Critical Care Nursing Exam – Complete
Exam 16 with Verified Answers (2026
Edition)
Question 1: A client in the intensive care unit (ICU) is experiencing septic shock. Which finding indicates
the client is in the early (compensatory) stage of shock?
A) Hypotension and bradycardia
B) Tachycardia and tachypnea
C) Oliguria and anuria
D) Metabolic acidosis and hyperkalemia
Answer: B) Tachycardia and tachypnea
Rationale: In the early (compensatory) stage of septic shock, the body attempts to maintain cardiac
output and tissue perfusion through compensatory mechanisms, including tachycardia (increased heart
rate) and tachypnea (increased respiratory rate). Hypotension, oliguria, metabolic acidosis, and
hyperkalemia are signs of the progressive or irreversible stages of shock. Early recognition and treatment
of sepsis are critical to prevent progression to multi-organ failure.
Question 2: A client is admitted to the ICU with acute respiratory distress syndrome (ARDS). Which
arterial blood gas (ABG) finding is most consistent with this diagnosis?
A) PaO₂ 55 mmHg, PaCO₂ 48 mmHg, pH 7.32
B) PaO₂ 80 mmHg, PaCO₂ 35 mmHg, pH 7.38
C) PaO₂ 45 mmHg, PaCO₂ 30 mmHg, pH 7.48
D) PaO₂ 90 mmHg, PaCO₂ 40 mmHg, pH 7.40
Answer: A) PaO₂ 55 mmHg, PaCO₂ 48 mmHg, pH 7.32
Rationale: ARDS is characterized by severe hypoxemia (PaO₂ <60 mmHg) that is refractory to oxygen
therapy, along with respiratory acidosis (elevated PaCO₂ and low pH) in the later stages. The PaO₂/FiO₂
ratio is <300 in ARDS. The nurse should monitor the client's oxygenation, ventilation, and lung
compliance. Treatment includes lung-protective ventilation, prone positioning, and supportive care.
Question 3: A client with a severe traumatic brain injury (TBI) has an intracranial pressure (ICP) monitor
in place. The ICP reading is 22 mmHg. Which action should the nurse take?
,A) Continue to monitor the ICP
B) Notify the healthcare provider immediately
C) Administer mannitol as prescribed
D) Both B and C
Answer: D) Both B and C
Rationale: Normal ICP is 5-15 mmHg. An ICP of 22 mmHg is elevated and requires immediate
intervention. The nurse should notify the healthcare provider and administer mannitol (osmotic diuretic)
as prescribed to reduce ICP. Other interventions include elevating the head of the bed to 30 degrees,
maintaining normothermia, and ensuring adequate oxygenation and ventilation.
Question 4: A client in the ICU is receiving mechanical ventilation. The high-pressure alarm sounds.
Which action should the nurse take first?
A) Suction the client's airway
B) Check the ventilator circuit for kinks
C) Assess the client's respiratory status
D) Notify the respiratory therapist
Answer: C) Assess the client's respiratory status
Rationale: The high-pressure alarm on a ventilator indicates increased airway resistance or decreased
lung compliance. The first action is to assess the client's respiratory status (breath sounds, oxygen
saturation, respiratory rate, and effort). The nurse should then check the ventilator circuit, suction the
airway if needed, and notify the respiratory therapist. The priority is to ensure the client's safety and
adequate ventilation.
Question 5: A client with acute myocardial infarction (MI) develops cardiogenic shock. Which finding is
most consistent with this diagnosis?
A) Hypotension, tachycardia, and cool, clammy skin
B) Hypertension, bradycardia, and warm, flushed skin
C) Hypotension, bradycardia, and warm, flushed skin
D) Hypertension, tachycardia, and cool, clammy skin
Answer: A) Hypotension, tachycardia, and cool, clammy skin
Rationale: Cardiogenic shock is characterized by decreased cardiac output leading to hypotension,
tachycardia (compensatory), and cool, clammy skin (due to peripheral vasoconstriction). The client may
also have oliguria, altered mental status, and pulmonary congestion. Treatment includes inotropic
support, vasopressors, and mechanical circulatory support (IABP, LVAD).
Question 6: A client with severe sepsis has a central venous catheter in place. Which finding indicates
the client is developing sepsis-induced acute kidney injury (AKI)?
, A) Urine output of 300 mL in 24 hours
B) Serum creatinine of 1.2 mg/dL
C) Blood urea nitrogen (BUN) of 20 mg/dL
D) Serum potassium of 4.0 mEq/L
Answer: A) Urine output of 300 mL in 24 hours
Rationale: Sepsis-induced AKI is characterized by oliguria (urine output <400 mL/day), elevated serum
creatinine, and elevated BUN. A urine output of 300 mL in 24 hours indicates oliguria and AKI. The nurse
should monitor urine output, renal function tests, and fluid balance. Early recognition and treatment of
AKI are essential to prevent further renal damage.
Question 7: A client in the ICU is receiving continuous renal replacement therapy (CRRT). Which finding
indicates the therapy is effective?
A) Decreased serum creatinine and BUN
B) Increased serum creatinine and BUN
C) Decreased urine output
D) Increased serum potassium
Answer: A) Decreased serum creatinine and BUN
Rationale: CRRT is used to remove waste products and excess fluid in critically ill clients with AKI.
Effectiveness is demonstrated by decreased serum creatinine and BUN, improved acid-base balance, and
resolution of electrolyte imbalances. The nurse should monitor the client's fluid balance, electrolyte
levels, and vital signs during CRRT.
Question 8: A client with a severe head injury is at risk for diabetes insipidus (DI). Which finding
indicates DI?
A) Polyuria and polydipsia with dilute urine
B) Oliguria and hypernatremia with concentrated urine
C) Polyuria and polydipsia with concentrated urine
D) Oliguria and hyponatremia with dilute urine
Answer: A) Polyuria and polydipsia with dilute urine
Rationale: Diabetes insipidus (DI) is characterized by excessive urination (polyuria) and excessive thirst
(polydipsia) with dilute urine (low specific gravity). It is caused by decreased ADH secretion (central DI) or
decreased renal response to ADH (nephrogenic DI). The nurse should monitor urine output, specific
gravity, and serum osmolality, and administer desmopressin (DDAVP) as prescribed for central DI.
Question 9: A client in the ICU is receiving vasopressor therapy (norepinephrine) for septic shock. Which
finding indicates the medication is effective?
Exam 16 with Verified Answers (2026
Edition)
Question 1: A client in the intensive care unit (ICU) is experiencing septic shock. Which finding indicates
the client is in the early (compensatory) stage of shock?
A) Hypotension and bradycardia
B) Tachycardia and tachypnea
C) Oliguria and anuria
D) Metabolic acidosis and hyperkalemia
Answer: B) Tachycardia and tachypnea
Rationale: In the early (compensatory) stage of septic shock, the body attempts to maintain cardiac
output and tissue perfusion through compensatory mechanisms, including tachycardia (increased heart
rate) and tachypnea (increased respiratory rate). Hypotension, oliguria, metabolic acidosis, and
hyperkalemia are signs of the progressive or irreversible stages of shock. Early recognition and treatment
of sepsis are critical to prevent progression to multi-organ failure.
Question 2: A client is admitted to the ICU with acute respiratory distress syndrome (ARDS). Which
arterial blood gas (ABG) finding is most consistent with this diagnosis?
A) PaO₂ 55 mmHg, PaCO₂ 48 mmHg, pH 7.32
B) PaO₂ 80 mmHg, PaCO₂ 35 mmHg, pH 7.38
C) PaO₂ 45 mmHg, PaCO₂ 30 mmHg, pH 7.48
D) PaO₂ 90 mmHg, PaCO₂ 40 mmHg, pH 7.40
Answer: A) PaO₂ 55 mmHg, PaCO₂ 48 mmHg, pH 7.32
Rationale: ARDS is characterized by severe hypoxemia (PaO₂ <60 mmHg) that is refractory to oxygen
therapy, along with respiratory acidosis (elevated PaCO₂ and low pH) in the later stages. The PaO₂/FiO₂
ratio is <300 in ARDS. The nurse should monitor the client's oxygenation, ventilation, and lung
compliance. Treatment includes lung-protective ventilation, prone positioning, and supportive care.
Question 3: A client with a severe traumatic brain injury (TBI) has an intracranial pressure (ICP) monitor
in place. The ICP reading is 22 mmHg. Which action should the nurse take?
,A) Continue to monitor the ICP
B) Notify the healthcare provider immediately
C) Administer mannitol as prescribed
D) Both B and C
Answer: D) Both B and C
Rationale: Normal ICP is 5-15 mmHg. An ICP of 22 mmHg is elevated and requires immediate
intervention. The nurse should notify the healthcare provider and administer mannitol (osmotic diuretic)
as prescribed to reduce ICP. Other interventions include elevating the head of the bed to 30 degrees,
maintaining normothermia, and ensuring adequate oxygenation and ventilation.
Question 4: A client in the ICU is receiving mechanical ventilation. The high-pressure alarm sounds.
Which action should the nurse take first?
A) Suction the client's airway
B) Check the ventilator circuit for kinks
C) Assess the client's respiratory status
D) Notify the respiratory therapist
Answer: C) Assess the client's respiratory status
Rationale: The high-pressure alarm on a ventilator indicates increased airway resistance or decreased
lung compliance. The first action is to assess the client's respiratory status (breath sounds, oxygen
saturation, respiratory rate, and effort). The nurse should then check the ventilator circuit, suction the
airway if needed, and notify the respiratory therapist. The priority is to ensure the client's safety and
adequate ventilation.
Question 5: A client with acute myocardial infarction (MI) develops cardiogenic shock. Which finding is
most consistent with this diagnosis?
A) Hypotension, tachycardia, and cool, clammy skin
B) Hypertension, bradycardia, and warm, flushed skin
C) Hypotension, bradycardia, and warm, flushed skin
D) Hypertension, tachycardia, and cool, clammy skin
Answer: A) Hypotension, tachycardia, and cool, clammy skin
Rationale: Cardiogenic shock is characterized by decreased cardiac output leading to hypotension,
tachycardia (compensatory), and cool, clammy skin (due to peripheral vasoconstriction). The client may
also have oliguria, altered mental status, and pulmonary congestion. Treatment includes inotropic
support, vasopressors, and mechanical circulatory support (IABP, LVAD).
Question 6: A client with severe sepsis has a central venous catheter in place. Which finding indicates
the client is developing sepsis-induced acute kidney injury (AKI)?
, A) Urine output of 300 mL in 24 hours
B) Serum creatinine of 1.2 mg/dL
C) Blood urea nitrogen (BUN) of 20 mg/dL
D) Serum potassium of 4.0 mEq/L
Answer: A) Urine output of 300 mL in 24 hours
Rationale: Sepsis-induced AKI is characterized by oliguria (urine output <400 mL/day), elevated serum
creatinine, and elevated BUN. A urine output of 300 mL in 24 hours indicates oliguria and AKI. The nurse
should monitor urine output, renal function tests, and fluid balance. Early recognition and treatment of
AKI are essential to prevent further renal damage.
Question 7: A client in the ICU is receiving continuous renal replacement therapy (CRRT). Which finding
indicates the therapy is effective?
A) Decreased serum creatinine and BUN
B) Increased serum creatinine and BUN
C) Decreased urine output
D) Increased serum potassium
Answer: A) Decreased serum creatinine and BUN
Rationale: CRRT is used to remove waste products and excess fluid in critically ill clients with AKI.
Effectiveness is demonstrated by decreased serum creatinine and BUN, improved acid-base balance, and
resolution of electrolyte imbalances. The nurse should monitor the client's fluid balance, electrolyte
levels, and vital signs during CRRT.
Question 8: A client with a severe head injury is at risk for diabetes insipidus (DI). Which finding
indicates DI?
A) Polyuria and polydipsia with dilute urine
B) Oliguria and hypernatremia with concentrated urine
C) Polyuria and polydipsia with concentrated urine
D) Oliguria and hyponatremia with dilute urine
Answer: A) Polyuria and polydipsia with dilute urine
Rationale: Diabetes insipidus (DI) is characterized by excessive urination (polyuria) and excessive thirst
(polydipsia) with dilute urine (low specific gravity). It is caused by decreased ADH secretion (central DI) or
decreased renal response to ADH (nephrogenic DI). The nurse should monitor urine output, specific
gravity, and serum osmolality, and administer desmopressin (DDAVP) as prescribed for central DI.
Question 9: A client in the ICU is receiving vasopressor therapy (norepinephrine) for septic shock. Which
finding indicates the medication is effective?
