PCCN EXAM: 200 FRESH PRACTICE QUESTIONS
WITH CORRECT ANSWERS AND DETAILED
RATIONALES (2026 EDITION)
Exam Weighting Reference:
This second question bank is entirely different from the first and
follows the same official AACN PCCN test plan weights: Clinical
Judgment (80%) — Cardiovascular (33%), Pulmonary (14%),
Endocrine/Hematology/Gastrointestinal/Renal (18%),
Neurology/Multisystem/Behavioral (15%) — and Professional Caring
and Ethical Practice (20%). All 200 items, scenarios, and rationales are
new.
Part 1: Cardiovascular (Questions 1–66)
1. A client admitted with a non-ST-elevation myocardial infarction
(NSTEMI) is started on enoxaparin. Which laboratory value should the
nurse monitor to evaluate the anticoagulant effect in a client with
renal impairment?
A. INR
B. Anti-Xa level
C. Bleeding time
D. D-dimer
Answer: B. In renal impairment, enoxaparin clearance is reduced, and anti-
Xa monitoring is recommended to avoid over-anticoagulation. INR
evaluates warfarin, not enoxaparin.
,2. A client with heart failure and an ejection fraction of 25% is prescribed
sacubitril/valsartan. Which assessment finding requires holding the
medication and notifying the provider?
A. Blood pressure 92/58 mm Hg with dizziness
B. Heart rate 78 beats/min
C. Potassium 4.2 mEq/L
D. Weight loss of 0.5 kg
Answer: A. Sacubitril/valsartan is a vasodilator that can cause symptomatic
hypotension. A systolic pressure below 95 mm Hg with symptoms warrants
holding the dose and provider notification.
3. A client is admitted with syncope and a heart rate of 36 beats/min. The
ECG shows complete heart block. Which intervention is priority while
awaiting transcutaneous pacing?
A. Administer atropine 1 mg IV per protocol
B. Administer adenosine 6 mg IV push
C. Apply oxygen and place the client in Trendelenburg position only
D. Encourage the client to ambulate
Answer: A. Atropine is the first-line medication for symptomatic
bradycardia per ACLS, including complete heart block, while preparing for
pacing.
4. A client with an inferior wall myocardial infarction develops
bradycardia and hypotension. Which intervention should the nurse
anticipate first?
A. Administer a fluid bolus and atropine as ordered
B. Administer nitroglycerin
C. Administer a beta-blocker
D. Administer furosemide
Answer: A. Inferior MI often involves the right coronary artery and can
cause bradycardia and hypotension (Bezold-Jarisch reflex or right
, ventricular involvement). Fluids and atropine are first-line; nitrates and
beta-blockers can worsen hypotension.
5. A client with a mechanical aortic valve is taking warfarin and reports
bleeding gums. The INR is 6.8. Which action is priority?
A. Administer vitamin K as ordered and hold warfarin
B. Continue warfarin and reassess in 24 hours
C. Administer protamine sulfate
D. Increase the warfarin dose
Answer: A. An INR of 6.8 is dangerously supratherapeutic. The priority is to
hold warfarin and administer vitamin K per orders. Protamine reverses
heparin, not warfarin.
6. A client with dilated cardiomyopathy is started on sacubitril/valsartan
and carvedilol. Which instruction about sacubitril/valsartan is
essential?
A. “Take this medication with grapefruit juice.”
B. “Do not take this within 36 hours of an ACE inhibitor.”
C. “Stop the medication if you develop a cough.”
D. “Take this medication only when symptomatic.”
Answer: B. Sacubitril/valsartan must not be administered within 36 hours
of an ACE inhibitor due to the risk of angioedema.
7. A client with a thoracic aortic dissection is prescribed an esmolol
infusion. Which parameter is the priority for titration?
A. Heart rate and blood pressure
B. Urine output
C. Respiratory rate
D. Temperature
Answer: A. Esmolol is titrated to reduce heart rate and blood pressure,
decreasing shear stress on the aortic wall.
, 8. A client with heart failure has a pulmonary artery catheter in place.
The nurse notes a cardiac index of 1.8 L/min/m² and a PAWP of 22 mm
Hg. Which intervention is most appropriate?
A. Administer a fluid bolus
B. Administer an inotropic agent as ordered
C. Encourage ambulation
D. Apply warm blankets
Answer: B. Low cardiac index with elevated PAWP indicates poor
contractility with adequate preload. Inotropic support is indicated.
9. A client with atrial flutter has a ventricular rate of 150 beats/min.
Which medication is most appropriate for rate control?
A. Adenosine
B. Diltiazem
C. Atropine
D. Epinephrine
Answer: B. Diltiazem is used for rate control in atrial flutter. Adenosine is
diagnostic/therapeutic for SVT, not rate control of flutter.
10. A client with a permanent pacemaker set at 70 beats/min has a
heart rate of 45 beats/min. What is the priority action?
A. Document the finding and reassess in 30 minutes
B. Assess for pacemaker failure and notify the provider
C. Encourage the client to ambulate
D. Administer a sedative
Answer: B. A heart rate below the set rate suggests pacemaker failure
(battery depletion, lead fracture, or failure to capture). Immediate
assessment and provider notification are required.
11. A client with acute pericarditis has a blood pressure of 88/70 mm
Hg and muffled heart sounds. What is the priority action?
A. Administer a fluid bolus and notify the provider immediately
WITH CORRECT ANSWERS AND DETAILED
RATIONALES (2026 EDITION)
Exam Weighting Reference:
This second question bank is entirely different from the first and
follows the same official AACN PCCN test plan weights: Clinical
Judgment (80%) — Cardiovascular (33%), Pulmonary (14%),
Endocrine/Hematology/Gastrointestinal/Renal (18%),
Neurology/Multisystem/Behavioral (15%) — and Professional Caring
and Ethical Practice (20%). All 200 items, scenarios, and rationales are
new.
Part 1: Cardiovascular (Questions 1–66)
1. A client admitted with a non-ST-elevation myocardial infarction
(NSTEMI) is started on enoxaparin. Which laboratory value should the
nurse monitor to evaluate the anticoagulant effect in a client with
renal impairment?
A. INR
B. Anti-Xa level
C. Bleeding time
D. D-dimer
Answer: B. In renal impairment, enoxaparin clearance is reduced, and anti-
Xa monitoring is recommended to avoid over-anticoagulation. INR
evaluates warfarin, not enoxaparin.
,2. A client with heart failure and an ejection fraction of 25% is prescribed
sacubitril/valsartan. Which assessment finding requires holding the
medication and notifying the provider?
A. Blood pressure 92/58 mm Hg with dizziness
B. Heart rate 78 beats/min
C. Potassium 4.2 mEq/L
D. Weight loss of 0.5 kg
Answer: A. Sacubitril/valsartan is a vasodilator that can cause symptomatic
hypotension. A systolic pressure below 95 mm Hg with symptoms warrants
holding the dose and provider notification.
3. A client is admitted with syncope and a heart rate of 36 beats/min. The
ECG shows complete heart block. Which intervention is priority while
awaiting transcutaneous pacing?
A. Administer atropine 1 mg IV per protocol
B. Administer adenosine 6 mg IV push
C. Apply oxygen and place the client in Trendelenburg position only
D. Encourage the client to ambulate
Answer: A. Atropine is the first-line medication for symptomatic
bradycardia per ACLS, including complete heart block, while preparing for
pacing.
4. A client with an inferior wall myocardial infarction develops
bradycardia and hypotension. Which intervention should the nurse
anticipate first?
A. Administer a fluid bolus and atropine as ordered
B. Administer nitroglycerin
C. Administer a beta-blocker
D. Administer furosemide
Answer: A. Inferior MI often involves the right coronary artery and can
cause bradycardia and hypotension (Bezold-Jarisch reflex or right
, ventricular involvement). Fluids and atropine are first-line; nitrates and
beta-blockers can worsen hypotension.
5. A client with a mechanical aortic valve is taking warfarin and reports
bleeding gums. The INR is 6.8. Which action is priority?
A. Administer vitamin K as ordered and hold warfarin
B. Continue warfarin and reassess in 24 hours
C. Administer protamine sulfate
D. Increase the warfarin dose
Answer: A. An INR of 6.8 is dangerously supratherapeutic. The priority is to
hold warfarin and administer vitamin K per orders. Protamine reverses
heparin, not warfarin.
6. A client with dilated cardiomyopathy is started on sacubitril/valsartan
and carvedilol. Which instruction about sacubitril/valsartan is
essential?
A. “Take this medication with grapefruit juice.”
B. “Do not take this within 36 hours of an ACE inhibitor.”
C. “Stop the medication if you develop a cough.”
D. “Take this medication only when symptomatic.”
Answer: B. Sacubitril/valsartan must not be administered within 36 hours
of an ACE inhibitor due to the risk of angioedema.
7. A client with a thoracic aortic dissection is prescribed an esmolol
infusion. Which parameter is the priority for titration?
A. Heart rate and blood pressure
B. Urine output
C. Respiratory rate
D. Temperature
Answer: A. Esmolol is titrated to reduce heart rate and blood pressure,
decreasing shear stress on the aortic wall.
, 8. A client with heart failure has a pulmonary artery catheter in place.
The nurse notes a cardiac index of 1.8 L/min/m² and a PAWP of 22 mm
Hg. Which intervention is most appropriate?
A. Administer a fluid bolus
B. Administer an inotropic agent as ordered
C. Encourage ambulation
D. Apply warm blankets
Answer: B. Low cardiac index with elevated PAWP indicates poor
contractility with adequate preload. Inotropic support is indicated.
9. A client with atrial flutter has a ventricular rate of 150 beats/min.
Which medication is most appropriate for rate control?
A. Adenosine
B. Diltiazem
C. Atropine
D. Epinephrine
Answer: B. Diltiazem is used for rate control in atrial flutter. Adenosine is
diagnostic/therapeutic for SVT, not rate control of flutter.
10. A client with a permanent pacemaker set at 70 beats/min has a
heart rate of 45 beats/min. What is the priority action?
A. Document the finding and reassess in 30 minutes
B. Assess for pacemaker failure and notify the provider
C. Encourage the client to ambulate
D. Administer a sedative
Answer: B. A heart rate below the set rate suggests pacemaker failure
(battery depletion, lead fracture, or failure to capture). Immediate
assessment and provider notification are required.
11. A client with acute pericarditis has a blood pressure of 88/70 mm
Hg and muffled heart sounds. What is the priority action?
A. Administer a fluid bolus and notify the provider immediately
