[Critical Care Nursing] COMPLETE EXAM QUESTIONS AND
VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A 68-year-old patient is admitted to the intensive care unit with severe sepsis secondary to
pneumonia. The patient is hypotensive despite a 30 mL/kg fluid bolus and requires vasopressor
support. Which of the following clinical findings would be the most sensitive indicator of the
patient's response to fluid resuscitation?
A. Increase in mean arterial pressure to 65 mmHg
B. Decrease in serum lactate level
C. Increase in central venous pressure to 12 mmHg
D. Decrease in heart rate to 100 beats per minute
Correct Answer: B. Decrease in serum lactate level
Rationale: Serum lactate is a marker of tissue hypoperfusion and is a sensitive indicator of the
effectiveness of fluid resuscitation in septic shock. A decreasing lactate trend suggests improved
tissue perfusion and oxygen delivery. While an increase in MAP to 65 mmHg is a target, it can be
influenced by vasopressors and may not reflect true microcirculatory improvement. An increase in
CVP is a poor predictor of fluid responsiveness. A decrease in heart rate can be a non-specific finding
influenced by many factors.
2. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. The
provider orders a lung-protective ventilation strategy. Which set of ventilator settings best
achieves this goal?
A. Tidal volume 10 mL/kg PBW, PEEP 5 cm H₂O, Plateau pressure < 30 cm H₂O
B. Tidal volume 8 mL/kg PBW, PEEP 10 cm H₂O, Plateau pressure < 35 cm H₂O
C. Tidal volume 6 mL/kg PBW, PEEP 12 cm H₂O, Plateau pressure < 30 cm H₂O
D. Tidal volume 12 mL/kg PBW, PEEP 8 cm H₂O, Plateau pressure < 25 cm H₂O
Correct Answer: C. Tidal volume 6 mL/kg PBW, PEEP 12 cm H₂O, Plateau pressure < 30 cm H₂O
Rationale: The ARDSNet protocol recommends a low tidal volume (6 mL/kg of predicted body weight)
and a plateau pressure of ≤ 30 cm H₂O to prevent ventilator-induced lung injury. Higher PEEP is often
used to recruit and stabilize alveoli, although the optimal level is individualized. Option A uses a tidal
volume that is too high, option B's plateau pressure target is too high, and option D's tidal volume is
dangerously high.
3. A nurse is assessing a patient who has just undergone a pericardiocentesis for cardiac
tamponade. Which finding would indicate a successful procedure and resolution of the
tamponade?
A. Increased jugular venous pressure
B. Muffled heart sounds
,C. Improvement in pulsus paradoxus
D. Narrowing pulse pressure
Correct Answer: C. Improvement in pulsus paradoxus
Rationale: Pulsus paradoxus, an exaggerated decrease in systolic blood pressure during inspiration, is
a classic sign of cardiac tamponade. Successful pericardiocentesis removes fluid from the pericardial
sac, relieving the compression on the heart and allowing normal cardiac filling. This would be
reflected by a decrease or resolution of pulsus paradoxus. Increased JVP, muffled heart sounds, and
narrowing pulse pressure are all signs of worsening tamponade.
4. In the management of a patient with status epilepticus, which of the following is the primary
goal of pharmacologic intervention?
A. Achieve a deep level of sedation
B. Terminate all seizure activity on the electroencephalogram (EEG)
C. Prevent neuronal injury from prolonged seizure activity
D. Maintain a Glasgow Coma Scale score of 15
Correct Answer: C. Prevent neuronal injury from prolonged seizure activity
Rationale: The primary goal of pharmacologic treatment for status epilepticus is the rapid
termination of clinical and electrical seizure activity to prevent irreversible neuronal damage and
systemic complications. While achieving a burst-suppression pattern on EEG may be a goal for
refractory status epilepticus, it is not the primary initial goal. Maintaining a GCS of 15 is unrealistic
and sedation is a side effect, not a primary goal.
5. A nurse is caring for a patient with a pulmonary artery catheter. The waveform displayed shows
a characteristic "a" wave. Which event is responsible for the generation of this waveform?
A. Right ventricular contraction
B. Tricuspid valve closure
C. Atrial contraction
D. Pulmonary valve opening
Correct Answer: C. Atrial contraction
Rationale: In a pulmonary artery wedge pressure (PAWP) tracing, the "a" wave corresponds to atrial
systole (contraction). Following the "a" wave, the "c" wave is caused by the bulging of the tricuspid
valve into the right atrium during right ventricular systole, and the "v" wave reflects passive atrial
filling against a closed tricuspid valve during ventricular systole.
6. A patient with a severe traumatic brain injury (TBI) has an intracranial pressure (ICP) monitor in
place. The nurse notes a sudden increase in ICP from 16 to 28 mmHg. What is the nurse's priority
action?
A. Administer a bolus of hypertonic saline
B. Raise the head of the bed to 90 degrees
C. Assess the patient for signs of herniation
D. Notify the provider immediately
Correct Answer: C. Assess the patient for signs of herniation
Rationale: A sudden increase in ICP is a critical event that can precipitate brain herniation. The
nurse's priority is to perform a rapid neurologic assessment, including pupillary response and motor
function, to evaluate for herniation syndromes (e.g., Cushing's triad, posturing, unilateral pupillary
,dilation). While hypertonic saline, elevating the head of the bed, and notifying the provider are all
appropriate interventions, a focused assessment to determine the cause and severity of the elevation
must take precedence to guide immediate action.
7. A patient is admitted with diabetic ketoacidosis (DKA). The initial blood glucose is 650 mg/dL
and serum potassium is 5.5 mEq/L. Which of the following is the most appropriate initial
intervention regarding potassium replacement?
A. Begin IV potassium replacement immediately
B. Hold potassium replacement until the patient is urinating
C. Hold potassium replacement until the serum glucose drops below 250 mg/dL
D. Do not initiate potassium replacement at this time
Correct Answer: D. Do not initiate potassium replacement at this time
Rationale: In DKA, patients often have a total body potassium deficit, but serum levels may be
elevated or normal due to acidosis causing a shift of potassium out of cells. With a serum potassium
of 5.5 mEq/L, it is unsafe to administer potassium replacement as it could precipitate hyperkalemia.
Replacement should be initiated once the serum potassium falls below the normal range, typically 5.0
mEq/L, and the patient has adequate urine output.
8. A patient receiving enteral nutrition via a nasogastric tube has a gastric residual volume (GRV) of
250 mL. What is the nurse's most appropriate intervention?
A. Discard the residual and continue the infusion at the same rate
B. Hold the feeding and notify the provider
C. Reinstill the residual and continue the infusion
D. Hold the feeding and check the residual again in 1 hour
Correct Answer: C. Reinstill the residual and continue the infusion
Rationale: Current guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN)
recommend that GRVs of < 500 mL should not automatically halt enteral feedings unless there are
other signs of intolerance. Reinstilling GRVs is recommended to prevent loss of electrolytes and
enzymes. The residual should be reinstilled and the feeding continued. Holding the feeding is not
indicated for a GRV of 250 mL.
9. A patient is being treated with therapeutic hypothermia after a cardiac arrest. The nurse is
monitoring for the most common complication associated with this therapy. Which complication is
the nurse most likely to observe?
A. Hyperglycemia
B. Seizures
C. Shivering
D. Coagulopathy
Correct Answer: C. Shivering
Rationale: Shivering is the most common and often most difficult complication to manage during
therapeutic hypothermia. It is a physiologic response to cold that increases metabolic demand and
can counteract the intended neuroprotective effects. While hyperglycemia, seizures, and
coagulopathy are all potential complications, shivering is the most frequently observed.
10. A nurse is preparing to administer a thrombolytic agent to a patient with an acute ST-segment
elevation myocardial infarction (STEMI). Which of the following is an absolute contraindication to
, the administration of this therapy?
A. Age greater than 75 years
B. History of chronic hypertension
C. Prior cerebrovascular accident (CVA) within 3 months
D. Systolic blood pressure of 160 mmHg
Correct Answer: C. Prior cerebrovascular accident (CVA) within 3 months
Rationale: A prior CVA within the last 3 months is an absolute contraindication to thrombolytic
therapy due to the significant risk of intracranial hemorrhage. Other absolute contraindications
include active internal bleeding, suspected aortic dissection, and significant closed head/facial
trauma within 3 months. Age >75, a history of hypertension, and a systolic BP of 160 are relative, not
absolute, contraindications.
11. A patient is being mechanically ventilated in the assist-control (AC) mode with a set tidal
volume of 500 mL. The patient triggers a breath. What is the volume delivered during this patient-
triggered breath?
A. Less than 500 mL, determined by patient effort
B. 500 mL
C. More than 500 mL, due to the patient's effort
D. Determined by the patient's inspiratory flow rate
Correct Answer: B. 500 mL
Rationale: In assist-control (AC) ventilation, every breath delivered by the ventilator, whether patient-
triggered or machine-triggered, delivers the set tidal volume. The patient's effort determines the
trigger and the inspiratory flow rate, but the volume delivered is the preset mandatory volume. This
distinguishes AC from pressure support or other modes where the volume is dependent on patient
effort.
12. A patient is admitted with acute liver failure and has an elevated ammonia level. Which
medication is most likely to be administered to help reduce the serum ammonia concentration?
A. N-acetylcysteine
B. Lactulose
C. Rifaximin
D. Vitamin K
Correct Answer: B. Lactulose
Rationale: Lactulose is a non-absorbable disaccharide that acidifies the colonic lumen, converting
ammonia (NH3) to the less-absorbable ammonium ion (NH4+), which is then excreted in the stool. It
also promotes bacterial uptake of ammonia. Rifaximin is an antibiotic that reduces ammonia-
producing gut flora, often used in conjunction with lactulose. N-acetylcysteine is used for
acetaminophen toxicity, and Vitamin K is used for coagulopathy, not elevated ammonia.
13. A patient who has sustained a cervical spinal cord injury at the C4 level is at high risk for which
of the following life-threatening complications?
A. Autonomic dysreflexia
B. Neurogenic shock
C. Spinal shock
D. Cauda equina syndrome
VERIFIED ANSWERS | 2026–2027 LATEST UPDATE |
GUARANTEED PASS | DETAILED RATIONALES | FULL STUDY
GUIDE | EXAM PREP | PRACTICE TEST | CERTIFICATION
PREPARATION
Section One: Questions 1–100
1. A 68-year-old patient is admitted to the intensive care unit with severe sepsis secondary to
pneumonia. The patient is hypotensive despite a 30 mL/kg fluid bolus and requires vasopressor
support. Which of the following clinical findings would be the most sensitive indicator of the
patient's response to fluid resuscitation?
A. Increase in mean arterial pressure to 65 mmHg
B. Decrease in serum lactate level
C. Increase in central venous pressure to 12 mmHg
D. Decrease in heart rate to 100 beats per minute
Correct Answer: B. Decrease in serum lactate level
Rationale: Serum lactate is a marker of tissue hypoperfusion and is a sensitive indicator of the
effectiveness of fluid resuscitation in septic shock. A decreasing lactate trend suggests improved
tissue perfusion and oxygen delivery. While an increase in MAP to 65 mmHg is a target, it can be
influenced by vasopressors and may not reflect true microcirculatory improvement. An increase in
CVP is a poor predictor of fluid responsiveness. A decrease in heart rate can be a non-specific finding
influenced by many factors.
2. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. The
provider orders a lung-protective ventilation strategy. Which set of ventilator settings best
achieves this goal?
A. Tidal volume 10 mL/kg PBW, PEEP 5 cm H₂O, Plateau pressure < 30 cm H₂O
B. Tidal volume 8 mL/kg PBW, PEEP 10 cm H₂O, Plateau pressure < 35 cm H₂O
C. Tidal volume 6 mL/kg PBW, PEEP 12 cm H₂O, Plateau pressure < 30 cm H₂O
D. Tidal volume 12 mL/kg PBW, PEEP 8 cm H₂O, Plateau pressure < 25 cm H₂O
Correct Answer: C. Tidal volume 6 mL/kg PBW, PEEP 12 cm H₂O, Plateau pressure < 30 cm H₂O
Rationale: The ARDSNet protocol recommends a low tidal volume (6 mL/kg of predicted body weight)
and a plateau pressure of ≤ 30 cm H₂O to prevent ventilator-induced lung injury. Higher PEEP is often
used to recruit and stabilize alveoli, although the optimal level is individualized. Option A uses a tidal
volume that is too high, option B's plateau pressure target is too high, and option D's tidal volume is
dangerously high.
3. A nurse is assessing a patient who has just undergone a pericardiocentesis for cardiac
tamponade. Which finding would indicate a successful procedure and resolution of the
tamponade?
A. Increased jugular venous pressure
B. Muffled heart sounds
,C. Improvement in pulsus paradoxus
D. Narrowing pulse pressure
Correct Answer: C. Improvement in pulsus paradoxus
Rationale: Pulsus paradoxus, an exaggerated decrease in systolic blood pressure during inspiration, is
a classic sign of cardiac tamponade. Successful pericardiocentesis removes fluid from the pericardial
sac, relieving the compression on the heart and allowing normal cardiac filling. This would be
reflected by a decrease or resolution of pulsus paradoxus. Increased JVP, muffled heart sounds, and
narrowing pulse pressure are all signs of worsening tamponade.
4. In the management of a patient with status epilepticus, which of the following is the primary
goal of pharmacologic intervention?
A. Achieve a deep level of sedation
B. Terminate all seizure activity on the electroencephalogram (EEG)
C. Prevent neuronal injury from prolonged seizure activity
D. Maintain a Glasgow Coma Scale score of 15
Correct Answer: C. Prevent neuronal injury from prolonged seizure activity
Rationale: The primary goal of pharmacologic treatment for status epilepticus is the rapid
termination of clinical and electrical seizure activity to prevent irreversible neuronal damage and
systemic complications. While achieving a burst-suppression pattern on EEG may be a goal for
refractory status epilepticus, it is not the primary initial goal. Maintaining a GCS of 15 is unrealistic
and sedation is a side effect, not a primary goal.
5. A nurse is caring for a patient with a pulmonary artery catheter. The waveform displayed shows
a characteristic "a" wave. Which event is responsible for the generation of this waveform?
A. Right ventricular contraction
B. Tricuspid valve closure
C. Atrial contraction
D. Pulmonary valve opening
Correct Answer: C. Atrial contraction
Rationale: In a pulmonary artery wedge pressure (PAWP) tracing, the "a" wave corresponds to atrial
systole (contraction). Following the "a" wave, the "c" wave is caused by the bulging of the tricuspid
valve into the right atrium during right ventricular systole, and the "v" wave reflects passive atrial
filling against a closed tricuspid valve during ventricular systole.
6. A patient with a severe traumatic brain injury (TBI) has an intracranial pressure (ICP) monitor in
place. The nurse notes a sudden increase in ICP from 16 to 28 mmHg. What is the nurse's priority
action?
A. Administer a bolus of hypertonic saline
B. Raise the head of the bed to 90 degrees
C. Assess the patient for signs of herniation
D. Notify the provider immediately
Correct Answer: C. Assess the patient for signs of herniation
Rationale: A sudden increase in ICP is a critical event that can precipitate brain herniation. The
nurse's priority is to perform a rapid neurologic assessment, including pupillary response and motor
function, to evaluate for herniation syndromes (e.g., Cushing's triad, posturing, unilateral pupillary
,dilation). While hypertonic saline, elevating the head of the bed, and notifying the provider are all
appropriate interventions, a focused assessment to determine the cause and severity of the elevation
must take precedence to guide immediate action.
7. A patient is admitted with diabetic ketoacidosis (DKA). The initial blood glucose is 650 mg/dL
and serum potassium is 5.5 mEq/L. Which of the following is the most appropriate initial
intervention regarding potassium replacement?
A. Begin IV potassium replacement immediately
B. Hold potassium replacement until the patient is urinating
C. Hold potassium replacement until the serum glucose drops below 250 mg/dL
D. Do not initiate potassium replacement at this time
Correct Answer: D. Do not initiate potassium replacement at this time
Rationale: In DKA, patients often have a total body potassium deficit, but serum levels may be
elevated or normal due to acidosis causing a shift of potassium out of cells. With a serum potassium
of 5.5 mEq/L, it is unsafe to administer potassium replacement as it could precipitate hyperkalemia.
Replacement should be initiated once the serum potassium falls below the normal range, typically 5.0
mEq/L, and the patient has adequate urine output.
8. A patient receiving enteral nutrition via a nasogastric tube has a gastric residual volume (GRV) of
250 mL. What is the nurse's most appropriate intervention?
A. Discard the residual and continue the infusion at the same rate
B. Hold the feeding and notify the provider
C. Reinstill the residual and continue the infusion
D. Hold the feeding and check the residual again in 1 hour
Correct Answer: C. Reinstill the residual and continue the infusion
Rationale: Current guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN)
recommend that GRVs of < 500 mL should not automatically halt enteral feedings unless there are
other signs of intolerance. Reinstilling GRVs is recommended to prevent loss of electrolytes and
enzymes. The residual should be reinstilled and the feeding continued. Holding the feeding is not
indicated for a GRV of 250 mL.
9. A patient is being treated with therapeutic hypothermia after a cardiac arrest. The nurse is
monitoring for the most common complication associated with this therapy. Which complication is
the nurse most likely to observe?
A. Hyperglycemia
B. Seizures
C. Shivering
D. Coagulopathy
Correct Answer: C. Shivering
Rationale: Shivering is the most common and often most difficult complication to manage during
therapeutic hypothermia. It is a physiologic response to cold that increases metabolic demand and
can counteract the intended neuroprotective effects. While hyperglycemia, seizures, and
coagulopathy are all potential complications, shivering is the most frequently observed.
10. A nurse is preparing to administer a thrombolytic agent to a patient with an acute ST-segment
elevation myocardial infarction (STEMI). Which of the following is an absolute contraindication to
, the administration of this therapy?
A. Age greater than 75 years
B. History of chronic hypertension
C. Prior cerebrovascular accident (CVA) within 3 months
D. Systolic blood pressure of 160 mmHg
Correct Answer: C. Prior cerebrovascular accident (CVA) within 3 months
Rationale: A prior CVA within the last 3 months is an absolute contraindication to thrombolytic
therapy due to the significant risk of intracranial hemorrhage. Other absolute contraindications
include active internal bleeding, suspected aortic dissection, and significant closed head/facial
trauma within 3 months. Age >75, a history of hypertension, and a systolic BP of 160 are relative, not
absolute, contraindications.
11. A patient is being mechanically ventilated in the assist-control (AC) mode with a set tidal
volume of 500 mL. The patient triggers a breath. What is the volume delivered during this patient-
triggered breath?
A. Less than 500 mL, determined by patient effort
B. 500 mL
C. More than 500 mL, due to the patient's effort
D. Determined by the patient's inspiratory flow rate
Correct Answer: B. 500 mL
Rationale: In assist-control (AC) ventilation, every breath delivered by the ventilator, whether patient-
triggered or machine-triggered, delivers the set tidal volume. The patient's effort determines the
trigger and the inspiratory flow rate, but the volume delivered is the preset mandatory volume. This
distinguishes AC from pressure support or other modes where the volume is dependent on patient
effort.
12. A patient is admitted with acute liver failure and has an elevated ammonia level. Which
medication is most likely to be administered to help reduce the serum ammonia concentration?
A. N-acetylcysteine
B. Lactulose
C. Rifaximin
D. Vitamin K
Correct Answer: B. Lactulose
Rationale: Lactulose is a non-absorbable disaccharide that acidifies the colonic lumen, converting
ammonia (NH3) to the less-absorbable ammonium ion (NH4+), which is then excreted in the stool. It
also promotes bacterial uptake of ammonia. Rifaximin is an antibiotic that reduces ammonia-
producing gut flora, often used in conjunction with lactulose. N-acetylcysteine is used for
acetaminophen toxicity, and Vitamin K is used for coagulopathy, not elevated ammonia.
13. A patient who has sustained a cervical spinal cord injury at the C4 level is at high risk for which
of the following life-threatening complications?
A. Autonomic dysreflexia
B. Neurogenic shock
C. Spinal shock
D. Cauda equina syndrome
