PROGRESSIVE CARE RN (PCCN) PRACTICE EXAM 2026
500 QUESTIONS WITH DETAILED ANSWERS
(RATIONALES) LATEST & ACCURATE | VERIFIED FOR
GUARANTEED PASS
SECTION 1: CARDIOVASCULAR (Questions 1-180)
Q1. A patient with NSTEMI develops recurrent chest pain with new ST depression.
What is the next intervention?
A) Thrombolytics
B) Urgent PCI
C) Increase heparin
D) Morphine and reassess
ANSWER: B
RATIONALE: Recurrent ischemia with dynamic ECG changes in NSTEMI indicates
high-risk instability. Urgent PCI (<24 hrs) is preferred over medical titration to
restore perfusion and prevent infarction.
Q2. Most specific lab for acute MI?
A) CRP
B) Troponin I
C) BNP
D) CK
ANSWER: B
RATIONALE: Cardiac troponins I and T are highly specific to myocardial necrosis.
CRP and BNP are not specific to MI; CK lacks cardiac specificity.
Q3. HF patient EF 25% on furosemide, lisinopril, digoxin. Most concerning finding?
,A) K+ 3.2 mEq/L
B) Weight +1 kg
C) HR 58
D) BP 110/70
ANSWER: A
RATIONALE: Hypokalemia (K<3.5) with digoxin therapy markedly increases risk of
digoxin toxicity and fatal dysrhythmias. Weight gain indicates fluid retention but is
less immediately life-threatening.
Q4. Unstable narrow-complex tachycardia, HR 140, BP 90/60, diaphoretic. Priority
action?
A) Amiodarone 150 mg IV
B) Synchronized cardioversion
C) Adenosine 6 mg rapid IV
D) 12-lead ECG
ANSWER: C
RATIONALE: Unstable SVT requires immediate pharmacologic conversion.
Adenosine is first-line for narrow-complex SVT; cardioversion is used if adenosine
fails or patient is extremely unstable.
Q5. ECG change indicating transmural MI?
A) ST depression
B) Peaked T waves
C) Pathologic Q waves
D) U waves
ANSWER: C
,RATIONALE: Pathologic Q waves (≥0.04 sec or >25% of R wave) represent
irreversible transmural necrosis. ST elevation indicates acute injury but is
reversible.
Q6. Before giving digoxin for AFib, most important assessment?
A) Apical pulse 1 full minute
B) BP both arms
C) Respiratory rate
D) LOC
ANSWER: A
RATIONALE: Digoxin has a narrow therapeutic index; holding dose for apical pulse
<60 bpm prevents toxicity. A full minute ensures accurate rate detection in
irregular rhythms.
Q7. BNP 1,200 pg/mL in HF. Most appropriate intervention?
A) Increase IV fluids
B) Furosemide
C) Emergent intubation
D) Normal saline bolus
ANSWER: B
RATIONALE: Markedly elevated BNP indicates volume overload. Loop diuretics
reduce preload and relieve congestion; fluids would worsen the condition.
Q8. Suspected endocarditis with fever, new murmur, petechiae. Priority?
A) Blood cultures before antibiotics
B) Broad-spectrum antibiotics now
C) Echocardiogram
, D) Warm compresses
ANSWER: A
RATIONALE: Blood cultures must be drawn prior to antibiotics to identify the
causative organism. Delaying cultures reduces diagnostic yield and guides
targeted therapy.
Q9. Stable VT with pulse. Nurse's first action?
A) Defibrillation
B) Amiodarone IV
C) Assess airway and breathing
D) Synchronized cardioversion
ANSWER: C
RATIONALE: ABCs always come first. Even in a dysrhythmia, ensure patent airway
and adequate ventilation before medication or procedural interventions.
Q10. Major risk factor for infective endocarditis?
A) Hypertension
B) IV drug use
C) Diabetes
D) Obesity
ANSWER: B
RATIONALE: IV drug use introduces bacteria directly into the bloodstream, causing
right-sided endocarditis. Valvular disease and prosthetic valves are other major
risks.
Q11. Pericarditis chest pain relieved by sitting forward. Anticipated med?
A) Morphine
500 QUESTIONS WITH DETAILED ANSWERS
(RATIONALES) LATEST & ACCURATE | VERIFIED FOR
GUARANTEED PASS
SECTION 1: CARDIOVASCULAR (Questions 1-180)
Q1. A patient with NSTEMI develops recurrent chest pain with new ST depression.
What is the next intervention?
A) Thrombolytics
B) Urgent PCI
C) Increase heparin
D) Morphine and reassess
ANSWER: B
RATIONALE: Recurrent ischemia with dynamic ECG changes in NSTEMI indicates
high-risk instability. Urgent PCI (<24 hrs) is preferred over medical titration to
restore perfusion and prevent infarction.
Q2. Most specific lab for acute MI?
A) CRP
B) Troponin I
C) BNP
D) CK
ANSWER: B
RATIONALE: Cardiac troponins I and T are highly specific to myocardial necrosis.
CRP and BNP are not specific to MI; CK lacks cardiac specificity.
Q3. HF patient EF 25% on furosemide, lisinopril, digoxin. Most concerning finding?
,A) K+ 3.2 mEq/L
B) Weight +1 kg
C) HR 58
D) BP 110/70
ANSWER: A
RATIONALE: Hypokalemia (K<3.5) with digoxin therapy markedly increases risk of
digoxin toxicity and fatal dysrhythmias. Weight gain indicates fluid retention but is
less immediately life-threatening.
Q4. Unstable narrow-complex tachycardia, HR 140, BP 90/60, diaphoretic. Priority
action?
A) Amiodarone 150 mg IV
B) Synchronized cardioversion
C) Adenosine 6 mg rapid IV
D) 12-lead ECG
ANSWER: C
RATIONALE: Unstable SVT requires immediate pharmacologic conversion.
Adenosine is first-line for narrow-complex SVT; cardioversion is used if adenosine
fails or patient is extremely unstable.
Q5. ECG change indicating transmural MI?
A) ST depression
B) Peaked T waves
C) Pathologic Q waves
D) U waves
ANSWER: C
,RATIONALE: Pathologic Q waves (≥0.04 sec or >25% of R wave) represent
irreversible transmural necrosis. ST elevation indicates acute injury but is
reversible.
Q6. Before giving digoxin for AFib, most important assessment?
A) Apical pulse 1 full minute
B) BP both arms
C) Respiratory rate
D) LOC
ANSWER: A
RATIONALE: Digoxin has a narrow therapeutic index; holding dose for apical pulse
<60 bpm prevents toxicity. A full minute ensures accurate rate detection in
irregular rhythms.
Q7. BNP 1,200 pg/mL in HF. Most appropriate intervention?
A) Increase IV fluids
B) Furosemide
C) Emergent intubation
D) Normal saline bolus
ANSWER: B
RATIONALE: Markedly elevated BNP indicates volume overload. Loop diuretics
reduce preload and relieve congestion; fluids would worsen the condition.
Q8. Suspected endocarditis with fever, new murmur, petechiae. Priority?
A) Blood cultures before antibiotics
B) Broad-spectrum antibiotics now
C) Echocardiogram
, D) Warm compresses
ANSWER: A
RATIONALE: Blood cultures must be drawn prior to antibiotics to identify the
causative organism. Delaying cultures reduces diagnostic yield and guides
targeted therapy.
Q9. Stable VT with pulse. Nurse's first action?
A) Defibrillation
B) Amiodarone IV
C) Assess airway and breathing
D) Synchronized cardioversion
ANSWER: C
RATIONALE: ABCs always come first. Even in a dysrhythmia, ensure patent airway
and adequate ventilation before medication or procedural interventions.
Q10. Major risk factor for infective endocarditis?
A) Hypertension
B) IV drug use
C) Diabetes
D) Obesity
ANSWER: B
RATIONALE: IV drug use introduces bacteria directly into the bloodstream, causing
right-sided endocarditis. Valvular disease and prosthetic valves are other major
risks.
Q11. Pericarditis chest pain relieved by sitting forward. Anticipated med?
A) Morphine
