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PCCN · Progressive care certification

PCCN certification for progressive care nurses

The Progressive Care Certified Nurse (PCCN) certification is the specialty credential of progressive care nursing, awarded by AACN Certification Corporation, the certification arm of the American Association of Critical-Care Nurses. It is meant for RNs and APRNs who give direct care to acutely ill adults who are moderately stable but at risk of becoming unstable, in progressive care, step-down, telemetry, intermediate care, direct observation and similar settings. It is a voluntary specialty certification (accredited by ABSNC and accepted by the Magnet Recognition Program), not a state license, and you earn it by passing one exam.

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The exam, at a glance

Questions

150 questions, 125 scored

Time

3 hours

Pass line

82 of 125 scored

Exam fee

Currently $260 member / $375 non-member

Sources: PCCN exam handbook, AACN exam statistics, AACN PCCN page. Checked October 2026. Fees, windows and pass rates change; check AACN before you apply.

Meaning

What PCCN means

The letters stand for Progressive Care Certified Nurse. AACN currently lists the credential as PCCN (Adult), and nurses who hold it write it after the degree and the license: BSN, RN, PCCN. Say it letter by letter, P-C-C-N.

A certification is not a license. Your state RN license is what lets you work a step-down unit at all; the PCCN is a national exam result that says you know that patient population. No state requires it for a progressive care or telemetry job. What it is worth on your unit is your employer's call: some pay for the exam, some list it as preferred in postings.

It is a working credential, not a rare one: 21,568 nurses held a current PCCN in AACN's 2025 figures.

Patients

Who earns it: progressive care, step-down and telemetry nurses

AACN describes the PCCN patient as acutely ill and moderately stable, with potential to become unstable; typically 1 nurse to 3 or 4 patients. That is the patient one step below the ICU: the post-PCI patient with a fresh femoral access site, the heart failure admission on IV diuretics, the COPD exacerbation on BiPAP, the DKA patient on an insulin infusion, the septic patient who just transferred down.

If your patients are critically ill and unstable most shifts, you are looking at the wrong exam; the PCCN vs CCRN comparison sorts that out in a few minutes.

Weights

Where the points are

The exam is Clinical Judgment 80% and Professional Caring and Ethical Practice 20%. Inside that 80, three areas carry most of the weight: cardiovascular 20%, multisystem 15% and respiratory 14%, together 49% of the exam. Cardiovascular alone is roughly 25 of the 125 scored items.

  1. #1CV20%

    Cardiovascular 1A

    Cardiovascular guide

  2. #2MULTI15%

    Multisystem 4B

    Drill the Multisystem chip

  3. #3RESP14%

    Respiratory 2A

    Respiratory guide

  4. #4CARE11%

    Advocacy, caring practices, diversity, teaching II-a

    Drill the Caring & advocacy chip

  5. #5SYS9%

    Collaboration, systems thinking, clinical inquiry II-b

    Drill the Collaboration & systems chip

  6. #6NEURO7%

    Neurology 3C

    Drill the Neuro & behavioral chip

  7. #7GI7%

    Gastrointestinal 3D

    Drill the Endo · GI · Renal chip

  8. #8ENDO6%

    Endocrine 3A

    Drill the Endo · GI · Renal chip

  9. #9RENAL4%

    Renal 3E

    Drill the Endo · GI · Renal chip

  10. #10HEME3%

    Hematology, immunology, oncology 3B

    Drill the Endo · GI · Renal chip

  11. #11BEHAV3%

    Behavioral and psychosocial 4C

    Drill the Neuro & behavioral chip

  12. #12MSK2%

    Musculoskeletal 4A

    Drill the Endo · GI · Renal chip

Test-plan areas ranked by weight (AACN, exams on or after February 6, 2024). Weights add to 101 because AACN rounds each area.

The pass line is 82 of the 125 scored questions. Put the other way round, you can miss 43 scored items and still pass. Spend those misses at the bottom of the grid, not at the top.

So the order is: the heavy three first; then the two caring and ethics areas (11% and 9%), with endocrine, GI, renal and neurology; hematology, behavioral health and musculoskeletal last. Musculoskeletal is roughly two or three scored items (2% of 125). The PCCN study guide turns this order into a week-by-week plan; the exam page covers format, scoring and test day.

Quick test

Start with 28 PCCN practice questions

Four items from each of the seven study domains, 28 in all, interleaved so no system runs twice in a row. Pick a chip to drill one system. The score sheet at the end names your biggest leak, weighted by what that system is worth on the exam. For the full spread, the 60-question PCCN practice test follows the test-plan weights. They are practice items written for study, not exam questions.

0 answered · 0 right

Item 01 Cardiovascular (1A)

A patient returns to the unit after catheter ablation for atrial fibrillation through the right femoral vein. Which nursing action is the PRIORITY?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, B: check groin site and distal pulses

After femoral access, the site is checked for bleeding and hematoma along with distal pulses, and the leg is kept straight for the prescribed period. Early ambulation risks bleeding, and heat promotes vasodilation and bleeding. Anticoagulation is continued around AF ablation because the procedure itself raises the risk of thromboembolism.

Your pick, A: Heat causes vasodilation and can increase bleeding at the puncture site.

Your pick, C: Anticoagulation continues around AF ablation because the procedure raises the risk of thromboembolism.

Your pick, D: Walking 30 minutes after a femoral procedure risks bleeding; bed rest is kept for the ordered time.

Item 02 Multisystem (4B)

During a respiratory pandemic surge, the unit has no more private rooms. Which placement is MOST appropriate?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, C: cohort patients with the same confirmed infection

When private rooms are unavailable, patients with the same laboratory-confirmed infection may share a room to limit spread. A patient with pending results may be uninfected and would be exposed. Immunocompromised patients must not share with infected patients. Hallway placement exposes others and prevents isolation.

Your pick, A: Hallway placement exposes others and makes isolation impossible.

Your pick, B: A neutropenic patient must never share a room with an infected patient.

Your pick, D: A patient with pending results may not be infected and would be exposed.

Item 03 Respiratory (2A)

A patient with ARDS and septic shock has pH 7.12, PaCO2 55 mm Hg, and HCO3 14 mEq/L. The nurse interprets this as

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, D: mixed respiratory and metabolic acidosis

The PaCO2 is elevated (respiratory acidosis) while the HCO3 is low (metabolic acidosis), so both processes lower the pH — a mixed acidosis. Respiratory compensation for metabolic acidosis would lower the PaCO2, not raise it. Metabolic compensation for respiratory acidosis would raise the HCO3. A low HCO3 excludes a purely respiratory disorder.

Your pick, A: A low HCO3 rules out a purely respiratory disorder.

Your pick, B: Metabolic compensation for respiratory acidosis would raise the HCO3.

Your pick, C: Respiratory compensation for metabolic acidosis would lower the PaCO2, not raise it.

Item 04 Endocrine (3A)

A 58-year-old patient admitted for cellulitis has a BMI of 36, polyuria, and thirst. Fasting glucose is 164 mg/dL on two mornings, HbA1c is 8.1%, and urine ketones are negative. Which condition is MOST LIKELY?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, B: type 2 diabetes mellitus

Obesity, middle age, repeated fasting hyperglycemia, an HbA1c of 6.5% or higher, and absent ketones point to type 2 diabetes driven by insulin resistance. Type 1 diabetes usually presents with ketosis from absolute insulin deficiency. Diabetes insipidus causes polyuria without hyperglycemia. Stress hyperglycemia from acute illness would not raise the HbA1c, which reflects roughly 3 months of glycemia.

Your pick, A: Stress hyperglycemia would not raise the HbA1c, which reflects about 3 months of glucose.

Your pick, C: Diabetes insipidus causes polyuria without hyperglycemia.

Your pick, D: Type 1 diabetes usually presents with ketosis from absolute insulin deficiency.

Item 05 Advocacy, caring practices, diversity, teaching (II-a)

The family of a patient with refractory heart failure and repeated admissions asks for a palliative care consultation. The attending declines, saying the patient is "not dying yet." The nurse's BEST action is to

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, C: share the family's goals with the attending and escalate if needed

Palliative care is appropriate at any stage of serious illness alongside disease treatment, so the nurse advocates by conveying the family's goals and the benefit of a consult, escalating through the chain of command if needed. Telling the family it is only for the final days repeats the attending's misconception. Hospice is a different service requiring a limited prognosis and forgoing disease treatment, and documenting without advocating leaves the need unmet.

Your pick, A: Documenting without advocating leaves the family's need unmet.

Your pick, B: Hospice is a different service that requires a limited prognosis.

Your pick, D: This repeats the attending's misconception about palliative care.

Item 06 Neurology (3C)

A patient with an acute ischemic stroke did not receive thrombolysis and has passed a swallow screen. Which medication should the nurse anticipate within 48 hours of onset?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, A: aspirin

Aspirin started within 24–48 hours reduces early recurrent stroke in patients who do not receive thrombolysis. Urgent full anticoagulation with heparin or warfarin increases hemorrhagic transformation without reducing early recurrence, even when atrial fibrillation is present. Nimodipine is used for subarachnoid hemorrhage, not ischemic stroke.

Your pick, B: Early warfarin also raises the risk of hemorrhagic transformation.

Your pick, C: Nimodipine is used for subarachnoid hemorrhage, not ischemic stroke.

Your pick, D: Urgent heparin raises the risk of hemorrhagic transformation without reducing early recurrence.

Item 07 Collaboration, systems thinking, clinical inquiry (II-b)

A telemetry unit starts an early mobility protocol to shorten length of stay. Which metric is the MOST appropriate balancing measure?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, B: rate of patient falls during ambulation

A balancing measure watches for unintended harm created by a change, and more frequent ambulation of telemetry patients can increase falls. Average length of stay is the outcome the protocol is trying to improve. The percentage of patients walked before noon and the number of physical therapy consults track whether the protocol is being carried out, so they are process measures.

Your pick, A: Length of stay is the outcome the protocol is trying to improve.

Your pick, C: Walking before noon tracks whether the protocol is followed, which makes it a process measure.

Your pick, D: PT consult counts are also a process measure, not a balancing one.

Item 08 Cardiovascular (1A)

Two hours after CABG, a patient's temperature is 34.8 °C, chest tube drainage is 180 mL/h, and there is oozing from line sites. The ACT and platelet count are normal. Which intervention is MOST appropriate?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, A: Actively rewarm the patient

Hypothermia slows the clotting enzymes and impairs platelet function even when laboratory values, which are run at 37 °C, look normal, so active rewarming to at least 36 °C is a first step in managing postoperative bleeding. Protamine is not needed with a normal ACT, and platelets are not given empirically with a normal count. Re-exploration is considered if bleeding persists after correction or exceeds surgical thresholds.

Your pick, B: Platelets are not given empirically when the count is normal.

Your pick, C: Re-exploration is considered if bleeding continues after hypothermia is corrected.

Your pick, D: A normal ACT means there is no residual heparin for protamine to reverse.

Item 09 Multisystem (4B)

On postoperative day 2 after hip arthroplasty, a patient receiving enoxaparin prophylaxis reports new flank and abdominal discomfort. Hemoglobin has fallen from 11.2 to 7.3 g/dL, HR 112, BP 102/64, lactate 2.8 mmol/L. The nurse should FIRST

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, D: notify the provider of suspected hemorrhage

A falling hemoglobin, rising lactate, tachycardia, and new flank pain in an anticoagulated postoperative patient suggest retroperitoneal or surgical-site hemorrhage, requiring urgent provider notification for imaging, transfusion, and holding anticoagulation. Giving enoxaparin would worsen the bleeding. Waiting 4 hours allows further blood loss, and oral fluids with ambulation do not address shock.

Your pick, A: Waiting 4 hours allows more blood loss.

Your pick, B: Giving enoxaparin now would make the bleeding worse.

Your pick, C: Oral fluids and walking do nothing for evolving hemorrhagic shock.

Item 10 Respiratory (2A)

A patient with pneumonia has temperature 38.9 °C, HR 118, RR 26, BP 88/50, and lactate 4.1 mmol/L. Blood cultures have been drawn. Regarding antibiotics, the nurse should

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, D: give antibiotics within 1 hour after cultures

Hypotension with a lactate of 4 mmol/L in suspected infection indicates probable septic shock, and broad-spectrum antimicrobials should be given within 1 hour of recognition, alongside crystalloid resuscitation. Waiting for sputum cultures delays life-saving therapy. Fluids and antibiotics are given in parallel, not sequentially. Treatment should not wait for a repeat lactate.

Your pick, A: Waiting for sputum culture results delays life-saving treatment.

Your pick, B: Treatment should not wait 6 hours for a repeat lactate.

Your pick, C: Fluids and antibiotics are given in parallel, not one after the other.

Item 11 Hematology, immunology, oncology (3B)

A patient with multiple myeloma and bone pain has a creatinine of 1.6 mg/dL. Which order should the nurse question?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, D: Ibuprofen 800 mg every 8 hours

Myeloma light chains already injure the kidneys, and NSAIDs reduce renal blood flow and can precipitate acute kidney injury, so they are avoided. Opioids are appropriate for myeloma bone pain. Generous hydration protects the kidneys, and bisphosphonates reduce bone destruction, with the dose adjusted for renal function.

Your pick, A: Generous hydration protects the kidneys in myeloma.

Your pick, B: Opioids are appropriate for myeloma bone pain.

Your pick, C: Bisphosphonates reduce bone destruction; the dose is adjusted for renal function.

Item 12 Advocacy, caring practices, diversity, teaching (II-a)

A patient with metastatic cancer who prefers comfort-focused care is admitted with sepsis that is now responding to antibiotics. The family asks about hospice. The nurse's BEST action is to

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, D: request a palliative care consult to clarify the goals of care

Palliative care can clarify goals now, including whether finishing antibiotics serves comfort, and plan a hospice transition that matches the patient's wishes. Stopping antibiotics abruptly before goals are clarified may cause suffering from recurrent infection. Deferring the discussion delays needed planning, and ICU transfer conflicts with the patient's stated preference.

Your pick, A: Stopping antibiotics before goals are clarified may cause suffering from recurrent infection.

Your pick, B: Deferring the discussion delays planning the patient needs.

Your pick, C: ICU transfer conflicts with the patient's comfort-focused preference.

Item 13 Neurology (3C)

A patient with cerebral edema and signs of impending herniation has BP 88/52 and HR 118. The provider orders hyperosmolar therapy. Which agent is MOST appropriate?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, A: 3% hypertonic saline bolus

Hypertonic saline reduces brain edema while expanding intravascular volume, supporting BP and cerebral perfusion. Mannitol causes osmotic diuresis that can worsen hypotension. Hypotonic 0.45% saline increases brain edema. Furosemide lowers volume and BP without an adequate osmotic effect.

Your pick, B: Hypotonic 0.45% saline increases brain edema.

Your pick, C: Furosemide lowers volume and BP without a useful osmotic effect.

Your pick, D: Mannitol's osmotic diuresis can make the hypotension worse.

Item 14 Collaboration, systems thinking, clinical inquiry (II-b)

A patient with cardiogenic shock is being transferred from the progressive care unit to the ICU. Which handoff statement BEST conveys priority information?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, C: SBP fell from 104 to 82 over 3 hours; repeat lactate pending

Transfer handoff should lead with recent trends and pending results the receiving team must act on, such as a falling blood pressure and a lactate awaiting follow-up. The admission history is useful background but does not tell the ICU team what is changing now. Family contact preferences and home medications are appropriate to pass on but do not drive immediate care in cardiogenic shock.

Your pick, A: Home medications are worth passing on but do not drive immediate care in shock.

Your pick, B: Admission history is useful background but does not show what is changing now.

Your pick, D: Family contact preferences are worth passing on but do not drive immediate care.

Item 15 Cardiovascular (1A)

A 75 kg patient is on a heparin infusion (25,000 units in 250 mL) at 12 units/kg/h. Per protocol, the rate is increased by 3 units/kg/h. What is the new pump rate?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, A: 11.25 mL/h

The new dose is 12 + 3 = 15 units/kg/h × 75 kg = 1,125 units/h; at 100 units/mL (25,000 ÷ 250), the rate is 11.25 mL/h. A rate of 2.25 mL/h programs only the increase, 9 mL/h is the old rate that the increase was never added to, and 112.5 mL/h is a tenfold error in the concentration.

Your pick, B: 2.25 mL/h is only the increase, not the new total rate.

Your pick, C: 112.5 mL/h is a tenfold error in the concentration.

Your pick, D: 9 mL/h is the old rate with the increase not added.

Item 16 Multisystem (4B)

The nurse plans to walk a patient recovering from septic shock. Which finding is a reason to HOLD progressive mobility today?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, C: norepinephrine dose increased 2 hours ago

An escalating vasopressor requirement signals hemodynamic instability, so mobility is held until stable. A resting heart rate below about 120, SpO2 of at least 90% on modest oxygen, and lines or catheters are not barriers to early mobility.

Your pick, A: SpO2 93% on modest oxygen is acceptable for mobility.

Your pick, B: A urinary catheter is not a barrier to walking.

Your pick, D: A resting HR of 96 is within the usual range for early mobility.

Item 17 Respiratory (2A)

A patient with pulmonary sarcoidosis develops new confusion, polyuria, and constipation. Which laboratory value should the nurse check FIRST?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, B: serum calcium

Granulomas in sarcoidosis produce active vitamin D, which increases calcium absorption and causes hypercalcemia, presenting as confusion, polyuria and constipation. Sodium disorders cause confusion but not constipation, and polyuria with hyponatremia would be unusual. Magnesium and phosphate abnormalities do not produce this pattern of symptoms.

Your pick, A: Magnesium disorders do not produce this pattern of symptoms.

Your pick, C: Phosphate disorders do not produce this pattern of symptoms.

Your pick, D: Sodium disorders cause confusion but not constipation, and polyuria is unusual with low sodium.

Item 18 Gastrointestinal (3D)

A patient receiving antibiotics and continuous tube feeding has 5 liquid stools a day. Which action should the nurse take FIRST?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, A: test the stool for C. difficile

New diarrhea in a patient on antibiotics must be tested for C. difficile first, and liquid medications containing sorbitol are also reviewed. Stopping feeding or switching to parenteral nutrition is rarely necessary and loses the benefits of enteral nutrition. Antidiarrheals are withheld until C. difficile is excluded because they can precipitate toxic megacolon.

Your pick, B: Stopping the feeding is rarely needed and loses the benefits of enteral nutrition.

Your pick, C: Parenteral nutrition is rarely needed and loses the benefits of enteral feeding.

Your pick, D: Antidiarrheals are withheld until C. difficile is ruled out because they can cause toxic megacolon.

Item 19 Advocacy, caring practices, diversity, teaching (II-a)

A patient with COPD who lives in a rural area with frequent power outages is being discharged on continuous home oxygen by concentrator. Which discharge action is MOST important?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, A: Arrange backup oxygen cylinders from the supplier

A concentrator stops when the power fails, so backup compressed-gas cylinders are the standard safeguard, along with registering with the utility as a medical-needs household. Portable concentrator batteries last only hours and need electricity to recharge. Lowering the flow risks hypoxemia, and driving during outages in a rural area may be unsafe or impossible.

Your pick, B: Lowering the flow risks hypoxemia.

Your pick, C: Portable concentrator batteries last only hours and need power to recharge.

Your pick, D: Driving to the hospital in a rural outage may be unsafe or impossible.

Item 20 Neurology (3C)

A patient with systemic lupus erythematosus on high-dose prednisone becomes acutely confused and has a new-onset generalized seizure. After seizure precautions, the nurse should anticipate

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, B: brain imaging and cerebrospinal fluid analysis

New seizure and confusion in SLE may reflect neuropsychiatric lupus, CNS infection in an immunosuppressed host, or stroke, so imaging and CSF analysis are needed. Stopping prednisone abruptly risks adrenal crisis and a lupus flare. A psychiatric referral misses organic causes. Symptomatic comfort measures ignore a potentially life-threatening process.

Your pick, A: A psychiatric referral misses the organic causes that must be ruled out.

Your pick, C: Stopping high-dose prednisone abruptly risks adrenal crisis and a lupus flare.

Your pick, D: Comfort measures ignore a possibly life-threatening process.

Item 21 Collaboration, systems thinking, clinical inquiry (II-b)

A nurse calls the provider because a patient's SpO2 has dropped from 95% to 84% on 2 L nasal cannula with new crackles. Which statement is the MOST effective SBAR recommendation?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, B: "I need you to see the patient at the bedside now."

The recommendation states exactly what the nurse needs and when, a bedside evaluation now, leaving no ambiguity. Voicing concern is a useful escalation phrase but is not itself a request for action. An open question hands the decision back without a clear ask, and noting that respiratory therapy was notified is background, not a recommendation.

Your pick, A: Noting that RT was notified is background, not a recommendation.

Your pick, C: Voicing concern is useful but is not a request for action.

Your pick, D: An open question hands the decision back without a clear ask.

Item 22 Cardiovascular (1A)

A patient with a new bundle branch block is at risk for wide-complex tachycardia. Which single monitoring lead is BEST for differentiating bundle branch blocks and wide-QRS rhythms?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, C: Lead V1

Lead V1 sits over the right ventricle and septum, so it shows the direction of ventricular activation; this distinguishes right from left bundle branch block and helps separate ventricular tachycardia from aberrant conduction. Lead II is best for seeing P waves and atrial rhythms, which is why it is the common default. Leads III and aVF view the inferior wall and are used for ST-segment monitoring in inferior ischemia.

Your pick, A: aVF also views the inferior wall and does not separate bundle branch blocks well.

Your pick, B: Lead III views the inferior wall and is used for inferior ST monitoring.

Your pick, D: Lead II is best for P waves and atrial rhythms, not for bundle branch morphology.

Item 23 Multisystem (4B)

During bedside central line insertion, the nurse sees the provider's sterile gown sleeve touch the nonsterile bed rail. The nurse's BEST action is to

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, D: stop the procedure and replace the sleeve

The CLABSI insertion bundle empowers the nurse to stop the procedure when sterile technique is broken, so the contaminated gown sleeve is replaced before continuing. Documenting or reporting afterward allows a contaminated line to be placed. Prophylactic antibiotics are not recommended and do not substitute for aseptic insertion.

Your pick, A: Documenting afterward lets a contaminated line go in.

Your pick, B: Prophylactic antibiotics are not recommended and do not replace aseptic technique.

Your pick, C: Reporting afterward does not prevent the contamination.

Item 24 Respiratory (2A)

A patient with thick secretions develops dyspnea. Chest x-ray shows opacification of the right upper lobe with the trachea and mediastinum shifted TOWARD the right. The MOST likely cause is

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, D: right upper lobe atelectasis

Mucus plugging causes resorption atelectasis, and the volume loss pulls the trachea and mediastinum toward the affected side. A tension pneumothorax and a large pleural effusion add volume to the hemithorax and push the mediastinum away. Lobar pneumonia causes consolidation without volume loss, so the mediastinum stays midline.

Your pick, A: A large effusion adds volume and pushes the mediastinum away.

Your pick, B: Lobar pneumonia consolidates without volume loss, so the trachea stays midline.

Your pick, C: A tension pneumothorax pushes the trachea away from the affected side.

Item 25 Renal (3E)

A patient who has just started maintenance hemodialysis asks about protein in the diet. Which response by the nurse is BEST?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, B: "Your protein needs increase once you are on dialysis."

Dialysis removes amino acids and protein, and patients on maintenance hemodialysis need about 1.0 to 1.2 g/kg/day to prevent malnutrition. Protein restriction applies to some patients with CKD before dialysis, not after it starts. High-quality animal protein is encouraged, and protein intake does matter because malnutrition increases mortality.

Your pick, A: Protein intake matters, because malnutrition raises mortality on dialysis.

Your pick, C: High-quality animal protein is encouraged on dialysis.

Your pick, D: Protein restriction applies to some patients before dialysis, not after it starts.

Item 26 Advocacy, caring practices, diversity, teaching (II-a)

An older adult with low vision is being discharged on warfarin with INR monitoring. Which teaching strategy BEST supports safe self-management?

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, C: Large-print materials with teach-back of bleeding signs

Large-print materials adapt the teaching to low vision, and teach-back confirms the patient can recognize bleeding, the key safety issue with warfarin. Teaching a family member instead bypasses the patient's own ability to self-manage. Standard print is unreadable for a patient with low vision, and a smartphone app assumes visual and technology access that has not been assessed.

Your pick, A: Standard print is unreadable for a patient with low vision.

Your pick, B: An app assumes visual and technology access that has not been assessed.

Your pick, D: Teaching a family member instead bypasses the patient's own self-management.

Item 27 Behavioral and psychosocial (4C)

Before cardiac catheterization, a patient says, 'I'm scared something will go wrong.' The nurse's BEST response is

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, A: "Tell me what worries you most about it."

An open invitation to describe specific fears lets the nurse correct misconceptions and target teaching. False reassurance, whether about the procedure or the cardiologist, dismisses the concern and ends the conversation, and a 'why' question can feel judgmental and put the patient on the defensive.

Your pick, B: Pointing to the cardiologist's experience is also false reassurance.

Your pick, C: False reassurance dismisses the concern and ends the conversation.

Your pick, D: A 'why' question can feel judgmental and make the patient defensive.

Item 28 Collaboration, systems thinking, clinical inquiry (II-b)

Over 3 hours, a telemetry patient's HR rose from 108 to 122, RR from 18 to 22, and SpO2 fell from 96% to 94% on room air. BP is 124/76, and the patient is alert. The nurse's BEST action is to

Tick one box. The rationale is written here once you answer.

Right.Not the keyed answer.

Keyed answer, C: report the trend to the provider now

A steady rise in heart rate and respiratory rate with a slowly falling SpO2 is an early deterioration pattern even while blood pressure is normal, so the provider should be told now so the cause can be found. Continuing hourly checks because blood pressure is stable misses that hypotension is a late sign. Waiting for scheduled rounds delays evaluation of an active trend. Oxygen is not indicated at SpO2 94%, and a 2-hour recheck postpones escalation.

Your pick, A: Hypotension is a late sign, so a stable BP is no reason to wait.

Your pick, B: Oxygen is not needed at 94%, and a 2-hour recheck postpones escalation.

Your pick, D: Waiting for rounds delays evaluation of an active trend.

Score sheet

You answered 0 and got 0 right.

Answer a few items and the sheet ranks your weakest system by points lost.

For scale: the real exam pass line is 82 of the 125 scored questions. This set is practice, not a calibrated score.

Keys: 1 to 4 tick an answer, the arrow keys move between items.

4 steps

How to earn PCCN certification in four steps

  1. Check your license and hours

    You need a current, unencumbered U.S. RN or APRN license and one of two hour routes: 1,750 hours of direct care of acutely ill adults in the previous 2 years, with 875 of them in the most recent year, or at least 2,000 hours of direct care of acutely ill adults in the previous 5 years, with 144 of them in the most recent year. You also name a supervisor or an RN or physician colleague who can verify your hours if AACN audits the application. Eligibility, hour by hour.

  2. Apply to AACN Certification Corporation

    The exam fee is currently $260 for AACN members and $375 for non-members (checked October 2026; AACN can change fees without notice); ask about group (10 or more) and employer voucher discounts before you pay. Online applications are usually processed the same day; paper ones take 2 to 4 weeks. On timing: normally 90 days to test after approval, and AACN is currently allowing 180 days (checked October 2026). Apply through AACN’s PCCN (Adult) page.

  3. Sit the exam with PSI

    You test at a PSI test center or by PSI live remote proctoring: 150 multiple-choice questions, 125 scored and 25 unscored, in 3 hours. You get a result on screen right after the exam, and a detailed score report by email within 24 hours. If it goes wrong, AACN allows up to 4 attempts at the same exam in a rolling 12-month period. How the exam works.

  4. Renew every three years

    The credential is valid for 3 years, counted from the first day of the month you pass. Renewal needs 432 hours of direct care of acutely ill adults in the 3-year period, 144 of them in the final 12 months, plus either continuing education or a retake of the exam, with a 90-day grace period. Renewal in detail.

Which exam

PCCN or CCRN?

Same association, different patient. PCCN patients are acutely ill and moderately stable, with potential to become unstable; typically 1 nurse to 3 or 4 patients; CCRN patients are critically ill and unstable; typically 1 nurse to 1 or 2 patients. If most of your assignments look like the first, book the PCCN. Nurses who float between a step-down unit and the ICU should read the side-by-side PCCN vs CCRN page before they apply.

Keep going on your phone

The app carries our full PCCN practice bank with a rationale on every item, so the heaviest systems keep getting worked after you close this page.

Get the PCCN appPractice free on this site

Routes

Where to go next

If you wantGo to
The exact hours, the license rule and renewalCertification requirements
Format, scoring, fees and test dayThe exam, in detail
Sixty questions weighted like the examPractice test
A study order by pointsStudy guide
The heaviest area (20%)Cardiovascular guide
The third-heaviest area (14%)Respiratory guide
Which of the two exams is yoursPCCN vs CCRN
Who writes this site and howAbout Brain Sheet

Guides for multisystem, neurology and behavioral health, endocrine-GI-renal and the two caring and ethics areas are planned. Until they exist, drill those chips in the practice test.

FAQ

Questions nurses ask

What does PCCN stand for?

Progressive Care Certified Nurse (PCCN). AACN currently lists it as PCCN (Adult).

What is a PCCN nurse?

A registered nurse, or an APRN, who has passed the PCCN exam and keeps the credential current. Most work progressive care, step-down, telemetry or intermediate care, with acutely ill adults who could become unstable.

How do you get your PCCN?

Meet the hours (1,750 hours of direct care of acutely ill adults in the previous 2 years, with 875 of them in the most recent year, or the 5-year route), apply online, then pass the exam with PSI. The requirements page has the detail.

What is the difference between a certified nurse and an RN?

The RN is a state license and the legal permission to practice. Certification is voluntary: a national exam that shows specialty knowledge on top of the license. You need the license first; the PCCN never replaces it.

Is PCCN certification worth it?

For a nurse who plans to stay in progressive care, usually yes: it is accredited, Magnet hospitals count it, and some employers pay for the exam or add a differential. Ask your unit what it pays before you book.

How hard is the PCCN exam?

70.1% of first-time candidates passed in 2025 (3,321 tested), after 68.2% in 2024 and 70.3% in 2023. So roughly three in ten first-timers fail. The three heavy systems hold about half the scored items, so that is where a miss costs most.

What does PCCN-K stand for?

It stood for the knowledge-professional PCCN, and there is no separate PCCN-K any more. Since November 2023 AACN awards the same PCCN through two pathways: Direct Care, and Knowledge Professional for nurses who influence the care of acutely ill adults without mainly giving direct care, such as educators and managers. The exam is the same; only the eligibility rules differ. The hour rules on this site are the Direct Care ones.

What study materials are there for the PCCN?

AACN sells its own practice exam; no prep product is required. Review books, courses and question banks are sold by others. The PCCN study guide sorts them and sets a study order by exam weight.

Next

Sixty more questions, weighted like the exam

The practice test carries the full test-plan spread, from cardiovascular down to musculoskeletal, and its score sheet ranks your weakest system by the points it costs.

Get the PCCN appPractice free on this site