PCCN Progressive Care Certified Nurse Exam 2026/2027
Practice Questions And Answers 2026/2027 | Complete
Questions And Answers (Verified Answers) | Exam Prep
| Comprehensive Exam Guide 2026&2027
1. A patient with acute decompensated heart failure is receiving oxygen and IV diuretics.
Which assessment finding requires the nurse's most immediate intervention?
A. 2+ bilateral ankle edema
B. New confusion and inability to follow commands
C. Urine output of 45 mL/hr
D. Blood pressure of 138/84 mmHg
Answer: B
New confusion may indicate worsening hypoxemia or decreased cerebral perfusion and
requires immediate assessment and intervention. Peripheral edema and adequate urine
output are less immediately concerning.
2. A patient with COPD becomes increasingly somnolent while receiving supplemental
oxygen. Which finding is most concerning?
A. Respiratory rate of 10/min with increasing PaCO2
B. Oxygen saturation of 92%
C. Mild bilateral wheezing
D. Productive cough with clear sputum
Answer: A
A declining respiratory rate accompanied by rising PaCO2 suggests worsening hypoventilation
and possible acute hypercapnic respiratory failure.
3. A patient with atrial fibrillation has a heart rate of 156/min, blood pressure of 82/48
mmHg, and new chest discomfort. What should the nurse anticipate?
A. Oral potassium supplementation
B. Routine ECG monitoring only
C. Immediate synchronized cardioversion
D. Ambulation to assess exercise tolerance
Answer: C
Atrial fibrillation with rapid ventricular response causing hypotension and ischemic symptoms
represents hemodynamic instability and may require immediate synchronized cardioversion.
,4. A patient receiving IV potassium chloride reports burning at the peripheral IV site.
What is the nurse's priority action?
A. Increase the infusion rate
B. Apply a warm compress while continuing the infusion
C. Flush the catheter forcefully
D. Stop the infusion and assess IV patency and the site
Answer: D
IV potassium is irritating and extravasation or infiltration can cause tissue injury. The infusion
should be stopped while the IV site is assessed.
5. A patient with pneumonia has a respiratory rate of 32/min, oxygen saturation of 86%,
and increasing work of breathing. Which intervention should the nurse perform first?
A. Encourage oral fluids
B. Apply supplemental oxygen and reassess respiratory status
C. Obtain a sputum culture before intervening
D. Place the patient flat in bed
Answer: B
Hypoxemia and increased work of breathing require immediate support of oxygenation while
further diagnostic and therapeutic measures are initiated.
6. Which patient is at greatest risk for developing delirium?
A. A 28-year-old with an uncomplicated fracture
B. A 35-year-old awaiting discharge after minor surgery
C. An 82-year-old with infection, dehydration, and polypharmacy
D. A 41-year-old with stable hypertension
Answer: C
Advanced age combined with infection, dehydration, and multiple medications substantially
increases delirium risk.
7. A patient with suspected sepsis has a lactate level of 4.6 mmol/L, hypotension, and
altered mental status. Which finding most strongly indicates tissue hypoperfusion?
A. Elevated lactate level
B. Temperature of 37.8°C
C. Heart rate of 88/min
D. White blood cell count of 11,000/mm³
Answer: A
An elevated lactate in the setting of suspected sepsis can indicate impaired tissue oxygen
utilization or perfusion and is an important marker of illness severity.
,8. A patient receiving heparin develops a platelet count that falls from 220,000/mm³ to
92,000/mm³ several days after therapy begins. What complication should the nurse
suspect?
A. Disseminated intravascular coagulation
B. Iron-deficiency anemia
C. Thrombotic thrombocytopenic purpura
D. Heparin-induced thrombocytopenia
Answer: D
A substantial platelet decline several days after heparin exposure is characteristic of heparin-
induced thrombocytopenia, which carries a significant risk of thrombosis.
9. A patient with acute kidney injury has potassium of 6.7 mEq/L and peaked T waves on
ECG. Which prescribed intervention should the nurse prioritize?
A. Oral calcium supplement
B. IV calcium administration as ordered
C. Restrict dietary sodium
D. Encourage potassium-rich foods
Answer: B
IV calcium helps stabilize the cardiac membrane during severe hyperkalemia with ECG
changes. It does not remove potassium but provides urgent cardiac protection.
10. A patient with suspected pulmonary embolism suddenly develops dyspnea, pleuritic
chest pain, and tachycardia. What is the priority nursing action?
A. Encourage ambulation
B. Place the patient in Trendelenburg position
C. Assess oxygenation and provide supplemental oxygen as indicated
D. Administer an oral sedative
Answer: C
Acute pulmonary embolism can rapidly compromise oxygenation. Supporting airway and
breathing while escalating care is the immediate priority.
11. Which assessment finding in a patient with acute coronary syndrome requires the most
urgent response?
A. New ST-segment elevation accompanied by severe chest pain
B. Mild anxiety
C. Heart rate of 94/min
D. Blood pressure of 142/86 mmHg
Answer: A
, New ST-segment elevation with severe chest pain may indicate acute myocardial injury
requiring immediate reperfusion-focused management.
12. A patient with heart failure is prescribed digoxin. Which finding should cause the nurse
to withhold the medication and notify the provider?
A. Apical pulse of 54/min
B. Blood pressure of 128/76 mmHg
C. Respiratory rate of 18/min
D. Potassium of 4.2 mEq/L
Answer: A
Digoxin can slow cardiac conduction. Significant bradycardia warrants withholding the
medication and further assessment.
13. A patient with COPD is anxious and using accessory muscles to breathe. Which
position generally promotes improved ventilation?
A. Supine with legs elevated
B. High-Fowler's position with arms supported
C. Flat prone position
D. Trendelenburg position
Answer: B
An upright position with supported upper extremities can improve diaphragmatic mechanics
and reduce the work of breathing.
14. A patient receiving noninvasive positive-pressure ventilation repeatedly removes the
mask because of anxiety. What should the nurse do first?
A. Immediately restrain the patient
B. Discontinue the therapy permanently
C. Assess anxiety, explain the therapy, and improve mask tolerance
D. Increase the pressure without assessment
Answer: C
Addressing anxiety and improving tolerance may allow effective noninvasive ventilation
while avoiding unnecessary escalation or restraint.
15. A patient with a central venous catheter develops fever and chills during an infusion.
What is the priority nursing action?
A. Ignore the symptoms if blood pressure is normal
B. Assess the patient and notify the provider while following infection-management protocols
C. Increase the infusion rate
D. Remove the catheter without an order in every situation
Practice Questions And Answers 2026/2027 | Complete
Questions And Answers (Verified Answers) | Exam Prep
| Comprehensive Exam Guide 2026&2027
1. A patient with acute decompensated heart failure is receiving oxygen and IV diuretics.
Which assessment finding requires the nurse's most immediate intervention?
A. 2+ bilateral ankle edema
B. New confusion and inability to follow commands
C. Urine output of 45 mL/hr
D. Blood pressure of 138/84 mmHg
Answer: B
New confusion may indicate worsening hypoxemia or decreased cerebral perfusion and
requires immediate assessment and intervention. Peripheral edema and adequate urine
output are less immediately concerning.
2. A patient with COPD becomes increasingly somnolent while receiving supplemental
oxygen. Which finding is most concerning?
A. Respiratory rate of 10/min with increasing PaCO2
B. Oxygen saturation of 92%
C. Mild bilateral wheezing
D. Productive cough with clear sputum
Answer: A
A declining respiratory rate accompanied by rising PaCO2 suggests worsening hypoventilation
and possible acute hypercapnic respiratory failure.
3. A patient with atrial fibrillation has a heart rate of 156/min, blood pressure of 82/48
mmHg, and new chest discomfort. What should the nurse anticipate?
A. Oral potassium supplementation
B. Routine ECG monitoring only
C. Immediate synchronized cardioversion
D. Ambulation to assess exercise tolerance
Answer: C
Atrial fibrillation with rapid ventricular response causing hypotension and ischemic symptoms
represents hemodynamic instability and may require immediate synchronized cardioversion.
,4. A patient receiving IV potassium chloride reports burning at the peripheral IV site.
What is the nurse's priority action?
A. Increase the infusion rate
B. Apply a warm compress while continuing the infusion
C. Flush the catheter forcefully
D. Stop the infusion and assess IV patency and the site
Answer: D
IV potassium is irritating and extravasation or infiltration can cause tissue injury. The infusion
should be stopped while the IV site is assessed.
5. A patient with pneumonia has a respiratory rate of 32/min, oxygen saturation of 86%,
and increasing work of breathing. Which intervention should the nurse perform first?
A. Encourage oral fluids
B. Apply supplemental oxygen and reassess respiratory status
C. Obtain a sputum culture before intervening
D. Place the patient flat in bed
Answer: B
Hypoxemia and increased work of breathing require immediate support of oxygenation while
further diagnostic and therapeutic measures are initiated.
6. Which patient is at greatest risk for developing delirium?
A. A 28-year-old with an uncomplicated fracture
B. A 35-year-old awaiting discharge after minor surgery
C. An 82-year-old with infection, dehydration, and polypharmacy
D. A 41-year-old with stable hypertension
Answer: C
Advanced age combined with infection, dehydration, and multiple medications substantially
increases delirium risk.
7. A patient with suspected sepsis has a lactate level of 4.6 mmol/L, hypotension, and
altered mental status. Which finding most strongly indicates tissue hypoperfusion?
A. Elevated lactate level
B. Temperature of 37.8°C
C. Heart rate of 88/min
D. White blood cell count of 11,000/mm³
Answer: A
An elevated lactate in the setting of suspected sepsis can indicate impaired tissue oxygen
utilization or perfusion and is an important marker of illness severity.
,8. A patient receiving heparin develops a platelet count that falls from 220,000/mm³ to
92,000/mm³ several days after therapy begins. What complication should the nurse
suspect?
A. Disseminated intravascular coagulation
B. Iron-deficiency anemia
C. Thrombotic thrombocytopenic purpura
D. Heparin-induced thrombocytopenia
Answer: D
A substantial platelet decline several days after heparin exposure is characteristic of heparin-
induced thrombocytopenia, which carries a significant risk of thrombosis.
9. A patient with acute kidney injury has potassium of 6.7 mEq/L and peaked T waves on
ECG. Which prescribed intervention should the nurse prioritize?
A. Oral calcium supplement
B. IV calcium administration as ordered
C. Restrict dietary sodium
D. Encourage potassium-rich foods
Answer: B
IV calcium helps stabilize the cardiac membrane during severe hyperkalemia with ECG
changes. It does not remove potassium but provides urgent cardiac protection.
10. A patient with suspected pulmonary embolism suddenly develops dyspnea, pleuritic
chest pain, and tachycardia. What is the priority nursing action?
A. Encourage ambulation
B. Place the patient in Trendelenburg position
C. Assess oxygenation and provide supplemental oxygen as indicated
D. Administer an oral sedative
Answer: C
Acute pulmonary embolism can rapidly compromise oxygenation. Supporting airway and
breathing while escalating care is the immediate priority.
11. Which assessment finding in a patient with acute coronary syndrome requires the most
urgent response?
A. New ST-segment elevation accompanied by severe chest pain
B. Mild anxiety
C. Heart rate of 94/min
D. Blood pressure of 142/86 mmHg
Answer: A
, New ST-segment elevation with severe chest pain may indicate acute myocardial injury
requiring immediate reperfusion-focused management.
12. A patient with heart failure is prescribed digoxin. Which finding should cause the nurse
to withhold the medication and notify the provider?
A. Apical pulse of 54/min
B. Blood pressure of 128/76 mmHg
C. Respiratory rate of 18/min
D. Potassium of 4.2 mEq/L
Answer: A
Digoxin can slow cardiac conduction. Significant bradycardia warrants withholding the
medication and further assessment.
13. A patient with COPD is anxious and using accessory muscles to breathe. Which
position generally promotes improved ventilation?
A. Supine with legs elevated
B. High-Fowler's position with arms supported
C. Flat prone position
D. Trendelenburg position
Answer: B
An upright position with supported upper extremities can improve diaphragmatic mechanics
and reduce the work of breathing.
14. A patient receiving noninvasive positive-pressure ventilation repeatedly removes the
mask because of anxiety. What should the nurse do first?
A. Immediately restrain the patient
B. Discontinue the therapy permanently
C. Assess anxiety, explain the therapy, and improve mask tolerance
D. Increase the pressure without assessment
Answer: C
Addressing anxiety and improving tolerance may allow effective noninvasive ventilation
while avoiding unnecessary escalation or restraint.
15. A patient with a central venous catheter develops fever and chills during an infusion.
What is the priority nursing action?
A. Ignore the symptoms if blood pressure is normal
B. Assess the patient and notify the provider while following infection-management protocols
C. Increase the infusion rate
D. Remove the catheter without an order in every situation
