NCLEX RN Critical Care Nursing Exam 1
100 Questions plus Correct Answers
(Verified Answers) Plus Rationales
2026
Question 1
A client in the intensive care unit suddenly develops severe dyspnea, an oxygen
saturation of 82%, and a respiratory rate of 34/min. What is the nurse's priority
action?
A. Obtain a complete health history
B. Apply oxygen and assess airway and breathing
C. Administer prescribed oral medication
D. Obtain a routine temperature
Answer: Apply oxygen and assess airway and breathing
Rationale: Airway and breathing are immediate priorities. Severe hypoxemia
requires rapid intervention with oxygen while the nurse assesses and
supports the airway and respiratory status.
Question 2
A client with septic shock has a blood pressure of 78/42 mm Hg despite
receiving IV fluids. Which medication would the nurse anticipate
administering?
A. Furosemide
B. Norepinephrine
C. Acetaminophen
D. Regular insulin
,Answer: Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor commonly used to
maintain blood pressure and organ perfusion in septic shock when adequate
fluid resuscitation does not restore blood pressure.
Question 3
Which assessment finding is most concerning in a client with increased
intracranial pressure?
A. Headache
B. Restlessness
C. Decreasing level of consciousness
D. Mild nausea
Answer: Decreasing level of consciousness
Rationale: A declining level of consciousness is an important indicator of
worsening cerebral function and increased intracranial pressure.
Question 4
A client with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation. Which intervention is appropriate?
A. Use very large tidal volumes
B. Maintain a low tidal volume strategy
C. Keep the client completely flat
D. Avoid positive end-expiratory pressure
Answer: Maintain a low tidal volume strategy
Rationale: Lung-protective ventilation using low tidal volumes helps reduce
ventilator-induced lung injury in clients with ARDS.
,Question 5
A client receiving a blood transfusion suddenly develops fever, chills, and flank
pain. What is the nurse's priority action?
A. Slow the transfusion
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Continue the transfusion and reassess
Answer: Stop the transfusion immediately
Rationale: Fever, chills, and flank pain may indicate an acute hemolytic
transfusion reaction. The transfusion must be stopped immediately, and the
IV line should be maintained with appropriate compatible fluid according to
protocol.
Question 6
A client with hyperkalemia has peaked T waves on the ECG. Which medication
should the nurse anticipate administering first to stabilize the cardiac
membrane?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Furosemide
D. Regular insulin alone
Answer: Calcium gluconate
Rationale: IV calcium stabilizes the cardiac membrane and reduces the
immediate risk of life-threatening dysrhythmias caused by severe
hyperkalemia.
Question 7
Which finding is characteristic of hypovolemic shock?
A. Bounding pulses
B. Bradycardia
, C. Cool, clammy skin
D. Hypertension
Answer: Cool, clammy skin
Rationale: Hypovolemia causes decreased cardiac output and compensatory
vasoconstriction, producing cool, pale, clammy skin and often tachycardia
and hypotension.
Question 8
A client develops ventricular fibrillation and is unresponsive. Which
intervention should occur immediately?
A. Defibrillation
B. Oral amiodarone
C. Synchronized cardioversion
D. Vagal stimulation
Answer: Defibrillation
Rationale: Ventricular fibrillation is a pulseless, life-threatening rhythm
treated with immediate unsynchronized defibrillation along with high-quality
CPR.
Question 9
A client with an acute myocardial infarction develops cardiogenic shock. Which
finding would the nurse expect?
A. Warm skin and bounding pulses
B. Pulmonary congestion and hypotension
C. Increased urine output
D. Severe hypertension
Answer: Pulmonary congestion and hypotension
Rationale: Cardiogenic shock results from inadequate cardiac pumping.
Reduced cardiac output causes hypotension and poor tissue perfusion, while
left ventricular failure can cause pulmonary congestion.
100 Questions plus Correct Answers
(Verified Answers) Plus Rationales
2026
Question 1
A client in the intensive care unit suddenly develops severe dyspnea, an oxygen
saturation of 82%, and a respiratory rate of 34/min. What is the nurse's priority
action?
A. Obtain a complete health history
B. Apply oxygen and assess airway and breathing
C. Administer prescribed oral medication
D. Obtain a routine temperature
Answer: Apply oxygen and assess airway and breathing
Rationale: Airway and breathing are immediate priorities. Severe hypoxemia
requires rapid intervention with oxygen while the nurse assesses and
supports the airway and respiratory status.
Question 2
A client with septic shock has a blood pressure of 78/42 mm Hg despite
receiving IV fluids. Which medication would the nurse anticipate
administering?
A. Furosemide
B. Norepinephrine
C. Acetaminophen
D. Regular insulin
,Answer: Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor commonly used to
maintain blood pressure and organ perfusion in septic shock when adequate
fluid resuscitation does not restore blood pressure.
Question 3
Which assessment finding is most concerning in a client with increased
intracranial pressure?
A. Headache
B. Restlessness
C. Decreasing level of consciousness
D. Mild nausea
Answer: Decreasing level of consciousness
Rationale: A declining level of consciousness is an important indicator of
worsening cerebral function and increased intracranial pressure.
Question 4
A client with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation. Which intervention is appropriate?
A. Use very large tidal volumes
B. Maintain a low tidal volume strategy
C. Keep the client completely flat
D. Avoid positive end-expiratory pressure
Answer: Maintain a low tidal volume strategy
Rationale: Lung-protective ventilation using low tidal volumes helps reduce
ventilator-induced lung injury in clients with ARDS.
,Question 5
A client receiving a blood transfusion suddenly develops fever, chills, and flank
pain. What is the nurse's priority action?
A. Slow the transfusion
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Continue the transfusion and reassess
Answer: Stop the transfusion immediately
Rationale: Fever, chills, and flank pain may indicate an acute hemolytic
transfusion reaction. The transfusion must be stopped immediately, and the
IV line should be maintained with appropriate compatible fluid according to
protocol.
Question 6
A client with hyperkalemia has peaked T waves on the ECG. Which medication
should the nurse anticipate administering first to stabilize the cardiac
membrane?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Furosemide
D. Regular insulin alone
Answer: Calcium gluconate
Rationale: IV calcium stabilizes the cardiac membrane and reduces the
immediate risk of life-threatening dysrhythmias caused by severe
hyperkalemia.
Question 7
Which finding is characteristic of hypovolemic shock?
A. Bounding pulses
B. Bradycardia
, C. Cool, clammy skin
D. Hypertension
Answer: Cool, clammy skin
Rationale: Hypovolemia causes decreased cardiac output and compensatory
vasoconstriction, producing cool, pale, clammy skin and often tachycardia
and hypotension.
Question 8
A client develops ventricular fibrillation and is unresponsive. Which
intervention should occur immediately?
A. Defibrillation
B. Oral amiodarone
C. Synchronized cardioversion
D. Vagal stimulation
Answer: Defibrillation
Rationale: Ventricular fibrillation is a pulseless, life-threatening rhythm
treated with immediate unsynchronized defibrillation along with high-quality
CPR.
Question 9
A client with an acute myocardial infarction develops cardiogenic shock. Which
finding would the nurse expect?
A. Warm skin and bounding pulses
B. Pulmonary congestion and hypotension
C. Increased urine output
D. Severe hypertension
Answer: Pulmonary congestion and hypotension
Rationale: Cardiogenic shock results from inadequate cardiac pumping.
Reduced cardiac output causes hypotension and poor tissue perfusion, while
left ventricular failure can cause pulmonary congestion.
