PCCN PRACTICE EXAM 2026/2027 |
Questions and Answers | Progressive
Care Certified Nurse Test
Section 1: Cardiovascular (Questions 1–30)
1. A patient presents with an elevated ST segment in leads II, III, and aVF. Which
coronary artery is most likely occluded?
• A. Left anterior descending artery
• B. Right coronary artery
• C. Left circumflex artery
• D. Left main coronary artery
• Leads II, III, and aVF are inferior leads. The right coronary artery (RCA)
supplies the inferior wall in most patients. An inferior MI with ST elevation
in these leads strongly suggests RCA occlusion.
2. A patient with heart failure has a BNP of 1,200 pg/mL. What does this
indicate?
• A. Normal cardiac function
• B. Mild dehydration
• C. Elevated ventricular wall stress
• D. Renal failure
• BNP is released when ventricular myocytes are stretched due to
increased volume or pressure. A level >100 pg/mL suggests heart failure;
1,200 indicates significant ventricular wall stress.
,3. Which medication is first-line for a patient with symptomatic bradycardia and
a pulse?
• A. Adenosine
• B. Atropine
• C. Amiodarone
• D. Epinephrine
• Atropine 0.5 mg IV is first-line for symptomatic bradycardia. It blocks
vagal input to the SA node, increasing heart rate.
4. A patient's telemetry shows a chaotic, irregular baseline with no identifiable P
waves or QRS complexes. What is this rhythm?
• A. Ventricular tachycardia
• B. Atrial fibrillation
• C. Ventricular fibrillation
• D. Asystole
• Ventricular fibrillation is a chaotic, disorganized rhythm with no
effective cardiac output. It is a pulseless rhythm requiring immediate
defibrillation.
5. A patient on furosemide has a potassium level of 3.1 mEq/L. Which
assessment finding is most concerning?
• A. Blood pressure 138/82
• B. Heart rate 88
• C. Frequent PVCs on telemetry
• D. Urine output 50 mL/hr
• Hypokalemia (K+ <3.5) increases myocardial irritability and can cause
PVCs, which can progress to lethal arrhythmias.
,6. Which finding is most consistent with cardiac tamponade?
• A. Widened pulse pressure
• B. Muffled heart sounds, JVD, and hypotension
• C. Bradycardia and hypertension
• D. Decreased JVD and clear lungs
• Beck's triad (muffled heart sounds, JVD, hypotension) is classic for
cardiac tamponade. Pulsus paradoxus may also be present.
7. A patient is started on amiodarone. Which adverse effect requires
monitoring?
• A. Hyperkalemia
• B. Pulmonary toxicity
• C. Hyperglycemia
• D. Hypertension
• Amiodarone can cause pulmonary fibrosis, thyroid dysfunction, corneal
microdeposits, and hepatotoxicity. Pulmonary toxicity is a serious adverse
effect.
8. A patient with an acute MI is prescribed morphine. What is the primary
purpose?
• A. To reduce anxiety
• B. To relieve pain and reduce myocardial oxygen demand
• C. To increase heart rate
• D. To prevent infection
• Morphine relieves pain, reduces sympathetic stimulation, decreases
preload and afterload, and lowers myocardial oxygen demand.
, 9. Which lab value is most specific for acute myocardial infarction?
• A. CK-MB
• B. Troponin I
• C. Myoglobin
• D. LDH
• Troponin I is highly specific and sensitive for myocardial injury. It rises
within 3–6 hours and remains elevated for 7–10 days.
10. A patient has a heart rate of 42, blood pressure 88/50, and is confused. What
is the priority intervention?
• A. Administer amiodarone
• B. Prepare for transcutaneous pacing
• C. Administer adenosine
• D. Start CPR
• Symptomatic bradycardia unresponsive to atropine requires
transcutaneous pacing. The patient is unstable (hypotension, confusion).
11. Which condition is a contraindication to thrombolytic therapy?
• A. Recent ischemic stroke within 3 months
• B. Hypertension 150/90
• C. Age 70
• D. Diabetes
• Recent ischemic stroke, active bleeding, recent surgery, and severe
hypertension are contraindications to thrombolytics.
12. A patient with heart failure is on carvedilol. What is the expected
therapeutic effect?
Questions and Answers | Progressive
Care Certified Nurse Test
Section 1: Cardiovascular (Questions 1–30)
1. A patient presents with an elevated ST segment in leads II, III, and aVF. Which
coronary artery is most likely occluded?
• A. Left anterior descending artery
• B. Right coronary artery
• C. Left circumflex artery
• D. Left main coronary artery
• Leads II, III, and aVF are inferior leads. The right coronary artery (RCA)
supplies the inferior wall in most patients. An inferior MI with ST elevation
in these leads strongly suggests RCA occlusion.
2. A patient with heart failure has a BNP of 1,200 pg/mL. What does this
indicate?
• A. Normal cardiac function
• B. Mild dehydration
• C. Elevated ventricular wall stress
• D. Renal failure
• BNP is released when ventricular myocytes are stretched due to
increased volume or pressure. A level >100 pg/mL suggests heart failure;
1,200 indicates significant ventricular wall stress.
,3. Which medication is first-line for a patient with symptomatic bradycardia and
a pulse?
• A. Adenosine
• B. Atropine
• C. Amiodarone
• D. Epinephrine
• Atropine 0.5 mg IV is first-line for symptomatic bradycardia. It blocks
vagal input to the SA node, increasing heart rate.
4. A patient's telemetry shows a chaotic, irregular baseline with no identifiable P
waves or QRS complexes. What is this rhythm?
• A. Ventricular tachycardia
• B. Atrial fibrillation
• C. Ventricular fibrillation
• D. Asystole
• Ventricular fibrillation is a chaotic, disorganized rhythm with no
effective cardiac output. It is a pulseless rhythm requiring immediate
defibrillation.
5. A patient on furosemide has a potassium level of 3.1 mEq/L. Which
assessment finding is most concerning?
• A. Blood pressure 138/82
• B. Heart rate 88
• C. Frequent PVCs on telemetry
• D. Urine output 50 mL/hr
• Hypokalemia (K+ <3.5) increases myocardial irritability and can cause
PVCs, which can progress to lethal arrhythmias.
,6. Which finding is most consistent with cardiac tamponade?
• A. Widened pulse pressure
• B. Muffled heart sounds, JVD, and hypotension
• C. Bradycardia and hypertension
• D. Decreased JVD and clear lungs
• Beck's triad (muffled heart sounds, JVD, hypotension) is classic for
cardiac tamponade. Pulsus paradoxus may also be present.
7. A patient is started on amiodarone. Which adverse effect requires
monitoring?
• A. Hyperkalemia
• B. Pulmonary toxicity
• C. Hyperglycemia
• D. Hypertension
• Amiodarone can cause pulmonary fibrosis, thyroid dysfunction, corneal
microdeposits, and hepatotoxicity. Pulmonary toxicity is a serious adverse
effect.
8. A patient with an acute MI is prescribed morphine. What is the primary
purpose?
• A. To reduce anxiety
• B. To relieve pain and reduce myocardial oxygen demand
• C. To increase heart rate
• D. To prevent infection
• Morphine relieves pain, reduces sympathetic stimulation, decreases
preload and afterload, and lowers myocardial oxygen demand.
, 9. Which lab value is most specific for acute myocardial infarction?
• A. CK-MB
• B. Troponin I
• C. Myoglobin
• D. LDH
• Troponin I is highly specific and sensitive for myocardial injury. It rises
within 3–6 hours and remains elevated for 7–10 days.
10. A patient has a heart rate of 42, blood pressure 88/50, and is confused. What
is the priority intervention?
• A. Administer amiodarone
• B. Prepare for transcutaneous pacing
• C. Administer adenosine
• D. Start CPR
• Symptomatic bradycardia unresponsive to atropine requires
transcutaneous pacing. The patient is unstable (hypotension, confusion).
11. Which condition is a contraindication to thrombolytic therapy?
• A. Recent ischemic stroke within 3 months
• B. Hypertension 150/90
• C. Age 70
• D. Diabetes
• Recent ischemic stroke, active bleeding, recent surgery, and severe
hypertension are contraindications to thrombolytics.
12. A patient with heart failure is on carvedilol. What is the expected
therapeutic effect?
