PCCN Certification Exam
Questions and Answers| Latest Update| Guaranteed Pass
1. A patient in the progressive care unit develops new-onset atrial fibrillation with
a ventricular rate of 148 and a blood pressure of 88/54 mmHg. The patient
reports mild dizziness. What is the priority nursing action?
A. Administer IV metoprolol as ordered
B. Prepare the patient for synchronized cardioversion
C. Obtain a 12-lead ECG and notify the provider immediately
D. Administer a fluid bolus of normal saline
Answer: C — Obtain a 12-lead ECG and notify the provider immediately
Rationale: A new hemodynamically significant dysrhythmia requires
immediate confirmation with a 12-lead ECG and prompt provider notification
before intervention. Although the patient is symptomatic (hypotension,
dizziness), she is not in extremis, so rapid assessment and communication
precede rate-control drugs or cardioversion, which require a provider order and
further evaluation.
2. Which finding is most consistent with acute right ventricular infarction?
A. Clear lung sounds, jugular venous distention, hypotension
B. Bilateral crackles, S3 gallop, orthopnea
C. Pulsus paradoxus and muffled heart sounds
D. Bounding peripheral pulses and widened pulse pressure
Answer: A — Clear lung sounds, jugular venous distention, hypotension
Rationale: Right ventricular infarction classically presents with the triad of
jugular venous distention, hypotension, and clear lung fields because the right
ventricle fails to deliver adequate preload to the left side, while left-sided
(pulmonary) congestion is typically absent.
,3. A patient with an ST-elevation myocardial infarction affecting the inferior wall
develops hypotension after receiving sublingual nitroglycerin. What is the most
likely explanation?
A. Anaphylactic reaction to nitroglycerin
B. Concurrent right ventricular infarction with preload dependence
C. Cardiac tamponade
D. Vasovagal response unrelated to the infarction
Answer: B — Concurrent right ventricular infarction with preload
dependence
Rationale: Inferior MIs frequently involve the right coronary artery and right
ventricle. A preload-dependent right ventricle cannot compensate for the
venodilation caused by nitrates, producing profound hypotension. Nitrates
should be used cautiously or avoided in suspected RV infarction.
4. Which laboratory marker rises first after acute myocardial injury and is useful
for very early detection?
A. CK-MB
B. Troponin I
C. High-sensitivity troponin
D. Myoglobin
Answer: D — Myoglobin
Rationale: Myoglobin rises within 1-2 hours of myocardial injury, making it the
earliest marker to become detectable, although it lacks cardiac specificity.
Troponins (including high-sensitivity assays) are more specific but still take
slightly longer to rise above the reference range in a conventional non-high-
sensitivity comparison; myoglobin remains the fastest-rising marker overall.
5. A patient with heart failure with reduced ejection fraction is started on a beta-
blocker. The nurse should monitor most closely for which early adverse effect?
A. Hyperkalemia
B. Worsening of heart failure symptoms
C. Tachycardia
D. Hypertensive crisis
Answer: B — Worsening of heart failure symptoms
, Rationale: Beta-blockers have a negative inotropic effect and can transiently
worsen heart failure symptoms when initiated or up-titrated, so patients
require close monitoring for fluid retention and decreased cardiac output
during initiation, even though long-term therapy improves outcomes.
6. Which hemodynamic parameter best differentiates cardiogenic shock from
hypovolemic shock?
A. Heart rate
B. Systemic vascular resistance
C. Pulmonary artery occlusion (wedge) pressure
D. Mean arterial pressure
Answer: C — Pulmonary artery occlusion (wedge) pressure
Rationale: In cardiogenic shock the pulmonary artery occlusion pressure (PAOP)
is elevated because of impaired left ventricular emptying and back-up of
pressure into the pulmonary circulation, whereas in hypovolemic shock the
PAOP is low because of inadequate circulating volume. Both conditions can
present with tachycardia and elevated SVR.
7. A patient develops a widened QRS complex and peaked T waves on telemetry.
Which electrolyte abnormality should be suspected?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypercalcemia
Answer: B — Hyperkalemia
Rationale: Hyperkalemia produces characteristic ECG changes that progress
from peaked T waves to widened QRS complexes, PR prolongation, loss of P
waves, and eventually a sine-wave pattern as serum potassium rises, reflecting
altered myocardial cell membrane excitability.
8. Which finding would the nurse expect in a patient with cardiac tamponade?
A. Increased pulse pressure
B. Pulsus paradoxus greater than 10 mmHg
C. Bradycardia and hypertension
, D. Kussmaul sign only, with no change in pulse
Answer: B — Pulsus paradoxus greater than 10 mmHg
Rationale: Pulsus paradoxus (an exaggerated drop in systolic blood pressure of
more than 10 mmHg during inspiration) occurs in cardiac tamponade because
the fluid-filled pericardium restricts ventricular filling and exaggerates the
normal inspiratory decrease in left ventricular stroke volume.
9. A patient receiving a continuous heparin infusion for an NSTEMI has a PTT of
110 seconds (therapeutic range 60-80 seconds). What should the nurse anticipate?
A. Increasing the infusion rate
B. Decreasing or holding the infusion per protocol and rechecking PTT
C. Administering protamine sulfate immediately regardless of bleeding
D. Discontinuing all anticoagulation permanently
Answer: B — Decreasing or holding the infusion per protocol and rechecking
PTT
Rationale: A supratherapeutic PTT indicates the patient is at increased
bleeding risk. Standard weight-based heparin protocols direct the nurse to
decrease or briefly hold the infusion and recheck the PTT per protocol;
protamine is reserved for active serious bleeding or significantly
supratherapeutic levels, not used routinely for a mildly elevated result.
10. Which of the following best describes the mechanism of action of dobutamine
in the treatment of cardiogenic shock?
A. Pure alpha-1 agonist causing vasoconstriction
B. Beta-1 agonist increasing myocardial contractility and cardiac output
C. Phosphodiesterase inhibitor reducing afterload
D. Direct vasodilation of coronary arteries only
Answer: B — Beta-1 agonist increasing myocardial contractility and cardiac
output
Rationale: Dobutamine is a synthetic catecholamine with predominant beta-1
agonist activity that increases myocardial contractility (positive inotropy) and
modestly increases heart rate, improving cardiac output in cardiogenic shock
with relatively less peripheral vasoconstriction than other vasopressors.
Questions and Answers| Latest Update| Guaranteed Pass
1. A patient in the progressive care unit develops new-onset atrial fibrillation with
a ventricular rate of 148 and a blood pressure of 88/54 mmHg. The patient
reports mild dizziness. What is the priority nursing action?
A. Administer IV metoprolol as ordered
B. Prepare the patient for synchronized cardioversion
C. Obtain a 12-lead ECG and notify the provider immediately
D. Administer a fluid bolus of normal saline
Answer: C — Obtain a 12-lead ECG and notify the provider immediately
Rationale: A new hemodynamically significant dysrhythmia requires
immediate confirmation with a 12-lead ECG and prompt provider notification
before intervention. Although the patient is symptomatic (hypotension,
dizziness), she is not in extremis, so rapid assessment and communication
precede rate-control drugs or cardioversion, which require a provider order and
further evaluation.
2. Which finding is most consistent with acute right ventricular infarction?
A. Clear lung sounds, jugular venous distention, hypotension
B. Bilateral crackles, S3 gallop, orthopnea
C. Pulsus paradoxus and muffled heart sounds
D. Bounding peripheral pulses and widened pulse pressure
Answer: A — Clear lung sounds, jugular venous distention, hypotension
Rationale: Right ventricular infarction classically presents with the triad of
jugular venous distention, hypotension, and clear lung fields because the right
ventricle fails to deliver adequate preload to the left side, while left-sided
(pulmonary) congestion is typically absent.
,3. A patient with an ST-elevation myocardial infarction affecting the inferior wall
develops hypotension after receiving sublingual nitroglycerin. What is the most
likely explanation?
A. Anaphylactic reaction to nitroglycerin
B. Concurrent right ventricular infarction with preload dependence
C. Cardiac tamponade
D. Vasovagal response unrelated to the infarction
Answer: B — Concurrent right ventricular infarction with preload
dependence
Rationale: Inferior MIs frequently involve the right coronary artery and right
ventricle. A preload-dependent right ventricle cannot compensate for the
venodilation caused by nitrates, producing profound hypotension. Nitrates
should be used cautiously or avoided in suspected RV infarction.
4. Which laboratory marker rises first after acute myocardial injury and is useful
for very early detection?
A. CK-MB
B. Troponin I
C. High-sensitivity troponin
D. Myoglobin
Answer: D — Myoglobin
Rationale: Myoglobin rises within 1-2 hours of myocardial injury, making it the
earliest marker to become detectable, although it lacks cardiac specificity.
Troponins (including high-sensitivity assays) are more specific but still take
slightly longer to rise above the reference range in a conventional non-high-
sensitivity comparison; myoglobin remains the fastest-rising marker overall.
5. A patient with heart failure with reduced ejection fraction is started on a beta-
blocker. The nurse should monitor most closely for which early adverse effect?
A. Hyperkalemia
B. Worsening of heart failure symptoms
C. Tachycardia
D. Hypertensive crisis
Answer: B — Worsening of heart failure symptoms
, Rationale: Beta-blockers have a negative inotropic effect and can transiently
worsen heart failure symptoms when initiated or up-titrated, so patients
require close monitoring for fluid retention and decreased cardiac output
during initiation, even though long-term therapy improves outcomes.
6. Which hemodynamic parameter best differentiates cardiogenic shock from
hypovolemic shock?
A. Heart rate
B. Systemic vascular resistance
C. Pulmonary artery occlusion (wedge) pressure
D. Mean arterial pressure
Answer: C — Pulmonary artery occlusion (wedge) pressure
Rationale: In cardiogenic shock the pulmonary artery occlusion pressure (PAOP)
is elevated because of impaired left ventricular emptying and back-up of
pressure into the pulmonary circulation, whereas in hypovolemic shock the
PAOP is low because of inadequate circulating volume. Both conditions can
present with tachycardia and elevated SVR.
7. A patient develops a widened QRS complex and peaked T waves on telemetry.
Which electrolyte abnormality should be suspected?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypercalcemia
Answer: B — Hyperkalemia
Rationale: Hyperkalemia produces characteristic ECG changes that progress
from peaked T waves to widened QRS complexes, PR prolongation, loss of P
waves, and eventually a sine-wave pattern as serum potassium rises, reflecting
altered myocardial cell membrane excitability.
8. Which finding would the nurse expect in a patient with cardiac tamponade?
A. Increased pulse pressure
B. Pulsus paradoxus greater than 10 mmHg
C. Bradycardia and hypertension
, D. Kussmaul sign only, with no change in pulse
Answer: B — Pulsus paradoxus greater than 10 mmHg
Rationale: Pulsus paradoxus (an exaggerated drop in systolic blood pressure of
more than 10 mmHg during inspiration) occurs in cardiac tamponade because
the fluid-filled pericardium restricts ventricular filling and exaggerates the
normal inspiratory decrease in left ventricular stroke volume.
9. A patient receiving a continuous heparin infusion for an NSTEMI has a PTT of
110 seconds (therapeutic range 60-80 seconds). What should the nurse anticipate?
A. Increasing the infusion rate
B. Decreasing or holding the infusion per protocol and rechecking PTT
C. Administering protamine sulfate immediately regardless of bleeding
D. Discontinuing all anticoagulation permanently
Answer: B — Decreasing or holding the infusion per protocol and rechecking
PTT
Rationale: A supratherapeutic PTT indicates the patient is at increased
bleeding risk. Standard weight-based heparin protocols direct the nurse to
decrease or briefly hold the infusion and recheck the PTT per protocol;
protamine is reserved for active serious bleeding or significantly
supratherapeutic levels, not used routinely for a mildly elevated result.
10. Which of the following best describes the mechanism of action of dobutamine
in the treatment of cardiogenic shock?
A. Pure alpha-1 agonist causing vasoconstriction
B. Beta-1 agonist increasing myocardial contractility and cardiac output
C. Phosphodiesterase inhibitor reducing afterload
D. Direct vasodilation of coronary arteries only
Answer: B — Beta-1 agonist increasing myocardial contractility and cardiac
output
Rationale: Dobutamine is a synthetic catecholamine with predominant beta-1
agonist activity that increases myocardial contractility (positive inotropy) and
modestly increases heart rate, improving cardiac output in cardiogenic shock
with relatively less peripheral vasoconstriction than other vasopressors.
