PCCN-Style Practice Exam| YEAR 2026–2027 |
Comprehensive 100-Question Practice Test
with Answers & Rationales| Pdf Access
ALREADY GRADED A+.
Questions 1–25: Cardiovascular & Hemodynamic
1. A progressive-care client reports crushing substernal chest pain radiating to the left arm.
Which action is the priority?
A. Obtain a routine temperature
B. Assess vital signs and obtain a 12-lead ECG promptly
C. Encourage ambulation
D. Offer a meal
Answer: B. Assess vital signs and obtain a 12-lead ECG promptly
Rationale: New ischemic-type chest pain may indicate acute coronary syndrome. Rapid
assessment and ECG help identify myocardial ischemia and guide treatment.
2. Which ECG finding is most concerning for acute myocardial injury?
A. ST-segment elevation
B. Normal sinus rhythm
C. Occasional PAC
D. Sinus bradycardia
Answer: A. ST-segment elevation
Rationale: New ST-segment elevation in an appropriate clinical setting can indicate acute
myocardial injury and requires immediate evaluation.
,3. A client with acute coronary syndrome suddenly becomes hypotensive, cool, and confused.
Which complication should the nurse suspect?
A. Cardiogenic shock
B. Mild dehydration
C. Stable angina
D. Hyperthyroidism
Answer: A. Cardiogenic shock
Rationale: Hypotension, cool clammy skin, altered mental status, and poor perfusion following
cardiac injury are consistent with cardiogenic shock.
4. Which hemodynamic finding is expected with left ventricular failure?
A. Increased pulmonary capillary pressures
B. Decreased pulmonary congestion
C. Increased urine output
D. Reduced left atrial pressure
Answer: A. Increased pulmonary capillary pressures
Rationale: Left ventricular dysfunction causes blood to back up into the pulmonary circulation,
increasing pulmonary pressures and causing pulmonary edema.
5. A client with heart failure has severe dyspnea, crackles, and pink frothy sputum. What
should the nurse recognize?
A. Pulmonary edema
B. Dehydration
C. Pneumothorax
D. Stable COPD
Answer: A. Pulmonary edema
Rationale: Severe dyspnea, diffuse crackles, hypoxemia, and pink frothy sputum are classic
manifestations of acute pulmonary edema.
6. Which position is generally appropriate for acute pulmonary edema?
,A. Flat supine
B. High-Fowler's
C. Trendelenburg
D. Prone
Answer: B. High-Fowler's
Rationale: Upright positioning decreases venous return and improves lung expansion, helping
reduce respiratory distress.
7. A client with heart failure gains 2.5 kg (5.5 lb) in 3 days. What does this most likely
indicate?
A. Fluid retention
B. Fat loss
C. Improved cardiac output
D. Dehydration
Answer: A. Fluid retention
Rationale: Rapid weight gain is usually caused by fluid accumulation and can indicate worsening
heart failure.
8. Which laboratory marker is commonly associated with ventricular stretch and heart failure?
A. BNP
B. Amylase
C. Lipase
D. Bilirubin
Answer: A. BNP
Rationale: B-type natriuretic peptide (BNP) is released in response to ventricular stretch and
can support the assessment of heart failure.
9. A client with atrial fibrillation is at increased risk for:
A. Thromboembolic stroke
B. Hypoglycemia
, C. Appendicitis
D. Pneumothorax
Answer: A. Thromboembolic stroke
Rationale: Ineffective atrial contraction can cause blood stasis and thrombus formation,
increasing embolic stroke risk.
10. Which rhythm is characterized by an irregularly irregular ventricular rhythm and absence
of consistent P waves?
A. Atrial fibrillation
B. Sinus rhythm
C. First-degree AV block
D. Ventricular fibrillation
Answer: A. Atrial fibrillation
Rationale: Atrial fibrillation produces chaotic atrial activity, no distinct P waves, and an
irregularly irregular ventricular response.
11. A client develops ventricular tachycardia and has no pulse. Which intervention is
required?
A. Oral beta blocker
B. Immediate defibrillation and CPR according to protocol
C. Ambulation
D. Oral fluids
Answer: B. Immediate defibrillation and CPR according to protocol
Rationale: Pulseless ventricular tachycardia is a shockable cardiac arrest rhythm requiring
immediate resuscitation.
12. Which rhythm is also treated with immediate defibrillation when the client is pulseless?
A. Ventricular fibrillation
B. Sinus tachycardia
C. Atrial fibrillation
D. First-degree AV block
Comprehensive 100-Question Practice Test
with Answers & Rationales| Pdf Access
ALREADY GRADED A+.
Questions 1–25: Cardiovascular & Hemodynamic
1. A progressive-care client reports crushing substernal chest pain radiating to the left arm.
Which action is the priority?
A. Obtain a routine temperature
B. Assess vital signs and obtain a 12-lead ECG promptly
C. Encourage ambulation
D. Offer a meal
Answer: B. Assess vital signs and obtain a 12-lead ECG promptly
Rationale: New ischemic-type chest pain may indicate acute coronary syndrome. Rapid
assessment and ECG help identify myocardial ischemia and guide treatment.
2. Which ECG finding is most concerning for acute myocardial injury?
A. ST-segment elevation
B. Normal sinus rhythm
C. Occasional PAC
D. Sinus bradycardia
Answer: A. ST-segment elevation
Rationale: New ST-segment elevation in an appropriate clinical setting can indicate acute
myocardial injury and requires immediate evaluation.
,3. A client with acute coronary syndrome suddenly becomes hypotensive, cool, and confused.
Which complication should the nurse suspect?
A. Cardiogenic shock
B. Mild dehydration
C. Stable angina
D. Hyperthyroidism
Answer: A. Cardiogenic shock
Rationale: Hypotension, cool clammy skin, altered mental status, and poor perfusion following
cardiac injury are consistent with cardiogenic shock.
4. Which hemodynamic finding is expected with left ventricular failure?
A. Increased pulmonary capillary pressures
B. Decreased pulmonary congestion
C. Increased urine output
D. Reduced left atrial pressure
Answer: A. Increased pulmonary capillary pressures
Rationale: Left ventricular dysfunction causes blood to back up into the pulmonary circulation,
increasing pulmonary pressures and causing pulmonary edema.
5. A client with heart failure has severe dyspnea, crackles, and pink frothy sputum. What
should the nurse recognize?
A. Pulmonary edema
B. Dehydration
C. Pneumothorax
D. Stable COPD
Answer: A. Pulmonary edema
Rationale: Severe dyspnea, diffuse crackles, hypoxemia, and pink frothy sputum are classic
manifestations of acute pulmonary edema.
6. Which position is generally appropriate for acute pulmonary edema?
,A. Flat supine
B. High-Fowler's
C. Trendelenburg
D. Prone
Answer: B. High-Fowler's
Rationale: Upright positioning decreases venous return and improves lung expansion, helping
reduce respiratory distress.
7. A client with heart failure gains 2.5 kg (5.5 lb) in 3 days. What does this most likely
indicate?
A. Fluid retention
B. Fat loss
C. Improved cardiac output
D. Dehydration
Answer: A. Fluid retention
Rationale: Rapid weight gain is usually caused by fluid accumulation and can indicate worsening
heart failure.
8. Which laboratory marker is commonly associated with ventricular stretch and heart failure?
A. BNP
B. Amylase
C. Lipase
D. Bilirubin
Answer: A. BNP
Rationale: B-type natriuretic peptide (BNP) is released in response to ventricular stretch and
can support the assessment of heart failure.
9. A client with atrial fibrillation is at increased risk for:
A. Thromboembolic stroke
B. Hypoglycemia
, C. Appendicitis
D. Pneumothorax
Answer: A. Thromboembolic stroke
Rationale: Ineffective atrial contraction can cause blood stasis and thrombus formation,
increasing embolic stroke risk.
10. Which rhythm is characterized by an irregularly irregular ventricular rhythm and absence
of consistent P waves?
A. Atrial fibrillation
B. Sinus rhythm
C. First-degree AV block
D. Ventricular fibrillation
Answer: A. Atrial fibrillation
Rationale: Atrial fibrillation produces chaotic atrial activity, no distinct P waves, and an
irregularly irregular ventricular response.
11. A client develops ventricular tachycardia and has no pulse. Which intervention is
required?
A. Oral beta blocker
B. Immediate defibrillation and CPR according to protocol
C. Ambulation
D. Oral fluids
Answer: B. Immediate defibrillation and CPR according to protocol
Rationale: Pulseless ventricular tachycardia is a shockable cardiac arrest rhythm requiring
immediate resuscitation.
12. Which rhythm is also treated with immediate defibrillation when the client is pulseless?
A. Ventricular fibrillation
B. Sinus tachycardia
C. Atrial fibrillation
D. First-degree AV block
