PROGRESSIVE CARE RN A EXAM SUMMER 2026/2027
UPDATED | All Answered Correctly | PCCN Prep | Pass
Guaranteed - A+ Graded
[SECTION 1: CARDIOVASCULAR - ACUTE CORONARY SYNDROMES &
ARRHYTHMIAS (Q1-20)]
Q1. A 62-year-old male presents with chest pressure, diaphoresis, and nausea. ECG
shows ST-segment elevation in leads V1-V4. Troponin I is 8.5 ng/mL (normal <0.04).
Which diagnosis is most appropriate?
A. NSTEMI
B. STEMI [CORRECT]
C. Unstable angina
D. Non-cardiac chest pain
Rationale: STEMI is diagnosed by ST-segment elevation in contiguous leads (V1-V4
indicate anterior wall involvement) with elevated troponin. NSTEMI (A) shows ST
depression or T-wave inversion without ST elevation. Unstable angina (C) has similar
symptoms but no troponin elevation. Non-cardiac pain (D) would not show these ECG
changes or troponin rise. Per 2026 ACC/AHA guidelines, anterior STEMI requires
,emergent reperfusion. PCCN Safety: Door-to-balloon time <90 minutes, door-to-needle
<30 minutes if PCI unavailable.
Q2. A patient with inferior STEMI (ST elevation in II, III, aVF) develops hypotension, clear
lung sounds, and jugular venous distension. Which complication is most likely?
A. Cardiogenic shock from left ventricular failure
B. Right ventricular infarction [CORRECT]
C. Papillary muscle rupture
D. Ventricular septal defect
Rationale: Inferior STEMI with hypotension, clear lungs, and JVD is the classic triad for
right ventricular infarction (RCA occlusion). RV infarction causes decreased preload to
the left ventricle. LV failure (A) causes pulmonary edema. Papillary muscle rupture (C)
causes acute MR with pulmonary edema. VSD (D) causes a new holosystolic murmur
and biventricular failure. PCCN Safety: Avoid nitrates and diuretics in RV infarction—they
worsen preload-dependent RV function.
Q3. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m², PCWP 24
mmHg, and SVR 1800 dynes/sec/cm⁵. Which hemodynamic profile is present?
A. High-output failure
B. Low-output, high-afterload (cold and wet) [CORRECT]
C. Low-output, low-afterload (warm and dry)
,D. High-output, low-afterload (warm and wet)
Rationale: CI <2.2 L/min/m² indicates low output; PCWP >18 indicates "wet" (elevated
filling pressures); SVR >1500 indicates high afterload. This is the classic "cold and wet"
profile of cardiogenic shock. High-output failure (A, D) shows CI >2.5. "Warm and dry"
(C) shows normal/low PCWP. PCCN Safety: Inotropes (dobutamine) and afterload
reduction (IABP, Impella) are indicated.
Q4. An ECG rhythm strip shows irregularly irregular R-R intervals, no discernible P
waves, and narrow QRS complexes at a rate of 140 bpm. Which rhythm is present?
A. Atrial flutter
B. Atrial fibrillation with rapid ventricular response [CORRECT]
C. Sinus tachycardia
D. Ventricular tachycardia
Rationale: Irregularly irregular rhythm with absent P waves and fibrillatory waves is
diagnostic of atrial fibrillation. The rate of 140 indicates rapid ventricular response.
Atrial flutter (A) shows regular sawtooth flutter waves. Sinus tachycardia (C) has regular
P waves preceding each QRS. VT (D) has wide QRS complexes. PCCN Safety: Rate
control (diltiazem, amiodarone) or rhythm control (cardioversion if unstable) per ACLS
2026.
, Q5. A patient with new-onset atrial fibrillation and a rate of 160 bpm becomes
hypotensive (SBP 78/52) with altered mental status. What is the priority intervention?
A. Administer diltiazem 15 mg IV push
B. Administer metoprolol 5 mg IV
C. Synchronized cardioversion at 100-200 J [CORRECT]
D. Administer amiodarone 150 mg IV over 10 minutes
Rationale: Unstable atrial fibrillation (hypotension, altered mental status, signs of shock)
requires immediate synchronized cardioversion (100-200 J biphasic). Rate-control
agents (A, B) are contraindicated in unstable patients as they worsen hypotension.
Amiodarone (D) is appropriate for stable patients or after cardioversion. PCCN Safety:
Synchronized shock avoids R-on-T phenomenon; defibrillation pads placed
anterior-posterior for AFib.
Q6. An ECG shows progressive prolongation of the PR interval until a QRS complex is
dropped, then the cycle repeats. Which conduction abnormality is present?
A. First-degree AV block
B. Second-degree AV block Type I (Wenckebach) [CORRECT]
C. Second-degree AV block Type II (Mobitz II)
D. Third-degree AV block
Rationale: Wenckebach (Mobitz I) shows progressive PR prolongation until a dropped
beat, with the PR interval shortening after the dropped beat. First-degree (A) shows
UPDATED | All Answered Correctly | PCCN Prep | Pass
Guaranteed - A+ Graded
[SECTION 1: CARDIOVASCULAR - ACUTE CORONARY SYNDROMES &
ARRHYTHMIAS (Q1-20)]
Q1. A 62-year-old male presents with chest pressure, diaphoresis, and nausea. ECG
shows ST-segment elevation in leads V1-V4. Troponin I is 8.5 ng/mL (normal <0.04).
Which diagnosis is most appropriate?
A. NSTEMI
B. STEMI [CORRECT]
C. Unstable angina
D. Non-cardiac chest pain
Rationale: STEMI is diagnosed by ST-segment elevation in contiguous leads (V1-V4
indicate anterior wall involvement) with elevated troponin. NSTEMI (A) shows ST
depression or T-wave inversion without ST elevation. Unstable angina (C) has similar
symptoms but no troponin elevation. Non-cardiac pain (D) would not show these ECG
changes or troponin rise. Per 2026 ACC/AHA guidelines, anterior STEMI requires
,emergent reperfusion. PCCN Safety: Door-to-balloon time <90 minutes, door-to-needle
<30 minutes if PCI unavailable.
Q2. A patient with inferior STEMI (ST elevation in II, III, aVF) develops hypotension, clear
lung sounds, and jugular venous distension. Which complication is most likely?
A. Cardiogenic shock from left ventricular failure
B. Right ventricular infarction [CORRECT]
C. Papillary muscle rupture
D. Ventricular septal defect
Rationale: Inferior STEMI with hypotension, clear lungs, and JVD is the classic triad for
right ventricular infarction (RCA occlusion). RV infarction causes decreased preload to
the left ventricle. LV failure (A) causes pulmonary edema. Papillary muscle rupture (C)
causes acute MR with pulmonary edema. VSD (D) causes a new holosystolic murmur
and biventricular failure. PCCN Safety: Avoid nitrates and diuretics in RV infarction—they
worsen preload-dependent RV function.
Q3. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m², PCWP 24
mmHg, and SVR 1800 dynes/sec/cm⁵. Which hemodynamic profile is present?
A. High-output failure
B. Low-output, high-afterload (cold and wet) [CORRECT]
C. Low-output, low-afterload (warm and dry)
,D. High-output, low-afterload (warm and wet)
Rationale: CI <2.2 L/min/m² indicates low output; PCWP >18 indicates "wet" (elevated
filling pressures); SVR >1500 indicates high afterload. This is the classic "cold and wet"
profile of cardiogenic shock. High-output failure (A, D) shows CI >2.5. "Warm and dry"
(C) shows normal/low PCWP. PCCN Safety: Inotropes (dobutamine) and afterload
reduction (IABP, Impella) are indicated.
Q4. An ECG rhythm strip shows irregularly irregular R-R intervals, no discernible P
waves, and narrow QRS complexes at a rate of 140 bpm. Which rhythm is present?
A. Atrial flutter
B. Atrial fibrillation with rapid ventricular response [CORRECT]
C. Sinus tachycardia
D. Ventricular tachycardia
Rationale: Irregularly irregular rhythm with absent P waves and fibrillatory waves is
diagnostic of atrial fibrillation. The rate of 140 indicates rapid ventricular response.
Atrial flutter (A) shows regular sawtooth flutter waves. Sinus tachycardia (C) has regular
P waves preceding each QRS. VT (D) has wide QRS complexes. PCCN Safety: Rate
control (diltiazem, amiodarone) or rhythm control (cardioversion if unstable) per ACLS
2026.
, Q5. A patient with new-onset atrial fibrillation and a rate of 160 bpm becomes
hypotensive (SBP 78/52) with altered mental status. What is the priority intervention?
A. Administer diltiazem 15 mg IV push
B. Administer metoprolol 5 mg IV
C. Synchronized cardioversion at 100-200 J [CORRECT]
D. Administer amiodarone 150 mg IV over 10 minutes
Rationale: Unstable atrial fibrillation (hypotension, altered mental status, signs of shock)
requires immediate synchronized cardioversion (100-200 J biphasic). Rate-control
agents (A, B) are contraindicated in unstable patients as they worsen hypotension.
Amiodarone (D) is appropriate for stable patients or after cardioversion. PCCN Safety:
Synchronized shock avoids R-on-T phenomenon; defibrillation pads placed
anterior-posterior for AFib.
Q6. An ECG shows progressive prolongation of the PR interval until a QRS complex is
dropped, then the cycle repeats. Which conduction abnormality is present?
A. First-degree AV block
B. Second-degree AV block Type I (Wenckebach) [CORRECT]
C. Second-degree AV block Type II (Mobitz II)
D. Third-degree AV block
Rationale: Wenckebach (Mobitz I) shows progressive PR prolongation until a dropped
beat, with the PR interval shortening after the dropped beat. First-degree (A) shows
