BARKLEY PCCN PRACTICE EXAM EXAM with
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Cardiovascular Alterations and Electrocardiography
2. Pulmonary and Respiratory Failure Management
3. Neurological and Endocrine Emergencies
4. Renal, Gastrointestinal, and Multisystem Critical Care
5. Professional Caring, Ethical Practice, and Clinical Judgment
1. A 58-year-old male is admitted to the progressive care unit following an acute anterior wall
myocardial infarction. On telemetry, he develops nonsustained ventricular tachycardia (NSVT)
lasting 6 beats at a rate of 160 beats/min. His serum potassium is 3.8 mEq/L and magnesium is
1.6 mg/dL. What is the priority nursing intervention?
A. Administer amiodarone 150 mg IV push immediately regardless of electrolyte levels
B. Administer intravenous magnesium sulfate and potassium chloride repletion to correct
underlying electrolyte imbalances
C. Initiate a lidocaine continuous infusion at 4 mg/min
D. Apply transcutaneous pacing pads at 80 beats/min
CORRECT ANSWER : B
Rationale: Hypomagnesemia and hypokalemia are common, reversible triggers for ventricular
ectopy and malignant arrhythmias post-myocardial infarction. Correcting these electrolytes is
the primary initial intervention before antiarrhythmic drugs unless the patient is
hemodynamically unstable. Options A and C prematurely introduce antiarrhythmics without
addressing the root electrolyte trigger, while pacing (Option D) is inappropriate for tachycardia.
,2. A 64-year-old female with decompensated heart failure is receiving a continuous infusion of
dobutamine. Her heart rate increases from 88 to 118 beats/min, and she reports palpitations and
mild chest discomfort. Blood pressure is 100/60 mmHg. What is the most appropriate nursing
action?
A. Discontinue the dobutamine infusion immediately without notifying the provider
B. Notify the healthcare provider and anticipate decreasing the dobutamine infusion rate
due to drug-induced tachycardia and increased myocardial oxygen demand
C. Administer sublingual nitroglycerin and increase the dobutamine dose
D. Administer metoprolol IV push immediately to drop the heart rate to 60 beats/min
CORRECT ANSWER : B
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and stroke
volume, but it frequently causes dose-limiting tachycardia and increased myocardial oxygen
demand. The provider should be notified to down-titrate the infusion. Stopping it abruptly
(Option A) can precipitate acute heart failure decompensation, while beta-blockers (Option D)
directly oppose dobutamine's inotropic mechanism.
3. A progressive care nurse is monitoring a 72-year-old male post-coronary artery bypass graft
(CABG). Two hours post-op, his chest tube output drops to zero over 2 hours, blood pressure
falls to 80/50 mmHg, central venous pressure rises to 18 mmHg, and his heart tones appear
muffled. What acute life-threatening complication is occurring?
A. Acute pulmonary embolism
B. Cardiac tamponade resulting from mediastinal blood accumulation compressing the
heart chambers
C. Tension pneumothorax
D. Acute kidney injury
CORRECT ANSWER : B
Rationale: Cardiac tamponade is characterized by Beck's triad: hypotension, elevated CVP/JVD,
and muffled heart sounds, often precipitated by sudden cessation of mediastinal chest tube
drainage. Accumulated blood restricts ventricular filling and drops cardiac output. Tension
pneumothorax (Option C) would present with unilateral absent breath sounds and tracheal
deviation.
4. A 50-year-old male is admitted with acute decompensated heart failure. He is dyspneic, with
bilateral crackles halfway up his lung fields, an SpO2 of 88% on room air, and a blood pressure
, of 170/95 mmHg. Furosemide 40 mg IV is administered. Which additional medication class is
most effective for rapid afterload reduction in acute pulmonary edema?
A. Non-selective beta blockers
B. Intravenous vasodilators such as nitroglycerin or nitroprusside
C. High-dose oral calcium channel blockers
D. Vasopressin receptor antagonists
CORRECT ANSWER : B
Rationale: In acute flash pulmonary edema with hypertension, IV vasodilators (like
nitroglycerin) rapidly reduce systemic vascular resistance (afterload), decreasing left ventricular
work and pulmonary congestion. Loop diuretics take time to work, and beta-blockers can worsen
acute decompensation.
5. A progressive care nurse evaluates a patient with a permanent dual-chamber pacemaker. The
ECG monitor shows pacing spikes that are not followed by P waves or QRS complexes. What
malfunction does this rhythm strip demonstrate?
A. Failure to capture
B. Failure to pace (or failure to output)
C. Undersensing leading to competitive rhythm
D. Fusion beats
CORRECT ANSWER : B
Rationale: Failure to pace (output failure) occurs when the pacemaker fails to deliver an
electrical stimulus when expected, evidenced by missing pacing spikes on the ECG. Failure to
capture occurs when spikes are present but not followed by depolarization.
6. A 66-year-old female is admitted with unstable angina. She is placed on continuous ECG
monitoring. A rhythm strip reveals a regular rhythm at 42 beats/min, normal PR interval, narrow
QRS complexes, and stable blood pressure of 110/70 mmHg. She is asymptomatic. What is the
most appropriate initial nursing management?
A. Immediately perform transcutaneous pacing at 90 beats/min
B. Continue close hemodynamic monitoring, notify the provider, and have transcutaneous
pacing pads ready at the bedside
Questions and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Cardiovascular Alterations and Electrocardiography
2. Pulmonary and Respiratory Failure Management
3. Neurological and Endocrine Emergencies
4. Renal, Gastrointestinal, and Multisystem Critical Care
5. Professional Caring, Ethical Practice, and Clinical Judgment
1. A 58-year-old male is admitted to the progressive care unit following an acute anterior wall
myocardial infarction. On telemetry, he develops nonsustained ventricular tachycardia (NSVT)
lasting 6 beats at a rate of 160 beats/min. His serum potassium is 3.8 mEq/L and magnesium is
1.6 mg/dL. What is the priority nursing intervention?
A. Administer amiodarone 150 mg IV push immediately regardless of electrolyte levels
B. Administer intravenous magnesium sulfate and potassium chloride repletion to correct
underlying electrolyte imbalances
C. Initiate a lidocaine continuous infusion at 4 mg/min
D. Apply transcutaneous pacing pads at 80 beats/min
CORRECT ANSWER : B
Rationale: Hypomagnesemia and hypokalemia are common, reversible triggers for ventricular
ectopy and malignant arrhythmias post-myocardial infarction. Correcting these electrolytes is
the primary initial intervention before antiarrhythmic drugs unless the patient is
hemodynamically unstable. Options A and C prematurely introduce antiarrhythmics without
addressing the root electrolyte trigger, while pacing (Option D) is inappropriate for tachycardia.
,2. A 64-year-old female with decompensated heart failure is receiving a continuous infusion of
dobutamine. Her heart rate increases from 88 to 118 beats/min, and she reports palpitations and
mild chest discomfort. Blood pressure is 100/60 mmHg. What is the most appropriate nursing
action?
A. Discontinue the dobutamine infusion immediately without notifying the provider
B. Notify the healthcare provider and anticipate decreasing the dobutamine infusion rate
due to drug-induced tachycardia and increased myocardial oxygen demand
C. Administer sublingual nitroglycerin and increase the dobutamine dose
D. Administer metoprolol IV push immediately to drop the heart rate to 60 beats/min
CORRECT ANSWER : B
Rationale: Dobutamine is a beta-1 agonist that increases myocardial contractility and stroke
volume, but it frequently causes dose-limiting tachycardia and increased myocardial oxygen
demand. The provider should be notified to down-titrate the infusion. Stopping it abruptly
(Option A) can precipitate acute heart failure decompensation, while beta-blockers (Option D)
directly oppose dobutamine's inotropic mechanism.
3. A progressive care nurse is monitoring a 72-year-old male post-coronary artery bypass graft
(CABG). Two hours post-op, his chest tube output drops to zero over 2 hours, blood pressure
falls to 80/50 mmHg, central venous pressure rises to 18 mmHg, and his heart tones appear
muffled. What acute life-threatening complication is occurring?
A. Acute pulmonary embolism
B. Cardiac tamponade resulting from mediastinal blood accumulation compressing the
heart chambers
C. Tension pneumothorax
D. Acute kidney injury
CORRECT ANSWER : B
Rationale: Cardiac tamponade is characterized by Beck's triad: hypotension, elevated CVP/JVD,
and muffled heart sounds, often precipitated by sudden cessation of mediastinal chest tube
drainage. Accumulated blood restricts ventricular filling and drops cardiac output. Tension
pneumothorax (Option C) would present with unilateral absent breath sounds and tracheal
deviation.
4. A 50-year-old male is admitted with acute decompensated heart failure. He is dyspneic, with
bilateral crackles halfway up his lung fields, an SpO2 of 88% on room air, and a blood pressure
, of 170/95 mmHg. Furosemide 40 mg IV is administered. Which additional medication class is
most effective for rapid afterload reduction in acute pulmonary edema?
A. Non-selective beta blockers
B. Intravenous vasodilators such as nitroglycerin or nitroprusside
C. High-dose oral calcium channel blockers
D. Vasopressin receptor antagonists
CORRECT ANSWER : B
Rationale: In acute flash pulmonary edema with hypertension, IV vasodilators (like
nitroglycerin) rapidly reduce systemic vascular resistance (afterload), decreasing left ventricular
work and pulmonary congestion. Loop diuretics take time to work, and beta-blockers can worsen
acute decompensation.
5. A progressive care nurse evaluates a patient with a permanent dual-chamber pacemaker. The
ECG monitor shows pacing spikes that are not followed by P waves or QRS complexes. What
malfunction does this rhythm strip demonstrate?
A. Failure to capture
B. Failure to pace (or failure to output)
C. Undersensing leading to competitive rhythm
D. Fusion beats
CORRECT ANSWER : B
Rationale: Failure to pace (output failure) occurs when the pacemaker fails to deliver an
electrical stimulus when expected, evidenced by missing pacing spikes on the ECG. Failure to
capture occurs when spikes are present but not followed by depolarization.
6. A 66-year-old female is admitted with unstable angina. She is placed on continuous ECG
monitoring. A rhythm strip reveals a regular rhythm at 42 beats/min, normal PR interval, narrow
QRS complexes, and stable blood pressure of 110/70 mmHg. She is asymptomatic. What is the
most appropriate initial nursing management?
A. Immediately perform transcutaneous pacing at 90 beats/min
B. Continue close hemodynamic monitoring, notify the provider, and have transcutaneous
pacing pads ready at the bedside
