1
PCCN Exam Questions and Answers with
Rationales 2025/2026 | Progressive Care
Certified Nurse Test Bank | 150 Practice
Questions | Pass Guarantee
SECTION 1 – Multiple-Choice Core (110 Questions)
1. The nurse notes a progressive-care patient suddenly converts from sinus
rhythm to atrial fibrillation with a ventricular rate of 170 beats/min. The
FIRST priority is to:
A. Administer adenosine 6 mg IV push
B. Assess blood pressure and level of consciousness
C. Obtain a stat 12-lead ECG
D. Prepare for synchronized cardioversion
Answer: B
Rationale: Rapid ventricular response may compromise perfusion; initial
action is to assess clinical stability per AHA ACLS guidelines (2025
Update).
2. A patient with acute respiratory failure on high-flow nasal cannula (HFNC
50 L/min, FiO₂ 0.50) becomes increasingly tachypneic with PaCO₂ 55
mmHg (previously 45). The nurse should:
A. Increase HFNC FiO₂ to 0.60
B. Transition to non-invasive ventilation (NIV)
C. Sedate and initiate mechanical ventilation
D. Add aerosolized bronchodilator
Answer: B
Rationale: Rising PaCO₂ indicates worsening ventilation; NIV provides
both PEEP and pressure support, reducing work of breathing (ATS 2025
HFNC/NIV consensus).
, 2
3. When assessing a patient 6 hours post-percutaneous coronary intervention
(PCI) via radial access, the nurse notes hand pallor and a weak radial pulse.
The MOST likely complication is:
A. Retroperitoneal bleed
B. Radial artery occlusion
C. Stent thrombosis
D. Acute limb ischemia from dissection
Answer: B
Rationale: Pallor + weak pulse after radial PCI suggests occlusion;
progressive-care protocol includes duplex and anticoagulation evaluation
(ESC 2025 radial best-practice).
4. A patient with heart failure with preserved ejection fraction (HFpEF)
develops acute hypertension 210/110 mmHg and flash pulmonary edema.
The nurse should anticipate administering:
A. Metoprolol 5 mg IV q5 min
B. Nicardipine infusion starting 5 mg/h
C. Furosemide 40 mg PO
D. Digoxin 0.25 mg IV
Answer: B
Rationale: Rapid afterload reduction with nicardipine improves diastolic
filling and pulmonary congestion (AHA HF 2025 guidelines).
5. A patient on a Diltiazem drip at 15 mg/hr for rate-controlled AF suddenly
becomes hypotensive (82/50 mmHg) with HR 52. The nurse’s IMMEDIATE
action is to:
A. Give atropine 0.5 mg IV
B. Stop the diltiazem infusion
C. Begin dopamine 5 µg/kg/min
D. Obtain stat calcium gluconate
Answer: B
Rationale: Calcium-channel blocker toxicity → bradycardia & vasodilation;
stop drug first, then consider antidotes (AHA ACLS 2025).
6. Which finding signals impending respiratory failure in a patient with
Guillain-Barré syndrome?
, 3
A. Oxygen saturation 94 % on 2 L NC
B. Negative inspiratory force (NIF) –15 cm H₂O
C. Tidal volume 400 mL (IBW 70 kg)
D. Respiratory rate 22/min
Answer: B
Rationale: NIF < –20 cm H₂O or VC < 20 mL/kg predicts need for
intubation (AACN Neuro 2025).
7. A patient with subarachnoid hemorrhage (Day 2) develops sudden onset of
hyponatremia (Na 128 mEq/L) and polyuria. The nurse should suspect:
A. Diabetes insipidus
B. Cerebral salt wasting
C. SIADH
D. Acute tubular necrosis
Answer: B
Rationale: Salt wasting presents with hyponatremia + high urine
Na/polyuria; requires Na replacement (Neurocritical Care 2025).
8. The nurse is titrating a heparin infusion per protocol (PTT q6h). The PTT is
120 seconds (goal 60–80). The nurse should:
A. Continue current rate
B. Increase rate by 2 units/kg/h
C. Stop infusion for 1 hour and restart at reduced rate
D. Switch to argatroban
Answer: C
Rationale: Supratherapeutic PTT → hold dose then reduce; prevents
bleeding (ACCP 2025 anticoag guidelines).
9. A patient with COPD exacerbation receiving bi-level NIV has ABG: pH
7.28, PaCO₂ 65 mmHg, HCO₃ 30 mEq/L. The nurse should:
A. Increase IPAP by 2 cm H₂O
B. Increase EPAP by 2 cm H₂O
C. Add 1 L/min O₂ to raise SpO₂ to 100 %
D. Switch to CPAP
Answer: A
, 4
Rationale: Raising IPAP augments tidal volume and CO₂ removal; EPAP
addresses oxygenation/PEEPi (GOLD 2025).
10.Which ECG change is MOST concerning in a patient with chest pain?
A. Sinus tachycardia
B. Peaked T waves in V₂–V₃
C. New 2 mm ST elevation in two contiguous leads
D. First-degree AV block
Answer: C
Rationale: STEMI mandates immediate reperfusion (AHA 2025).
11.A patient with acute kidney injury (AKI) on continuous renal replacement
therapy (CRRT) has sudden filter pressure alarms and dark streaks in the
effluent. The nurse should FIRST:
A. Increase anticoagulant dose
B. Check access & return lines for kinks
C. Reduce blood-flow rate to 50 mL/min
D. Change filter immediately
Answer: B
Rationale: High pressure + dark streaks suggest clotting often due to line
obstruction; correct cause first (AACN CRRT 2025).
12.A patient with acute pancreatitis has a nasogastric tube placed. The nurse
notes sudden tachypnea and SpO₂ 88 %. Suspected cause is:
A. Aspiration pneumonia
B. Acute respiratory distress syndrome (ARDS)
C. Pulmonary embolism
D. Pneumothorax
Answer: B
Rationale: Severe pancreatitis can precipitate early ARDS via systemic
inflammation (ACG 2025).
13.Which intervention is PRIORITY for a patient with symptomatic
bradycardia (HR 38, BP 78/50)?
A. Transcutaneous pacing
B. Isoproterenol 2 µg/min
C. Atropine 0.5 mg IV
PCCN Exam Questions and Answers with
Rationales 2025/2026 | Progressive Care
Certified Nurse Test Bank | 150 Practice
Questions | Pass Guarantee
SECTION 1 – Multiple-Choice Core (110 Questions)
1. The nurse notes a progressive-care patient suddenly converts from sinus
rhythm to atrial fibrillation with a ventricular rate of 170 beats/min. The
FIRST priority is to:
A. Administer adenosine 6 mg IV push
B. Assess blood pressure and level of consciousness
C. Obtain a stat 12-lead ECG
D. Prepare for synchronized cardioversion
Answer: B
Rationale: Rapid ventricular response may compromise perfusion; initial
action is to assess clinical stability per AHA ACLS guidelines (2025
Update).
2. A patient with acute respiratory failure on high-flow nasal cannula (HFNC
50 L/min, FiO₂ 0.50) becomes increasingly tachypneic with PaCO₂ 55
mmHg (previously 45). The nurse should:
A. Increase HFNC FiO₂ to 0.60
B. Transition to non-invasive ventilation (NIV)
C. Sedate and initiate mechanical ventilation
D. Add aerosolized bronchodilator
Answer: B
Rationale: Rising PaCO₂ indicates worsening ventilation; NIV provides
both PEEP and pressure support, reducing work of breathing (ATS 2025
HFNC/NIV consensus).
, 2
3. When assessing a patient 6 hours post-percutaneous coronary intervention
(PCI) via radial access, the nurse notes hand pallor and a weak radial pulse.
The MOST likely complication is:
A. Retroperitoneal bleed
B. Radial artery occlusion
C. Stent thrombosis
D. Acute limb ischemia from dissection
Answer: B
Rationale: Pallor + weak pulse after radial PCI suggests occlusion;
progressive-care protocol includes duplex and anticoagulation evaluation
(ESC 2025 radial best-practice).
4. A patient with heart failure with preserved ejection fraction (HFpEF)
develops acute hypertension 210/110 mmHg and flash pulmonary edema.
The nurse should anticipate administering:
A. Metoprolol 5 mg IV q5 min
B. Nicardipine infusion starting 5 mg/h
C. Furosemide 40 mg PO
D. Digoxin 0.25 mg IV
Answer: B
Rationale: Rapid afterload reduction with nicardipine improves diastolic
filling and pulmonary congestion (AHA HF 2025 guidelines).
5. A patient on a Diltiazem drip at 15 mg/hr for rate-controlled AF suddenly
becomes hypotensive (82/50 mmHg) with HR 52. The nurse’s IMMEDIATE
action is to:
A. Give atropine 0.5 mg IV
B. Stop the diltiazem infusion
C. Begin dopamine 5 µg/kg/min
D. Obtain stat calcium gluconate
Answer: B
Rationale: Calcium-channel blocker toxicity → bradycardia & vasodilation;
stop drug first, then consider antidotes (AHA ACLS 2025).
6. Which finding signals impending respiratory failure in a patient with
Guillain-Barré syndrome?
, 3
A. Oxygen saturation 94 % on 2 L NC
B. Negative inspiratory force (NIF) –15 cm H₂O
C. Tidal volume 400 mL (IBW 70 kg)
D. Respiratory rate 22/min
Answer: B
Rationale: NIF < –20 cm H₂O or VC < 20 mL/kg predicts need for
intubation (AACN Neuro 2025).
7. A patient with subarachnoid hemorrhage (Day 2) develops sudden onset of
hyponatremia (Na 128 mEq/L) and polyuria. The nurse should suspect:
A. Diabetes insipidus
B. Cerebral salt wasting
C. SIADH
D. Acute tubular necrosis
Answer: B
Rationale: Salt wasting presents with hyponatremia + high urine
Na/polyuria; requires Na replacement (Neurocritical Care 2025).
8. The nurse is titrating a heparin infusion per protocol (PTT q6h). The PTT is
120 seconds (goal 60–80). The nurse should:
A. Continue current rate
B. Increase rate by 2 units/kg/h
C. Stop infusion for 1 hour and restart at reduced rate
D. Switch to argatroban
Answer: C
Rationale: Supratherapeutic PTT → hold dose then reduce; prevents
bleeding (ACCP 2025 anticoag guidelines).
9. A patient with COPD exacerbation receiving bi-level NIV has ABG: pH
7.28, PaCO₂ 65 mmHg, HCO₃ 30 mEq/L. The nurse should:
A. Increase IPAP by 2 cm H₂O
B. Increase EPAP by 2 cm H₂O
C. Add 1 L/min O₂ to raise SpO₂ to 100 %
D. Switch to CPAP
Answer: A
, 4
Rationale: Raising IPAP augments tidal volume and CO₂ removal; EPAP
addresses oxygenation/PEEPi (GOLD 2025).
10.Which ECG change is MOST concerning in a patient with chest pain?
A. Sinus tachycardia
B. Peaked T waves in V₂–V₃
C. New 2 mm ST elevation in two contiguous leads
D. First-degree AV block
Answer: C
Rationale: STEMI mandates immediate reperfusion (AHA 2025).
11.A patient with acute kidney injury (AKI) on continuous renal replacement
therapy (CRRT) has sudden filter pressure alarms and dark streaks in the
effluent. The nurse should FIRST:
A. Increase anticoagulant dose
B. Check access & return lines for kinks
C. Reduce blood-flow rate to 50 mL/min
D. Change filter immediately
Answer: B
Rationale: High pressure + dark streaks suggest clotting often due to line
obstruction; correct cause first (AACN CRRT 2025).
12.A patient with acute pancreatitis has a nasogastric tube placed. The nurse
notes sudden tachypnea and SpO₂ 88 %. Suspected cause is:
A. Aspiration pneumonia
B. Acute respiratory distress syndrome (ARDS)
C. Pulmonary embolism
D. Pneumothorax
Answer: B
Rationale: Severe pancreatitis can precipitate early ARDS via systemic
inflammation (ACG 2025).
13.Which intervention is PRIORITY for a patient with symptomatic
bradycardia (HR 38, BP 78/50)?
A. Transcutaneous pacing
B. Isoproterenol 2 µg/min
C. Atropine 0.5 mg IV
