PCCN EXAM QUESTIONS |LATEST UPDATED
2026/2027 |A COMPLETE SOLUTION WITH
VERIFIED QUESTIONS AND ANSWERS WITH
RATIONALES|GET IT 100% CORRECT |GRADED A+
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-
diastolic pressure (LVEDP), the pressure exerted on the ventricular muscle
at the end of diastole when the ventricle is full. This enables blood to
flow from a higher pressure through open arteries to a lower pressure, a
pressure gradient known as coronary artery prefusion pressure. As
diastolic pressure drops, there is a decrease in coronary artery blood
flow. Coronary artery perfusion is not affected by systolic pressure,
afterload or SVR, but they all increase the demand of oxygen in the
heart.
A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay.
Which of the following is the most common serious side effect that may
occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
D. rhinorrhea
,C. swelling of the tongue and face
Although all of the answers may occur, swelling og the tongue and face is
the most serious and may require intervention. Patients should be
instructed to seek medical attention immediately for any signs of swelling
in the tongue or throat.
Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts
D. It occurs during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant
(stiff) left ventricle. An S4 is also called an atrial heart sound since it
occurs at the end of diastolic filling when the atria contracts and fully
fills the left ventricle. Known as "atrial kick", this filling is important to
cardiac output. The increased end-diastolic volume in the ventricle
improves cardiac output. When the left ventricle is stiff (decreased
compliance with long term hypertension, aortic stenosis or with acute
STEMI), the atrium has to pump harder to move blood from the atrium to
the ventricle, causing a turbulent blood flow and extra heart sound. This
heart sound is always pathologic. It occurs before ventricular contraction,
is best heard with the bell of the stethoscope and is never a normal heart
sound, even in children.
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
C. Q-wave formation
D. ST-segment depression and T-wave inversion
D. ST segment depression and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle.
That change is seen on the 12 lead ECG as ST-segment depression and T
,wave inversion, which demonstrate subendocardial ischemia -- the
innermost layer of muscle in the myocardium. ST-segment elevation
indicates acute injury or infarction, ST segment depression and T wave
elevation may indicate an electrolyte abnormality, while Q wave
formation indicates total infarction.
Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
D. vasodilate vessels
A. improve cardiac output and tissue perfusion
The term "inotropic" refers to affecting the force of myocardial
contraction. Improvement of cardiac muscle contraction leads to
improved cardiac output and tissue perfusion.
A patient in the ED is now being admitted to telemetry bwith complaint
of chest pain and has been judged to be a possible candidate for therapy
with alteplase (Activase). Which of the following is not considered a
contraindication for the use of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed
A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All
the other answers -- recent abdominal surgery, recent gastrointestinal
bleeding and a recent intracranial bleed -- are contraindications for the
use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload)
, A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output.
If the SVR (afterload) is high and the cardiac output low, the patient may
still have a normal BP. the pulse pressure will be lower, but this is a
compensatory response by the heart to maintain BP. If the SVR (afterload)
is low (as in early septic shock), the cardiac output is very high, thereby
trying to support BP.
The layer of the arterial vessel wall responsible for changes in the
diameter of the artery is the:
A. media
B. intima
C. externa
D. adventitia
A. media
The media layer of the arterial wall contains vascular smooth muscle cells
and is responsible for arterial tone. Vasoactive substances released in
response to the sympathetic nervous system and/or the renin-angiotensin
system determine arterial tone. Intima, externa and adventitia are
incorrect.
A patient presents in acute distress with rales halfway up bilaterally; cool
and clammy extremities; elevated jugular venous distention (JVD);
oxygen saturations at 95%, down from 99%; and complaints of shortness of
breath. Which of the following findings correspond to the patient's
cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion
D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary
edema, causing pulmonary congestion. Pneumonia can also cause fluid in
2026/2027 |A COMPLETE SOLUTION WITH
VERIFIED QUESTIONS AND ANSWERS WITH
RATIONALES|GET IT 100% CORRECT |GRADED A+
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-
diastolic pressure (LVEDP), the pressure exerted on the ventricular muscle
at the end of diastole when the ventricle is full. This enables blood to
flow from a higher pressure through open arteries to a lower pressure, a
pressure gradient known as coronary artery prefusion pressure. As
diastolic pressure drops, there is a decrease in coronary artery blood
flow. Coronary artery perfusion is not affected by systolic pressure,
afterload or SVR, but they all increase the demand of oxygen in the
heart.
A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay.
Which of the following is the most common serious side effect that may
occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
D. rhinorrhea
,C. swelling of the tongue and face
Although all of the answers may occur, swelling og the tongue and face is
the most serious and may require intervention. Patients should be
instructed to seek medical attention immediately for any signs of swelling
in the tongue or throat.
Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts
D. It occurs during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant
(stiff) left ventricle. An S4 is also called an atrial heart sound since it
occurs at the end of diastolic filling when the atria contracts and fully
fills the left ventricle. Known as "atrial kick", this filling is important to
cardiac output. The increased end-diastolic volume in the ventricle
improves cardiac output. When the left ventricle is stiff (decreased
compliance with long term hypertension, aortic stenosis or with acute
STEMI), the atrium has to pump harder to move blood from the atrium to
the ventricle, causing a turbulent blood flow and extra heart sound. This
heart sound is always pathologic. It occurs before ventricular contraction,
is best heard with the bell of the stethoscope and is never a normal heart
sound, even in children.
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
C. Q-wave formation
D. ST-segment depression and T-wave inversion
D. ST segment depression and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle.
That change is seen on the 12 lead ECG as ST-segment depression and T
,wave inversion, which demonstrate subendocardial ischemia -- the
innermost layer of muscle in the myocardium. ST-segment elevation
indicates acute injury or infarction, ST segment depression and T wave
elevation may indicate an electrolyte abnormality, while Q wave
formation indicates total infarction.
Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
D. vasodilate vessels
A. improve cardiac output and tissue perfusion
The term "inotropic" refers to affecting the force of myocardial
contraction. Improvement of cardiac muscle contraction leads to
improved cardiac output and tissue perfusion.
A patient in the ED is now being admitted to telemetry bwith complaint
of chest pain and has been judged to be a possible candidate for therapy
with alteplase (Activase). Which of the following is not considered a
contraindication for the use of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed
A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All
the other answers -- recent abdominal surgery, recent gastrointestinal
bleeding and a recent intracranial bleed -- are contraindications for the
use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
D. contractility and SVR (afterload)
, A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output.
If the SVR (afterload) is high and the cardiac output low, the patient may
still have a normal BP. the pulse pressure will be lower, but this is a
compensatory response by the heart to maintain BP. If the SVR (afterload)
is low (as in early septic shock), the cardiac output is very high, thereby
trying to support BP.
The layer of the arterial vessel wall responsible for changes in the
diameter of the artery is the:
A. media
B. intima
C. externa
D. adventitia
A. media
The media layer of the arterial wall contains vascular smooth muscle cells
and is responsible for arterial tone. Vasoactive substances released in
response to the sympathetic nervous system and/or the renin-angiotensin
system determine arterial tone. Intima, externa and adventitia are
incorrect.
A patient presents in acute distress with rales halfway up bilaterally; cool
and clammy extremities; elevated jugular venous distention (JVD);
oxygen saturations at 95%, down from 99%; and complaints of shortness of
breath. Which of the following findings correspond to the patient's
cardiac status?
A. no pulmonary congestion, normal perfusion
B. no pulmonary congestion, low perfusion
C. pulmonary congestion, normal perfusion
D. pulmonary congestion, low perfusion
D. pulmonary congestion, low perfusion
Rales indicate fluid in the alveolar sacs, possibly secondary to pulmonary
edema, causing pulmonary congestion. Pneumonia can also cause fluid in
