Nursing 354 Critical Care Nursing
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
1. A critically ill patient suddenly develops severe dyspnea, hypotension, and
distended neck veins. Which condition should the nurse suspect first?
A. Hypovolemic shock
B. Cardiac tamponade
C. Neurogenic shock
D. Septic shock
Answer: Cardiac tamponade
Rationale: Cardiac tamponade restricts ventricular filling because fluid
accumulates in the pericardial space. Hypotension, jugular venous distention,
and muffled heart sounds are classic findings.
2. Which assessment finding is most concerning in a patient receiving
mechanical ventilation?
,A. Oxygen saturation of 96%
B. Respiratory rate of 18/min
C. Sudden increase in peak airway pressure
D. Heart rate of 82/min
Answer: Sudden increase in peak airway pressure
Rationale: A sudden rise in airway pressure may indicate airway obstruction,
secretions, bronchospasm, decreased lung compliance, or pneumothorax and
requires immediate assessment.
3. A patient with septic shock has a blood pressure of 78/44 mm Hg despite fluid
resuscitation. Which medication is commonly prescribed as the first-line
vasopressor?
A. Norepinephrine
B. Furosemide
C. Digoxin
D. Adenosine
Answer: Norepinephrine
Rationale: Norepinephrine is commonly used as the first-line vasopressor for
persistent hypotension in septic shock after adequate fluid resuscitation.
4. Which finding is most characteristic of left-sided heart failure?
A. Peripheral edema only
B. Jugular venous distention only
C. Pulmonary crackles
D. Enlarged liver
Answer: Pulmonary crackles
Rationale: Left-sided heart failure causes pulmonary congestion, which
commonly produces crackles, dyspnea, and hypoxemia.
,5. Which arterial blood gas result indicates respiratory acidosis?
A. pH 7.50, PaCO₂ 30 mm Hg
B. pH 7.30, PaCO₂ 52 mm Hg
C. pH 7.48, HCO₃⁻ 30 mEq/L
D. pH 7.32, HCO₃⁻ 18 mEq/L
Answer: pH 7.30, PaCO₂ 52 mm Hg
Rationale: Respiratory acidosis is characterized by decreased pH and increased
PaCO₂ because of inadequate ventilation.
6. A patient develops sudden chest pain, hypotension, and absent breath sounds
on the right side. Which condition is most likely?
A. Pulmonary edema
B. Tension pneumothorax
C. Pleural effusion
D. Atelectasis
Answer: Tension pneumothorax
Rationale: Tension pneumothorax can cause sudden respiratory distress,
unilateral absent breath sounds, hypotension, and obstructive shock.
7. Which finding suggests increased intracranial pressure?
A. Bradycardia with widening pulse pressure
B. Tachycardia with narrow pulse pressure
C. Hypotension with tachypnea
D. Fever with diarrhea
Answer: Bradycardia with widening pulse pressure
, Rationale: Bradycardia, widened pulse pressure, and abnormal respirations are
components of Cushing's response and indicate possible increased intracranial
pressure.
8. Which intervention is appropriate for a patient with increased intracranial
pressure?
A. Keep the head flat
B. Encourage frequent coughing
C. Elevate the head of the bed
D. Place the patient in Trendelenburg position
Answer: Elevate the head of the bed
Rationale: Elevating the head of the bed can promote venous drainage from the
brain and help reduce intracranial pressure.
9. Which patient should the critical care nurse assess first?
A. Patient with stable angina reporting mild discomfort
B. Patient with potassium of 6.8 mEq/L and ECG changes
C. Patient requesting assistance with hygiene
D. Patient with chronic back pain
Answer: Patient with potassium of 6.8 mEq/L and ECG changes
Rationale: Severe hyperkalemia with ECG changes can rapidly cause life-
threatening dysrhythmias and requires immediate intervention.
10. Which ECG finding is commonly associated with hyperkalemia?
A. Peaked T waves
B. Prominent U waves
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1. A critically ill patient suddenly develops severe dyspnea, hypotension, and
distended neck veins. Which condition should the nurse suspect first?
A. Hypovolemic shock
B. Cardiac tamponade
C. Neurogenic shock
D. Septic shock
Answer: Cardiac tamponade
Rationale: Cardiac tamponade restricts ventricular filling because fluid
accumulates in the pericardial space. Hypotension, jugular venous distention,
and muffled heart sounds are classic findings.
2. Which assessment finding is most concerning in a patient receiving
mechanical ventilation?
,A. Oxygen saturation of 96%
B. Respiratory rate of 18/min
C. Sudden increase in peak airway pressure
D. Heart rate of 82/min
Answer: Sudden increase in peak airway pressure
Rationale: A sudden rise in airway pressure may indicate airway obstruction,
secretions, bronchospasm, decreased lung compliance, or pneumothorax and
requires immediate assessment.
3. A patient with septic shock has a blood pressure of 78/44 mm Hg despite fluid
resuscitation. Which medication is commonly prescribed as the first-line
vasopressor?
A. Norepinephrine
B. Furosemide
C. Digoxin
D. Adenosine
Answer: Norepinephrine
Rationale: Norepinephrine is commonly used as the first-line vasopressor for
persistent hypotension in septic shock after adequate fluid resuscitation.
4. Which finding is most characteristic of left-sided heart failure?
A. Peripheral edema only
B. Jugular venous distention only
C. Pulmonary crackles
D. Enlarged liver
Answer: Pulmonary crackles
Rationale: Left-sided heart failure causes pulmonary congestion, which
commonly produces crackles, dyspnea, and hypoxemia.
,5. Which arterial blood gas result indicates respiratory acidosis?
A. pH 7.50, PaCO₂ 30 mm Hg
B. pH 7.30, PaCO₂ 52 mm Hg
C. pH 7.48, HCO₃⁻ 30 mEq/L
D. pH 7.32, HCO₃⁻ 18 mEq/L
Answer: pH 7.30, PaCO₂ 52 mm Hg
Rationale: Respiratory acidosis is characterized by decreased pH and increased
PaCO₂ because of inadequate ventilation.
6. A patient develops sudden chest pain, hypotension, and absent breath sounds
on the right side. Which condition is most likely?
A. Pulmonary edema
B. Tension pneumothorax
C. Pleural effusion
D. Atelectasis
Answer: Tension pneumothorax
Rationale: Tension pneumothorax can cause sudden respiratory distress,
unilateral absent breath sounds, hypotension, and obstructive shock.
7. Which finding suggests increased intracranial pressure?
A. Bradycardia with widening pulse pressure
B. Tachycardia with narrow pulse pressure
C. Hypotension with tachypnea
D. Fever with diarrhea
Answer: Bradycardia with widening pulse pressure
, Rationale: Bradycardia, widened pulse pressure, and abnormal respirations are
components of Cushing's response and indicate possible increased intracranial
pressure.
8. Which intervention is appropriate for a patient with increased intracranial
pressure?
A. Keep the head flat
B. Encourage frequent coughing
C. Elevate the head of the bed
D. Place the patient in Trendelenburg position
Answer: Elevate the head of the bed
Rationale: Elevating the head of the bed can promote venous drainage from the
brain and help reduce intracranial pressure.
9. Which patient should the critical care nurse assess first?
A. Patient with stable angina reporting mild discomfort
B. Patient with potassium of 6.8 mEq/L and ECG changes
C. Patient requesting assistance with hygiene
D. Patient with chronic back pain
Answer: Patient with potassium of 6.8 mEq/L and ECG changes
Rationale: Severe hyperkalemia with ECG changes can rapidly cause life-
threatening dysrhythmias and requires immediate intervention.
10. Which ECG finding is commonly associated with hyperkalemia?
A. Peaked T waves
B. Prominent U waves
