AACN PCCN® Adult ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
CARDIOVASCULAR
Question 1
A 62-year-old male with a history of hypertension presents with sudden onset of substernal
chest pain radiating to the jaw, diaphoresis, and nausea. His ECG shows ST-segment elevation in
leads V1-V4. Which coronary artery is most likely occluded?
• A. Right coronary artery
• B. Left circumflex artery
• C. Left anterior descending artery
• D. Posterior descending artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior wall myocardial infarction.
The left anterior descending (LAD) artery supplies the anterior wall and interventricular septum.
The right coronary artery supplies the inferior wall (II, III, aVF). The left circumflex artery
supplies the lateral wall (I, aVL, V5-V6). Prompt recognition and reperfusion are critical in acute
coronary syndromes.
Question 2
A patient is admitted with acute decompensated heart failure. Which finding is most consistent
with this diagnosis?
• A. BNP 1,500 pg/mL
, • B. Troponin I 0.02 ng/mL
• C. Creatinine 0.8 mg/dL
• D. Hemoglobin 14 g/dL
Answer: A. BNP 1,500 pg/mL
Rationale: B-type natriuretic peptide (BNP) is elevated in heart failure and correlates with
ventricular wall stress. BNP >100 pg/mL suggests heart failure, with higher levels indicating
more severe volume overload. This finding helps distinguish cardiac from pulmonary causes of
dyspnea.
Question 3
A patient with atrial fibrillation has a ventricular rate of 140 bpm and is hemodynamically
stable. Which medication is most appropriate for rate control?
• A. Adenosine
• B. Diltiazem
• C. Atropine
• D. Lidocaine
Answer: B. Diltiazem
Rationale: Diltiazem, a calcium channel blocker, is commonly used for rate control in stable
atrial fibrillation. Adenosine is used for supraventricular tachycardia. Atropine treats
bradycardia. Lidocaine is an antiarrhythmic used for ventricular arrhythmias.
Question 4
A patient with an acute inferior wall MI develops bradycardia and hypotension. The most
appropriate initial intervention is:
• A. Atropine 0.5 mg IV
• B. Epinephrine infusion
• C. Immediate transcutaneous pacing
• D. Norepinephrine infusion
Answer: A. Atropine 0.5 mg IV
,Rationale: Inferior wall MIs often involve the right coronary artery, which supplies the SA and
AV nodes, leading to bradycardia and heart block. Atropine is first-line for symptomatic
bradycardia. Transcutaneous pacing is used if atropine is ineffective. Epinephrine and
norepinephrine are vasopressors for hypotension but do not specifically address
bradyarrhythmias.
Question 5
A patient presents with hypotension, jugular venous distention, and muffled heart sounds.
Which condition is most likely?
• A. Cardiac tamponade
• B. Pulmonary embolism
• C. Tension pneumothorax
• D. Acute myocardial infarction
Answer: A. Cardiac tamponade
Rationale: Beck's triad (hypotension, jugular venous distention, and muffled heart sounds)
indicates cardiac tamponade, where fluid in the pericardial sac compresses the heart and
reduces cardiac output. Immediate intervention with pericardiocentesis may be required.
Tension pneumothorax presents with absent breath sounds and tracheal deviation.
Question 6
A patient is receiving a continuous infusion of norepinephrine. The nurse notes pallor and
swelling at the IV site. The most appropriate action is:
• A. Continue the infusion and monitor
• B. Stop the infusion immediately and notify the provider
• C. Apply warm compresses
• D. Slow the infusion rate
Answer: B. Stop the infusion immediately and notify the provider
Rationale: Pallor and swelling at an IV site receiving a vasopressor indicates extravasation,
which can cause tissue necrosis. The infusion should be stopped immediately and the provider
notified. Phentolamine may be administered locally to prevent tissue damage.
, Question 7
A patient with heart failure has an ejection fraction of 25%. Which medication is most likely to
improve survival?
• A. Digoxin
• B. Metoprolol succinate
• C. Furosemide
• D. Hydralazine
Answer: B. Metoprolol succinate
Rationale: Beta-blockers (e.g., metoprolol succinate, carvedilol) are cornerstone therapy for
heart failure with reduced ejection fraction and have been shown to improve survival. Digoxin
improves symptoms but not mortality. Furosemide manages volume overload. Hydralazine is
used in specific populations.
Question 8
Which ECG finding is most characteristic of pericarditis?
• A. ST-segment elevation with reciprocal depression
• B. Diffuse ST-segment elevation with PR depression
• C. Deep Q waves in leads II, III, and aVF
• D. Prolonged QT interval
Answer: B. Diffuse ST-segment elevation with PR depression
Rationale: Pericarditis typically presents with diffuse ST-segment elevation and PR depression
across most leads, without reciprocal changes. This distinguishes it from myocardial infarction,
which shows ST elevation with reciprocal changes in opposite leads.
Question 9
A patient with a permanent pacemaker has a pacing spike that is not followed by a QRS
complex. This indicates:
• A. Failure to capture
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
CARDIOVASCULAR
Question 1
A 62-year-old male with a history of hypertension presents with sudden onset of substernal
chest pain radiating to the jaw, diaphoresis, and nausea. His ECG shows ST-segment elevation in
leads V1-V4. Which coronary artery is most likely occluded?
• A. Right coronary artery
• B. Left circumflex artery
• C. Left anterior descending artery
• D. Posterior descending artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior wall myocardial infarction.
The left anterior descending (LAD) artery supplies the anterior wall and interventricular septum.
The right coronary artery supplies the inferior wall (II, III, aVF). The left circumflex artery
supplies the lateral wall (I, aVL, V5-V6). Prompt recognition and reperfusion are critical in acute
coronary syndromes.
Question 2
A patient is admitted with acute decompensated heart failure. Which finding is most consistent
with this diagnosis?
• A. BNP 1,500 pg/mL
, • B. Troponin I 0.02 ng/mL
• C. Creatinine 0.8 mg/dL
• D. Hemoglobin 14 g/dL
Answer: A. BNP 1,500 pg/mL
Rationale: B-type natriuretic peptide (BNP) is elevated in heart failure and correlates with
ventricular wall stress. BNP >100 pg/mL suggests heart failure, with higher levels indicating
more severe volume overload. This finding helps distinguish cardiac from pulmonary causes of
dyspnea.
Question 3
A patient with atrial fibrillation has a ventricular rate of 140 bpm and is hemodynamically
stable. Which medication is most appropriate for rate control?
• A. Adenosine
• B. Diltiazem
• C. Atropine
• D. Lidocaine
Answer: B. Diltiazem
Rationale: Diltiazem, a calcium channel blocker, is commonly used for rate control in stable
atrial fibrillation. Adenosine is used for supraventricular tachycardia. Atropine treats
bradycardia. Lidocaine is an antiarrhythmic used for ventricular arrhythmias.
Question 4
A patient with an acute inferior wall MI develops bradycardia and hypotension. The most
appropriate initial intervention is:
• A. Atropine 0.5 mg IV
• B. Epinephrine infusion
• C. Immediate transcutaneous pacing
• D. Norepinephrine infusion
Answer: A. Atropine 0.5 mg IV
,Rationale: Inferior wall MIs often involve the right coronary artery, which supplies the SA and
AV nodes, leading to bradycardia and heart block. Atropine is first-line for symptomatic
bradycardia. Transcutaneous pacing is used if atropine is ineffective. Epinephrine and
norepinephrine are vasopressors for hypotension but do not specifically address
bradyarrhythmias.
Question 5
A patient presents with hypotension, jugular venous distention, and muffled heart sounds.
Which condition is most likely?
• A. Cardiac tamponade
• B. Pulmonary embolism
• C. Tension pneumothorax
• D. Acute myocardial infarction
Answer: A. Cardiac tamponade
Rationale: Beck's triad (hypotension, jugular venous distention, and muffled heart sounds)
indicates cardiac tamponade, where fluid in the pericardial sac compresses the heart and
reduces cardiac output. Immediate intervention with pericardiocentesis may be required.
Tension pneumothorax presents with absent breath sounds and tracheal deviation.
Question 6
A patient is receiving a continuous infusion of norepinephrine. The nurse notes pallor and
swelling at the IV site. The most appropriate action is:
• A. Continue the infusion and monitor
• B. Stop the infusion immediately and notify the provider
• C. Apply warm compresses
• D. Slow the infusion rate
Answer: B. Stop the infusion immediately and notify the provider
Rationale: Pallor and swelling at an IV site receiving a vasopressor indicates extravasation,
which can cause tissue necrosis. The infusion should be stopped immediately and the provider
notified. Phentolamine may be administered locally to prevent tissue damage.
, Question 7
A patient with heart failure has an ejection fraction of 25%. Which medication is most likely to
improve survival?
• A. Digoxin
• B. Metoprolol succinate
• C. Furosemide
• D. Hydralazine
Answer: B. Metoprolol succinate
Rationale: Beta-blockers (e.g., metoprolol succinate, carvedilol) are cornerstone therapy for
heart failure with reduced ejection fraction and have been shown to improve survival. Digoxin
improves symptoms but not mortality. Furosemide manages volume overload. Hydralazine is
used in specific populations.
Question 8
Which ECG finding is most characteristic of pericarditis?
• A. ST-segment elevation with reciprocal depression
• B. Diffuse ST-segment elevation with PR depression
• C. Deep Q waves in leads II, III, and aVF
• D. Prolonged QT interval
Answer: B. Diffuse ST-segment elevation with PR depression
Rationale: Pericarditis typically presents with diffuse ST-segment elevation and PR depression
across most leads, without reciprocal changes. This distinguishes it from myocardial infarction,
which shows ST elevation with reciprocal changes in opposite leads.
Question 9
A patient with a permanent pacemaker has a pacing spike that is not followed by a QRS
complex. This indicates:
• A. Failure to capture
