PCCN CERTIFICATION EXAM |ACTUAL QUESTIONS
AND VERIFIED ANSWERS 2026-2027 UPDATED
EDITION|GRADED A+
Question 1
1. A 49-year-old male was recently admitted with an inferior wall MI resulting from 100%
occlusion of the right coronary artery (RCA). The 12-lead ECG reveals ST elevation in leads
II, III, and a VF. You would expect to see reciprocal changes in which leads?
A. I, a VR
B. V1, V2
C. V3, V4
D. I, a VL
CORRECT ANSWER
D. I, aVL. The RCA perfuses the inferior wall and the mirror image or reciprocal change
will be seen in the high lateral wall, which is reflected in leads I, and aVL on the 12-Lead
ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate with the
anterior area of the heart. The aVR lead does not provide much diagnostic value as all
energy is depolarizing away from this lead.
Question 2
2. You are summoned to the room of a 30 year old female who is experiencing sustained
tonic-clonic convulsions while sitting in a chair. A family member states:"She was just
talking to us and suddenly she let out a shriek and started flopping like a fish out of
water." What is your initial priority of care?
A. Call for help and safety guide the patient to the floor.
B. Call for help and administer a prescribed antiepileptic.
C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure.
CORRECT ANSWER
1
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, A. Call for help and safely guide the patient to the floor. Patient safety is the first priority.
Once the patient is safe from immediate harm or injury, the seizure activity must be
terminated. Seizure abatement is accomplished by the administration of a
benzodiazepine. Antiepileptic medications are useful in the prevention of seizure of
activity.
Question 3
3. A 46 year old patient presents with pneumonia and sepsis. He was treated with 4 days
of antibiotics and IV fluids. He is increasingly short of breath and is now on 100% FiO2 via
non-rebreather mask. You obtain an ABG with the following results: pH 7.20 / PaCO2 68 /
PaO2 102 / HCO3 28. A chest x-ray reveals bilateral pulmonary infiltrates. The patient is
likely developing:
A. Worsening pneumonia
B. Acute Respiratory Distress Syndrome
C. Pulmonary embolus
D. Atelectasis
CORRECT ANSWER
B. Acute Respiratory Distress Syndrome. Criteria for ARDS include bilateral pulmonary
infiltrates on chest x-ray and a P/F ratio ≤ 300; it is further rated as mild-moderate-severe
ARDS based on the P/F ratio. To calculate the P/F ratio, divide the PaO2 from an ABG by
the FiO2. In this case 102 (PaO2) ÷ 1.0 (100% FiO2) = 102, making it borderline severe
ARDS. Other criteria for ARDS include decreased compliance, refractory hypoxemia and
low expired minute volume. The patient needs to be transferred to the ICU and will likely
require intubation & mechanical ventilation.
Question 4
4. A 56 year old male is admitted to the PCU with a hypertensive crisis. His blood pressure
is now 205/125 mm Hg and his is complaining of a headache with nausea. He reports he
ran out of blood pressure medication three days ago, but also appears to be confused to
the date and situation. What is the most appropriate treatment approach?
2
@https://www.stuvia.com/user/thestudyvault
, A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication,
then gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive
medication.
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications,
then switch to oral antihypertensive medications for maintenance
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications,
then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral
antihypertensive medications.
D. Slowly lower the diastolic pressure to 85 mm Hg wi
CORRECT ANSWER
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
medications, and then continue to gradually reduce the diastolic pressure to 85 mm Hg
with oral antihypertensive medications. The patient is experiencing a hypertensive crisis
with associated hypertensive encephalopathy. This requires emergent treatment by
rapidly decreasing the diastolic blood pressure to around 100 mm Hg using intravenous
antihypertensive medications. The maximum initial decrease should be no more than
25% reduction from initial presenting value. Reducing the blood pressure too quickly can
lead to cerebral edema or renal failure. The initial decrease should take place over 2-6
hours. Once the BP is controlled and symptoms have resolved the patient should be
transitioned to oral antihypertensive medications with a goal to reduce the diastolic
pressure gradually to 85 mm Hg over the next 2-3 months.
Question 5
5. Which of the following labs must be closely monitored when administering Lisinopril to
a patient with systolic heart failure?
A. Sodium
B. Phosphate
C. Magnesium
D. Potassium
CORRECT ANSWER
D. Potassium. Patients taking angiotensin converting enzyme inhibitors may experience
hyperkalemia. ACE inhibitors block angiotensin II, which may lead to decreased
3
@https://www.stuvia.com/user/thestudyvault
AND VERIFIED ANSWERS 2026-2027 UPDATED
EDITION|GRADED A+
Question 1
1. A 49-year-old male was recently admitted with an inferior wall MI resulting from 100%
occlusion of the right coronary artery (RCA). The 12-lead ECG reveals ST elevation in leads
II, III, and a VF. You would expect to see reciprocal changes in which leads?
A. I, a VR
B. V1, V2
C. V3, V4
D. I, a VL
CORRECT ANSWER
D. I, aVL. The RCA perfuses the inferior wall and the mirror image or reciprocal change
will be seen in the high lateral wall, which is reflected in leads I, and aVL on the 12-Lead
ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate with the
anterior area of the heart. The aVR lead does not provide much diagnostic value as all
energy is depolarizing away from this lead.
Question 2
2. You are summoned to the room of a 30 year old female who is experiencing sustained
tonic-clonic convulsions while sitting in a chair. A family member states:"She was just
talking to us and suddenly she let out a shriek and started flopping like a fish out of
water." What is your initial priority of care?
A. Call for help and safety guide the patient to the floor.
B. Call for help and administer a prescribed antiepileptic.
C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure.
CORRECT ANSWER
1
@https://www.stuvia.com/user/thestudyvault
, A. Call for help and safely guide the patient to the floor. Patient safety is the first priority.
Once the patient is safe from immediate harm or injury, the seizure activity must be
terminated. Seizure abatement is accomplished by the administration of a
benzodiazepine. Antiepileptic medications are useful in the prevention of seizure of
activity.
Question 3
3. A 46 year old patient presents with pneumonia and sepsis. He was treated with 4 days
of antibiotics and IV fluids. He is increasingly short of breath and is now on 100% FiO2 via
non-rebreather mask. You obtain an ABG with the following results: pH 7.20 / PaCO2 68 /
PaO2 102 / HCO3 28. A chest x-ray reveals bilateral pulmonary infiltrates. The patient is
likely developing:
A. Worsening pneumonia
B. Acute Respiratory Distress Syndrome
C. Pulmonary embolus
D. Atelectasis
CORRECT ANSWER
B. Acute Respiratory Distress Syndrome. Criteria for ARDS include bilateral pulmonary
infiltrates on chest x-ray and a P/F ratio ≤ 300; it is further rated as mild-moderate-severe
ARDS based on the P/F ratio. To calculate the P/F ratio, divide the PaO2 from an ABG by
the FiO2. In this case 102 (PaO2) ÷ 1.0 (100% FiO2) = 102, making it borderline severe
ARDS. Other criteria for ARDS include decreased compliance, refractory hypoxemia and
low expired minute volume. The patient needs to be transferred to the ICU and will likely
require intubation & mechanical ventilation.
Question 4
4. A 56 year old male is admitted to the PCU with a hypertensive crisis. His blood pressure
is now 205/125 mm Hg and his is complaining of a headache with nausea. He reports he
ran out of blood pressure medication three days ago, but also appears to be confused to
the date and situation. What is the most appropriate treatment approach?
2
@https://www.stuvia.com/user/thestudyvault
, A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication,
then gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive
medication.
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications,
then switch to oral antihypertensive medications for maintenance
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive medications,
then continue to gradually reduce the diastolic pressure to 85 mm Hg with oral
antihypertensive medications.
D. Slowly lower the diastolic pressure to 85 mm Hg wi
CORRECT ANSWER
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
medications, and then continue to gradually reduce the diastolic pressure to 85 mm Hg
with oral antihypertensive medications. The patient is experiencing a hypertensive crisis
with associated hypertensive encephalopathy. This requires emergent treatment by
rapidly decreasing the diastolic blood pressure to around 100 mm Hg using intravenous
antihypertensive medications. The maximum initial decrease should be no more than
25% reduction from initial presenting value. Reducing the blood pressure too quickly can
lead to cerebral edema or renal failure. The initial decrease should take place over 2-6
hours. Once the BP is controlled and symptoms have resolved the patient should be
transitioned to oral antihypertensive medications with a goal to reduce the diastolic
pressure gradually to 85 mm Hg over the next 2-3 months.
Question 5
5. Which of the following labs must be closely monitored when administering Lisinopril to
a patient with systolic heart failure?
A. Sodium
B. Phosphate
C. Magnesium
D. Potassium
CORRECT ANSWER
D. Potassium. Patients taking angiotensin converting enzyme inhibitors may experience
hyperkalemia. ACE inhibitors block angiotensin II, which may lead to decreased
3
@https://www.stuvia.com/user/thestudyvault
