ICU Basics

Test plan

PCCN Test Plan: Percentages and Study Priorities

By ·

The PCCN test plan gives 80% of scored questions to clinical judgment and 20% to Professional Caring and Ethical Practice, and the biggest clinical areas are cardiovascular (20%), multisystem (15%) and respiratory (14%). Those three plus professional caring make up about 69% of the exam, so they are where to start.

This post ranks the areas by weight, explains how progressive care questions differ from ICU-level questions, and turns the percentages into study priorities. Format, eligibility and test-day rules are in the full exam guide, linked at the end.

PCCN test plan percentages, ranked by weight

The current plan applies to exams taken on or after February 6, 2024. The exam has 150 questions in 3 hours: 125 scored and 25 unscored pretest questions. The passing score is 82 of the 125 scored questions.

AACN PCCN test plan, exams on or after February 6, 2024. The clinical subareas total 81% because AACN rounds each one; the clinical judgment total is 80%. Item counts are shares of 125, rounded.
RankContent areaShareAbout this many scored items
1Cardiovascular20%25
1Professional Caring and Ethical Practice20%25
3Multisystem15%19
4Respiratory14%17 to 18
5Neurology7%9
5Gastrointestinal7%9
7Endocrine6%7 to 8
8Renal4%5
9Hematology, Immunology, Oncology3%4
9Behavioral and Psychosocial3%4
11Musculoskeletal2%2 to 3

The five smaller systems (endocrine, hematology, neurology, GI and renal) add up to 27%, more than cardiovascular on its own. They are worth studying, but as a group: no single one of them is worth more than 9 questions.

How the PCCN differs from the CCRN

Both exams come from AACN, use the same 80/20 split and the same Synergy Model, and have 150 questions. The difference is the patient. PCCN eligibility counts hours caring for acutely ill adults in settings such as step-down, intermediate care, telemetry, direct observation, transitional care and the emergency department. The CCRN is for critically ill patients.

Current AACN test plans. CCRN groups the body systems differently, so the "other systems" row is the remainder of clinical judgment.
AreaPCCNCCRN (Adult)
Cardiovascular20%13%
Respiratory14%12%
Multisystem15%16%
Other body systems combined31%39%
Professional Caring and Ethical Practice20%20%

In practice, PCCN questions tend to sit one step earlier in the patient's course. Instead of managing the ventilator, you decide whether BiPAP is working. Instead of titrating several vasopressors, you notice the patient whose blood pressure is drifting after a procedure. Typical PCCN testable actions include QTc and ST-segment monitoring, care after sheath removal, chest tubes, BiPAP, insulin infusions, NIHSS stroke scoring, delirium screening with the CAM and alcohol withdrawal scoring with the CIWA.

Highest-yield study priorities by weight

  1. Cardiovascular (20%): rhythms on telemetry, ACS and post-PCI care, heart failure, hypertensive crises, and complications after sheath removal.
  2. Professional Caring and Ethical Practice (20%): do a short set every study day. Learn the patterns: escalate unsafe situations, fix systems rather than work around them, use interpreters and teach-back.
  3. Multisystem (15%): sepsis and early shock, acid-base and electrolytes, pain and sedation, end-of-life care, and deterioration that crosses systems.
  4. Respiratory (14%): COPD and asthma exacerbations, noninvasive ventilation, pneumonia, pulmonary embolism and chest tubes.
  5. The 27% group: study by the problem that brings a patient to step-down, such as DKA, GI bleeding, stroke after thrombolysis, acute kidney injury and neuromuscular weakness.
  6. The small areas last: behavioral, hematology and musculoskeletal are about 10 questions combined.

Take a baseline mock exam first. Then put your hours where a big area and a low baseline score overlap. A 20% area where you score 55% costs you more points than a 4% area where you score 40%.

Sample questions: spotting the patient who is getting worse

Both questions come from the ICU Basics PCCN bank and show the progressive care skill the test plan rewards: reading a trend and acting before the patient crashes.

Question 1 · Cardiovascular

Two hours after a femoral arterial sheath is removed following PCI, a patient reports new back and flank pain. BP has fallen from 128/76 to 96/58 mm Hg and HR is 112. The groin site is soft with no visible hematoma. Which complication should the nurse suspect FIRST?

  1. Retroperitoneal hemorrhage
  2. Femoral pseudoaneurysm
  3. Contrast-induced nephropathy
  4. Vasovagal reaction to sheath removal
Show the answer and rationale

Answer: A

  • A. Correct. Back or flank pain with hypotension and tachycardia after femoral access, with a clean groin, is retroperitoneal bleeding until proven otherwise.
  • B. A pseudoaneurysm causes a pulsatile, often tender groin mass with a bruit, not flank pain with shock.
  • C. Contrast nephropathy raises creatinine over 24 to 72 hours and does not cause acute pain or hypotension.
  • D. Vasovagal reactions occur during or immediately after removal with bradycardia, not tachycardia, and resolve quickly.

Retroperitoneal hemorrhage is a hidden bleed behind the peritoneum from a high femoral puncture. Blood collects where it cannot be seen, so the groin looks normal while the patient develops back, flank, or abdominal pain, tachycardia, and hypotension. The nurse should hold anticoagulants, obtain a stat CBC and type and screen, start fluids, and notify the interventionalist for CT.

Sources: AACN Essentials of Progressive Care, 5th ed.; AACN Core Curriculum, 8th ed.

Question 2 · Endocrine, Heme, Neuro, GI, Renal

A patient with Guillain-Barré syndrome has been on the progressive care unit for 2 days. Vital capacity has decreased from 2.4 L to 1.1 L, and negative inspiratory force is -22 cm H₂O. Which action is MOST appropriate?

  1. Encourage coughing and deep breathing and recheck the values in 4 hours
  2. Notify the provider for transfer and possible airway support
  3. Start incentive spirometry every hour while awake and record the volumes
  4. Apply 2 L oxygen and continue serial measurements every 4 hours
Show the answer and rationale

Answer: B

  • A. Weak respiratory muscles cannot generate an effective cough; this does not address the risk.
  • B. Correct. A vital capacity below 20 mL/kg or a rapidly falling trend with a NIF weaker than -30 cm H₂O predicts respiratory failure.
  • C. Spirometry does not reverse neuromuscular weakness and may exhaust the patient.
  • D. Oxygen does not address weak ventilation, and the trend already meets criteria for escalation.

Ascending paralysis in GBS can involve the diaphragm. Bedside spirometry (vital capacity, NIF) is monitored every 2 to 4 hours, and the trend matters more than a single value. The 20/30/40 rule (VC under 20 mL/kg, NIF weaker than -30 cm H₂O, or maximal expiratory pressure under 40 cm H₂O), or a fall of more than 30% in any of these, signals impending failure. Autonomic instability and dysphagia are also monitored.

Sources: Bradley & Daroff's Neurology, 8th ed.; AACN Core Curriculum, 8th ed.

Walk-through for the sheath question: new back or flank pain plus falling blood pressure and rising heart rate after femoral access means bleeding until proven otherwise. A soft groin with no hematoma does not rule it out, because a retroperitoneal bleed collects out of sight. The other options do not fit the whole picture: none of them explains back pain together with a falling pressure and a rising heart rate. The patient needs anticoagulation reviewed, labs and an urgent call to the interventional team.

Walk-through for the Guillain-Barré question: vital capacity has fallen by more than half in two days and the inspiratory force is weak. That trend signals respiratory muscle failure on the way, which is a reason for ICU-level care. Incentive spirometry, oxygen or more coughing all keep the patient on the unit while the muscles weaken, and rechecking in 4 hours loses time. Calling the provider for transfer is the safe answer.

Frequently asked questions

How many questions are on the PCCN exam?

The PCCN has 150 questions in 3 hours. 125 are scored and 25 are unscored pretest questions.

What is the passing score for the PCCN?

AACN lists 82 of the 125 scored questions, effective January 31, 2024. It is a raw count, not a percentage.

What is the largest section of the PCCN?

Cardiovascular and Professional Caring and Ethical Practice are tied at 20% each. Multisystem (15%) and respiratory (14%) come next.

Should I take the PCCN or the CCRN?

It depends on your patients. The PCCN counts hours with acutely ill adults in settings such as step-down and telemetry; the CCRN requires most hours with critically ill patients.

Practice free in your browser3,800+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.

Sources

  1. AACN Newsroom. Revised PCCN Certification Exam Launches Feb. 6, 2024. Link
  2. AACN. 2022 National Practice Analysis of Progressive Care Nurses. Link
  3. AACN. Frequently Asked Questions About PCCN Certification. Link
  4. AACN. PCCN (Adult) – Direct Care Pathway. Link
  5. AACN. Certification Exam Statistics and Cut Scores. Link
  6. AACN. CCRN (Adult) – Direct Care Pathway. Link
  7. Attachaipanich T, Khawaja M, Takahashi EA, et al. Percutaneous coronary intervention and vascular access complications: a contemporary review. npj Cardiovasc Health. 2026;3:23. Link
  8. Tai WA, Wu CH, Ling K, et al. Iatrogenic retroperitoneal hematoma as an access-site complication of neurointervention. J Chin Med Assoc. 2022;85(7):774-781. Link
  9. Shang P, Feng J, Wu W, Zhang HL. Intensive care and treatment of severe Guillain-Barré syndrome. Front Pharmacol. 2021;12:608130. Link