2025 Progressive Care Certified Nurse (PCCN Certification
Exam) by AACN with All the 150 Questions from Actual
Exam, 100% Correct Answers and Rationale
Section 1: Clinical Judgment - Clinical Actions: Cardiovascular (Questions 1–13)
1. A 65-year-old patient on a telemetry unit develops new-onset atrial fibrillation with a
rapid ventricular response (HR 130 bpm, BP 110/70 mm Hg). The patient is stable but
symptomatic with palpitations. What is the priority nursing intervention?
A) Administer metoprolol 5 mg IV as ordered.
B) Prepare for synchronized cardioversion.
C) Start amiodarone infusion.
D) Obtain an echocardiogram immediately. Correct Answer: A) Administer metoprolol 5
mg IV as ordered.
Rationale: For stable AF with RVR, rate control with beta-blockers like metoprolol is
first-line to slow AV conduction and reduce symptoms. AACN cardiovascular guidelines
align with AHA recommendations for progressive care settings.
2. A patient with heart failure exacerbation has a BNP of 800 pg/mL, crackles in the bases,
and weight gain of 5 lbs in 2 days. What pharmacologic intervention is most appropriate
to reduce preload?
A) Furosemide 40 mg IV.
B) Digoxin 0.125 mg PO.
C) Lisinopril 10 mg PO.
D) Spironolactone 25 mg PO. Correct Answer: A) Furosemide 40 mg IV.
Rationale: Loop diuretics like furosemide promote fluid loss to alleviate congestion in
acute HF. AACN heart failure management emphasizes rapid diuresis in progressive
care.
3. During assessment of a patient with suspected pulmonary embolism, which clinical
finding is most indicative of hemodynamic instability?
A) Hypotension (SBP <90 mm Hg) and tachycardia.
B) Mild dyspnea only.
C) Leg swelling.
D) Normal vital signs. Correct Answer: A) Hypotension (SBP <90 mm Hg) and
tachycardia.
Rationale: Hemodynamic instability in PE is marked by shock signs, requiring immediate
thrombolysis or support. AACN pulmonary embolism protocols prioritize stability
assessment.
4. A post-op cardiac surgery patient on a step-down unit has a central line showing CVP 12
mm Hg and urine output 20 mL/hr. What is the most likely cause of oliguria?
A) Fluid overload.
B) Hypovolemia.
C) Renal artery stenosis.
D) Medication effect. Correct Answer: A) Fluid overload.
Rationale: Elevated CVP with low UO suggests overload, common post-cardiac surgery.
AACN hemodynamic monitoring guides fluid management in progressive care.
,5. A patient with stable angina develops chest pain at rest. ECG shows T-wave inversions.
What is the next step?
A) Administer sublingual nitroglycerin and monitor.
B) Prepare for emergent PCI.
C) Start heparin infusion.
D) Discharge home. Correct Answer: A) Administer sublingual nitroglycerin and
monitor.
Rationale: Unstable angina requires anti-ischemic therapy and observation. AACN ACS
management in progressive care follows AHA guidelines.
6. In a patient with a permanent pacemaker, the telemetry strip shows failure to capture.
What is the priority action?
A) Assess the patient for symptoms and notify the provider.
B) Increase the pacing rate.
C) Administer atropine.
D) Perform CPR. Correct Answer: A) Assess the patient for symptoms and notify the
provider.
Rationale: Failure to capture may indicate lead issues; assess stability first. AACN
pacemaker management emphasizes troubleshooting.
7. A patient with cardiomyopathy has an EF of 30%. What teaching point for self-
management?
A) Daily weight monitoring and low-sodium diet.
B) High-salt diet.
C) No exercise.
D) Ignore symptoms. Correct Answer: A) Daily weight monitoring and low-sodium diet.
Rationale: Monitors fluid status and reduces exacerbation risk. AACN heart failure
patient education.
8. During IV nitroglycerin infusion for hypertension, the patient's BP drops to 90/50 mm
Hg. What is the initial response?
A) Stop the infusion and notify the provider.
B) Increase the dose.
C) Administer fluids.
D) Continue infusion. Correct Answer: A) Stop the infusion and notify the provider.
Rationale: Hypotension is a side effect; discontinue to prevent harm. AACN
pharmacology in progressive care.
9. A patient with mitral valve prolapse reports palpitations. What diagnostic test is
indicated?
A) Echocardiogram.
B) Stress test.
C) Holter monitor.
D) No test needed. Correct Answer: A) Echocardiogram.
Rationale: Echo assesses valve function. AACN valvular disease assessment.
10. A patient on telemetry develops sinus bradycardia (HR 45 bpm) with dizziness. What
intervention?
A) Prepare for atropine 0.5 mg IV.
B) Administer beta-blocker.
C) Ignore if asymptomatic.
, D) Start pacemaker. Correct Answer: A) Prepare for atropine 0.5 mg IV.
Rationale: Symptomatic bradycardia requires pharmacologic intervention. AACN
dysrhythmia protocols.
11. In a patient with acute pericarditis, what ECG change is classic?
A) Diffuse ST elevation.
B) Q waves.
C) ST depression.
D) Normal ECG. Correct Answer: A) Diffuse ST elevation.
Rationale: Indicates inflammation. AACN cardiovascular assessment.
12. A patient with DVT starts heparin. What lab to monitor?
A) aPTT.
B) PT/INR.
C) Platelet count.
D) All of the above. Correct Answer: D) All of the above.
Rationale: aPTT for dosing, INR for overlap, platelets for HIT. AACN anticoagulation
management.
13. A patient with heart block is asymptomatic. What management?
A) Observation and telemetry monitoring.
B) Immediate pacing.
C) Atropine IV.
D) Discharge. Correct Answer: A) Observation and telemetry monitoring.
Rationale: Asymptomatic blocks may not require intervention. AACN dysrhythmia
guidelines.
Section 2: Clinical Judgment - Clinical Actions: Pulmonary (Questions 14–27)
14. A patient on a progressive care unit with pneumonia has SpO2 92% on room air and
crackles. What is the initial oxygen therapy?
A) Nasal cannula at 2 L/min.
B) Non-rebreather mask at 15 L/min.
C) BiPAP.
D) No oxygen. Correct Answer: A) Nasal cannula at 2 L/min.
Rationale: Low-flow oxygen titrates to SpO2 92–95%. AACN pulmonary assessment.
15. A patient with COPD exacerbation has PaCO2 55 mm Hg and pH 7.32. What
intervention?
A) Initiate non-invasive ventilation (BiPAP).
B) Intubate immediately.
C) Administer high-flow oxygen.
D) Observe. Correct Answer: A) Initiate non-invasive ventilation (BiPAP).
Rationale: BiPAP supports ventilation in hypercapnic respiratory failure. AACN COPD
management.
16. During assessment for acute respiratory distress, which finding indicates severity?
A) PaO2/FiO2 ratio <200.
B) Normal ABG.
C) Mild dyspnea.
D) SpO2 >95%. Correct Answer: A) PaO2/FiO2 ratio <200.
Rationale: Berlin criteria for moderate ARDS. AACN respiratory failure protocols.
17. A patient with asthma has wheezing and RR 28/min. What first-line medication?
Exam) by AACN with All the 150 Questions from Actual
Exam, 100% Correct Answers and Rationale
Section 1: Clinical Judgment - Clinical Actions: Cardiovascular (Questions 1–13)
1. A 65-year-old patient on a telemetry unit develops new-onset atrial fibrillation with a
rapid ventricular response (HR 130 bpm, BP 110/70 mm Hg). The patient is stable but
symptomatic with palpitations. What is the priority nursing intervention?
A) Administer metoprolol 5 mg IV as ordered.
B) Prepare for synchronized cardioversion.
C) Start amiodarone infusion.
D) Obtain an echocardiogram immediately. Correct Answer: A) Administer metoprolol 5
mg IV as ordered.
Rationale: For stable AF with RVR, rate control with beta-blockers like metoprolol is
first-line to slow AV conduction and reduce symptoms. AACN cardiovascular guidelines
align with AHA recommendations for progressive care settings.
2. A patient with heart failure exacerbation has a BNP of 800 pg/mL, crackles in the bases,
and weight gain of 5 lbs in 2 days. What pharmacologic intervention is most appropriate
to reduce preload?
A) Furosemide 40 mg IV.
B) Digoxin 0.125 mg PO.
C) Lisinopril 10 mg PO.
D) Spironolactone 25 mg PO. Correct Answer: A) Furosemide 40 mg IV.
Rationale: Loop diuretics like furosemide promote fluid loss to alleviate congestion in
acute HF. AACN heart failure management emphasizes rapid diuresis in progressive
care.
3. During assessment of a patient with suspected pulmonary embolism, which clinical
finding is most indicative of hemodynamic instability?
A) Hypotension (SBP <90 mm Hg) and tachycardia.
B) Mild dyspnea only.
C) Leg swelling.
D) Normal vital signs. Correct Answer: A) Hypotension (SBP <90 mm Hg) and
tachycardia.
Rationale: Hemodynamic instability in PE is marked by shock signs, requiring immediate
thrombolysis or support. AACN pulmonary embolism protocols prioritize stability
assessment.
4. A post-op cardiac surgery patient on a step-down unit has a central line showing CVP 12
mm Hg and urine output 20 mL/hr. What is the most likely cause of oliguria?
A) Fluid overload.
B) Hypovolemia.
C) Renal artery stenosis.
D) Medication effect. Correct Answer: A) Fluid overload.
Rationale: Elevated CVP with low UO suggests overload, common post-cardiac surgery.
AACN hemodynamic monitoring guides fluid management in progressive care.
,5. A patient with stable angina develops chest pain at rest. ECG shows T-wave inversions.
What is the next step?
A) Administer sublingual nitroglycerin and monitor.
B) Prepare for emergent PCI.
C) Start heparin infusion.
D) Discharge home. Correct Answer: A) Administer sublingual nitroglycerin and
monitor.
Rationale: Unstable angina requires anti-ischemic therapy and observation. AACN ACS
management in progressive care follows AHA guidelines.
6. In a patient with a permanent pacemaker, the telemetry strip shows failure to capture.
What is the priority action?
A) Assess the patient for symptoms and notify the provider.
B) Increase the pacing rate.
C) Administer atropine.
D) Perform CPR. Correct Answer: A) Assess the patient for symptoms and notify the
provider.
Rationale: Failure to capture may indicate lead issues; assess stability first. AACN
pacemaker management emphasizes troubleshooting.
7. A patient with cardiomyopathy has an EF of 30%. What teaching point for self-
management?
A) Daily weight monitoring and low-sodium diet.
B) High-salt diet.
C) No exercise.
D) Ignore symptoms. Correct Answer: A) Daily weight monitoring and low-sodium diet.
Rationale: Monitors fluid status and reduces exacerbation risk. AACN heart failure
patient education.
8. During IV nitroglycerin infusion for hypertension, the patient's BP drops to 90/50 mm
Hg. What is the initial response?
A) Stop the infusion and notify the provider.
B) Increase the dose.
C) Administer fluids.
D) Continue infusion. Correct Answer: A) Stop the infusion and notify the provider.
Rationale: Hypotension is a side effect; discontinue to prevent harm. AACN
pharmacology in progressive care.
9. A patient with mitral valve prolapse reports palpitations. What diagnostic test is
indicated?
A) Echocardiogram.
B) Stress test.
C) Holter monitor.
D) No test needed. Correct Answer: A) Echocardiogram.
Rationale: Echo assesses valve function. AACN valvular disease assessment.
10. A patient on telemetry develops sinus bradycardia (HR 45 bpm) with dizziness. What
intervention?
A) Prepare for atropine 0.5 mg IV.
B) Administer beta-blocker.
C) Ignore if asymptomatic.
, D) Start pacemaker. Correct Answer: A) Prepare for atropine 0.5 mg IV.
Rationale: Symptomatic bradycardia requires pharmacologic intervention. AACN
dysrhythmia protocols.
11. In a patient with acute pericarditis, what ECG change is classic?
A) Diffuse ST elevation.
B) Q waves.
C) ST depression.
D) Normal ECG. Correct Answer: A) Diffuse ST elevation.
Rationale: Indicates inflammation. AACN cardiovascular assessment.
12. A patient with DVT starts heparin. What lab to monitor?
A) aPTT.
B) PT/INR.
C) Platelet count.
D) All of the above. Correct Answer: D) All of the above.
Rationale: aPTT for dosing, INR for overlap, platelets for HIT. AACN anticoagulation
management.
13. A patient with heart block is asymptomatic. What management?
A) Observation and telemetry monitoring.
B) Immediate pacing.
C) Atropine IV.
D) Discharge. Correct Answer: A) Observation and telemetry monitoring.
Rationale: Asymptomatic blocks may not require intervention. AACN dysrhythmia
guidelines.
Section 2: Clinical Judgment - Clinical Actions: Pulmonary (Questions 14–27)
14. A patient on a progressive care unit with pneumonia has SpO2 92% on room air and
crackles. What is the initial oxygen therapy?
A) Nasal cannula at 2 L/min.
B) Non-rebreather mask at 15 L/min.
C) BiPAP.
D) No oxygen. Correct Answer: A) Nasal cannula at 2 L/min.
Rationale: Low-flow oxygen titrates to SpO2 92–95%. AACN pulmonary assessment.
15. A patient with COPD exacerbation has PaCO2 55 mm Hg and pH 7.32. What
intervention?
A) Initiate non-invasive ventilation (BiPAP).
B) Intubate immediately.
C) Administer high-flow oxygen.
D) Observe. Correct Answer: A) Initiate non-invasive ventilation (BiPAP).
Rationale: BiPAP supports ventilation in hypercapnic respiratory failure. AACN COPD
management.
16. During assessment for acute respiratory distress, which finding indicates severity?
A) PaO2/FiO2 ratio <200.
B) Normal ABG.
C) Mild dyspnea.
D) SpO2 >95%. Correct Answer: A) PaO2/FiO2 ratio <200.
Rationale: Berlin criteria for moderate ARDS. AACN respiratory failure protocols.
17. A patient with asthma has wheezing and RR 28/min. What first-line medication?
