PCCN – Progressive Care Certified Nurse Exam
2026/2027 | Practice Questions And Answers|
Complete Questions And Answers (Verified Answers) |
Exam Prep | Comprehensive Exam Guide 2026&2027
1. A patient with acute decompensated heart failure develops worsening dyspnea, bilateral
crackles, an oxygen saturation of 86%, and pink frothy sputum. Which intervention should
the progressive care nurse prioritize?
A. Encourage oral fluids
B. Place the patient in a high-Fowler position and administer oxygen
C. Place the patient supine
D. Encourage ambulation
Answer: B
The patient has findings consistent with acute pulmonary edema. Upright positioning
decreases venous return and improves lung expansion, while supplemental oxygen addresses
hypoxemia.
2. A patient with atrial fibrillation has a ventricular rate of 158/min, blood pressure of
82/48 mm Hg, chest discomfort, and altered mental status. Which intervention should the
nurse anticipate?
A. Oral metoprolol
B. Vagal maneuvers
C. Immediate synchronized cardioversion
D. Routine observation
Answer: C
Hypotension, altered mental status, and ischemic symptoms indicate hemodynamic
instability. Synchronized cardioversion is the appropriate urgent intervention for unstable
tachyarrhythmia.
3. A patient receiving unfractionated heparin develops a platelet count decrease from
220,000/mm³ to 92,000/mm³ on day 6 of therapy. Which complication should the nurse
suspect?
A. Heparin-induced thrombocytopenia
B. Disseminated intravascular coagulation
C. Vitamin K deficiency
D. Thrombotic thrombocytopenic purpura
Answer: A
,A platelet fall of more than 50% occurring several days after heparin exposure strongly
suggests heparin-induced thrombocytopenia, which carries a significant risk of thrombosis.
4. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L and peaked T
waves on the ECG. Which prescription should the nurse implement first?
A. Oral potassium replacement
B. Intravenous calcium administration
C. Dietary potassium restriction
D. Sodium-restricted diet
Answer: B
IV calcium stabilizes the cardiac membrane and reduces the immediate risk of fatal
dysrhythmias. It does not lower serum potassium but is prioritized when ECG changes are
present.
5. A patient with COPD exacerbation is receiving oxygen through a nasal cannula. The
patient becomes increasingly somnolent, and arterial blood gas results show pH 7.25 and
PaCO2 68 mm Hg. Which intervention should the nurse anticipate?
A. Discontinue all oxygen
B. Encourage oral fluids only
C. Increase sedating medications
D. Prepare for noninvasive ventilatory support
Answer: D
The patient has acute respiratory acidosis with significant hypercapnia and altered
consciousness. Noninvasive ventilatory support may improve ventilation and reduce carbon
dioxide retention when clinically appropriate.
6. A patient with suspected septic shock has a blood pressure of 78/42 mm Hg despite initial
fluid resuscitation. Which medication does the nurse anticipate as the first-line
vasopressor?
A. Norepinephrine
B. Furosemide
C. Nitroglycerin
D. Diltiazem
Answer: A
Norepinephrine is commonly used as the first-line vasopressor for persistent hypotension
associated with septic shock after adequate fluid resuscitation.
7. A patient with acute coronary syndrome reports crushing substernal chest pain
radiating to the jaw. Which finding requires immediate reassessment after nitroglycerin
administration?
,A. Mild headache
B. Facial flushing
C. Blood pressure of 84/50 mm Hg
D. Heart rate of 88/min
Answer: C
Nitroglycerin can cause significant vasodilation and hypotension. Severe hypotension requires
immediate reassessment and intervention because coronary and systemic perfusion may be
compromised.
8. A patient with an acute ischemic stroke suddenly develops difficulty speaking and right-
sided weakness. Which information is most important for determining eligibility for time-
sensitive reperfusion therapy?
A. Last known well time
B. Favorite medication
C. Dietary history
D. Previous vaccination history
Answer: A
The last known well time establishes the onset window for acute stroke treatment decisions
and is therefore a critical piece of information.
9. A patient receiving a continuous insulin infusion for diabetic ketoacidosis has a
potassium level of 3.0 mEq/L. Which action is most appropriate?
A. Increase the insulin infusion
B. Administer potassium replacement as prescribed
C. Administer sodium bicarbonate routinely
D. Stop all fluid therapy
Answer: B
Insulin drives potassium into cells and can worsen hypokalemia. When potassium is
significantly low, potassium replacement is prioritized according to the treatment protocol
before further insulin administration.
10. A patient with severe sepsis has a serum lactate of 5.2 mmol/L. What does this finding
most directly suggest?
A. Adequate tissue oxygenation
B. Improved renal clearance
C. Increased tissue hypoperfusion or impaired oxygen utilization
D. Resolution of the underlying infection
Answer: C
, An elevated lactate level can indicate inadequate tissue perfusion or impaired cellular oxygen
utilization and is an important marker when evaluating severe systemic illness.
11. A patient with left-sided heart failure develops orthopnea and worsening pulmonary
crackles. Which pathophysiologic process primarily explains these findings?
A. Increased pulmonary venous pressure
B. Reduced systemic venous pressure
C. Decreased pulmonary capillary pressure
D. Increased lymphatic drainage
Answer: A
Left ventricular dysfunction increases pressure behind the failing ventricle, causing pulmonary
venous and capillary pressure to rise and promoting pulmonary congestion.
12. A patient with a suspected pulmonary embolism suddenly develops pleuritic chest pain,
tachycardia, and oxygen saturation of 84%. What is the nurse's priority?
A. Encourage ambulation
B. Provide oxygen and rapidly assess the patient's respiratory status
C. Offer a large meal
D. Place the patient in Trendelenburg position
Answer: B
Acute hypoxemia is the immediate threat. Oxygenation and rapid respiratory assessment
take priority while definitive evaluation and treatment are initiated.
13. A patient receiving warfarin has an INR of 6.2 and reports black, tarry stools. Which
action is most appropriate?
A. Administer the next dose
B. Encourage foods high in potassium
C. Hold warfarin and notify the provider immediately
D. Encourage strenuous exercise
Answer: C
A markedly elevated INR combined with evidence of gastrointestinal bleeding indicates
excessive anticoagulation and requires prompt intervention.
14. A patient with acute heart failure is prescribed IV furosemide. Which assessment best
evaluates the immediate therapeutic response?
A. Nail color
B. Urine output and respiratory status
C. Appetite
D. Bowel sounds
2026/2027 | Practice Questions And Answers|
Complete Questions And Answers (Verified Answers) |
Exam Prep | Comprehensive Exam Guide 2026&2027
1. A patient with acute decompensated heart failure develops worsening dyspnea, bilateral
crackles, an oxygen saturation of 86%, and pink frothy sputum. Which intervention should
the progressive care nurse prioritize?
A. Encourage oral fluids
B. Place the patient in a high-Fowler position and administer oxygen
C. Place the patient supine
D. Encourage ambulation
Answer: B
The patient has findings consistent with acute pulmonary edema. Upright positioning
decreases venous return and improves lung expansion, while supplemental oxygen addresses
hypoxemia.
2. A patient with atrial fibrillation has a ventricular rate of 158/min, blood pressure of
82/48 mm Hg, chest discomfort, and altered mental status. Which intervention should the
nurse anticipate?
A. Oral metoprolol
B. Vagal maneuvers
C. Immediate synchronized cardioversion
D. Routine observation
Answer: C
Hypotension, altered mental status, and ischemic symptoms indicate hemodynamic
instability. Synchronized cardioversion is the appropriate urgent intervention for unstable
tachyarrhythmia.
3. A patient receiving unfractionated heparin develops a platelet count decrease from
220,000/mm³ to 92,000/mm³ on day 6 of therapy. Which complication should the nurse
suspect?
A. Heparin-induced thrombocytopenia
B. Disseminated intravascular coagulation
C. Vitamin K deficiency
D. Thrombotic thrombocytopenic purpura
Answer: A
,A platelet fall of more than 50% occurring several days after heparin exposure strongly
suggests heparin-induced thrombocytopenia, which carries a significant risk of thrombosis.
4. A patient with chronic kidney disease has a potassium level of 6.8 mEq/L and peaked T
waves on the ECG. Which prescription should the nurse implement first?
A. Oral potassium replacement
B. Intravenous calcium administration
C. Dietary potassium restriction
D. Sodium-restricted diet
Answer: B
IV calcium stabilizes the cardiac membrane and reduces the immediate risk of fatal
dysrhythmias. It does not lower serum potassium but is prioritized when ECG changes are
present.
5. A patient with COPD exacerbation is receiving oxygen through a nasal cannula. The
patient becomes increasingly somnolent, and arterial blood gas results show pH 7.25 and
PaCO2 68 mm Hg. Which intervention should the nurse anticipate?
A. Discontinue all oxygen
B. Encourage oral fluids only
C. Increase sedating medications
D. Prepare for noninvasive ventilatory support
Answer: D
The patient has acute respiratory acidosis with significant hypercapnia and altered
consciousness. Noninvasive ventilatory support may improve ventilation and reduce carbon
dioxide retention when clinically appropriate.
6. A patient with suspected septic shock has a blood pressure of 78/42 mm Hg despite initial
fluid resuscitation. Which medication does the nurse anticipate as the first-line
vasopressor?
A. Norepinephrine
B. Furosemide
C. Nitroglycerin
D. Diltiazem
Answer: A
Norepinephrine is commonly used as the first-line vasopressor for persistent hypotension
associated with septic shock after adequate fluid resuscitation.
7. A patient with acute coronary syndrome reports crushing substernal chest pain
radiating to the jaw. Which finding requires immediate reassessment after nitroglycerin
administration?
,A. Mild headache
B. Facial flushing
C. Blood pressure of 84/50 mm Hg
D. Heart rate of 88/min
Answer: C
Nitroglycerin can cause significant vasodilation and hypotension. Severe hypotension requires
immediate reassessment and intervention because coronary and systemic perfusion may be
compromised.
8. A patient with an acute ischemic stroke suddenly develops difficulty speaking and right-
sided weakness. Which information is most important for determining eligibility for time-
sensitive reperfusion therapy?
A. Last known well time
B. Favorite medication
C. Dietary history
D. Previous vaccination history
Answer: A
The last known well time establishes the onset window for acute stroke treatment decisions
and is therefore a critical piece of information.
9. A patient receiving a continuous insulin infusion for diabetic ketoacidosis has a
potassium level of 3.0 mEq/L. Which action is most appropriate?
A. Increase the insulin infusion
B. Administer potassium replacement as prescribed
C. Administer sodium bicarbonate routinely
D. Stop all fluid therapy
Answer: B
Insulin drives potassium into cells and can worsen hypokalemia. When potassium is
significantly low, potassium replacement is prioritized according to the treatment protocol
before further insulin administration.
10. A patient with severe sepsis has a serum lactate of 5.2 mmol/L. What does this finding
most directly suggest?
A. Adequate tissue oxygenation
B. Improved renal clearance
C. Increased tissue hypoperfusion or impaired oxygen utilization
D. Resolution of the underlying infection
Answer: C
, An elevated lactate level can indicate inadequate tissue perfusion or impaired cellular oxygen
utilization and is an important marker when evaluating severe systemic illness.
11. A patient with left-sided heart failure develops orthopnea and worsening pulmonary
crackles. Which pathophysiologic process primarily explains these findings?
A. Increased pulmonary venous pressure
B. Reduced systemic venous pressure
C. Decreased pulmonary capillary pressure
D. Increased lymphatic drainage
Answer: A
Left ventricular dysfunction increases pressure behind the failing ventricle, causing pulmonary
venous and capillary pressure to rise and promoting pulmonary congestion.
12. A patient with a suspected pulmonary embolism suddenly develops pleuritic chest pain,
tachycardia, and oxygen saturation of 84%. What is the nurse's priority?
A. Encourage ambulation
B. Provide oxygen and rapidly assess the patient's respiratory status
C. Offer a large meal
D. Place the patient in Trendelenburg position
Answer: B
Acute hypoxemia is the immediate threat. Oxygenation and rapid respiratory assessment
take priority while definitive evaluation and treatment are initiated.
13. A patient receiving warfarin has an INR of 6.2 and reports black, tarry stools. Which
action is most appropriate?
A. Administer the next dose
B. Encourage foods high in potassium
C. Hold warfarin and notify the provider immediately
D. Encourage strenuous exercise
Answer: C
A markedly elevated INR combined with evidence of gastrointestinal bleeding indicates
excessive anticoagulation and requires prompt intervention.
14. A patient with acute heart failure is prescribed IV furosemide. Which assessment best
evaluates the immediate therapeutic response?
A. Nail color
B. Urine output and respiratory status
C. Appetite
D. Bowel sounds
