PCCN EXAM FULL QUESTIONS AND ANSWERS
2026 GRADED A+
◉ inferior MI 12 lead ekg changes. Answer: ST elevation in leads II,
III, aVF
reciprocal ST depression changes in I and aVL
RCA affected in 65%, L circumflex in others
◉ right ventricular infarction 12 lead ekg changes. Answer: V1, V2R-
V4R
proximal RCA and inferior wall MI
◉ R vent infarction s and s/ tx. Answer: tachycardia
hypotension
JVD
R sided echo will show blood backing up in the R side of the heart,
poor forward flow to the L side of the heart
tx: fluids ( preload dependent), + inotrope- dobutamine, avoid meds
that lower preload- nitrates, morphine, beta blockers, diurectics
R side of the heart is stunned with poor wall movement
,◉ inferior wall MI s and s/ tx. Answer: bradycardia- if symptomatic
us atropine
high grade AV heart block (maybe temp perm)
Second dree type 1
hypotension
n/v
diaphoresis
monitor for s and s of R vent infarction
◉ septal wall Mi ekg changes. Answer: ST elevation change in V1-V2
reciprocal ST depression changes in leads II,III,aVF
LAD affected
◉ anterior wall MI ekg changes. Answer: ST elevation in lead V2-V4
st depression in leads II, III, aVF
artery affected: LAD/ L main
◉ Anterior and septal wall MI s and s. Answer: L vent failure: s3 and
s4 heart sounds
shock
2nd degree type 2, third degree
prepare to pace!
,bundle branch block
new loud murmur= suspect ventricular septal rupture or papillary
musc rupture= get an echo!
◉ lateral wall Mi ekg changes. Answer: ST elevation in leads I, aVL,
V5-V6
no reciprocal changes
L circumflex and LAD affected
can be associates with other MI locations (inferior and anterior)
◉ posterior wall MI ekg changes. Answer: St elevation in posterior
leads V7-V9
St depression in leads V1-V2
RCA affected in 90%, L circumflex 10%
Tall upright R waves in V1-V2
associated with inferior or lateral wall MI
◉ LAD perfuses. Answer: septum and L anterior wall
◉ RCA perfuses. Answer: the inferior wall, r vent, r atrium
posterior wall in 90% of ppl
, ◉ L circumflex perfuses. Answer: the posterior wall in 10% of
people, L lateral wall of the L vent
◉ normal ph levels. Answer: 7.35-7.45
◉ norm PaO2. Answer: 80-100
◉ norm PaCO2. Answer: 35-45
◉ norm HCO3. Answer: 22-26
◉ norm base deficit. Answer: -2 to +2
◉ SaO2. Answer: 95-100%
◉ normal urine specific gravity. Answer: 1.010-1.02
◉ normal urine osmolarity. Answer: 500-850 mOsm/ kg
◉ normal urine Na. Answer: 40-100
◉ normal BUN/Cr ratio. Answer: 10:1-15:1
2026 GRADED A+
◉ inferior MI 12 lead ekg changes. Answer: ST elevation in leads II,
III, aVF
reciprocal ST depression changes in I and aVL
RCA affected in 65%, L circumflex in others
◉ right ventricular infarction 12 lead ekg changes. Answer: V1, V2R-
V4R
proximal RCA and inferior wall MI
◉ R vent infarction s and s/ tx. Answer: tachycardia
hypotension
JVD
R sided echo will show blood backing up in the R side of the heart,
poor forward flow to the L side of the heart
tx: fluids ( preload dependent), + inotrope- dobutamine, avoid meds
that lower preload- nitrates, morphine, beta blockers, diurectics
R side of the heart is stunned with poor wall movement
,◉ inferior wall MI s and s/ tx. Answer: bradycardia- if symptomatic
us atropine
high grade AV heart block (maybe temp perm)
Second dree type 1
hypotension
n/v
diaphoresis
monitor for s and s of R vent infarction
◉ septal wall Mi ekg changes. Answer: ST elevation change in V1-V2
reciprocal ST depression changes in leads II,III,aVF
LAD affected
◉ anterior wall MI ekg changes. Answer: ST elevation in lead V2-V4
st depression in leads II, III, aVF
artery affected: LAD/ L main
◉ Anterior and septal wall MI s and s. Answer: L vent failure: s3 and
s4 heart sounds
shock
2nd degree type 2, third degree
prepare to pace!
,bundle branch block
new loud murmur= suspect ventricular septal rupture or papillary
musc rupture= get an echo!
◉ lateral wall Mi ekg changes. Answer: ST elevation in leads I, aVL,
V5-V6
no reciprocal changes
L circumflex and LAD affected
can be associates with other MI locations (inferior and anterior)
◉ posterior wall MI ekg changes. Answer: St elevation in posterior
leads V7-V9
St depression in leads V1-V2
RCA affected in 90%, L circumflex 10%
Tall upright R waves in V1-V2
associated with inferior or lateral wall MI
◉ LAD perfuses. Answer: septum and L anterior wall
◉ RCA perfuses. Answer: the inferior wall, r vent, r atrium
posterior wall in 90% of ppl
, ◉ L circumflex perfuses. Answer: the posterior wall in 10% of
people, L lateral wall of the L vent
◉ normal ph levels. Answer: 7.35-7.45
◉ norm PaO2. Answer: 80-100
◉ norm PaCO2. Answer: 35-45
◉ norm HCO3. Answer: 22-26
◉ norm base deficit. Answer: -2 to +2
◉ SaO2. Answer: 95-100%
◉ normal urine specific gravity. Answer: 1.010-1.02
◉ normal urine osmolarity. Answer: 500-850 mOsm/ kg
◉ normal urine Na. Answer: 40-100
◉ normal BUN/Cr ratio. Answer: 10:1-15:1
