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CLN500: Critical Care / ICU – Questions with
Correct Answers Comprehensive Nursing
Exam Guide
Total Questions: 60
Format: Multiple choice (45) + select all that apply (5) + clinical scenarios (10)
Target Level: Undergraduate (BSN) / Graduate (MSN) bridge
Focus: Hemodynamics, mechanical ventilation, shock, sepsis, ARDS, arrhythmias, neurology,
sedation, renal replacement therapy, and emergency critical care interventions.
DOMAIN I: HEMODYNAMIC MONITORING & ASSESSMENT (8 questions)
Q1. A patient with septic shock has an arterial line (A-line) and a pulmonary artery catheter
(PAC). Which hemodynamic profile is consistent with early (warm) septic shock?
A. High cardiac output (CO), low systemic vascular resistance (SVR)
B. Low cardiac output, high SVR
C. Low cardiac output, low SVR
D. High cardiac output, high SVR
Correct Answer: A
Rationale: Early septic shock is hyperdynamic: increased CO (compensatory), decreased SVR
(vasodilation). Late septic shock (decompensated) may have low CO with low SVR.
Q2. The nurse obtains the following hemodynamic values for a patient:
• Cardiac output (CO) = 3.2 L/min
• Central venous pressure (CVP) = 2 mmHg
• Pulmonary artery wedge pressure (PAWP) = 4 mmHg
• Systemic vascular resistance (SVR) = 1800 dynes·sec/cm⁵
The nurse interprets these findings as consistent with:
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock (septic)
D. Obstructive shock
Correct Answer: B
Rationale: Low CO, low CVP, low PAWP, high SVR indicate hypovolemia. Cardiogenic shock (A)
,2
would have high CVP/PAWP; distributive (C) low SVR; obstructive (D) high CVP/PAWP with low
CO (e.g., tamponade, PE).
Q3. A patient with a pulmonary artery catheter has a PAWP of 22 mmHg (normal 4-12). The
nurse assesses jugular vein distention, crackles in both lungs, and an S3 gallop. The priority
intervention is:
A. Administer furosemide (Lasix) IV
B. Increase IV fluid rate
C. Start norepinephrine infusion
D. Position patient supine
Correct Answer: A
Rationale: Elevated PAWP indicates left ventricular failure/fluid overload. Furosemide reduces
preload. IV fluids (B) would worsen; norepinephrine (C) for hypotension; supine (D) may worsen
orthopnea.
Q4. The nurse is caring for a patient with a radial arterial line. Which finding indicates the need
to replace the transducer system?
A. Damped waveform with loss of dicrotic notch
B. Square wave test shows one overshoot then rapid return to baseline
C. Mean arterial pressure (MAP) of 70 mmHg
D. Systolic pressure 10 mmHg higher than non-invasive cuff
Correct Answer: A
Rationale: Damped waveform with loss of dicrotic notch indicates air bubbles, clot, or kinked
tubing. Square wave test (B) normal; MAP 70 acceptable; A-line always reads slightly higher
than cuff (D).
Q5. A patient’s central venous pressure (CVP) is 18 mmHg (normal 2-6). The nurse should assess
for:
A. Hypovolemia
B. Right ventricular failure or fluid overload
C. Left ventricular failure
D. Arterial vasodilation
Correct Answer: B
Rationale: Elevated CVP indicates increased right atrial pressure – right heart failure, fluid
, 3
overload, or pulmonary hypertension. Hypovolemia (A) causes low CVP; left heart failure (C)
elevates PAWP, not CVP initially.
Q6. A patient with cardiogenic shock has the following values: CO 2.1 L/min, CVP 14 mmHg,
PAWP 20 mmHg, SVR 1600 dynes·sec/cm⁵. The nurse expects the provider to order:
A. Dobutamine infusion
B. Norepinephrine infusion
C. IV furosemide only
D. Large volume normal saline bolus
Correct Answer: A
Rationale: Cardiogenic shock with low CO and high filling pressures requires inotropic support
(dobutamine). Norepinephrine (B) is for vasodilatory shock; furosemide (C) treats overload but
not low CO; fluids (D) would worsen.
Q7. A patient has an intra-arterial blood pressure monitoring system. The nurse notices the
waveform is over-damped. The most likely cause is:
A. Air bubbles in the tubing
B. Catheter too large for artery
C. Excessive tubing length
D. Blood clots at catheter tip
Correct Answer: D
Rationale: Over-damped waveform (rounded, no dicrotic notch, low systolic) is caused by clots,
kinks, or loose connections. Air bubbles (A) cause under-damping (hyper-resonant waveform).
Catheter size (B) not typical cause.
Q8. A patient with a pulmonary artery catheter has a mixed venous oxygen saturation (SvO₂) of
52% (normal 60-80%). The nurse should assess for:
A. Adequate oxygen delivery
B. Decreased oxygen consumption (e.g., sedation, hypothermia)
C. Increased oxygen extraction (e.g., decreased CO, increased metabolic demand)
D. Hyperoxia
Correct Answer: C
Rationale: Low SvO₂ indicates increased oxygen extraction due to low cardiac output, anemia,
CLN500: Critical Care / ICU – Questions with
Correct Answers Comprehensive Nursing
Exam Guide
Total Questions: 60
Format: Multiple choice (45) + select all that apply (5) + clinical scenarios (10)
Target Level: Undergraduate (BSN) / Graduate (MSN) bridge
Focus: Hemodynamics, mechanical ventilation, shock, sepsis, ARDS, arrhythmias, neurology,
sedation, renal replacement therapy, and emergency critical care interventions.
DOMAIN I: HEMODYNAMIC MONITORING & ASSESSMENT (8 questions)
Q1. A patient with septic shock has an arterial line (A-line) and a pulmonary artery catheter
(PAC). Which hemodynamic profile is consistent with early (warm) septic shock?
A. High cardiac output (CO), low systemic vascular resistance (SVR)
B. Low cardiac output, high SVR
C. Low cardiac output, low SVR
D. High cardiac output, high SVR
Correct Answer: A
Rationale: Early septic shock is hyperdynamic: increased CO (compensatory), decreased SVR
(vasodilation). Late septic shock (decompensated) may have low CO with low SVR.
Q2. The nurse obtains the following hemodynamic values for a patient:
• Cardiac output (CO) = 3.2 L/min
• Central venous pressure (CVP) = 2 mmHg
• Pulmonary artery wedge pressure (PAWP) = 4 mmHg
• Systemic vascular resistance (SVR) = 1800 dynes·sec/cm⁵
The nurse interprets these findings as consistent with:
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock (septic)
D. Obstructive shock
Correct Answer: B
Rationale: Low CO, low CVP, low PAWP, high SVR indicate hypovolemia. Cardiogenic shock (A)
,2
would have high CVP/PAWP; distributive (C) low SVR; obstructive (D) high CVP/PAWP with low
CO (e.g., tamponade, PE).
Q3. A patient with a pulmonary artery catheter has a PAWP of 22 mmHg (normal 4-12). The
nurse assesses jugular vein distention, crackles in both lungs, and an S3 gallop. The priority
intervention is:
A. Administer furosemide (Lasix) IV
B. Increase IV fluid rate
C. Start norepinephrine infusion
D. Position patient supine
Correct Answer: A
Rationale: Elevated PAWP indicates left ventricular failure/fluid overload. Furosemide reduces
preload. IV fluids (B) would worsen; norepinephrine (C) for hypotension; supine (D) may worsen
orthopnea.
Q4. The nurse is caring for a patient with a radial arterial line. Which finding indicates the need
to replace the transducer system?
A. Damped waveform with loss of dicrotic notch
B. Square wave test shows one overshoot then rapid return to baseline
C. Mean arterial pressure (MAP) of 70 mmHg
D. Systolic pressure 10 mmHg higher than non-invasive cuff
Correct Answer: A
Rationale: Damped waveform with loss of dicrotic notch indicates air bubbles, clot, or kinked
tubing. Square wave test (B) normal; MAP 70 acceptable; A-line always reads slightly higher
than cuff (D).
Q5. A patient’s central venous pressure (CVP) is 18 mmHg (normal 2-6). The nurse should assess
for:
A. Hypovolemia
B. Right ventricular failure or fluid overload
C. Left ventricular failure
D. Arterial vasodilation
Correct Answer: B
Rationale: Elevated CVP indicates increased right atrial pressure – right heart failure, fluid
, 3
overload, or pulmonary hypertension. Hypovolemia (A) causes low CVP; left heart failure (C)
elevates PAWP, not CVP initially.
Q6. A patient with cardiogenic shock has the following values: CO 2.1 L/min, CVP 14 mmHg,
PAWP 20 mmHg, SVR 1600 dynes·sec/cm⁵. The nurse expects the provider to order:
A. Dobutamine infusion
B. Norepinephrine infusion
C. IV furosemide only
D. Large volume normal saline bolus
Correct Answer: A
Rationale: Cardiogenic shock with low CO and high filling pressures requires inotropic support
(dobutamine). Norepinephrine (B) is for vasodilatory shock; furosemide (C) treats overload but
not low CO; fluids (D) would worsen.
Q7. A patient has an intra-arterial blood pressure monitoring system. The nurse notices the
waveform is over-damped. The most likely cause is:
A. Air bubbles in the tubing
B. Catheter too large for artery
C. Excessive tubing length
D. Blood clots at catheter tip
Correct Answer: D
Rationale: Over-damped waveform (rounded, no dicrotic notch, low systolic) is caused by clots,
kinks, or loose connections. Air bubbles (A) cause under-damping (hyper-resonant waveform).
Catheter size (B) not typical cause.
Q8. A patient with a pulmonary artery catheter has a mixed venous oxygen saturation (SvO₂) of
52% (normal 60-80%). The nurse should assess for:
A. Adequate oxygen delivery
B. Decreased oxygen consumption (e.g., sedation, hypothermia)
C. Increased oxygen extraction (e.g., decreased CO, increased metabolic demand)
D. Hyperoxia
Correct Answer: C
Rationale: Low SvO₂ indicates increased oxygen extraction due to low cardiac output, anemia,
