BSN Advanced Medical-Surgical Nursing Exam 5: Critical
Care and Complex Systems 2026 UPDATED ACTUAL
Questions and CORRECT Answers
1. A patient in the ICU is being treated for septic shock. The nurse notes a Mean
Arterial Pressure (MAP) of 58 mmHg. Which action should the nurse prioritize?
A. Increase the rate of the maintenance IV fluids.
B. Place the patient in a High-Fowler’s position.
C. Notify the provider and prepare for vasopressor administration.
D. Document the finding as a normal response to therapy.
Answer: C
Rationale: A MAP of at least 65 mmHg is generally required to maintain adequate organ
perfusion. In septic shock, if fluid resuscitation fails to maintain MAP, vasopressors like
norepinephrine are indicated.
2. Which clinical finding is most indicative of the ‘Early’ or ‘Compensatory’ stage
of shock?
A. Anuria and metabolic acidosis
B. Systolic blood pressure below 80 mmHg
C. Narrowing pulse pressure and tachycardia
D. Absent peripheral pulses and cold, mottled skin
Answer: C
Rationale: During the compensatory stage, the body uses the SNS to maintain cardiac
output. Tachycardia and a narrowing pulse pressure (due to increased SVR) are early signs.
,3. A patient with ARDS is placed on mechanical ventilation with High Positive
End-Expiratory Pressure (PEEP). What is the nurse’s primary concern regarding
high PEEP levels?
A. Increased risk of oxygen toxicity
B. Decreased risk of alveolar collapse
C. Barotrauma and decreased cardiac output
D. Increased pulmonary capillary wedge pressure
Answer: C
Rationale: High levels of PEEP increase intrathoracic pressure, which can lead to
pneumothorax (barotrauma) and decreased venous return, subsequently lowering cardiac
output.
4. A nurse is caring for a patient with a Pulmonary Artery Catheter. The patient’s
Pulmonary Capillary Wedge Pressure (PCWP) is 18 mmHg. This likely indicates:
A. Left-sided heart failure or fluid volume overload
B. Hypovolemic shock
C. Right-sided heart failure
D. Pulmonary embolism
Answer: A
Rationale: Normal PCWP is 4-12 mmHg. An elevation (18 mmHg) suggests left ventricular
end-diastolic pressure is high, common in fluid overload or left heart failure.
5. The nurse is monitoring a patient for ‘Cushing’s Triad’ following a traumatic
brain injury. Which set of vital signs aligns with this condition?
A. Tachycardia, Hypotension, Tachypnea
B. Bradycardia, Hypotension, Cheyne-Stokes respirations
C. Tachycardia, Hypertension, Bradypnea
D. Bradycardia, Hypertension with widening pulse pressure, Irregular respirations
Answer: D
, Rationale: Cushing’s Triad is a late sign of increased ICP consisting of systolic
hypertension (widening pulse pressure), bradycardia, and irregular/altered respirations.
6. A patient with a spinal cord injury at T4 reports a sudden, severe headache
and is profusely sweating above the level of injury. What is the priority nursing
action?
A. Administer an ordered analgesic for the headache.
B. Lower the head of the bed to the flat position.
C. Perform a neurological assessment (GCS).
D. Check the patient’s blood pressure immediately.
Answer: D
Rationale: These are classic signs of Autonomic Dysreflexia, a medical emergency. The first
step is to assess BP, then sit the patient up to lower BP, and find the noxious stimulus
(usually bladder/bowel).
7. Which arterial blood gas (ABG) result reflects partially compensated
respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 28
B. pH 7.45, PaCO2 30, HCO3 20
C. pH 7.35, PaCO2 48, HCO3 26
D. pH 7.28, PaCO2 40, HCO3 18
Answer: A
Rationale: In respiratory acidosis, pH is low and PaCO2 is high. Partial compensation
occurs when the HCO3 rises above normal (26) to buffer the acid, but the pH has not yet
returned to the normal range.
Care and Complex Systems 2026 UPDATED ACTUAL
Questions and CORRECT Answers
1. A patient in the ICU is being treated for septic shock. The nurse notes a Mean
Arterial Pressure (MAP) of 58 mmHg. Which action should the nurse prioritize?
A. Increase the rate of the maintenance IV fluids.
B. Place the patient in a High-Fowler’s position.
C. Notify the provider and prepare for vasopressor administration.
D. Document the finding as a normal response to therapy.
Answer: C
Rationale: A MAP of at least 65 mmHg is generally required to maintain adequate organ
perfusion. In septic shock, if fluid resuscitation fails to maintain MAP, vasopressors like
norepinephrine are indicated.
2. Which clinical finding is most indicative of the ‘Early’ or ‘Compensatory’ stage
of shock?
A. Anuria and metabolic acidosis
B. Systolic blood pressure below 80 mmHg
C. Narrowing pulse pressure and tachycardia
D. Absent peripheral pulses and cold, mottled skin
Answer: C
Rationale: During the compensatory stage, the body uses the SNS to maintain cardiac
output. Tachycardia and a narrowing pulse pressure (due to increased SVR) are early signs.
,3. A patient with ARDS is placed on mechanical ventilation with High Positive
End-Expiratory Pressure (PEEP). What is the nurse’s primary concern regarding
high PEEP levels?
A. Increased risk of oxygen toxicity
B. Decreased risk of alveolar collapse
C. Barotrauma and decreased cardiac output
D. Increased pulmonary capillary wedge pressure
Answer: C
Rationale: High levels of PEEP increase intrathoracic pressure, which can lead to
pneumothorax (barotrauma) and decreased venous return, subsequently lowering cardiac
output.
4. A nurse is caring for a patient with a Pulmonary Artery Catheter. The patient’s
Pulmonary Capillary Wedge Pressure (PCWP) is 18 mmHg. This likely indicates:
A. Left-sided heart failure or fluid volume overload
B. Hypovolemic shock
C. Right-sided heart failure
D. Pulmonary embolism
Answer: A
Rationale: Normal PCWP is 4-12 mmHg. An elevation (18 mmHg) suggests left ventricular
end-diastolic pressure is high, common in fluid overload or left heart failure.
5. The nurse is monitoring a patient for ‘Cushing’s Triad’ following a traumatic
brain injury. Which set of vital signs aligns with this condition?
A. Tachycardia, Hypotension, Tachypnea
B. Bradycardia, Hypotension, Cheyne-Stokes respirations
C. Tachycardia, Hypertension, Bradypnea
D. Bradycardia, Hypertension with widening pulse pressure, Irregular respirations
Answer: D
, Rationale: Cushing’s Triad is a late sign of increased ICP consisting of systolic
hypertension (widening pulse pressure), bradycardia, and irregular/altered respirations.
6. A patient with a spinal cord injury at T4 reports a sudden, severe headache
and is profusely sweating above the level of injury. What is the priority nursing
action?
A. Administer an ordered analgesic for the headache.
B. Lower the head of the bed to the flat position.
C. Perform a neurological assessment (GCS).
D. Check the patient’s blood pressure immediately.
Answer: D
Rationale: These are classic signs of Autonomic Dysreflexia, a medical emergency. The first
step is to assess BP, then sit the patient up to lower BP, and find the noxious stimulus
(usually bladder/bowel).
7. Which arterial blood gas (ABG) result reflects partially compensated
respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 28
B. pH 7.45, PaCO2 30, HCO3 20
C. pH 7.35, PaCO2 48, HCO3 26
D. pH 7.28, PaCO2 40, HCO3 18
Answer: A
Rationale: In respiratory acidosis, pH is low and PaCO2 is high. Partial compensation
occurs when the HCO3 rises above normal (26) to buffer the acid, but the pH has not yet
returned to the normal range.
