PCCN
Certification Exam Set 2026 | Practice Questions, Answers
& Detailed Rationales | Comprehensive Study Guide
Resource Features
➢ PCCN certification practice questions
➢ Answers for self-assessment
➢ Detailed rationales
➢ Progressive-care clinical scenarios
➢ Cardiovascular review
, PCCN Certification Exam Set 2026 | Practice
Questions, Answers & Detailed Rationales |
Comprehensive Study Guide
Question 1
Coronary artery perfusion is dependent upon:
A) Diastolic pressure
B) Systolic pressure
C) Afterload
D) Systemic vascular resistance (SVR)
Correct Answer: A) Diastolic pressure
Rationale: Diastolic pressure in the aortic root is higher than left
ventricular end-diastolic pressure (LVEDP), the pressure exerted on the
ventricular muscle at the end of diastole when the ventricle is full. This
enables blood to flow from a higher pressure through open arteries to a
lower pressure, a pressure gradient known as coronary artery perfusion
pressure. As diastolic pressure drops, there is a decrease in coronary artery
blood flow. Coronary artery perfusion is not affected by systolic pressure,
afterload, or SVR, but they all increase the demand of oxygen in the heart.
Coronary arteries fill during diastole, making diastolic pressure the critical
determinant of coronary perfusion.
,Question 2
A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay.
Which of the following is the most common serious side effect that may
occur?
A) A nonproductive cough
B) Pedal edema
C) Swelling of the tongue and face
D) Rhinorrhea
Correct Answer: C) Swelling of the tongue and face
Rationale: Although all of the answers may occur, swelling of the tongue
and face (angioedema) is the most serious and may require immediate
intervention. Angioedema is a potentially life-threatening reaction to ACE
inhibitors that can cause airway obstruction. Patients should be instructed
to seek medical attention immediately for any signs of swelling in the
tongue or throat. A nonproductive cough is a common but not serious side
effect of ACE inhibitors. Pedal edema and rhinorrhea are not typical side
effects of ACE inhibitors.
Question 3
Which of the following best describes the fourth heart sound (S4)?
, A) It occurs after ventricular contraction
B) It is best heard with the diaphragm of the stethoscope
C) It is a normal finding in children
D) It occurs during late diastole when the atria contracts
Correct Answer: D) It occurs during late diastole when the atria
contracts
Rationale: The presence of the extra heart sound S4 signifies a poorly
compliant (stiff) left ventricle. An S4 is also called an atrial heart sound
since it occurs at the end of diastolic filling when the atria contracts and
fully fills the left ventricle. Known as "atrial kick," this filling is important to
cardiac output. When the left ventricle is stiff (decreased compliance with
long-term hypertension, aortic stenosis, or acute STEMI), the atrium has to
pump harder to move blood from the atrium to the ventricle, causing
turbulent flow. S4 is best heard with the bell of the stethoscope and is
always abnormal in adults.
Question 4
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A) ST-segment elevation
B) ST-segment depression and T-wave elevation
C) Q-wave formation
D) ST-segment depression and T-wave inversion
Certification Exam Set 2026 | Practice Questions, Answers
& Detailed Rationales | Comprehensive Study Guide
Resource Features
➢ PCCN certification practice questions
➢ Answers for self-assessment
➢ Detailed rationales
➢ Progressive-care clinical scenarios
➢ Cardiovascular review
, PCCN Certification Exam Set 2026 | Practice
Questions, Answers & Detailed Rationales |
Comprehensive Study Guide
Question 1
Coronary artery perfusion is dependent upon:
A) Diastolic pressure
B) Systolic pressure
C) Afterload
D) Systemic vascular resistance (SVR)
Correct Answer: A) Diastolic pressure
Rationale: Diastolic pressure in the aortic root is higher than left
ventricular end-diastolic pressure (LVEDP), the pressure exerted on the
ventricular muscle at the end of diastole when the ventricle is full. This
enables blood to flow from a higher pressure through open arteries to a
lower pressure, a pressure gradient known as coronary artery perfusion
pressure. As diastolic pressure drops, there is a decrease in coronary artery
blood flow. Coronary artery perfusion is not affected by systolic pressure,
afterload, or SVR, but they all increase the demand of oxygen in the heart.
Coronary arteries fill during diastole, making diastolic pressure the critical
determinant of coronary perfusion.
,Question 2
A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay.
Which of the following is the most common serious side effect that may
occur?
A) A nonproductive cough
B) Pedal edema
C) Swelling of the tongue and face
D) Rhinorrhea
Correct Answer: C) Swelling of the tongue and face
Rationale: Although all of the answers may occur, swelling of the tongue
and face (angioedema) is the most serious and may require immediate
intervention. Angioedema is a potentially life-threatening reaction to ACE
inhibitors that can cause airway obstruction. Patients should be instructed
to seek medical attention immediately for any signs of swelling in the
tongue or throat. A nonproductive cough is a common but not serious side
effect of ACE inhibitors. Pedal edema and rhinorrhea are not typical side
effects of ACE inhibitors.
Question 3
Which of the following best describes the fourth heart sound (S4)?
, A) It occurs after ventricular contraction
B) It is best heard with the diaphragm of the stethoscope
C) It is a normal finding in children
D) It occurs during late diastole when the atria contracts
Correct Answer: D) It occurs during late diastole when the atria
contracts
Rationale: The presence of the extra heart sound S4 signifies a poorly
compliant (stiff) left ventricle. An S4 is also called an atrial heart sound
since it occurs at the end of diastolic filling when the atria contracts and
fully fills the left ventricle. Known as "atrial kick," this filling is important to
cardiac output. When the left ventricle is stiff (decreased compliance with
long-term hypertension, aortic stenosis, or acute STEMI), the atrium has to
pump harder to move blood from the atrium to the ventricle, causing
turbulent flow. S4 is best heard with the bell of the stethoscope and is
always abnormal in adults.
Question 4
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A) ST-segment elevation
B) ST-segment depression and T-wave elevation
C) Q-wave formation
D) ST-segment depression and T-wave inversion
