Critical Care NCLEX-Style Practice Exam
Review – Advanced Critical Care Nursing
Questions & Rationales
Instructions: This comprehensive practice exam contains 100 questions covering critical care nursing
concepts, including hemodynamic monitoring, mechanical ventilation, shock states, cardiac arrest, and
multisystem organ failure. Select the best answer. Answers are in bold and rationales are in italic.
HEMODYNAMIC MONITORING AND SHOCK (Questions 1-30)
1. A client in the intensive care unit has a pulmonary artery catheter in place. Which hemodynamic
parameter reflects 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: Pulmonary artery wedge pressure (PAWP), also known as pulmonary capillary wedge pressure
(PCWP), reflects left ventricular end-diastolic pressure and preload. CVP reflects right ventricular preload.
2. A client is diagnosed with cardiogenic shock. Which hemodynamic finding is most consistent with
this diagnosis?
A) Increased cardiac output and decreased SVR
B) Decreased cardiac output and increased SVR
C) Increased cardiac output and increased SVR
D) Decreased cardiac output and decreased SVR
Answer: B
Rationale: Cardiogenic shock is characterized by decreased cardiac output due to pump failure and
increased systemic vascular resistance (SVR) as a compensatory response to hypotension.
3. A client with septic shock is receiving fluid resuscitation. Which assessment finding indicates the
most improvement?
A) Increased heart rate
B) Decreased urine output
C) Improved mean arterial pressure (MAP)
D) Decreased central venous pressure (CVP)
,Answer: C
Rationale: Improved mean arterial pressure (MAP) indicates improved perfusion and response to fluid
resuscitation. MAP should be maintained at ≥ 65 mmHg in septic shock.
4. A client is receiving norepinephrine for septic shock. What is the primary mechanism of action of
this medication?
A) Beta-1 agonist causing increased cardiac contractility
B) Alpha-1 agonist causing vasoconstriction
C) Beta-2 agonist causing bronchodilation
D) Dopamine agonist causing renal vasodilation
Answer: B
Rationale: Norepinephrine is a potent alpha-1 agonist that causes vasoconstriction, increasing systemic
vascular resistance (SVR) and blood pressure. It is the first-line vasopressor in septic shock.
5. A client with hypovolemic shock has a heart rate of 120 bpm and blood pressure of 85/50 mmHg.
Which intervention is the priority?
A) Administer vasopressors
B) Administer IV fluids
C) Administer blood products
D) Administer antibiotics
Answer: B
Rationale: The priority in hypovolemic shock is to replace intravascular volume with IV fluids
(crystalloids). Vasopressors are used if fluid resuscitation does not restore perfusion.
6. A client is diagnosed with distributive shock. Which type of shock is classified as distributive?
A) Hypovolemic shock
B) Cardiogenic shock
C) Septic shock
D) Obstructive shock
Answer: C
Rationale: Distributive shock includes septic shock, anaphylactic shock, and neurogenic shock. It is
characterized by massive vasodilation and maldistribution of blood flow.
7. A client is receiving an intra-aortic balloon pump (IABP) for cardiogenic shock. Which action should
the nurse take?
A) Monitor for signs of bleeding and infection
B) Position the client flat with both legs straight
C) Place the client in high Fowler's position
D) Ambulate the client as soon as possible
Answer: A
, Rationale: IABP insertion sites are at risk for bleeding and infection. The client should be kept flat with
the affected leg straight to prevent complications.
8. A client has a pulmonary artery catheter and the nurse notes a PAWP of 25 mmHg. What does this
indicate?
A) Hypovolemia
B) Left ventricular failure
C) Right ventricular failure
D) Pulmonary embolism
Answer: B
Rationale: PAWP (also called PCWP) is elevated in left ventricular failure (pulmonary congestion). Normal
PAWP is 6-12 mmHg. A value of 25 mmHg indicates significant left-sided heart failure.
9. A client with neurogenic shock is receiving IV fluids and vasopressors. Which assessment finding
indicates improvement?
A) Increased heart rate
B) Increased blood pressure
C) Decreased urine output
D) Decreased level of consciousness
Answer: B
Rationale: Increased blood pressure indicates improved perfusion. Neurogenic shock is characterized by
hypotension and bradycardia due to loss of sympathetic tone.
10. A client is diagnosed with anaphylactic shock. Which medication should the nurse administer first?
A) Epinephrine
B) Diphenhydramine
C) Albuterol
D) Methylprednisolone
Answer: A
Rationale: Epinephrine is the first-line treatment for anaphylactic shock. It causes bronchodilation,
vasoconstriction, and increased cardiac output.
11. A client is on a ventilator and has a positive end-expiratory pressure (PEEP) of 10 cm H2O. Which
complication should the nurse monitor for?
A) Pneumothorax
B) Hypotension
C) Decreased cardiac output
D) All of the above
Answer: D
Review – Advanced Critical Care Nursing
Questions & Rationales
Instructions: This comprehensive practice exam contains 100 questions covering critical care nursing
concepts, including hemodynamic monitoring, mechanical ventilation, shock states, cardiac arrest, and
multisystem organ failure. Select the best answer. Answers are in bold and rationales are in italic.
HEMODYNAMIC MONITORING AND SHOCK (Questions 1-30)
1. A client in the intensive care unit has a pulmonary artery catheter in place. Which hemodynamic
parameter reflects 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: Pulmonary artery wedge pressure (PAWP), also known as pulmonary capillary wedge pressure
(PCWP), reflects left ventricular end-diastolic pressure and preload. CVP reflects right ventricular preload.
2. A client is diagnosed with cardiogenic shock. Which hemodynamic finding is most consistent with
this diagnosis?
A) Increased cardiac output and decreased SVR
B) Decreased cardiac output and increased SVR
C) Increased cardiac output and increased SVR
D) Decreased cardiac output and decreased SVR
Answer: B
Rationale: Cardiogenic shock is characterized by decreased cardiac output due to pump failure and
increased systemic vascular resistance (SVR) as a compensatory response to hypotension.
3. A client with septic shock is receiving fluid resuscitation. Which assessment finding indicates the
most improvement?
A) Increased heart rate
B) Decreased urine output
C) Improved mean arterial pressure (MAP)
D) Decreased central venous pressure (CVP)
,Answer: C
Rationale: Improved mean arterial pressure (MAP) indicates improved perfusion and response to fluid
resuscitation. MAP should be maintained at ≥ 65 mmHg in septic shock.
4. A client is receiving norepinephrine for septic shock. What is the primary mechanism of action of
this medication?
A) Beta-1 agonist causing increased cardiac contractility
B) Alpha-1 agonist causing vasoconstriction
C) Beta-2 agonist causing bronchodilation
D) Dopamine agonist causing renal vasodilation
Answer: B
Rationale: Norepinephrine is a potent alpha-1 agonist that causes vasoconstriction, increasing systemic
vascular resistance (SVR) and blood pressure. It is the first-line vasopressor in septic shock.
5. A client with hypovolemic shock has a heart rate of 120 bpm and blood pressure of 85/50 mmHg.
Which intervention is the priority?
A) Administer vasopressors
B) Administer IV fluids
C) Administer blood products
D) Administer antibiotics
Answer: B
Rationale: The priority in hypovolemic shock is to replace intravascular volume with IV fluids
(crystalloids). Vasopressors are used if fluid resuscitation does not restore perfusion.
6. A client is diagnosed with distributive shock. Which type of shock is classified as distributive?
A) Hypovolemic shock
B) Cardiogenic shock
C) Septic shock
D) Obstructive shock
Answer: C
Rationale: Distributive shock includes septic shock, anaphylactic shock, and neurogenic shock. It is
characterized by massive vasodilation and maldistribution of blood flow.
7. A client is receiving an intra-aortic balloon pump (IABP) for cardiogenic shock. Which action should
the nurse take?
A) Monitor for signs of bleeding and infection
B) Position the client flat with both legs straight
C) Place the client in high Fowler's position
D) Ambulate the client as soon as possible
Answer: A
, Rationale: IABP insertion sites are at risk for bleeding and infection. The client should be kept flat with
the affected leg straight to prevent complications.
8. A client has a pulmonary artery catheter and the nurse notes a PAWP of 25 mmHg. What does this
indicate?
A) Hypovolemia
B) Left ventricular failure
C) Right ventricular failure
D) Pulmonary embolism
Answer: B
Rationale: PAWP (also called PCWP) is elevated in left ventricular failure (pulmonary congestion). Normal
PAWP is 6-12 mmHg. A value of 25 mmHg indicates significant left-sided heart failure.
9. A client with neurogenic shock is receiving IV fluids and vasopressors. Which assessment finding
indicates improvement?
A) Increased heart rate
B) Increased blood pressure
C) Decreased urine output
D) Decreased level of consciousness
Answer: B
Rationale: Increased blood pressure indicates improved perfusion. Neurogenic shock is characterized by
hypotension and bradycardia due to loss of sympathetic tone.
10. A client is diagnosed with anaphylactic shock. Which medication should the nurse administer first?
A) Epinephrine
B) Diphenhydramine
C) Albuterol
D) Methylprednisolone
Answer: A
Rationale: Epinephrine is the first-line treatment for anaphylactic shock. It causes bronchodilation,
vasoconstriction, and increased cardiac output.
11. A client is on a ventilator and has a positive end-expiratory pressure (PEEP) of 10 cm H2O. Which
complication should the nurse monitor for?
A) Pneumothorax
B) Hypotension
C) Decreased cardiac output
D) All of the above
Answer: D
