Progressive Care Certified Nurse (PCCN) Final Exam –
Complete Test Bank
Questions 1–250
Domain 1: Cardiovascular (Questions 1–65)
1. A 62-year-old male presents with chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4.
Which is the priority nursing action?
A) Administer sublingual nitroglycerin
B) Activate the cardiac catheterization lab for primary PCI
C) Administer IV morphine for pain
D) Obtain a chest X-ray
Answer B: Activate the cardiac catheterization lab for primary PCI
,Rationale: STEMI requires immediate reperfusion; primary PCI is preferred if
available within 90 minutes of arrival.
2. A patient with heart failure has crackles in both lung bases and an ejection
fraction of 35%. Which medication should the nurse anticipate
administering?
A) Metoprolol succinate
B) Sacubitril/valsartan (ARNI)
C) Diltiazem
D) Digoxin
Answer B: Sacubitril/valsartan (ARNI)
Rationale: Sacubitril/valsartan is preferred over ACE inhibitors or ARBs in
HFrEF to reduce mortality and hospitalizations.
3. A patient is in atrial fibrillation with a ventricular rate of 150 bpm and is
hemodynamically unstable with BP 85/50. Which is the most appropriate
treatment?
A) Amiodarone IV
B) Synchronized cardioversion
C) Digoxin IV
D) Diltiazem IV
,Answer B: Synchronized cardioversion
Rationale: Unstable atrial fibrillation with rapid ventricular response requires
immediate synchronized cardioversion.
4. A patient with a history of hypertension presents with sudden onset of
severe "tearing" chest pain radiating to the back. BP is 180/100 in the right
arm and 140/80 in the left arm. Which is the most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer B: Aortic dissection
Rationale: Tearing chest pain with pulse differential suggests aortic dissection;
requires immediate CT angiography.
5. A patient is receiving IV heparin for a pulmonary embolism. The aPTT is
110 seconds (therapeutic range 60–80 seconds). Which is the priority nursing
action?
A) Administer vitamin K
B) Hold the heparin infusion and notify the provider
C) Increase the heparin infusion rate
, D) Administer protamine sulfate
Answer B: Hold the heparin infusion and notify the provider
Rationale: An aPTT >100 seconds increases bleeding risk; the infusion should
be held and dose adjusted.
6. A patient with heart failure is on a low-sodium diet. Which meal choice
indicates a need for further teaching?
A) Baked chicken with steamed vegetables
B) Ham sandwich with pickles and chips
C) Fresh fruit and yogurt
D) Grilled fish with rice
Answer B: Ham sandwich with pickles and chips
Rationale: Ham, pickles, and chips are high in sodium; not appropriate for a
low-sodium diet.
7. A patient with acute myocardial infarction develops hypotension and JVD.
The nurse should suspect:
A) Cardiogenic shock
B) Cardiac tamponade
C) Pulmonary embolism
D) Aortic dissection
Complete Test Bank
Questions 1–250
Domain 1: Cardiovascular (Questions 1–65)
1. A 62-year-old male presents with chest pain radiating to the left arm,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4.
Which is the priority nursing action?
A) Administer sublingual nitroglycerin
B) Activate the cardiac catheterization lab for primary PCI
C) Administer IV morphine for pain
D) Obtain a chest X-ray
Answer B: Activate the cardiac catheterization lab for primary PCI
,Rationale: STEMI requires immediate reperfusion; primary PCI is preferred if
available within 90 minutes of arrival.
2. A patient with heart failure has crackles in both lung bases and an ejection
fraction of 35%. Which medication should the nurse anticipate
administering?
A) Metoprolol succinate
B) Sacubitril/valsartan (ARNI)
C) Diltiazem
D) Digoxin
Answer B: Sacubitril/valsartan (ARNI)
Rationale: Sacubitril/valsartan is preferred over ACE inhibitors or ARBs in
HFrEF to reduce mortality and hospitalizations.
3. A patient is in atrial fibrillation with a ventricular rate of 150 bpm and is
hemodynamically unstable with BP 85/50. Which is the most appropriate
treatment?
A) Amiodarone IV
B) Synchronized cardioversion
C) Digoxin IV
D) Diltiazem IV
,Answer B: Synchronized cardioversion
Rationale: Unstable atrial fibrillation with rapid ventricular response requires
immediate synchronized cardioversion.
4. A patient with a history of hypertension presents with sudden onset of
severe "tearing" chest pain radiating to the back. BP is 180/100 in the right
arm and 140/80 in the left arm. Which is the most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer B: Aortic dissection
Rationale: Tearing chest pain with pulse differential suggests aortic dissection;
requires immediate CT angiography.
5. A patient is receiving IV heparin for a pulmonary embolism. The aPTT is
110 seconds (therapeutic range 60–80 seconds). Which is the priority nursing
action?
A) Administer vitamin K
B) Hold the heparin infusion and notify the provider
C) Increase the heparin infusion rate
, D) Administer protamine sulfate
Answer B: Hold the heparin infusion and notify the provider
Rationale: An aPTT >100 seconds increases bleeding risk; the infusion should
be held and dose adjusted.
6. A patient with heart failure is on a low-sodium diet. Which meal choice
indicates a need for further teaching?
A) Baked chicken with steamed vegetables
B) Ham sandwich with pickles and chips
C) Fresh fruit and yogurt
D) Grilled fish with rice
Answer B: Ham sandwich with pickles and chips
Rationale: Ham, pickles, and chips are high in sodium; not appropriate for a
low-sodium diet.
7. A patient with acute myocardial infarction develops hypotension and JVD.
The nurse should suspect:
A) Cardiogenic shock
B) Cardiac tamponade
C) Pulmonary embolism
D) Aortic dissection
