RN Critical Care Competency Exam —
Code: RN-CC-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1.
A mechanically ventilated patient with ARDS has a PaO₂ of 54 mmHg despite an
FiO₂ of 0.80 and PEEP of 10 cm H₂O. The patient is hemodynamically stable.
Which intervention should the nurse anticipate?
A. Decrease PEEP to prevent barotrauma
B. Increase tidal volume to 10 mL/kg
C. Initiate prone positioning
D. Administer a rapid crystalloid bolus
Answer: C. Initiate prone positioning
Rationale: Prone positioning improves ventilation-perfusion matching and can
improve oxygenation in severe ARDS. Increasing tidal volume increases
,ventilator-induced lung injury, while reducing PEEP may worsen alveolar
collapse.
2.
A patient receiving norepinephrine for septic shock develops a MAP of 78 mmHg,
urine output of 45 mL/hr, and improving lactate. Which finding best indicates that
the current therapy is effective?
A. Heart rate of 118/min
B. MAP maintained above the target
C. Cool extremities
D. Increasing serum lactate
Answer: B. MAP maintained above the target
Rationale: Maintaining an adequate MAP supports organ perfusion in septic
shock. Urine output and lactate trends are also important indicators, but the
MAP directly reflects the immediate hemodynamic goal.
3.
A patient with an acute myocardial infarction develops pulmonary edema and
hypotension. Which finding is most concerning for cardiogenic shock?
A. Warm extremities and bounding pulses
B. Pulmonary crackles with low cardiac output
C. Increased urine output
D. Bradycardia with hypertension
Answer: B. Pulmonary crackles with low cardiac output
Rationale: Cardiogenic shock results from inadequate cardiac pump function,
producing reduced cardiac output and systemic hypoperfusion. Left ventricular
failure commonly causes pulmonary congestion and crackles.
4.
,A patient with increased intracranial pressure suddenly develops hypertension,
bradycardia, and irregular respirations. How should the nurse interpret these
findings?
A. Neurogenic shock
B. Cushing response
C. Hypovolemic shock
D. Early septic shock
Answer: B. Cushing response
Rationale: Hypertension with widening pulse pressure, bradycardia, and
abnormal respirations is the classic Cushing response and indicates critically
increased intracranial pressure with possible brainstem compression.
5.
A patient with severe traumatic brain injury has an ICP of 24 mmHg. Which
nursing intervention is most appropriate?
A. Keep the head flat
B. Maintain the neck in neutral alignment
C. Encourage frequent coughing
D. Place the patient in Trendelenburg position
Answer: B. Maintain the neck in neutral alignment
Rationale: Neutral head and neck alignment promotes cerebral venous drainage
and can reduce ICP. Head-down positioning and coughing may increase
intracranial pressure.
6.
A patient with diabetic ketoacidosis is receiving IV insulin. Which laboratory
finding requires the most immediate attention before continuing the insulin
infusion?
, A. Glucose 280 mg/dL
B. Potassium 2.8 mEq/L
C. Sodium 134 mEq/L
D. Bicarbonate 16 mEq/L
Answer: B. Potassium 2.8 mEq/L
Rationale: Insulin drives potassium into cells and can cause life-threatening
hypokalemia. Severe hypokalemia must be corrected before insulin is continued.
7.
A patient develops pulseless ventricular tachycardia. What is the priority
intervention?
A. Synchronized cardioversion
B. Defibrillation
C. Adenosine administration
D. Atropine administration
Answer: B. Defibrillation
Rationale: Pulseless ventricular tachycardia is a shockable cardiac arrest
rhythm. Immediate unsynchronized defibrillation combined with high-quality
CPR is indicated.
8.
A patient with atrial fibrillation has a ventricular rate of 168/min, BP 72/40 mmHg,
chest pain, and altered mental status. What is the priority treatment?
A. Oral beta blocker
B. IV adenosine
C. Synchronized cardioversion
D. Vagal maneuvers
Answer: C. Synchronized cardioversion
Code: RN-CC-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1.
A mechanically ventilated patient with ARDS has a PaO₂ of 54 mmHg despite an
FiO₂ of 0.80 and PEEP of 10 cm H₂O. The patient is hemodynamically stable.
Which intervention should the nurse anticipate?
A. Decrease PEEP to prevent barotrauma
B. Increase tidal volume to 10 mL/kg
C. Initiate prone positioning
D. Administer a rapid crystalloid bolus
Answer: C. Initiate prone positioning
Rationale: Prone positioning improves ventilation-perfusion matching and can
improve oxygenation in severe ARDS. Increasing tidal volume increases
,ventilator-induced lung injury, while reducing PEEP may worsen alveolar
collapse.
2.
A patient receiving norepinephrine for septic shock develops a MAP of 78 mmHg,
urine output of 45 mL/hr, and improving lactate. Which finding best indicates that
the current therapy is effective?
A. Heart rate of 118/min
B. MAP maintained above the target
C. Cool extremities
D. Increasing serum lactate
Answer: B. MAP maintained above the target
Rationale: Maintaining an adequate MAP supports organ perfusion in septic
shock. Urine output and lactate trends are also important indicators, but the
MAP directly reflects the immediate hemodynamic goal.
3.
A patient with an acute myocardial infarction develops pulmonary edema and
hypotension. Which finding is most concerning for cardiogenic shock?
A. Warm extremities and bounding pulses
B. Pulmonary crackles with low cardiac output
C. Increased urine output
D. Bradycardia with hypertension
Answer: B. Pulmonary crackles with low cardiac output
Rationale: Cardiogenic shock results from inadequate cardiac pump function,
producing reduced cardiac output and systemic hypoperfusion. Left ventricular
failure commonly causes pulmonary congestion and crackles.
4.
,A patient with increased intracranial pressure suddenly develops hypertension,
bradycardia, and irregular respirations. How should the nurse interpret these
findings?
A. Neurogenic shock
B. Cushing response
C. Hypovolemic shock
D. Early septic shock
Answer: B. Cushing response
Rationale: Hypertension with widening pulse pressure, bradycardia, and
abnormal respirations is the classic Cushing response and indicates critically
increased intracranial pressure with possible brainstem compression.
5.
A patient with severe traumatic brain injury has an ICP of 24 mmHg. Which
nursing intervention is most appropriate?
A. Keep the head flat
B. Maintain the neck in neutral alignment
C. Encourage frequent coughing
D. Place the patient in Trendelenburg position
Answer: B. Maintain the neck in neutral alignment
Rationale: Neutral head and neck alignment promotes cerebral venous drainage
and can reduce ICP. Head-down positioning and coughing may increase
intracranial pressure.
6.
A patient with diabetic ketoacidosis is receiving IV insulin. Which laboratory
finding requires the most immediate attention before continuing the insulin
infusion?
, A. Glucose 280 mg/dL
B. Potassium 2.8 mEq/L
C. Sodium 134 mEq/L
D. Bicarbonate 16 mEq/L
Answer: B. Potassium 2.8 mEq/L
Rationale: Insulin drives potassium into cells and can cause life-threatening
hypokalemia. Severe hypokalemia must be corrected before insulin is continued.
7.
A patient develops pulseless ventricular tachycardia. What is the priority
intervention?
A. Synchronized cardioversion
B. Defibrillation
C. Adenosine administration
D. Atropine administration
Answer: B. Defibrillation
Rationale: Pulseless ventricular tachycardia is a shockable cardiac arrest
rhythm. Immediate unsynchronized defibrillation combined with high-quality
CPR is indicated.
8.
A patient with atrial fibrillation has a ventricular rate of 168/min, BP 72/40 mmHg,
chest pain, and altered mental status. What is the priority treatment?
A. Oral beta blocker
B. IV adenosine
C. Synchronized cardioversion
D. Vagal maneuvers
Answer: C. Synchronized cardioversion
