NGN HESI RN CRITICAL CARE V2
EXAM QUESTIONS AND ANSWERS
1. A patient with a pulmonary artery catheter has a pulmonary artery wedge pressure
(PAWP) of 26 mmHg. Which clinical assessment finding is the nurse most likely to observe?
A. Decreased capillary refill and bounding pulses
B. Increased urinary output and flat neck veins
C. Jugular venous distention and bilateral crackles
D. Hyperactive bowel sounds and hypertension
Answer: C
Conceptual Explanation: A PAWP of 26 mmHg is significantly elevated (normal is 6-12
mmHg), indicating left ventricular failure or fluid volume overload, which leads to
pulmonary congestion (crackles) and backup into the systemic venous system (JVD).
2. A patient on mechanical ventilation is receiving PEEP of 15 cm H2O. Which complication
should the nurse prioritize for monitoring?
A. Increased cardiac output
B. Barotrauma and pneumothorax
,C. Respiratory alkalosis
D. Decreased intracranial pressure
Answer: B
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which puts
the patient at risk for barotrauma, such as a pneumothorax, and can also decrease cardiac
output by reducing venous return.
3. The nurse is assessing a patient with a traumatic brain injury and notes a blood pressure of
180/60, heart rate of 48, and irregular respirations. What is the priority nursing action?
A. Prepare for immediate intubation and notification of the neurosurgeon
B. Administer a beta-blocker to lower the heart rate
C. Increase the IV fluid rate to maintain MAP
D. Place the patient in Trendelenburg position
Answer: A
Conceptual Explanation: These findings represent Cushing’s Triad, a late sign of increased
intracranial pressure (ICP) and impending brain herniation. The nurse must prioritize
airway management and urgent surgical intervention.
4. A patient in the early stages of septic shock is likely to exhibit which of the following
hemodynamic profiles?
A. High cardiac output and low systemic vascular resistance (SVR)
, B. Low cardiac output and high systemic vascular resistance (SVR)
C. High PAWP and low cardiac output
D. Normal SVR and low heart rate
Answer: A
Conceptual Explanation: Early (hyperdynamic) septic shock is characterized by
vasodilation (low SVR) and a compensatory increase in cardiac output to maintain
perfusion.
5. Which rhythm is characterized by a complete dissociation between the atria and ventricles,
requiring immediate transcutaneous pacing?
A. First-degree AV block
B. Second-degree AV block Type I
C. Atrial Fibrillation with RVR
D. Third-degree AV block
Answer: D
Conceptual Explanation: Third-degree (complete) heart block involves no communication
between atria and ventricles, leading to severe bradycardia and hemodynamic instability,
requiring urgent pacing.
EXAM QUESTIONS AND ANSWERS
1. A patient with a pulmonary artery catheter has a pulmonary artery wedge pressure
(PAWP) of 26 mmHg. Which clinical assessment finding is the nurse most likely to observe?
A. Decreased capillary refill and bounding pulses
B. Increased urinary output and flat neck veins
C. Jugular venous distention and bilateral crackles
D. Hyperactive bowel sounds and hypertension
Answer: C
Conceptual Explanation: A PAWP of 26 mmHg is significantly elevated (normal is 6-12
mmHg), indicating left ventricular failure or fluid volume overload, which leads to
pulmonary congestion (crackles) and backup into the systemic venous system (JVD).
2. A patient on mechanical ventilation is receiving PEEP of 15 cm H2O. Which complication
should the nurse prioritize for monitoring?
A. Increased cardiac output
B. Barotrauma and pneumothorax
,C. Respiratory alkalosis
D. Decreased intracranial pressure
Answer: B
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which puts
the patient at risk for barotrauma, such as a pneumothorax, and can also decrease cardiac
output by reducing venous return.
3. The nurse is assessing a patient with a traumatic brain injury and notes a blood pressure of
180/60, heart rate of 48, and irregular respirations. What is the priority nursing action?
A. Prepare for immediate intubation and notification of the neurosurgeon
B. Administer a beta-blocker to lower the heart rate
C. Increase the IV fluid rate to maintain MAP
D. Place the patient in Trendelenburg position
Answer: A
Conceptual Explanation: These findings represent Cushing’s Triad, a late sign of increased
intracranial pressure (ICP) and impending brain herniation. The nurse must prioritize
airway management and urgent surgical intervention.
4. A patient in the early stages of septic shock is likely to exhibit which of the following
hemodynamic profiles?
A. High cardiac output and low systemic vascular resistance (SVR)
, B. Low cardiac output and high systemic vascular resistance (SVR)
C. High PAWP and low cardiac output
D. Normal SVR and low heart rate
Answer: A
Conceptual Explanation: Early (hyperdynamic) septic shock is characterized by
vasodilation (low SVR) and a compensatory increase in cardiac output to maintain
perfusion.
5. Which rhythm is characterized by a complete dissociation between the atria and ventricles,
requiring immediate transcutaneous pacing?
A. First-degree AV block
B. Second-degree AV block Type I
C. Atrial Fibrillation with RVR
D. Third-degree AV block
Answer: D
Conceptual Explanation: Third-degree (complete) heart block involves no communication
between atria and ventricles, leading to severe bradycardia and hemodynamic instability,
requiring urgent pacing.
