PCCN CERTIFICATION EXAMS SET 2026
COMPLETE QUESTIONS WITH ANSWERS
ALREADY PASSED
Domain: Cardiovascular System (Questions 1–20)
1. A patient with acute decompensated heart failure presents with dyspnea, jugular
venous distension, crackles in both lungs, and an S3 gallop. Which medication is
the priority?
• A) Metoprolol
• B) Furosemide
• C) Digoxin
• D) Spironolactone
Correct ,,,,answer,,,,: B) Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and
pulmonary congestion in acute decompensated heart failure. Beta-blockers
(metoprolol) are not first-line in acute settings as they can worsen acute
decompensation. Digoxin is used for rate control in atrial fibrillation but does not
address acute pulmonary congestion. Spironolactone is an adjunct for chronic HF
management.
2. Which ECG finding is most consistent with acute pericarditis?
, • A) ST-segment depression in V1–V3
• B) Diffuse ST-segment elevation with PR depression
• C) Narrow QRS complex with tachycardia
• D) Pathologic Q waves in inferior leads
Correct ,,,,answer,,,,: B) Diffuse ST-segment elevation with PR depression
Rationale: Pericarditis classically shows diffuse ST elevation (concave up) and PR
depression across multiple leads. ST depression in V1–V3 suggests posterior MI or
right ventricular strain. Pathologic Q waves indicate prior myocardial infarction
and are not seen in pericarditis.
3. A patient with an anterior wall STEMI develops hypotension and crackles to the
mid-scapulae. The most likely cause is:
• A) Right ventricular infarction
• B) Acute mitral regurgitation
• C) Papillary muscle rupture
• D) Left ventricular failure
Correct ,,,,answer,,,,: D) Left ventricular failure
Rationale: Anterior MI often leads to left ventricular failure and cardiogenic shock
due to extensive myocardial damage affecting a large portion of the left ventricle.
RV infarction is more common in inferior MI and presents with hypotension and
clear lungs. Papillary muscle rupture causes acute, severe mitral regurgitation
with a new murmur.
,4. A patient with atrial fibrillation with rapid ventricular response (RVR) has a
heart rate of 150 bpm and BP 100/60 mm Hg. The patient is stable. First-line
medication is:
• A) Amiodarone
• B) Diltiazem
• C) Lidocaine
• D) Adenosine
Correct ,,,,answer,,,,: B) Diltiazem
Rationale: Diltiazem (calcium channel blocker) is first-line for rate control in
stable atrial fibrillation with RVR. Amiodarone is reserved for rhythm control in
unstable or refractory cases. Lidocaine is for ventricular arrhythmias. Adenosine
is for supraventricular tachycardia, not AF with RVR.
5. Which of the following is a contraindication to thrombolytic therapy in acute
ischemic stroke?
• A) Age > 80 years
• B) Systolic BP > 185 mm Hg after treatment
• C) History of atrial fibrillation
• D) Blood glucose > 50 mg/dL
Correct ,,,,answer,,,,: B) Systolic BP > 185 mm Hg after treatment
Rationale: Uncontrolled hypertension (SBP >185 or DBP >110 despite treatment)
is a contraindication to tPA due to increased intracranial hemorrhage risk. Age
>80 alone is not an absolute contraindication. AF is not a contraindication.
Hypoglycemia would need correction but is not a contraindication if corrected.
, 6. A patient with a permanent pacemaker has a heart rate of 45 bpm with pacing
spikes not followed by QRS complexes. This is called:
• A) Failure to sense
• B) Failure to capture
• C) Oversensing
• D) Pacemaker syndrome
Correct ,,,,answer,,,,: B) Failure to capture
Rationale: Pacing spikes without subsequent depolarization (no QRS) indicate
failure to capture. Failure to sense occurs when the pacemaker fires at
inappropriate times (spikes on T waves). Oversensing means the pacemaker
incorrectly inhibits pacing. Pacemaker syndrome describes symptoms from loss of
AV synchrony.
7. A patient presents with chest pain. ECG shows ST elevation in leads II, III, and
aVF with reciprocal changes in V1–V3. Which artery is most likely occluded?
• A) Left anterior descending (LAD)
• B) Left circumflex (LCX)
• C) Right coronary artery (RCA)
• D) Left main coronary artery
Correct ,,,,answer,,,,: C) Right coronary artery (RCA)
*Rationale: Inferior wall STEMI (leads II, III, aVF) is typically caused by RCA
occlusion. LAD occlusion causes anterior/septal MI (V1–V4). LCX occlusion
COMPLETE QUESTIONS WITH ANSWERS
ALREADY PASSED
Domain: Cardiovascular System (Questions 1–20)
1. A patient with acute decompensated heart failure presents with dyspnea, jugular
venous distension, crackles in both lungs, and an S3 gallop. Which medication is
the priority?
• A) Metoprolol
• B) Furosemide
• C) Digoxin
• D) Spironolactone
Correct ,,,,answer,,,,: B) Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload and
pulmonary congestion in acute decompensated heart failure. Beta-blockers
(metoprolol) are not first-line in acute settings as they can worsen acute
decompensation. Digoxin is used for rate control in atrial fibrillation but does not
address acute pulmonary congestion. Spironolactone is an adjunct for chronic HF
management.
2. Which ECG finding is most consistent with acute pericarditis?
, • A) ST-segment depression in V1–V3
• B) Diffuse ST-segment elevation with PR depression
• C) Narrow QRS complex with tachycardia
• D) Pathologic Q waves in inferior leads
Correct ,,,,answer,,,,: B) Diffuse ST-segment elevation with PR depression
Rationale: Pericarditis classically shows diffuse ST elevation (concave up) and PR
depression across multiple leads. ST depression in V1–V3 suggests posterior MI or
right ventricular strain. Pathologic Q waves indicate prior myocardial infarction
and are not seen in pericarditis.
3. A patient with an anterior wall STEMI develops hypotension and crackles to the
mid-scapulae. The most likely cause is:
• A) Right ventricular infarction
• B) Acute mitral regurgitation
• C) Papillary muscle rupture
• D) Left ventricular failure
Correct ,,,,answer,,,,: D) Left ventricular failure
Rationale: Anterior MI often leads to left ventricular failure and cardiogenic shock
due to extensive myocardial damage affecting a large portion of the left ventricle.
RV infarction is more common in inferior MI and presents with hypotension and
clear lungs. Papillary muscle rupture causes acute, severe mitral regurgitation
with a new murmur.
,4. A patient with atrial fibrillation with rapid ventricular response (RVR) has a
heart rate of 150 bpm and BP 100/60 mm Hg. The patient is stable. First-line
medication is:
• A) Amiodarone
• B) Diltiazem
• C) Lidocaine
• D) Adenosine
Correct ,,,,answer,,,,: B) Diltiazem
Rationale: Diltiazem (calcium channel blocker) is first-line for rate control in
stable atrial fibrillation with RVR. Amiodarone is reserved for rhythm control in
unstable or refractory cases. Lidocaine is for ventricular arrhythmias. Adenosine
is for supraventricular tachycardia, not AF with RVR.
5. Which of the following is a contraindication to thrombolytic therapy in acute
ischemic stroke?
• A) Age > 80 years
• B) Systolic BP > 185 mm Hg after treatment
• C) History of atrial fibrillation
• D) Blood glucose > 50 mg/dL
Correct ,,,,answer,,,,: B) Systolic BP > 185 mm Hg after treatment
Rationale: Uncontrolled hypertension (SBP >185 or DBP >110 despite treatment)
is a contraindication to tPA due to increased intracranial hemorrhage risk. Age
>80 alone is not an absolute contraindication. AF is not a contraindication.
Hypoglycemia would need correction but is not a contraindication if corrected.
, 6. A patient with a permanent pacemaker has a heart rate of 45 bpm with pacing
spikes not followed by QRS complexes. This is called:
• A) Failure to sense
• B) Failure to capture
• C) Oversensing
• D) Pacemaker syndrome
Correct ,,,,answer,,,,: B) Failure to capture
Rationale: Pacing spikes without subsequent depolarization (no QRS) indicate
failure to capture. Failure to sense occurs when the pacemaker fires at
inappropriate times (spikes on T waves). Oversensing means the pacemaker
incorrectly inhibits pacing. Pacemaker syndrome describes symptoms from loss of
AV synchrony.
7. A patient presents with chest pain. ECG shows ST elevation in leads II, III, and
aVF with reciprocal changes in V1–V3. Which artery is most likely occluded?
• A) Left anterior descending (LAD)
• B) Left circumflex (LCX)
• C) Right coronary artery (RCA)
• D) Left main coronary artery
Correct ,,,,answer,,,,: C) Right coronary artery (RCA)
*Rationale: Inferior wall STEMI (leads II, III, aVF) is typically caused by RCA
occlusion. LAD occlusion causes anterior/septal MI (V1–V4). LCX occlusion
