PCCN-K Progressive care knowledge
certification emphasizing leadership,
education, systems improvement, and
evidence-based patient care practices.
Section 1: Cardiovascular System (Q1-20)
Question 1
A patient in the progressive care unit has atrial fibrillation with a ventricular rate of
140 bpm. The patient is hemodynamically stable. Which medication is first-line for
rate control?
A) Amiodarone
B) Metoprolol
C) Digoxin
D) Lidocaine
Rationale: For stable atrial fibrillation with rapid ventricular response, beta-
blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem)
are first-line. Amiodarone is for rhythm control or unstable patients. Digoxin is
second-line.
Question 2
A patient with heart failure with reduced ejection fraction (HFrEF) is on carvedilol,
lisinopril, and furosemide. The patient reports dizziness and a heart rate of 52 bpm.
The nurse’s priority action is to:
A) Administer atropine
B) Hold the next dose of carvedilol and notify the provider
C) Increase the furosemide dose
D) Give a fluid bolus
Rationale: Symptomatic bradycardia (HR <60 with dizziness) is a reason to hold
beta-blockers. Carvedilol reduces heart rate; the provider may adjust dose.
,Question 3
A patient presents with chest pain, ST-segment depression in leads V3-V5, and
elevated troponin. The patient is not a candidate for thrombolytics. The nurse
anticipates which intervention?
A) Emergent coronary artery bypass grafting
B) Percutaneous coronary intervention (PCI)
C) Intravenous nitroglycerin only
D) Conservative medical management
Rationale: Non-ST elevation MI (NSTEMI) with high-risk features (elevated
troponin) often requires PCI within 24 hours if no contraindications.
Question 4
A patient is admitted with hypertensive emergency (BP 210/120 mm Hg) and acute
kidney injury. Which IV antihypertensive is preferred?
A) Oral nifedipine
B) Nicardipine infusion
C) Sublingual clonidine
D) Hydralazine bolus
Rationale: Nicardipine (calcium channel blocker) IV is titratable and preferred for
hypertensive emergencies. Sublingual nifedipine is dangerous (uncontrolled
hypotension). Hydralazine is used but can cause reflex tachycardia.
Question 5
A patient with a pulmonary artery catheter has a cardiac index of 1.8 L/min/m²
(normal 2.5-4.0). This indicates:
A) Normal cardiac output
B) Low cardiac output (cardiogenic shock)
C) High cardiac output
D) Adequate perfusion
Rationale: Cardiac index <2.2 L/min/m² indicates cardiogenic shock. CI =
CO/BSA.
,Question 6
A patient post-cardiac arrest has a targeted temperature management (TTM) order.
The target core temperature is:
A) 35-36°C
B) 32-36°C (typically 33-36°C)
C) 37-38°C
D) 28-30°C
Rationale: Current guidelines recommend TTM with target 32-36°C for comatose
post-cardiac arrest patients. Avoid fever (>37.7°C).
Question 7
A patient on a nitroglycerin drip at 50 mcg/min develops hypotension (80/50 mm
Hg). The nurse should:
A) Increase the rate
B) Stop or decrease the nitroglycerin and assess
C) Administer phenylephrine
D) Raise the head of bed
Rationale: Nitroglycerin causes venodilation and hypotension. Reduce or stop
infusion; give fluid bolus if needed.
Question 8
A patient with a new onset of third-degree AV block has a heart rate of 38 bpm and
is lethargic. The priority action is:
A) Administer atropine
B) Prepare for transcutaneous pacing
C) Give adenosine
D) Start dopamine
Rationale: Symptomatic bradycardia from complete heart block requires
immediate pacing. Atropine is ineffective for infranodal block.
, Question 9
A patient is admitted with acute decompensated heart failure. Which finding is
most indicative of adequate diuresis?
A) Blood pressure 150/90 mm Hg
B) Daily weight loss of 1 kg (2.2 lbs) over 24 hours
C) Jugular venous distension at 45°
D) +3 pitting edema
Rationale: Daily weight is the most reliable indicator of fluid loss. 1 kg =
approximately 1 L of fluid. JVD and edema indicate persistent overload.
Question 10
A patient with a mechanical aortic valve is on warfarin. The INR is 1.5 (target 2.5-
3.5). The nurse should:
A) Continue same dose
B) Notify provider for dose adjustment
C) Hold warfarin for one day
D) Give vitamin K
Rationale: INR below target increases thrombotic risk. Provider will increase
dose. Vitamin K is for bleeding or supratherapeutic INR.
Question 11
A patient with an inferior wall MI develops bradycardia, hypotension, and JVD.
The nurse suspects:
A) Pericarditis
B) Right ventricular infarction
C) Acute mitral regurgitation
D) Ventricular septal rupture
Rationale: Right ventricular infarction (often with inferior MI) causes low cardiac
output, hypotension, and elevated CVP (JVD). Treatment: volume expansion.
Question 12
certification emphasizing leadership,
education, systems improvement, and
evidence-based patient care practices.
Section 1: Cardiovascular System (Q1-20)
Question 1
A patient in the progressive care unit has atrial fibrillation with a ventricular rate of
140 bpm. The patient is hemodynamically stable. Which medication is first-line for
rate control?
A) Amiodarone
B) Metoprolol
C) Digoxin
D) Lidocaine
Rationale: For stable atrial fibrillation with rapid ventricular response, beta-
blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem)
are first-line. Amiodarone is for rhythm control or unstable patients. Digoxin is
second-line.
Question 2
A patient with heart failure with reduced ejection fraction (HFrEF) is on carvedilol,
lisinopril, and furosemide. The patient reports dizziness and a heart rate of 52 bpm.
The nurse’s priority action is to:
A) Administer atropine
B) Hold the next dose of carvedilol and notify the provider
C) Increase the furosemide dose
D) Give a fluid bolus
Rationale: Symptomatic bradycardia (HR <60 with dizziness) is a reason to hold
beta-blockers. Carvedilol reduces heart rate; the provider may adjust dose.
,Question 3
A patient presents with chest pain, ST-segment depression in leads V3-V5, and
elevated troponin. The patient is not a candidate for thrombolytics. The nurse
anticipates which intervention?
A) Emergent coronary artery bypass grafting
B) Percutaneous coronary intervention (PCI)
C) Intravenous nitroglycerin only
D) Conservative medical management
Rationale: Non-ST elevation MI (NSTEMI) with high-risk features (elevated
troponin) often requires PCI within 24 hours if no contraindications.
Question 4
A patient is admitted with hypertensive emergency (BP 210/120 mm Hg) and acute
kidney injury. Which IV antihypertensive is preferred?
A) Oral nifedipine
B) Nicardipine infusion
C) Sublingual clonidine
D) Hydralazine bolus
Rationale: Nicardipine (calcium channel blocker) IV is titratable and preferred for
hypertensive emergencies. Sublingual nifedipine is dangerous (uncontrolled
hypotension). Hydralazine is used but can cause reflex tachycardia.
Question 5
A patient with a pulmonary artery catheter has a cardiac index of 1.8 L/min/m²
(normal 2.5-4.0). This indicates:
A) Normal cardiac output
B) Low cardiac output (cardiogenic shock)
C) High cardiac output
D) Adequate perfusion
Rationale: Cardiac index <2.2 L/min/m² indicates cardiogenic shock. CI =
CO/BSA.
,Question 6
A patient post-cardiac arrest has a targeted temperature management (TTM) order.
The target core temperature is:
A) 35-36°C
B) 32-36°C (typically 33-36°C)
C) 37-38°C
D) 28-30°C
Rationale: Current guidelines recommend TTM with target 32-36°C for comatose
post-cardiac arrest patients. Avoid fever (>37.7°C).
Question 7
A patient on a nitroglycerin drip at 50 mcg/min develops hypotension (80/50 mm
Hg). The nurse should:
A) Increase the rate
B) Stop or decrease the nitroglycerin and assess
C) Administer phenylephrine
D) Raise the head of bed
Rationale: Nitroglycerin causes venodilation and hypotension. Reduce or stop
infusion; give fluid bolus if needed.
Question 8
A patient with a new onset of third-degree AV block has a heart rate of 38 bpm and
is lethargic. The priority action is:
A) Administer atropine
B) Prepare for transcutaneous pacing
C) Give adenosine
D) Start dopamine
Rationale: Symptomatic bradycardia from complete heart block requires
immediate pacing. Atropine is ineffective for infranodal block.
, Question 9
A patient is admitted with acute decompensated heart failure. Which finding is
most indicative of adequate diuresis?
A) Blood pressure 150/90 mm Hg
B) Daily weight loss of 1 kg (2.2 lbs) over 24 hours
C) Jugular venous distension at 45°
D) +3 pitting edema
Rationale: Daily weight is the most reliable indicator of fluid loss. 1 kg =
approximately 1 L of fluid. JVD and edema indicate persistent overload.
Question 10
A patient with a mechanical aortic valve is on warfarin. The INR is 1.5 (target 2.5-
3.5). The nurse should:
A) Continue same dose
B) Notify provider for dose adjustment
C) Hold warfarin for one day
D) Give vitamin K
Rationale: INR below target increases thrombotic risk. Provider will increase
dose. Vitamin K is for bleeding or supratherapeutic INR.
Question 11
A patient with an inferior wall MI develops bradycardia, hypotension, and JVD.
The nurse suspects:
A) Pericarditis
B) Right ventricular infarction
C) Acute mitral regurgitation
D) Ventricular septal rupture
Rationale: Right ventricular infarction (often with inferior MI) causes low cardiac
output, hypotension, and elevated CVP (JVD). Treatment: volume expansion.
Question 12
