NUR445 CRITICAL CARE EXAM 1 WITH 100%
DETAILED CORRECT ANSWERS 2025/2026
STUDY SET
Section 1: Hemodynamics & Shock (Questions 1–15)
1. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg despite fluid
resuscitation. What is the priority intervention?
A) Administer vasopressors as ordered
B) Increase the rate of IV fluids
C) Reposition the patient supine
D) Obtain a blood culture
Answer: A
Rationale: A MAP < 65 mmHg indicates inadequate organ perfusion. After fluid resuscitation,
vasopressors (e.g., norepinephrine) are indicated to restore MAP to ≥ 65 mmHg and maintain tissue
perfusion.
2. Which hemodynamic parameter is most indicative of left ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output (CO)
D) Systemic vascular resistance (SVR)
Answer: B
Rationale: PAWP (also called pulmonary capillary wedge pressure) reflects left atrial pressure and is the
best measure of left ventricular preload. CVP reflects right ventricular preload.
3. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m² (normal: 2.5–4.0). Which finding
would the nurse expect?
A) Bounding pulses and warm extremities
B) Cool, clammy skin and decreased urine output
C) Increased urine output and clear lung sounds
, D) Flushed skin and bounding pulses
Answer: B
Rationale: Low cardiac index indicates poor tissue perfusion, resulting in compensatory vasoconstriction
(cool, clammy skin) and decreased renal perfusion (low urine output).
4. Which type of shock is characterized by a low CVP, low PAWP, and low SVR?
A) Cardiogenic shock
B) Obstructive shock
C) Distributive shock (septic)
D) Hypovolemic shock
Answer: C
Rationale: Septic (distributive) shock typically shows low CVP/PAWP (relative hypovolemia) and low SVR
(vasodilation). Cardiogenic shock shows high filling pressures. Hypovolemic shock shows low filling
pressures but normal or high SVR.
5. A patient in hypovolemic shock receives 2 L of lactated Ringer's solution. MAP increases from 48 to
62 mmHg. What does this indicate?
A) The patient is fluid responsive
B) The patient needs blood transfusion
C) Vasopressors are now contraindicated
D) The patient has developed fluid overload
Answer: A
*Rationale: A positive response to fluid challenge (increase in MAP, improvement in heart rate, urine
output > 0.5 mL/kg/hr) indicates the patient is fluid responsive and hypovolemia is a contributing
factor.*
6. Which medication is the first-line vasopressor for septic shock?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Vasopressin
Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign
guidelines due to its potent vasoconstrictive effects with less tachycardia than dopamine.
7. A patient with an intra-aortic balloon pump (IABP) has a waveform with early deflation. What is the
most likely consequence?
, A) Increased afterload
B) Decreased coronary perfusion
C) Increased cardiac output
D) Decreased left ventricular workload
Answer: B
Rationale: Early deflation of the IABP balloon causes the balloon to deflate before the aortic valve opens,
reducing diastolic augmentation and decreasing coronary artery perfusion pressure.
8. Which finding is most consistent with obstructive shock?
A) Widened pulse pressure and bounding pulses
B) Elevated jugular venous distension (JVD) and muffled heart sounds
C) Warm, dry skin and low CVP
D) Crackles and frothy sputum
Answer: B
Rationale: Obstructive shock (e.g., cardiac tamponade, tension pneumothorax) presents with elevated
JVD, muffled heart sounds (tamponade), and hypotension. This is Beck's triad.
9. The nurse is caring for a patient with a pulmonary artery catheter. Which value directly measures
right ventricular afterload?
A) Pulmonary vascular resistance (PVR)
B) Systemic vascular resistance (SVR)
C) Central venous pressure (CVP)
D) Cardiac index (CI)
Answer: A
Rationale: PVR is the resistance against which the right ventricle must pump (right ventricular afterload).
SVR is left ventricular afterload.
10. A patient's ScvO₂ (central venous oxygen saturation) is 55% (normal ≥ 70%). What does this
indicate?
A) Adequate oxygen delivery
B) Increased oxygen extraction due to low cardiac output
C) Hyperdynamic circulation
D) Venous admixture from left-to-right shunt
Answer: B
Rationale: Low ScvO₂ (< 70%) indicates increased oxygen extraction by tissues, typically due to low
DETAILED CORRECT ANSWERS 2025/2026
STUDY SET
Section 1: Hemodynamics & Shock (Questions 1–15)
1. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg despite fluid
resuscitation. What is the priority intervention?
A) Administer vasopressors as ordered
B) Increase the rate of IV fluids
C) Reposition the patient supine
D) Obtain a blood culture
Answer: A
Rationale: A MAP < 65 mmHg indicates inadequate organ perfusion. After fluid resuscitation,
vasopressors (e.g., norepinephrine) are indicated to restore MAP to ≥ 65 mmHg and maintain tissue
perfusion.
2. Which hemodynamic parameter is most indicative of left ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output (CO)
D) Systemic vascular resistance (SVR)
Answer: B
Rationale: PAWP (also called pulmonary capillary wedge pressure) reflects left atrial pressure and is the
best measure of left ventricular preload. CVP reflects right ventricular preload.
3. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m² (normal: 2.5–4.0). Which finding
would the nurse expect?
A) Bounding pulses and warm extremities
B) Cool, clammy skin and decreased urine output
C) Increased urine output and clear lung sounds
, D) Flushed skin and bounding pulses
Answer: B
Rationale: Low cardiac index indicates poor tissue perfusion, resulting in compensatory vasoconstriction
(cool, clammy skin) and decreased renal perfusion (low urine output).
4. Which type of shock is characterized by a low CVP, low PAWP, and low SVR?
A) Cardiogenic shock
B) Obstructive shock
C) Distributive shock (septic)
D) Hypovolemic shock
Answer: C
Rationale: Septic (distributive) shock typically shows low CVP/PAWP (relative hypovolemia) and low SVR
(vasodilation). Cardiogenic shock shows high filling pressures. Hypovolemic shock shows low filling
pressures but normal or high SVR.
5. A patient in hypovolemic shock receives 2 L of lactated Ringer's solution. MAP increases from 48 to
62 mmHg. What does this indicate?
A) The patient is fluid responsive
B) The patient needs blood transfusion
C) Vasopressors are now contraindicated
D) The patient has developed fluid overload
Answer: A
*Rationale: A positive response to fluid challenge (increase in MAP, improvement in heart rate, urine
output > 0.5 mL/kg/hr) indicates the patient is fluid responsive and hypovolemia is a contributing
factor.*
6. Which medication is the first-line vasopressor for septic shock?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Vasopressin
Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign
guidelines due to its potent vasoconstrictive effects with less tachycardia than dopamine.
7. A patient with an intra-aortic balloon pump (IABP) has a waveform with early deflation. What is the
most likely consequence?
, A) Increased afterload
B) Decreased coronary perfusion
C) Increased cardiac output
D) Decreased left ventricular workload
Answer: B
Rationale: Early deflation of the IABP balloon causes the balloon to deflate before the aortic valve opens,
reducing diastolic augmentation and decreasing coronary artery perfusion pressure.
8. Which finding is most consistent with obstructive shock?
A) Widened pulse pressure and bounding pulses
B) Elevated jugular venous distension (JVD) and muffled heart sounds
C) Warm, dry skin and low CVP
D) Crackles and frothy sputum
Answer: B
Rationale: Obstructive shock (e.g., cardiac tamponade, tension pneumothorax) presents with elevated
JVD, muffled heart sounds (tamponade), and hypotension. This is Beck's triad.
9. The nurse is caring for a patient with a pulmonary artery catheter. Which value directly measures
right ventricular afterload?
A) Pulmonary vascular resistance (PVR)
B) Systemic vascular resistance (SVR)
C) Central venous pressure (CVP)
D) Cardiac index (CI)
Answer: A
Rationale: PVR is the resistance against which the right ventricle must pump (right ventricular afterload).
SVR is left ventricular afterload.
10. A patient's ScvO₂ (central venous oxygen saturation) is 55% (normal ≥ 70%). What does this
indicate?
A) Adequate oxygen delivery
B) Increased oxygen extraction due to low cardiac output
C) Hyperdynamic circulation
D) Venous admixture from left-to-right shunt
Answer: B
Rationale: Low ScvO₂ (< 70%) indicates increased oxygen extraction by tissues, typically due to low
