AACN PCCN PRACTICE TEST EXAM
2026/2027 | Questions and Answers |
Progressive Care Cert
1. A patient is admitted to the Progressive Care Unit (PCU) with an acute
exacerbation of heart failure. Which of the following assessment findings would
the nurse expect to observe?
A. Hypertension and bradycardia
B. Jugular Venous Distension (JVD) and crackles in the lungs
C. Decreased respiratory rate and dry mucous membranes
D. Warm, flushed skin and peripheral edema
• Correct Answer: B. Jugular Venous Distension (JVD) and crackles in the
lungs
• Rationale: In acute heart failure, the heart's ability to pump effectively
is compromised, leading to fluid backup. Fluid backs up into the systemic
venous system, causing JVD, and into the pulmonary system, causing
crackles (rales) as fluid leaks into the alveoli. Hypertension and tachycardia
are more common than hypotension and bradycardia.
2. A patient is receiving a continuous infusion of heparin for a deep vein
thrombosis (DVT). The nurse notes a new order for aPTT monitoring. The
therapeutic goal for aPTT during heparin therapy is typically:
A. 1.5 to 2.5 times the control value
B. 2.5 to 3.5 times the control value
C. An INR of 2.0 to 3.0
D. An aPTT of 20 to 30 seconds
• Correct Answer: A. 1.5 to 2.5 times the control value
• Rationale: The activated partial thromboplastin time (aPTT) is used to
monitor unfractionated heparin therapy. The therapeutic range is typically
, 1.5 to 2.5 times the normal control value, which generally corresponds to
60-80 seconds. An INR of 2.0-3.0 is the therapeutic goal for warfarin
therapy.
3. Which of the following is the most common cause of sepsis in a critically ill
patient?
A. Fungal infection
B. Viral infection
C. Gram-negative bacterial infection
D. Gram-positive bacterial infection
• Correct Answer: C. Gram-negative bacterial infection
• Rationale: While any organism can cause sepsis, gram-negative bacteria
(e.g., E. coli, Klebsiella, Pseudomonas) are a very common cause, often
originating from the urinary tract, lungs, or abdomen. However, gram-
positive bacteria (e.g., Staphylococcus aureus) are also a frequent cause.
The most common overall source is the respiratory system.
4. A patient with a new tracheostomy is being suctioned. The nurse should limit
each suction pass to no more than:
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
• Correct Answer: C. 15 seconds
• Rationale: Suctioning should be limited to 10-15 seconds per pass to
minimize the risk of hypoxemia and tissue trauma. The patient should be
hyperoxygenated before and between suction passes.
5. A patient is prescribed furosemide (Lasix). Which of the following lab values is
most important for the nurse to monitor?
A. Sodium
B. Potassium
,C. Calcium
D. Magnesium
• Correct Answer: B. Potassium
• Rationale: Furosemide is a loop diuretic that causes the excretion of
potassium, leading to a high risk of hypokalemia. Hypokalemia can cause
cardiac dysrhythmias, muscle weakness, and other complications, making it
the most critical electrolyte to monitor.
6. A patient is exhibiting signs of alcohol withdrawal, including tremors,
diaphoresis, and a heart rate of 120 bpm. Which medication is most appropriate
for the nurse to anticipate administering?
A. Morphine sulfate
B. Lorazepam (Ativan)
C. Haloperidol (Haldol)
D. Diphenhydramine (Benadryl)
• Correct Answer: B. Lorazepam (Ativan)
• Rationale: Benzodiazepines, such as lorazepam (Ativan), are the first-
line treatment for alcohol withdrawal. They work by enhancing the effect of
GABA, an inhibitory neurotransmitter, to reduce symptoms like tremors,
agitation, and autonomic hyperactivity. Haloperidol may be used for severe
agitation but does not treat the underlying withdrawal.
7. The nurse is caring for a patient with acute respiratory distress syndrome
(ARDS). Which of the following ventilator settings is a priority to prevent further
lung injury?
A. High tidal volume
B. Low positive end-expiratory pressure (PEEP)
C. Low tidal volume
D. High respiratory rate
• Correct Answer: C. Low tidal volume
, • Rationale: Lung-protective ventilation is the standard of care for ARDS.
This strategy uses low tidal volumes (e.g., 4-8 mL/kg of predicted body
weight) to prevent volutrauma (overdistension of the alveoli). Higher PEEP
is also used to recruit collapsed alveoli and improve oxygenation.
8. Which of the following is a classic sign of increased intracranial pressure (ICP)?
A. Tachycardia and hypotension
B. Bradycardia and hypertension
C. Hyperthermia and tachycardia
D. Hypotension and tachypnea
• Correct Answer: B. Bradycardia and hypertension
• Rationale: Cushing's triad is a late sign of increased ICP and consists of
bradycardia, hypertension (often with a widened pulse pressure), and
irregular respirations. It indicates impending herniation and is a medical
emergency.
9. A patient is admitted with diabetic ketoacidosis (DKA). The initial priority of
nursing management is:
A. Administering a bolus of insulin
B. Restoring fluid volume
C. Correcting potassium levels
D. Administering sodium bicarbonate
• Correct Answer: B. Restoring fluid volume
• Rationale: Patients in DKA are severely dehydrated due to osmotic
diuresis from hyperglycemia. The first priority is rapid fluid resuscitation
with isotonic fluids (e.g., 0.9% NaCl) to restore intravascular volume and
perfusion. Insulin is administered after fluids are started, and potassium is
replaced as needed.
10. A patient is receiving a blood transfusion and develops fever, chills, and flank
pain. The nurse's first action should be to:
A. Stop the transfusion and maintain IV access with new tubing.
2026/2027 | Questions and Answers |
Progressive Care Cert
1. A patient is admitted to the Progressive Care Unit (PCU) with an acute
exacerbation of heart failure. Which of the following assessment findings would
the nurse expect to observe?
A. Hypertension and bradycardia
B. Jugular Venous Distension (JVD) and crackles in the lungs
C. Decreased respiratory rate and dry mucous membranes
D. Warm, flushed skin and peripheral edema
• Correct Answer: B. Jugular Venous Distension (JVD) and crackles in the
lungs
• Rationale: In acute heart failure, the heart's ability to pump effectively
is compromised, leading to fluid backup. Fluid backs up into the systemic
venous system, causing JVD, and into the pulmonary system, causing
crackles (rales) as fluid leaks into the alveoli. Hypertension and tachycardia
are more common than hypotension and bradycardia.
2. A patient is receiving a continuous infusion of heparin for a deep vein
thrombosis (DVT). The nurse notes a new order for aPTT monitoring. The
therapeutic goal for aPTT during heparin therapy is typically:
A. 1.5 to 2.5 times the control value
B. 2.5 to 3.5 times the control value
C. An INR of 2.0 to 3.0
D. An aPTT of 20 to 30 seconds
• Correct Answer: A. 1.5 to 2.5 times the control value
• Rationale: The activated partial thromboplastin time (aPTT) is used to
monitor unfractionated heparin therapy. The therapeutic range is typically
, 1.5 to 2.5 times the normal control value, which generally corresponds to
60-80 seconds. An INR of 2.0-3.0 is the therapeutic goal for warfarin
therapy.
3. Which of the following is the most common cause of sepsis in a critically ill
patient?
A. Fungal infection
B. Viral infection
C. Gram-negative bacterial infection
D. Gram-positive bacterial infection
• Correct Answer: C. Gram-negative bacterial infection
• Rationale: While any organism can cause sepsis, gram-negative bacteria
(e.g., E. coli, Klebsiella, Pseudomonas) are a very common cause, often
originating from the urinary tract, lungs, or abdomen. However, gram-
positive bacteria (e.g., Staphylococcus aureus) are also a frequent cause.
The most common overall source is the respiratory system.
4. A patient with a new tracheostomy is being suctioned. The nurse should limit
each suction pass to no more than:
A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 20 seconds
• Correct Answer: C. 15 seconds
• Rationale: Suctioning should be limited to 10-15 seconds per pass to
minimize the risk of hypoxemia and tissue trauma. The patient should be
hyperoxygenated before and between suction passes.
5. A patient is prescribed furosemide (Lasix). Which of the following lab values is
most important for the nurse to monitor?
A. Sodium
B. Potassium
,C. Calcium
D. Magnesium
• Correct Answer: B. Potassium
• Rationale: Furosemide is a loop diuretic that causes the excretion of
potassium, leading to a high risk of hypokalemia. Hypokalemia can cause
cardiac dysrhythmias, muscle weakness, and other complications, making it
the most critical electrolyte to monitor.
6. A patient is exhibiting signs of alcohol withdrawal, including tremors,
diaphoresis, and a heart rate of 120 bpm. Which medication is most appropriate
for the nurse to anticipate administering?
A. Morphine sulfate
B. Lorazepam (Ativan)
C. Haloperidol (Haldol)
D. Diphenhydramine (Benadryl)
• Correct Answer: B. Lorazepam (Ativan)
• Rationale: Benzodiazepines, such as lorazepam (Ativan), are the first-
line treatment for alcohol withdrawal. They work by enhancing the effect of
GABA, an inhibitory neurotransmitter, to reduce symptoms like tremors,
agitation, and autonomic hyperactivity. Haloperidol may be used for severe
agitation but does not treat the underlying withdrawal.
7. The nurse is caring for a patient with acute respiratory distress syndrome
(ARDS). Which of the following ventilator settings is a priority to prevent further
lung injury?
A. High tidal volume
B. Low positive end-expiratory pressure (PEEP)
C. Low tidal volume
D. High respiratory rate
• Correct Answer: C. Low tidal volume
, • Rationale: Lung-protective ventilation is the standard of care for ARDS.
This strategy uses low tidal volumes (e.g., 4-8 mL/kg of predicted body
weight) to prevent volutrauma (overdistension of the alveoli). Higher PEEP
is also used to recruit collapsed alveoli and improve oxygenation.
8. Which of the following is a classic sign of increased intracranial pressure (ICP)?
A. Tachycardia and hypotension
B. Bradycardia and hypertension
C. Hyperthermia and tachycardia
D. Hypotension and tachypnea
• Correct Answer: B. Bradycardia and hypertension
• Rationale: Cushing's triad is a late sign of increased ICP and consists of
bradycardia, hypertension (often with a widened pulse pressure), and
irregular respirations. It indicates impending herniation and is a medical
emergency.
9. A patient is admitted with diabetic ketoacidosis (DKA). The initial priority of
nursing management is:
A. Administering a bolus of insulin
B. Restoring fluid volume
C. Correcting potassium levels
D. Administering sodium bicarbonate
• Correct Answer: B. Restoring fluid volume
• Rationale: Patients in DKA are severely dehydrated due to osmotic
diuresis from hyperglycemia. The first priority is rapid fluid resuscitation
with isotonic fluids (e.g., 0.9% NaCl) to restore intravascular volume and
perfusion. Insulin is administered after fluids are started, and potassium is
replaced as needed.
10. A patient is receiving a blood transfusion and develops fever, chills, and flank
pain. The nurse's first action should be to:
A. Stop the transfusion and maintain IV access with new tubing.
