conscious, D50 or glucagon if not.

Hematology & HIT

The most-tested hematology topic is heparin-induced thrombocytopenia: an immune reaction 5–10 days into heparin in which platelets fall by 50% or more and the patient clots, not bleeds. Stop all heparin (including flushes), start a non-heparin anticoagulant (argatroban, bivalirudin, fondaparinux), do not give platelet transfusions, and avoid warfarin until platelets recover; use the 4Ts score.^[8]

Monitor warfarin with the INR (reverse with vitamin K, PCC, or FFP). For autoimmune disease, Guillain-Barré syndrome causes ascending paralysis after an infection — monitor vital capacity for respiratory failure.

Neurology (Stroke, ICP & Seizures)

For stroke, recognize with FAST/BE-FAST and score severity with the NIHSS. Ischemic stroke (about 87%) within the window gets IV thrombolytics and, for large-vessel occlusion, mechanical thrombectomy — time is brain.

After thrombolysis: frequent neuro and BP checks, bleeding precautions, and no invasive lines for 24 hours. Screen for dysphagia before any oral intake.^[9]

Watch for raised intracranial pressure (normal 5–15 mmHg): a declining level of consciousness and the late, ominous Cushing’s triad (hypertension with a widened pulse pressure, bradycardia, irregular respirations). Manage with the head of bed at 30°, the head midline, normocapnia, and osmotic therapy.

Status epilepticus (a seizure ≥5 minutes or recurrent without recovery) is an emergency treated first-line with a benzodiazepine; maintain seizure precautions. Distinguish acute, reversible delirium (screen with the CAM/CAM-ICU) from progressive dementia, and treat hepatic encephalopathy with lactulose and rifaximin.

Gastrointestinal

A GI bleed is upper (hematemesis, coffee-ground emesis, melena — peptic ulcer or varices) or lower (hematochezia). A variceal bleed needs octreotide, urgent endoscopy, and band ligation.

Nursing: large-bore IV access, fluids and blood, NPO, type and cross, and PPI for ulcers. Pancreatitis brings severe epigastric pain radiating to the back with elevated lipase and amylase (Cullen’s and Grey Turner’s signs if hemorrhagic) — bowel rest, fluids, and pain control, watching for SIRS and hypocalcemia.

Cirrhosis brings varices, ascites, encephalopathy, and coagulopathy. For C. difficile, use contact precautions and soap-and-water hand hygiene (alcohol does not kill spores).

Renal & Electrolytes

Classify acute kidney injury as prerenal (low perfusion — most common, often reversible), intrarenal (ATN, nephrotoxins, contrast), or postrenal (obstruction). Monitor BUN and creatinine, urine output (oliguria <0.5 mL/kg/hr), and electrolytes, and avoid nephrotoxins. In CKD/ESRD, protect the AV fistula (no BP, blood draws, or IVs in that arm; assess the thrill and bruit).

Hyperkalemia is the highest-yield electrolyte emergency. It progresses on the ECG and is treated in a fixed order — stabilize, shift, remove.

Hypokalemia (U waves, arrhythmia) is replaced carefully — never IV push, and check magnesium. Hyponatremia and hypernatremia are both corrected slowly (osmotic demyelination vs cerebral edema), and hypomagnesemia causes torsades and refractory hypokalemia.

Musculoskeletal, Multisystem & Psychosocial

This grouping is 20% combined, dominated by Multisystem at 15% — the second-largest single domain — with Behavioral/Psychosocial at 3% and Musculoskeletal at 2%.^[1] Sepsis, shock, healthcare-associated infections, pressure injuries, end-of-life care, and withdrawal all live here.

Musculoskeletal & Compartment Syndrome

Compartment syndrome is rising pressure in a closed fascial compartment causing ischemia — the 6 P’s (pain out of proportion and with passive stretch, pallor, paresthesia, pulselessness late, paralysis, poikilothermia). It is a surgical emergency (fasciotomy); do not elevate the limb above the heart or apply ice, which worsens perfusion.

Watch for it after crush injuries, fractures, and casts. Prevent the complications of immobility (VTE, pressure injury, pneumonia) and assess fall risk.

Sepsis & Shock States

Sepsis is life-threatening organ dysfunction from a dysregulated response to infection; septic shock is sepsis plus persistent hypotension requiring vasopressors to keep the MAP ≥65 mmHg with a lactate above 2 despite fluids. Screen with qSOFA/SOFA and trend the lactate.

The Hour-1 bundle (measure lactate, draw cultures before antibiotics, give broad-spectrum antibiotics, give 30 mL/kg crystalloid for hypotension or lactate ≥4, and start norepinephrine) is the highest-yield Multisystem content.^[4][5] Recognize the four shock patterns and treat the cause.

Healthcare-Acquired Infections, MDROs & Precautions

Prevent HAIs with bundles: CLABSI (sterile insertion, chlorhexidine, scrub the hub, daily line review), CAUTI (insert only when indicated, aseptic technique, closed system, early removal), SSI (timed prophylactic antibiotics, glucose control, normothermia), and hospital-acquired/ventilator pneumonia (head of bed 30–45°, oral care, mobility).^[6] Apply transmission-based precautions: MRSA and VRE = contact; influenza = droplet; TB, measles, and varicella = airborne (N95 + negative-pressure room); C. difficile = contact with soap-and-water.^[7]

Pressure Injuries, Pain & End-of-Life

Stage pressure injuries by the NPIAP system and prevent them with the Braden scale, repositioning every 2 hours, offloading, skin and moisture care, and nutrition.^[14] Manage acute and chronic pain with multimodal analgesia while monitoring for opioid-induced respiratory depression.

Distinguish palliative care (symptom relief at any stage) from hospice/ end-of-life care (comfort-focused); honor advance directives, surrogate decision-makers, and DNR/DNI orders. Rhabdomyolysis (elevated CK, dark urine) is treated with aggressive IV fluids while monitoring potassium and renal function.

Withdrawal & Psychosocial

Alcohol withdrawal escalates from tremor and anxiety (6–24 h) to seizures (12–48 h) to delirium tremens (48–96 h: autonomic instability, hallucinations — potentially fatal). Assess with the CIWA-Ar scale and treat with symptom-triggered benzodiazepines, giving thiamine before glucose to prevent Wernicke encephalopathy.^[12]

For agitation or aggression, de-escalate first and use restraints only as a last resort (ordered, time-limited, monitored). Screen for anxiety, depression (including suicidality), and substance use, and provide non-judgmental care.

Professional Caring & Ethical Practice

This category is 20% of the exam and is tested entirely through the Synergy Model nurse competencies — not body systems. It splits into two groupings: Advocacy / Caring Practices / Response to Diversity / Facilitation of Learning (11%) and Collaboration / Systems Thinking / Clinical Inquiry (9%).^[1][3]

Advocacy & Moral Agency

Advocacy means representing the patient’s wishes, values, and best interests and acting as a moral agent to identify and resolve ethical concerns. Apply the ethical principles — autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), and fidelity/veracity.

The ANA Code of Ethics for Nurses is the foundation AACN bases certification on. For informed consent, the provider obtains consent while the nurse witnesses and verifies understanding. Honor advance directives and surrogate decision-makers, and recognize moral distress — knowing the right action but being constrained from taking it.

Caring Practices & Response to Diversity

Caring practices create a compassionate, vigilant, therapeutic environment — presence, engagement, comfort, and dignity, including family-centered care and family presence per policy. Response to diversity means recognizing and incorporating cultural, spiritual, linguistic, and individual differences, using professional interpreters (not family) for limited-English patients. Facilitation of learning uses the teach-back method, assesses health literacy and readiness, and delivers discharge teaching that reduces readmissions.

Collaboration & Systems Thinking

Collaboration is interdisciplinary teamwork toward shared goals, anchored by structured communication — SBAR for hand-offs and escalation, closed-loop communication, and rapid-response activation.^[15] Systems thinking sees the patient within the whole system: managing resources and transitions of care, supporting a just culture with non-punitive error reporting, and meeting national patient-safety goals — including verifying patients with two identifiers, medication reconciliation, and alarm management.

Clinical Inquiry & Safety

Clinical inquiry is ongoing questioning and evaluation of practice — evidence-based practice (integrating best evidence, clinical expertise, and patient values), bundle compliance, audits, and outcome measurement. The progressive-care nurse practices at Benner’s competent stage: safe, organized, and able to recognize when to escalate.

How to Use This Study Guide

Work through the guide one domain at a time. After each domain, check it off in the contents to raise your exam-readiness score, then drill the same content in our free practice questions and flashcards — active recall and timed practice are what move knowledge into exam-day performance.

• Weight your time by the blueprint. Cardiovascular (20%) and Multisystem (15%) are 35% of the exam — start there, then Respiratory (14%).
• Stay at the progressive-care level. The PCCN tests early recognition and escalation of a moderately stable patient — not ICU-level independent management.
• Memorize the high-yield emergencies. ACS reperfusion times, Beck’s triad, the sepsis Hour-1 bundle, DKA/HHS, HIT, and hyperkalemia treatment appear again and again.
• Don’t skip the 20% Synergy category. Advocacy, ethics, SBAR, and safety questions are a full fifth of the exam and are easy points if you know the framework.
• Practice clinical judgment. On every scenario, recognize the cue, prioritize, take the safe action within scope, and escalate.

Common questions PCCN candidates search and get asked — each answered briefly and backed by an official source (AACN, SCCM, CDC, NIH, AHRQ, or NPIAP). Tap any card to test yourself.

PCCN Glossary

Key PCCN terms in one place. Hover any dotted term throughout the guide for its definition; the full list is below.

PCCN

Progressive Care Certified Nurse — the AACN Certification Corporation credential for nurses who care for acutely ill adults who are moderately stable but at elevated risk of instability (progressive, intermediate, step-down, telemetry, transitional care).

AACN

American Association of Critical-Care Nurses; its AACN Certification Corporation owns and administers the PCCN, CCRN, and related exams.

Synergy Model

The AACN Synergy Model for Patient Care — the framework behind every AACN certification, in which optimal outcomes occur when the nurse's competencies match the patient's characteristics.

CCRN

Critical Care Registered Nurse — the AACN certification for nurses caring for unstable, critically ill ICU patients; the PCCN covers the less acute, progressive-care level.

Clinical Judgment

The 80% clinical (body-system) category of the PCCN test plan, and one of the eight Synergy Model nurse competencies — clinical reasoning, decision-making, and a global grasp of the situation.

ACS

Acute coronary syndrome — the spectrum of unstable angina, NSTEMI, and STEMI caused by acute coronary plaque rupture and thrombus.

STEMI

ST-elevation myocardial infarction — a fully occluded coronary artery showing persistent ST elevation (≥1 mm in ≥2 contiguous leads or new LBBB); needs emergency reperfusion.

NSTEMI

Non-ST-elevation MI — partial occlusion with elevated troponin but no persistent ST elevation (ST depression or T-wave inversion).

troponin

The most specific cardiac biomarker of myocardial injury; elevated in NSTEMI and STEMI, normal in unstable angina.

Beck's triad

The three classic signs of cardiac tamponade — hypotension, jugular venous distension, and muffled heart sounds.

tamponade

Cardiac tamponade — pericardial fluid compressing the heart and impairing ventricular filling; treated with pericardiocentesis.

pulsus paradoxus

A drop in systolic blood pressure of more than 10 mmHg on inspiration; a sign of cardiac tamponade.

atrial fibrillation

An irregularly irregular rhythm with no discernible P waves; carries stroke and rapid-ventricular-response risk and is anticoagulated using CHA₂DS₂-VASc.

torsades de pointes

A polymorphic ventricular tachycardia associated with a prolonged QT interval; treated with IV magnesium.

cardioversion

A synchronized electrical shock used to convert an unstable tachyarrhythmia (such as atrial fibrillation with rapid response) back to sinus rhythm.

cardiogenic shock

Shock from pump failure — low cardiac output with cold, clammy skin, pulmonary congestion, and a rising lactate; treated with inotropes.

BNP

B-type natriuretic peptide — a biomarker elevated in heart failure; NT-proBNP is the related precursor.

GDMT

Guideline-directed medical therapy for heart failure — typically an ACE inhibitor/ARB or ARNI, a beta-blocker, a mineralocorticoid antagonist, an SGLT2 inhibitor, and a diuretic.

hypertensive emergency

Severely elevated blood pressure WITH acute end-organ damage (encephalopathy, stroke, ACS, pulmonary edema, AKI, dissection); treated with IV titratable agents, lowering BP gradually.

TAVR

Transcatheter aortic valve replacement — a minimally invasive valve procedure; watch for new conduction block (possible pacemaker), vascular bleeding, and stroke.

ABG

Arterial blood gas — measures pH, PaCO₂, HCO₃, and oxygenation to classify acid-base disorders and respiratory status.

ROME

An acid-base memory aid: Respiratory Opposite (pH and CO₂ move opposite ways), Metabolic Equal (pH and bicarbonate move the same way).

ARDS

Acute respiratory distress syndrome — diffuse inflammatory lung injury causing refractory hypoxemia and bilateral infiltrates not explained by cardiac failure; managed with lung-protective ventilation.

NIV

Non-invasive ventilation (CPAP or BiPAP) delivered by mask; BiPAP is first-line for hypercapnic COPD exacerbations to avoid intubation.

tension pneumothorax

Air trapped under pressure in the pleural space causing tracheal deviation, hypotension, and JVD; an emergency treated with needle decompression.

pulmonary embolism

A clot obstructing pulmonary circulation, causing sudden dyspnea, pleuritic pain, and hypoxia; massive PE causes obstructive shock and is treated with anticoagulation or thrombolytics.

capnography

Continuous end-tidal CO₂ monitoring used to detect early respiratory depression, especially with opioids or sedation.

DKA

Diabetic ketoacidosis — hyperglycemia (>250 mg/dL) with ketosis and an anion-gap acidosis (pH <7.3); presents with Kussmaul breathing and fruity breath.

HHS

Hyperosmolar hyperglycemic state — extreme hyperglycemia (>600 mg/dL, often >1,000) with markedly elevated osmolality and profound dehydration but minimal ketosis; typically in older type 2 patients.

SIADH

Syndrome of inappropriate antidiuretic hormone — too much ADH causing water retention, concentrated urine, and dilutional hyponatremia; treated with fluid restriction.

diabetes insipidus

Too little ADH (or renal resistance) causing massive dilute urine output and hypernatremia; treated with fluid replacement and desmopressin (DDAVP).

HIT

Heparin-induced thrombocytopenia — an immune reaction 5–10 days after heparin in which platelets fall ≥50% and the patient paradoxically clots; stop all heparin and start a non-heparin anticoagulant.

NIHSS

The NIH Stroke Scale — a standardized 15-item neurologic exam that scores stroke severity and guides treatment.

Cushing's triad

A late, ominous sign of raised intracranial pressure: hypertension with a widened pulse pressure, bradycardia, and irregular respirations.

status epilepticus

A seizure lasting 5 minutes or longer, or recurrent seizures without recovery; an emergency treated first-line with a benzodiazepine.

delirium

An acute, fluctuating, often reversible disturbance of attention and cognition (from infection, medications, hypoxia, electrolytes, or withdrawal) — distinct from the chronic, progressive decline of dementia.

CAM

The Confusion Assessment Method (and CAM-ICU) — the validated tool for screening for delirium.

hepatic encephalopathy

Confusion from elevated ammonia in liver failure; treated with lactulose and rifaximin.

GI bleed

Bleeding in the gastrointestinal tract — upper (hematemesis, coffee-ground emesis, melena) or lower (hematochezia); managed with large-bore access, fluids/blood, and endoscopy.

pancreatitis

Inflammation of the pancreas with severe epigastric pain radiating to the back and elevated lipase and amylase; managed with bowel rest, fluids, and pain control.

AKI

Acute kidney injury — a sudden drop in kidney function classified as prerenal (low perfusion), intrarenal (direct damage), or postrenal (obstruction).

AV fistula

An arteriovenous fistula for hemodialysis access; protect it — no blood pressures, blood draws, or IVs in that arm, and assess for a thrill and bruit.

hyperkalemia

A high serum potassium that progresses on the ECG from peaked T waves to a widened QRS to a sine wave; treated by stabilizing (calcium), shifting, and removing.

compartment syndrome

Rising pressure in a closed fascial compartment causing ischemia; the 6 P's (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia); an emergency fasciotomy — do not elevate or ice.

sepsis

Life-threatening organ dysfunction from a dysregulated host response to infection; screened with qSOFA/SOFA and treated with the Hour-1 bundle.

septic shock

Sepsis with persistent hypotension requiring vasopressors to keep the MAP ≥65 mmHg plus a lactate above 2 despite adequate fluid resuscitation.

MAP

Mean arterial pressure — the perfusion target in shock; keep it at 65 mmHg or higher.

lactate

A marker of tissue hypoperfusion that is measured and trended in sepsis and shock.

norepinephrine

The first-line vasopressor for septic and other distributive shock; titrated to maintain the MAP ≥65 mmHg.

CLABSI

Central-line-associated bloodstream infection — prevented with sterile insertion, chlorhexidine, scrubbing the hub, and daily review of line necessity.

CAUTI

Catheter-associated urinary tract infection — prevented by inserting only when indicated, aseptic technique, a closed system, and early removal.

CIWA

The CIWA-Ar scale — Clinical Institute Withdrawal Assessment for Alcohol, revised; it scores withdrawal severity and drives symptom-triggered benzodiazepine dosing.

delirium tremens

The most severe stage of alcohol withdrawal (48–96 hours): autonomic instability, hallucinations, and confusion; potentially fatal.

pressure injury

Localized skin and tissue damage over a bony prominence from pressure; staged 1–4 plus deep-tissue and unstageable by NPIAP, and risk-assessed with the Braden scale.

rhabdomyolysis

Muscle breakdown releasing myoglobin that can cause acute kidney injury; marked by elevated CK and dark, tea-colored urine; treated with aggressive IV fluids.

SBAR

Situation, Background, Assessment, Recommendation — a structured communication format for hand-offs and escalation, part of AHRQ's TeamSTEPPS.

moral distress

Knowing the ethically right action but being constrained from taking it; a recognized professional-practice concern in the Synergy Model.

autonomy

The ethical principle of a patient's right to self-determination — to make their own informed health-care decisions.

advance directive

A document (living will or durable power of attorney for health care) that states a patient's care wishes if they become unable to decide.

two identifiers

Verifying a patient with two pieces of identifying information (such as name plus date of birth) before any medication, procedure, specimen, or transfusion.

Benner's stages

Benner's Stages of Clinical Competence (novice → advanced beginner → competent → proficient → expert); the PCCN certifies the third stage, the competent progressive-care nurse.

PCCN Study Guide FAQ

References

1. 1.AACN Certification Corporation. “PCCN Exam Handbook & Test Plan (effective Feb 6, 2024).” AACN. ↑
2. 2.AACN Certification Corporation. “PCCN (Adult) — Get Certified.” AACN. ↑
3. 3.American Association of Critical-Care Nurses. “AACN Synergy Model for Patient Care.” AACN. ↑
4. 4.Society of Critical Care Medicine. “Surviving Sepsis Campaign Guidelines.” SCCM. ↑
5. 5.Centers for Disease Control and Prevention (CDC). “Sepsis.” CDC. ↑
6. 6.Centers for Disease Control and Prevention (CDC). “Healthcare-Associated Infections (CLABSI, CAUTI, SSI, HAP).” CDC. ↑
7. 7.Centers for Disease Control and Prevention (CDC). “MRSA & Isolation Precautions.” CDC. ↑
8. 8.National Institutes of Health / NHLBI. “Heart, Lung & Blood Health Topics (ACS, HF, HIT).” NIH/NHLBI. ↑
9. 9.National Institutes of Health / NINDS. “NIH Stroke Scale (NIHSS).” NIH/NINDS. ↑
10. 10.National Institutes of Health / NIDDK. “Diabetes, DKA, Kidney Disease & GI Health Information.” NIH/NIDDK. ↑
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16. 16.U.S. Food and Drug Administration (FDA). “DailyMed — Drug Labeling (norepinephrine, nitroglycerin, insulin, heparin).” FDA. ↑
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