A patient with an acute inferior STEMI has BP 82/50 mmHg, HR 58/min, jugular venous distension, and clear lung sounds. Right-sided leads show ST elevation in V4R. Which order should the nurse question?

Nitroglycerin 0.4 mg sublingual

pH PaCO₂ HCO₃⁻ PaO₂ 7.26 72 mmHg 32 mEq/L 54 mmHg An ABG is obtained for a patient with COPD who is drowsy. How should the nurse interpret these results?

Acute respiratory acidosis superimposed on chronic compensated respiratory acidosis

Uncompensated respiratory acidosis

Metabolic alkalosis with respiratory compensation

A patient on day 7 of unfractionated heparin after hip surgery has platelets fall from 260,000 to 95,000/mm³ and a new swollen, painful left calf. Which action is most appropriate?

Stop all heparin, including flushes, and start argatroban as ordered

A patient receiving hemodialysis for the first time develops headache, nausea, restlessness, and confusion near the end of the treatment. BP is 136/82 mmHg. What is the most likely cause?

Dialysis disequilibrium syndrome

A patient with decision-making capacity who has end-stage COPD declines intubation. The patient's son insists that 'everything be done.' What is the nurse's most appropriate action?

Support the patient's decision and facilitate a family meeting with the care team

Document the disagreement and take no further action

Follow the son's wishes because he is the next of kin

Ask the provider to assess the patient for depression before honoring the decision

pH PaCO₂ HCO₃⁻ Na⁺ Cl⁻ 7.29 29 mmHg 14 mEq/L 140 mEq/L 116 mEq/L Interpret this ABG from a patient with severe diarrhea.

Metabolic acidosis with respiratory compensation

Mixed respiratory and metabolic alkalosis

A patient with CKD on hemodialysis has an AV fistula in the left arm. Which finding requires immediate notification of the provider?

Mild bruising at the needle site

A palpable thrill and audible bruit

Using the Synergy Model, a patient with multiple comorbidities, frequent medication changes, and a family with limited transportation and income is best described as having which characteristics?

High complexity and limited resource availability

High stability and full participation in care

High resiliency and high predictability

PCCN (Progressive Care)

Free PCCN Practice Questions

10 sample questions for the PCCN (Progressive Care), with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Endocrine, Respiratory, Hematology/Immunology/Oncology, Neurology, Gastrointestinal, Renal, Musculoskeletal, Multisystem, Professional Caring and Ethical Practice.

Question 1 · Endocrine
A patient with an acute inferior STEMI has BP 82/50 mmHg, HR 58/min, jugular venous distension, and clear lung sounds. Right-sided leads show ST elevation in V4R. Which order should the nurse question?
- A.Normal saline 500 mL IV bolus
- B.Nitroglycerin 0.4 mg sublingual
- C.Aspirin 324 mg chewed
- D.Prepare for primary PCI
Show answer and explanation
Answer: B. Nitroglycerin 0.4 mg sublingual
Hypotension, JVD, and clear lungs with ST elevation in V4R indicate right ventricular infarction. The RV is preload-dependent, so nitrates (and diuretics) can cause profound hypotension. Volume loading, aspirin, and emergent reperfusion are all appropriate.
Question 2 · Respiratory
pH PaCO₂ HCO₃⁻ PaO₂
7.26 72 mmHg 32 mEq/L 54 mmHg
An ABG is obtained for a patient with COPD who is drowsy. How should the nurse interpret these results?
- A.Acute respiratory acidosis superimposed on chronic compensated respiratory acidosis
- B.Uncompensated respiratory acidosis
- C.Compensated metabolic acidosis
- D.Metabolic alkalosis with respiratory compensation
Show answer and explanation
Answer: A. Acute respiratory acidosis superimposed on chronic compensated respiratory acidosis
The low pH with a PaCO₂ of 72 indicates acute respiratory acidosis. The elevated bicarbonate reflects chronic renal compensation for long-standing CO₂ retention, but it is insufficient for the acute rise. This acute-on-chronic hypercapnia with drowsiness is an indication for BiPAP.
Question 3 · Hematology/Immunology/Oncology
A patient on day 7 of unfractionated heparin after hip surgery has platelets fall from 260,000 to 95,000/mm³ and a new swollen, painful left calf. Which action is most appropriate?
- A.Switch to enoxaparin
- B.Transfuse platelets
- C.Stop all heparin, including flushes, and start argatroban as ordered
- D.Start warfarin immediately
Show answer and explanation
Answer: C. Stop all heparin, including flushes, and start argatroban as ordered
A platelet drop of more than 50% 5–10 days after heparin exposure with new thrombosis indicates heparin-induced thrombocytopenia. All heparin, including LMWH and flushes, must be stopped and a direct thrombin inhibitor started. Platelet transfusion and early warfarin can worsen thrombosis.
Question 4 · Renal
A patient receiving hemodialysis for the first time develops headache, nausea, restlessness, and confusion near the end of the treatment. BP is 136/82 mmHg. What is the most likely cause?
- A.Hypervolemia
- B.Dialysis disequilibrium syndrome
- C.Air embolism
- D.Hyperkalemia
Show answer and explanation
Answer: B. Dialysis disequilibrium syndrome
Dialysis disequilibrium syndrome results from rapid removal of urea from the blood, creating an osmotic gradient that shifts water into brain cells and causes cerebral edema. It is most common with first treatments and very high BUN. Prevention includes shorter, slower initial sessions.
Question 5 · Professional Caring and Ethical Practice
A patient with decision-making capacity who has end-stage COPD declines intubation. The patient's son insists that 'everything be done.' What is the nurse's most appropriate action?
- A.Document the disagreement and take no further action
- B.Follow the son's wishes because he is the next of kin
- C.Ask the provider to assess the patient for depression before honoring the decision
- D.Support the patient's decision and facilitate a family meeting with the care team
Show answer and explanation
Answer: D. Support the patient's decision and facilitate a family meeting with the care team
A patient with decision-making capacity has the right to refuse treatment (autonomy). The nurse advocates for the patient's decision while supporting the family through communication, such as a family meeting. A surrogate's wishes do not override those of a capable patient.
Question 6 · Endocrine
A patient reports chest pressure. The 12-lead ECG shows ST elevation in leads II, III, and aVF with ST depression in I and aVL. Which coronary artery is most likely occluded?
- A.Circumflex
- B.Left main
- C.Right coronary artery
- D.Left anterior descending
Show answer and explanation
Answer: C. Right coronary artery
ST elevation in the inferior leads (II, III, aVF) with reciprocal depression in the high lateral leads indicates an inferior STEMI, most commonly due to right coronary artery occlusion. The RCA also supplies the SA and AV nodes in most people, so bradycardia and AV block are common.
Question 7 · Respiratory
pH PaCO₂ HCO₃⁻ Na⁺ Cl⁻
7.29 29 mmHg 14 mEq/L 140 mEq/L 116 mEq/L
Interpret this ABG from a patient with severe diarrhea.
- A.Mixed respiratory and metabolic alkalosis
- B.Metabolic alkalosis
- C.Metabolic acidosis with respiratory compensation
- D.Respiratory acidosis
Show answer and explanation
Answer: C. Metabolic acidosis with respiratory compensation
Low pH with low bicarbonate indicates metabolic acidosis; the low PaCO₂ reflects respiratory compensation. Diarrhea causes a normal anion gap (hyperchloremic) metabolic acidosis through bicarbonate loss: 140 − (116 + 14) = 10.
Question 8 · Hematology/Immunology/Oncology
A patient with sepsis develops oozing from IV sites and hematuria. Labs: platelets 42,000/mm³, fibrinogen 88 mg/dL, D-dimer markedly elevated, and prolonged PT and aPTT. Which blood product is indicated to correct the fibrinogen level?
- A.Platelets only
- B.Albumin
- C.Cryoprecipitate
- D.Packed red blood cells
Show answer and explanation
Answer: C. Cryoprecipitate
The labs indicate DIC. Cryoprecipitate contains concentrated fibrinogen and is given for bleeding with low fibrinogen. Platelets and plasma may also be needed, but treating the underlying sepsis is the definitive therapy.
Question 9 · Renal
A patient with CKD on hemodialysis has an AV fistula in the left arm. Which finding requires immediate notification of the provider?
- A.Absence of a thrill and bruit
- B.Warmth over the fistula
- C.Mild bruising at the needle site
- D.A palpable thrill and audible bruit
Show answer and explanation
Answer: A. Absence of a thrill and bruit
A palpable thrill and audible bruit confirm fistula patency. Their absence suggests thrombosis, which requires prompt intervention to salvage the access.
Question 10 · Professional Caring and Ethical Practice
Using the Synergy Model, a patient with multiple comorbidities, frequent medication changes, and a family with limited transportation and income is best described as having which characteristics?
- A.High complexity and limited resource availability
- B.Low vulnerability
- C.High stability and full participation in care
- D.High resiliency and high predictability
Show answer and explanation
Answer: A. High complexity and limited resource availability
Complexity refers to the entanglement of multiple systems (body, family, therapies), and resource availability includes financial, social, and personal resources. This patient needs a nurse with strong systems thinking and advocacy.

pH	PaCO₂	HCO₃⁻	PaO₂
7.26	72 mmHg	32 mEq/L	54 mmHg

pH	PaCO₂	HCO₃⁻	Na⁺	Cl⁻
7.29	29 mmHg	14 mEq/L	140 mEq/L	116 mEq/L

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