NGN HESI RN CRITICAL CARE
COMPREHENSIVE EXAM QUESTIONS
AND CORRECT ANSWERS
1. A patient in the ICU is being treated for septic shock. Despite adequate fluid resuscitation,
the mean arterial pressure (MAP) remains 55 mmHg. Which vasopressor is considered the
first-line choice for this patient?
A. Dopamine
B. Vasopressin
C. Epinephrine
D. Norepinephrine
Answer: D
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock that
is refractory to fluid resuscitation to maintain a MAP of at least 65 mmHg.
2. A nurse is caring for a patient with a pulmonary artery catheter. The pulmonary artery
wedge pressure (PAWP) is measured at 22 mmHg. Which clinical condition is most likely
associated with this finding?
A. Hypovolemic shock
B. Right-sided heart failure
,C. Left-sided heart failure
D. Pulmonary embolism
Answer: C
Conceptual Explanation: Normal PAWP is 4-12 mmHg. An elevated PAWP (22 mmHg)
indicates increased pressure in the left atrium and left ventricle, common in left-sided
heart failure or fluid overload.
3. While managing a patient on mechanical ventilation with Positive End-Expiratory Pressure
(PEEP) set at 15 cm H2O, the nurse should monitor for which adverse hemodynamic effect?
A. Increased cardiac output
B. Decreased intracranial pressure
C. Increased systemic vascular resistance
D. Decreased venous return
Answer: D
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which can
compress the vena cava and decrease venous return to the heart, leading to decreased
cardiac output.
4. A patient with a traumatic brain injury (TBI) exhibits Cushing’s Triad. Which assessment
findings should the nurse expect?
A. Tachycardia, hypotension, and tachypnea
, B. Tachycardia, hypertension, and Cheyne-Stokes respirations
C. Bradycardia, systolic hypertension with widened pulse pressure, and irregular
respirations
D. Bradycardia, hypotension, and bradypnea
Answer: C
Conceptual Explanation: Cushing’s Triad is a late sign of increased intracranial pressure
consisting of bradycardia, systolic hypertension (widened pulse pressure), and irregular
respirations.
5. A patient develops Acute Respiratory Distress Syndrome (ARDS). Which arterial blood gas
(ABG) finding is the hallmark of the early stages of ARDS?
A. Respiratory acidosis with hypoxemia
B. Refractory hypoxemia despite high FiO2
C. Metabolic alkalosis
D. Respiratory alkalosis with hypercapnia
Answer: B
Conceptual Explanation: The hallmark of ARDS is refractory hypoxemia, which is
hypoxemia that does not respond to increasing concentrations of oxygen.
COMPREHENSIVE EXAM QUESTIONS
AND CORRECT ANSWERS
1. A patient in the ICU is being treated for septic shock. Despite adequate fluid resuscitation,
the mean arterial pressure (MAP) remains 55 mmHg. Which vasopressor is considered the
first-line choice for this patient?
A. Dopamine
B. Vasopressin
C. Epinephrine
D. Norepinephrine
Answer: D
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock that
is refractory to fluid resuscitation to maintain a MAP of at least 65 mmHg.
2. A nurse is caring for a patient with a pulmonary artery catheter. The pulmonary artery
wedge pressure (PAWP) is measured at 22 mmHg. Which clinical condition is most likely
associated with this finding?
A. Hypovolemic shock
B. Right-sided heart failure
,C. Left-sided heart failure
D. Pulmonary embolism
Answer: C
Conceptual Explanation: Normal PAWP is 4-12 mmHg. An elevated PAWP (22 mmHg)
indicates increased pressure in the left atrium and left ventricle, common in left-sided
heart failure or fluid overload.
3. While managing a patient on mechanical ventilation with Positive End-Expiratory Pressure
(PEEP) set at 15 cm H2O, the nurse should monitor for which adverse hemodynamic effect?
A. Increased cardiac output
B. Decreased intracranial pressure
C. Increased systemic vascular resistance
D. Decreased venous return
Answer: D
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which can
compress the vena cava and decrease venous return to the heart, leading to decreased
cardiac output.
4. A patient with a traumatic brain injury (TBI) exhibits Cushing’s Triad. Which assessment
findings should the nurse expect?
A. Tachycardia, hypotension, and tachypnea
, B. Tachycardia, hypertension, and Cheyne-Stokes respirations
C. Bradycardia, systolic hypertension with widened pulse pressure, and irregular
respirations
D. Bradycardia, hypotension, and bradypnea
Answer: C
Conceptual Explanation: Cushing’s Triad is a late sign of increased intracranial pressure
consisting of bradycardia, systolic hypertension (widened pulse pressure), and irregular
respirations.
5. A patient develops Acute Respiratory Distress Syndrome (ARDS). Which arterial blood gas
(ABG) finding is the hallmark of the early stages of ARDS?
A. Respiratory acidosis with hypoxemia
B. Refractory hypoxemia despite high FiO2
C. Metabolic alkalosis
D. Respiratory alkalosis with hypercapnia
Answer: B
Conceptual Explanation: The hallmark of ARDS is refractory hypoxemia, which is
hypoxemia that does not respond to increasing concentrations of oxygen.
