KAPLAN CRITICAL CARE NURSING QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | INSTANT DOWNLOAD PDF
Core Domains*
* - Cardiovascular Critical Care
* - Respiratory Failure and Mechanical Ventilation
* - Neurological Critical Care and ICP Management
* - Renal Failure and Continuous Renal Replacement Therapy
* - Sepsis and Hemodynamic Monitoring
* - Critical Care Pharmacology and Medication Safety
* - Ethics, Legal Compliance, and Professional Standards
* - Trauma, Burns, and Emergency Critical Care
* * Introduction
* This comprehensive assessment is designed to evaluate nursing professionals' mastery of critical care nursing
principles and clinical decision-making skills essential for high-acuity patient environments. The exam covers foundational theory, applied
professional knowledge, regulatory and legal compliance, ethics, and real-world clinical scenarios that critical care nurses encounter daily. All
questions are multiple-choice with four options, including scenario-based items that test critical thinking and prioritization abilities. The
assessment emphasizes real-world application, requiring nurses to demonstrate competence in hemodynamic monitoring, mechanical ventilation
management, emergency interventions, medication safety, and ethical decision-making. Success on this exam indicates readiness to provide safe,
evidence-based care to critically ill patients in intensive care units and emergency settings.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient in the ICU isMechanical ventilation with positive end-expiratory pressure (PEEP) of 12 cm H2O. The nurse notes a sudden drop in blood
pressure from 120/80 to 85/50 mmHg. What is the priority nursing action?
A. Increase the PEEP to 15 cm H2O
B. Administer a bolus of normal saline
C. Assess for signs of pneumothorax
D. Decrease the tidal volume
,🟢 C. Assess for signs of pneumothorax
🔴 RATIONALE: High PEEP can cause barotrauma leading to pneumothorax, which presents with sudden hypotension due to decreased venous
return. Assessing for pneumothorax (asymmetrical breath sounds, tracheal deviation, decreased oxygenation) is the priority before administering
fluids or adjusting ventilator settings.
Question 2
Which assessment finding indicates the need for immediate intervention in a patient with a central venous catheter?
A. Insertion site shows mild erythema
B. Patient reports pain at the insertion site
C. Axillary temperature of 38.2°C (100.8°F)
D. Slight dressing looseness
🟢 C. Axillary temperature of 38.2°C (100.8°F)
🔴 RATIONALE: Fever in a patient with a central line is a potential sign of catheter-related bloodstream infection (CRBSI), which requires
immediate evaluation and possible catheter removal. Mild erythema and slight dressing looseness need attention but are less urgent.
Question 3
A patient with septic shock has a lactate level of 5.2 mmol/L. What does this elevated lactate indicate?
A. Adequate tissue perfusion
B. Metabolic alkalosis
C. Tissue hypoperfusion and anaerobic metabolism
D. Liver dysfunction only
🟢 C. Tissue hypoperfusion and anaerobic metabolism
🔴 RATIONALE: Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and shift to anaerobic metabolism, a hallmark of septic shock. It is a
critical marker for guiding resuscitation efforts and predicting mortality.
,Question 4
Which medication requires continuous cardiac monitoring during IV infusion in the ICU?
A. Fentanyl
B. Propofol
C. Dopamine
D. Pandonic
🟢 C. Dopamine
🔴 RATIONALE: Dopamine is a vasopressor with inotropic and chronotropic effects that can cause arrhythmias. Continuous cardiac monitoring is
essential to detect dysrhythmias early during infusion.
Question 5
A patient with increased intracranial pressure (ICP) has a cerebral perfusion pressure (CPP) of 50 mmHg. What is the priority intervention?
A. Administer mannitol 0.5 g/kg IV
B. Elevate the head of bed to 15 degrees
C. Increase sedation dose
D. Apply bilateral ankle restraints
🟢 A. Administer mannitol 0.5 g/kg IV
🔴 RATIONALE: Normal CPP is 60-100 mmHg. A CPP of 50 mmHg indicates inadequate cerebral perfusion. Mannitol is an osmotic diuretic that
reduces ICP and improves CPP. Head elevation should be 30 degrees, not 15.
Question 6
Which finding in a patient on mechanical ventilation requires immediate notification of the respiratory therapist?
, A. Peak inspiratory pressure of 28 cm H2O
B. Plateau pressure of 32 cm H2O
C. SpO2 of 94% on FiO2 40%
D. Tidal volume of 6 mL/kg ideal body weight
🟢 B. Plateau pressure of 32 cm H2O
🔴 RATIONALE: Plateau pressure >30 cm H2O increases risk of ventilator-induced lung injury (VILI). This requires immediate intervention to
adjust ventilator settings. Peak pressure of 28 is acceptable, and SpO2 94% is adequate.
Question 7
A patient with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. What is the first medication the nurse should anticipate administering?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin 10 units regular IV with dextrose
C. Furosemide 40 mg IV
D. Calcium gluconate 10 mL 10% IV
🟢 D. Calcium gluconate 10 mL 10% IV
🔴 RATIONALE: Calcium gluconate stabilizes cardiac membranes and is the first-line treatment for severe hyperkalemia to prevent arrhythmias.
Insulin/dextrose shifts potassium intracellularly but is secondary to cardiac protection.
Question 8
Which assessment finding indicates successful treatment of cardiogenic shock?
A. Mean arterial pressure (MAP) of 55 mmHg
B. Urine output of 0.3 mL/kg/hr
C. Lactate level decreasing from 4.5 to 2.1 mmol/L
D. Heart rate of 118 bpm
🟢 C. Lactate level decreasing from 4.5 to 2.1 mmol/L
Q&A | INSTANT DOWNLOAD PDF
Core Domains*
* - Cardiovascular Critical Care
* - Respiratory Failure and Mechanical Ventilation
* - Neurological Critical Care and ICP Management
* - Renal Failure and Continuous Renal Replacement Therapy
* - Sepsis and Hemodynamic Monitoring
* - Critical Care Pharmacology and Medication Safety
* - Ethics, Legal Compliance, and Professional Standards
* - Trauma, Burns, and Emergency Critical Care
* * Introduction
* This comprehensive assessment is designed to evaluate nursing professionals' mastery of critical care nursing
principles and clinical decision-making skills essential for high-acuity patient environments. The exam covers foundational theory, applied
professional knowledge, regulatory and legal compliance, ethics, and real-world clinical scenarios that critical care nurses encounter daily. All
questions are multiple-choice with four options, including scenario-based items that test critical thinking and prioritization abilities. The
assessment emphasizes real-world application, requiring nurses to demonstrate competence in hemodynamic monitoring, mechanical ventilation
management, emergency interventions, medication safety, and ethical decision-making. Success on this exam indicates readiness to provide safe,
evidence-based care to critically ill patients in intensive care units and emergency settings.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient in the ICU isMechanical ventilation with positive end-expiratory pressure (PEEP) of 12 cm H2O. The nurse notes a sudden drop in blood
pressure from 120/80 to 85/50 mmHg. What is the priority nursing action?
A. Increase the PEEP to 15 cm H2O
B. Administer a bolus of normal saline
C. Assess for signs of pneumothorax
D. Decrease the tidal volume
,🟢 C. Assess for signs of pneumothorax
🔴 RATIONALE: High PEEP can cause barotrauma leading to pneumothorax, which presents with sudden hypotension due to decreased venous
return. Assessing for pneumothorax (asymmetrical breath sounds, tracheal deviation, decreased oxygenation) is the priority before administering
fluids or adjusting ventilator settings.
Question 2
Which assessment finding indicates the need for immediate intervention in a patient with a central venous catheter?
A. Insertion site shows mild erythema
B. Patient reports pain at the insertion site
C. Axillary temperature of 38.2°C (100.8°F)
D. Slight dressing looseness
🟢 C. Axillary temperature of 38.2°C (100.8°F)
🔴 RATIONALE: Fever in a patient with a central line is a potential sign of catheter-related bloodstream infection (CRBSI), which requires
immediate evaluation and possible catheter removal. Mild erythema and slight dressing looseness need attention but are less urgent.
Question 3
A patient with septic shock has a lactate level of 5.2 mmol/L. What does this elevated lactate indicate?
A. Adequate tissue perfusion
B. Metabolic alkalosis
C. Tissue hypoperfusion and anaerobic metabolism
D. Liver dysfunction only
🟢 C. Tissue hypoperfusion and anaerobic metabolism
🔴 RATIONALE: Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and shift to anaerobic metabolism, a hallmark of septic shock. It is a
critical marker for guiding resuscitation efforts and predicting mortality.
,Question 4
Which medication requires continuous cardiac monitoring during IV infusion in the ICU?
A. Fentanyl
B. Propofol
C. Dopamine
D. Pandonic
🟢 C. Dopamine
🔴 RATIONALE: Dopamine is a vasopressor with inotropic and chronotropic effects that can cause arrhythmias. Continuous cardiac monitoring is
essential to detect dysrhythmias early during infusion.
Question 5
A patient with increased intracranial pressure (ICP) has a cerebral perfusion pressure (CPP) of 50 mmHg. What is the priority intervention?
A. Administer mannitol 0.5 g/kg IV
B. Elevate the head of bed to 15 degrees
C. Increase sedation dose
D. Apply bilateral ankle restraints
🟢 A. Administer mannitol 0.5 g/kg IV
🔴 RATIONALE: Normal CPP is 60-100 mmHg. A CPP of 50 mmHg indicates inadequate cerebral perfusion. Mannitol is an osmotic diuretic that
reduces ICP and improves CPP. Head elevation should be 30 degrees, not 15.
Question 6
Which finding in a patient on mechanical ventilation requires immediate notification of the respiratory therapist?
, A. Peak inspiratory pressure of 28 cm H2O
B. Plateau pressure of 32 cm H2O
C. SpO2 of 94% on FiO2 40%
D. Tidal volume of 6 mL/kg ideal body weight
🟢 B. Plateau pressure of 32 cm H2O
🔴 RATIONALE: Plateau pressure >30 cm H2O increases risk of ventilator-induced lung injury (VILI). This requires immediate intervention to
adjust ventilator settings. Peak pressure of 28 is acceptable, and SpO2 94% is adequate.
Question 7
A patient with acute kidney injury (AKI) has a potassium level of 6.8 mEq/L. What is the first medication the nurse should anticipate administering?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin 10 units regular IV with dextrose
C. Furosemide 40 mg IV
D. Calcium gluconate 10 mL 10% IV
🟢 D. Calcium gluconate 10 mL 10% IV
🔴 RATIONALE: Calcium gluconate stabilizes cardiac membranes and is the first-line treatment for severe hyperkalemia to prevent arrhythmias.
Insulin/dextrose shifts potassium intracellularly but is secondary to cardiac protection.
Question 8
Which assessment finding indicates successful treatment of cardiogenic shock?
A. Mean arterial pressure (MAP) of 55 mmHg
B. Urine output of 0.3 mL/kg/hr
C. Lactate level decreasing from 4.5 to 2.1 mmol/L
D. Heart rate of 118 bpm
🟢 C. Lactate level decreasing from 4.5 to 2.1 mmol/L
