4/2/26, 8:45 PM PCCN questions
PCCN EXAM TEST BANK 2026 WITH 400 QUESTIONS
AND CORRECT DETAILED ANSWERS (100% CORRECT
ANSWERS) PCCN EXAM PREP TEST BANK (NEWLY
UPDATED 2026-2027!!)
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 og 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.
1/105
,4/2/26, 8:45 PM PCCN questions
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
volume in the ventricle improves cardiac output. When the left ventricle is stiff
(decreased compliance with long term hypertension, aortic stenosis or with acute
STEMI), the atrium has to pump harder to move blood from the atrium to the
ventricle, causing a turbulent blood flow and extra heart sound. This heart sound
is always pathologic. It occurs before ventricular contraction, is best heard with
the bell of the stethoscope and is never a normal heart sound, even in children.
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.
2/105
,4/2/26, 8:45 PM PCCN questions
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 bwith complaint of chest
pain and has been judged to be a possible candidate for therapy with alteplase
(Activase). 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.
3/105
, 4/2/26, 8:45 PM PCCN questions
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.
The layer of the arterial vessel wall responsible for changes in the diameter of the
artery is the:
A. media
B. intima
C. externa
D. adventitia
A. media
The media layer of the arterial wall contains vascular smooth muscle cells
and is responsible for arterial tone. Vasoactive substances released in
response to the sympathetic nervous system and/or the renin-angiotensin
system determine arterial tone. Intima, externa and adventitia are incorrect.
4/105
PCCN EXAM TEST BANK 2026 WITH 400 QUESTIONS
AND CORRECT DETAILED ANSWERS (100% CORRECT
ANSWERS) PCCN EXAM PREP TEST BANK (NEWLY
UPDATED 2026-2027!!)
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 og 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.
1/105
,4/2/26, 8:45 PM PCCN questions
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
volume in the ventricle improves cardiac output. When the left ventricle is stiff
(decreased compliance with long term hypertension, aortic stenosis or with acute
STEMI), the atrium has to pump harder to move blood from the atrium to the
ventricle, causing a turbulent blood flow and extra heart sound. This heart sound
is always pathologic. It occurs before ventricular contraction, is best heard with
the bell of the stethoscope and is never a normal heart sound, even in children.
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.
2/105
,4/2/26, 8:45 PM PCCN questions
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 bwith complaint of chest
pain and has been judged to be a possible candidate for therapy with alteplase
(Activase). 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.
3/105
, 4/2/26, 8:45 PM PCCN questions
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.
The layer of the arterial vessel wall responsible for changes in the diameter of the
artery is the:
A. media
B. intima
C. externa
D. adventitia
A. media
The media layer of the arterial wall contains vascular smooth muscle cells
and is responsible for arterial tone. Vasoactive substances released in
response to the sympathetic nervous system and/or the renin-angiotensin
system determine arterial tone. Intima, externa and adventitia are incorrect.
4/105
