PROGRESSIVE CARE RN A — COMPLETE SOLUTIONS (2025/2026)
Introduction
The Progressive Care Registered Nurse (RN) role involves managing high-acuity patients
in a step-down or Progressive Care Unit (PCU), bridging the gap between intensive care
and general medical-surgical units. PCU RNs care for patients with complex conditions
requiring close monitoring, such as those with cardiac, respiratory, neurological, or
multisystem issues, while fostering stabilization for transfer or discharge. Core clinical
areas include hemodynamic stability, cardiac rhythm interpretation, respiratory
management, electrolyte and fluid balance, endocrine emergencies, high-acuity
assessments, medication safety, and evidence-based interventions. This exam guide,
tailored for the 2025/2026 clinical period, provides original, scenario-based questions
with detailed explanations to ensure mastery of PCU nursing competencies, formatted
professionally in Markdown.
Question 1
A 62-year-old patient with heart failure presents with dyspnea, JVD, and 3+ pitting edema.
Which initial intervention should the PCU RN prioritize?
A. Administer IV furosemide 40 mg
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain a 12-lead ECG
D. Elevate the head of the bed to 45 degrees
Correct Answer: D — Elevate the head of the bed to 45 degrees
Explanation: Elevating the head of the bed improves respiratory effort and reduces
preload in heart failure exacerbations, addressing dyspnea immediately. Furosemide (A)
requires a physician order and baseline labs, oxygen (B) may be needed but isn’t the
priority without SpO2 data, and an ECG (C) is diagnostic, not an intervention.
Question 2
A patient’s telemetry shows frequent PVCs (>6/min). What is the RN’s first action?
A. Administer amiodarone 150 mg IV bolus
B. Assess the patient’s hemodynamic status
C. Notify the physician immediately
D. Initiate oxygen at 4 L/min
Correct Answer: B — Assess the patient’s hemodynamic status
Explanation: Frequent PVCs may indicate irritability, but the RN must first assess for
symptoms like hypotension or chest pain to determine urgency. Amiodarone (A) requires
,an order and stability confirmation, notifying the physician (C) follows assessment, and
oxygen (D) is unwarranted without hypoxia.
Question 3
A patient on BiPAP for COPD exacerbation has a PaCO2 of 70 mmHg and pH of 7.30.
What should the RN do next?
A. Increase BiPAP IPAP settings
B. Discontinue BiPAP and apply high-flow oxygen
C. Monitor the patient and reassess in 1 hour
D. Prepare for intubation
Correct Answer: C — Monitor the patient and reassess in 1 hour
Explanation: The PaCO2 is elevated, but pH 7.30 indicates compensated respiratory
acidosis, common in COPD. Continued BiPAP and monitoring are appropriate. Increasing
IPAP (A) risks pneumothorax, high-flow oxygen (B) may worsen CO2 retention, and
intubation (D) is premature without decompensation.
Question 4
A patient’s K⁺ level is 6.2 mEq/L. Which medication should the RN anticipate?
A. Potassium chloride 20 mEq IV
B. Sodium bicarbonate 50 mEq IV
C. Calcium gluconate 1 g IV
D. Magnesium sulfate 2 g IV
Correct Answer: C — Calcium gluconate 1 g IV
Explanation: Hyperkalemia (K⁺ >6.0 mEq/L) risks cardiac dysrhythmias. Calcium
gluconate stabilizes cardiac membranes. Potassium chloride (A) worsens hyperkalemia,
bicarbonate (B) is secondary, and magnesium (D) is unrelated.
Question 5
A patient with suspected sepsis has a lactate of 3.8 mmol/L and BP 88/54 mmHg. What is
the priority intervention?
A. Administer acetaminophen 650 mg
B. Initiate a 30 mL/kg NS bolus
C. Draw repeat lactate in 2 hours
D. Start vancomycin 1 g IV
Correct Answer: B — Initiate a 30 mL/kg NS bolus
,Explanation: Sepsis with hypotension and elevated lactate requires immediate fluid
resuscitation per Surviving Sepsis guidelines. Acetaminophen (A) is for fever, repeat
lactate (C) follows initial treatment, and antibiotics (D) are secondary to fluid.
Question 6
A patient post-CABG reports chest pain and has new ST elevation on telemetry. What
should the RN do first?
A. Administer morphine 2 mg IV
B. Notify the rapid response team
C. Obtain a stat 12-lead ECG
D. Increase oxygen to 4 L/min
Correct Answer: C — Obtain a stat 12-lead ECG
Explanation: ST elevation suggests acute ischemia or infarction, requiring immediate
ECG to confirm. Morphine (A) treats pain but delays diagnosis, rapid response (B)
follows ECG, and oxygen (D) is secondary without hypoxia.
Question 7
A patient on a nitroglycerin drip at 10 mcg/min reports a headache. BP is 110/70 mmHg.
What should the RN do?
A. Stop the drip immediately
B. Decrease the drip to 5 mcg/min
C. Administer acetaminophen 650 mg
D. Increase the drip to 15 mcg/min
Correct Answer: C — Administer acetaminophen 650 mg
Explanation: Headache is a common nitroglycerin side effect, managed with
acetaminophen. Stopping (A) or decreasing (B) the drip is unnecessary with stable BP,
and increasing (D) may worsen the headache.
Question 8
A patient with a history of stroke exhibits new slurred speech and right-sided weakness.
What is the RN’s priority?
A. Administer aspirin 325 mg
B. Perform a NIHSS assessment
C. Prepare for a stat CT scan
D. Apply oxygen at 2 L/min
Correct Answer: B — Perform a NIHSS assessment
, Explanation: New neurological deficits suggest a stroke, requiring a NIHSS to quantify
severity and guide intervention. Aspirin (A) is contraindicated without ruling out
hemorrhage, CT (C) follows assessment, and oxygen (D) is not indicated without
hypoxia.
Question 9
A patient receiving a blood transfusion develops urticaria and itching. What should the
RN do first?
A. Administer diphenhydramine 25 mg IV
B. Stop the transfusion
C. Increase the transfusion rate
D. Monitor for 30 minutes
Correct Answer: B — Stop the transfusion
Explanation: Urticaria and itching indicate a possible allergic reaction, requiring
immediate cessation of the transfusion to prevent worsening. Diphenhydramine (A) is
secondary, increasing the rate (C) is dangerous, and monitoring (D) delays action.
Question 10
A patient with DKA has a glucose of 450 mg/dL and K⁺ of 3.2 mEq/L. What should the RN
anticipate?
A. Regular insulin IV bolus
B. Potassium chloride 20 mEq IV
C. Sodium bicarbonate 50 mEq IV
D. Dextrose 5% IV infusion
Correct Answer: B — Potassium chloride 20 mEq IV
Explanation: Hypokalemia in DKA worsens with insulin therapy, risking arrhythmias.
Potassium replacement is prioritized before insulin (A). Bicarbonate (C) is rarely used,
and dextrose (D) is for later stabilization.
Question 11
A patient’s telemetry shows atrial fibrillation with a HR of 130 bpm. BP is 100/60 mmHg.
What is the priority?
A. Administer diltiazem 20 mg IV
B. Prepare for synchronized cardioversion
C. Assess for symptoms of instability
D. Start heparin 5000 units IV
Correct Answer: C — Assess for symptoms of instability
Introduction
The Progressive Care Registered Nurse (RN) role involves managing high-acuity patients
in a step-down or Progressive Care Unit (PCU), bridging the gap between intensive care
and general medical-surgical units. PCU RNs care for patients with complex conditions
requiring close monitoring, such as those with cardiac, respiratory, neurological, or
multisystem issues, while fostering stabilization for transfer or discharge. Core clinical
areas include hemodynamic stability, cardiac rhythm interpretation, respiratory
management, electrolyte and fluid balance, endocrine emergencies, high-acuity
assessments, medication safety, and evidence-based interventions. This exam guide,
tailored for the 2025/2026 clinical period, provides original, scenario-based questions
with detailed explanations to ensure mastery of PCU nursing competencies, formatted
professionally in Markdown.
Question 1
A 62-year-old patient with heart failure presents with dyspnea, JVD, and 3+ pitting edema.
Which initial intervention should the PCU RN prioritize?
A. Administer IV furosemide 40 mg
B. Apply oxygen at 2 L/min via nasal cannula
C. Obtain a 12-lead ECG
D. Elevate the head of the bed to 45 degrees
Correct Answer: D — Elevate the head of the bed to 45 degrees
Explanation: Elevating the head of the bed improves respiratory effort and reduces
preload in heart failure exacerbations, addressing dyspnea immediately. Furosemide (A)
requires a physician order and baseline labs, oxygen (B) may be needed but isn’t the
priority without SpO2 data, and an ECG (C) is diagnostic, not an intervention.
Question 2
A patient’s telemetry shows frequent PVCs (>6/min). What is the RN’s first action?
A. Administer amiodarone 150 mg IV bolus
B. Assess the patient’s hemodynamic status
C. Notify the physician immediately
D. Initiate oxygen at 4 L/min
Correct Answer: B — Assess the patient’s hemodynamic status
Explanation: Frequent PVCs may indicate irritability, but the RN must first assess for
symptoms like hypotension or chest pain to determine urgency. Amiodarone (A) requires
,an order and stability confirmation, notifying the physician (C) follows assessment, and
oxygen (D) is unwarranted without hypoxia.
Question 3
A patient on BiPAP for COPD exacerbation has a PaCO2 of 70 mmHg and pH of 7.30.
What should the RN do next?
A. Increase BiPAP IPAP settings
B. Discontinue BiPAP and apply high-flow oxygen
C. Monitor the patient and reassess in 1 hour
D. Prepare for intubation
Correct Answer: C — Monitor the patient and reassess in 1 hour
Explanation: The PaCO2 is elevated, but pH 7.30 indicates compensated respiratory
acidosis, common in COPD. Continued BiPAP and monitoring are appropriate. Increasing
IPAP (A) risks pneumothorax, high-flow oxygen (B) may worsen CO2 retention, and
intubation (D) is premature without decompensation.
Question 4
A patient’s K⁺ level is 6.2 mEq/L. Which medication should the RN anticipate?
A. Potassium chloride 20 mEq IV
B. Sodium bicarbonate 50 mEq IV
C. Calcium gluconate 1 g IV
D. Magnesium sulfate 2 g IV
Correct Answer: C — Calcium gluconate 1 g IV
Explanation: Hyperkalemia (K⁺ >6.0 mEq/L) risks cardiac dysrhythmias. Calcium
gluconate stabilizes cardiac membranes. Potassium chloride (A) worsens hyperkalemia,
bicarbonate (B) is secondary, and magnesium (D) is unrelated.
Question 5
A patient with suspected sepsis has a lactate of 3.8 mmol/L and BP 88/54 mmHg. What is
the priority intervention?
A. Administer acetaminophen 650 mg
B. Initiate a 30 mL/kg NS bolus
C. Draw repeat lactate in 2 hours
D. Start vancomycin 1 g IV
Correct Answer: B — Initiate a 30 mL/kg NS bolus
,Explanation: Sepsis with hypotension and elevated lactate requires immediate fluid
resuscitation per Surviving Sepsis guidelines. Acetaminophen (A) is for fever, repeat
lactate (C) follows initial treatment, and antibiotics (D) are secondary to fluid.
Question 6
A patient post-CABG reports chest pain and has new ST elevation on telemetry. What
should the RN do first?
A. Administer morphine 2 mg IV
B. Notify the rapid response team
C. Obtain a stat 12-lead ECG
D. Increase oxygen to 4 L/min
Correct Answer: C — Obtain a stat 12-lead ECG
Explanation: ST elevation suggests acute ischemia or infarction, requiring immediate
ECG to confirm. Morphine (A) treats pain but delays diagnosis, rapid response (B)
follows ECG, and oxygen (D) is secondary without hypoxia.
Question 7
A patient on a nitroglycerin drip at 10 mcg/min reports a headache. BP is 110/70 mmHg.
What should the RN do?
A. Stop the drip immediately
B. Decrease the drip to 5 mcg/min
C. Administer acetaminophen 650 mg
D. Increase the drip to 15 mcg/min
Correct Answer: C — Administer acetaminophen 650 mg
Explanation: Headache is a common nitroglycerin side effect, managed with
acetaminophen. Stopping (A) or decreasing (B) the drip is unnecessary with stable BP,
and increasing (D) may worsen the headache.
Question 8
A patient with a history of stroke exhibits new slurred speech and right-sided weakness.
What is the RN’s priority?
A. Administer aspirin 325 mg
B. Perform a NIHSS assessment
C. Prepare for a stat CT scan
D. Apply oxygen at 2 L/min
Correct Answer: B — Perform a NIHSS assessment
, Explanation: New neurological deficits suggest a stroke, requiring a NIHSS to quantify
severity and guide intervention. Aspirin (A) is contraindicated without ruling out
hemorrhage, CT (C) follows assessment, and oxygen (D) is not indicated without
hypoxia.
Question 9
A patient receiving a blood transfusion develops urticaria and itching. What should the
RN do first?
A. Administer diphenhydramine 25 mg IV
B. Stop the transfusion
C. Increase the transfusion rate
D. Monitor for 30 minutes
Correct Answer: B — Stop the transfusion
Explanation: Urticaria and itching indicate a possible allergic reaction, requiring
immediate cessation of the transfusion to prevent worsening. Diphenhydramine (A) is
secondary, increasing the rate (C) is dangerous, and monitoring (D) delays action.
Question 10
A patient with DKA has a glucose of 450 mg/dL and K⁺ of 3.2 mEq/L. What should the RN
anticipate?
A. Regular insulin IV bolus
B. Potassium chloride 20 mEq IV
C. Sodium bicarbonate 50 mEq IV
D. Dextrose 5% IV infusion
Correct Answer: B — Potassium chloride 20 mEq IV
Explanation: Hypokalemia in DKA worsens with insulin therapy, risking arrhythmias.
Potassium replacement is prioritized before insulin (A). Bicarbonate (C) is rarely used,
and dextrose (D) is for later stabilization.
Question 11
A patient’s telemetry shows atrial fibrillation with a HR of 130 bpm. BP is 100/60 mmHg.
What is the priority?
A. Administer diltiazem 20 mg IV
B. Prepare for synchronized cardioversion
C. Assess for symptoms of instability
D. Start heparin 5000 units IV
Correct Answer: C — Assess for symptoms of instability
