PCCN EXAM TEST BANK Actual Exam 2026/2027
Complete Questions and Answers Detailed
Rationales Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular | Q1 – Q10
Section 2 | Pulmonary | Q11 – Q20
Section 3 | Neurologic | Q21 – Q30
Section 4 | Renal, Endocrine, and Gastrointestinal | Q31 – Q40
Section 5 | Multisystem, Behavioral, and Professional Caring | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CARDIOVASCULAR Q1 – Q10
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Question 1 of 50
A 68-year-old male is admitted to the telemetry unit after an anterior wall STEMI. He
received PCI with a drug-eluting stent to the LAD 4 hours ago. His vital signs are BP
98/62 mmHg, HR 112 bpm, RR 24/min, SpO2 91% on 4L NC. He is diaphoretic and
reports increasing chest pressure. His lungs are clear bilaterally. The bedside nurse
notes his neck veins are distended and his heart sounds are muffled.
A. Increase the oxygen to 6L NC and obtain a stat chest x-ray
B. Administer a 500 mL normal saline bolus and reassess in 15 minutes
C. Notify the provider immediately for emergent pericardiocentesis
D. Titrate nitroglycerin per protocol to reduce afterload
Correct Answer: C
Rationale: The triad of hypotension, jugular venous distention, and muffled heart sounds
in a post-PCI patient is classic for cardiac tamponade, a known complication of cardiac
,catheterization. Emergent pericardiocentesis is the definitive treatment to relieve
pericardial pressure and restore cardiac output. Increasing oxygen or giving fluids will
not address the underlying mechanical obstruction, and nitroglycerin would worsen the
hypotension. Post-procedure tamponade can develop hours after PCI, so vigilance for
Beck's triad remains essential even after the patient returns to the unit.
Question 2 of 50
A 72-year-old female with a history of systolic heart failure (EF 30%) presents to the
progressive care unit with acute dyspnea, bilateral crackles, and pink frothy sputum. Her
BP is 186/104 mmHg, HR 118 bpm, RR 32/min. She is placed on BiPAP with
improvement in work of breathing. The provider orders IV nitroglycerin, furosemide, and
morphine.
A. Monitor the patient closely for reflex tachycardia and worsening renal function
B. Hold the morphine until the systolic BP drops below 140 mmHg
C. Start a low-dose dopamine infusion to preserve renal perfusion
D. Increase the furosemide dose if the patient does not produce 500 mL urine within 1
hour
Correct Answer: A
Rationale: The combination of afterload reduction with nitroglycerin, diuresis with
furosemide, and venodilation with morphine can precipitate hypotension and reflex
tachycardia, which further compromises coronary perfusion and renal blood flow.
Holding morphine solely for BP is not indicated since morphine reduces preload and
anxiety without significantly dropping BP in this setting. Dopamine is not routinely used
for renal protection in acute cardiogenic pulmonary edema, and setting an arbitrary
urine output target ignores the need for hemodynamic stabilization first.
Question 3 of 50
,A 54-year-old male with a history of atrial fibrillation on warfarin presents with
palpitations, lightheadedness, and fatigue. His ECG shows an irregularly irregular
rhythm with a ventricular rate of 152 bpm and narrow QRS complexes. His BP is 102/68
mmHg.
A. Prepare for immediate synchronized cardioversion at 100 joules
B. Administer IV diltiazem 0.25 mg/kg bolus followed by an infusion
C. Administer IV adenosine 6 mg rapid push followed by a 12 mg dose if needed
D. Give IV metoprolol 5 mg every 5 minutes for a total of 15 mg
Correct Answer: B
Rationale: This patient has rapid atrial fibrillation with a narrow-complex QRS and is
hemodynamically stable enough for rate control; diltiazem is the preferred first-line
agent for ventricular rate control in AF with RVR. Synchronized cardioversion is reserved
for unstable patients with signs of shock, ischemia, or altered mental status. Adenosine
is used for reentrant supraventricular tachycardias, not atrial fibrillation, and metoprolol
is less effective for acute rate control and may worsen hypotension in this setting.
Question 4 of 50
A 61-year-old male is 8 hours post-CABG x3 and suddenly develops hypotension (BP
76/48 mmHg), tachycardia (HR 128 bpm), and muffled heart sounds. His mediastinal
chest tube output has decreased from 150 mL/hr to 20 mL/hr over the past 2 hours. His
CVP has risen from 8 mmHg to 18 mmHg.
A. Increase the suction on the mediastinal chest tubes to -30 cmH2O
B. Prepare the patient for emergent return to the OR for mediastinal exploration
C. Administer a 1 L crystalloid bolus and reassess hemodynamics
D. Give IV epinephrine 0.1 mg push for symptomatic bradycardia
Correct Answer: B
Rationale: The combination of hypotension, rising CVP, muffled heart sounds, and a
sudden drop in chest tube output after CABG is highly suggestive of cardiac tamponade
, from mediastinal bleeding and clot accumulation. Increasing chest tube suction will not
evacuate a formed clot, and fluid boluses or epinephrine are temporizing measures that
do not address the underlying mechanical compression of the heart. Postoperative
tamponade after cardiac surgery is a surgical emergency requiring prompt mediastinal
exploration and evacuation.
Question 5 of 50
A 45-year-old female with hypertrophic cardiomyopathy is admitted with chest pain and
dyspnea. Her ECG shows left ventricular hypertrophy with ST-T wave changes. Her BP is
142/88 mmHg, HR 96 bpm. She reports that her symptoms worsen with exertion and
improve when she lies down.
A. Start an IV nitroglycerin drip to reduce preload and afterload
B. Administer IV fluids to increase preload and maintain ventricular filling
C. Initiate a dobutamine infusion to improve contractility
D. Place the patient in the supine position with legs elevated
Correct Answer: B
Rationale: In hypertrophic cardiomyopathy, the obstructive physiology worsens with
decreased preload or increased contractility; maintaining adequate preload with IV
fluids helps prevent dynamic outflow tract obstruction. Nitroglycerin and dobutamine
would both worsen obstruction by reducing preload and increasing contractility,
respectively. While supine positioning with leg elevation can help, it is not a standalone
intervention and fluids are the priority to optimize ventricular filling.
Question 6 of 50
A 58-year-old male with a history of dilated cardiomyopathy (EF 20%) is admitted with
worsening dyspnea and peripheral edema. His home medications include lisinopril,
carvedilol, furosemide, and spironolactone. His labs show K+ 5.8 mEq/L, creatinine 2.4
mg/dL, and BNP 2,400 pg/mL.
Complete Questions and Answers Detailed
Rationales Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular | Q1 – Q10
Section 2 | Pulmonary | Q11 – Q20
Section 3 | Neurologic | Q21 – Q30
Section 4 | Renal, Endocrine, and Gastrointestinal | Q31 – Q40
Section 5 | Multisystem, Behavioral, and Professional Caring | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male is admitted to the telemetry unit after an anterior wall STEMI. He
received PCI with a drug-eluting stent to the LAD 4 hours ago. His vital signs are BP
98/62 mmHg, HR 112 bpm, RR 24/min, SpO2 91% on 4L NC. He is diaphoretic and
reports increasing chest pressure. His lungs are clear bilaterally. The bedside nurse
notes his neck veins are distended and his heart sounds are muffled.
A. Increase the oxygen to 6L NC and obtain a stat chest x-ray
B. Administer a 500 mL normal saline bolus and reassess in 15 minutes
C. Notify the provider immediately for emergent pericardiocentesis
D. Titrate nitroglycerin per protocol to reduce afterload
Correct Answer: C
Rationale: The triad of hypotension, jugular venous distention, and muffled heart sounds
in a post-PCI patient is classic for cardiac tamponade, a known complication of cardiac
,catheterization. Emergent pericardiocentesis is the definitive treatment to relieve
pericardial pressure and restore cardiac output. Increasing oxygen or giving fluids will
not address the underlying mechanical obstruction, and nitroglycerin would worsen the
hypotension. Post-procedure tamponade can develop hours after PCI, so vigilance for
Beck's triad remains essential even after the patient returns to the unit.
Question 2 of 50
A 72-year-old female with a history of systolic heart failure (EF 30%) presents to the
progressive care unit with acute dyspnea, bilateral crackles, and pink frothy sputum. Her
BP is 186/104 mmHg, HR 118 bpm, RR 32/min. She is placed on BiPAP with
improvement in work of breathing. The provider orders IV nitroglycerin, furosemide, and
morphine.
A. Monitor the patient closely for reflex tachycardia and worsening renal function
B. Hold the morphine until the systolic BP drops below 140 mmHg
C. Start a low-dose dopamine infusion to preserve renal perfusion
D. Increase the furosemide dose if the patient does not produce 500 mL urine within 1
hour
Correct Answer: A
Rationale: The combination of afterload reduction with nitroglycerin, diuresis with
furosemide, and venodilation with morphine can precipitate hypotension and reflex
tachycardia, which further compromises coronary perfusion and renal blood flow.
Holding morphine solely for BP is not indicated since morphine reduces preload and
anxiety without significantly dropping BP in this setting. Dopamine is not routinely used
for renal protection in acute cardiogenic pulmonary edema, and setting an arbitrary
urine output target ignores the need for hemodynamic stabilization first.
Question 3 of 50
,A 54-year-old male with a history of atrial fibrillation on warfarin presents with
palpitations, lightheadedness, and fatigue. His ECG shows an irregularly irregular
rhythm with a ventricular rate of 152 bpm and narrow QRS complexes. His BP is 102/68
mmHg.
A. Prepare for immediate synchronized cardioversion at 100 joules
B. Administer IV diltiazem 0.25 mg/kg bolus followed by an infusion
C. Administer IV adenosine 6 mg rapid push followed by a 12 mg dose if needed
D. Give IV metoprolol 5 mg every 5 minutes for a total of 15 mg
Correct Answer: B
Rationale: This patient has rapid atrial fibrillation with a narrow-complex QRS and is
hemodynamically stable enough for rate control; diltiazem is the preferred first-line
agent for ventricular rate control in AF with RVR. Synchronized cardioversion is reserved
for unstable patients with signs of shock, ischemia, or altered mental status. Adenosine
is used for reentrant supraventricular tachycardias, not atrial fibrillation, and metoprolol
is less effective for acute rate control and may worsen hypotension in this setting.
Question 4 of 50
A 61-year-old male is 8 hours post-CABG x3 and suddenly develops hypotension (BP
76/48 mmHg), tachycardia (HR 128 bpm), and muffled heart sounds. His mediastinal
chest tube output has decreased from 150 mL/hr to 20 mL/hr over the past 2 hours. His
CVP has risen from 8 mmHg to 18 mmHg.
A. Increase the suction on the mediastinal chest tubes to -30 cmH2O
B. Prepare the patient for emergent return to the OR for mediastinal exploration
C. Administer a 1 L crystalloid bolus and reassess hemodynamics
D. Give IV epinephrine 0.1 mg push for symptomatic bradycardia
Correct Answer: B
Rationale: The combination of hypotension, rising CVP, muffled heart sounds, and a
sudden drop in chest tube output after CABG is highly suggestive of cardiac tamponade
, from mediastinal bleeding and clot accumulation. Increasing chest tube suction will not
evacuate a formed clot, and fluid boluses or epinephrine are temporizing measures that
do not address the underlying mechanical compression of the heart. Postoperative
tamponade after cardiac surgery is a surgical emergency requiring prompt mediastinal
exploration and evacuation.
Question 5 of 50
A 45-year-old female with hypertrophic cardiomyopathy is admitted with chest pain and
dyspnea. Her ECG shows left ventricular hypertrophy with ST-T wave changes. Her BP is
142/88 mmHg, HR 96 bpm. She reports that her symptoms worsen with exertion and
improve when she lies down.
A. Start an IV nitroglycerin drip to reduce preload and afterload
B. Administer IV fluids to increase preload and maintain ventricular filling
C. Initiate a dobutamine infusion to improve contractility
D. Place the patient in the supine position with legs elevated
Correct Answer: B
Rationale: In hypertrophic cardiomyopathy, the obstructive physiology worsens with
decreased preload or increased contractility; maintaining adequate preload with IV
fluids helps prevent dynamic outflow tract obstruction. Nitroglycerin and dobutamine
would both worsen obstruction by reducing preload and increasing contractility,
respectively. While supine positioning with leg elevation can help, it is not a standalone
intervention and fluids are the priority to optimize ventricular filling.
Question 6 of 50
A 58-year-old male with a history of dilated cardiomyopathy (EF 20%) is admitted with
worsening dyspnea and peripheral edema. His home medications include lisinopril,
carvedilol, furosemide, and spironolactone. His labs show K+ 5.8 mEq/L, creatinine 2.4
mg/dL, and BNP 2,400 pg/mL.
