1
PCCN Exam Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales |
100% Verified – Pass Guaranteed – A+ Graded
Section 1: Cardiovascular System (Questions 1-45)
Q1: A patient is admitted with STEMI. The ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Left Circumflex (LCx)
C. Right Coronary Artery (RCA)
D. Left Main Coronary Artery
Correct Answer: C
Rationale: Leads II, III, and aVF view the inferior wall of the heart, which is supplied by the
RCA in most individuals (right-dominant circulation). LAD (A) supplies the anterior wall (V1-
V4). LCx (B) supplies the lateral wall (I, aVL, V5-V6). Left Main (D) occlusion is usually fatal.
Q2: A patient with acute decompensated heart failure presents with crackles, JVD, S3 gallop, and
BP 85/50 mmHg. Which medication is the priority to improve cardiac output?
A. Furosemide (Lasix)
B. Metoprolol (Lopressor)
C. Nitroglycerin
D. Dobutamine (Dobutrex)
Correct Answer: D
Rationale: The patient is in cardiogenic shock (low BP, signs of fluid overload). Inotropes like
Dobutamine increase myocardial contractility and cardiac output. Diuretics (A) and Nitrates (C)
reduce preload and would further drop the BP. Beta-blockers (B) are contraindicated in acute
decompensated HF with hypotension.
,2
Q3: A patient on telemetry has a rhythm with no P waves, an irregularly irregular R-R interval,
and a narrow QRS complex. The patient is hemodynamically stable. What is the priority
intervention?
A. Immediate synchronized cardioversion.
B. Administer Amiodarone.
C. Administer Metoprolol to control rate.
D. Prepare for transcutaneous pacing.
Correct Answer: C
Rationale: The rhythm is Atrial Fibrillation. In a stable patient, the priority is rate control (beta-
blockers or calcium channel blockers) to prevent tachycardia-induced cardiomyopathy.
Cardioversion (A) is for unstable patients or new-onset AF <48 hours. Amiodarone (B) is used if
rate control fails or in HF. Pacing (D) is for bradycardia.
Q4: A patient with a pulmonary artery catheter has the following hemodynamic values: Cardiac
Output (CO) 3.5 L/min, Cardiac Index (CI) 1.8 L/min/m², Mixed Venous Oxygen Saturation
(SvO2) 60%, and Systemic Vascular Resistance (SVR) 1800 dynes·sec/cm⁵. These values are
consistent with:
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Anaphylactic shock
Correct Answer: B
Rationale: The patient has a low CO/CI (pump failure) and high SVR (vasoconstriction to
maintain BP). These are classic findings in cardiogenic shock. Septic shock (C) typically
presents with high CO/CI (early) or normal CO with low SVR. Hypovolemic shock (A) would
have high SVR but low PAOP (not provided, but implied low volume).
Q5: Which ECG finding is most concerning for impending ventricular fibrillation?
A. First-degree AV block
B. Frequent Premature Ventricular Contractions (PVCs)
C. Atrial flutter with 4:1 block
,3
D. Sinus bradycardia
Correct Answer: B
Rationale: Frequent PVCs, especially if they are multifocal or occur on the T wave (R-on-T
phenomenon), are a warning sign of ventricular irritability and can precipitate Ventricular
Fibrillation. First-degree block (A) and sinus bradycardia (D) are generally stable. Atrial flutter
(C) is usually stable.
Q6: A patient is receiving nitroprusside (Nipride) for a hypertensive emergency. The nurse must
monitor for which specific sign of toxicity?
A. Tinnitus
B. Metabolic acidosis and thiocyanate toxicity
C. Hyperkalemia
D. Constipation
Correct Answer: B
Rationale: Nitroprusside metabolizes into cyanide and thiocyanate. Signs of cyanide toxicity
include metabolic acidosis, altered mental status, and cardiac instability. Tinnitus (A) is
associated with loop diuretics or aspirin.
Q7: A patient with aortic stenosis reports chest pain, syncope, and dyspnea on exertion. What is
the pathophysiological cause of these symptoms?
A. Regurgitation of blood back into the left atrium
B. Obstruction of blood flow from the left ventricle
C. Dilation of the aortic root
D. Thickening of the pericardium
Correct Answer: B
Rationale: Aortic stenosis causes a fixed obstruction to outflow from the left ventricle, leading to
angina (ischemia), syncope (fixed cardiac output), and dyspnea (elevated left atrial pressure).
Q8: A patient presents with sudden tearing chest pain radiating to the back. BP is 180/110 in the
right arm and 140/90 in the left arm. What is the immediate pharmacological intervention?
, 4
A. Thrombolytics
B. Beta-blocker (e.g., Labetalol)
C. High-dose Aspirin
D. Furosemide
Correct Answer: B
Rationale: This is a classic presentation of aortic dissection. The immediate goal is to reduce
shear force by lowering heart rate and blood pressure using beta-blockers. Thrombolytics (A) are
contraindicated as they can worsen the bleeding.
Q9: A patient with an inferior wall MI develops second-degree AV block (Mobitz Type I). The
heart rate is 50. The patient is asymptomatic. What is the appropriate action?
A. Prepare for immediate transvenous pacing.
B. Administer Atropine.
C. Continue monitoring and have atropine available.
D. Administer Amiodarone.
Correct Answer: C
Rationale: Type I (Wenckebach) is usually transient and benign, especially with inferior MI. If
the patient is stable and asymptomatic with adequate hemodynamics, conservative management
with monitoring is appropriate. Pacing (A) is for symptomatic bradycardia or Type II blocks.
Q10: The nurse is assessing a patient with an arterial line. The waveform shows an overdamped
appearance (sluggish upstroke, loss of dicrotic notch). What is the priority nursing action?
A. Check the stopcock position and flush the line.
B. Zero the transducer.
C. Administer a fluid bolus.
D. Increase the scale on the monitor.
Correct Answer: A
Rationale: Overdamping is caused by air bubbles, clots, or kinks in the tubing. Flushing the line
and checking connections restores accuracy. Zeroing (B) corrects baseline drift but not damping.
PCCN Exam Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales |
100% Verified – Pass Guaranteed – A+ Graded
Section 1: Cardiovascular System (Questions 1-45)
Q1: A patient is admitted with STEMI. The ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Left Circumflex (LCx)
C. Right Coronary Artery (RCA)
D. Left Main Coronary Artery
Correct Answer: C
Rationale: Leads II, III, and aVF view the inferior wall of the heart, which is supplied by the
RCA in most individuals (right-dominant circulation). LAD (A) supplies the anterior wall (V1-
V4). LCx (B) supplies the lateral wall (I, aVL, V5-V6). Left Main (D) occlusion is usually fatal.
Q2: A patient with acute decompensated heart failure presents with crackles, JVD, S3 gallop, and
BP 85/50 mmHg. Which medication is the priority to improve cardiac output?
A. Furosemide (Lasix)
B. Metoprolol (Lopressor)
C. Nitroglycerin
D. Dobutamine (Dobutrex)
Correct Answer: D
Rationale: The patient is in cardiogenic shock (low BP, signs of fluid overload). Inotropes like
Dobutamine increase myocardial contractility and cardiac output. Diuretics (A) and Nitrates (C)
reduce preload and would further drop the BP. Beta-blockers (B) are contraindicated in acute
decompensated HF with hypotension.
,2
Q3: A patient on telemetry has a rhythm with no P waves, an irregularly irregular R-R interval,
and a narrow QRS complex. The patient is hemodynamically stable. What is the priority
intervention?
A. Immediate synchronized cardioversion.
B. Administer Amiodarone.
C. Administer Metoprolol to control rate.
D. Prepare for transcutaneous pacing.
Correct Answer: C
Rationale: The rhythm is Atrial Fibrillation. In a stable patient, the priority is rate control (beta-
blockers or calcium channel blockers) to prevent tachycardia-induced cardiomyopathy.
Cardioversion (A) is for unstable patients or new-onset AF <48 hours. Amiodarone (B) is used if
rate control fails or in HF. Pacing (D) is for bradycardia.
Q4: A patient with a pulmonary artery catheter has the following hemodynamic values: Cardiac
Output (CO) 3.5 L/min, Cardiac Index (CI) 1.8 L/min/m², Mixed Venous Oxygen Saturation
(SvO2) 60%, and Systemic Vascular Resistance (SVR) 1800 dynes·sec/cm⁵. These values are
consistent with:
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Anaphylactic shock
Correct Answer: B
Rationale: The patient has a low CO/CI (pump failure) and high SVR (vasoconstriction to
maintain BP). These are classic findings in cardiogenic shock. Septic shock (C) typically
presents with high CO/CI (early) or normal CO with low SVR. Hypovolemic shock (A) would
have high SVR but low PAOP (not provided, but implied low volume).
Q5: Which ECG finding is most concerning for impending ventricular fibrillation?
A. First-degree AV block
B. Frequent Premature Ventricular Contractions (PVCs)
C. Atrial flutter with 4:1 block
,3
D. Sinus bradycardia
Correct Answer: B
Rationale: Frequent PVCs, especially if they are multifocal or occur on the T wave (R-on-T
phenomenon), are a warning sign of ventricular irritability and can precipitate Ventricular
Fibrillation. First-degree block (A) and sinus bradycardia (D) are generally stable. Atrial flutter
(C) is usually stable.
Q6: A patient is receiving nitroprusside (Nipride) for a hypertensive emergency. The nurse must
monitor for which specific sign of toxicity?
A. Tinnitus
B. Metabolic acidosis and thiocyanate toxicity
C. Hyperkalemia
D. Constipation
Correct Answer: B
Rationale: Nitroprusside metabolizes into cyanide and thiocyanate. Signs of cyanide toxicity
include metabolic acidosis, altered mental status, and cardiac instability. Tinnitus (A) is
associated with loop diuretics or aspirin.
Q7: A patient with aortic stenosis reports chest pain, syncope, and dyspnea on exertion. What is
the pathophysiological cause of these symptoms?
A. Regurgitation of blood back into the left atrium
B. Obstruction of blood flow from the left ventricle
C. Dilation of the aortic root
D. Thickening of the pericardium
Correct Answer: B
Rationale: Aortic stenosis causes a fixed obstruction to outflow from the left ventricle, leading to
angina (ischemia), syncope (fixed cardiac output), and dyspnea (elevated left atrial pressure).
Q8: A patient presents with sudden tearing chest pain radiating to the back. BP is 180/110 in the
right arm and 140/90 in the left arm. What is the immediate pharmacological intervention?
, 4
A. Thrombolytics
B. Beta-blocker (e.g., Labetalol)
C. High-dose Aspirin
D. Furosemide
Correct Answer: B
Rationale: This is a classic presentation of aortic dissection. The immediate goal is to reduce
shear force by lowering heart rate and blood pressure using beta-blockers. Thrombolytics (A) are
contraindicated as they can worsen the bleeding.
Q9: A patient with an inferior wall MI develops second-degree AV block (Mobitz Type I). The
heart rate is 50. The patient is asymptomatic. What is the appropriate action?
A. Prepare for immediate transvenous pacing.
B. Administer Atropine.
C. Continue monitoring and have atropine available.
D. Administer Amiodarone.
Correct Answer: C
Rationale: Type I (Wenckebach) is usually transient and benign, especially with inferior MI. If
the patient is stable and asymptomatic with adequate hemodynamics, conservative management
with monitoring is appropriate. Pacing (A) is for symptomatic bradycardia or Type II blocks.
Q10: The nurse is assessing a patient with an arterial line. The waveform shows an overdamped
appearance (sluggish upstroke, loss of dicrotic notch). What is the priority nursing action?
A. Check the stopcock position and flush the line.
B. Zero the transducer.
C. Administer a fluid bolus.
D. Increase the scale on the monitor.
Correct Answer: A
Rationale: Overdamping is caused by air bubbles, clots, or kinks in the tubing. Flushing the line
and checking connections restores accuracy. Zeroing (B) corrects baseline drift but not damping.
