PCCN EXAM: 200 PRACTICE QUESTIONS WITH
CORRECT ANSWERS AND DETAILED RATIONALES
(2026 EDITION)
Part 1: Cardiovascular (Questions 1–66)
1. A client in the progressive care unit develops sudden-onset
tearing chest pain radiating to the back, with a blood pressure
difference of 22 mm Hg between arms. What is the priority
nursing action?
A. Administer a PRN dose of morphine and reassess in 15 minutes
B. Notify the provider immediately and prepare for emergent imaging
C. Obtain a 12-lead ECG and apply supplemental oxygen
D. Document the finding as musculoskeletal pain
Answer: B. Tearing chest pain with inter-arm blood pressure
differential is a classic presentation of aortic dissection, a life-
threatening emergency requiring immediate provider notification and
urgent imaging (CT angiography or TEE). Analgesia and ECG are
supportive but do not replace emergent escalation.
2. A client with acute decompensated heart failure has a brain
natriuretic peptide (BNP) of 1,850 pg/mL. Which finding is most
, consistent with this diagnosis?
A. Dry mucous membranes and poor skin turgor
B. Bibasilar crackles, jugular venous distension, and S3 gallop
C. Bradycardia with hypertension and warm extremities
D. Polyuria and decreased serum potassium
Answer: B. Elevated BNP reflects ventricular wall stretch from volume
overload. Bibasilar crackles, JVD, and an S3 gallop are hallmark signs
of decompensated heart failure. Dry mucous membranes and polyuria
suggest dehydration or diuresis, not acute congestion.
3. A client on a heparin infusion for pulmonary embolism has an
aPTT of 110 seconds (therapeutic range 60–80 seconds). Which
action is priority?
A. Increase the infusion rate to maintain the therapeutic range
B. Stop the infusion and assess for bleeding
C. Continue the current rate and recheck in 6 hours
D. Administer vitamin K
Answer: B. An aPTT of 110 seconds is supratherapeutic and places
the client at high risk for hemorrhage. The priority is to stop the
infusion, assess for bleeding, and notify the provider. Vitamin K
reverses warfarin, not heparin; protamine sulfate is the heparin
antidote.
4. A client with a new implantable cardioverter-defibrillator (ICD)
asks what to do if the device fires while they are awake. What is
the nurse’s best response?
A. “You should immediately lie flat and wait for the shock to pass.”
B. “If you feel a shock, sit or lie down and notify your provider if you
receive more than one shock.”
C. “You should drive yourself to the emergency department after any
shock.”
D. “The device only fires during sleep, so you will not feel it.”
Answer: B. A single ICD shock in an awake client is often a normal
response to a lethal dysrhythmia. Sitting or lying down prevents injury
from a fall. Multiple shocks, or shocks accompanied by symptoms,
, require emergency evaluation. Driving should be avoided after a
shock until cleared.
5. A client with ST-elevation myocardial infarction (STEMI) is
receiving a nitroglycerin infusion. Which finding requires
immediate discontinuation of the infusion?
A. Blood pressure of 112/68 mm Hg
B. Headache rated 4/10
C. Heart rate of 88 beats/min
D. Blood pressure of 84/50 mm Hg with diaphoresis
Answer: D. Nitroglycerin is a potent vasodilator. A systolic blood
pressure below 90 mm Hg with diaphoresis indicates hemodynamic
compromise and requires immediate discontinuation and provider
notification. Headache is a common side effect and does not require
stopping the infusion.
6. A client with heart failure is prescribed furosemide. Which
laboratory value requires the most immediate follow-up?
A. Sodium 136 mEq/L
B. Potassium 2.8 mEq/L
C. Magnesium 1.9 mg/dL
D. BUN 22 mg/dL
Answer: B. Loop diuretics cause potassium wasting. A potassium
level of 2.8 mEq/L is critically low and places the client at risk for
lethal ventricular dysrhythmias. Electrolyte replacement and provider
notification are required urgently.
7. A client with a history of heart failure reports a 3-pound weight
gain over the past 24 hours. What is the nurse’s best
interpretation?
A. This is a normal fluctuation and requires no action
B. This may indicate fluid retention and requires further assessment
and provider notification
C. The client should increase fluid intake
D. The client should double the diuretic dose
Answer: B. A weight gain of 2–3 pounds in 24 hours (or 5 pounds in
a week) suggests fluid retention in heart failure and warrants
, assessment and provider notification. Clients should not adjust
diuretic doses independently.
8. A client with a permanent pacemaker has a heart rate of 38
beats/min and reports dizziness. What is the priority nursing
action?
A. Place the client in Trendelenburg position and administer atropine
as ordered
B. Document the finding and reassess in 30 minutes
C. Encourage the client to ambulate to increase the heart rate
D. Apply oxygen and wait for the provider to round
Answer: A. Symptomatic bradycardia with hemodynamic
compromise requires immediate intervention. Trendelenburg
positioning supports cerebral perfusion, and atropine is the first-line
medication for symptomatic bradycardia. Assessment of pacemaker
function (capture, sensing, output) is also essential.
9. A client is admitted with chest pain and a 12-lead ECG shows ST
elevation 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
Answer: B. ST elevation in the inferior leads (II, III, aVF) indicates an
inferior wall myocardial infarction, most commonly caused by
occlusion of the right coronary artery.
10. A client with peripheral arterial disease reports intermittent
claudication. Which instruction is most appropriate?
A. Elevate the legs above heart level at rest
B. Exercise to the point of pain, then rest, and gradually increase
distance
C. Apply warm compresses to the affected extremity
D. Avoid all physical activity
Answer: B. Intermittent claudication is managed with a structured
walking program: walk until pain occurs, rest until it subsides, and
CORRECT ANSWERS AND DETAILED RATIONALES
(2026 EDITION)
Part 1: Cardiovascular (Questions 1–66)
1. A client in the progressive care unit develops sudden-onset
tearing chest pain radiating to the back, with a blood pressure
difference of 22 mm Hg between arms. What is the priority
nursing action?
A. Administer a PRN dose of morphine and reassess in 15 minutes
B. Notify the provider immediately and prepare for emergent imaging
C. Obtain a 12-lead ECG and apply supplemental oxygen
D. Document the finding as musculoskeletal pain
Answer: B. Tearing chest pain with inter-arm blood pressure
differential is a classic presentation of aortic dissection, a life-
threatening emergency requiring immediate provider notification and
urgent imaging (CT angiography or TEE). Analgesia and ECG are
supportive but do not replace emergent escalation.
2. A client with acute decompensated heart failure has a brain
natriuretic peptide (BNP) of 1,850 pg/mL. Which finding is most
, consistent with this diagnosis?
A. Dry mucous membranes and poor skin turgor
B. Bibasilar crackles, jugular venous distension, and S3 gallop
C. Bradycardia with hypertension and warm extremities
D. Polyuria and decreased serum potassium
Answer: B. Elevated BNP reflects ventricular wall stretch from volume
overload. Bibasilar crackles, JVD, and an S3 gallop are hallmark signs
of decompensated heart failure. Dry mucous membranes and polyuria
suggest dehydration or diuresis, not acute congestion.
3. A client on a heparin infusion for pulmonary embolism has an
aPTT of 110 seconds (therapeutic range 60–80 seconds). Which
action is priority?
A. Increase the infusion rate to maintain the therapeutic range
B. Stop the infusion and assess for bleeding
C. Continue the current rate and recheck in 6 hours
D. Administer vitamin K
Answer: B. An aPTT of 110 seconds is supratherapeutic and places
the client at high risk for hemorrhage. The priority is to stop the
infusion, assess for bleeding, and notify the provider. Vitamin K
reverses warfarin, not heparin; protamine sulfate is the heparin
antidote.
4. A client with a new implantable cardioverter-defibrillator (ICD)
asks what to do if the device fires while they are awake. What is
the nurse’s best response?
A. “You should immediately lie flat and wait for the shock to pass.”
B. “If you feel a shock, sit or lie down and notify your provider if you
receive more than one shock.”
C. “You should drive yourself to the emergency department after any
shock.”
D. “The device only fires during sleep, so you will not feel it.”
Answer: B. A single ICD shock in an awake client is often a normal
response to a lethal dysrhythmia. Sitting or lying down prevents injury
from a fall. Multiple shocks, or shocks accompanied by symptoms,
, require emergency evaluation. Driving should be avoided after a
shock until cleared.
5. A client with ST-elevation myocardial infarction (STEMI) is
receiving a nitroglycerin infusion. Which finding requires
immediate discontinuation of the infusion?
A. Blood pressure of 112/68 mm Hg
B. Headache rated 4/10
C. Heart rate of 88 beats/min
D. Blood pressure of 84/50 mm Hg with diaphoresis
Answer: D. Nitroglycerin is a potent vasodilator. A systolic blood
pressure below 90 mm Hg with diaphoresis indicates hemodynamic
compromise and requires immediate discontinuation and provider
notification. Headache is a common side effect and does not require
stopping the infusion.
6. A client with heart failure is prescribed furosemide. Which
laboratory value requires the most immediate follow-up?
A. Sodium 136 mEq/L
B. Potassium 2.8 mEq/L
C. Magnesium 1.9 mg/dL
D. BUN 22 mg/dL
Answer: B. Loop diuretics cause potassium wasting. A potassium
level of 2.8 mEq/L is critically low and places the client at risk for
lethal ventricular dysrhythmias. Electrolyte replacement and provider
notification are required urgently.
7. A client with a history of heart failure reports a 3-pound weight
gain over the past 24 hours. What is the nurse’s best
interpretation?
A. This is a normal fluctuation and requires no action
B. This may indicate fluid retention and requires further assessment
and provider notification
C. The client should increase fluid intake
D. The client should double the diuretic dose
Answer: B. A weight gain of 2–3 pounds in 24 hours (or 5 pounds in
a week) suggests fluid retention in heart failure and warrants
, assessment and provider notification. Clients should not adjust
diuretic doses independently.
8. A client with a permanent pacemaker has a heart rate of 38
beats/min and reports dizziness. What is the priority nursing
action?
A. Place the client in Trendelenburg position and administer atropine
as ordered
B. Document the finding and reassess in 30 minutes
C. Encourage the client to ambulate to increase the heart rate
D. Apply oxygen and wait for the provider to round
Answer: A. Symptomatic bradycardia with hemodynamic
compromise requires immediate intervention. Trendelenburg
positioning supports cerebral perfusion, and atropine is the first-line
medication for symptomatic bradycardia. Assessment of pacemaker
function (capture, sensing, output) is also essential.
9. A client is admitted with chest pain and a 12-lead ECG shows ST
elevation 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
Answer: B. ST elevation in the inferior leads (II, III, aVF) indicates an
inferior wall myocardial infarction, most commonly caused by
occlusion of the right coronary artery.
10. A client with peripheral arterial disease reports intermittent
claudication. Which instruction is most appropriate?
A. Elevate the legs above heart level at rest
B. Exercise to the point of pain, then rest, and gradually increase
distance
C. Apply warm compresses to the affected extremity
D. Avoid all physical activity
Answer: B. Intermittent claudication is managed with a structured
walking program: walk until pain occurs, rest until it subsides, and
