PCCN CERTIFICATION EXAM FULL PRACTICE TEST
2026/2027 | Verified Answers for Progressive Care Certified
Nurse | Pass Guaranteed - A+ Graded
[Section 1: Cardiovascular System - Hemodynamics, ECG, ACS, Heart Failure]
Q1. What does the pulmonary artery wedge pressure (PAWP) directly measure?
A. Right ventricular preload
B. Left ventricular preload [CORRECT]
C. Pulmonary vascular resistance
D. Systemic vascular resistance
Rationale: PAWP reflects left atrial and left ventricular end-diastolic pressure (preload).
Options A, C, and D are measured via CVP and calculated cardiac indices, not PAWP.
Correct Answer: B
Q2. Which ECG finding is most specific for left ventricular hypertrophy?
A. Wide QRS complex
B. ST-segment depression
C. S wave in V1 + R wave in V5 > 35 mm [CORRECT]
D. Deep Q waves in leads II, III, aVF
Rationale: The Sokolow-Lyon criteria (S wave in V1 + R wave in V5 > 35 mm) are highly
specific for LVH. The others indicate bundle branch blocks, ischemia, or infarction.
Correct Answer: C
Q3. A patient presents with acute decompensated heart failure. Which medication is
contraindicated due to a lack of mortality benefit and potential harm?
A. Carvedilol
B. Enalapril
C. Milrinone [CORRECT]
D. Spironolactone
Rationale: Milrinone is a positive inotrope that increases mortality in routine heart failure
and is reserved for end-stage cardiogenic shock. The others are guideline-directed
medical therapies proven to reduce mortality.
Correct Answer: C
Q4. What is the primary hemodynamic effect of nitroprusside?
A. Decreases afterload [CORRECT]
B. Increases preload
,C. Increases contractility
D. Decreases heart rate
Rationale: Nitroprusside is a potent arterial and venous vasodilator, primarily reducing
systemic vascular resistance (afterload). It does not directly affect contractility or
chronotropy.
Correct Answer: A
Q5. Which chamber of the heart is most vulnerable to ischemia during right coronary
artery (RCA) occlusion?
A. Left atrium
B. Left ventricle
C. Right ventricle [CORRECT]
D. Aortic root
Rationale: The RCA supplies the right ventricle in 80% of the population. Left-sided
structures are primarily supplied by the left main and left anterior descending arteries.
Correct Answer: C
Q6. A patient with an inferior STEMI develops hypotension and clear lung fields. What is
the initial intervention?
A. Administer furosemide
B. Administer a 500 mL normal saline bolus [CORRECT]
C. Initiate dobutamine
D. Perform synchronized cardioversion
Rationale: Hypotension with clear lungs post-inferior STEMI indicates right ventricular
infarction, which is preload-dependent. Fluid resuscitation is first-line; diuretics and
vasodilators are contraindicated.
Correct Answer: B
Q7. A patient's arterial waveform shows a steep upstroke, high systolic peak, and rapid
decline. What is the most likely corresponding hemodynamic state?
A. Low stroke volume and high SVR
B. High stroke volume and low SVR [CORRECT]
C. Aortic stenosis
D. Cardiac tamponade
Rationale: A bounding arterial waveform indicates increased stroke volume and
decreased systemic vascular resistance (e.g., sepsis or anemia). Aortic stenosis and
tamponade cause low stroke volume with slow upstrokes.
Correct Answer: B
Q8. A patient with severe aortic stenosis develops acute pulmonary edema. Which
intervention should the nurse anticipate?
,A. Nitroglycerin drip
B. Intra-aortic balloon pump (IABP) [CORRECT]
C. High-dose dobutamine
D. Aggressive diuresis only
Rationale: IABP reduces afterload and increases coronary perfusion without causing
profound hypotension in severe AS. Nitroglycerin and aggressive diuresis can cause
dangerous preload/afterload reduction leading to shock.
Correct Answer: B
Q9. What is the earliest ECG change seen in an acute myocardial infarction?
A. Pathological Q wave
B. Hyperacute T wave [CORRECT]
C. ST-segment elevation
D. T-wave inversion
Rationale: Hyperacute (peaked) T waves are the first electrical sign of myocardial
ischemia/infarction, occurring before ST elevation or Q waves develop.
Correct Answer: B
Q10. A patient has a PAWP of 25 mmHg and a cardiac index of 1.8 L/min/m2. Which
shock state is this?
A. Distributive shock
B. Hypovolemic shock
C. Cardiogenic shock [CORRECT]
D. Obstructive shock
Rationale: Elevated PAWP (fluid overload) with low cardiac index indicates pump failure,
defining cardiogenic shock. Hypovolemic and distributive shocks present with low
PAWP.
Correct Answer: C
Q11. Which medication requires continuous arterial blood pressure monitoring due to
the risk of severe, sudden hypertension?
A. Nitroprusside
B. Esmolol
C. Phenylephrine [CORRECT]
D. Nitroglycerin
Rationale: Phenylephrine is a potent pure alpha-agonist causing profound
vasoconstriction, risking extreme hypertension and reflex bradycardia. The others are
vasodilators or beta-blockers.
Correct Answer: C
, Q12. A patient is receiving heparin for ACS. The aPTT is 110 seconds. What is the
priority nursing action?
A. Increase the heparin drip rate
B. Administer protamine sulfate [CORRECT]
C. Draw a repeat aPTT in 6 hours
D. Administer fresh frozen plasma
Rationale: An aPTT of 110 seconds is critically high (therapeutic is typically 60-80
seconds), indicating high bleeding risk. Protamine sulfate is the specific reversal agent
for heparin. FFP is not indicated for heparin reversal.
Correct Answer: B
Q13. In a patient with an LVAD, which finding requires immediate intervention?
A. Pump speed of 9000 rpm
B. PI (Pulsatility Index) of 4 [CORRECT]
C. MAP of 75 mmHg
D. Power of 5 watts
Rationale: An elevated PI (> 4) indicates suction events, arrhythmias, or hypovolemia
causing the pump to struggle. Normal PI is typically 2-4. MAP, power, and speed are
within typical parameters.
Correct Answer: B
Q14. What is the primary purpose of a Valsalva maneuver during a narrow-complex
tachycardia?
A. Increase heart rate
B. Stimulate the vagus nerve to terminate the arrhythmia [CORRECT]
C. Increase systemic blood pressure
D. Decrease intrathoracic pressure
Rationale: Valsalva increases intrathoracic pressure, stimulating the vagus nerve to
slow AV node conduction, potentially terminating AV-nodal reentrant tachycardias.
Correct Answer: B
Q15. A post-MI patient has a troponin I of 0.8 ng/mL at 6 hours. What does this
indicate?
A. Normal, no infarction
B. Myocardial injury/infarction [CORRECT]
C. Skeletal muscle damage
D. Renal failure only
Rationale: Troponin I > 0.04 ng/mL (99th percentile) indicates myocardial injury. At 6
hours post-symptom onset, this level confirms an acute coronary syndrome.
Correct Answer: B
2026/2027 | Verified Answers for Progressive Care Certified
Nurse | Pass Guaranteed - A+ Graded
[Section 1: Cardiovascular System - Hemodynamics, ECG, ACS, Heart Failure]
Q1. What does the pulmonary artery wedge pressure (PAWP) directly measure?
A. Right ventricular preload
B. Left ventricular preload [CORRECT]
C. Pulmonary vascular resistance
D. Systemic vascular resistance
Rationale: PAWP reflects left atrial and left ventricular end-diastolic pressure (preload).
Options A, C, and D are measured via CVP and calculated cardiac indices, not PAWP.
Correct Answer: B
Q2. Which ECG finding is most specific for left ventricular hypertrophy?
A. Wide QRS complex
B. ST-segment depression
C. S wave in V1 + R wave in V5 > 35 mm [CORRECT]
D. Deep Q waves in leads II, III, aVF
Rationale: The Sokolow-Lyon criteria (S wave in V1 + R wave in V5 > 35 mm) are highly
specific for LVH. The others indicate bundle branch blocks, ischemia, or infarction.
Correct Answer: C
Q3. A patient presents with acute decompensated heart failure. Which medication is
contraindicated due to a lack of mortality benefit and potential harm?
A. Carvedilol
B. Enalapril
C. Milrinone [CORRECT]
D. Spironolactone
Rationale: Milrinone is a positive inotrope that increases mortality in routine heart failure
and is reserved for end-stage cardiogenic shock. The others are guideline-directed
medical therapies proven to reduce mortality.
Correct Answer: C
Q4. What is the primary hemodynamic effect of nitroprusside?
A. Decreases afterload [CORRECT]
B. Increases preload
,C. Increases contractility
D. Decreases heart rate
Rationale: Nitroprusside is a potent arterial and venous vasodilator, primarily reducing
systemic vascular resistance (afterload). It does not directly affect contractility or
chronotropy.
Correct Answer: A
Q5. Which chamber of the heart is most vulnerable to ischemia during right coronary
artery (RCA) occlusion?
A. Left atrium
B. Left ventricle
C. Right ventricle [CORRECT]
D. Aortic root
Rationale: The RCA supplies the right ventricle in 80% of the population. Left-sided
structures are primarily supplied by the left main and left anterior descending arteries.
Correct Answer: C
Q6. A patient with an inferior STEMI develops hypotension and clear lung fields. What is
the initial intervention?
A. Administer furosemide
B. Administer a 500 mL normal saline bolus [CORRECT]
C. Initiate dobutamine
D. Perform synchronized cardioversion
Rationale: Hypotension with clear lungs post-inferior STEMI indicates right ventricular
infarction, which is preload-dependent. Fluid resuscitation is first-line; diuretics and
vasodilators are contraindicated.
Correct Answer: B
Q7. A patient's arterial waveform shows a steep upstroke, high systolic peak, and rapid
decline. What is the most likely corresponding hemodynamic state?
A. Low stroke volume and high SVR
B. High stroke volume and low SVR [CORRECT]
C. Aortic stenosis
D. Cardiac tamponade
Rationale: A bounding arterial waveform indicates increased stroke volume and
decreased systemic vascular resistance (e.g., sepsis or anemia). Aortic stenosis and
tamponade cause low stroke volume with slow upstrokes.
Correct Answer: B
Q8. A patient with severe aortic stenosis develops acute pulmonary edema. Which
intervention should the nurse anticipate?
,A. Nitroglycerin drip
B. Intra-aortic balloon pump (IABP) [CORRECT]
C. High-dose dobutamine
D. Aggressive diuresis only
Rationale: IABP reduces afterload and increases coronary perfusion without causing
profound hypotension in severe AS. Nitroglycerin and aggressive diuresis can cause
dangerous preload/afterload reduction leading to shock.
Correct Answer: B
Q9. What is the earliest ECG change seen in an acute myocardial infarction?
A. Pathological Q wave
B. Hyperacute T wave [CORRECT]
C. ST-segment elevation
D. T-wave inversion
Rationale: Hyperacute (peaked) T waves are the first electrical sign of myocardial
ischemia/infarction, occurring before ST elevation or Q waves develop.
Correct Answer: B
Q10. A patient has a PAWP of 25 mmHg and a cardiac index of 1.8 L/min/m2. Which
shock state is this?
A. Distributive shock
B. Hypovolemic shock
C. Cardiogenic shock [CORRECT]
D. Obstructive shock
Rationale: Elevated PAWP (fluid overload) with low cardiac index indicates pump failure,
defining cardiogenic shock. Hypovolemic and distributive shocks present with low
PAWP.
Correct Answer: C
Q11. Which medication requires continuous arterial blood pressure monitoring due to
the risk of severe, sudden hypertension?
A. Nitroprusside
B. Esmolol
C. Phenylephrine [CORRECT]
D. Nitroglycerin
Rationale: Phenylephrine is a potent pure alpha-agonist causing profound
vasoconstriction, risking extreme hypertension and reflex bradycardia. The others are
vasodilators or beta-blockers.
Correct Answer: C
, Q12. A patient is receiving heparin for ACS. The aPTT is 110 seconds. What is the
priority nursing action?
A. Increase the heparin drip rate
B. Administer protamine sulfate [CORRECT]
C. Draw a repeat aPTT in 6 hours
D. Administer fresh frozen plasma
Rationale: An aPTT of 110 seconds is critically high (therapeutic is typically 60-80
seconds), indicating high bleeding risk. Protamine sulfate is the specific reversal agent
for heparin. FFP is not indicated for heparin reversal.
Correct Answer: B
Q13. In a patient with an LVAD, which finding requires immediate intervention?
A. Pump speed of 9000 rpm
B. PI (Pulsatility Index) of 4 [CORRECT]
C. MAP of 75 mmHg
D. Power of 5 watts
Rationale: An elevated PI (> 4) indicates suction events, arrhythmias, or hypovolemia
causing the pump to struggle. Normal PI is typically 2-4. MAP, power, and speed are
within typical parameters.
Correct Answer: B
Q14. What is the primary purpose of a Valsalva maneuver during a narrow-complex
tachycardia?
A. Increase heart rate
B. Stimulate the vagus nerve to terminate the arrhythmia [CORRECT]
C. Increase systemic blood pressure
D. Decrease intrathoracic pressure
Rationale: Valsalva increases intrathoracic pressure, stimulating the vagus nerve to
slow AV node conduction, potentially terminating AV-nodal reentrant tachycardias.
Correct Answer: B
Q15. A post-MI patient has a troponin I of 0.8 ng/mL at 6 hours. What does this
indicate?
A. Normal, no infarction
B. Myocardial injury/infarction [CORRECT]
C. Skeletal muscle damage
D. Renal failure only
Rationale: Troponin I > 0.04 ng/mL (99th percentile) indicates myocardial injury. At 6
hours post-symptom onset, this level confirms an acute coronary syndrome.
Correct Answer: B
