PCCN Progressive care nursing certification validating specialized knowledge caring for acutely ill patients requiring advanced observation and treatment.

PCCN Progressive care nursing certification
validating specialized knowledge caring for
acutely ill patients requiring advanced
observation and treatment.

Question 1
A patient in the progressive care unit (PCU) with a history of heart failure develops
acute dyspnea, crackles in all lung fields, and an SpO₂ of 88% on 2 L/min nasal
cannula. Which intervention should the nurse implement FIRST?
A) Administer furosemide 40 mg IV push
B) Place the patient in high-Fowler’s position
C) Apply a non-rebreather mask at 15 L/min
D) Notify the rapid response team
Answer: B – Rationale: High-Fowler’s position reduces preload and improves
ventilation immediately. Oxygen should be increased, but positioning is the first
non-invasive action. Furosemide will follow.


Question 2
A patient with a diagnosis of acute decompensated heart failure has a pulmonary
artery catheter in place. Hemodynamic values: cardiac index (CI) 1.8 L/min/m²
(normal 2.5-4.0), pulmonary artery occlusion pressure (PAOP) 22 mm Hg (normal
6-12). Which medication does the nurse anticipate?
A) Dobutamine infusion
B) Norepinephrine infusion
C) IV furosemide
D) Nitroprusside
Answer: A – Rationale: Low CI + high PAOP = cardiogenic shock with
pulmonary congestion. Dobutamine (inotrope) increases contractility and CI.
Diuretics treat congestion but not low output.

,Question 3
A patient on telemetry has a heart rate of 42 beats/min, BP 88/52 mm Hg, and
reports dizziness. The rhythm is sinus bradycardia with no ectopy. Which
medication should the nurse prepare to administer?
A) Epinephrine 1 mg IV push
B) Atropine 0.5 mg IV
C) Amiodarone 150 mg IV
D) Adenosine 6 mg rapid IV push
Answer: B – Rationale: Symptomatic bradycardia (hypotension, dizziness)
requires atropine as first-line treatment (0.5 mg IV, repeat up to 3 mg).
Epinephrine or dopamine is second-line.


Question 4
A patient with a new onset of atrial fibrillation with rapid ventricular response (HR
150) has a BP of 110/70 mm Hg and reports mild chest pressure. The nurse
prepares for which intervention?
A) Synchronized cardioversion
B) IV amiodarone
C) IV metoprolol
D) Immediate defibrillation
Answer: C – Rationale: The patient is stable (no severe hypotension, altered
mental status, or severe heart failure). Rate control with IV beta-blocker
(metoprolol) or diltiazem is first-line. Synchronized cardioversion is for unstable
patients.


Question 5
A patient with a history of COPD is on 2 L/min oxygen via nasal cannula. The
nurse notes increasing confusion and lethargy. An arterial blood gas (ABG) shows:
pH 7.31, PaCO₂ 72 mm Hg, HCO₃ 32 mEq/L, PaO₂ 58 mm Hg. The nurse should
FIRST:
A) Increase oxygen to 4 L/min
B) Prepare for non-invasive positive pressure ventilation (NIPPV)

,C) Administer sodium bicarbonate
D) Obtain a stat chest X-ray
Answer: B – Rationale: The ABG shows acute-on-chronic respiratory acidosis
(pH <7.35, high PaCO₂, elevated HCO₃). NIPPV (BiPAP) can improve ventilation
and avoid intubation.


Question 6
A patient with an acute myocardial infarction (MI) develops a new harsh
holosystolic murmur at the left sternal border with a palpable thrill. The patient
becomes hypotensive. The nurse suspects:
A) Acute mitral regurgitation
B) Ventricular septal rupture (VSR)
C) Papillary muscle rupture
D) Pericarditis
Answer: B – Rationale: VSR post-MI presents with a harsh holosystolic murmur
at the left sternal border (not apex) with a thrill, often with cardiogenic shock.
Apical murmur suggests MR.


Question 7
A patient with a subarachnoid hemorrhage has a mean arterial pressure (MAP) of
110 mm Hg and an ICP of 28 mm Hg. The cerebral perfusion pressure (CPP) is:
A) 82 mm Hg (normal)
B) 138 mm Hg
C) 60 mm Hg
D) 45 mm Hg
Answer: A – *Rationale: CPP = MAP – ICP = 110 – 28 = 82 mm Hg. Target CPP
is 60-80 mm Hg (some sources 50-70). 82 is slightly elevated but acceptable;
hypertension may be allowed to maintain CPP.*


Question 8

, A patient receiving a heparin infusion for a pulmonary embolism has an aPTT of
110 seconds (therapeutic range 60-80). The nurse should:
A) Decrease the heparin rate by 2 units/kg/hr
B) Stop the heparin infusion and notify the provider
C) Continue the infusion at the same rate
D) Administer protamine sulfate
Answer: B – Rationale: aPTT >100 seconds significantly increases bleeding risk.
The infusion should be stopped temporarily; provider will adjust dose or restart at
a lower rate.


Question 9
A patient with diabetic ketoacidosis (DKA) has a serum potassium of 2.9 mEq/L.
Which action should the nurse take BEFORE starting an insulin infusion?
A) Administer IV potassium replacement
B) Begin insulin infusion at 0.1 units/kg/hr
C) Give sodium bicarbonate for acidosis
D) Start normal saline with potassium and insulin simultaneously
Answer: A – *Rationale: Insulin drives K⁺ into cells and can worsen hypokalemia,
leading to arrhythmias. Correct K⁺ to >3.3 mEq/L before initiating insulin
infusion.*


Question 10
A patient post-cardiac arrest is on targeted temperature management (TTM) at
33°C. Which complication is most important to monitor for?
A) Shivering
B) Coagulopathy and bleeding
C) Hyperglycemia
D) Seizures
Answer: B – Rationale: Hypothermia impairs platelet function and coagulation
factors, increasing bleeding risk. Shivering is common but treatable; coagulopathy
can be life-threatening.