• 60 questions

PCCN Practice Test

Unofficial PCCN exam practice for step-down and telemetry nurses, weighted like the published test plan.

A patient has sharp chest pain that is worse lying flat and with a deep breath. Which other finding points to pericarditis?

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Exam mode: 50 questions, 60 minutes.

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Unofficial practice questions, not affiliated with the American Association of Critical-Care Nurses (AACN). Bank checked October 12, 2026.

The real exam, as its certifying body describes it

Questions
150
Time limit
180 minutes
Fee
$260 for AACN members, $375 for nonmembers (computer-based exam)
Retakes
At most four tries in any 12 months running
Where
A PSI testing center or live remote proctoring from your own computer
Results
Shown on screen when a computer-based exam ends; a detailed score report is emailed within 24 hours

Checked October 12, 2026 against PCCN Exam Handbook, Direct Care Eligibility Pathway (July 2026), and the PCCN (Adult) page, aacn.org. Rules change, so confirm with the agency itself before your test.

AACN's own PCCN (Adult) page

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All 60 questions

Cardiovascular 12

  • A day after a large heart attack a patient becomes confused. Which set of findings fits cardiogenic shock? MedlinePlus Medical Encyclopedia, "Cardiogenic shock", Symptoms; Exams and Tests. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: cardiogenic shock.
  • A patient has calf pain that starts with walking and stops after a few minutes of rest. At night the pain is worse with the legs raised and eases when they dangle. What does this describe? MedlinePlus Medical Encyclopedia, "Peripheral artery disease - legs", Symptoms. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: vascular disease.
  • A patient has sharp chest pain that is worse lying flat and with a deep breath. Which other finding points to pericarditis? MedlinePlus Medical Encyclopedia, "Pericarditis", Symptoms; Exams and Tests. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: acute inflammatory disease.
  • A patient in new atrial fibrillation, with the heart rate now controlled, asks why a blood thinner was ordered. What is the reason? MedlinePlus Medical Encyclopedia, "Atrial fibrillation and atrial flutter", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: dysrhythmias.
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Cardiovascular, continued

  • A patient in third-degree heart block is fainting. Which two kinds of pacemaker are used only in emergencies and are not permanent? MedlinePlus Medical Encyclopedia, "Heart pacemaker", Description; "Heart block", lead section. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: dysrhythmias (pacemakers).
  • A patient returns from a cardiac catheterization done through the groin. Why is the patient kept lying flat for a few to several hours? MedlinePlus Medical Encyclopedia, "Cardiac catheterization", How the Test is Performed. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: cardiac/vascular catheterization.
  • A patient taking digoxin and a diuretic for heart failure reports nausea, confusion and changes in how colors look. Which lab result makes digoxin toxicity more likely? MedlinePlus Medical Encyclopedia, "Digitalis toxicity", Causes; Symptoms. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: heart failure (medicines).
  • A patient with an ST-elevation heart attack arrives at a hospital that does angioplasty. Within what time of arrival should the artery be opened? MedlinePlus Medical Encyclopedia, "Heart attack", Treatment, Emergency procedures. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: acute coronary syndromes.
  • A patient with high blood pressure reports sudden tearing chest pain that moves to the back. Blood pressure is much lower in the left arm than in the right. What is suspected? MedlinePlus Medical Encyclopedia, "Aortic dissection", Symptoms; Exams and Tests. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: aneurysms (dissecting or ruptured).
  • A stable patient has a sudden regular heart rate of 190 a minute, identified as PSVT. Which technique may interrupt the episode? MedlinePlus Medical Encyclopedia, "Paroxysmal supraventricular tachycardia (PSVT)", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: dysrhythmias.
  • An echocardiogram report says the left ventricle is stiff and fills poorly, but its pumping power is normal. Which type of heart failure is this? MedlinePlus Medical Encyclopedia, "Heart failure", Causes. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: heart failure.
  • Hours after an invasive heart procedure a patient is restless, with low blood pressure, bulging neck veins and faint heart sounds. A bedside echocardiogram shows fluid around the heart. Which procedure should the nurse prepare for? MedlinePlus Medical Encyclopedia, "Cardiac tamponade", Exams and Tests; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 1A Cardiovascular: cardiac tamponade.

Respiratory 8

  • A drowsy patient with COPD has an arterial blood gas of pH 7.30, PaCO2 60 mm Hg and bicarbonate 26. Which imbalance does this show? MedlinePlus Medical Encyclopedia, "Blood gases", Normal Results; "Respiratory acidosis", lead section. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: COPD exacerbation (interpret blood gases).
  • A patient given IV opioids has small pupils and breathes 8 times a minute. Naloxone restores normal breathing. Why must close monitoring continue? MedlinePlus Medical Encyclopedia, "Opioid intoxication", Symptoms; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: respiratory depression (medication-induced).
  • A patient has sudden sharp chest pain and shortness of breath. Which finding on listening to the chest fits a collapsed lung? MedlinePlus Medical Encyclopedia, "Collapsed lung (pneumothorax)", Exams and Tests; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: pleural space complications.
  • A patient taking opioid pain medicine stops breathing for short periods during sleep and makes no effort to breathe. What causes central sleep apnea? MedlinePlus Medical Encyclopedia, "Central sleep apnea", Causes. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: sleep apnea (obstructive, central).
  • A patient treated for septic shock becomes short of breath with crackles and low oxygen, and the chest x-ray suggests ARDS. Why might an echocardiogram be ordered? MedlinePlus Medical Encyclopedia, "Acute respiratory distress syndrome", Symptoms; Exams and Tests. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: acute respiratory distress syndrome (ARDS).
  • A patient who has had lung surgery is taught to use an incentive spirometer. Which instruction is correct? MedlinePlus Medical Encyclopedia, "Using an incentive spirometer", How to Use an Incentive Spirometer. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: thoracic surgery.
  • A patient with a chest tube for a pneumothorax asks when the tube will come out. What is the usual answer? MedlinePlus Medical Encyclopedia, "Chest tube insertion", Description. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: pleural space complications (chest tubes).
  • A patient with a pulmonary embolus has active bleeding and cannot take blood thinners. Which device may be placed to keep large clots from reaching the lungs? MedlinePlus Medical Encyclopedia, "Pulmonary embolus", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 2A Respiratory: pulmonary embolism.

Endocrine, blood, neuro, GI, renal 16

  • A patient has severe upper abdominal pain that spreads to the back and is worse lying flat. Which blood test is the more specific sign of acute pancreatitis? MedlinePlus Medical Encyclopedia, "Acute pancreatitis", Symptoms; Exams and Tests. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3D Gastrointestinal: pancreatitis.
  • A patient has sudden right-sided weakness and trouble speaking. Before a clot-dissolving medicine is considered, what must be done? MedlinePlus Medical Encyclopedia, "Thrombolytic therapy", Strokes. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3C Neurology: stroke.
  • A patient on antibiotics has watery diarrhea ten times a day, and the stool toxin test is positive for C difficile. Besides stopping the antibiotic that caused it, which medicines are most often used? MedlinePlus Medical Encyclopedia, "Pseudomembranous colitis", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3D Gastrointestinal: GI infections (C. difficile).
  • A patient passes very large amounts of pale, dilute urine and has intense thirst. The diagnosis is central diabetes insipidus. Which medicine is used to regulate it? MedlinePlus Medical Encyclopedia, "Diabetes insipidus", Symptoms; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3A Endocrine: diabetes insipidus.
  • A patient receiving heparin has a falling platelet count. What sets heparin-induced thrombocytopenia apart from other drug-induced low platelet counts? MedlinePlus Medical Encyclopedia, "Drug-induced thrombocytopenia", Causes; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3B Hematology/Immunology/Oncology: coagulopathies, medication induced (heparin [HIT]).
  • A patient with a partial small bowel obstruction is on bowel rest with IV fluids and a nasogastric tube to suction. What is the tube for? MedlinePlus Medical Encyclopedia, "Intestinal obstruction and Ileus", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3D Gastrointestinal: GI motility disorders (obstruction).
  • A patient with cirrhosis is confused and has a flapping tremor of the hands. Which medicine is given to lower the ammonia level? MedlinePlus Medical Encyclopedia, "Loss of brain function - liver disease", Exams and Tests; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3C Neurology: encephalopathy (hepatic).
  • A patient with cirrhosis vomits blood and has a fast heart rate and low blood pressure. Bleeding esophageal varices are suspected. Which IV medicine tightens blood vessels to help stop the bleeding? MedlinePlus Medical Encyclopedia, "Bleeding esophageal varices", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3D Gastrointestinal: GI bleed (upper).
  • A patient with kidney disease has a very high potassium level with ECG changes. Which IV treatment is aimed at the heart and muscle effects of the high potassium? MedlinePlus Medical Encyclopedia, "High potassium level", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3E Renal: electrolyte imbalances.
  • A patient with long-standing diabetes has a glucose reading of 50 mg/dL but reports no symptoms at all. What is this called? MedlinePlus Medical Encyclopedia, "Low blood sugar", Symptoms; Exams and Tests. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3A Endocrine: hypoglycemia.
  • A patient with SIADH has a low sodium level and mild confusion. What is the first step of treatment in all cases? MedlinePlus Medical Encyclopedia, "Syndrome of inappropriate antidiuretic hormone secretion", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3A Endocrine: SIADH.
  • After a recent illness a patient has weakness that began in the legs and is moving upward, with absent knee reflexes. Guillain-Barre syndrome is suspected. Which function needs the closest watch? MedlinePlus Medical Encyclopedia, "Guillain-Barre syndrome", Symptoms; Exams and Tests. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3B Hematology/Immunology/Oncology: autoimmune disorders (Guillain-Barre syndrome).
  • An 82-year-old who was clear yesterday is confused today, drifting between lethargy and agitation within hours. What does this pattern suggest? MedlinePlus Medical Encyclopedia, "Delirium", Symptoms; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3C Neurology: delirium.
  • Before a cardiac catheterization, which patients are noted as more likely to have kidney damage from the contrast dye? MedlinePlus Medical Encyclopedia, "Cardiac catheterization", Risks. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3E Renal: acute kidney injury (nephrotoxic procedures).
  • During an NIH Stroke Scale exam a patient fails an arm task, then asks to try again and does better. How is the item scored? Wikipedia, "National Institutes of Health Stroke Scale", lead section; Performing the scale. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3C Neurology: stroke (NIH Stroke Scale).
  • Two patients have very high blood glucose. Which finding points to diabetic ketoacidosis and not to hyperosmolar hyperglycemic state? MedlinePlus Medical Encyclopedia, "Diabetic ketoacidosis", Causes; Symptoms; "Diabetic hyperglycemic hyperosmolar syndrome", lead section. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 3A Endocrine: diabetic ketoacidosis; hyperosmolar hyperglycemic state.

Musculoskeletal, multisystem, psychosocial 12

  • A patient in alcohol withdrawal has a CIWA-Ar total of 18. How is this score classed? Wikipedia, "Clinical Institute Withdrawal Assessment for Alcohol", lead section. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4C Behavioral / Psychosocial: substance use disorder (withdrawal assessment tools).
  • A patient needs a central line for a long course of antibiotics. Which factor raises the risk of a central line infection? MedlinePlus Medical Encyclopedia, "Central line infections - hospitals", Preventing Central Line Infections in the Hospital; What the Hospital Should Do. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: healthcare-acquired infections (CLABSI).
  • A patient recovering from an overdose has been anxious for days. Today he is suddenly calm and is giving away his belongings. How should the nurse read this? MedlinePlus Medical Encyclopedia, "Suicide and suicidal behavior", Symptoms; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4C Behavioral / Psychosocial: psychological disorders (suicidal ideation).
  • A patient who drank heavily every day until admission is being watched for withdrawal seizures. When are these seizures most common? MedlinePlus Medical Encyclopedia, "Delirium tremens", Symptoms. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: alcohol withdrawal syndrome.
  • A patient who uses heroin daily was admitted 12 hours ago and is now agitated. Which finding points to opioid withdrawal and not to opioid intoxication? MedlinePlus Medical Encyclopedia, "Opiate and opioid withdrawal", Symptoms; "Opioid intoxication", Symptoms. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: substance withdrawal.
  • A patient with a cast on a broken lower leg has pain far greater than expected. Pain medicine and raising the leg do not ease it, and the toes are numb and pale. What does acute compartment syndrome need? MedlinePlus Medical Encyclopedia, "Compartment syndrome", Symptoms; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4A Musculoskeletal: compartment syndrome.
  • A patient with a urinary tract infection is being watched for sepsis. Which changes may be the earliest signs? MedlinePlus Medical Encyclopedia, "Sepsis", Symptoms; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: sepsis.
  • A patient with an indwelling urinary catheter has no fever, pain or confusion, but a culture of urine from the bag grows bacteria. What does this result mean? MedlinePlus Medical Encyclopedia, "Catheter-related UTI", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: healthcare-acquired infections (CAUTI).
  • A pressure injury on the buttocks is covered with yellow and tan dead tissue, so its depth cannot be seen. How is it classified? MedlinePlus Medical Encyclopedia, "How to care for pressure sores", Symptoms. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: pressure injuries.
  • After a crush injury to the leg a patient has tender muscles and cola-colored urine. Rhabdomyolysis is suspected. What is the main aim of giving fluids? MedlinePlus Medical Encyclopedia, "Rhabdomyolysis", Symptoms; Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: rhabdomyolysis.
  • Minutes after an IV antibiotic starts, a patient has hives and wheezing. Which sign warns of dangerous throat swelling? MedlinePlus Medical Encyclopedia, "Anaphylaxis", Treatment. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: shock states (anaphylactic).
  • Two patients have low blood pressure and a fast pulse. Which skin finding is listed for septic shock and not for hypovolemic shock? MedlinePlus Medical Encyclopedia, "Septic shock", Symptoms; "Hypovolemic shock", Symptoms. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 4B Multisystem: shock states.

Advocacy, caring, diversity, learning 7

  • A nurse has taught a patient how to take warfarin at home. Which statement uses the teach-back method? AHRQ, Health Literacy Universal Precautions Toolkit, Tool 5: Use the Teach-Back Method, Overview; Action, Try the teach-back method. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 5D Facilitation of Learning.
  • A patient has a living will and asks the nurse what else he might need. What can a living will not do? MedlinePlus Medical Encyclopedia, "Advance care directives", Living Wills; Other Types of Advance Directives. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 5A Advocacy / Moral Agency.
  • A patient keeping a religious fast asks to take his daily medicines after sunset. The nurse arranges with the provider to retime the doses that can safely move. Which competency is shown? AACN Certification Corporation, PCCN Exam Handbook (July 2026), AACN Synergy Model for Patient Care, Nurse Characteristics. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 5C Response to Diversity.
  • A patient with a do-not-resuscitate order develops pneumonia. The family asks whether antibiotics and pain medicine will now be stopped. What is true of a DNR order? MedlinePlus Medical Encyclopedia, "Do-not-resuscitate order", What is a DNR?; Making the Decision. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 5B Caring Practices.
  • A sedated patient's daughter says he would not have wanted the planned procedure. The nurse brings her concern to the team and asks for an ethics review. Which Synergy Model nurse competency is this? AACN Certification Corporation, PCCN Exam Handbook (July 2026), AACN Synergy Model for Patient Care, Nurse Characteristics. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 5A Advocacy / Moral Agency.
  • Before a planned heart procedure the patient tells the nurse that no one explained the other options for treatment. What should the nurse do? MedlinePlus Medical Encyclopedia, "Informed consent - adults", What is Informed Consent?; What Should Occur During the Informed Consent Process?. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 5A Advocacy / Moral Agency.
  • In the Synergy Model, caring practices aim to promote comfort and healing and to prevent unnecessary suffering. Which caring behaviors does the model name? AACN Certification Corporation, PCCN Exam Handbook (July 2026), AACN Synergy Model for Patient Care, Nurse Characteristics. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 5B Caring Practices.

Collaboration, systems, inquiry 5

  • A nurse calls about a patient whose blood pressure is falling after a heart catheterization and says, "I think he is bleeding at the groin site." Which part of SBAR is this sentence? AHRQ, TeamSTEPPS 3.0, Tool: SBAR, the four parts. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 6A Collaboration.
  • A nurse has told a provider she is concerned about a dose, that she is uncomfortable giving it, and that it is a safety issue. The issue is still not acknowledged. By the CUS tool, what comes next? AHRQ, TeamSTEPPS 3.0, Tool: CUS, the three steps. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 6A Collaboration.
  • A nurse notices that the unit's routine for reviewing urinary catheters differs from current guidance. She reviews the evidence and proposes a change in practice. Which competency is this? AACN Certification Corporation, PCCN Exam Handbook (July 2026), AACN Synergy Model for Patient Care, Nurse Characteristics. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 6C Clinical Inquiry.
  • A patient with heart failure has been readmitted three times. The nurse arranges a home scale, a follow-up call and pharmacy help with the cost of medicines, across the hospital and the clinic. Which competency is this? AACN Certification Corporation, PCCN Exam Handbook (July 2026), AACN Synergy Model for Patient Care, Nurse Characteristics. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 6B Systems Thinking.
  • According to the Synergy Model, the framework of the exam, when does synergy result? AACN Certification Corporation, PCCN Exam Handbook (July 2026), AACN Synergy Model for Patient Care, AACN Synergy Model for Patient Care. Outline: PCCN Test Plan (exams taken on and after February 6, 2024), 6B Systems Thinking.

How this list was compiled: Our own questions, written to the PCCN Test Plan of AACN Certification Corporation for exams taken on and after February 6, 2024, in the PCCN Exam Handbook, Direct Care Eligibility Pathway, July 2026 (https://www.aacn.org/-/media/aacn-website/certification/get-certified/handbooks/pccnexamhandbook.pdf, linked from https://www.aacn.org/certification/get-certified/pccn-adult, read 2026-10-12). The bank holds 12, 8, 16, 12, 7 and 5 questions under the plan's six headings, close to its weights. Every fact was read on 2026-10-12 in the public page the question names: the MedlinePlus Medical Encyclopedia of the US National Library of Medicine, AHRQ's TeamSTEPPS 3.0 tools and health literacy toolkit, the Synergy Model pages of the handbook, and two named Wikipedia articles for the stroke and alcohol withdrawal scales. Licence: Questions, choices and explanations are original work of this site.

How it works

This free PCCN practice test has 60 questions of our own on the test plan for the adult progressive care nursing exam. It is unofficial and not affiliated with the American Association of Critical-Care Nurses or AACN Certification Corporation.

Read the full guide

What the PCCN exam covers

The test plan for exams sat from February 6, 2024 onward, read October 12, 2026, gives clinical judgment 80%: cardiovascular 20, respiratory 14, multisystem 15, and the other body systems 2 to 7 each. Professional caring and ethical practice is 20%. The 60 questions follow those shares.

Pace of the timed test

The timed test here asks 50 questions in 60 minutes: a third of the real exam's questions in a third of its time.

Where the answers come from

Each answer names the public page it was checked on: the MedlinePlus Medical Encyclopedia of the US National Library of Medicine, AHRQ's TeamSTEPPS and teach-back tools, the Synergy Model pages of the exam handbook, or a Wikipedia article for the stroke and alcohol withdrawal scales.

  • The test plan lists nursing actions as well as conditions: blood gases, chest tubes, pacemakers, the NIH Stroke Scale and withdrawal scales such as CIWA.

Questions and answers

How many questions are on the PCCN exam?

150 multiple-choice questions in 3 hours, by the exam handbook of July 2026. 125 are scored. The other 25 gather statistics for future exams and do not count.

What is a passing score on the PCCN exam?

The handbook prints no number. A panel of subject matter experts sets the passing point with a method called the modified Angoff, and each candidate is measured against that standard.

Who can take the PCCN exam?

A nurse with a current, unencumbered US RN or APRN license and direct care of acutely ill adults: 1,750 hours in two years with 875 in the latest year, or 2,000 hours in five years with 144 in the latest year.

Are these real PCCN exam questions?

No. The 60 questions were written for this page from the public test plan and the public page each one names. The handbook's sample questions, the certifying body's practice exam and review books were not used.

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