PROGRESSIVE CARE CERTIFIED NURSE PCCN CERTIFICATION EXAM
QUESTIONS AND ANSWERS WITH RATIONALE 2025–2026 GRADED A+
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
C. Q-wave formation
D. ST-segment depression and T-wave inversion
D. ST segment depression and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle. That
change is seen on the 12 lead ECG as ST-segment depression and T wave
inversion, which demonstrate subendocardial ischemia -- the innermost layer of
muscle in the myocardium. ST-segment elevation indicates acute injury or
infarction, ST segment depression and T wave elevation may indicate an
electrolyte abnormality, while Q wave formation indicates total infarction.
Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
,D. vasodilate vessels
A. improve cardiac output and tissue perfusion
The term "inotropic" refers to affecting the force of myocardial contraction.
Improvement of cardiac muscle contraction leads to improved cardiac output and
tissue perfusion.
A patient in the ED is now being admitted to telemetry with complaint of chest
pain and has been judged to be a possible candidate for therapy with alteplase
(Activas). Which of the following is not considered a contraindication for the use
of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed
A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other
answers -- recent abdominal surgery, recent gastrointestinal bleeding and a recent
intracranial bleed -- are contraindications for the use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
,D. contractility and SVR (afterload)
A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the
SVR (afterload) is high and the cardiac output low, the patient may still have a
normal BP. the pulse pressure will be lower, but this is a compensatory response
by the heart to maintain BP. If the SVR (afterload) is low (as in early septic shock),
the cardiac output is very high, thereby trying to support BP.
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic
pressure (LVEDP), the pressure exerted on the ventricular muscle at the end of
diastole when the ventricle is full. This enables blood to flow from a higher
pressure through open arteries to a lower pressure, a pressure gradient known as
coronary artery prefusion pressure. As diastolic pressure drops, there is a decrease
in coronary artery blood flow. Coronary artery perfusion is not affected by systolic
pressure, afterload or SVR, but they all increase the demand of oxygen in the heart.
, A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay. Which of
the following is the most common serious side effect that may occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
D. rhinorrhea
C. swelling of the tongue and face
Although all of the answers may occur, swelling go the tongue and face is the most
serious and may require intervention. Patients should be instructed to seek medical
attention immediately for any signs of swelling in the tongue or throat.
AD
Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts
D. It occurs during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left
ventricle. An S4 is also called an atrial heart sound since it occurs at the end of
diastolic filling when the atria contracts and fully fills the left ventricle. Known as
"atrial kick", this filling is important to cardiac output. The increased end-diastolic
QUESTIONS AND ANSWERS WITH RATIONALE 2025–2026 GRADED A+
Which pathologic changes found on the 12-lead ECG indicate myocardial
ischemia?
A. ST-segment elevation
B. ST-segment depression and T-wave elevation
C. Q-wave formation
D. ST-segment depression and T-wave inversion
D. ST segment depression and T wave inversion
Myocardial ischemia changes the repolarization of the ventricular muscle. That
change is seen on the 12 lead ECG as ST-segment depression and T wave
inversion, which demonstrate subendocardial ischemia -- the innermost layer of
muscle in the myocardium. ST-segment elevation indicates acute injury or
infarction, ST segment depression and T wave elevation may indicate an
electrolyte abnormality, while Q wave formation indicates total infarction.
Positive inotropic agents are used to:
A. improve cardiac output and tissue perfusion
B. decrease water loss through the kidneys
C. increase heart rate
,D. vasodilate vessels
A. improve cardiac output and tissue perfusion
The term "inotropic" refers to affecting the force of myocardial contraction.
Improvement of cardiac muscle contraction leads to improved cardiac output and
tissue perfusion.
A patient in the ED is now being admitted to telemetry with complaint of chest
pain and has been judged to be a possible candidate for therapy with alteplase
(Activas). Which of the following is not considered a contraindication for the use
of this medication?
A. current antibiotic use
B. recent abdominal surgery
C. recent gastrointestinal bleed
D. recent intracranial bleed
A. current antibiotic use
Use of antibiotics is not a contraindication for the use of alteplase. All the other
answers -- recent abdominal surgery, recent gastrointestinal bleeding and a recent
intracranial bleed -- are contraindications for the use of any fibrinolytic.
The two major components that determine blood pressure are:
A. systemic vascular resistance (SVR) (afterload) and cardiac output
B. contractility and SVR (afterload)
C. preload and SVR (afterload)
,D. contractility and SVR (afterload)
A. SVR (afterload) and cardiac output
The equation for BP is: BP = SVR x cardiac output.
BP is determined by resistance of the arterial bed and the cardiac output. If the
SVR (afterload) is high and the cardiac output low, the patient may still have a
normal BP. the pulse pressure will be lower, but this is a compensatory response
by the heart to maintain BP. If the SVR (afterload) is low (as in early septic shock),
the cardiac output is very high, thereby trying to support BP.
Coronary artery perfusion is dependent upon:
A. diastolic pressure
B. systolic pressure
C. afterload
D. systemic vascular resistance (SVR)
A. diastolic pressure
Diastolic pressure in the aortic root is higher than left ventricular end-diastolic
pressure (LVEDP), the pressure exerted on the ventricular muscle at the end of
diastole when the ventricle is full. This enables blood to flow from a higher
pressure through open arteries to a lower pressure, a pressure gradient known as
coronary artery prefusion pressure. As diastolic pressure drops, there is a decrease
in coronary artery blood flow. Coronary artery perfusion is not affected by systolic
pressure, afterload or SVR, but they all increase the demand of oxygen in the heart.
, A post-STEMI (ST elevation myocardial infarction) patient is started on an
angiotensin-converting enzyme (ACE) inhibitor during his hospital stay. Which of
the following is the most common serious side effect that may occur?
A. a nonproductive cough
B. pedal edema
C. swelling of the tongue and face
D. rhinorrhea
C. swelling of the tongue and face
Although all of the answers may occur, swelling go the tongue and face is the most
serious and may require intervention. Patients should be instructed to seek medical
attention immediately for any signs of swelling in the tongue or throat.
AD
Which of the following best describes the fourth heart sound (S4):
A. It occurs after ventricular contraction
B. It is best heard with the diaphragm of the stethoscope
C. It is a normal finding in children
D. It occurs during late diastole when the atria contracts
D. It occurs during late diastole when the atria contracts
The presence of the extra heart sound S4 signifies a poorly compliant (stiff) left
ventricle. An S4 is also called an atrial heart sound since it occurs at the end of
diastolic filling when the atria contracts and fully fills the left ventricle. Known as
"atrial kick", this filling is important to cardiac output. The increased end-diastolic
