PCCN Practice Exam – 260 Questions With Rationales
| Adult Progressive Care Nursing | Aacn Certification |
Updated For 2026 High-Yield Exams
TABLE OF CONTENTS
1. Cardiovascular System (Questions 1–50)
2. Pulmonary System (Questions 51–90)
3. Neurologic System (Questions 91–120)
4. Renal & Endocrine Systems (Questions 121–150)
5. Gastrointestinal & Multisystem (Questions 151–180)
6. Hematology, Immunology & Infectious Disease (Questions 181–210)
7. Professional Caring & Ethical Practice (Questions 211–260)
CARDIOVASCULAR SYSTEM (Questions 1–50)
Question 1 A patient with acute decompensated heart failure presents with crackles in both lungs,
JVD, and 3+ pitting edema in the legs. Vital signs: BP 110/70, HR 102, RR 24, SpO2 90% on room
air. Which medication should the nurse anticipate first?
A. IV furosemide (Lasix) B. IV dobutamine C. IV nitroglycerin D. Oral metoprolol
Correct Answer: A Rationale: IV furosemide is the first-line treatment for acute decompensated
heart failure with fluid overload (crackles, edema). It reduces preload and pulmonary congestion.
Dobutamine (B) and nitroglycerin (C) may be used but are not first-line. Beta-blockers (D) are started
after stabilization.
Question 2 (Select all that apply) Which of the following are signs of right-sided heart failure?
(Select all that apply)
,A. Jugular venous distension (JVD) B. Peripheral edema C. Hepatomegaly D. Ascites E. Crackles in
lungs
Correct Answers: A, B, C, D Rationale: Right-sided heart failure causes systemic congestion: JVD
(A), peripheral edema (B), hepatomegaly (C), and ascites (D). Crackles (E) are a sign of left-sided
heart failure (pulmonary congestion).
Question 3 A patient with heart failure has a B-type natriuretic peptide (BNP) level of 800 pg/mL.
What does this indicate?
A. Elevated BNP suggests heart failure (normal <100 pg/mL) B. Normal BNP C. Low BNP suggests
heart failure D. BNP is not useful in heart failure
Correct Answer: A Rationale: BNP is released from ventricular myocytes in response to increased
wall stress. A BNP >100 pg/mL suggests heart failure. BNP is used to differentiate cardiac from
pulmonary causes of dyspnea.
Question 4 A patient with heart failure is on lisinopril (ACE inhibitor). Which lab value should the
nurse monitor?
A. Potassium and creatinine B. Hemoglobin C. Platelets D. Liver enzymes
Correct Answer: A Rationale: ACE inhibitors can cause hyperkalemia and acute kidney injury
(especially with NSAIDs or dehydration). Monitor potassium and creatinine (A). Hemoglobin (B),
platelets (C), and liver enzymes (D) are not directly affected.
Question 5 (Select all that apply) Which of the following are contraindications to ACE inhibitors?
(Select all that apply)
A. History of angioedema B. Pregnancy C. Bilateral renal artery stenosis D. Hyperkalemia (K
>5.5) E. Hypertension
Correct Answers: A, B, C, D Rationale: ACE inhibitors are contraindicated in angioedema (A),
pregnancy (B) (fetal toxicity), bilateral renal artery stenosis (C), and hyperkalemia (D). Hypertension
(E) is an indication.
Question 6 A patient with heart failure is on carvedilol (beta-blocker). Which finding requires
holding the medication?
A. Heart rate 52 beats/min B. Blood pressure 110/70 C. Respiratory rate 18 D. Weight gain of 2 lbs in
1 week
,Correct Answer: A Rationale: Beta-blockers can cause bradycardia. Hold if HR <60. BP 110/70 (B)
is acceptable. RR 18 (C) is normal. Weight gain (D) indicates fluid retention and may require diuretic
adjustment.
Question 7 A patient with acute coronary syndrome has ST depression in leads V1-V4. What is the
most likely diagnosis?
A. Anterior ischemia (subendocardial) B. Inferior ischemia C. Lateral ischemia D. Posterior MI
Correct Answer: A Rationale: ST depression in V1-V4 suggests anterior ischemia (subendocardial
injury). ST elevation (B) would indicate infarction. Lateral ischemia (C) is in V5-V6, I, aVL.
Posterior MI (D) shows ST depression in V1-V3 and tall R waves.
Question 8 (Select all that apply) Which of the following are risk factors for coronary artery disease?
(Select all that apply)
A. Hypertension B. Hyperlipidemia C. Smoking D. Diabetes E. Family history
Correct Answers: A, B, C, D, E Rationale: All are risk factors for CAD. Modifiable: hypertension
(A), hyperlipidemia (B), smoking (C), diabetes (D). Non-modifiable: family history (E), age, male
gender.
Question 9 A patient with acute MI is on a continuous infusion of nitroglycerin. Which side effect
should the nurse monitor?
A. Hypotension B. Tachycardia C. Headache D. All of the above
Correct Answer: D Rationale: Nitroglycerin causes vasodilation → hypotension (A), reflex
tachycardia (B), and headache (C). All are potential side effects.
Question 10 A patient with acute MI has a new onset of a harsh holosystolic murmur at the left
sternal border. Which complication should the nurse suspect?
A. Ventricular septal defect (VSD) B. Papillary muscle rupture (mitral regurgitation) C. Left
ventricular aneurysm D. Pericarditis
Correct Answer: A Rationale: VSD causes a harsh holosystolic murmur at the left sternal border.
Papillary muscle rupture (B) causes a systolic murmur at the apex. Aneurysm (C) causes persistent ST
elevation. Pericarditis (D) causes a friction rub.
Question 11 (Select all that apply) Which of the following are signs of cardiogenic shock? (Select all
that apply)
, A. Hypotension (SBP <90) B. Tachycardia C. Cool, clammy skin D. Oliguria (<30 mL/hr) E. Altered
mental status
Correct Answers: A, B, C, D, E Rationale: Cardiogenic shock is caused by pump failure. Signs:
hypotension (A), tachycardia (B), cool, clammy skin (C) (vasoconstriction), oliguria (D), and altered
mental status (E).
Question 12 A patient in cardiogenic shock is on dobutamine. What is the mechanism of action?
A. Beta-1 agonist (increases contractility, minimal vasoconstriction) B. Alpha-1 agonist
(vasoconstriction) C. Beta-2 agonist (vasodilation) D. Phosphodiesterase inhibitor (increases cAMP)
Correct Answer: A Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility
(inotropy) with mild chronotropy and mild vasodilation (beta-2 effects). It is used in cardiogenic
shock with low cardiac output.
Question 13 A patient with heart failure is on milrinone. Which side effect should the nurse monitor?
A. Arrhythmias (ventricular tachycardia) B. Hypertension C. Bradycardia D. Hyperkalemia
Correct Answer: A Rationale: Milrinone is a phosphodiesterase inhibitor with inotropic and
vasodilatory effects. It can cause arrhythmias (ventricular tachycardia), hypotension (not hypertension
– B), and thrombocytopenia.
Question 14 (Select all that apply) Which of the following are indications for pacemaker insertion?
(Select all that apply)
A. Symptomatic bradycardia B. Third-degree heart block C. Sick sinus syndrome D. Atrial fibrillation
with rapid ventricular response E. Asystole (temporary pacing)
Correct Answers: A, B, C, E Rationale: Symptomatic bradycardia (A), third-degree heart block (B),
sick sinus syndrome (C), and asystole (E) are indications. Atrial fibrillation with rapid ventricular
response (D) is treated with rate control, not pacing.
Question 15 A patient with heart failure has a PAWP of 18 mm Hg. What does this indicate?
A. Normal filling pressure B. Elevated filling pressure (fluid overload) C. Low filling pressure
(dehydration) D. Right ventricular failure
Correct Answer: B Rationale: Normal PAWP is 6-12 mm Hg. 18 mm Hg indicates elevated left
ventricular filling pressure (fluid overload). PAWP (A) is not normal. Low filling pressure (C) is <6.
Right ventricular failure (D) is assessed by CVP.
| Adult Progressive Care Nursing | Aacn Certification |
Updated For 2026 High-Yield Exams
TABLE OF CONTENTS
1. Cardiovascular System (Questions 1–50)
2. Pulmonary System (Questions 51–90)
3. Neurologic System (Questions 91–120)
4. Renal & Endocrine Systems (Questions 121–150)
5. Gastrointestinal & Multisystem (Questions 151–180)
6. Hematology, Immunology & Infectious Disease (Questions 181–210)
7. Professional Caring & Ethical Practice (Questions 211–260)
CARDIOVASCULAR SYSTEM (Questions 1–50)
Question 1 A patient with acute decompensated heart failure presents with crackles in both lungs,
JVD, and 3+ pitting edema in the legs. Vital signs: BP 110/70, HR 102, RR 24, SpO2 90% on room
air. Which medication should the nurse anticipate first?
A. IV furosemide (Lasix) B. IV dobutamine C. IV nitroglycerin D. Oral metoprolol
Correct Answer: A Rationale: IV furosemide is the first-line treatment for acute decompensated
heart failure with fluid overload (crackles, edema). It reduces preload and pulmonary congestion.
Dobutamine (B) and nitroglycerin (C) may be used but are not first-line. Beta-blockers (D) are started
after stabilization.
Question 2 (Select all that apply) Which of the following are signs of right-sided heart failure?
(Select all that apply)
,A. Jugular venous distension (JVD) B. Peripheral edema C. Hepatomegaly D. Ascites E. Crackles in
lungs
Correct Answers: A, B, C, D Rationale: Right-sided heart failure causes systemic congestion: JVD
(A), peripheral edema (B), hepatomegaly (C), and ascites (D). Crackles (E) are a sign of left-sided
heart failure (pulmonary congestion).
Question 3 A patient with heart failure has a B-type natriuretic peptide (BNP) level of 800 pg/mL.
What does this indicate?
A. Elevated BNP suggests heart failure (normal <100 pg/mL) B. Normal BNP C. Low BNP suggests
heart failure D. BNP is not useful in heart failure
Correct Answer: A Rationale: BNP is released from ventricular myocytes in response to increased
wall stress. A BNP >100 pg/mL suggests heart failure. BNP is used to differentiate cardiac from
pulmonary causes of dyspnea.
Question 4 A patient with heart failure is on lisinopril (ACE inhibitor). Which lab value should the
nurse monitor?
A. Potassium and creatinine B. Hemoglobin C. Platelets D. Liver enzymes
Correct Answer: A Rationale: ACE inhibitors can cause hyperkalemia and acute kidney injury
(especially with NSAIDs or dehydration). Monitor potassium and creatinine (A). Hemoglobin (B),
platelets (C), and liver enzymes (D) are not directly affected.
Question 5 (Select all that apply) Which of the following are contraindications to ACE inhibitors?
(Select all that apply)
A. History of angioedema B. Pregnancy C. Bilateral renal artery stenosis D. Hyperkalemia (K
>5.5) E. Hypertension
Correct Answers: A, B, C, D Rationale: ACE inhibitors are contraindicated in angioedema (A),
pregnancy (B) (fetal toxicity), bilateral renal artery stenosis (C), and hyperkalemia (D). Hypertension
(E) is an indication.
Question 6 A patient with heart failure is on carvedilol (beta-blocker). Which finding requires
holding the medication?
A. Heart rate 52 beats/min B. Blood pressure 110/70 C. Respiratory rate 18 D. Weight gain of 2 lbs in
1 week
,Correct Answer: A Rationale: Beta-blockers can cause bradycardia. Hold if HR <60. BP 110/70 (B)
is acceptable. RR 18 (C) is normal. Weight gain (D) indicates fluid retention and may require diuretic
adjustment.
Question 7 A patient with acute coronary syndrome has ST depression in leads V1-V4. What is the
most likely diagnosis?
A. Anterior ischemia (subendocardial) B. Inferior ischemia C. Lateral ischemia D. Posterior MI
Correct Answer: A Rationale: ST depression in V1-V4 suggests anterior ischemia (subendocardial
injury). ST elevation (B) would indicate infarction. Lateral ischemia (C) is in V5-V6, I, aVL.
Posterior MI (D) shows ST depression in V1-V3 and tall R waves.
Question 8 (Select all that apply) Which of the following are risk factors for coronary artery disease?
(Select all that apply)
A. Hypertension B. Hyperlipidemia C. Smoking D. Diabetes E. Family history
Correct Answers: A, B, C, D, E Rationale: All are risk factors for CAD. Modifiable: hypertension
(A), hyperlipidemia (B), smoking (C), diabetes (D). Non-modifiable: family history (E), age, male
gender.
Question 9 A patient with acute MI is on a continuous infusion of nitroglycerin. Which side effect
should the nurse monitor?
A. Hypotension B. Tachycardia C. Headache D. All of the above
Correct Answer: D Rationale: Nitroglycerin causes vasodilation → hypotension (A), reflex
tachycardia (B), and headache (C). All are potential side effects.
Question 10 A patient with acute MI has a new onset of a harsh holosystolic murmur at the left
sternal border. Which complication should the nurse suspect?
A. Ventricular septal defect (VSD) B. Papillary muscle rupture (mitral regurgitation) C. Left
ventricular aneurysm D. Pericarditis
Correct Answer: A Rationale: VSD causes a harsh holosystolic murmur at the left sternal border.
Papillary muscle rupture (B) causes a systolic murmur at the apex. Aneurysm (C) causes persistent ST
elevation. Pericarditis (D) causes a friction rub.
Question 11 (Select all that apply) Which of the following are signs of cardiogenic shock? (Select all
that apply)
, A. Hypotension (SBP <90) B. Tachycardia C. Cool, clammy skin D. Oliguria (<30 mL/hr) E. Altered
mental status
Correct Answers: A, B, C, D, E Rationale: Cardiogenic shock is caused by pump failure. Signs:
hypotension (A), tachycardia (B), cool, clammy skin (C) (vasoconstriction), oliguria (D), and altered
mental status (E).
Question 12 A patient in cardiogenic shock is on dobutamine. What is the mechanism of action?
A. Beta-1 agonist (increases contractility, minimal vasoconstriction) B. Alpha-1 agonist
(vasoconstriction) C. Beta-2 agonist (vasodilation) D. Phosphodiesterase inhibitor (increases cAMP)
Correct Answer: A Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility
(inotropy) with mild chronotropy and mild vasodilation (beta-2 effects). It is used in cardiogenic
shock with low cardiac output.
Question 13 A patient with heart failure is on milrinone. Which side effect should the nurse monitor?
A. Arrhythmias (ventricular tachycardia) B. Hypertension C. Bradycardia D. Hyperkalemia
Correct Answer: A Rationale: Milrinone is a phosphodiesterase inhibitor with inotropic and
vasodilatory effects. It can cause arrhythmias (ventricular tachycardia), hypotension (not hypertension
– B), and thrombocytopenia.
Question 14 (Select all that apply) Which of the following are indications for pacemaker insertion?
(Select all that apply)
A. Symptomatic bradycardia B. Third-degree heart block C. Sick sinus syndrome D. Atrial fibrillation
with rapid ventricular response E. Asystole (temporary pacing)
Correct Answers: A, B, C, E Rationale: Symptomatic bradycardia (A), third-degree heart block (B),
sick sinus syndrome (C), and asystole (E) are indications. Atrial fibrillation with rapid ventricular
response (D) is treated with rate control, not pacing.
Question 15 A patient with heart failure has a PAWP of 18 mm Hg. What does this indicate?
A. Normal filling pressure B. Elevated filling pressure (fluid overload) C. Low filling pressure
(dehydration) D. Right ventricular failure
Correct Answer: B Rationale: Normal PAWP is 6-12 mm Hg. 18 mm Hg indicates elevated left
ventricular filling pressure (fluid overload). PAWP (A) is not normal. Low filling pressure (C) is <6.
Right ventricular failure (D) is assessed by CVP.
