PCCN EXAM TEST BANK 2026/2027
Questions and Correct Detailed Answers (100% Correct Answers)
Progressive Care Certified Nurse (PCCN) Examination Preparation | Newly Updated
Section 1: Cardiovascular System (Q1-Q40)
ACS, Heart Failure, Valvular Disease, Cardiomyopathies, Pericarditis, Endocarditis, and Vascular Disorders
Q1: A 68-year-old patient presents to the progressive care unit with crushing substernal chest pain that began 2 hours ago. The
12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. Troponin I is elevated at 2.8 ng/mL. Which intervention
should the nurse anticipate FIRST?
A. Administer clopidogrel 600 mg orally
B. Obtain a bedside echocardiogram
C. Prepare the patient for emergent percutaneous coronary intervention (PCI)
D. Initiate thrombolytic therapy with alteplase
Correct Answer: C
Rationale: The patient presents with an acute inferior STEMI. AHA/ACC 2026 guidelines recommend emergent PCI as the preferred reperfusion
strategy when it can be performed within 120 minutes of first medical contact. PCI is superior to fibrinolytics in reducing mortality, reinfarction,
and stroke. Clopidogrel is adjunctive therapy but not the first intervention. Echocardiography does not take priority over reperfusion.
Thrombolytics are indicated only when PCI is not available within the guideline-recommended timeframe.
Q2: A patient with HFrEF (LVEF 30%) is started on sacubitril/valsartan. The nurse should monitor for which MOST
significant adverse effect during initiation?
A. Hyperkalemia and angioedema
B. Reflex tachycardia and palpitations
C. Peripheral edema and weight gain
D. Thrombocytopenia and bleeding
Correct Answer: A
Rationale: Sacubitril/valsartan (ARNI) combines a neprilysin inhibitor with an ARB. Neprilysin inhibition increases bradykinin levels, while
valsartan blocks AT1 receptors, creating risk for hyperkalemia through reduced aldosterone secretion and angioedema through bradykinin
accumulation. Patients must have a 36-hour washout period from ACE inhibitors due to life-threatening angioedema risk. Reflex tachycardia is
not expected as this medication reduces afterload. Peripheral edema would improve with this therapy.
Q3: A 55-year-old female with severe aortic stenosis (aortic valve area 0.7 cm2) is admitted with syncope. Which
hemodynamic finding is MOST consistent with this valvular pathology?
A. Elevated cardiac output with low systemic vascular resistance
B. Fixed cardiac output with narrowed pulse pressure
C. Wide pulse pressure with elevated stroke volume
D. Low pulmonary artery occlusion pressure with elevated cardiac index
Correct Answer: B
Rationale: Severe aortic stenosis creates a fixed obstruction to LV outflow, resulting in a fixed cardiac output that cannot increase to meet
metabolic demands, explaining the syncope. The obstruction also causes a narrowed pulse pressure because systolic pressure cannot be
maintained while diastolic pressure is relatively preserved. Wide pulse pressure is seen in aortic regurgitation. Low PAOP and elevated CI would
suggest volume depletion or sepsis.
Q4: The nurse is caring for a patient receiving continuous heparin infusion for ACS. The aPTT is 78 seconds (therapeutic
60-80 seconds). The patient develops new oozing from the IV site and hemoglobin drops from 12.1 to 9.8 g/dL. Which action
FIRST?
A. Administer protamine sulfate intravenously
B. Decrease the heparin infusion rate by 50%
C. Stop the heparin infusion and notify the provider immediately
D. Draw a stat fibrinogen level and platelet count
Correct Answer: C
PCCN Exam Test Bank 2026/2027 | Page 1
,Rationale: The patient demonstrates major bleeding (active oozing and significant hemoglobin drop of 2.3 g/dL) on therapeutic heparin. The
priority is to immediately stop the heparin infusion to halt further anticoagulant effect, then notify the provider for potential protamine sulfate
administration. Protamine may be needed but requires a provider order. Simply decreasing the rate is insufficient with active major bleeding.
While HIT should be on the differential, stopping heparin is the immediate priority.
Q5: A patient with acute decompensated heart failure is receiving milrinone at 0.5 mcg/kg/min. The nurse understands
milrinone differs from dobutamine in which CRITICAL way?
A. Milrinone reduces pulmonary vascular resistance while dobutamine does not
B. Milrinone is a direct beta-1 agonist while dobutamine is a phosphodiesterase-3 inhibitor
C. Milrinone decreases myocardial oxygen demand while dobutamine increases it
D. Milrinone causes vasoconstriction while dobutamine causes vasodilation
Correct Answer: A
Rationale: Milrinone is a PDE-3 inhibitor increasing intracellular cAMP in both cardiac and vascular smooth muscle, producing inotropic
effects and vasodilation including pulmonary vasodilation, making it useful in RV failure and pulmonary hypertension. Dobutamine is
primarily a beta-1 agonist with minimal effect on pulmonary vascular resistance. Dobutamine is the PDE-3 inhibitor, not milrinone (option B is
reversed). Both can increase myocardial oxygen demand, though milrinone may have a more favorable profile.
Q6: A 72-year-old patient arrives post-PCI of the LAD. A radial compression device is in place. Which finding requires
IMMEDIATE intervention?
A. Capillary refill of 3 seconds in the affected hand
B. Presence of a small hematoma at the access site (2 cm)
C. Numbness and tingling in the affected fingers with loss of doppler signal
D. Mild discomfort at the access site rated 3/10
Correct Answer: C
Rationale: Numbness, tingling, and loss of Doppler signal suggest acute arterial compromise or thrombosis, a vascular emergency requiring
immediate intervention. Capillary refill of 3 seconds is at the upper limit of normal. A 2 cm hematoma is expected. Mild discomfort is common.
The nurse must perform a modified Allen test and notify the interventional team if Doppler signals are absent.
Q7: A patient with dilated cardiomyopathy (LVEF 25%) is evaluated for an ICD. Which is an ACC/AHA Class I indication
for ICD implantation?
A. LVEF 25% with NYHA Class II symptoms and ischemic etiology
B. LVEF 25% with NYHA Class IV symptoms awaiting transplant
C. LVEF 35% with non-ischemic cardiomyopathy and syncope
D. LVEF 40% with sustained monomorphic ventricular tachycardia
Correct Answer: A
Rationale: Per ACC/AHA/HRS 2026 guidelines, a Class I indication for primary prevention ICD includes ischemic cardiomyopathy, LVEF 35%
or less, NYHA Class II-III, on optimal medical therapy for at least 3 months, and reasonable 1-year survival expectation. NYHA Class IV
patients awaiting transplant may not benefit due to poor prognosis. The patient in option A meets all criteria for a Class I recommendation.
Q8: The nurse assesses a patient with suspected acute pericarditis. Which constellation of findings is MOST diagnostic?
A. Diffuse ST-segment elevation, PR segment depression, and positional chest pain
B. Localized ST elevation in contiguous leads, deep T-wave inversions, and troponin elevation
C. Wide QRS complexes, electrical alternans, and pulsus paradoxus
D. J-point elevation, prominent T waves, and hypotension with clear lung fields
Correct Answer: A
Rationale: Acute pericarditis is characterized by diffuse (widespread) ST-segment elevation and PR segment depression on ECG, along with
positional chest pain worsened by deep inspiration. Localized ST elevation with troponin elevation suggests STEMI. Wide QRS with electrical
alternans suggests cardiac tamponade. J-point elevation is consistent with early repolarization, a benign finding.
Q9: A patient with infective endocarditis has positive blood cultures for Staphylococcus aureus. Echo reveals a 12 mm mobile
vegetation on the aortic valve. Which finding suggests URGENT surgical intervention?
A. Fever persisting for 48 hours after appropriate antibiotics
B. New first-degree atrioventricular block on ECG
C. Embolic event to the spleen confirmed on CT
D. Two sets of blood cultures positive for the same organism
Correct Answer: B
Rationale: New first-degree AV block in aortic valve endocarditis suggests aortic root abscess extension into the conduction system, a Class I
indication for urgent surgery per AHA/ACC guidelines. Fever persisting 48 hours is expected early in treatment. Embolic events alone are not an
absolute surgical indication. Positive blood cultures confirm the diagnosis but do not alone indicate surgery.
PCCN Exam Test Bank 2026/2027 | Page 2
,Q10: A 62-year-old patient with chronic heart failure is prescribed ivabradine. This medication works by which mechanism
and requires which baseline assessment?
A. It blocks beta-1 receptors and requires blood pressure assessment
B. It inhibits the funny current (If) in the SA node and requires resting heart rate above 70 bpm
C. It inhibits ACE and requires serum potassium assessment
D. It antagonizes aldosterone receptors and requires renal function assessment
Correct Answer: B
Rationale: Ivabradine selectively inhibits HCN channels responsible for the If current in the SA node, reducing heart rate without affecting
contractility or blood pressure. It is indicated for sinus rhythm with HR above 70 bpm on maximally tolerated beta-blockers. It is contraindicated
in AF (ineffective outside sinus rhythm) and severe hepatic impairment.
Q11: A patient presents with BP 220/130 mmHg, severe headache, blurred vision, and confusion. The nurse should anticipate
which IMMEDIATE medication?
A. Oral clonidine 0.1 mg
B. Intravenous labetalol 20 mg
C. Sublingual nifedipine 10 mg
D. Intravenous hydralazine 10 mg
Correct Answer: B
Rationale: This is a hypertensive emergency with target organ damage (encephalopathy). IV labetalol provides rapid, controllable BP reduction
through combined alpha and beta blockade without increasing ICP. Goal is to reduce MAP by no more than 25% in the first hour. Oral
clonidine is too slow. Sublingual nifedipine is contraindicated due to unpredictable BP drops. IV hydralazine may increase ICP.
Q12: A patient with ACS is prescribed ticagrelor 180 mg loading dose. The nurse should instruct about which UNIQUE
characteristic?
A. It requires activation by CYP2C19 enzyme
B. It should be taken with food to enhance absorption
C. It causes reversible platelet inhibition and has dyspnea as a common side effect
D. It has a delayed onset of action of 24-48 hours
Correct Answer: C
Rationale: Ticagrelor is a direct-acting, reversible P2Y12 receptor antagonist, unlike clopidogrel which is an irreversible prodrug requiring
CYP2C19. A unique side effect is dyspnea (10-15% of patients). It has rapid onset (within 2 hours) and does not require food. Clopidogrel, not
ticagrelor, requires CYP2C19 activation.
Q13: A postoperative cardiac surgery patient has mediastinal chest tube output of 250 mL in the first hour. Which action is
MOST appropriate?
A. Clamp the chest tube and prepare for return to OR
B. Continue monitoring and reassess output in the next hour
C. Administer a 500 mL normal saline bolus
D. Prepare to administer aminocaproic acid per protocol
Correct Answer: B
Rationale: Post-CABG, chest tube output of 100-200 mL/hour is normal in the first 2 hours. At 250 mL in the first hour, continued close
monitoring with trending is appropriate. Clamping is never appropriate. Blood products and surgical exploration are indicated for sustained high
output (typically above 300-400 mL/hour for 2-3 consecutive hours) or hemodynamic compromise.
Q14: A patient with mitral regurgitation has a holosystolic murmur at the apex radiating to the axilla. Which hemodynamic
change would the nurse expect on PA catheterization?
A. Elevated PAOP with prominent V waves
B. Elevated PAOP with prominent A waves
C. Low PAOP with elevated cardiac output
D. Equalization of diastolic pressures across all chambers
Correct Answer: A
Rationale: Mitral regurgitation causes volume overload of the LA during systole, producing prominent V waves on the PAOP tracing as
regurgitant volume enters the atrium during ventricular systole. Prominent A waves are associated with aortic stenosis or HCM. Equalization of
diastolic pressures is seen in cardiac tamponade.
Q15: A patient with PAD reports worsening calf pain walking two blocks. The nurse should educate about which
FIRST-LINE treatment?
A. Surgical revascularization with bypass grafting
B. Supervised exercise therapy 30-45 minutes, 3 times per week
PCCN Exam Test Bank 2026/2027 | Page 3
, C. Endovascular angioplasty with stent placement
D. Dual antiplatelet therapy with aspirin 325 mg and clopidogrel
Correct Answer: B
Rationale: Supervised exercise therapy is the Class I, LOE A recommendation for claudication in PAD per ACC/AHA 2026 guidelines, improving
walking distance comparably to endovascular intervention. Revascularization is reserved for those failing exercise and medical management.
Antiplatelet therapy reduces cardiovascular risk but does not directly treat claudication.
Q16: A patient with suspected acute aortic dissection has tearing chest pain radiating to the back, BP 170/100 right arm and
120/80 left arm. Which diagnostic study is MOST appropriate?
A. Transthoracic echocardiogram
B. CT angiography of the chest and abdomen
C. Chest X-ray followed by TEE
D. Magnetic resonance angiography
Correct Answer: B
Rationale: CT angiography is the gold standard for suspected acute aortic dissection due to high sensitivity (above 95%), rapid acquisition, and
ability to identify dissection flap, true/false lumens, and branch vessel involvement. The BP differential suggests subclavian involvement. TEE is
invasive. MRA is too time-consuming for this emergency. Mortality increases 1-2% per hour without treatment.
Q17: A patient with HFpEF (LVEF 60%) is experiencing worsening dyspnea. Which medication has shown mortality benefit
in HFpEF per 2026 guidelines?
A. Sacubitril/valsartan
B. Empagliflozin 10 mg daily
C. Carvedilol 25 mg twice daily
D. Spironolactone 25 mg daily
Correct Answer: B
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have demonstrated reduced HF hospitalization and cardiovascular death in HFpEF
(EMPEROR-Preserved trial), making them the first class with a Class I recommendation. Sacubitril/valsartan and spironolactone have not
shown consistent mortality benefit in HFpEF. Beta-blockers are for rate control if AF coexists.
Q18: A nurse prepares to administer digoxin 0.25 mg IV for AF with RVR. Serum potassium is 3.1 mEq/L. Which action?
A. Administer digoxin and monitor HR in 30 minutes
B. Hold the digoxin and notify the provider of the potassium level
C. Administer digoxin with oral potassium simultaneously
D. Reduce the dose by 50% and administer with IV potassium
Correct Answer: B
Rationale: Hypokalemia (3.1 mEq/L) significantly increases digoxin toxicity risk because potassium competes with digoxin at the
Na+/K+-ATPase pump. Low potassium allows more digoxin binding, increasing toxicity. Hold digoxin and address hypokalemia first. Even
reducing the dose does not eliminate the enhanced sensitivity.
Q19: A 48-year-old with hypertrophic cardiomyopathy (HCM) presents with exertional syncope. Echo reveals a resting
LVOT gradient of 50 mmHg. Which medication is FIRST-LINE?
A. Digoxin to improve contractility
B. Metoprolol succinate to reduce the LVOT gradient
C. Nitroglycerin to decrease preload and improve symptoms
D. Milrinone to enhance cardiac output
Correct Answer: B
Rationale: In obstructive HCM (LVOT gradient above 30 mmHg), beta-blockers are first-line. They slow HR, increase diastolic filling, reduce
contractility (decreasing dynamic obstruction), and lower the LVOT gradient. Digoxin and milrinone increase contractility and would worsen
obstruction. Nitroglycerin decreases preload, reducing chamber size and worsening the obstruction.
Q20: A patient on a nitroglycerin infusion at 40 mcg/min for ADHF has BP drop from 110/70 to 82/50 mmHg. What should
the nurse do FIRST?
A. Stop the infusion and place the patient in Trendelenburg position
B. Decrease the infusion rate by 50% and reassess in 5 minutes
C. Administer a 500 mL NS bolus and continue current rate
D. Stop the infusion and prepare to administer phenylephrine
Correct Answer: A
Rationale: Significant hypotension from a vasodilator requires immediately stopping the infusion. Trendelenburg provides temporary
hemodynamic support. Simply decreasing the rate leaves the vasodilatory effect active. Phenylephrine may be needed but requires provider
orders after stopping the offending agent.
PCCN Exam Test Bank 2026/2027 | Page 4
Questions and Correct Detailed Answers (100% Correct Answers)
Progressive Care Certified Nurse (PCCN) Examination Preparation | Newly Updated
Section 1: Cardiovascular System (Q1-Q40)
ACS, Heart Failure, Valvular Disease, Cardiomyopathies, Pericarditis, Endocarditis, and Vascular Disorders
Q1: A 68-year-old patient presents to the progressive care unit with crushing substernal chest pain that began 2 hours ago. The
12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. Troponin I is elevated at 2.8 ng/mL. Which intervention
should the nurse anticipate FIRST?
A. Administer clopidogrel 600 mg orally
B. Obtain a bedside echocardiogram
C. Prepare the patient for emergent percutaneous coronary intervention (PCI)
D. Initiate thrombolytic therapy with alteplase
Correct Answer: C
Rationale: The patient presents with an acute inferior STEMI. AHA/ACC 2026 guidelines recommend emergent PCI as the preferred reperfusion
strategy when it can be performed within 120 minutes of first medical contact. PCI is superior to fibrinolytics in reducing mortality, reinfarction,
and stroke. Clopidogrel is adjunctive therapy but not the first intervention. Echocardiography does not take priority over reperfusion.
Thrombolytics are indicated only when PCI is not available within the guideline-recommended timeframe.
Q2: A patient with HFrEF (LVEF 30%) is started on sacubitril/valsartan. The nurse should monitor for which MOST
significant adverse effect during initiation?
A. Hyperkalemia and angioedema
B. Reflex tachycardia and palpitations
C. Peripheral edema and weight gain
D. Thrombocytopenia and bleeding
Correct Answer: A
Rationale: Sacubitril/valsartan (ARNI) combines a neprilysin inhibitor with an ARB. Neprilysin inhibition increases bradykinin levels, while
valsartan blocks AT1 receptors, creating risk for hyperkalemia through reduced aldosterone secretion and angioedema through bradykinin
accumulation. Patients must have a 36-hour washout period from ACE inhibitors due to life-threatening angioedema risk. Reflex tachycardia is
not expected as this medication reduces afterload. Peripheral edema would improve with this therapy.
Q3: A 55-year-old female with severe aortic stenosis (aortic valve area 0.7 cm2) is admitted with syncope. Which
hemodynamic finding is MOST consistent with this valvular pathology?
A. Elevated cardiac output with low systemic vascular resistance
B. Fixed cardiac output with narrowed pulse pressure
C. Wide pulse pressure with elevated stroke volume
D. Low pulmonary artery occlusion pressure with elevated cardiac index
Correct Answer: B
Rationale: Severe aortic stenosis creates a fixed obstruction to LV outflow, resulting in a fixed cardiac output that cannot increase to meet
metabolic demands, explaining the syncope. The obstruction also causes a narrowed pulse pressure because systolic pressure cannot be
maintained while diastolic pressure is relatively preserved. Wide pulse pressure is seen in aortic regurgitation. Low PAOP and elevated CI would
suggest volume depletion or sepsis.
Q4: The nurse is caring for a patient receiving continuous heparin infusion for ACS. The aPTT is 78 seconds (therapeutic
60-80 seconds). The patient develops new oozing from the IV site and hemoglobin drops from 12.1 to 9.8 g/dL. Which action
FIRST?
A. Administer protamine sulfate intravenously
B. Decrease the heparin infusion rate by 50%
C. Stop the heparin infusion and notify the provider immediately
D. Draw a stat fibrinogen level and platelet count
Correct Answer: C
PCCN Exam Test Bank 2026/2027 | Page 1
,Rationale: The patient demonstrates major bleeding (active oozing and significant hemoglobin drop of 2.3 g/dL) on therapeutic heparin. The
priority is to immediately stop the heparin infusion to halt further anticoagulant effect, then notify the provider for potential protamine sulfate
administration. Protamine may be needed but requires a provider order. Simply decreasing the rate is insufficient with active major bleeding.
While HIT should be on the differential, stopping heparin is the immediate priority.
Q5: A patient with acute decompensated heart failure is receiving milrinone at 0.5 mcg/kg/min. The nurse understands
milrinone differs from dobutamine in which CRITICAL way?
A. Milrinone reduces pulmonary vascular resistance while dobutamine does not
B. Milrinone is a direct beta-1 agonist while dobutamine is a phosphodiesterase-3 inhibitor
C. Milrinone decreases myocardial oxygen demand while dobutamine increases it
D. Milrinone causes vasoconstriction while dobutamine causes vasodilation
Correct Answer: A
Rationale: Milrinone is a PDE-3 inhibitor increasing intracellular cAMP in both cardiac and vascular smooth muscle, producing inotropic
effects and vasodilation including pulmonary vasodilation, making it useful in RV failure and pulmonary hypertension. Dobutamine is
primarily a beta-1 agonist with minimal effect on pulmonary vascular resistance. Dobutamine is the PDE-3 inhibitor, not milrinone (option B is
reversed). Both can increase myocardial oxygen demand, though milrinone may have a more favorable profile.
Q6: A 72-year-old patient arrives post-PCI of the LAD. A radial compression device is in place. Which finding requires
IMMEDIATE intervention?
A. Capillary refill of 3 seconds in the affected hand
B. Presence of a small hematoma at the access site (2 cm)
C. Numbness and tingling in the affected fingers with loss of doppler signal
D. Mild discomfort at the access site rated 3/10
Correct Answer: C
Rationale: Numbness, tingling, and loss of Doppler signal suggest acute arterial compromise or thrombosis, a vascular emergency requiring
immediate intervention. Capillary refill of 3 seconds is at the upper limit of normal. A 2 cm hematoma is expected. Mild discomfort is common.
The nurse must perform a modified Allen test and notify the interventional team if Doppler signals are absent.
Q7: A patient with dilated cardiomyopathy (LVEF 25%) is evaluated for an ICD. Which is an ACC/AHA Class I indication
for ICD implantation?
A. LVEF 25% with NYHA Class II symptoms and ischemic etiology
B. LVEF 25% with NYHA Class IV symptoms awaiting transplant
C. LVEF 35% with non-ischemic cardiomyopathy and syncope
D. LVEF 40% with sustained monomorphic ventricular tachycardia
Correct Answer: A
Rationale: Per ACC/AHA/HRS 2026 guidelines, a Class I indication for primary prevention ICD includes ischemic cardiomyopathy, LVEF 35%
or less, NYHA Class II-III, on optimal medical therapy for at least 3 months, and reasonable 1-year survival expectation. NYHA Class IV
patients awaiting transplant may not benefit due to poor prognosis. The patient in option A meets all criteria for a Class I recommendation.
Q8: The nurse assesses a patient with suspected acute pericarditis. Which constellation of findings is MOST diagnostic?
A. Diffuse ST-segment elevation, PR segment depression, and positional chest pain
B. Localized ST elevation in contiguous leads, deep T-wave inversions, and troponin elevation
C. Wide QRS complexes, electrical alternans, and pulsus paradoxus
D. J-point elevation, prominent T waves, and hypotension with clear lung fields
Correct Answer: A
Rationale: Acute pericarditis is characterized by diffuse (widespread) ST-segment elevation and PR segment depression on ECG, along with
positional chest pain worsened by deep inspiration. Localized ST elevation with troponin elevation suggests STEMI. Wide QRS with electrical
alternans suggests cardiac tamponade. J-point elevation is consistent with early repolarization, a benign finding.
Q9: A patient with infective endocarditis has positive blood cultures for Staphylococcus aureus. Echo reveals a 12 mm mobile
vegetation on the aortic valve. Which finding suggests URGENT surgical intervention?
A. Fever persisting for 48 hours after appropriate antibiotics
B. New first-degree atrioventricular block on ECG
C. Embolic event to the spleen confirmed on CT
D. Two sets of blood cultures positive for the same organism
Correct Answer: B
Rationale: New first-degree AV block in aortic valve endocarditis suggests aortic root abscess extension into the conduction system, a Class I
indication for urgent surgery per AHA/ACC guidelines. Fever persisting 48 hours is expected early in treatment. Embolic events alone are not an
absolute surgical indication. Positive blood cultures confirm the diagnosis but do not alone indicate surgery.
PCCN Exam Test Bank 2026/2027 | Page 2
,Q10: A 62-year-old patient with chronic heart failure is prescribed ivabradine. This medication works by which mechanism
and requires which baseline assessment?
A. It blocks beta-1 receptors and requires blood pressure assessment
B. It inhibits the funny current (If) in the SA node and requires resting heart rate above 70 bpm
C. It inhibits ACE and requires serum potassium assessment
D. It antagonizes aldosterone receptors and requires renal function assessment
Correct Answer: B
Rationale: Ivabradine selectively inhibits HCN channels responsible for the If current in the SA node, reducing heart rate without affecting
contractility or blood pressure. It is indicated for sinus rhythm with HR above 70 bpm on maximally tolerated beta-blockers. It is contraindicated
in AF (ineffective outside sinus rhythm) and severe hepatic impairment.
Q11: A patient presents with BP 220/130 mmHg, severe headache, blurred vision, and confusion. The nurse should anticipate
which IMMEDIATE medication?
A. Oral clonidine 0.1 mg
B. Intravenous labetalol 20 mg
C. Sublingual nifedipine 10 mg
D. Intravenous hydralazine 10 mg
Correct Answer: B
Rationale: This is a hypertensive emergency with target organ damage (encephalopathy). IV labetalol provides rapid, controllable BP reduction
through combined alpha and beta blockade without increasing ICP. Goal is to reduce MAP by no more than 25% in the first hour. Oral
clonidine is too slow. Sublingual nifedipine is contraindicated due to unpredictable BP drops. IV hydralazine may increase ICP.
Q12: A patient with ACS is prescribed ticagrelor 180 mg loading dose. The nurse should instruct about which UNIQUE
characteristic?
A. It requires activation by CYP2C19 enzyme
B. It should be taken with food to enhance absorption
C. It causes reversible platelet inhibition and has dyspnea as a common side effect
D. It has a delayed onset of action of 24-48 hours
Correct Answer: C
Rationale: Ticagrelor is a direct-acting, reversible P2Y12 receptor antagonist, unlike clopidogrel which is an irreversible prodrug requiring
CYP2C19. A unique side effect is dyspnea (10-15% of patients). It has rapid onset (within 2 hours) and does not require food. Clopidogrel, not
ticagrelor, requires CYP2C19 activation.
Q13: A postoperative cardiac surgery patient has mediastinal chest tube output of 250 mL in the first hour. Which action is
MOST appropriate?
A. Clamp the chest tube and prepare for return to OR
B. Continue monitoring and reassess output in the next hour
C. Administer a 500 mL normal saline bolus
D. Prepare to administer aminocaproic acid per protocol
Correct Answer: B
Rationale: Post-CABG, chest tube output of 100-200 mL/hour is normal in the first 2 hours. At 250 mL in the first hour, continued close
monitoring with trending is appropriate. Clamping is never appropriate. Blood products and surgical exploration are indicated for sustained high
output (typically above 300-400 mL/hour for 2-3 consecutive hours) or hemodynamic compromise.
Q14: A patient with mitral regurgitation has a holosystolic murmur at the apex radiating to the axilla. Which hemodynamic
change would the nurse expect on PA catheterization?
A. Elevated PAOP with prominent V waves
B. Elevated PAOP with prominent A waves
C. Low PAOP with elevated cardiac output
D. Equalization of diastolic pressures across all chambers
Correct Answer: A
Rationale: Mitral regurgitation causes volume overload of the LA during systole, producing prominent V waves on the PAOP tracing as
regurgitant volume enters the atrium during ventricular systole. Prominent A waves are associated with aortic stenosis or HCM. Equalization of
diastolic pressures is seen in cardiac tamponade.
Q15: A patient with PAD reports worsening calf pain walking two blocks. The nurse should educate about which
FIRST-LINE treatment?
A. Surgical revascularization with bypass grafting
B. Supervised exercise therapy 30-45 minutes, 3 times per week
PCCN Exam Test Bank 2026/2027 | Page 3
, C. Endovascular angioplasty with stent placement
D. Dual antiplatelet therapy with aspirin 325 mg and clopidogrel
Correct Answer: B
Rationale: Supervised exercise therapy is the Class I, LOE A recommendation for claudication in PAD per ACC/AHA 2026 guidelines, improving
walking distance comparably to endovascular intervention. Revascularization is reserved for those failing exercise and medical management.
Antiplatelet therapy reduces cardiovascular risk but does not directly treat claudication.
Q16: A patient with suspected acute aortic dissection has tearing chest pain radiating to the back, BP 170/100 right arm and
120/80 left arm. Which diagnostic study is MOST appropriate?
A. Transthoracic echocardiogram
B. CT angiography of the chest and abdomen
C. Chest X-ray followed by TEE
D. Magnetic resonance angiography
Correct Answer: B
Rationale: CT angiography is the gold standard for suspected acute aortic dissection due to high sensitivity (above 95%), rapid acquisition, and
ability to identify dissection flap, true/false lumens, and branch vessel involvement. The BP differential suggests subclavian involvement. TEE is
invasive. MRA is too time-consuming for this emergency. Mortality increases 1-2% per hour without treatment.
Q17: A patient with HFpEF (LVEF 60%) is experiencing worsening dyspnea. Which medication has shown mortality benefit
in HFpEF per 2026 guidelines?
A. Sacubitril/valsartan
B. Empagliflozin 10 mg daily
C. Carvedilol 25 mg twice daily
D. Spironolactone 25 mg daily
Correct Answer: B
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have demonstrated reduced HF hospitalization and cardiovascular death in HFpEF
(EMPEROR-Preserved trial), making them the first class with a Class I recommendation. Sacubitril/valsartan and spironolactone have not
shown consistent mortality benefit in HFpEF. Beta-blockers are for rate control if AF coexists.
Q18: A nurse prepares to administer digoxin 0.25 mg IV for AF with RVR. Serum potassium is 3.1 mEq/L. Which action?
A. Administer digoxin and monitor HR in 30 minutes
B. Hold the digoxin and notify the provider of the potassium level
C. Administer digoxin with oral potassium simultaneously
D. Reduce the dose by 50% and administer with IV potassium
Correct Answer: B
Rationale: Hypokalemia (3.1 mEq/L) significantly increases digoxin toxicity risk because potassium competes with digoxin at the
Na+/K+-ATPase pump. Low potassium allows more digoxin binding, increasing toxicity. Hold digoxin and address hypokalemia first. Even
reducing the dose does not eliminate the enhanced sensitivity.
Q19: A 48-year-old with hypertrophic cardiomyopathy (HCM) presents with exertional syncope. Echo reveals a resting
LVOT gradient of 50 mmHg. Which medication is FIRST-LINE?
A. Digoxin to improve contractility
B. Metoprolol succinate to reduce the LVOT gradient
C. Nitroglycerin to decrease preload and improve symptoms
D. Milrinone to enhance cardiac output
Correct Answer: B
Rationale: In obstructive HCM (LVOT gradient above 30 mmHg), beta-blockers are first-line. They slow HR, increase diastolic filling, reduce
contractility (decreasing dynamic obstruction), and lower the LVOT gradient. Digoxin and milrinone increase contractility and would worsen
obstruction. Nitroglycerin decreases preload, reducing chamber size and worsening the obstruction.
Q20: A patient on a nitroglycerin infusion at 40 mcg/min for ADHF has BP drop from 110/70 to 82/50 mmHg. What should
the nurse do FIRST?
A. Stop the infusion and place the patient in Trendelenburg position
B. Decrease the infusion rate by 50% and reassess in 5 minutes
C. Administer a 500 mL NS bolus and continue current rate
D. Stop the infusion and prepare to administer phenylephrine
Correct Answer: A
Rationale: Significant hypotension from a vasodilator requires immediately stopping the infusion. Trendelenburg provides temporary
hemodynamic support. Simply decreasing the rate leaves the vasodilatory effect active. Phenylephrine may be needed but requires provider
orders after stopping the offending agent.
PCCN Exam Test Bank 2026/2027 | Page 4
