NURSING CERTIFICATION
PROGRESSIVE CARE RN A — 2026/2027
Official Exam
Complete Blueprint Coverage
A+
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Cardiovascular
Pulmonary / Respiratory
Multisystem, Shock & Sepsis
Neurology, Endocrine, Renal, GI
Hematology & Professional Practice
STUVIAACTUALEXAM
, CARDIOVASCULAR
Q1.
A 68-year-old client on the progressive care unit develops sudden chest pain rated 8/10, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Blood pressure is 92/58 mm Hg. Which intervention is the
priority while preparing for emergent reperfusion?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes
B. Obtain informed consent for cardiac catheterization
C. Establish large-bore intravenous access and administer aspirin 325 mg chewed
D. Place the client in Trendelenburg position to improve coronary perfusion
Correct Answer: C
Rationale:
ST elevation in the inferior leads indicates an acute inferior STEMI. Immediate antiplatelet therapy with aspirin and reliable IV access are critical first
steps in the reperfusion pathway. Nitroglycerin is relatively contraindicated with hypotension, and Trendelenburg is not indicated.
Q2.
A client with acute decompensated heart failure has a pulmonary artery catheter in place. The cardiac output is 3.1 L/min,
cardiac index 1.7 L/min/m², and systemic vascular resistance is elevated. Which medication class is most appropriate to
improve forward flow?
A. Vasopressor such as norepinephrine
B. Arterial vasodilator such as nitroprusside
C. Beta-blocker such as metoprolol
D. Volume expander such as albumin
Correct Answer: C
Rationale:
Elevated SVR with low cardiac output indicates increased afterload impeding forward flow. An arterial vasodilator reduces afterload and improves
cardiac output. Vasopressors would increase afterload further; beta-blockers decrease contractility; volume would worsen congestion.
Q3.
A progressive care nurse is monitoring a client post-cardiac catheterization via the right femoral artery. Two hours later the
client reports severe back and flank pain; blood pressure has dropped from 128/78 to 96/54 mm Hg and heart rate is 118.
Which complication is most likely?
A. Retroperitoneal hemorrhage
B. Acute pericardial tamponade
C. Contrast-induced anaphylaxis
D. Coronary artery dissection
Correct Answer: A
Rationale:
Severe back or flank pain with hypotension after femoral access is classic for retroperitoneal bleeding. Tamponade usually presents with muffled
sounds and jugular distention; anaphylaxis would include respiratory and cutaneous findings; dissection would show ischemic ECG changes.
, CARDIOVASCULAR
Q4.
A client with chronic atrial fibrillation is receiving a continuous heparin infusion. The aPTT is 95 seconds (therapeutic range
60–80 seconds). Which action should the nurse take?
A. Increase the infusion rate by 2 units/kg/hour
B. Stop the infusion for 1 hour and notify the provider for a rate adjustment
C. Administer protamine sulfate 50 mg IV push
D. Continue the current rate and recheck aPTT in 6 hours
Correct Answer: A
Rationale:
An aPTT significantly above the therapeutic range increases bleeding risk. Standard practice is to hold the infusion briefly and obtain an order for a
reduced rate. Protamine is reserved for life-threatening hemorrhage; continuing the rate is unsafe.
Q5.
A client develops sudden onset of a new holosystolic murmur at the apex radiating to the axilla three days after an anterior
myocardial infarction. Blood pressure is 88/50 mm Hg and pulmonary crackles are present. Which complication does the
nurse suspect?
A. Ventricular septal rupture
B. Papillary muscle rupture causing acute mitral regurgitation
C. Free-wall rupture with tamponade
D. Dressler syndrome pericarditis
Correct Answer: D
Rationale:
A new holosystolic murmur at the apex with hemodynamic instability after anterior MI is characteristic of papillary muscle rupture and acute severe
mitral regurgitation. VSR produces a harsh murmur often heard at the left sternal border; free-wall rupture leads to sudden PEA; Dressler is later and
inflammatory.
Q6.
A client with hypertensive emergency has a blood pressure of 224/132 mm Hg and is receiving a nitroprusside infusion. The
nurse notes a progressive rise in serum lactate and the client becomes increasingly confused. Which action is indicated?
A. Increase the nitroprusside rate to achieve faster blood-pressure reduction
B. Suspect cyanide toxicity and prepare to discontinue the infusion
C. Add a beta-blocker to counteract reflex tachycardia
D. Administer a fluid bolus to improve cerebral perfusion
Correct Answer: D
Rationale:
Prolonged or high-dose nitroprusside can cause cyanide accumulation, manifested by elevated lactate, metabolic acidosis, and altered mentation.
The infusion must be stopped and the provider notified for alternative therapy and possible antidote.
PROGRESSIVE CARE RN A — 2026/2027
Official Exam
Complete Blueprint Coverage
A+
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Cardiovascular
Pulmonary / Respiratory
Multisystem, Shock & Sepsis
Neurology, Endocrine, Renal, GI
Hematology & Professional Practice
STUVIAACTUALEXAM
, CARDIOVASCULAR
Q1.
A 68-year-old client on the progressive care unit develops sudden chest pain rated 8/10, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Blood pressure is 92/58 mm Hg. Which intervention is the
priority while preparing for emergent reperfusion?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes
B. Obtain informed consent for cardiac catheterization
C. Establish large-bore intravenous access and administer aspirin 325 mg chewed
D. Place the client in Trendelenburg position to improve coronary perfusion
Correct Answer: C
Rationale:
ST elevation in the inferior leads indicates an acute inferior STEMI. Immediate antiplatelet therapy with aspirin and reliable IV access are critical first
steps in the reperfusion pathway. Nitroglycerin is relatively contraindicated with hypotension, and Trendelenburg is not indicated.
Q2.
A client with acute decompensated heart failure has a pulmonary artery catheter in place. The cardiac output is 3.1 L/min,
cardiac index 1.7 L/min/m², and systemic vascular resistance is elevated. Which medication class is most appropriate to
improve forward flow?
A. Vasopressor such as norepinephrine
B. Arterial vasodilator such as nitroprusside
C. Beta-blocker such as metoprolol
D. Volume expander such as albumin
Correct Answer: C
Rationale:
Elevated SVR with low cardiac output indicates increased afterload impeding forward flow. An arterial vasodilator reduces afterload and improves
cardiac output. Vasopressors would increase afterload further; beta-blockers decrease contractility; volume would worsen congestion.
Q3.
A progressive care nurse is monitoring a client post-cardiac catheterization via the right femoral artery. Two hours later the
client reports severe back and flank pain; blood pressure has dropped from 128/78 to 96/54 mm Hg and heart rate is 118.
Which complication is most likely?
A. Retroperitoneal hemorrhage
B. Acute pericardial tamponade
C. Contrast-induced anaphylaxis
D. Coronary artery dissection
Correct Answer: A
Rationale:
Severe back or flank pain with hypotension after femoral access is classic for retroperitoneal bleeding. Tamponade usually presents with muffled
sounds and jugular distention; anaphylaxis would include respiratory and cutaneous findings; dissection would show ischemic ECG changes.
, CARDIOVASCULAR
Q4.
A client with chronic atrial fibrillation is receiving a continuous heparin infusion. The aPTT is 95 seconds (therapeutic range
60–80 seconds). Which action should the nurse take?
A. Increase the infusion rate by 2 units/kg/hour
B. Stop the infusion for 1 hour and notify the provider for a rate adjustment
C. Administer protamine sulfate 50 mg IV push
D. Continue the current rate and recheck aPTT in 6 hours
Correct Answer: A
Rationale:
An aPTT significantly above the therapeutic range increases bleeding risk. Standard practice is to hold the infusion briefly and obtain an order for a
reduced rate. Protamine is reserved for life-threatening hemorrhage; continuing the rate is unsafe.
Q5.
A client develops sudden onset of a new holosystolic murmur at the apex radiating to the axilla three days after an anterior
myocardial infarction. Blood pressure is 88/50 mm Hg and pulmonary crackles are present. Which complication does the
nurse suspect?
A. Ventricular septal rupture
B. Papillary muscle rupture causing acute mitral regurgitation
C. Free-wall rupture with tamponade
D. Dressler syndrome pericarditis
Correct Answer: D
Rationale:
A new holosystolic murmur at the apex with hemodynamic instability after anterior MI is characteristic of papillary muscle rupture and acute severe
mitral regurgitation. VSR produces a harsh murmur often heard at the left sternal border; free-wall rupture leads to sudden PEA; Dressler is later and
inflammatory.
Q6.
A client with hypertensive emergency has a blood pressure of 224/132 mm Hg and is receiving a nitroprusside infusion. The
nurse notes a progressive rise in serum lactate and the client becomes increasingly confused. Which action is indicated?
A. Increase the nitroprusside rate to achieve faster blood-pressure reduction
B. Suspect cyanide toxicity and prepare to discontinue the infusion
C. Add a beta-blocker to counteract reflex tachycardia
D. Administer a fluid bolus to improve cerebral perfusion
Correct Answer: D
Rationale:
Prolonged or high-dose nitroprusside can cause cyanide accumulation, manifested by elevated lactate, metabolic acidosis, and altered mentation.
The infusion must be stopped and the provider notified for alternative therapy and possible antidote.
