PCCN Certification Exam | Latest Update 2026/2027 | 200
Practice Questions & Verified Answers | Complete Q&A Guide
| A+ Graded
1. A patient with nonSTelevation myocardial infarction (NSTEMI) develops recurrent chest pain despite
nitrate therapy. Which intervention should the progressive care nurse anticipate next?
A. Immediate thrombolytic therapy
B. Emergent percutaneous coronary intervention (PCI)
C. Highdose statin and discharge planning
D. Nitroprusside drip for afterload reduction
Answer: B. Emergent percutaneous coronary intervention (PCI).
Explanation: For highrisk NSTEMI patients with refractory ischemia, urgent PCI (<24 hours) is indicated.
Thrombolytics are reserved for STEMI without PCI access, not NSTEMI. Highdose statins are adjunctive
therapy, not the primary intervention for ongoing ischemia. Nitroprusside addresses afterload but does
not revascularize the occluded vessel.
2. Which laboratory finding is most specific for diagnosing acute myocardial infarction?
A. Elevated Creactive protein (CRP)
B. Elevated troponin I
C. Elevated Btype natriuretic peptide (BNP)
D. Elevated creatine kinase (CK)
Answer: B. Elevated troponin I.
,Explanation: Cardiac troponins (I and T) are the most specific biomarkers for myocardial necrosis. While
CKMB may be elevated, troponins have greater sensitivity and specificity for MI. CRP is a nonspecific
marker of inflammation, and BNP indicates heart failure, not acute MI.
3. Which ECG change is most indicative of prior transmural myocardial infarction?
A. STsegment depression
B. Peaked T waves
C. Pathologic Q waves
D. U waves
Answer: C. Pathologic Q waves.
Explanation: Pathologic Q waves (≥0.04 seconds wide or >25% of R wave amplitude) indicate transmural
infarction and irreversible myocardial damage. STsegment depression indicates ischemia, peaked T
waves suggest hyperkalemia, and U waves are associated with hypokalemia.
4. A patient with acute decompensated heart failure (ADHF) presents with dyspnea, cool extremities,
and an S3 gallop. Which medication is the priority firstline agent to reduce preload and improve
symptoms?
A. Metoprolol
B. Furosemide
C. Digoxin
D. Spironolactone
Answer: B. Furosemide.
,Explanation: Furosemide is a loop diuretic that rapidly reduces preload and pulmonary congestion in
acute decompensated heart failure. Betablockers are not firstline in acute settings. Digoxin is used for
rate control in atrial fibrillation, and spironolactone is a potassiumsparing diuretic used in chronic
management.
5. Which ECG finding is most consistent with pericarditis?
A. STsegment depression in V1–V3
B. Diffuse STsegment elevation with PR depression
C. Narrow QRS complex with tachycardia
D. Pathologic Q waves in inferior leads
Answer: B. Diffuse STsegment elevation with PR depression.
Explanation: Pericarditis classically shows diffuse ST elevation and PR depression across multiple leads.
Q waves suggest prior MI. STsegment depression in specific leads may indicate ischemia or other
conditions.
6. A patient with an anterior wall STEMI develops hypotension and crackles to the midscapulae. The
most likely cause is:
A. Right ventricular infarction
B. Acute mitral regurgitation
C. Papillary muscle rupture
D. Left ventricular failure
, Answer: D. Left ventricular failure.
Explanation: Anterior MI often leads to left ventricular failure and cardiogenic shock due to extensive
myocardial damage. RV infarction is more common in inferior MI. Papillary muscle rupture and acute
mitral regurgitation are possible complications but less likely than global LV failure.
7. A patient with atrial fibrillation with rapid ventricular response (RVR) has a heart rate of 150 bpm and
BP 100/60 mm Hg. The firstline medication is:
A. Amiodarone
B. Diltiazem
C. Lidocaine
D. Adenosine
Answer: B. Diltiazem.
Explanation: Diltiazem (calcium channel blocker) is firstline for rate control in stable atrial fibrillation
with RVR. Amiodarone is for rhythm control in unstable or refractory cases. Adenosine is used for
supraventricular tachycardia, not atrial fibrillation.
8. A patient in cardiogenic shock is receiving norepinephrine. The nurse should monitor for which
adverse effect?
A. Hypotension
B. Bradycardia
C. Peripheral vasoconstriction and decreased organ perfusion
D. Hyperglycemia
Practice Questions & Verified Answers | Complete Q&A Guide
| A+ Graded
1. A patient with nonSTelevation myocardial infarction (NSTEMI) develops recurrent chest pain despite
nitrate therapy. Which intervention should the progressive care nurse anticipate next?
A. Immediate thrombolytic therapy
B. Emergent percutaneous coronary intervention (PCI)
C. Highdose statin and discharge planning
D. Nitroprusside drip for afterload reduction
Answer: B. Emergent percutaneous coronary intervention (PCI).
Explanation: For highrisk NSTEMI patients with refractory ischemia, urgent PCI (<24 hours) is indicated.
Thrombolytics are reserved for STEMI without PCI access, not NSTEMI. Highdose statins are adjunctive
therapy, not the primary intervention for ongoing ischemia. Nitroprusside addresses afterload but does
not revascularize the occluded vessel.
2. Which laboratory finding is most specific for diagnosing acute myocardial infarction?
A. Elevated Creactive protein (CRP)
B. Elevated troponin I
C. Elevated Btype natriuretic peptide (BNP)
D. Elevated creatine kinase (CK)
Answer: B. Elevated troponin I.
,Explanation: Cardiac troponins (I and T) are the most specific biomarkers for myocardial necrosis. While
CKMB may be elevated, troponins have greater sensitivity and specificity for MI. CRP is a nonspecific
marker of inflammation, and BNP indicates heart failure, not acute MI.
3. Which ECG change is most indicative of prior transmural myocardial infarction?
A. STsegment depression
B. Peaked T waves
C. Pathologic Q waves
D. U waves
Answer: C. Pathologic Q waves.
Explanation: Pathologic Q waves (≥0.04 seconds wide or >25% of R wave amplitude) indicate transmural
infarction and irreversible myocardial damage. STsegment depression indicates ischemia, peaked T
waves suggest hyperkalemia, and U waves are associated with hypokalemia.
4. A patient with acute decompensated heart failure (ADHF) presents with dyspnea, cool extremities,
and an S3 gallop. Which medication is the priority firstline agent to reduce preload and improve
symptoms?
A. Metoprolol
B. Furosemide
C. Digoxin
D. Spironolactone
Answer: B. Furosemide.
,Explanation: Furosemide is a loop diuretic that rapidly reduces preload and pulmonary congestion in
acute decompensated heart failure. Betablockers are not firstline in acute settings. Digoxin is used for
rate control in atrial fibrillation, and spironolactone is a potassiumsparing diuretic used in chronic
management.
5. Which ECG finding is most consistent with pericarditis?
A. STsegment depression in V1–V3
B. Diffuse STsegment elevation with PR depression
C. Narrow QRS complex with tachycardia
D. Pathologic Q waves in inferior leads
Answer: B. Diffuse STsegment elevation with PR depression.
Explanation: Pericarditis classically shows diffuse ST elevation and PR depression across multiple leads.
Q waves suggest prior MI. STsegment depression in specific leads may indicate ischemia or other
conditions.
6. A patient with an anterior wall STEMI develops hypotension and crackles to the midscapulae. The
most likely cause is:
A. Right ventricular infarction
B. Acute mitral regurgitation
C. Papillary muscle rupture
D. Left ventricular failure
, Answer: D. Left ventricular failure.
Explanation: Anterior MI often leads to left ventricular failure and cardiogenic shock due to extensive
myocardial damage. RV infarction is more common in inferior MI. Papillary muscle rupture and acute
mitral regurgitation are possible complications but less likely than global LV failure.
7. A patient with atrial fibrillation with rapid ventricular response (RVR) has a heart rate of 150 bpm and
BP 100/60 mm Hg. The firstline medication is:
A. Amiodarone
B. Diltiazem
C. Lidocaine
D. Adenosine
Answer: B. Diltiazem.
Explanation: Diltiazem (calcium channel blocker) is firstline for rate control in stable atrial fibrillation
with RVR. Amiodarone is for rhythm control in unstable or refractory cases. Adenosine is used for
supraventricular tachycardia, not atrial fibrillation.
8. A patient in cardiogenic shock is receiving norepinephrine. The nurse should monitor for which
adverse effect?
A. Hypotension
B. Bradycardia
C. Peripheral vasoconstriction and decreased organ perfusion
D. Hyperglycemia
