,PCCN Exam 2026 | Comprehensive Test Bank | Questions And
Answers
TABLE OF CONTENTS
1. Cardiovascular — Q1–Q40
2. Respiratory — Q41–Q68
3. Endocrine — Q69–Q80
4. Hematology/Immunology/Oncology — Q81–Q86
5. Neurology — Q87–Q100
6. Gastrointestinal — Q101–Q114
7. Renal — Q115–Q122
8. Musculoskeletal — Q123–Q126
9. Multisystem — Q127–Q155
10. Behavioral/Psychosocial — Q156–Q160
11. Professional Caring and Ethical Practice — Q161–Q200
1. CARDIOVASCULAR
Q1. A patient with an acute myocardial infarction develops BP 82/48
mm Hg, HR 124/min, cool extremities, and urine output of 15 mL/hr.
Which finding most strongly indicates inadequate systemic
perfusion?
A) Heart rate 124/min
B) Blood pressure 82/48 mm Hg
C) Urine output 15 mL/hr
D) Cool extremities
Correct Answer: C) Urine output 15 mL/hr
Rationale: Reduced urine output reflects decreased renal perfusion and can
be an early indicator of inadequate cardiac output. In the setting of
hypotension and myocardial injury, oliguria suggests clinically significant
systemic hypoperfusion.
,Q2. A patient with cardiogenic shock has a cardiac index of 1.7
L/min/m² and a pulmonary artery wedge pressure of 24 mm Hg. How
should the nurse interpret these findings?
A) High output with low left-sided filling pressure
B) Low output with elevated left-sided filling pressure
C) Normal cardiac output with severe hypovolemia
D) High output caused by distributive shock
Correct Answer: B) Low output with elevated left-sided filling pressure
Rationale: A low cardiac index indicates impaired forward blood flow, while
an elevated wedge pressure reflects increased left-sided filling pressure.
Together these findings are consistent with left ventricular pump failure.
Q3. A patient reports crushing substernal chest pain with
diaphoresis and nausea. Which assessment should receive priority?
A) Bowel sounds
B) Skin turgor
C) Cardiac rhythm and hemodynamic status
D) Peripheral edema
Correct Answer: C) Cardiac rhythm and hemodynamic status
Rationale: Acute coronary ischemia can rapidly cause dysrhythmias,
ventricular dysfunction, and hemodynamic instability. Continuous
assessment of rhythm and circulation helps identify immediate life-
threatening deterioration.
Q4. Which ECG finding is most concerning in a patient receiving a
medication that can prolong ventricular repolarization?
A) Short PR interval
B) Peaked P waves
C) Prolonged QTc interval
D) Slightly elevated heart rate
Correct Answer: C) Prolonged QTc interval
Rationale: QTc prolongation increases the risk for torsades de pointes and
other ventricular dysrhythmias. The risk becomes particularly important
when QT-prolonging medications or electrolyte abnormalities are present.
Q5. A patient with cardiac tamponade becomes increasingly
hypotensive. Which additional finding is expected?
, A) Muffled heart sounds
B) Bounding pulses
C) Increased urine output
D) Increased pulse pressure
Correct Answer: A) Muffled heart sounds
Rationale: Pericardial fluid compresses the heart and impairs ventricular
filling. This can produce muffled heart sounds, hypotension, venous
congestion, and reduced cardiac output.
Q6. A patient develops sudden severe tearing chest pain radiating
to the back. Which condition should the nurse suspect?
A) Stable angina
B) Aortic dissection
C) Pericarditis
D) Gastroesophageal reflux
Correct Answer: B) Aortic dissection
Rationale: Sudden severe chest or back pain is characteristic of aortic
dissection. The condition can rapidly compromise blood flow to major organs
or result in catastrophic hemorrhage.
Q7. After femoral cardiac catheterization, a patient suddenly
reports severe leg pain and the pedal pulse is absent. What is the
priority concern?
A) Expected postprocedure discomfort
B) Arterial perfusion compromise
C) Fluid overload
D) Peripheral neuropathy
Correct Answer: B) Arterial perfusion compromise
Rationale: Loss of a previously present distal pulse after arterial
catheterization can indicate thrombosis, embolization, arterial injury, or
another vascular complication requiring immediate evaluation.
Q8. A patient with acute heart failure develops severe dyspnea,
crackles, and pink frothy sputum. Which intervention is the priority?
A) Place the patient flat
B) Encourage oral fluids
Answers
TABLE OF CONTENTS
1. Cardiovascular — Q1–Q40
2. Respiratory — Q41–Q68
3. Endocrine — Q69–Q80
4. Hematology/Immunology/Oncology — Q81–Q86
5. Neurology — Q87–Q100
6. Gastrointestinal — Q101–Q114
7. Renal — Q115–Q122
8. Musculoskeletal — Q123–Q126
9. Multisystem — Q127–Q155
10. Behavioral/Psychosocial — Q156–Q160
11. Professional Caring and Ethical Practice — Q161–Q200
1. CARDIOVASCULAR
Q1. A patient with an acute myocardial infarction develops BP 82/48
mm Hg, HR 124/min, cool extremities, and urine output of 15 mL/hr.
Which finding most strongly indicates inadequate systemic
perfusion?
A) Heart rate 124/min
B) Blood pressure 82/48 mm Hg
C) Urine output 15 mL/hr
D) Cool extremities
Correct Answer: C) Urine output 15 mL/hr
Rationale: Reduced urine output reflects decreased renal perfusion and can
be an early indicator of inadequate cardiac output. In the setting of
hypotension and myocardial injury, oliguria suggests clinically significant
systemic hypoperfusion.
,Q2. A patient with cardiogenic shock has a cardiac index of 1.7
L/min/m² and a pulmonary artery wedge pressure of 24 mm Hg. How
should the nurse interpret these findings?
A) High output with low left-sided filling pressure
B) Low output with elevated left-sided filling pressure
C) Normal cardiac output with severe hypovolemia
D) High output caused by distributive shock
Correct Answer: B) Low output with elevated left-sided filling pressure
Rationale: A low cardiac index indicates impaired forward blood flow, while
an elevated wedge pressure reflects increased left-sided filling pressure.
Together these findings are consistent with left ventricular pump failure.
Q3. A patient reports crushing substernal chest pain with
diaphoresis and nausea. Which assessment should receive priority?
A) Bowel sounds
B) Skin turgor
C) Cardiac rhythm and hemodynamic status
D) Peripheral edema
Correct Answer: C) Cardiac rhythm and hemodynamic status
Rationale: Acute coronary ischemia can rapidly cause dysrhythmias,
ventricular dysfunction, and hemodynamic instability. Continuous
assessment of rhythm and circulation helps identify immediate life-
threatening deterioration.
Q4. Which ECG finding is most concerning in a patient receiving a
medication that can prolong ventricular repolarization?
A) Short PR interval
B) Peaked P waves
C) Prolonged QTc interval
D) Slightly elevated heart rate
Correct Answer: C) Prolonged QTc interval
Rationale: QTc prolongation increases the risk for torsades de pointes and
other ventricular dysrhythmias. The risk becomes particularly important
when QT-prolonging medications or electrolyte abnormalities are present.
Q5. A patient with cardiac tamponade becomes increasingly
hypotensive. Which additional finding is expected?
, A) Muffled heart sounds
B) Bounding pulses
C) Increased urine output
D) Increased pulse pressure
Correct Answer: A) Muffled heart sounds
Rationale: Pericardial fluid compresses the heart and impairs ventricular
filling. This can produce muffled heart sounds, hypotension, venous
congestion, and reduced cardiac output.
Q6. A patient develops sudden severe tearing chest pain radiating
to the back. Which condition should the nurse suspect?
A) Stable angina
B) Aortic dissection
C) Pericarditis
D) Gastroesophageal reflux
Correct Answer: B) Aortic dissection
Rationale: Sudden severe chest or back pain is characteristic of aortic
dissection. The condition can rapidly compromise blood flow to major organs
or result in catastrophic hemorrhage.
Q7. After femoral cardiac catheterization, a patient suddenly
reports severe leg pain and the pedal pulse is absent. What is the
priority concern?
A) Expected postprocedure discomfort
B) Arterial perfusion compromise
C) Fluid overload
D) Peripheral neuropathy
Correct Answer: B) Arterial perfusion compromise
Rationale: Loss of a previously present distal pulse after arterial
catheterization can indicate thrombosis, embolization, arterial injury, or
another vascular complication requiring immediate evaluation.
Q8. A patient with acute heart failure develops severe dyspnea,
crackles, and pink frothy sputum. Which intervention is the priority?
A) Place the patient flat
B) Encourage oral fluids
