PCCN FINAL 2027 TEST ANSWERS AND QUESTIONS
SET A+
✔✔Symptoms of acute endocarditis of the mitral valve cause:
A. symptoms similar to heart failure
B. severe chest pain mimicking STEMI
C. Claudication-type pain
D. pain that is relieved by sitting up - ✔✔A. symptoms similar to heart failure
Symptoms of acute endocarditis are very similar to heart failure. The mitral valve with
infection may become incompetent and cause increased pulmonary pressures just like
left ventricular heart failure. The pateint will need heart failure treatment as well as
antibiotics. Claudication-type pain is caused by ischemia to the lower extremities. Pain
relieved by sitting up is usually pericarditis in nature.
✔✔With acute arterial insufficiency, the extremity will appear:
A. warm with normal color
B. warm with increased redness
C. cool with pale color
D. cool with normal color - ✔✔C. cool with pale color
The patient with acute arterial insufficiency will have a cool extremity and a pale
appearance, both due to lack of blood flow. The 6 P's to arterial circulation are: pulse
(palpation, Doppler), pain (pt's perception), pallor (color change), polar (decreased
temperature), paresthesia (numbness, pins and needles in extremity) and paralysis (not
feeling or moving).
✔✔A patient who has sustained a septal wall infarction several days ago now is
complaining of acute shortness of breath. The nurse auscultates rales bilaterally, notes
decreasing O2 saturations and lowered blood pressure. These signs and symptoms
may indicate:
A. Deep vein thrombosis
B. pneumonia
C. anxiety
D. acute ventricular septal defect (VSD) with heart failure - ✔✔D. acute ventricular
septal defect (VSD) with heart failure
,A complication of septal wall infarction is VSD. This may occur 3-7 days after infarction
and appears as acute decompensated heart failure. DVT does not have a presentation
of acute onset heart failure. Pneumonia may present with chest pain and rales on the
affected side, but not acute decompensated heart failure. Anxiety usually does not
change the patient's total physical exam with decreasing saturations, rales bilaterally
and acute shortness of breath.
✔✔An elderly patient with an abdominal aortic aneurysm decline surgery for the
condition. What medication may be helpful in the prevention of rupture of this
aneurysm?
A. benazepril (Lotensin)
B. captopril (Capoten)
C. metoprolol (Lopressor)
D. ramipril (Altace) - ✔✔C. metoprolol (Lopressor)
Beta blockers are the best treatment for the prevention of an abdominal aortic aneurysm
rupture. The other answers are all angiotensin-converting enzyme inhibitors and will
decrease the patient's hypertension; it is the beta blocker that is suggested for this
patient. Beta blockers, while decreasing blood pressure, also inhibit the force of
ventricular contraction, which helps prevent tension on the aortic wall, thereby reducing
stress and the possibility of rupture.
✔✔During the treatment of supraventricular tachycardia, which medication is given
rapidly intravenous (IV) push and may result in a brief sinus pause?
A. lidocaine (Xylocaine)
B. epinephrine (Adrenaclick)
C. adenosine (Adenocard)
D. procainamide - ✔✔C. adenosine (Adenocard)
Adenosine is used for the treatment of supraventricular tachycardia. It is given as a
rapid IV push with a large saline flush. It often results in a sinus pause, then the rhythm
converts to sinus. None of the other medications are used for supraventricular
tachycardia.
✔✔You are caring for a patient recently admitted with an inferior wall MI. Which of the
following 12-lead ECG findings would you anticipate?
A. T wave inversion in leads I and aVL
B. Q wave formation and ST segment elevation in leads II, III, and aVF
C. QRS duration greater than 0.01 in all leads
D. R wave taller in V6 - ✔✔B. Q wave formation and ST segment elevation in leads II,
III, and aVF
With STEMI, the patient will have ST segment elevation. The inferior leads are II, III,
and aVF. T wave inversion in leads I and aVL indicate ischemia in the anterior leads.
QRS duration that is prolonged may indicate an intraventricular conduction defect, and
an R wave taller in V6 is a bundle branch block.
✔✔A thoracic aortic aneurysm causes chest pain that:
,A. radiates to the left arm
B. radiates through to the back
C. is sharp and worse while reclining
D. is associated with diminished breath sounds - ✔✔B. radiates through to the back
Typically aortic aneurysms present with severe, acute onset of chest pain that radiates
through to the back. Pain that radiates to the left arm may indicate myocardial ischemia.
Sharp pain worsening with the reclined position may be pericarditis, and diminished
breath sounds could be anything that is caused by decreased tidal volume.
✔✔The most common ECG changes that occur during pulmonary embolus are:
A. Q waves in AVR and Lead I
B. tachycardia
C. Bradycardia and ST segment depression
D. high degree AV blocks - ✔✔B. tachycardia
The most common ECG changes that occur with pulmonary embolism are tachycardia (
a good first clinical condition of almost anything) and atrial fibrillation due to increased
pulmonary pressure, The other answers are incorrect.
✔✔The anterior left ventricle receives blood via the:
A. left circumflex artery
B. right coronary artery
C. posterior descending coronary artery
D. left anterior descending coronary artery - ✔✔D. left anterior descending coronary
artery
The left anterior descending coronary artery perfuses the entire left anterior section of
the left ventricle, two-thirds of the septum and the apex of the left ventricle. The right
coronary artery perfuses the right ventricle. The left circumflex perfuses the left lateral
ventricular wall, and the posterior descending coronary artery perfuses the inferior right
and left ventricular wall.
✔✔Patients with occlusion of the right coronary artery are at high risk for the
development of Mobitz type I heart blocks. This is because 90% of the population use
the right coronary artery to supply which part of the conduction system?
A. sinoarterial (SA) node
B. artrioventricular (AV) node
C. bundle branches
D. Purkinje fibers - ✔✔B. artrioventricular (AV) node
Although the right coronary artery perfuses the SA node, it is the AV node ischemia that
would cause a Mobitz Type 1 heart block. The bundle branches and the Purkinje fibers
are perfused by the right and left circulation and if ischemic, would cause worse
dysrhythmias such as complete heart block or idioventricular rhythm.
✔✔The amount of oxygen delivered to the tissues is determined by what factor:
A. cardiac output
B. hemoglobin levels
, C. oxygen saturation
D. all of the above - ✔✔D. all of the above
Cardiac output, hemoglobin levels and oxygen saturation all contribute to the amount of
oxygen delivered to the tissues
✔✔When assessing myocardial chest pain, which of the following is not a common
characteristic of angina:
A. discomfort that is precipitated by exercise
B. discomfort that is described as pressure or tightness
C. discomfort that is relieved with rest or nitroglycerin
D. pain that is intermittent and that comes and goes - ✔✔D. pain that is intermittent and
that comes and goes
Myocardial ischemia causing pain has the usual characteristics of precipitation by
exercise or exertion, described as pressure or tightness, and relief by rest and/or
nitroglycerin. Intermittent pain that comes and goes is not the usual presentation of
myocardial ischemia.
✔✔Signs of venous peripheral vascular disease in the legs include:
A. brown pigmentation at the ankles, warm legs, open area over the lateral malleolus
B. normal color, severe pain, open sore at the end of the great toe
C. shiny skin with no hair, pale extremities, pain with ambulation
D. pitting edema, absent pulses, thick toenails, feet becoming cyanotic when dependent
- ✔✔A. brown pigmentation at the ankles, warm legs, open area over the lateral
malleolus
Arterial insufficiency
Etiology: arteriosclerosis
Risk factors: smoking, DM, HTN
Pain: severe muscle ischemia, intermittent claudication, worse with exercise, pain at
rest, muscle fatigue, cramping, numbness
Vascular: decreased or absent pulses, pallor and rubor
Skin changes: shiny, dry, nail changes, coolness
Venous insufficiency
Pain: minimal to moderate steady pain, aching
Skin: thickening in tissues, dark, cyanotic, thickened and brown, with ulceration at sides
of ankles (a medial malleolus classic), and legs are warm since there is normal arterial
circulation
✔✔A patient presents with pulmonary edema characterized by tachycardia,
hypertension and cough with frothy sputum. What initial treatments are most common?
A. oxygen, nitroglycerin, loop diuretics, and morphine
B. oxygen, thiazide diuretics, and ACE inhibitors
C. oxygen and thiazide diuretics
D. oxygen, morphine, and calcium channel blockers - ✔✔A. oxygen, nitroglycerin, loop
diuretics, and morphine
SET A+
✔✔Symptoms of acute endocarditis of the mitral valve cause:
A. symptoms similar to heart failure
B. severe chest pain mimicking STEMI
C. Claudication-type pain
D. pain that is relieved by sitting up - ✔✔A. symptoms similar to heart failure
Symptoms of acute endocarditis are very similar to heart failure. The mitral valve with
infection may become incompetent and cause increased pulmonary pressures just like
left ventricular heart failure. The pateint will need heart failure treatment as well as
antibiotics. Claudication-type pain is caused by ischemia to the lower extremities. Pain
relieved by sitting up is usually pericarditis in nature.
✔✔With acute arterial insufficiency, the extremity will appear:
A. warm with normal color
B. warm with increased redness
C. cool with pale color
D. cool with normal color - ✔✔C. cool with pale color
The patient with acute arterial insufficiency will have a cool extremity and a pale
appearance, both due to lack of blood flow. The 6 P's to arterial circulation are: pulse
(palpation, Doppler), pain (pt's perception), pallor (color change), polar (decreased
temperature), paresthesia (numbness, pins and needles in extremity) and paralysis (not
feeling or moving).
✔✔A patient who has sustained a septal wall infarction several days ago now is
complaining of acute shortness of breath. The nurse auscultates rales bilaterally, notes
decreasing O2 saturations and lowered blood pressure. These signs and symptoms
may indicate:
A. Deep vein thrombosis
B. pneumonia
C. anxiety
D. acute ventricular septal defect (VSD) with heart failure - ✔✔D. acute ventricular
septal defect (VSD) with heart failure
,A complication of septal wall infarction is VSD. This may occur 3-7 days after infarction
and appears as acute decompensated heart failure. DVT does not have a presentation
of acute onset heart failure. Pneumonia may present with chest pain and rales on the
affected side, but not acute decompensated heart failure. Anxiety usually does not
change the patient's total physical exam with decreasing saturations, rales bilaterally
and acute shortness of breath.
✔✔An elderly patient with an abdominal aortic aneurysm decline surgery for the
condition. What medication may be helpful in the prevention of rupture of this
aneurysm?
A. benazepril (Lotensin)
B. captopril (Capoten)
C. metoprolol (Lopressor)
D. ramipril (Altace) - ✔✔C. metoprolol (Lopressor)
Beta blockers are the best treatment for the prevention of an abdominal aortic aneurysm
rupture. The other answers are all angiotensin-converting enzyme inhibitors and will
decrease the patient's hypertension; it is the beta blocker that is suggested for this
patient. Beta blockers, while decreasing blood pressure, also inhibit the force of
ventricular contraction, which helps prevent tension on the aortic wall, thereby reducing
stress and the possibility of rupture.
✔✔During the treatment of supraventricular tachycardia, which medication is given
rapidly intravenous (IV) push and may result in a brief sinus pause?
A. lidocaine (Xylocaine)
B. epinephrine (Adrenaclick)
C. adenosine (Adenocard)
D. procainamide - ✔✔C. adenosine (Adenocard)
Adenosine is used for the treatment of supraventricular tachycardia. It is given as a
rapid IV push with a large saline flush. It often results in a sinus pause, then the rhythm
converts to sinus. None of the other medications are used for supraventricular
tachycardia.
✔✔You are caring for a patient recently admitted with an inferior wall MI. Which of the
following 12-lead ECG findings would you anticipate?
A. T wave inversion in leads I and aVL
B. Q wave formation and ST segment elevation in leads II, III, and aVF
C. QRS duration greater than 0.01 in all leads
D. R wave taller in V6 - ✔✔B. Q wave formation and ST segment elevation in leads II,
III, and aVF
With STEMI, the patient will have ST segment elevation. The inferior leads are II, III,
and aVF. T wave inversion in leads I and aVL indicate ischemia in the anterior leads.
QRS duration that is prolonged may indicate an intraventricular conduction defect, and
an R wave taller in V6 is a bundle branch block.
✔✔A thoracic aortic aneurysm causes chest pain that:
,A. radiates to the left arm
B. radiates through to the back
C. is sharp and worse while reclining
D. is associated with diminished breath sounds - ✔✔B. radiates through to the back
Typically aortic aneurysms present with severe, acute onset of chest pain that radiates
through to the back. Pain that radiates to the left arm may indicate myocardial ischemia.
Sharp pain worsening with the reclined position may be pericarditis, and diminished
breath sounds could be anything that is caused by decreased tidal volume.
✔✔The most common ECG changes that occur during pulmonary embolus are:
A. Q waves in AVR and Lead I
B. tachycardia
C. Bradycardia and ST segment depression
D. high degree AV blocks - ✔✔B. tachycardia
The most common ECG changes that occur with pulmonary embolism are tachycardia (
a good first clinical condition of almost anything) and atrial fibrillation due to increased
pulmonary pressure, The other answers are incorrect.
✔✔The anterior left ventricle receives blood via the:
A. left circumflex artery
B. right coronary artery
C. posterior descending coronary artery
D. left anterior descending coronary artery - ✔✔D. left anterior descending coronary
artery
The left anterior descending coronary artery perfuses the entire left anterior section of
the left ventricle, two-thirds of the septum and the apex of the left ventricle. The right
coronary artery perfuses the right ventricle. The left circumflex perfuses the left lateral
ventricular wall, and the posterior descending coronary artery perfuses the inferior right
and left ventricular wall.
✔✔Patients with occlusion of the right coronary artery are at high risk for the
development of Mobitz type I heart blocks. This is because 90% of the population use
the right coronary artery to supply which part of the conduction system?
A. sinoarterial (SA) node
B. artrioventricular (AV) node
C. bundle branches
D. Purkinje fibers - ✔✔B. artrioventricular (AV) node
Although the right coronary artery perfuses the SA node, it is the AV node ischemia that
would cause a Mobitz Type 1 heart block. The bundle branches and the Purkinje fibers
are perfused by the right and left circulation and if ischemic, would cause worse
dysrhythmias such as complete heart block or idioventricular rhythm.
✔✔The amount of oxygen delivered to the tissues is determined by what factor:
A. cardiac output
B. hemoglobin levels
, C. oxygen saturation
D. all of the above - ✔✔D. all of the above
Cardiac output, hemoglobin levels and oxygen saturation all contribute to the amount of
oxygen delivered to the tissues
✔✔When assessing myocardial chest pain, which of the following is not a common
characteristic of angina:
A. discomfort that is precipitated by exercise
B. discomfort that is described as pressure or tightness
C. discomfort that is relieved with rest or nitroglycerin
D. pain that is intermittent and that comes and goes - ✔✔D. pain that is intermittent and
that comes and goes
Myocardial ischemia causing pain has the usual characteristics of precipitation by
exercise or exertion, described as pressure or tightness, and relief by rest and/or
nitroglycerin. Intermittent pain that comes and goes is not the usual presentation of
myocardial ischemia.
✔✔Signs of venous peripheral vascular disease in the legs include:
A. brown pigmentation at the ankles, warm legs, open area over the lateral malleolus
B. normal color, severe pain, open sore at the end of the great toe
C. shiny skin with no hair, pale extremities, pain with ambulation
D. pitting edema, absent pulses, thick toenails, feet becoming cyanotic when dependent
- ✔✔A. brown pigmentation at the ankles, warm legs, open area over the lateral
malleolus
Arterial insufficiency
Etiology: arteriosclerosis
Risk factors: smoking, DM, HTN
Pain: severe muscle ischemia, intermittent claudication, worse with exercise, pain at
rest, muscle fatigue, cramping, numbness
Vascular: decreased or absent pulses, pallor and rubor
Skin changes: shiny, dry, nail changes, coolness
Venous insufficiency
Pain: minimal to moderate steady pain, aching
Skin: thickening in tissues, dark, cyanotic, thickened and brown, with ulceration at sides
of ankles (a medial malleolus classic), and legs are warm since there is normal arterial
circulation
✔✔A patient presents with pulmonary edema characterized by tachycardia,
hypertension and cough with frothy sputum. What initial treatments are most common?
A. oxygen, nitroglycerin, loop diuretics, and morphine
B. oxygen, thiazide diuretics, and ACE inhibitors
C. oxygen and thiazide diuretics
D. oxygen, morphine, and calcium channel blockers - ✔✔A. oxygen, nitroglycerin, loop
diuretics, and morphine
