PCCN Certification Exam Prep | Complete
Practice Questions with Verified Answers &
Brief Rationales | Latest Update 2026/2027 |
Already Graded A+
Question 1
A 49-year-old male was recently admitted with an inferior wall MI resulting from 100%
occlusion of the right coronary artery (RCA). The 12-Lead ECG reveals ST elevation in
leads II, III, and aVF. You would expect to see reciprocal changes in which leads?
A. I, aVR
B. V₁, V₂
C. V₃, V₄
D. I, aVL
Answer: D
Rationale: The RCA perfuses the inferior wall and the mirror image or reciprocal
change will be seen in the high lateral wall, which is reflected in leads I and aVL on the
12-Lead ECG. Leads V₁ and V₂ correlate with the septal area, leads V₃ and V₄ correlate
with the anterior area.
Question 2
You are summoned to the room of a 30-year-old female who is experiencing sustained
tonic-clonic convulsions while sitting in a chair. A family member states: "She was just
talking to us and suddenly she let out a shriek and started flopping like a fish out of
water." What is your initial priority of care?
A. Call for help and safely guide the patient to the floor
B. Call for help and administer a prescribed antiepileptic
C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure
Answer: A
Rationale: Patient safety is the priority. The patient should be safely guided to the
floor to prevent injury during the seizure.
pg. 1
,Question 3
A 46-year-old patient presents with pneumonia and sepsis. He was treated with 4 days
of antibiotics and IV fluids. He is increasingly short of breath and is now on 100% FiO₂
via non-rebreather mask. You obtain an ABG with the following results: pH 7.20 /
PaCO₂ 68 / PaO₂ 102 / HCO₃ 28. A chest x-ray reveals bilateral pulmonary infiltrates.
The patient is likely developing:
A. Worsening pneumonia
B. Acute Respiratory Distress Syndrome
C. Pulmonary embolus
D. Atelectasis
Answer: B
Rationale: ARDS is characterized by acute onset, bilateral infiltrates, and hypoxemia
refractory to oxygen therapy. The PaO₂/FiO₂ ratio is <300 (102/1.0 = 102), consistent
with ARDS.
Question 4
A 56-year-old male is admitted to the PCU with a hypertensive crisis. His blood pressure
is now 205/125 mm Hg and he is complaining of a headache with nausea. He reports he
ran out of blood pressure medication three days ago, but also appears to be confused to
the date and situation. What is the most appropriate treatment approach?
A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive
medication, then gradually reduce the diastolic pressure to 85 mm Hg with oral
antihypertensive medications
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive
medications, then switch to oral antihypertensive medications for maintenance
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg with
oral antihypertensive medications
D. Slowly lower the diastolic pressure to 85 mm Hg
Answer: C
Rationale: In hypertensive crisis with end-organ damage, the initial goal is to reduce
diastolic pressure by 20-25% or to about 100 mm Hg over 1-2 hours, then gradually
lower to 85 mm Hg.
Question 5
Which of the following labs must be closely monitored when administering Lisinopril to
a patient with systolic heart failure?
pg. 2
,A. Sodium
B. Phosphate
C. Magnesium
D. Potassium
Answer: D
Rationale: ACE inhibitors can cause hyperkalemia by blocking angiotensin II, which
leads to decreased aldosterone. Aldosterone is responsible for excreting potassium from
the kidneys. BUN and creatinine should also be monitored.
Question 6
A 57-year-old man was admitted with an acute myocardial infarction and is rapidly
deteriorating. He has a BP of 86/42 (57), heart rate of 110, weak, thready pulses, and
mottled skin, especially at the knees. He has had minimal urine output the past 8 hours.
A Rapid Response is activated. Which of the following medications would be the best
option to increase the patient's cardiac output?
A. Dobutamine
B. Norepinephrine
C. Amiodarone
D. Phenylephrine
Answer: A
Rationale: Dobutamine is a positive inotropic medication used to improve myocardial
dysfunction in patients with a low cardiac index and elevated afterload. It improves
contractility and reduces afterload.
Question 7
You are caring for a patient post gastric bypass. Which of the following parameters
should you closely monitor after surgery?
A. HR, RR, temperature, WBC & MAP
B. Protein levels and vitamin B12
C. Albumin and pre-albumin levels
D. Signs of dumping syndrome
Answer: A
Rationale: Post-gastric bypass patients are at risk for anastomotic leaks, infection, and
hemodynamic instability. Vital signs, WBC, and MAP are essential for early detection of
complications.
pg. 3
, Question 8
You are caring for a patient admitted after a ground level fall. The patient has decreased
level of consciousness. On admission the patient is ordered to be a full code. The family
arrives with advanced directives stating the patient wishes not to have CPR performed
or life sustaining treatment continued. The nurse approaches the provider about this
discrepancy and the provider states "I am aware of the advanced directive, but the
daughter wants everything done." What is the appropriate next step by the nurse?
A. Ask the daughter why she wants everything done
B. Collaborate with the provider and social worker to schedule a family meeting
C. Tell the doctor we have to follow the patient's wishes
D. Discuss the situation with the nurse manager
Answer: B
Rationale: A family meeting with the provider, social worker, and family is the
appropriate next step to discuss the advanced directive and patient wishes.
Question 9
Which is the best intervention to promote safety of the patient receiving hemodialysis?
A. Direct visualization of the connection between the machine and the access device
B. Strict intake and output monitoring
C. Strict bedrest
D. Electrolyte assessment q 4 hours
Answer: A
Rationale: The nurse must be able to visualize the junction of the central venous
access and the dialysis unit at all times. Disconnection can result in exsanguination
within minutes.
Question 10
Four hours after starting an insulin infusion in a patient admitted with diabetic
ketoacidosis, the patient's blood glucose is 235 mg/dL. Which of the following fluids
should be administered at this point?
A. Hypertonic solution to hydrate the cell
B. D5.45 or D5NS with a glucose source
C. Isotonic saline bolus to maintain extracellular hydration
D. Hypotonic saline to provide cellular hydration
Answer: B
pg. 4
Practice Questions with Verified Answers &
Brief Rationales | Latest Update 2026/2027 |
Already Graded A+
Question 1
A 49-year-old male was recently admitted with an inferior wall MI resulting from 100%
occlusion of the right coronary artery (RCA). The 12-Lead ECG reveals ST elevation in
leads II, III, and aVF. You would expect to see reciprocal changes in which leads?
A. I, aVR
B. V₁, V₂
C. V₃, V₄
D. I, aVL
Answer: D
Rationale: The RCA perfuses the inferior wall and the mirror image or reciprocal
change will be seen in the high lateral wall, which is reflected in leads I and aVL on the
12-Lead ECG. Leads V₁ and V₂ correlate with the septal area, leads V₃ and V₄ correlate
with the anterior area.
Question 2
You are summoned to the room of a 30-year-old female who is experiencing sustained
tonic-clonic convulsions while sitting in a chair. A family member states: "She was just
talking to us and suddenly she let out a shriek and started flopping like a fish out of
water." What is your initial priority of care?
A. Call for help and safely guide the patient to the floor
B. Call for help and administer a prescribed antiepileptic
C. Call for help and administer a prescribed benzodiazepine
D. Call for help and monitor the course of the seizure
Answer: A
Rationale: Patient safety is the priority. The patient should be safely guided to the
floor to prevent injury during the seizure.
pg. 1
,Question 3
A 46-year-old patient presents with pneumonia and sepsis. He was treated with 4 days
of antibiotics and IV fluids. He is increasingly short of breath and is now on 100% FiO₂
via non-rebreather mask. You obtain an ABG with the following results: pH 7.20 /
PaCO₂ 68 / PaO₂ 102 / HCO₃ 28. A chest x-ray reveals bilateral pulmonary infiltrates.
The patient is likely developing:
A. Worsening pneumonia
B. Acute Respiratory Distress Syndrome
C. Pulmonary embolus
D. Atelectasis
Answer: B
Rationale: ARDS is characterized by acute onset, bilateral infiltrates, and hypoxemia
refractory to oxygen therapy. The PaO₂/FiO₂ ratio is <300 (102/1.0 = 102), consistent
with ARDS.
Question 4
A 56-year-old male is admitted to the PCU with a hypertensive crisis. His blood pressure
is now 205/125 mm Hg and he is complaining of a headache with nausea. He reports he
ran out of blood pressure medication three days ago, but also appears to be confused to
the date and situation. What is the most appropriate treatment approach?
A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive
medication, then gradually reduce the diastolic pressure to 85 mm Hg with oral
antihypertensive medications
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive
medications, then switch to oral antihypertensive medications for maintenance
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg with
oral antihypertensive medications
D. Slowly lower the diastolic pressure to 85 mm Hg
Answer: C
Rationale: In hypertensive crisis with end-organ damage, the initial goal is to reduce
diastolic pressure by 20-25% or to about 100 mm Hg over 1-2 hours, then gradually
lower to 85 mm Hg.
Question 5
Which of the following labs must be closely monitored when administering Lisinopril to
a patient with systolic heart failure?
pg. 2
,A. Sodium
B. Phosphate
C. Magnesium
D. Potassium
Answer: D
Rationale: ACE inhibitors can cause hyperkalemia by blocking angiotensin II, which
leads to decreased aldosterone. Aldosterone is responsible for excreting potassium from
the kidneys. BUN and creatinine should also be monitored.
Question 6
A 57-year-old man was admitted with an acute myocardial infarction and is rapidly
deteriorating. He has a BP of 86/42 (57), heart rate of 110, weak, thready pulses, and
mottled skin, especially at the knees. He has had minimal urine output the past 8 hours.
A Rapid Response is activated. Which of the following medications would be the best
option to increase the patient's cardiac output?
A. Dobutamine
B. Norepinephrine
C. Amiodarone
D. Phenylephrine
Answer: A
Rationale: Dobutamine is a positive inotropic medication used to improve myocardial
dysfunction in patients with a low cardiac index and elevated afterload. It improves
contractility and reduces afterload.
Question 7
You are caring for a patient post gastric bypass. Which of the following parameters
should you closely monitor after surgery?
A. HR, RR, temperature, WBC & MAP
B. Protein levels and vitamin B12
C. Albumin and pre-albumin levels
D. Signs of dumping syndrome
Answer: A
Rationale: Post-gastric bypass patients are at risk for anastomotic leaks, infection, and
hemodynamic instability. Vital signs, WBC, and MAP are essential for early detection of
complications.
pg. 3
, Question 8
You are caring for a patient admitted after a ground level fall. The patient has decreased
level of consciousness. On admission the patient is ordered to be a full code. The family
arrives with advanced directives stating the patient wishes not to have CPR performed
or life sustaining treatment continued. The nurse approaches the provider about this
discrepancy and the provider states "I am aware of the advanced directive, but the
daughter wants everything done." What is the appropriate next step by the nurse?
A. Ask the daughter why she wants everything done
B. Collaborate with the provider and social worker to schedule a family meeting
C. Tell the doctor we have to follow the patient's wishes
D. Discuss the situation with the nurse manager
Answer: B
Rationale: A family meeting with the provider, social worker, and family is the
appropriate next step to discuss the advanced directive and patient wishes.
Question 9
Which is the best intervention to promote safety of the patient receiving hemodialysis?
A. Direct visualization of the connection between the machine and the access device
B. Strict intake and output monitoring
C. Strict bedrest
D. Electrolyte assessment q 4 hours
Answer: A
Rationale: The nurse must be able to visualize the junction of the central venous
access and the dialysis unit at all times. Disconnection can result in exsanguination
within minutes.
Question 10
Four hours after starting an insulin infusion in a patient admitted with diabetic
ketoacidosis, the patient's blood glucose is 235 mg/dL. Which of the following fluids
should be administered at this point?
A. Hypertonic solution to hydrate the cell
B. D5.45 or D5NS with a glucose source
C. Isotonic saline bolus to maintain extracellular hydration
D. Hypotonic saline to provide cellular hydration
Answer: B
pg. 4
