NCLEX RN Critical Care Nursing Exam 2
100 Questions plus Correct Answers
(Verified Answers) Plus Rationales
2026
1. A client in septic shock has a blood pressure of 82/48 mm Hg after receiving
an initial fluid bolus. Which medication should the nurse anticipate
administering first to support blood pressure?
A. Furosemide
B. Norepinephrine
C. Metoprolol
D. Nitroglycerin
Answer: B. Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor for persistent
hypotension in septic shock after adequate fluid resuscitation. It increases
vascular tone and helps restore mean arterial pressure.
2. A mechanically ventilated client suddenly develops severe dyspnea,
hypotension, and absent breath sounds on the right side. Which complication
should the nurse suspect?
A. Pulmonary edema
B. Atelectasis
C. Tension pneumothorax
D. Pleural effusion
Answer: C. Tension pneumothorax
Rationale: Sudden respiratory distress, hypotension, and unilateral absent
breath sounds in a ventilated client are classic findings of tension
pneumothorax, which requires immediate intervention.
,3. Which finding is most concerning in a client with increased intracranial
pressure?
A. Headache
B. Vomiting
C. Decreasing level of consciousness
D. Photophobia
Answer: C. Decreasing level of consciousness
Rationale: A declining level of consciousness is an early and sensitive
indicator of worsening intracranial pressure and cerebral dysfunction.
4. A client with severe traumatic brain injury is receiving mechanical
ventilation. Which nursing intervention is appropriate?
A. Keep the head of the bed flat
B. Maintain the neck in neutral alignment
C. Encourage frequent coughing
D. Perform routine deep suctioning every hour
Answer: B. Maintain the neck in neutral alignment
Rationale: Neutral head and neck positioning promotes venous drainage from
the brain and helps reduce intracranial pressure.
5. A client with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. Which intervention is commonly used to improve oxygenation?
A. High tidal volumes
B. Low positive end-expiratory pressure
C. Positive end-expiratory pressure
D. Routine hyperventilation
Answer: C. Positive end-expiratory pressure
Rationale: PEEP helps keep alveoli open at the end of expiration, improving
functional residual capacity and oxygenation in ARDS.
,6. Which assessment finding in a client receiving a blood transfusion requires
the nurse to stop the transfusion immediately?
A. Mild hunger
B. Fever and chills
C. Blood pressure of 128/76 mm Hg
D. Heart rate of 78/min
Answer: B. Fever and chills
Rationale: Fever, chills, flushing, dyspnea, or back pain may indicate a
transfusion reaction. The transfusion should be stopped immediately and the
client assessed.
7. A client with diabetic ketoacidosis is receiving IV regular insulin. Which
laboratory value requires close monitoring because insulin can cause it to
decrease rapidly?
A. Sodium
B. Potassium
C. Calcium
D. Hemoglobin
Answer: B. Potassium
Rationale: Insulin drives potassium into cells, potentially causing
hypokalemia. Serum potassium must be monitored closely during DKA
treatment.
8. Which ECG finding is most associated with hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST elevation only
Answer: B. Peaked T waves
, Rationale: Tall, peaked T waves are an early ECG manifestation of
hyperkalemia. Progressive hyperkalemia can cause widening of the QRS and
life-threatening dysrhythmias.
9. A client with acute kidney injury has a potassium level of 6.8 mEq/L. Which
prescription should the nurse question?
A. Cardiac monitoring
B. IV calcium gluconate
C. Potassium chloride infusion
D. Repeat serum potassium
Answer: C. Potassium chloride infusion
Rationale: Potassium administration is contraindicated in significant
hyperkalemia and could worsen potentially fatal cardiac dysrhythmias.
10. A client with cardiogenic shock has pulmonary crackles, severe dyspnea,
and hypotension. Which medication may be prescribed to improve cardiac
contractility?
A. Dobutamine
B. Diphenhydramine
C. Acetaminophen
D. Calcium carbonate
Answer: A. Dobutamine
Rationale: Dobutamine is an inotropic medication that increases myocardial
contractility and can improve cardiac output in cardiogenic shock.
11. Which finding is most characteristic of hypovolemic shock?
A. Bounding pulses
B. Warm, flushed skin
C. Tachycardia and weak peripheral pulses
D. Bradycardia and hypertension
100 Questions plus Correct Answers
(Verified Answers) Plus Rationales
2026
1. A client in septic shock has a blood pressure of 82/48 mm Hg after receiving
an initial fluid bolus. Which medication should the nurse anticipate
administering first to support blood pressure?
A. Furosemide
B. Norepinephrine
C. Metoprolol
D. Nitroglycerin
Answer: B. Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor for persistent
hypotension in septic shock after adequate fluid resuscitation. It increases
vascular tone and helps restore mean arterial pressure.
2. A mechanically ventilated client suddenly develops severe dyspnea,
hypotension, and absent breath sounds on the right side. Which complication
should the nurse suspect?
A. Pulmonary edema
B. Atelectasis
C. Tension pneumothorax
D. Pleural effusion
Answer: C. Tension pneumothorax
Rationale: Sudden respiratory distress, hypotension, and unilateral absent
breath sounds in a ventilated client are classic findings of tension
pneumothorax, which requires immediate intervention.
,3. Which finding is most concerning in a client with increased intracranial
pressure?
A. Headache
B. Vomiting
C. Decreasing level of consciousness
D. Photophobia
Answer: C. Decreasing level of consciousness
Rationale: A declining level of consciousness is an early and sensitive
indicator of worsening intracranial pressure and cerebral dysfunction.
4. A client with severe traumatic brain injury is receiving mechanical
ventilation. Which nursing intervention is appropriate?
A. Keep the head of the bed flat
B. Maintain the neck in neutral alignment
C. Encourage frequent coughing
D. Perform routine deep suctioning every hour
Answer: B. Maintain the neck in neutral alignment
Rationale: Neutral head and neck positioning promotes venous drainage from
the brain and helps reduce intracranial pressure.
5. A client with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. Which intervention is commonly used to improve oxygenation?
A. High tidal volumes
B. Low positive end-expiratory pressure
C. Positive end-expiratory pressure
D. Routine hyperventilation
Answer: C. Positive end-expiratory pressure
Rationale: PEEP helps keep alveoli open at the end of expiration, improving
functional residual capacity and oxygenation in ARDS.
,6. Which assessment finding in a client receiving a blood transfusion requires
the nurse to stop the transfusion immediately?
A. Mild hunger
B. Fever and chills
C. Blood pressure of 128/76 mm Hg
D. Heart rate of 78/min
Answer: B. Fever and chills
Rationale: Fever, chills, flushing, dyspnea, or back pain may indicate a
transfusion reaction. The transfusion should be stopped immediately and the
client assessed.
7. A client with diabetic ketoacidosis is receiving IV regular insulin. Which
laboratory value requires close monitoring because insulin can cause it to
decrease rapidly?
A. Sodium
B. Potassium
C. Calcium
D. Hemoglobin
Answer: B. Potassium
Rationale: Insulin drives potassium into cells, potentially causing
hypokalemia. Serum potassium must be monitored closely during DKA
treatment.
8. Which ECG finding is most associated with hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. U waves
D. ST elevation only
Answer: B. Peaked T waves
, Rationale: Tall, peaked T waves are an early ECG manifestation of
hyperkalemia. Progressive hyperkalemia can cause widening of the QRS and
life-threatening dysrhythmias.
9. A client with acute kidney injury has a potassium level of 6.8 mEq/L. Which
prescription should the nurse question?
A. Cardiac monitoring
B. IV calcium gluconate
C. Potassium chloride infusion
D. Repeat serum potassium
Answer: C. Potassium chloride infusion
Rationale: Potassium administration is contraindicated in significant
hyperkalemia and could worsen potentially fatal cardiac dysrhythmias.
10. A client with cardiogenic shock has pulmonary crackles, severe dyspnea,
and hypotension. Which medication may be prescribed to improve cardiac
contractility?
A. Dobutamine
B. Diphenhydramine
C. Acetaminophen
D. Calcium carbonate
Answer: A. Dobutamine
Rationale: Dobutamine is an inotropic medication that increases myocardial
contractility and can improve cardiac output in cardiogenic shock.
11. Which finding is most characteristic of hypovolemic shock?
A. Bounding pulses
B. Warm, flushed skin
C. Tachycardia and weak peripheral pulses
D. Bradycardia and hypertension
