PCCN Exam Prep Practice Questions & Study Guide - 2026-2027 | Progressive Care Nursing
49-year-old male was recently admitted with an inferior 1. D. I, aVI. The RCA perfuses the inferior wall and the mirror image or reciprocal
wall change will be seen in the high latera wall, which is reflected in leads I, and aVL, on
MI resulting from 100% occlusion of the right coronary the 12-Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4
artery correlate With the anterior area of the heart. The aVR lead does not provide much
(RCA). The 12-Lead ECG reveals ST elevation in leads II, diagnostic value as all energy is depolarizing away from this lead.
Ill, and avF.
You would expect to see reciprocal changes in which
leads?
A. I, aVR
B. V, V2
C. V, VA
D I, aVL
You are summoned to the room of a 30-year-old female A. Call for help and safely guide the patient to the floor
who is experiencing sustained tonic-clonic convulsions Patient Safety is priority
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 safely 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
A 46-year-old patient presents with pneumonia and sepsis. B. Acute Respiratory Distress Syndrome
He was treated with 4 days of antibiotics and IV fluids. He
is increasingly short of breath and is now on 100% FiO, via
non-re-breather mask. You obtain an ABG with the
following results: pH 7.20 / PaCO, 68/ PaO, 102/ HCO, 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
A 56-year-old male is admitted to the PCU with a C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
hypertensive crisis. His blood pressure is now 205/125 mm medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg
Hg and he is complaining of a headache with nausea. He with oral antihypertensive medication
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?
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
medications
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
5. Which of the following labs must be closely monitored D. Potassium
when administering Lisinopril to a patient with systolic Patients taking angiotensin converting enzyme inhibitors may experience
heart failure? hyperkalemia. ACE inhibitors block angiotensin II, which may lead to decreased
A. Sodium aldosterone. Aldosterone is responsible forexcreting potassium from the kidneys.
B. Phosphate Therefore, ACE inhibitors can cause potassium retension and potassium levels
C. Magnesium should be monitored closely. In addition, renal labs such as BUN and creatinine
D Potassium should be monitored. If the patient develops more than a 20% increase in the
creatinine, the medication should be discontinued.
, PCCN Exam Prep Practice Questions & Study Guide - 2026-2027 | Progressive Care Nursing
A 57-year-old man was admitted with an acute myocardial A Dobutamine. Dobutamine is a positive inotropic medication used to improve
infarction and is rapidly deteriorating. He has a BP of 86/42 myocardial dysfunction on patients with a low cardiac index and elevated afterload.
(57), heart rate of 110, weak, thready pulses, and mottled It will improve contractility and reduce afterload. Milrinone, which is a
skin-especially at the knees. He has had minimal urine phosphodiesterase inhibitor could also be used as an alternative to dobutamine, in
output the past 8 hours. A Rapid Response is activated. the setting of decompensated heart failure. It is used cautiously in patients
Which of the following medications would be the best experiencing cardiogiogenic shock as one of the main side effects of Milrinone is
option to increase the patient's cardiac output? hypotension. The half life of Milrinone is about 6 hours. Norepinephrine and
A Dobutamine Phenylephrine cause vasoconstriction, which would increase the SVR and may
B Norepinephrine compromise cardiac output.
C Amiodarone
D Phenylephrine
You are caring for a patient post gastric bypass. Which of A* HR, RR, temperature, WBC & MAP
the following parameters should you closely monitor after
surgery?
A* HR, RR, temperature, WBC & MAP
B* Protein levels and vitamin B12
C* Albumin and pre-albumin levels
D* Signs of dumping syndrome
You are caring for a patient admitted after a ground level B* Collaborate with the provider and social worker to schedule a family meeting
fall. The patient has decreased level of consciousness. On
admission the patient is ordered to be a full code. The
family arrives with advanced directives stating the patient
wishes not to have CPR performed or life sustaining
treatment continued. The nurse approaches the provider
about this discrepancy and the provider states "I am aware
of the advanced directive, but the daughter wants
everything done."
What is the appropriate next step by the nurse?
A* Ask the daughter why she wants everything done
B* Collaborate with the provider and social worker to
schedule a family meeting
C* Tell the doctor we have to follow the patient's wishes
* Discuss the situation with the nurse manager
Which is the best intervention to promote safety of the A* Direct visualization of the connection between the machine and the access
patient receiving hemodialysis? device
A* Direct visualization of the connection between the
machine and the access device The nurse must be able to visualize the junction of the central venous access and
the dialysis unit at all times. Disconnection can result in exsanguination within
B* Strict intake and output monitoring minutes.
C* Strict bedrest
D* Electrolyte assessment q 4 hours
Four hours after starting an insulin infusion in a patient B D5.45 or D NS with a glucose source
admitted with diabetic ketoacidosis, the patient's blood Dextrose should be included in IV fluids since the glucose has dropped below 250.
glucose is 235 mg/dL. Which of the following fluids should This is done to prevent hypoglycycemia.
be administered at this point?
A Hypertonic solution to hydrate the cell
B D5.45 or D NS with a glucose source
C Isotonic saline bolus to maintain extracellular hydration
D Hypotonic saline to provide cellular hydration
11. A 45-year-old male is admitted to 1500m With Severe C* Initial lactate level 4.2 mmol/L, now 1.8 mmol/L
sepsis. Early goal directed therapy for sepsis include early fluid resuscitation at 30 mL/kg to
You are administering lactated ringers 500 ml IV boluses. A maintain the MAP greater than 65 mm Hg, ScvO2 greater that 70%, and urine
central line has been placed. Which of the findings below output greater than 0.5 mL/kg/hr. The goal is always to normalize the lactate level.
indicate the fluid boluses are having its intended effect? The lactate clearance (lactate decreasing to 1.8 mmol/L) is a trend in the right
A* MAP of 55 mm Hg direction and an indirect sign of increased perfusion.
B* ScvO, of 52%
C* Initial lactate level 4.2 mmol/L, now 1.8 mmol/L
D* Urine output of 15 ml/hour
, PCCN Exam Prep Practice Questions & Study Guide - 2026-2027 | Progressive Care Nursing
12. A 72-year-old male patient has been in the PCU for 6 C HIT
days for treatment of a COPD exacerbation. He has been The hallmark sign of Heparin Induced Thrombocytopenia (HIT) is a significant
receiving VTE prophylaxis with subcutaneous Heparin decrease in platelet count over a 24 hour period (>50% within 5-10 days of
since admission. Today, his platelet count decreased administering Heparin. The other hallmark sign is a new development of a DVT
significantly to 43,000 and he was found to have a new despite being on VTE prophylaxis. DIC and ITP can decrease platelet counts but
DVT on his right upper extremity. What do you suspect is with the specific scenario of a new DVT and precipitous drop in platelets the best
the most likely cause of these new findings? answer is HIT. Transfusion related acute lung injury (TRALI) is a complication from a
A DIC blood transfusion reaction, which causes acute lung injury typically within 6 hours of
B* ITP a blood transfusion.
C* HIT
D* TRALI
20. Which laboratory values are consistent in a patient with A. Elevated lipase, elevated amylase, hypocalcemia & hyperglycemia
acute pancreatitis?
A. Elevated lipase, elevated amylase, hypocalcemia &
hyperglycemia
B• Elevated lipase, elevated amylase, hypercalcemia &
hyperkalemia
C• Decreased lipase, elevated amylase, hypocalcemia &
hyperkalemia
D. Decreased lipase, decreased amylase, hypercalcemia
& hypokalemia
18. Several nurses on the unit are concerned with the C. Request an in-service from the device company•
accuracy of a new noninvasive device measuring stroke
volume. The best way to initially address their concerns is
to:•
A. Research new devices to replace the existing
equipment•
B. Discuss concerns with the attending physician during
rounds•
C. Request an in-service from the device company•
D. Take the issue to the unit nursing research council to
investigate
19. A 22-year-old female complains of palpitations. You C• Atrial tachycardia
see the following rhythm at the monitor:
AAAAA
You interpret the rhythm as:
A • Atrial fibrillation
B • Atrial flutter
C• Atrial tachycardia
D• Ventricular tachycardia
24. Which of the following medications should be avoided
in a patient with a right ventricular infarction who is
experiencing tachycardia and hypotension?
• Calcium channel blockers and ACE inhibitors
• Morphine and Nitroglycerin
• IV fluids and aspirin
• Plavix and Dobutamine
23. Which acid/base disturbance is associated with A
massive volume resuscitation with 0.9% saline?
• Metabolic acidosis
• Metabolic alkalosis
• Respiratory acidosis
• Respiratory alkalosis
49-year-old male was recently admitted with an inferior 1. D. I, aVI. The RCA perfuses the inferior wall and the mirror image or reciprocal
wall change will be seen in the high latera wall, which is reflected in leads I, and aVL, on
MI resulting from 100% occlusion of the right coronary the 12-Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4
artery correlate With the anterior area of the heart. The aVR lead does not provide much
(RCA). The 12-Lead ECG reveals ST elevation in leads II, diagnostic value as all energy is depolarizing away from this lead.
Ill, and avF.
You would expect to see reciprocal changes in which
leads?
A. I, aVR
B. V, V2
C. V, VA
D I, aVL
You are summoned to the room of a 30-year-old female A. Call for help and safely guide the patient to the floor
who is experiencing sustained tonic-clonic convulsions Patient Safety is priority
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 safely 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
A 46-year-old patient presents with pneumonia and sepsis. B. Acute Respiratory Distress Syndrome
He was treated with 4 days of antibiotics and IV fluids. He
is increasingly short of breath and is now on 100% FiO, via
non-re-breather mask. You obtain an ABG with the
following results: pH 7.20 / PaCO, 68/ PaO, 102/ HCO, 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
A 56-year-old male is admitted to the PCU with a C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
hypertensive crisis. His blood pressure is now 205/125 mm medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg
Hg and he is complaining of a headache with nausea. He with oral antihypertensive medication
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?
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
medications
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
5. Which of the following labs must be closely monitored D. Potassium
when administering Lisinopril to a patient with systolic Patients taking angiotensin converting enzyme inhibitors may experience
heart failure? hyperkalemia. ACE inhibitors block angiotensin II, which may lead to decreased
A. Sodium aldosterone. Aldosterone is responsible forexcreting potassium from the kidneys.
B. Phosphate Therefore, ACE inhibitors can cause potassium retension and potassium levels
C. Magnesium should be monitored closely. In addition, renal labs such as BUN and creatinine
D Potassium should be monitored. If the patient develops more than a 20% increase in the
creatinine, the medication should be discontinued.
, PCCN Exam Prep Practice Questions & Study Guide - 2026-2027 | Progressive Care Nursing
A 57-year-old man was admitted with an acute myocardial A Dobutamine. Dobutamine is a positive inotropic medication used to improve
infarction and is rapidly deteriorating. He has a BP of 86/42 myocardial dysfunction on patients with a low cardiac index and elevated afterload.
(57), heart rate of 110, weak, thready pulses, and mottled It will improve contractility and reduce afterload. Milrinone, which is a
skin-especially at the knees. He has had minimal urine phosphodiesterase inhibitor could also be used as an alternative to dobutamine, in
output the past 8 hours. A Rapid Response is activated. the setting of decompensated heart failure. It is used cautiously in patients
Which of the following medications would be the best experiencing cardiogiogenic shock as one of the main side effects of Milrinone is
option to increase the patient's cardiac output? hypotension. The half life of Milrinone is about 6 hours. Norepinephrine and
A Dobutamine Phenylephrine cause vasoconstriction, which would increase the SVR and may
B Norepinephrine compromise cardiac output.
C Amiodarone
D Phenylephrine
You are caring for a patient post gastric bypass. Which of A* HR, RR, temperature, WBC & MAP
the following parameters should you closely monitor after
surgery?
A* HR, RR, temperature, WBC & MAP
B* Protein levels and vitamin B12
C* Albumin and pre-albumin levels
D* Signs of dumping syndrome
You are caring for a patient admitted after a ground level B* Collaborate with the provider and social worker to schedule a family meeting
fall. The patient has decreased level of consciousness. On
admission the patient is ordered to be a full code. The
family arrives with advanced directives stating the patient
wishes not to have CPR performed or life sustaining
treatment continued. The nurse approaches the provider
about this discrepancy and the provider states "I am aware
of the advanced directive, but the daughter wants
everything done."
What is the appropriate next step by the nurse?
A* Ask the daughter why she wants everything done
B* Collaborate with the provider and social worker to
schedule a family meeting
C* Tell the doctor we have to follow the patient's wishes
* Discuss the situation with the nurse manager
Which is the best intervention to promote safety of the A* Direct visualization of the connection between the machine and the access
patient receiving hemodialysis? device
A* Direct visualization of the connection between the
machine and the access device The nurse must be able to visualize the junction of the central venous access and
the dialysis unit at all times. Disconnection can result in exsanguination within
B* Strict intake and output monitoring minutes.
C* Strict bedrest
D* Electrolyte assessment q 4 hours
Four hours after starting an insulin infusion in a patient B D5.45 or D NS with a glucose source
admitted with diabetic ketoacidosis, the patient's blood Dextrose should be included in IV fluids since the glucose has dropped below 250.
glucose is 235 mg/dL. Which of the following fluids should This is done to prevent hypoglycycemia.
be administered at this point?
A Hypertonic solution to hydrate the cell
B D5.45 or D NS with a glucose source
C Isotonic saline bolus to maintain extracellular hydration
D Hypotonic saline to provide cellular hydration
11. A 45-year-old male is admitted to 1500m With Severe C* Initial lactate level 4.2 mmol/L, now 1.8 mmol/L
sepsis. Early goal directed therapy for sepsis include early fluid resuscitation at 30 mL/kg to
You are administering lactated ringers 500 ml IV boluses. A maintain the MAP greater than 65 mm Hg, ScvO2 greater that 70%, and urine
central line has been placed. Which of the findings below output greater than 0.5 mL/kg/hr. The goal is always to normalize the lactate level.
indicate the fluid boluses are having its intended effect? The lactate clearance (lactate decreasing to 1.8 mmol/L) is a trend in the right
A* MAP of 55 mm Hg direction and an indirect sign of increased perfusion.
B* ScvO, of 52%
C* Initial lactate level 4.2 mmol/L, now 1.8 mmol/L
D* Urine output of 15 ml/hour
, PCCN Exam Prep Practice Questions & Study Guide - 2026-2027 | Progressive Care Nursing
12. A 72-year-old male patient has been in the PCU for 6 C HIT
days for treatment of a COPD exacerbation. He has been The hallmark sign of Heparin Induced Thrombocytopenia (HIT) is a significant
receiving VTE prophylaxis with subcutaneous Heparin decrease in platelet count over a 24 hour period (>50% within 5-10 days of
since admission. Today, his platelet count decreased administering Heparin. The other hallmark sign is a new development of a DVT
significantly to 43,000 and he was found to have a new despite being on VTE prophylaxis. DIC and ITP can decrease platelet counts but
DVT on his right upper extremity. What do you suspect is with the specific scenario of a new DVT and precipitous drop in platelets the best
the most likely cause of these new findings? answer is HIT. Transfusion related acute lung injury (TRALI) is a complication from a
A DIC blood transfusion reaction, which causes acute lung injury typically within 6 hours of
B* ITP a blood transfusion.
C* HIT
D* TRALI
20. Which laboratory values are consistent in a patient with A. Elevated lipase, elevated amylase, hypocalcemia & hyperglycemia
acute pancreatitis?
A. Elevated lipase, elevated amylase, hypocalcemia &
hyperglycemia
B• Elevated lipase, elevated amylase, hypercalcemia &
hyperkalemia
C• Decreased lipase, elevated amylase, hypocalcemia &
hyperkalemia
D. Decreased lipase, decreased amylase, hypercalcemia
& hypokalemia
18. Several nurses on the unit are concerned with the C. Request an in-service from the device company•
accuracy of a new noninvasive device measuring stroke
volume. The best way to initially address their concerns is
to:•
A. Research new devices to replace the existing
equipment•
B. Discuss concerns with the attending physician during
rounds•
C. Request an in-service from the device company•
D. Take the issue to the unit nursing research council to
investigate
19. A 22-year-old female complains of palpitations. You C• Atrial tachycardia
see the following rhythm at the monitor:
AAAAA
You interpret the rhythm as:
A • Atrial fibrillation
B • Atrial flutter
C• Atrial tachycardia
D• Ventricular tachycardia
24. Which of the following medications should be avoided
in a patient with a right ventricular infarction who is
experiencing tachycardia and hypotension?
• Calcium channel blockers and ACE inhibitors
• Morphine and Nitroglycerin
• IV fluids and aspirin
• Plavix and Dobutamine
23. Which acid/base disturbance is associated with A
massive volume resuscitation with 0.9% saline?
• Metabolic acidosis
• Metabolic alkalosis
• Respiratory acidosis
• Respiratory alkalosis
