FLORIDA BOARD OF NURSING CRITICAL
CARE NURSING CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1.
A 68-year-old patient is admitted to the ICU with septic shock secondary
to pneumonia. After receiving initial crystalloid resuscitation, the
patient's blood pressure remains 82/48 mmHg, MAP is 59 mmHg, urine
output is 10 mL/hr, and lactate is 4.8 mmol/L. A norepinephrine infusion
has been prescribed. Which assessment finding most strongly indicates
that the vasopressor therapy is achieving its immediate hemodynamic
goal?
A. Heart rate decreases from 118/min to 96/min
B. MAP increases to approximately 68–70 mmHg with improving
peripheral perfusion
C. Temperature decreases from 39.4°C to 38.2°C
D. White blood cell count decreases from 24,000/mm³ to 18,000/mm³
Answer: B. MAP increases to approximately 68–70 mmHg with
improving peripheral perfusion
Rationale: In septic shock, restoration of adequate arterial pressure
and tissue perfusion is an immediate priority. A MAP around 65
mmHg is a common initial target for many adults receiving
vasopressors, although targets may be individualized. Improving
capillary refill, mental status, urine output, and other perfusion
markers provides additional evidence that hemodynamic support is
1
,effective. Heart rate, temperature, and WBC count may change for
many reasons and are not the best immediate indicators of successful
vasopressor therapy.
2.
A mechanically ventilated patient suddenly develops a high-pressure
alarm. The patient's oxygen saturation falls from 97% to 86%, and the
ventilator displays markedly increased peak airway pressure. Which
nursing action should occur first?
A. Increase the PEEP
B. Immediately administer a sedative
C. Assess the patient and ventilator tubing for obstruction or
disconnection while providing appropriate oxygenation support
D. Decrease the tidal volume without assessing the patient
Answer: C. Assess the patient and ventilator tubing for obstruction
or disconnection while providing appropriate oxygenation support
Rationale: A sudden high-pressure alarm accompanied by
desaturation requires immediate patient assessment. Causes include
secretions, bronchospasm, biting of the endotracheal tube, kinked
tubing, decreased lung compliance, or pneumothorax. The nurse
should rapidly assess the patient, airway, tubing, breath sounds, and
ventilator while maintaining oxygenation. Adjusting ventilator settings
without identifying the cause can delay treatment of a potentially life-
threatening airway or respiratory problem.
3.
A patient with acute respiratory distress syndrome is receiving
mechanical ventilation. The ventilator is set to provide a low tidal
2
,volume based on predicted body weight. Which physiologic rationale
best explains this strategy?
A. It eliminates the need for PEEP
B. It reduces ventilator-induced lung injury from excessive alveolar
stretch
C. It increases airway resistance to prevent atelectasis
D. It guarantees normalization of arterial carbon dioxide
Answer: B. It reduces ventilator-induced lung injury from excessive
alveolar stretch
Rationale: Lung-protective ventilation in ARDS uses relatively low
tidal volumes based on predicted body weight to reduce volutrauma
and excessive alveolar stretch. Appropriate PEEP and oxygenation
strategies remain important. Carbon dioxide may increase with
permissive hypercapnia, depending on the clinical situation;
normalization of PaCO₂ is not the primary objective when lung-
protective ventilation is being used.
4.
A patient develops atrial fibrillation with a ventricular rate of 168/min.
The patient is pale, diaphoretic, confused, and has a blood pressure of
74/42 mmHg with chest discomfort. Which intervention should the
critical care nurse anticipate as the priority?
A. Oral anticoagulation only
B. Synchronized cardioversion
C. Vagal maneuvers
D. Observation for spontaneous conversion
Answer: B. Synchronized cardioversion
Rationale: Atrial fibrillation accompanied by hypotension, altered
mental status, and ischemic symptoms represents an unstable
3
, tachyarrhythmia. Immediate synchronized cardioversion is generally
indicated for an unstable patient. Anticoagulation and longer-term
rhythm or rate management may subsequently be addressed, but they
do not take priority over immediate stabilization of life-threatening
hemodynamic instability.
5.
A patient with an acute myocardial infarction develops hypotension,
cool clammy skin, oliguria, pulmonary crackles, and an elevated
pulmonary artery occlusion pressure. Which type of shock is most
likely?
A. Hypovolemic shock
B. Cardiogenic shock
C. Neurogenic shock
D. Distributive shock
Answer: B. Cardiogenic shock
Rationale: Cardiogenic shock results from inadequate cardiac pump
function. Reduced cardiac output causes systemic hypoperfusion,
while left ventricular failure commonly produces pulmonary
congestion and elevated filling pressures. The combination of
myocardial infarction, hypotension, cool skin, oliguria, pulmonary
edema, and increased left-sided filling pressure strongly supports
cardiogenic shock.
6.
A patient with severe traumatic blood loss has a heart rate of 132/min,
blood pressure of 82/46 mmHg, cool clammy skin, delayed capillary
refill, and decreased urine output. Which hemodynamic pattern is most
consistent with hypovolemic shock?
4
CARE NURSING CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1.
A 68-year-old patient is admitted to the ICU with septic shock secondary
to pneumonia. After receiving initial crystalloid resuscitation, the
patient's blood pressure remains 82/48 mmHg, MAP is 59 mmHg, urine
output is 10 mL/hr, and lactate is 4.8 mmol/L. A norepinephrine infusion
has been prescribed. Which assessment finding most strongly indicates
that the vasopressor therapy is achieving its immediate hemodynamic
goal?
A. Heart rate decreases from 118/min to 96/min
B. MAP increases to approximately 68–70 mmHg with improving
peripheral perfusion
C. Temperature decreases from 39.4°C to 38.2°C
D. White blood cell count decreases from 24,000/mm³ to 18,000/mm³
Answer: B. MAP increases to approximately 68–70 mmHg with
improving peripheral perfusion
Rationale: In septic shock, restoration of adequate arterial pressure
and tissue perfusion is an immediate priority. A MAP around 65
mmHg is a common initial target for many adults receiving
vasopressors, although targets may be individualized. Improving
capillary refill, mental status, urine output, and other perfusion
markers provides additional evidence that hemodynamic support is
1
,effective. Heart rate, temperature, and WBC count may change for
many reasons and are not the best immediate indicators of successful
vasopressor therapy.
2.
A mechanically ventilated patient suddenly develops a high-pressure
alarm. The patient's oxygen saturation falls from 97% to 86%, and the
ventilator displays markedly increased peak airway pressure. Which
nursing action should occur first?
A. Increase the PEEP
B. Immediately administer a sedative
C. Assess the patient and ventilator tubing for obstruction or
disconnection while providing appropriate oxygenation support
D. Decrease the tidal volume without assessing the patient
Answer: C. Assess the patient and ventilator tubing for obstruction
or disconnection while providing appropriate oxygenation support
Rationale: A sudden high-pressure alarm accompanied by
desaturation requires immediate patient assessment. Causes include
secretions, bronchospasm, biting of the endotracheal tube, kinked
tubing, decreased lung compliance, or pneumothorax. The nurse
should rapidly assess the patient, airway, tubing, breath sounds, and
ventilator while maintaining oxygenation. Adjusting ventilator settings
without identifying the cause can delay treatment of a potentially life-
threatening airway or respiratory problem.
3.
A patient with acute respiratory distress syndrome is receiving
mechanical ventilation. The ventilator is set to provide a low tidal
2
,volume based on predicted body weight. Which physiologic rationale
best explains this strategy?
A. It eliminates the need for PEEP
B. It reduces ventilator-induced lung injury from excessive alveolar
stretch
C. It increases airway resistance to prevent atelectasis
D. It guarantees normalization of arterial carbon dioxide
Answer: B. It reduces ventilator-induced lung injury from excessive
alveolar stretch
Rationale: Lung-protective ventilation in ARDS uses relatively low
tidal volumes based on predicted body weight to reduce volutrauma
and excessive alveolar stretch. Appropriate PEEP and oxygenation
strategies remain important. Carbon dioxide may increase with
permissive hypercapnia, depending on the clinical situation;
normalization of PaCO₂ is not the primary objective when lung-
protective ventilation is being used.
4.
A patient develops atrial fibrillation with a ventricular rate of 168/min.
The patient is pale, diaphoretic, confused, and has a blood pressure of
74/42 mmHg with chest discomfort. Which intervention should the
critical care nurse anticipate as the priority?
A. Oral anticoagulation only
B. Synchronized cardioversion
C. Vagal maneuvers
D. Observation for spontaneous conversion
Answer: B. Synchronized cardioversion
Rationale: Atrial fibrillation accompanied by hypotension, altered
mental status, and ischemic symptoms represents an unstable
3
, tachyarrhythmia. Immediate synchronized cardioversion is generally
indicated for an unstable patient. Anticoagulation and longer-term
rhythm or rate management may subsequently be addressed, but they
do not take priority over immediate stabilization of life-threatening
hemodynamic instability.
5.
A patient with an acute myocardial infarction develops hypotension,
cool clammy skin, oliguria, pulmonary crackles, and an elevated
pulmonary artery occlusion pressure. Which type of shock is most
likely?
A. Hypovolemic shock
B. Cardiogenic shock
C. Neurogenic shock
D. Distributive shock
Answer: B. Cardiogenic shock
Rationale: Cardiogenic shock results from inadequate cardiac pump
function. Reduced cardiac output causes systemic hypoperfusion,
while left ventricular failure commonly produces pulmonary
congestion and elevated filling pressures. The combination of
myocardial infarction, hypotension, cool skin, oliguria, pulmonary
edema, and increased left-sided filling pressure strongly supports
cardiogenic shock.
6.
A patient with severe traumatic blood loss has a heart rate of 132/min,
blood pressure of 82/46 mmHg, cool clammy skin, delayed capillary
refill, and decreased urine output. Which hemodynamic pattern is most
consistent with hypovolemic shock?
4
