PCCN Certification Progressive Care
Nursing Practice Exam: 150 Advanced
Multiple-Choice Questions with Rationales
Difficulty Level: Advanced / Hard
Target Audience: Registered nurses preparing for PCCN certification; progressive care and step-down
unit practitioners.
Format: 150 multiple-choice questions with four options each, one correct answer, detailed rationale,
and content-area mapping.
Citation Note: All questions are derived from AACN PCCN Test Plan content areas and testable nursing
actions, AACN Scope and Standards for Progressive Care Nursing Practice, and published PCCN review
materials including Pass PCCN! (Dennison), PCCN® Q & A: 200 Questions (Christie), and AACN
certification review resources .
Table of Contents
Section Content Area Question Range Percentage of Exam
I Cardiovascular Q1–Q45 30%
II Pulmonary Q46–Q75 20%
III Endocrine Q76–Q90 10%
IV Hematology / Immunology Q91–Q97 4.7%
V Neurology Q98–Q110 8.7%
VI Gastrointestinal Q111–Q120 6.7%
VII Renal Q121–Q130 6.7%
VIII Multisystem Q131–Q140 6.7%
,Section Content Area Question Range Percentage of Exam
IX Behavioral / Psychosocial Q141–Q145 3.3%
X Professional Caring & Ethical Practice Q146–Q150 3.3%
SECTION I: CARDIOVASCULAR (Q1–Q45)
🟢 Q1. A 68-year-old male is admitted to the progressive care unit with crushing substernal chest pain
that began 45 minutes ago. His ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🔴 Correct Answer: C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction,
which is most commonly caused by occlusion of the right coronary artery (RCA) in approximately 80% of
cases. The RCA supplies the inferior wall of the left ventricle. The left anterior descending artery supplies
the anterior wall (leads V1–V4). The left circumflex artery supplies the lateral wall (leads I, aVL, V5–V6).
The left main coronary artery supplies a large territory and would present with more diffuse changes
and hemodynamic collapse .
🟢 Q2. A patient with acute decompensated heart failure is receiving nesiritide (Natrecor). The nurse
should most closely monitor the patient for which side effect?
A. Hypokalemia
B. Hypotension
C. Ventricular dysrhythmia
D. Hypernatremia
🔴 Correct Answer: B. Hypotension
Rationale: Nesiritide is a recombinant form of human B-type natriuretic peptide that causes vasodilation
and natriuresis. Its most significant adverse effect is hypotension, which occurs because of its potent
vasodilatory properties. Patients should have frequent blood pressure monitoring during infusion.
Hypokalemia is more commonly associated with loop diuretics. Ventricular dysrhythmias are not a
primary side effect of nesiritide .
🟢 Q3. The heart sound most often associated with heart failure is:
A. An S3
B. A pericardial friction rub
,C. An S4
D. A systolic ejection murmur
🔴 Correct Answer: A. An S3
Rationale: An S3 gallop is the classic heart sound associated with heart failure. It occurs during rapid
ventricular filling in early diastole and is caused by the vibration of the ventricular walls when they are
distended by a large volume of blood. The presence of an S3 is a hallmark sign of volume overload and
systolic dysfunction. An S4 is associated with decreased ventricular compliance and is commonly heard
in diastolic dysfunction or hypertension. A pericardial friction rub indicates pericarditis .
🟢 Q4. A patient is admitted with acute decompensated heart failure and has a pulmonary artery
catheter in place. The following hemodynamic values are obtained: CVP 14 mmHg, PAWP 28 mmHg,
cardiac index 1.8 L/min/m², SVR 1,600 dynes/sec/cm⁻⁵. These findings are most consistent with:
A. Cardiogenic shock
B. Septic shock
C. Hypovolemic shock
D. Neurogenic shock
🔴 Correct Answer: A. Cardiogenic shock
Rationale: Cardiogenic shock is characterized by elevated filling pressures (CVP and PAWP), decreased
cardiac index (<2.2 L/min/m²), and elevated systemic vascular resistance (compensatory
vasoconstriction). The elevated PAWP (28 mmHg) indicates left ventricular failure with volume overload,
and the low cardiac index reflects poor forward flow. Septic shock presents with low SVR and often
elevated cardiac index. Hypovolemic shock presents with low CVP and PAWP. Neurogenic shock
presents with bradycardia and low SVR .
🟢 Q5. A patient with a dilated cardiomyopathy is at highest risk for which dysrhythmia?
A. Sinus bradycardia
B. Atrial fibrillation
C. Junctional rhythm
D. First-degree heart block
🔴 Correct Answer: B. Atrial fibrillation
Rationale: Dilated cardiomyopathy causes stretching and fibrosis of the atrial myocardium, which
predisposes patients to atrial fibrillation. The enlarged atria create a substrate for reentrant circuits.
Atrial fibrillation occurs in approximately 20–30% of patients with dilated cardiomyopathy and can
precipitate decompensated heart failure due to loss of atrial kick. Sinus bradycardia and junctional
rhythms are not characteristic of dilated cardiomyopathy .
🟢 Q6. A patient is scheduled for electrical cardioversion for symptomatic atrial fibrillation. The nurse
should ensure that:
A. The patient has been NPO for at least 2 hours
B. The defibrillator is set to synchronized mode
, C. Atropine is available at the bedside
D. The patient receives a bolus of amiodarone before the procedure
🔴 Correct Answer: B. The defibrillator is set to synchronized mode
Rationale: Synchronized cardioversion delivers a shock timed to the QRS complex to avoid delivering
energy during the T-wave, which could induce ventricular fibrillation. The defibrillator must be in
synchronized mode. The patient should be NPO for 6–8 hours, not 2 hours. Atropine is not indicated.
Amiodarone may be used but is not a prerequisite for the procedure .
🟢 Q7. Which physiologic change occurs as a direct result of cardiogenic shock?
A. Increase in capacitance
B. Increase in afterload
C. Decrease in preload
D. Decrease in systemic vascular resistance
🔴 Correct Answer: B. Increase in afterload
Rationale: Cardiogenic shock results from pump failure, leading to decreased cardiac output and
activation of compensatory mechanisms including the sympathetic nervous system and renin-
angiotensin-aldosterone system. These mechanisms cause vasoconstriction, which increases afterload
(systemic vascular resistance). Preload is typically increased due to fluid backup. Capacitance vessels
constrict, decreasing capacitance. SVR is elevated, not decreased .
🟢 Q8. A patient in the progressive care unit develops new-onset atrial fibrillation with a heart rate of 140
bpm and a blood pressure of 110/70 mmHg. What is the priority nursing action?
A. Prepare for immediate synchronized cardioversion
B. Administer IV diltiazem as ordered
C. Initiate CPR
D. Administer IV amiodarone as ordered
🔴 Correct Answer: B. Administer IV diltiazem as ordered
Rationale: For stable atrial fibrillation with rapid ventricular response (heart rate >120 bpm) and
adequate blood pressure, rate control is the priority. IV diltiazem (a calcium channel blocker) is the first-
line agent for rate control in stable patients. Synchronized cardioversion is indicated for unstable
patients (hypotension, ischemia, altered mental status, or acute heart failure). CPR is not indicated as
the patient has a pulse and adequate blood pressure .
🟢 Q9. A patient is receiving a continuous infusion of norepinephrine (Levophed) for cardiogenic shock.
The nurse understands that the primary purpose of this medication is to:
A. Decrease myocardial oxygen demand
B. Increase systemic vascular resistance
C. Increase heart rate
D. Decrease preload
🔴 Correct Answer: B. Increase systemic vascular resistance
Nursing Practice Exam: 150 Advanced
Multiple-Choice Questions with Rationales
Difficulty Level: Advanced / Hard
Target Audience: Registered nurses preparing for PCCN certification; progressive care and step-down
unit practitioners.
Format: 150 multiple-choice questions with four options each, one correct answer, detailed rationale,
and content-area mapping.
Citation Note: All questions are derived from AACN PCCN Test Plan content areas and testable nursing
actions, AACN Scope and Standards for Progressive Care Nursing Practice, and published PCCN review
materials including Pass PCCN! (Dennison), PCCN® Q & A: 200 Questions (Christie), and AACN
certification review resources .
Table of Contents
Section Content Area Question Range Percentage of Exam
I Cardiovascular Q1–Q45 30%
II Pulmonary Q46–Q75 20%
III Endocrine Q76–Q90 10%
IV Hematology / Immunology Q91–Q97 4.7%
V Neurology Q98–Q110 8.7%
VI Gastrointestinal Q111–Q120 6.7%
VII Renal Q121–Q130 6.7%
VIII Multisystem Q131–Q140 6.7%
,Section Content Area Question Range Percentage of Exam
IX Behavioral / Psychosocial Q141–Q145 3.3%
X Professional Caring & Ethical Practice Q146–Q150 3.3%
SECTION I: CARDIOVASCULAR (Q1–Q45)
🟢 Q1. A 68-year-old male is admitted to the progressive care unit with crushing substernal chest pain
that began 45 minutes ago. His ECG shows ST-segment elevation in leads II, III, and aVF. Which coronary
artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🔴 Correct Answer: C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction,
which is most commonly caused by occlusion of the right coronary artery (RCA) in approximately 80% of
cases. The RCA supplies the inferior wall of the left ventricle. The left anterior descending artery supplies
the anterior wall (leads V1–V4). The left circumflex artery supplies the lateral wall (leads I, aVL, V5–V6).
The left main coronary artery supplies a large territory and would present with more diffuse changes
and hemodynamic collapse .
🟢 Q2. A patient with acute decompensated heart failure is receiving nesiritide (Natrecor). The nurse
should most closely monitor the patient for which side effect?
A. Hypokalemia
B. Hypotension
C. Ventricular dysrhythmia
D. Hypernatremia
🔴 Correct Answer: B. Hypotension
Rationale: Nesiritide is a recombinant form of human B-type natriuretic peptide that causes vasodilation
and natriuresis. Its most significant adverse effect is hypotension, which occurs because of its potent
vasodilatory properties. Patients should have frequent blood pressure monitoring during infusion.
Hypokalemia is more commonly associated with loop diuretics. Ventricular dysrhythmias are not a
primary side effect of nesiritide .
🟢 Q3. The heart sound most often associated with heart failure is:
A. An S3
B. A pericardial friction rub
,C. An S4
D. A systolic ejection murmur
🔴 Correct Answer: A. An S3
Rationale: An S3 gallop is the classic heart sound associated with heart failure. It occurs during rapid
ventricular filling in early diastole and is caused by the vibration of the ventricular walls when they are
distended by a large volume of blood. The presence of an S3 is a hallmark sign of volume overload and
systolic dysfunction. An S4 is associated with decreased ventricular compliance and is commonly heard
in diastolic dysfunction or hypertension. A pericardial friction rub indicates pericarditis .
🟢 Q4. A patient is admitted with acute decompensated heart failure and has a pulmonary artery
catheter in place. The following hemodynamic values are obtained: CVP 14 mmHg, PAWP 28 mmHg,
cardiac index 1.8 L/min/m², SVR 1,600 dynes/sec/cm⁻⁵. These findings are most consistent with:
A. Cardiogenic shock
B. Septic shock
C. Hypovolemic shock
D. Neurogenic shock
🔴 Correct Answer: A. Cardiogenic shock
Rationale: Cardiogenic shock is characterized by elevated filling pressures (CVP and PAWP), decreased
cardiac index (<2.2 L/min/m²), and elevated systemic vascular resistance (compensatory
vasoconstriction). The elevated PAWP (28 mmHg) indicates left ventricular failure with volume overload,
and the low cardiac index reflects poor forward flow. Septic shock presents with low SVR and often
elevated cardiac index. Hypovolemic shock presents with low CVP and PAWP. Neurogenic shock
presents with bradycardia and low SVR .
🟢 Q5. A patient with a dilated cardiomyopathy is at highest risk for which dysrhythmia?
A. Sinus bradycardia
B. Atrial fibrillation
C. Junctional rhythm
D. First-degree heart block
🔴 Correct Answer: B. Atrial fibrillation
Rationale: Dilated cardiomyopathy causes stretching and fibrosis of the atrial myocardium, which
predisposes patients to atrial fibrillation. The enlarged atria create a substrate for reentrant circuits.
Atrial fibrillation occurs in approximately 20–30% of patients with dilated cardiomyopathy and can
precipitate decompensated heart failure due to loss of atrial kick. Sinus bradycardia and junctional
rhythms are not characteristic of dilated cardiomyopathy .
🟢 Q6. A patient is scheduled for electrical cardioversion for symptomatic atrial fibrillation. The nurse
should ensure that:
A. The patient has been NPO for at least 2 hours
B. The defibrillator is set to synchronized mode
, C. Atropine is available at the bedside
D. The patient receives a bolus of amiodarone before the procedure
🔴 Correct Answer: B. The defibrillator is set to synchronized mode
Rationale: Synchronized cardioversion delivers a shock timed to the QRS complex to avoid delivering
energy during the T-wave, which could induce ventricular fibrillation. The defibrillator must be in
synchronized mode. The patient should be NPO for 6–8 hours, not 2 hours. Atropine is not indicated.
Amiodarone may be used but is not a prerequisite for the procedure .
🟢 Q7. Which physiologic change occurs as a direct result of cardiogenic shock?
A. Increase in capacitance
B. Increase in afterload
C. Decrease in preload
D. Decrease in systemic vascular resistance
🔴 Correct Answer: B. Increase in afterload
Rationale: Cardiogenic shock results from pump failure, leading to decreased cardiac output and
activation of compensatory mechanisms including the sympathetic nervous system and renin-
angiotensin-aldosterone system. These mechanisms cause vasoconstriction, which increases afterload
(systemic vascular resistance). Preload is typically increased due to fluid backup. Capacitance vessels
constrict, decreasing capacitance. SVR is elevated, not decreased .
🟢 Q8. A patient in the progressive care unit develops new-onset atrial fibrillation with a heart rate of 140
bpm and a blood pressure of 110/70 mmHg. What is the priority nursing action?
A. Prepare for immediate synchronized cardioversion
B. Administer IV diltiazem as ordered
C. Initiate CPR
D. Administer IV amiodarone as ordered
🔴 Correct Answer: B. Administer IV diltiazem as ordered
Rationale: For stable atrial fibrillation with rapid ventricular response (heart rate >120 bpm) and
adequate blood pressure, rate control is the priority. IV diltiazem (a calcium channel blocker) is the first-
line agent for rate control in stable patients. Synchronized cardioversion is indicated for unstable
patients (hypotension, ischemia, altered mental status, or acute heart failure). CPR is not indicated as
the patient has a pulse and adequate blood pressure .
🟢 Q9. A patient is receiving a continuous infusion of norepinephrine (Levophed) for cardiogenic shock.
The nurse understands that the primary purpose of this medication is to:
A. Decrease myocardial oxygen demand
B. Increase systemic vascular resistance
C. Increase heart rate
D. Decrease preload
🔴 Correct Answer: B. Increase systemic vascular resistance
