PCCN CERTIFICATION EXAMS SET 2026 COMPLETE QUESTIONS
WITH ANSWERS ALREADY PASSED. UPDATED
1. A 49-year-old male was recently admitted with an inferior wall
bb bb bb bb bb bb bb bb bb bb
MI resulting from 100% occlusion of the right coronary artery
bb bb bb bb bb bb bb bb bb
(RCA). The 12-Lead ECG reveals ST elevation in leads II, Ill, and avF.
bb bb bb bb bb bb bb bb bb bb bb bb
You would expect to see reciprocal changes in which leads?
bb bb bb bb bb bb bb bb bb
A. I, aVR bb bb
B. V, V2 bb bb
C. V, VA bb bb
D I, aVL - 1. D. I, aVI. The RCA perfuses the inferior wall and the mirror image or reciprocal
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
change will be seen in the high latera wall, which is reflected in leads I, and aVL, on the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
12-Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
With the anterior area of the heart. The aVR lead does not provide much diagnostic value
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
as all energy is depolarizing away from this lead.
bb bb bb bb bb bb bb bb bb
bb bb You are summoned to the room of a 30-year-old female who is experiencing sustained
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb tonic-clonic convulsions while sitting in a chair. A family member states: "She was just
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb talking to us and suddenly she let out a shriek and started flopping like a fish out of water."
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb What is your initial priority of care?bb bb bb bb bb bb
A. Call for help and safely guide the patient to the floor
bb bb bb bb bb bb bb bb bb bb bb
B. Call for help and administer a prescribed antiepileptic
bb bb bb bb bb bb bb bb
C. Call for help and administer a prescribed benzodiazepine
bb bb bb bb bb bb bb bb
D. Call for help and monitor the course of the seizure - A. Call for help and safely guide the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
patient to the floor
bb bb bb bb
bb Patient Safety is priority bb bb bb
bb bb A 46-year-old patient presents with pneumonia and sepsis.
bb bb bb bb bb bb bb
,He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
and is now on 100% FiO, via non-re-breather mask. You obtain an ABG with the following
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
results: pH 7.20 / PaCO, 68/ PaO, 102/ HCO, 28. A chest x-ray reveals bilateral pulmonary
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
infiltrates. The patient is likely developing:
bb bb bb bb bb bb
A. Worsening pneumonia
bb bb
B. Acute Respiratory Distress Syndrome
bb bb bb bb
C. Pulmonary embolus
bb bb
D. Atelectasis - B. Acute Respiratory Distress Syndrome
bb bb bb bb bb bb bb bb
bb bb A 56-year-old male is admitted to the PCU with a hypertensive crisis. His blood pressure
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb is now 205/125 mm Hg and he is complaining of a headache with nausea. He reports he
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb ran out of blood pressure medication three days ago, but also appears to be confused to
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb the date and situation. What is the most appropriate treatment approach?
bb bb bb bb bb bb bb bb bb bb
A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication,
bb bb bb bb bb bb bb bb bb bb bb bb bb
then gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive
bb bb bb bb bb bb bb bb bb bb bb bb bb
medications
bb
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications,
bb bb bb bb bb bb bb bb bb bb bb bb bb
then switch to oral antihypertensive medications for maintenance
bb bb bb bb bb bb bb bb
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
bb bb bb bb bb bb bb bb bb bb bb bb
medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg with
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
oral antihypertensive medications
bb bb bb
D. Slowly lower the diastolic pressure to 85 mm - C. Rapidly lower the diastolic pressure to
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
100 mm Hg with IV antihypertensive medications, then continue to gradually reduce the
bb bb bb bb bb bb bb bb bb bb bb bb bb
diastolic pressure to 85 mm Hg with oral antihypertensive medication
bb bb bb bb bb bb bb bb bb bb
bb bb5. Which of the following labs must be closely monitored when administering Lisinopril to
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb a patient with systolic heart failure?
bb bb bb bb bb
,A. Sodium bb
B. Phosphate bb
C. Magnesium bb
D Potassium - D. Potassium
bb bb bb bb bb
Patients taking angiotensin converting enzyme inhibitors may experience hyperkalemia.
bb bb bb bb bb bb bb bb
ACE inhibitors block angiotensin II, which may lead to decreased aldosterone.
bb bb bb bb bb bb bb bb bb bb bb
Aldosterone is responsible forexcreting potassium from the kidneys. Therefore, ACE
bb bb bb bb bb bb bb bb bb bb
inhibitors can cause potassium retension and potassium levels should be monitored
bb bb bb bb bb bb bb bb bb bb bb
closely. In addition, renal labs such as BUN and creatinine should be monitored. If the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
patient develops more than a 20% increase in the creatinine, the medication should be
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
discontinued.
bb
bb bbA 57-year-old man was admitted with an acute myocardial infarction and is rapidly
bb bb bb bb bb bb bb bb bb bb bb bb
bb deteriorating. He has a BP of 86/42 bb bb bb bb bb bb
(57), heart rate of 110, weak, thready pulses, and mottled skin-especially at the knees. He
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
has had minimal urine output the past 8 hours. A Rapid Response is activated. Which of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
the following medications would be the best option to increase the patient's cardiac
bb bb bb bb bb bb bb bb bb bb bb bb bb
output?
bb
A Dobutamine
bb
B Norepinephrine
bb
C Amiodarone
bb
D Phenylephrine - A Dobutamine. Dobutamine is a positive inotropic medication used to
bb bb bb bb bb bb bb bb bb bb bb bb bb
improve myocardial dysfunction on patients with a low cardiac index and elevated
bb bb bb bb bb bb bb bb bb bb bb bb
afterload. It will improve contractility and reduce afterload. Milrinone, which is a
bb bb bb bb bb bb bb bb bb bb bb bb
phosphodiesterase inhibitor could also be used as an alternative to dobutamine, in the
bb bb bb bb bb bb bb bb bb bb bb bb bb
setting of decompensated heart failure. It is used cautiously in patients experiencing
bb bb bb bb bb bb bb bb bb bb bb bb
cardiogiogenic shock as one of the main side effects of Milrinone is hypotension. The half
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
life of Milrinone is about 6 hours. Norepinephrine and Phenylephrine cause
bb bb bb bb bb bb bb bb bb bb bb
vasoconstriction, which would increase the SVR and may compromise cardiac output.
bb bb bb bb bb bb bb bb bb bb bb
bb bb You are caring for a patient post gastric bypass. Which of the following parameters should
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb you closely monitor after surgery?
bb bb bb bb
, A* HR, RR, temperature, WBC & MAP
bb bb bb bb bb bb
B* Protein levels and vitamin B12
bb bb bb bb bb
C* Albumin and pre-albumin levels
bb bb bb bb
D* Signs of dumping syndrome - A* HR, RR, temperature, WBC & MAP
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb bb You are caring for a patient admitted after a ground level fall. The patient has decreased
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb level of consciousness. On admission the patient is ordered to be a full code. The family
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb arrives with advanced directives stating the patient wishes not to have CPR performed or
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb life sustaining treatment continued. The nurse approaches the provider about this
bb bb bb bb bb bb bb bb bb bb
bb discrepancy and the provider states "I am aware of the advanced directive, but the
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb daughter wants everything done." bb bb bb
What is the appropriate next step by the nurse?
bb bb bb bb bb bb bb bb
A* Ask the daughter why she wants everything done
bb bb bb bb bb bb bb bb
B* Collaborate with the provider and social worker to schedule a family meeting
bb bb bb bb bb bb bb bb bb bb bb bb
C* Tell the doctor we have to follow the patient's wishes
bb bb bb bb bb bb bb bb bb bb
* Discuss the situation with the nurse manager - B* Collaborate with the provider and
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
social worker to schedule a family meeting
bb bb bb bb bb bb bb
bb bb Which is the best intervention to promote safety of the patient receiving hemodialysis?
bb bb bb bb bb bb bb bb bb bb bb bb
A* Direct visualization of the connection between the machine and the access device
bb bb bb bb bb bb bb bb bb bb bb bb
B* Strict intake and output monitoring
bb bb bb bb bb
C* Strict bedrest
bb bb
WITH ANSWERS ALREADY PASSED. UPDATED
1. A 49-year-old male was recently admitted with an inferior wall
bb bb bb bb bb bb bb bb bb bb
MI resulting from 100% occlusion of the right coronary artery
bb bb bb bb bb bb bb bb bb
(RCA). The 12-Lead ECG reveals ST elevation in leads II, Ill, and avF.
bb bb bb bb bb bb bb bb bb bb bb bb
You would expect to see reciprocal changes in which leads?
bb bb bb bb bb bb bb bb bb
A. I, aVR bb bb
B. V, V2 bb bb
C. V, VA bb bb
D I, aVL - 1. D. I, aVI. The RCA perfuses the inferior wall and the mirror image or reciprocal
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
change will be seen in the high latera wall, which is reflected in leads I, and aVL, on the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
12-Lead ECG. Leads V1 and V2 correlate with the septal area, leads V3 and V4 correlate
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
With the anterior area of the heart. The aVR lead does not provide much diagnostic value
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
as all energy is depolarizing away from this lead.
bb bb bb bb bb bb bb bb bb
bb bb You are summoned to the room of a 30-year-old female who is experiencing sustained
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb tonic-clonic convulsions while sitting in a chair. A family member states: "She was just
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb talking to us and suddenly she let out a shriek and started flopping like a fish out of water."
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb What is your initial priority of care?bb bb bb bb bb bb
A. Call for help and safely guide the patient to the floor
bb bb bb bb bb bb bb bb bb bb bb
B. Call for help and administer a prescribed antiepileptic
bb bb bb bb bb bb bb bb
C. Call for help and administer a prescribed benzodiazepine
bb bb bb bb bb bb bb bb
D. Call for help and monitor the course of the seizure - A. Call for help and safely guide the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
patient to the floor
bb bb bb bb
bb Patient Safety is priority bb bb bb
bb bb A 46-year-old patient presents with pneumonia and sepsis.
bb bb bb bb bb bb bb
,He was treated with 4 days of antibiotics and IV fluids. He is increasingly short of breath
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
and is now on 100% FiO, via non-re-breather mask. You obtain an ABG with the following
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
results: pH 7.20 / PaCO, 68/ PaO, 102/ HCO, 28. A chest x-ray reveals bilateral pulmonary
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
infiltrates. The patient is likely developing:
bb bb bb bb bb bb
A. Worsening pneumonia
bb bb
B. Acute Respiratory Distress Syndrome
bb bb bb bb
C. Pulmonary embolus
bb bb
D. Atelectasis - B. Acute Respiratory Distress Syndrome
bb bb bb bb bb bb bb bb
bb bb A 56-year-old male is admitted to the PCU with a hypertensive crisis. His blood pressure
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb is now 205/125 mm Hg and he is complaining of a headache with nausea. He reports he
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb ran out of blood pressure medication three days ago, but also appears to be confused to
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb the date and situation. What is the most appropriate treatment approach?
bb bb bb bb bb bb bb bb bb bb
A. Rapidly lower the systolic pressure to 100 mm Hg with IV antihypertensive medication,
bb bb bb bb bb bb bb bb bb bb bb bb bb
then gradually reduce the diastolic pressure to 85 mm Hg with oral antihypertensive
bb bb bb bb bb bb bb bb bb bb bb bb bb
medications
bb
B. Slowly lower the systolic pressure to 120 mm Hg with IV antihypertensive medications,
bb bb bb bb bb bb bb bb bb bb bb bb bb
then switch to oral antihypertensive medications for maintenance
bb bb bb bb bb bb bb bb
C. Rapidly lower the diastolic pressure to 100 mm Hg with IV antihypertensive
bb bb bb bb bb bb bb bb bb bb bb bb
medications, then continue to gradually reduce the diastolic pressure to 85 mm Hg with
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
oral antihypertensive medications
bb bb bb
D. Slowly lower the diastolic pressure to 85 mm - C. Rapidly lower the diastolic pressure to
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
100 mm Hg with IV antihypertensive medications, then continue to gradually reduce the
bb bb bb bb bb bb bb bb bb bb bb bb bb
diastolic pressure to 85 mm Hg with oral antihypertensive medication
bb bb bb bb bb bb bb bb bb bb
bb bb5. Which of the following labs must be closely monitored when administering Lisinopril to
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb a patient with systolic heart failure?
bb bb bb bb bb
,A. Sodium bb
B. Phosphate bb
C. Magnesium bb
D Potassium - D. Potassium
bb bb bb bb bb
Patients taking angiotensin converting enzyme inhibitors may experience hyperkalemia.
bb bb bb bb bb bb bb bb
ACE inhibitors block angiotensin II, which may lead to decreased aldosterone.
bb bb bb bb bb bb bb bb bb bb bb
Aldosterone is responsible forexcreting potassium from the kidneys. Therefore, ACE
bb bb bb bb bb bb bb bb bb bb
inhibitors can cause potassium retension and potassium levels should be monitored
bb bb bb bb bb bb bb bb bb bb bb
closely. In addition, renal labs such as BUN and creatinine should be monitored. If the
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
patient develops more than a 20% increase in the creatinine, the medication should be
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
discontinued.
bb
bb bbA 57-year-old man was admitted with an acute myocardial infarction and is rapidly
bb bb bb bb bb bb bb bb bb bb bb bb
bb deteriorating. He has a BP of 86/42 bb bb bb bb bb bb
(57), heart rate of 110, weak, thready pulses, and mottled skin-especially at the knees. He
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
has had minimal urine output the past 8 hours. A Rapid Response is activated. Which of
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
the following medications would be the best option to increase the patient's cardiac
bb bb bb bb bb bb bb bb bb bb bb bb bb
output?
bb
A Dobutamine
bb
B Norepinephrine
bb
C Amiodarone
bb
D Phenylephrine - A Dobutamine. Dobutamine is a positive inotropic medication used to
bb bb bb bb bb bb bb bb bb bb bb bb bb
improve myocardial dysfunction on patients with a low cardiac index and elevated
bb bb bb bb bb bb bb bb bb bb bb bb
afterload. It will improve contractility and reduce afterload. Milrinone, which is a
bb bb bb bb bb bb bb bb bb bb bb bb
phosphodiesterase inhibitor could also be used as an alternative to dobutamine, in the
bb bb bb bb bb bb bb bb bb bb bb bb bb
setting of decompensated heart failure. It is used cautiously in patients experiencing
bb bb bb bb bb bb bb bb bb bb bb bb
cardiogiogenic shock as one of the main side effects of Milrinone is hypotension. The half
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
life of Milrinone is about 6 hours. Norepinephrine and Phenylephrine cause
bb bb bb bb bb bb bb bb bb bb bb
vasoconstriction, which would increase the SVR and may compromise cardiac output.
bb bb bb bb bb bb bb bb bb bb bb
bb bb You are caring for a patient post gastric bypass. Which of the following parameters should
bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb you closely monitor after surgery?
bb bb bb bb
, A* HR, RR, temperature, WBC & MAP
bb bb bb bb bb bb
B* Protein levels and vitamin B12
bb bb bb bb bb
C* Albumin and pre-albumin levels
bb bb bb bb
D* Signs of dumping syndrome - A* HR, RR, temperature, WBC & MAP
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb bb You are caring for a patient admitted after a ground level fall. The patient has decreased
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb level of consciousness. On admission the patient is ordered to be a full code. The family
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
bb arrives with advanced directives stating the patient wishes not to have CPR performed or
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb life sustaining treatment continued. The nurse approaches the provider about this
bb bb bb bb bb bb bb bb bb bb
bb discrepancy and the provider states "I am aware of the advanced directive, but the
bb bb bb bb bb bb bb bb bb bb bb bb bb
bb daughter wants everything done." bb bb bb
What is the appropriate next step by the nurse?
bb bb bb bb bb bb bb bb
A* Ask the daughter why she wants everything done
bb bb bb bb bb bb bb bb
B* Collaborate with the provider and social worker to schedule a family meeting
bb bb bb bb bb bb bb bb bb bb bb bb
C* Tell the doctor we have to follow the patient's wishes
bb bb bb bb bb bb bb bb bb bb
* Discuss the situation with the nurse manager - B* Collaborate with the provider and
bb bb bb bb bb bb bb bb bb bb bb bb bb bb bb
social worker to schedule a family meeting
bb bb bb bb bb bb bb
bb bb Which is the best intervention to promote safety of the patient receiving hemodialysis?
bb bb bb bb bb bb bb bb bb bb bb bb
A* Direct visualization of the connection between the machine and the access device
bb bb bb bb bb bb bb bb bb bb bb bb
B* Strict intake and output monitoring
bb bb bb bb bb
C* Strict bedrest
bb bb
