Progressive Care RN A (2026/2027) Actual
Exam Certification Practice Questions and
Answers Graded A+ Detailed Rationales - Pass
Guaranteed - A+ Graded
Domain: Cardiovascular – Acute Coronary Syndromes & Myocardial Infarction
Q1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating
to his left arm for the past 90 minutes. Vital signs: BP 156/92, HR 98, SpO2 94% on
room air. ECG shows ST elevation >2mm in leads II, III, and aVF with reciprocal ST
depression in leads I and aVL. Troponin I is pending. What is the priority intervention?
A. Administer aspirin 324 mg chewed and establish IV access
B. Prepare the patient for immediate synchronized cardioversion
C. Initiate heparin infusion and wait for troponin results before activating cath lab
D. Administer nitroglycerin 0.4 mg sublingual every 5 minutes × 3 doses
Correct Answer: A [CORRECT]
Rationale: Correct — The ECG indicates inferior wall STEMI (ST elevation II, III, aVF).
Immediate aspirin administration (chewed for rapid absorption) is the priority first step
per ACS guidelines, followed by cath lab activation regardless of biomarker results.
Distractor C is incorrect because troponin elevation is not required to diagnose STEMI;
ECG changes mandate immediate reperfusion therapy. (PCCN Domain: Cardiovascular
,– ACS Management; 2026/2027 Update: Door-to-balloon time remains <90 minutes
from first medical contact)
Q2. A 64-year-old female with NSTEMI is on medical management. Her chest pain has
resolved after nitroglycerin. Suddenly, she develops acute pulmonary edema,
hypotension (BP 78/50), and a new loud holosystolic murmur at the apex radiating to
the axilla. What is the most likely complication?
A. Acute mitral regurgitation due to papillary muscle rupture
B. Development of aortic stenosis from calcific degeneration
C. Left ventricular free wall rupture with cardiac tamponade
D. Acute ventricular septal defect formation
Correct Answer: A [CORRECT]
Rationale: Correct — Papillary muscle rupture post-MI causes acute mitral regurgitation,
presenting with sudden pulmonary edema, hypotension, and holosystolic murmur at the
apex. Distractor D (VSD) also causes new murmur but typically presents with harsh
holosystolic murmur at left lower sternal border with thrill. (PCCN Domain:
Cardiovascular – Post-MI Complications)
Q3. A patient with anterior wall STEMI received PCI 4 hours ago. The nurse notes
pericardial friction rub on auscultation and diffuse ST elevation on 12-lead ECG. The
patient reports sharp chest pain worsened by inspiration and supine positioning. What
is the priority nursing intervention?
A. Prepare for emergency pericardiocentesis
B. Position the patient upright and leaning forward, administer NSAIDs
C. Activate the cath lab for repeat emergency PCI
D. Administer morphine and obtain stat CT pulmonary angiogram
,Correct Answer: B [CORRECT]
Rationale: Correct — These findings indicate acute pericarditis (friction rub, pleuritic
pain improved leaning forward, diffuse ST elevation). Treatment includes positioning for
comfort and NSAIDs. Distractor A is incorrect because pericardiocentesis is reserved
for pericardial effusion with tamponade physiology (Beck's triad: hypotension, JVD,
muffled heart sounds). (PCCN Domain: Cardiovascular – Pericardial Conditions)
Q4. A patient post-MI day 3 complains of fever 38.2°C, pleuritic chest pain, and
pericardial friction rub. ECG shows diffuse ST elevation. Which complication should the
nurse suspect?
A. Dressler syndrome
B. Recurrent STEMI
C. Ventricular aneurysm formation
D. Acute pulmonary embolism
Correct Answer: A [CORRECT]
Rationale: Correct — Dressler syndrome (post-myocardial infarction syndrome) occurs
weeks to months post-MI with fever, pericarditis, and pleuritis. Distractor B (recurrent
MI) would show focal ST changes corresponding to coronary territory, not diffuse ST
elevation with systemic inflammation. (PCCN Domain: Cardiovascular – Post-MI
Complications)
Q5. A 72-year-old with STEMI is post-PCI. Which cardiac biomarker elevation pattern
indicates myocardial necrosis occurring 8 hours ago?
A. Troponin I beginning to rise, CK-MB normal
B. Troponin I peaked at 12 hours, CK-MB still elevated
C. CK-MB returning to baseline, troponin still elevated
, D. Both troponin and CK-MB at peak levels simultaneously
Correct Answer: B [CORRECT]
Rationale: Correct — Troponin I/T peaks at 12-24 hours post-MI and remains elevated
5-14 days; CK-MB peaks at 12-24 hours but returns to normal within 48-72 hours. At 8
hours, both would be rising toward peak. Distractor A is incorrect because CK-MB rises
within 4-6 hours, so it would not be normal at 8 hours. (PCCN Domain: Cardiovascular –
Cardiac Biomarkers)
Q6. A patient with ACS has the following vital signs: BP 82/48, HR 110, SpO2 89%. Lung
examination reveals bilateral crackles. The patient is confused and oliguric. What is the
priority intervention?
A. Administer sublingual nitroglycerin 0.4 mg
B. Initiate norepinephrine infusion and prepare for intra-aortic balloon pump
C. Administer metoprolol 25 mg orally
D. Initiate high-flow nasal cannula at 60 L/min and administer furosemide
Correct Answer: B [CORRECT]
Rationale: Correct — This patient presents cardiogenic shock (hypotension, organ
hypoperfusion) secondary to ACS. Vasopressors (norepinephrine) and mechanical
circulatory support are indicated. Distractor A (nitroglycerin) is contraindicated in
hypotension. Distractor C (beta-blocker) would worsen cardiogenic shock by further
depressing contractility. (PCCN Domain: Cardiovascular – Cardiogenic Shock)
Q7. A patient is receiving fibrinolytic therapy for STEMI. Which assessment finding
requires immediate discontinuation of the infusion?
A. Blood pressure 156/88 mmHg
B. Development of gingival bleeding and hematuria
Exam Certification Practice Questions and
Answers Graded A+ Detailed Rationales - Pass
Guaranteed - A+ Graded
Domain: Cardiovascular – Acute Coronary Syndromes & Myocardial Infarction
Q1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating
to his left arm for the past 90 minutes. Vital signs: BP 156/92, HR 98, SpO2 94% on
room air. ECG shows ST elevation >2mm in leads II, III, and aVF with reciprocal ST
depression in leads I and aVL. Troponin I is pending. What is the priority intervention?
A. Administer aspirin 324 mg chewed and establish IV access
B. Prepare the patient for immediate synchronized cardioversion
C. Initiate heparin infusion and wait for troponin results before activating cath lab
D. Administer nitroglycerin 0.4 mg sublingual every 5 minutes × 3 doses
Correct Answer: A [CORRECT]
Rationale: Correct — The ECG indicates inferior wall STEMI (ST elevation II, III, aVF).
Immediate aspirin administration (chewed for rapid absorption) is the priority first step
per ACS guidelines, followed by cath lab activation regardless of biomarker results.
Distractor C is incorrect because troponin elevation is not required to diagnose STEMI;
ECG changes mandate immediate reperfusion therapy. (PCCN Domain: Cardiovascular
,– ACS Management; 2026/2027 Update: Door-to-balloon time remains <90 minutes
from first medical contact)
Q2. A 64-year-old female with NSTEMI is on medical management. Her chest pain has
resolved after nitroglycerin. Suddenly, she develops acute pulmonary edema,
hypotension (BP 78/50), and a new loud holosystolic murmur at the apex radiating to
the axilla. What is the most likely complication?
A. Acute mitral regurgitation due to papillary muscle rupture
B. Development of aortic stenosis from calcific degeneration
C. Left ventricular free wall rupture with cardiac tamponade
D. Acute ventricular septal defect formation
Correct Answer: A [CORRECT]
Rationale: Correct — Papillary muscle rupture post-MI causes acute mitral regurgitation,
presenting with sudden pulmonary edema, hypotension, and holosystolic murmur at the
apex. Distractor D (VSD) also causes new murmur but typically presents with harsh
holosystolic murmur at left lower sternal border with thrill. (PCCN Domain:
Cardiovascular – Post-MI Complications)
Q3. A patient with anterior wall STEMI received PCI 4 hours ago. The nurse notes
pericardial friction rub on auscultation and diffuse ST elevation on 12-lead ECG. The
patient reports sharp chest pain worsened by inspiration and supine positioning. What
is the priority nursing intervention?
A. Prepare for emergency pericardiocentesis
B. Position the patient upright and leaning forward, administer NSAIDs
C. Activate the cath lab for repeat emergency PCI
D. Administer morphine and obtain stat CT pulmonary angiogram
,Correct Answer: B [CORRECT]
Rationale: Correct — These findings indicate acute pericarditis (friction rub, pleuritic
pain improved leaning forward, diffuse ST elevation). Treatment includes positioning for
comfort and NSAIDs. Distractor A is incorrect because pericardiocentesis is reserved
for pericardial effusion with tamponade physiology (Beck's triad: hypotension, JVD,
muffled heart sounds). (PCCN Domain: Cardiovascular – Pericardial Conditions)
Q4. A patient post-MI day 3 complains of fever 38.2°C, pleuritic chest pain, and
pericardial friction rub. ECG shows diffuse ST elevation. Which complication should the
nurse suspect?
A. Dressler syndrome
B. Recurrent STEMI
C. Ventricular aneurysm formation
D. Acute pulmonary embolism
Correct Answer: A [CORRECT]
Rationale: Correct — Dressler syndrome (post-myocardial infarction syndrome) occurs
weeks to months post-MI with fever, pericarditis, and pleuritis. Distractor B (recurrent
MI) would show focal ST changes corresponding to coronary territory, not diffuse ST
elevation with systemic inflammation. (PCCN Domain: Cardiovascular – Post-MI
Complications)
Q5. A 72-year-old with STEMI is post-PCI. Which cardiac biomarker elevation pattern
indicates myocardial necrosis occurring 8 hours ago?
A. Troponin I beginning to rise, CK-MB normal
B. Troponin I peaked at 12 hours, CK-MB still elevated
C. CK-MB returning to baseline, troponin still elevated
, D. Both troponin and CK-MB at peak levels simultaneously
Correct Answer: B [CORRECT]
Rationale: Correct — Troponin I/T peaks at 12-24 hours post-MI and remains elevated
5-14 days; CK-MB peaks at 12-24 hours but returns to normal within 48-72 hours. At 8
hours, both would be rising toward peak. Distractor A is incorrect because CK-MB rises
within 4-6 hours, so it would not be normal at 8 hours. (PCCN Domain: Cardiovascular –
Cardiac Biomarkers)
Q6. A patient with ACS has the following vital signs: BP 82/48, HR 110, SpO2 89%. Lung
examination reveals bilateral crackles. The patient is confused and oliguric. What is the
priority intervention?
A. Administer sublingual nitroglycerin 0.4 mg
B. Initiate norepinephrine infusion and prepare for intra-aortic balloon pump
C. Administer metoprolol 25 mg orally
D. Initiate high-flow nasal cannula at 60 L/min and administer furosemide
Correct Answer: B [CORRECT]
Rationale: Correct — This patient presents cardiogenic shock (hypotension, organ
hypoperfusion) secondary to ACS. Vasopressors (norepinephrine) and mechanical
circulatory support are indicated. Distractor A (nitroglycerin) is contraindicated in
hypotension. Distractor C (beta-blocker) would worsen cardiogenic shock by further
depressing contractility. (PCCN Domain: Cardiovascular – Cardiogenic Shock)
Q7. A patient is receiving fibrinolytic therapy for STEMI. Which assessment finding
requires immediate discontinuation of the infusion?
A. Blood pressure 156/88 mmHg
B. Development of gingival bleeding and hematuria
