PCCN Exam Questions & Answers 2026/2027 - Verified Answers AACN Progressive Care Certified Nurse
PCCN Exam Questions & Answers
2026/2027 (Verified Answers)
Comprehensive PCCN Certification Practice Exam
Aligned with AACN PCCN Examination Content Outline · 250 Questions with Detailed Rationales
Section 1: Cardiovascular System (Q1-55)
ACS, Heart Failure, Dysrhythmias, Valvular Disease, Cardiomyopathies, & Vascular Disorders
Q1: A 58-year-old male presents with substernal chest pain radiating to the left arm, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which assessment finding is most likely associated
with this presentation?
A. ST elevation in leads V1-V4
B. Right ventricular involvement suggested by ST elevation in V4R [CORRECT]
C. Posterior wall involvement suggested by ST depression in V1-V2
D. Anterolateral involvement suggested by ST elevation in I, aVL, V5-V6
Correct Answer: B
Rationale: ST elevation in II, III, and aVF indicates an inferior wall STEMI, often caused by right coronary artery (RCA) occlusion. RCA
occlusion commonly involves the right ventricle, and ST elevation in right precordial lead V4R is the most sensitive indicator of RV
infarction. Assessing for RV involvement is critical because nitrates are relatively contraindicated due to RV preload dependence. Options
A, C, D describe anterior, posterior, and lateral wall infarcts, respectively.
Q2: A patient with an inferior STEMI and suspected RV involvement has a blood pressure of 86/52 mmHg. Which
intervention is most appropriate?
A. Administer sublingual nitroglycerin immediately
B. Administer IV morphine 4 mg
C. Administer a 500 mL IV normal saline bolus and reassess [CORRECT]
D. Administer IV metoprolol 5 mg
Correct Answer: C
Rationale: Right ventricular infarction produces a preload-dependent state. RV dysfunction impairs filling and cardiac output, leading to
hypotension that worsens with venodilators (nitroglycerin) or negative inotropes (beta-blockers). The correct response is a careful IV fluid
bolus (250-500 mL NS) to optimize RV preload, then reassess. Nitroglycerin and morphine (Option A, B) are contraindicated.
Beta-blockers (Option D) are contraindicated acutely in RV infarct with hypotension.
Page 1
,PCCN Exam Questions & Answers 2026/2027 - Verified Answers AACN Progressive Care Certified Nurse
Q3: A 65-year-old patient is admitted with NSTEMI. Cardiac biomarkers are ordered. Which finding is most
consistent with acute myocardial injury?
A. Troponin I 0.02 ng/mL (reference <0.04 ng/mL)
B. Troponin I 1.8 ng/mL with chest pain onset 4 hours ago [CORRECT]
C. CK-MB 2% of total CK
D. Myoglobin 50 ng/mL at 2 hours post chest pain
Correct Answer: B
Rationale: Troponin I >0.04 ng/mL indicates myocardial injury. A rise to 1.8 ng/mL 4 hours after symptom onset is consistent with acute
MI - troponin rises within 3-4 hours of injury, peaks at 24 hours. CK-MB ratio >5% suggests myocardial injury but is less
sensitive/specific than troponin. Myoglobin rises earliest (1-2 hours) but lacks specificity. Option A is normal. Option C is normal. Option
D is borderline.
Q4: A patient with acute decompensated heart failure has the following hemodynamics: BP 88/50, HR 110, PAOP 24
mmHg, CI 1.8 L/min/m2. Which vasoactive medication is most appropriate?
A. Norepinephrine
B. Dobutamine [CORRECT]
C. Nitroprusside
D. Milrinone
Correct Answer: B
Rationale: This patient has a 'wet-cold' profile: low CI (1.8), high PAOP (24), hypotension. Dobutamine, a beta-1 agonist, increases
contractility and cardiac output while maintaining some vasopressor effect via beta-1 mediated vasoconstriction. Norepinephrine (Option
A) is first-line for septic shock but adds vasoconstriction without inotropy in cardiogenic states. Nitroprusside (Option C) would worsen
hypotension. Milrinone (Option D) is a PDE-III inhibitor that may cause hypotension in a patient already hypotensive.
Q5: For patients with acute heart failure with reduced ejection fraction (HFrEF), the four pillars of
guideline-directed medical therapy (GDMT) include all of the following EXCEPT:
A. ARNI (or ACE inhibitor if ARNI not tolerated)
B. Beta-blocker (carvedilol, metoprolol succinate, or bisoprolol)
C. Calcium channel blocker (amlodipine) [CORRECT]
D. SGLT2 inhibitor (dapagliflozin or empagliflozin)
Correct Answer: C
Rationale: The four pillars of HFrEF GDMT are: (1) ARNI (preferred) or ACE inhibitor/ARB, (2) evidence-based beta-blocker, (3) MRA
(spironolactone/ eplerenone), and (4) SGLT2 inhibitor. Calcium channel blockers (amlodipine) are not part of GDMT for HFrEF; they
may be used for hypertension in HFpEF but do not improve mortality in HFrEF. Non-dihydropyridines (diltiazem, verapamil) are
contraindicated in HFrEF due to negative inotropy.
Page 2
,PCCN Exam Questions & Answers 2026/2027 - Verified Answers AACN Progressive Care Certified Nurse
Q6: A patient is admitted with acute decompensated heart failure. Labs show BNP 1850 pg/mL. Which statement
best describes the clinical significance of this finding?
A. BNP >100 indicates heart failure; this is a mild elevation
B. BNP >500 pg/mL strongly supports heart failure; 1850 indicates significant ventricular wall stress and fluid overload
[CORRECT]
C. BNP is not useful in acute settings
D. BNP 1850 indicates primarily renal dysfunction
Correct Answer: B
Rationale: BNP <100 pg/mL essentially excludes heart failure; 100-500 is intermediate; >500 strongly supports HF. A level of 1850
indicates significant ventricular wall stress and fluid overload, supporting ADHF diagnosis. BNP can be elevated in renal failure, PE, and
critical illness, but extreme elevations strongly suggest HF. Option A is wrong - this is a major elevation. Option C is wrong - BNP is
useful acutely. Option D is wrong - renal dysfunction alone rarely causes this magnitude.
Q7: A patient with chronic HF reports increasing dyspnea and weight gain of 4 pounds in 2 days. Which assessment
is the priority?
A. Auscultate lung sounds for crackles and assess for jugular venous distension [CORRECT]
B. Check serum potassium
C. Obtain a sleep study
D. Schedule a treadmill stress test
Correct Answer: A
Rationale: Sudden weight gain (>2-3 lbs/day or 5 lbs/week) in HF indicates fluid retention. The priority assessment is for signs of volume
overload - crackles, JVD, edema, S3 gallop. Option B is important for diuretic management but secondary. Option C is for sleep apnea
evaluation, not acute decompensation. Option D is inappropriate during decompensation - stress testing is deferred until stabilized.
Q8: A 72-year-old patient with aortic stenosis presents with syncope, angina, and dyspnea on exertion. Which
symptom triad is classic for this valvular disorder?
A. Angina, syncope, and heart failure (Dyspnea) - the classic triad of severe AS [CORRECT]
B. Pulsating headache, diaphoresis, and palpitations
C. Hemoptysis, orthopnea, and hoarseness
D. Dysphagia, weight loss, and fatigue
Correct Answer: A
Rationale: The classic triad of severe aortic stenosis is angina (due to supply-demand mismatch from LVH and decreased coronary
perfusion), syncope (exertional due to fixed cardiac output and vasodilation), and heart failure symptoms (dyspnea). Survival after
symptom onset averages 2-5 years without valve replacement. Options B, C, D do not match the AS symptom triad.
Q9: The classic murmur of aortic stenosis is best described as:
A. Diastolic decrescendo murmur at the left upper sternal border
B. Crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids [CORRECT]
C. Holosystolic murmur at the apex radiating to the axilla
D. Mid-systolic click with late systolic murmur at the apex
Correct Answer: B
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic ejection murmur best heard at the right upper sternal border (aortic
area), radiating to the carotid arteries. The carotid radiation reflects the turbulent ejection. Option A is aortic regurgitation. Option C is
mitral regurgitation. Option D is mitral valve prolapse.
Page 3
, PCCN Exam Questions & Answers 2026/2027 - Verified Answers AACN Progressive Care Certified Nurse
Q10: A patient with mitral regurgitation has which characteristic murmur?
A. Diastolic rumble at the apex
B. Holosystolic (pansystolic) murmur at the apex radiating to the axilla [CORRECT]
C. Systolic ejection murmur at the right upper sternal border
D. Continuous machinery murmur at the left upper sternal border
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur at the apex radiating to the axilla, due to retrograde flow
across the incompetent mitral valve throughout systole. Option A is mitral stenosis. Option C is aortic stenosis. Option D is patent ductus
arteriosus.
Q11: A patient with hypertrophic cardiomyopathy (HCM) presents with exertional syncope. Which intervention is
contraindicated?
A. Beta-blocker
B. IV normal saline bolus
C. Digoxin
D. Nitrates [CORRECT]
Correct Answer: D
Rationale: Hypertrophic cardiomyopathy involves dynamic LV outflow obstruction worsened by decreased preload (nitrates, diuretics),
decreased afterload (vasodilators), or increased contractility (digoxin, dobutamine). The treatment preserves preload and reduces
contractility (beta-blockers, disopyramide). IV fluids (Option B) increase preload and reduce obstruction. Digoxin (Option C) increases
contractility and worsens obstruction - also contraindicated. Nitrates (Option D) reduce preload and worsen obstruction.
Q12: Which of the following ECG findings is most consistent with hyperkalemia?
A. Peaked T waves, widened QRS, and prolonged PR interval [CORRECT]
B. U waves and flat T waves
C. ST-segment depression and T-wave inversion
D. Diffuse ST-segment elevation
Correct Answer: A
Rationale: Hyperkalemia produces a progression of ECG changes: peaked (tented) T waves, widened QRS, prolonged PR interval, then
sine-wave pattern and asystole/VF. Option B (U waves, flat T waves) indicates hypokalemia. Option C suggests ischemia or strain. Option
D suggests pericarditis or large MI.
Q13: A patient with acute decompensated heart failure is started on IV nitroglycerin at 10 mcg/min. The BP drops
from 110/70 to 88/52. Which action should the nurse take first?
A. Increase the nitroglycerin to 20 mcg/min
B. Decrease or discontinue nitroglycerin and reassess; consider norepinephrine if symptomatic [CORRECT]
C. Administer IV metoprolol 5 mg
D. Administer IV furosemide 80 mg
Correct Answer: B
Rationale: Nitroglycerin is a venous and arterial vasodilator that lowers preload and afterload. Hypotension indicates over-titration. The
nurse should decrease/discontinue the infusion and reassess; if hypotension persists or symptoms develop, consider a vasopressor
(norepinephrine) to maintain perfusion. Increasing nitroglycerin (Option A) would worsen hypotension. Beta-blockers (Option C) are
contraindicated in decompensation. Furosemide (Option D) might be appropriate if volume overloaded, but the immediate concern is the
hypotension from nitroglycerin.
Page 4
PCCN Exam Questions & Answers
2026/2027 (Verified Answers)
Comprehensive PCCN Certification Practice Exam
Aligned with AACN PCCN Examination Content Outline · 250 Questions with Detailed Rationales
Section 1: Cardiovascular System (Q1-55)
ACS, Heart Failure, Dysrhythmias, Valvular Disease, Cardiomyopathies, & Vascular Disorders
Q1: A 58-year-old male presents with substernal chest pain radiating to the left arm, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which assessment finding is most likely associated
with this presentation?
A. ST elevation in leads V1-V4
B. Right ventricular involvement suggested by ST elevation in V4R [CORRECT]
C. Posterior wall involvement suggested by ST depression in V1-V2
D. Anterolateral involvement suggested by ST elevation in I, aVL, V5-V6
Correct Answer: B
Rationale: ST elevation in II, III, and aVF indicates an inferior wall STEMI, often caused by right coronary artery (RCA) occlusion. RCA
occlusion commonly involves the right ventricle, and ST elevation in right precordial lead V4R is the most sensitive indicator of RV
infarction. Assessing for RV involvement is critical because nitrates are relatively contraindicated due to RV preload dependence. Options
A, C, D describe anterior, posterior, and lateral wall infarcts, respectively.
Q2: A patient with an inferior STEMI and suspected RV involvement has a blood pressure of 86/52 mmHg. Which
intervention is most appropriate?
A. Administer sublingual nitroglycerin immediately
B. Administer IV morphine 4 mg
C. Administer a 500 mL IV normal saline bolus and reassess [CORRECT]
D. Administer IV metoprolol 5 mg
Correct Answer: C
Rationale: Right ventricular infarction produces a preload-dependent state. RV dysfunction impairs filling and cardiac output, leading to
hypotension that worsens with venodilators (nitroglycerin) or negative inotropes (beta-blockers). The correct response is a careful IV fluid
bolus (250-500 mL NS) to optimize RV preload, then reassess. Nitroglycerin and morphine (Option A, B) are contraindicated.
Beta-blockers (Option D) are contraindicated acutely in RV infarct with hypotension.
Page 1
,PCCN Exam Questions & Answers 2026/2027 - Verified Answers AACN Progressive Care Certified Nurse
Q3: A 65-year-old patient is admitted with NSTEMI. Cardiac biomarkers are ordered. Which finding is most
consistent with acute myocardial injury?
A. Troponin I 0.02 ng/mL (reference <0.04 ng/mL)
B. Troponin I 1.8 ng/mL with chest pain onset 4 hours ago [CORRECT]
C. CK-MB 2% of total CK
D. Myoglobin 50 ng/mL at 2 hours post chest pain
Correct Answer: B
Rationale: Troponin I >0.04 ng/mL indicates myocardial injury. A rise to 1.8 ng/mL 4 hours after symptom onset is consistent with acute
MI - troponin rises within 3-4 hours of injury, peaks at 24 hours. CK-MB ratio >5% suggests myocardial injury but is less
sensitive/specific than troponin. Myoglobin rises earliest (1-2 hours) but lacks specificity. Option A is normal. Option C is normal. Option
D is borderline.
Q4: A patient with acute decompensated heart failure has the following hemodynamics: BP 88/50, HR 110, PAOP 24
mmHg, CI 1.8 L/min/m2. Which vasoactive medication is most appropriate?
A. Norepinephrine
B. Dobutamine [CORRECT]
C. Nitroprusside
D. Milrinone
Correct Answer: B
Rationale: This patient has a 'wet-cold' profile: low CI (1.8), high PAOP (24), hypotension. Dobutamine, a beta-1 agonist, increases
contractility and cardiac output while maintaining some vasopressor effect via beta-1 mediated vasoconstriction. Norepinephrine (Option
A) is first-line for septic shock but adds vasoconstriction without inotropy in cardiogenic states. Nitroprusside (Option C) would worsen
hypotension. Milrinone (Option D) is a PDE-III inhibitor that may cause hypotension in a patient already hypotensive.
Q5: For patients with acute heart failure with reduced ejection fraction (HFrEF), the four pillars of
guideline-directed medical therapy (GDMT) include all of the following EXCEPT:
A. ARNI (or ACE inhibitor if ARNI not tolerated)
B. Beta-blocker (carvedilol, metoprolol succinate, or bisoprolol)
C. Calcium channel blocker (amlodipine) [CORRECT]
D. SGLT2 inhibitor (dapagliflozin or empagliflozin)
Correct Answer: C
Rationale: The four pillars of HFrEF GDMT are: (1) ARNI (preferred) or ACE inhibitor/ARB, (2) evidence-based beta-blocker, (3) MRA
(spironolactone/ eplerenone), and (4) SGLT2 inhibitor. Calcium channel blockers (amlodipine) are not part of GDMT for HFrEF; they
may be used for hypertension in HFpEF but do not improve mortality in HFrEF. Non-dihydropyridines (diltiazem, verapamil) are
contraindicated in HFrEF due to negative inotropy.
Page 2
,PCCN Exam Questions & Answers 2026/2027 - Verified Answers AACN Progressive Care Certified Nurse
Q6: A patient is admitted with acute decompensated heart failure. Labs show BNP 1850 pg/mL. Which statement
best describes the clinical significance of this finding?
A. BNP >100 indicates heart failure; this is a mild elevation
B. BNP >500 pg/mL strongly supports heart failure; 1850 indicates significant ventricular wall stress and fluid overload
[CORRECT]
C. BNP is not useful in acute settings
D. BNP 1850 indicates primarily renal dysfunction
Correct Answer: B
Rationale: BNP <100 pg/mL essentially excludes heart failure; 100-500 is intermediate; >500 strongly supports HF. A level of 1850
indicates significant ventricular wall stress and fluid overload, supporting ADHF diagnosis. BNP can be elevated in renal failure, PE, and
critical illness, but extreme elevations strongly suggest HF. Option A is wrong - this is a major elevation. Option C is wrong - BNP is
useful acutely. Option D is wrong - renal dysfunction alone rarely causes this magnitude.
Q7: A patient with chronic HF reports increasing dyspnea and weight gain of 4 pounds in 2 days. Which assessment
is the priority?
A. Auscultate lung sounds for crackles and assess for jugular venous distension [CORRECT]
B. Check serum potassium
C. Obtain a sleep study
D. Schedule a treadmill stress test
Correct Answer: A
Rationale: Sudden weight gain (>2-3 lbs/day or 5 lbs/week) in HF indicates fluid retention. The priority assessment is for signs of volume
overload - crackles, JVD, edema, S3 gallop. Option B is important for diuretic management but secondary. Option C is for sleep apnea
evaluation, not acute decompensation. Option D is inappropriate during decompensation - stress testing is deferred until stabilized.
Q8: A 72-year-old patient with aortic stenosis presents with syncope, angina, and dyspnea on exertion. Which
symptom triad is classic for this valvular disorder?
A. Angina, syncope, and heart failure (Dyspnea) - the classic triad of severe AS [CORRECT]
B. Pulsating headache, diaphoresis, and palpitations
C. Hemoptysis, orthopnea, and hoarseness
D. Dysphagia, weight loss, and fatigue
Correct Answer: A
Rationale: The classic triad of severe aortic stenosis is angina (due to supply-demand mismatch from LVH and decreased coronary
perfusion), syncope (exertional due to fixed cardiac output and vasodilation), and heart failure symptoms (dyspnea). Survival after
symptom onset averages 2-5 years without valve replacement. Options B, C, D do not match the AS symptom triad.
Q9: The classic murmur of aortic stenosis is best described as:
A. Diastolic decrescendo murmur at the left upper sternal border
B. Crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids [CORRECT]
C. Holosystolic murmur at the apex radiating to the axilla
D. Mid-systolic click with late systolic murmur at the apex
Correct Answer: B
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic ejection murmur best heard at the right upper sternal border (aortic
area), radiating to the carotid arteries. The carotid radiation reflects the turbulent ejection. Option A is aortic regurgitation. Option C is
mitral regurgitation. Option D is mitral valve prolapse.
Page 3
, PCCN Exam Questions & Answers 2026/2027 - Verified Answers AACN Progressive Care Certified Nurse
Q10: A patient with mitral regurgitation has which characteristic murmur?
A. Diastolic rumble at the apex
B. Holosystolic (pansystolic) murmur at the apex radiating to the axilla [CORRECT]
C. Systolic ejection murmur at the right upper sternal border
D. Continuous machinery murmur at the left upper sternal border
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur at the apex radiating to the axilla, due to retrograde flow
across the incompetent mitral valve throughout systole. Option A is mitral stenosis. Option C is aortic stenosis. Option D is patent ductus
arteriosus.
Q11: A patient with hypertrophic cardiomyopathy (HCM) presents with exertional syncope. Which intervention is
contraindicated?
A. Beta-blocker
B. IV normal saline bolus
C. Digoxin
D. Nitrates [CORRECT]
Correct Answer: D
Rationale: Hypertrophic cardiomyopathy involves dynamic LV outflow obstruction worsened by decreased preload (nitrates, diuretics),
decreased afterload (vasodilators), or increased contractility (digoxin, dobutamine). The treatment preserves preload and reduces
contractility (beta-blockers, disopyramide). IV fluids (Option B) increase preload and reduce obstruction. Digoxin (Option C) increases
contractility and worsens obstruction - also contraindicated. Nitrates (Option D) reduce preload and worsen obstruction.
Q12: Which of the following ECG findings is most consistent with hyperkalemia?
A. Peaked T waves, widened QRS, and prolonged PR interval [CORRECT]
B. U waves and flat T waves
C. ST-segment depression and T-wave inversion
D. Diffuse ST-segment elevation
Correct Answer: A
Rationale: Hyperkalemia produces a progression of ECG changes: peaked (tented) T waves, widened QRS, prolonged PR interval, then
sine-wave pattern and asystole/VF. Option B (U waves, flat T waves) indicates hypokalemia. Option C suggests ischemia or strain. Option
D suggests pericarditis or large MI.
Q13: A patient with acute decompensated heart failure is started on IV nitroglycerin at 10 mcg/min. The BP drops
from 110/70 to 88/52. Which action should the nurse take first?
A. Increase the nitroglycerin to 20 mcg/min
B. Decrease or discontinue nitroglycerin and reassess; consider norepinephrine if symptomatic [CORRECT]
C. Administer IV metoprolol 5 mg
D. Administer IV furosemide 80 mg
Correct Answer: B
Rationale: Nitroglycerin is a venous and arterial vasodilator that lowers preload and afterload. Hypotension indicates over-titration. The
nurse should decrease/discontinue the infusion and reassess; if hypotension persists or symptoms develop, consider a vasopressor
(norepinephrine) to maintain perfusion. Increasing nitroglycerin (Option A) would worsen hypotension. Beta-blockers (Option C) are
contraindicated in decompensation. Furosemide (Option D) might be appropriate if volume overloaded, but the immediate concern is the
hypotension from nitroglycerin.
Page 4
