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Progressive Critical Care Nursing Practice Test

PCCN exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

The PCCN certification exams focus 80 percent on clinical judgment and 20 percent on professional caring and ethical practice. Our comprehensive course prepares you in the following categories:

Clinical Judgment

- Cardiovascular
- Pulmonary
- Endocrine
- Hematology
- Gastrointestinal
- Renal
- Neurology
- Behavioral/Psychosocial
- Musculoskeletal
- Professional Caring and Ethical Practice
- Advocacy/Moral Agency
- Caring Practices
- Response to Diversity
- Facilitation of Learning
- Collaboration
- Systems Thinking
- Clinical Inquiry
- Learning Outcomes

At the completion of this learning activity- participants should be able to:

Validate their knowledge of progressive care nursing Briefly review the pathophysiology of single and multisystem dysfunction in adult patients and the medical and pharmacologic management of each Identify the progressive care nursing management needs for adult patients with single or multisystem organ abnormalities Successful Completion

Learners must complete 100 percent of the activity and the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.
12.8 contact hours awarded- CERP Category A
Exam Eligibility

Are you eligible to take the PCCN or PCCN-K exam- Eligibility requirements and links to handbooks with test plans are available on our “Get Certified” pages — click here to get started: PCCN (Adult) or PCCN-K (Adult) .

PCCN and PCCN-K certifications emphasize the knowledge that the progressive nursing specialty requires and the essential acute care nursing practices that you can apply in your role every day in a step-down unit- emergency or telemetry department or another progressive care environment.

PCCN and PCCN-K specialty certifications also demonstrate your knowledge and dedication to hospital administrators- peers and patients- while giving you the satisfaction of your achievement. PCCN and PCCN-K credentials are granted by AACN Certification Corporation.

Validate and enhance your knowledge and Boost patient outcomes. Take advantage of this detailed review course and earn your PCCN or PCCN-K certification.

The American Association of Critical-Care Nurses (AACN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centers (ANCC's) Commission on Accreditation- ANCC Provider Number 0012. AACN has been approved as a provider of continuing education in nursing by the California Board of Registered Nursing (CBRN)- Provider number CEP 1036. This activity is approved for 12.8 contact hours.

AACN programming meets the standards of most states that require mandatory CE contact hours for license and/or certification renewal. AACN recommends consulting with your state board of nursing or credentialing organization before submitting CE to fulfill continuing education requirements.

AACN and AACN Certification Corporation consider the American Nurses Association (ANA) Code of Ethics for Nurses foundational for nursing practice- providing a framework for making ethical decisions and fulfilling responsibilities to the public- colleagues and the profession. AACN Certification Corporations mission of public protection supports a standard of excellence where certified nurses have a responsibility to read about- understand and act in a manner congruent with the ANA Code of Ethics for Nurses.

I. CLINICAL JUDGMENT (80%)
A. Cardiovascular (27%)
1. Acute coronary syndromes
a. non-ST segment elevation myocardial infarction
b. ST segment elevation myocardial infarction
c. unstable angina
2. Acute inflammatory disease (e.g.- myocarditis- endocarditis- pericarditis)
3. Aneurysm
a. dissecting
b. repair
4. Cardiac surgery (e.g.- post ICU care)
5. Cardiac tamponade
6. Cardiac/vascular catheterization
a. diagnostic
b. interventional
7. Cardiogenic shock
8. Cardiomyopathies
a. dilated (e.g.- ischemic/non-ischemic)
b. hypertrophic
c. restrictive
9. Dysrhythmias
10. Heart failure
a. acute exacerbations (e.g.- pulmonary edema)
b. chronic
11. Hypertension (uncontrolled)
12. Hypertensive crisis
13. Minimally-invasive cardiac surgery (i.e. nonsternal approach)
14. Valvular heart disease
15. Vascular disease
B. Pulmonary (17%)
1. Acute respiratory distress syndrome (ARDS)
2. Asthma (severe)
3. COPD exacerbation
4. Minimally-invasive thoracic surgery (e.g.- VATS)
5. Obstructive sleep apnea
6. Pleural space complications (e.g.- pneumothorax- hemothorax- pleural effusion- empyema- chylothorax)
7. Pulmonary embolism
8. Pulmonary hypertension
9. Respiratory depression (e.g.- medicationinduced- decreased-LOC-induced)
10. Respiratory failure
a. acute
b. chronic
c. failure to wean
11. Respiratory infections (e.g.- pneumonia)
12. Thoracic surgery (e.g.- lobectomy- pneumonectomy)
C. Endocrine/Hematology/Neurology/Gastrointestinal/Renal (20%)
1. Endocrine
a. diabetes mellitus
b. diabetic ketoacidosis
c. hyperglycemia
d. hypoglycemia
2. Hematology/Immunology/Oncology
a. anemia
b. coagulopathies: medication-induced (e.g.- Coumadin- platelet inhibitors- heparin [HIT])
3. Neurology
a. encephalopathy (e.g.- hypoxic-ischemic- metabolic- infectious- hepatic)
b. seizure disorders
c. stroke
4. Gastrointestinal
a. functional GI disorders (e.g.- obstruction- ileus- diabetic gastroparesis- gastroesophageal reflux- irritable bowel syndrome)
b. GI bleed
i. lower
ii. upper
c. GI infections (e.g.- C. difficile)
d. GI surgeries (e.g.- resections- esophagogastrectomy- bariatric)
e. hepatic disorders (e.g.- cirrhosis- hepatitis- portal hypertension)
f. ischemic bowel
g. malnutrition (e.g.- failure to thrive- malabsorption disorders)
h. pancreatitis
5. Renal
a. acute kidney injury (AKI)
b. chronic kidney disease (CKD)
c. electrolyte imbalances
d. end-stage renal disease (ESRD)
D. Musculoskeletal/Multisystem/Psychosocial (16%)
1. Musculoskeletal
a. functional issues (e.g.- immobility- falls- gait disorders)
2. Multisystem
a. end of life
b. healthcare-acquired infections
i. catheter-associated urinary tract infections (CAUTI)
ii. central-line-associated bloodstream infections (CLABSI)
iii. surgical site infection (SSI)
c. infectious diseases
i. influenza
ii. multidrug-resistant organisms (e.g.- MRSA- VRE- CRE- ESBL)
d. pain
i. acute
ii. chronic
e. palliative care
f. pressure injuries (ulcers)
g. rhabdomyolysis
h. sepsis
i. shock states
i. anaphylactic
ii. hypovolemic
j. toxic ingestion/inhalation/drug overdose
k. wounds (e.g.- infectious- surgical- trauma)
3. Behavioral/Psychosocial
a. altered mental status
b. delirium
c. dementia
d. disruptive behaviors- aggression- violence
e. psychological disorders
i. anxiety
ii. depression
f. substance abuse
i. alcohol withdrawal
ii. chronic alcohol abuse
iii. chronic drug abuse
iv. drug-seeking behavior
v. drug withdrawal
II. PROFESSIONAL CARING AND ETHICAL PRACTICE (20%)
A. Advocacy/Moral Agency
B. Caring Practices
C. Response to Diversity
D. Facilitation of Learning
E. Collaboration
F. Systems Thinking
G. Clinical Inquiry Cardiovascular
• Identify- interpret and monitor
o dysrhythmias
o QTc intervals
o ST segments
• Manage patients requiring
o ablation
o arterial closure devices
o arterial/venous sheaths
o cardiac catheterization
o cardioversion
o defibrillation
o pacemakers
o percutaneous coronary intervention (PCI)
o transesophageal echocardiogram (TEE)
• Monitor hemodynamic status and recognize signs and symptoms of hemodynamic instability
• Select leads for cardiac monitoring for the indicated disease process
• Titrate vasoactive medications
o Dobutamine
o Dopamine
o Nitroglycerin Pulmonary
• Interpret ABGs
• Maintain airway
• Monitor patients pre and post
o bronchoscopy
o chest tube insertion
o thoracentesis
• Manage patients requiring mechanical ventilation
• Manage patients requiring non-invasive O2 or ventilation delivery systems
o BiPAP
o CPAP
o face masks
o high-flow therapy
o nasal cannula
o non-breather mask
o venti-masks
• Manage patients requiring respiratory monitoring devices:
o continuous SpO2
o end-tidal CO2 (capnography)
Manage patients requiring tracheostomy tubes
• Manage patients with chest tubes (including pleural drains)
• Recognize respiratory complications and initiate interventions
Endocrine/Hematology/Neurology/Gastrointestinal/Renal
• Endocrine
o manage and titrate insulin infusions
• Hematology/Immunology/Oncology
o administer blood products and monitor patient response
• Neurology
o perform bedside screening for dysphagia
o use NIH Stroke Scale (NIHSS)
• Gastrointestinal
o manage patients pre- and post-procedure (e.g.- EGD- colonoscopy)
o manage patients who have fecal containment devices
o manage patients who have tubes and drains
o recognize indications for and complications of enteral and parenteral nutrition
• Renal
o identify medications that can be removed during dialysis
o identify medications that may cause nephrotoxicity
o initiate renal protective measures for nephrotoxic procedures
o manage patients pre- and post-hemodialysis Musculoskeletal/Multisystem/Psychosocial
• Musculoskeletal
o initiate and monitor progressive mobility measures
• Multisystem
o administer medications for procedural sedation and monitor patient response
o differentiate types of wounds- pressure injuries
o manage patients with complex wounds (e.g.- fistulas- drains and vacuum-assisted closure devices)
o manage patients with infections
• Psychosocial
o implement suicide prevention measures
o screen patients using a delirium assessment tool (e.g.- CAM)
o use alcohol withdrawal assessment tools (e.g.- CIWA)
General
• Administer medications and monitor patient response
• Anticipate therapeutic regimens
• Monitor diagnostic test results
• Perform an assessment pertinent to the system
• Provide health promotion interventions for patients- populations and diseases
• Provide patient and family education unique to the clinical situation
• Recognize procedural and surgical complications
• Recognize urgent situations and initiate interventions
• Use complementary alternative medicine techniques and non-pharmacologic interventions

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Nursing
PCCN
AACN Progressive Critical Care Nursing 2026
https://killexams.com/pass4sure/exam-detail/PCCN
Question: 528
What is the primary mechanism of action of corticosteroids in the management
of acute respiratory distress syndrome (ARDS)?
A. Vasoconstriction
B. Anti-inflammatory
C. Bronchodilation
D. Surfactant production
Answer: B
Explanation: The primary mechanism of action of corticosteroids in the
management of acute respiratory distress syndrome (ARDS) is their anti-
inflammatory effect. ARDS is characterized by widespread inflammation and
increased permeability of the alveolar-capillary membrane, leading to
pulmonary edema and impaired gas exchange. Corticosteroids help to suppress
this excessive inflammatory response, which can Boost lung function and
facilitate recovery in ARDS patients.
Question: 529
A patient with severe sepsis has a lactate level of 5 mmol/L. Which of the
following is the next appropriate step in management?
A. Administration of broad-spectrum antibiotics
B. Initiation of fluid resuscitation
C. Vasopressor therapy
D. Measurement of central venous oxygen saturation
Answer: D
Explanation: In severe sepsis, a lactate level > 4 mmol/L indicates tissue
hypoperfusion and is an indication for early goal-directed therapy, which
includes measurement of central venous oxygen saturation to guide fluid and
vasopressor administration.
Question: 530
A patient with a history of atrial fibrillation is admitted with chest pain and
shortness of breath. The nurse should prioritize obtaining which of the
following diagnostic tests?
A. Electrocardiogram (ECG)
B. Chest X-ray
C. Troponin level
D. All of the above
Answer: D
Explanation: In a patient with atrial fibrillation and new-onset chest pain and
shortness of breath, the nurse should prioritize obtaining an electrocardiogram,
a chest X-ray, and a troponin level. These diagnostic tests can help determine
the underlying cause of the patient's symptoms, such as myocardial infarction,
pulmonary embolism, or other cardiac-related issues.
Question: 531
Which of the following is the most appropriate initial management for a patient
with status epilepticus?
A. Benzodiazepines
B. Phenytoin
C. Levetiracetam
D. Both A and B
Answer: D
Explanation: The most appropriate initial management for a patient with status
epilepticus is the administration of benzodiazepines (e.g., lorazepam or
diazepam) followed by a long-acting antiseizure medication such as phenytoin.
This combination helps terminate the seizure and prevent recurrence.
Question: 532
A 55-year-old man with a history of coronary artery disease and hypertension
presents to the emergency department with chest pain, shortness of breath, and
sweating. His vital signs are: blood pressure 90/60 mmHg, heart rate 110 bpm,
respiratory rate 24 breaths/min, and oxygen saturation 88% on room air. An
ECG shows ST-segment elevation in the inferior leads. What is the most
appropriate immediate management?
A. Administer aspirin and nitroglycerin
B. Perform emergent coronary angiography and percutaneous coronary
intervention
C. Administer thrombolytic therapy
D. Provide supplemental oxygen and obtain urgent cardiology consultation
Answer: C
Explanation: The clinical presentation of chest pain, shortness of breath,
hypotension, tachycardia, and ST-segment elevation on ECG is consistent with
an acute ST-elevation myocardial infarction (STEMI) involving the inferior
wall of the heart. The most appropriate immediate management in this scenario
is to administer thrombolytic therapy, which can help dissolve the coronary
artery thrombus and restore blood flow to the affected myocardium. Emergent
coronary angiography and percutaneous coronary intervention are also
appropriate, but thrombolytics can be initiated more rapidly in the emergency
department. Supplemental oxygen and cardiology consultation are also
important, but should not delay initiation of thrombolytic therapy.
Question: 533
A client with acute renal failure is placed on continuous renal replacement
therapy (CRRT). Which of the following is the most important nursing
intervention to prevent complications?
A. Closely monitor fluid balance
B. Administer anticoagulants
C. Assess for bleeding
D. Maintain adequate blood flow
Answer: D
Explanation: Maintaining adequate blood flow to the CRRT circuit is the most
important nursing intervention to prevent complications, such as clotting or
filter failure. Closely monitoring fluid balance, administering anticoagulants,
and assessing for bleeding are also important interventions, but maintaining
adequate blood flow is the critical factor in preventing CRRT-related
complications.
Question: 534
What is the recommended strategy for preventing pressure injuries in a
critically ill patient?
A. Turning and repositioning
B. Use of specialty mattresses
C. Skin assessment and moisture management
D. All of the above
Answer: D
Explanation: The recommended strategy for preventing pressure injuries in a
critically ill patient includes a combination of turning and repositioning, use of
specialty mattresses (e.g., air mattresses), and regular skin assessment with
appropriate moisture management. This comprehensive approach helps reduce
the risk of pressure injury development.
Question: 535
A patient with a history of end-stage renal disease (ESRD) on hemodialysis
presents with a fever, hypotension, and altered mental status. The nurse
suspects which of the following complications?
A. Hyperkalemia
B. Uremic encephalopathy
C. Dialysis disequilibrium syndrome
D. Hemodialysis-associated hypotension
Answer: C
Explanation: The symptoms of fever, hypotension, and altered mental status in
a patient with ESRD on hemodialysis are most likely indicative of dialysis
disequilibrium syndrome. This condition occurs due to the rapid removal of
waste products and electrolytes during dialysis, which can lead to cerebral
edema and neurological symptoms. Hyperkalemia, uremic encephalopathy, and
hemodialysis-associated hypotension are other potential complications, but the
presented symptoms are most characteristic of dialysis disequilibrium
syndrome.
Question: 536
A patient with a history of hypertension and type 2 diabetes mellitus is
admitted with new-onset atrial fibrillation. The physician orders amiodarone
and apixaban (Eliquis) for the patient. Which of the following is the most
important nursing consideration?
A. Monitoring the patient's thyroid function
B. Assessing for signs of bleeding
C. Checking the patient's serum potassium level
D. Educating the patient on the importance of medication adherence
Answer: B
Explanation: The most important nursing consideration for a patient with new-
onset atrial fibrillation who is started on amiodarone and apixaban is assessing
for signs of bleeding. Apixaban is an anticoagulant that increases the risk of
bleeding, which requires close monitoring. Monitoring thyroid function and
serum potassium level are important but less critical in the immediate
management of this patient. Educating the patient on medication adherence is
also important but should not be the top priority.
Question: 537
A patient with a history of traumatic brain injury (TBI) develops a fever and
altered mental status. Which of the following is the most likely cause of the
fever?
A. Urinary tract infection
B. Ventilator-associated pneumonia
C. Central nervous system infection
D. Sepsis of unknown source
Answer: C
Explanation: In a patient with a history of TBI who develops a fever and
altered mental status, the most likely cause of the fever is a central nervous
system (CNS) infection, such as meningitis or ventriculitis. Patients with TBI
are at increased risk of CNS infections due to the disruption of the blood-brain
barrier and the presence of foreign devices, such as ventricular catheters. Other
possible causes, such as urinary tract infection, pneumonia, or sepsis, are also
possible but less likely in this specific scenario.
Question: 538
A 50-year-old patient with a history of congestive heart failure presents with
shortness of breath, edema, and fatigue. Arterial blood gas (ABG) analysis
shows the following:
pH: 7.46
paCO2: 30 mmHg
pO2: 85 mmHg
HCO3-: 22 mEq/L
What is the most likely diagnosis?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: D
Explanation: The given ABG results indicate respiratory alkalosis. The
increased pH (7.46), decreased paCO2 (30 mmHg), and normal bicarbonate (22
mEq/L) are characteristic of respiratory alkalosis.
In patients with congestive heart failure, respiratory alkalosis can occur as a
compensatory mechanism to Boost oxygenation and ventilation. The
shortness of breath, edema, and fatigue reported by the patient are common
symptoms associated with congestive heart failure and the resulting respiratory
alkalosis.
The normal bicarbonate level suggests that the respiratory system is the primary
driver of the acid-base imbalance, rather than a metabolic compensation.
Question: 539
A patient with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation. The physician orders neuromuscular blocking agents
(NMBAs) for the patient. Which of the following is the most appropriate
nursing intervention?
A. Perform daily spontaneous breathing trials to assess for extubation readiness.
B. Administer scheduled sedation to maintain the patient's Richmond Agitation-
Sedation Scale (RASS) at -4 to -5.
C. Ensure the patient receives physical therapy and early mobilization while on
NMBAs.
D. Monitor the patient's train-of-four (TOF) ratio to assess the depth of
neuromuscular blockade.
Answer: D
Explanation: The most appropriate nursing intervention for a patient with
ARDS receiving NMBAs is to monitor the patient's train-of-four (TOF) ratio to
assess the depth of neuromuscular blockade. Monitoring the TOF ratio helps
ensure the appropriate level of blockade is maintained, which is critical for the
management of ARDS. Performing spontaneous breathing trials, administering
sedation, and providing early mobilization are also important interventions, but
monitoring the TOF ratio is the most appropriate in this scenario.
Question: 540
A patient with a history of chronic obstructive pulmonary disease (COPD) and
cor pulmonale is admitted with an acute exacerbation. Which of the following
is the most appropriate initial management?
A. Administer high-flow oxygen therapy
B. Initiate non-invasive ventilation (NIV)
C. Perform emergency intubation
D. Administer diuretic therapy
Answer: B
Explanation: In a patient with COPD and cor pulmonale presenting with an
acute exacerbation, the most appropriate initial management is to initiate non-
invasive ventilation (NIV), such as bilevel positive airway pressure (BiPAP) or
continuous positive airway pressure (CPAP). NIV can help Boost gas
exchange, reduce the work of breathing, and avoid the need for invasive
mechanical ventilation. High-flow oxygen therapy and diuretic therapy may
also be indicated, but NIV should be the first-line intervention.
Question: 541
Which of the following is the most appropriate initial antibiotic regimen for a
patient with severe sepsis?
A. Ceftriaxone
B. Vancomycin
C. Broad-spectrum antibiotic combination
D. Targeted antibiotic based on culture results
Answer: C
Explanation: The most appropriate initial antibiotic regimen for a patient with
severe sepsis is a broad-spectrum antibiotic combination. This helps provide
empiric coverage while awaiting culture results, which is crucial for improving
outcomes.
Question: 542
A 55-year-old patient with a history of chronic heart failure is admitted to the
ICU with acute decompensation. The patient presents with severe dyspnea,
pulmonary edema, and hypotension. What is the most appropriate initial
management?
A. Diuretic therapy
B. Vasodilator therapy
C. Inotropic support
D. All of the above
Answer: D
Explanation: The appropriate initial management for a patient with acute
decompensated heart failure includes diuretic therapy to reduce fluid overload,
vasodilator therapy to decrease afterload and preload, and inotropic support to
improve cardiac contractility. This comprehensive approach is crucial in
stabilizing the patient's hemodynamic status and managing the acute
exacerbation of heart failure.
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