PCCN Certification Practice Exam: Latest
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Question 1: A patient with acute decompensated heart failure presents with crackles in
both lungs, JVD, and 3+ pitting edema in the legs. Vital signs: BP 110/70, HR 102, RR 24,
SpO2 90% on room air. Which medication should the nurse anticipate first?
A. IV furosemide (Lasix)
B. IV dobutamine
C. IV nitroglycerin
D. Oral metoprolol
Correct Answer: A. IV furosemide is the first-line treatment for acute decompensated
heart failure with fluid overload (crackles, edema). It reduces preload and pulmonary
congestion.
Question 2: (Select all that apply) Which of the following are signs of right-sided heart
failure?
A. Jugular venous distension (JVD)
B. Peripheral edema
C. Hepatomegaly
D. Ascites
E. Crackles in lungs
Correct Answers: A, B, C, D. Right-sided heart failure causes systemic congestion: JVD
(A), peripheral edema (B), hepatomegaly (C), and ascites (D). Crackles (E) are a sign of
left-sided heart failure (pulmonary congestion).
Question 3: A patient with heart failure has a B-type natriuretic peptide (BNP) level of
800 pg/mL. What does this indicate?
A. Elevated BNP suggests heart failure (normal <100 pg/mL)
B. Normal BNP
, C. Low BNP suggests heart failure
D. BNP is not useful in heart failure
Correct Answer: A. BNP is released from ventricular myocytes in response to increased
wall stress. A BNP >100 pg/mL suggests heart failure.
Question 4: A patient with heart failure is on lisinopril (ACE inhibitor). Which lab value
should the nurse monitor?
A. Potassium and creatinine
B. Hemoglobin
C. Platelets
D. Liver enzymes
Correct Answer: A. ACE inhibitors can cause hyperkalemia and acute kidney injury.
Monitor potassium and creatinine.
Question 5: (Select all that apply) Which of the following are contraindications to ACE
inhibitors?
A. History of angioedema
B. Pregnancy
C. Bilateral renal artery stenosis
D. Hyperkalemia (K >5.5)
E. Hypertension
Correct Answers: A, B, C, D. ACE inhibitors are contraindicated in angioedema (A),
pregnancy (B) (fetal toxicity), bilateral renal artery stenosis (C), and hyperkalemia (D).
Hypertension (E) is an indication.
Question 6: A patient with heart failure is on carvedilol (beta-blocker). Which finding
requires holding the medication?
A. Heart rate 52 beats/min
B. Blood pressure 110/70
C. Respiratory rate 18
D. Weight gain of 2 lbs in 1 week
Correct Answer: A. Beta-blockers can cause bradycardia and heart block. Hold the
medication if heart rate is <60, SBP <90, or if the patient develops signs of heart failure
exacerbation.
, Question 7: A patient with heart failure has a PAWP of 18 mm Hg. What does this
indicate?
A. Normal filling pressure
B. Elevated filling pressure (fluid overload)
C. Low filling pressure (dehydration)
D. Right ventricular failure
Correct Answer: B. Normal PAWP is 6-12 mm Hg. 18 mm Hg indicates elevated left
ventricular filling pressure (fluid overload).
Question 8: A patient with an acute MI has ST elevation in leads II, III, and aVF. Which
coronary artery is affected?
A. Left anterior descending (LAD)
B. Right coronary artery (RCA)
C. Left circumflex (LCx)
D. Left main coronary artery
Correct Answer: B. Inferior MI (II, III, aVF) is caused by RCA occlusion. LAD (A) causes
anterior MI (V1-V4). LCx (C) causes lateral MI (I, aVL, V5-V6).
Question 9: (Select all that apply) Which of the following are components of the
"CHA₂DS₂-VASc" score for stroke risk in atrial fibrillation?
A. Congestive heart failure
B. Hypertension
C. Age ≥75 (2 points)
D. Diabetes
E. Stroke/TIA (2 points)
F. Vascular disease (MI, PAD)
G. Age 65-74 (1 point)
H. Sex category (female = 1 point)
Correct Answers: A, B, C, D, E, F, G, H. All are components of the CHA₂DS₂-VASc score
used to guide anticoagulation in atrial fibrillation.
Question 10: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which
treatment is indicated?
A. Aspirin
B. Warfarin or DOAC (direct oral anticoagulant)
Blueprint||questions and answers with
rationales/graded A+/2026 update/100%
correct MOST RECENT
Question 1: A patient with acute decompensated heart failure presents with crackles in
both lungs, JVD, and 3+ pitting edema in the legs. Vital signs: BP 110/70, HR 102, RR 24,
SpO2 90% on room air. Which medication should the nurse anticipate first?
A. IV furosemide (Lasix)
B. IV dobutamine
C. IV nitroglycerin
D. Oral metoprolol
Correct Answer: A. IV furosemide is the first-line treatment for acute decompensated
heart failure with fluid overload (crackles, edema). It reduces preload and pulmonary
congestion.
Question 2: (Select all that apply) Which of the following are signs of right-sided heart
failure?
A. Jugular venous distension (JVD)
B. Peripheral edema
C. Hepatomegaly
D. Ascites
E. Crackles in lungs
Correct Answers: A, B, C, D. Right-sided heart failure causes systemic congestion: JVD
(A), peripheral edema (B), hepatomegaly (C), and ascites (D). Crackles (E) are a sign of
left-sided heart failure (pulmonary congestion).
Question 3: A patient with heart failure has a B-type natriuretic peptide (BNP) level of
800 pg/mL. What does this indicate?
A. Elevated BNP suggests heart failure (normal <100 pg/mL)
B. Normal BNP
, C. Low BNP suggests heart failure
D. BNP is not useful in heart failure
Correct Answer: A. BNP is released from ventricular myocytes in response to increased
wall stress. A BNP >100 pg/mL suggests heart failure.
Question 4: A patient with heart failure is on lisinopril (ACE inhibitor). Which lab value
should the nurse monitor?
A. Potassium and creatinine
B. Hemoglobin
C. Platelets
D. Liver enzymes
Correct Answer: A. ACE inhibitors can cause hyperkalemia and acute kidney injury.
Monitor potassium and creatinine.
Question 5: (Select all that apply) Which of the following are contraindications to ACE
inhibitors?
A. History of angioedema
B. Pregnancy
C. Bilateral renal artery stenosis
D. Hyperkalemia (K >5.5)
E. Hypertension
Correct Answers: A, B, C, D. ACE inhibitors are contraindicated in angioedema (A),
pregnancy (B) (fetal toxicity), bilateral renal artery stenosis (C), and hyperkalemia (D).
Hypertension (E) is an indication.
Question 6: A patient with heart failure is on carvedilol (beta-blocker). Which finding
requires holding the medication?
A. Heart rate 52 beats/min
B. Blood pressure 110/70
C. Respiratory rate 18
D. Weight gain of 2 lbs in 1 week
Correct Answer: A. Beta-blockers can cause bradycardia and heart block. Hold the
medication if heart rate is <60, SBP <90, or if the patient develops signs of heart failure
exacerbation.
, Question 7: A patient with heart failure has a PAWP of 18 mm Hg. What does this
indicate?
A. Normal filling pressure
B. Elevated filling pressure (fluid overload)
C. Low filling pressure (dehydration)
D. Right ventricular failure
Correct Answer: B. Normal PAWP is 6-12 mm Hg. 18 mm Hg indicates elevated left
ventricular filling pressure (fluid overload).
Question 8: A patient with an acute MI has ST elevation in leads II, III, and aVF. Which
coronary artery is affected?
A. Left anterior descending (LAD)
B. Right coronary artery (RCA)
C. Left circumflex (LCx)
D. Left main coronary artery
Correct Answer: B. Inferior MI (II, III, aVF) is caused by RCA occlusion. LAD (A) causes
anterior MI (V1-V4). LCx (C) causes lateral MI (I, aVL, V5-V6).
Question 9: (Select all that apply) Which of the following are components of the
"CHA₂DS₂-VASc" score for stroke risk in atrial fibrillation?
A. Congestive heart failure
B. Hypertension
C. Age ≥75 (2 points)
D. Diabetes
E. Stroke/TIA (2 points)
F. Vascular disease (MI, PAD)
G. Age 65-74 (1 point)
H. Sex category (female = 1 point)
Correct Answers: A, B, C, D, E, F, G, H. All are components of the CHA₂DS₂-VASc score
used to guide anticoagulation in atrial fibrillation.
Question 10: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which
treatment is indicated?
A. Aspirin
B. Warfarin or DOAC (direct oral anticoagulant)
