PROGRESSIVE CARE CERTIFIED NURSE WITH CORRECT
ACTUAL QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+ (2025/2026)
Cardiovascular (1–25)
1. A 68-year-old patient with a history of heart failure is admitted with acute
dyspnea. The nurse notes jugular venous distension, crackles in the lung bases,
and 3+ pitting edema in the lower extremities. Which medication does the nurse
anticipate will be ordered first to relieve the patient's symptoms?
A) Metoprolol 25 mg orally
B) Furosemide 40 mg IV push
C) Lisinopril 10 mg orally
D) Digoxin 0.25 mg IV push
Answer: B
Rationale: The patient is exhibiting signs of acute decompensated heart failure
with volume overload (JVD, crackles, edema). IV loop diuretics (furosemide,
bumetanide, torsemide) are first-line to rapidly reduce preload and relieve
pulmonary congestion. Beta-blockers and ACE inhibitors are for chronic
management.
2. A patient is on a cardiac monitor. The nurse observes a regular rhythm with a
heart rate of 48 bpm, no P waves, and a narrow QRS complex. What is the most
likely rhythm?
A) Sinus bradycardia
B) Junctional rhythm
,C) Atrial fibrillation with slow ventricular response
D) First-degree atrioventricular block
Answer: B
*Rationale: A junctional rhythm originates from the AV junction. It is characterized
by a rate of 40–60 bpm, absence of P waves (or inverted P waves before or after
QRS), and a narrow QRS complex. Sinus bradycardia would have P waves. First-
degree AV block has P waves but a prolonged PR interval.*
3. A patient with acute coronary syndrome (ACS) is receiving a heparin infusion.
The nurse is monitoring the patient for signs of bleeding. Which laboratory value
should the nurse monitor to assess the adequacy of anticoagulation for heparin?
A) Prothrombin time (PT)
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Platelet count
Answer: B
*Rationale: Unfractionated heparin is monitored using the aPTT, with a
therapeutic target typically 1.5–2.5 times the normal control. PT/INR is used to
monitor warfarin. Platelets are monitored for heparin-induced thrombocytopenia
(HIT).*
4. A patient with a history of atrial fibrillation is taking warfarin. The INR is 1.2. The
nurse should anticipate which order from the healthcare provider?
A) Increase the warfarin dose
B) Administer vitamin K 10 mg orally
C) Hold the warfarin and administer enoxaparin
D) Give a dose of protamine sulfate
Answer: A
Rationale: The target INR for atrial fibrillation is typically 2–3 (2.5–3.5 for
mechanical valves). An INR of 1.2 is subtherapeutic, so the warfarin dose is usually
,increased. Vitamin K is used for supratherapeutic INR with bleeding. Protamine
reverses heparin.
5. A patient is admitted with chest pain. The 12-lead ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, typically caused by occlusion of the right coronary artery (or dominant
left circumflex in some patients). The LAD supplies the anterior wall (V1–V4), and
the circumflex supplies the lateral wall (I, aVL, V5–V6).
6. A patient with heart failure has a pulmonary artery catheter in place. The nurse
notes that the pulmonary artery wedge pressure (PAWP) is 22 mmHg (normal 6–
12 mmHg). This finding indicates:
A) Hypovolemia
B) Elevated left ventricular filling pressure
C) Decreased cardiac output
D) Pulmonary hypertension
Answer: B
*Rationale: PAWP reflects left atrial pressure and left ventricular end-diastolic
pressure (preload). An elevated PAWP (>18 mmHg) indicates increased left
ventricular filling pressure, commonly seen in heart failure, mitral regurgitation, or
volume overload.*
, 7. A patient is receiving a continuous infusion of dobutamine. The nurse
understands that the primary action of dobutamine is:
A) Increased systemic vascular resistance
B) Increased myocardial contractility (positive inotropy)
C) Decreased heart rate
D) Vasoconstriction
Answer: B
*Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility
(positive inotropy) and increases heart rate (positive chronotropy). It also has mild
beta-2 effects (vasodilation). It is used in cardiogenic shock or heart failure to
increase cardiac output.*
8. A patient with hypertension is started on lisinopril. The nurse should monitor
the patient for which potential adverse effect?
A) Dry cough
B) Peripheral edema
C) Hyperkalemia
D) Both A and C
Answer: D
Rationale: ACE inhibitors (lisinopril, enalapril) can cause a dry, persistent cough
(due to bradykinin accumulation) and hyperkalemia (due to reduced aldosterone).
They can also cause angioedema, hypotension, and renal impairment. Peripheral
edema is more common with calcium channel blockers.
9. A patient is in atrial fibrillation with a rapid ventricular response of 140 bpm.
The patient is hemodynamically stable with a blood pressure of 110/70 mmHg.
Which medication is first-line for acute rate control?
A) Amiodarone 150 mg IV over 10 minutes
B) Diltiazem 0.25 mg/kg IV push
ACTUAL QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+ (2025/2026)
Cardiovascular (1–25)
1. A 68-year-old patient with a history of heart failure is admitted with acute
dyspnea. The nurse notes jugular venous distension, crackles in the lung bases,
and 3+ pitting edema in the lower extremities. Which medication does the nurse
anticipate will be ordered first to relieve the patient's symptoms?
A) Metoprolol 25 mg orally
B) Furosemide 40 mg IV push
C) Lisinopril 10 mg orally
D) Digoxin 0.25 mg IV push
Answer: B
Rationale: The patient is exhibiting signs of acute decompensated heart failure
with volume overload (JVD, crackles, edema). IV loop diuretics (furosemide,
bumetanide, torsemide) are first-line to rapidly reduce preload and relieve
pulmonary congestion. Beta-blockers and ACE inhibitors are for chronic
management.
2. A patient is on a cardiac monitor. The nurse observes a regular rhythm with a
heart rate of 48 bpm, no P waves, and a narrow QRS complex. What is the most
likely rhythm?
A) Sinus bradycardia
B) Junctional rhythm
,C) Atrial fibrillation with slow ventricular response
D) First-degree atrioventricular block
Answer: B
*Rationale: A junctional rhythm originates from the AV junction. It is characterized
by a rate of 40–60 bpm, absence of P waves (or inverted P waves before or after
QRS), and a narrow QRS complex. Sinus bradycardia would have P waves. First-
degree AV block has P waves but a prolonged PR interval.*
3. A patient with acute coronary syndrome (ACS) is receiving a heparin infusion.
The nurse is monitoring the patient for signs of bleeding. Which laboratory value
should the nurse monitor to assess the adequacy of anticoagulation for heparin?
A) Prothrombin time (PT)
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Platelet count
Answer: B
*Rationale: Unfractionated heparin is monitored using the aPTT, with a
therapeutic target typically 1.5–2.5 times the normal control. PT/INR is used to
monitor warfarin. Platelets are monitored for heparin-induced thrombocytopenia
(HIT).*
4. A patient with a history of atrial fibrillation is taking warfarin. The INR is 1.2. The
nurse should anticipate which order from the healthcare provider?
A) Increase the warfarin dose
B) Administer vitamin K 10 mg orally
C) Hold the warfarin and administer enoxaparin
D) Give a dose of protamine sulfate
Answer: A
Rationale: The target INR for atrial fibrillation is typically 2–3 (2.5–3.5 for
mechanical valves). An INR of 1.2 is subtherapeutic, so the warfarin dose is usually
,increased. Vitamin K is used for supratherapeutic INR with bleeding. Protamine
reverses heparin.
5. A patient is admitted with chest pain. The 12-lead ECG shows ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Left circumflex artery
C) Right coronary artery
D) Left main coronary artery
Answer: C
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, typically caused by occlusion of the right coronary artery (or dominant
left circumflex in some patients). The LAD supplies the anterior wall (V1–V4), and
the circumflex supplies the lateral wall (I, aVL, V5–V6).
6. A patient with heart failure has a pulmonary artery catheter in place. The nurse
notes that the pulmonary artery wedge pressure (PAWP) is 22 mmHg (normal 6–
12 mmHg). This finding indicates:
A) Hypovolemia
B) Elevated left ventricular filling pressure
C) Decreased cardiac output
D) Pulmonary hypertension
Answer: B
*Rationale: PAWP reflects left atrial pressure and left ventricular end-diastolic
pressure (preload). An elevated PAWP (>18 mmHg) indicates increased left
ventricular filling pressure, commonly seen in heart failure, mitral regurgitation, or
volume overload.*
, 7. A patient is receiving a continuous infusion of dobutamine. The nurse
understands that the primary action of dobutamine is:
A) Increased systemic vascular resistance
B) Increased myocardial contractility (positive inotropy)
C) Decreased heart rate
D) Vasoconstriction
Answer: B
*Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility
(positive inotropy) and increases heart rate (positive chronotropy). It also has mild
beta-2 effects (vasodilation). It is used in cardiogenic shock or heart failure to
increase cardiac output.*
8. A patient with hypertension is started on lisinopril. The nurse should monitor
the patient for which potential adverse effect?
A) Dry cough
B) Peripheral edema
C) Hyperkalemia
D) Both A and C
Answer: D
Rationale: ACE inhibitors (lisinopril, enalapril) can cause a dry, persistent cough
(due to bradykinin accumulation) and hyperkalemia (due to reduced aldosterone).
They can also cause angioedema, hypotension, and renal impairment. Peripheral
edema is more common with calcium channel blockers.
9. A patient is in atrial fibrillation with a rapid ventricular response of 140 bpm.
The patient is hemodynamically stable with a blood pressure of 110/70 mmHg.
Which medication is first-line for acute rate control?
A) Amiodarone 150 mg IV over 10 minutes
B) Diltiazem 0.25 mg/kg IV push
