ATI Critical Care Nursing 2026/2027 | ACTUAL-
Style Practice Questions & Answers, ATI RN Critical
Care Exam Prep, Intensive Care Nursing Test Bank,
Hemodynamic Monitoring, Respiratory Failure,
Shock, Sepsis, Cardiac Emergencies, Ventilator
Management, Prioritization, and Detailed
Rationales
Question 1: A nurse is caring for a client with acute respiratory distress
syndrome (ARDS). Which ventilator setting should the nurse anticipate
to improve oxygenation by recruiting collapsed alveoli?
A. Low positive end-expiratory pressure (PEEP)
B. High tidal volume
C. Increased PEEP
D. Decreased respiratory rate
CORRECT ANSWER: C. Increased PEEP
Rationale: In ARDS, increased PEEP is used to recruit collapsed alveoli and
improve oxygenation by preventing alveolar collapse at end-expiration.
High tidal volumes can cause further lung injury (volutrauma), and low
PEEP would not effectively recruit collapsed alveoli.
Question 2: A client with a chest tube has continuous bubbling in the
water seal chamber. What does this finding indicate?
A. Normal expected finding
B. An air leak in the system
C. The suction is set too high
D. The lung has fully re-expanded
CORRECT ANSWER: B. An air leak in the system
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak in the chest tube system. Intermittent bubbling may be normal with
respiration, but continuous bubbling requires investigation for leaks at
connection sites or the insertion site.
Question 3: A nurse is preparing to suction a client with a
tracheostomy. Which action should the nurse take first?
A. Instill 5 mL of normal saline into the tracheostomy
B. Hyperoxygenate the client with 100% oxygen
,C. Suction for 30 seconds
D. Apply suction while inserting the catheter
CORRECT ANSWER: B. Hyperoxygenate the client with 100% oxygen
Rationale: Hyperoxygenation before suctioning prevents hypoxemia, which
can occur during the procedure. Saline instillation is no longer routinely
recommended, and suction should only be applied during withdrawal, not
insertion.
Question 4: A client with COPD has an oxygen saturation of 85% on
room air. Which oxygen delivery method is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 1-2 L/min titrated to 88-92%
C. Simple face mask at 8 L/min
D. Venturi mask at 40%
CORRECT ANSWER: B. Nasal cannula at 1-2 L/min titrated to 88-92%
Rationale: Clients with COPD may retain CO2 and rely on hypoxic drive.
Low-flow oxygen via nasal cannula at 1-2 L/min titrated to an SpO2 of 88-
92% is safest to avoid suppressing respiratory drive.
Question 5: A nurse is assessing a client with a suspected pulmonary
embolism. Which finding is most consistent with this condition?
A. Bradycardia and hypertension
B. Sudden onset of dyspnea and pleuritic chest pain
C. Productive cough with green sputum
D. Gradual onset of fever and chills
CORRECT ANSWER: B. Sudden onset of dyspnea and pleuritic chest
pain
Rationale: Pulmonary embolism typically presents with sudden dyspnea,
pleuritic chest pain, tachycardia, and hypoxemia. Bradycardia,
hypertension, and productive cough are not typical findings.
Question 6: A client is admitted with acute respiratory failure. Which
arterial blood gas value indicates respiratory acidosis?
A. pH 7.48, PaCO2 30 mm Hg
B. pH 7.30, PaCO2 55 mm Hg
,C. pH 7.50, PaCO2 40 mm Hg
D. pH 7.35, PaCO2 45 mm Hg
CORRECT ANSWER: B. pH 7.30, PaCO2 55 mm Hg
Rationale: Respiratory acidosis is characterized by a pH below 7.35 and a
PaCO2 above 45 mm Hg due to hypoventilation. The other options do not
demonstrate the expected pattern for respiratory acidosis.
Question 7: A nurse is caring for a client with a left ventricular assist
device (LVAD) who has a low flow alarm. What should the nurse do
first?
A. Assess the client's blood pressure and listen for audible alarms
B. Call the VAD coordinator
C. Administer a fluid bolus
D. Increase the VAD speed
CORRECT ANSWER: A. Assess the client's blood pressure and listen for
audible alarms
Rationale: Low flow can be caused by hypovolemia, tamponade, or inflow
obstruction. The nurse should assess the client first before taking other
actions. VAD settings should not be adjusted independently.
Question 8: A client with a new onset of atrial fibrillation has a heart
rate of 150 bpm and blood pressure of 90/60 mmHg. The nurse should
prepare for which intervention?
A. Synchronized cardioversion
B. Defibrillation
C. Oral amiodarone
D. Vagal maneuvers
CORRECT ANSWER: A. Synchronized cardioversion
Rationale: Unstable atrial fibrillation (hypotension, chest pain, altered
mental status) requires immediate synchronized cardioversion.
Defibrillation is for pulseless rhythms.
Question 9: A client with a permanent pacemaker has a heart rate of 50
bpm and reports dizziness. The ECG shows pacemaker spikes with no
captured QRS complexes. This is called:
, A. Failure to capture
B. Failure to sense
C. Failure to pace
D. Oversensing
CORRECT ANSWER: A. Failure to capture
Rationale: Failure to capture occurs when the pacemaker fires but does not
depolarize the myocardium, resulting in no QRS complex after the spike.
Causes include lead dislodgement, fibrosis, or electrolyte abnormalities.
Question 10: A client with an acute inferior wall myocardial infarction
develops bradycardia (HR 40) and hypotension. The nurse should
anticipate administration of:
A. Atropine 0.5 mg IV
B. Amiodarone 150 mg IV
C. Adenosine 6 mg IV
D. Lidocaine 100 mg IV
CORRECT ANSWER: A. Atropine 0.5 mg IV
Rationale: Symptomatic bradycardia in the setting of inferior wall MI is
often due to increased vagal tone. Atropine is the first-line treatment.
Amiodarone, adenosine, and lidocaine are used for tachyarrhythmias.
Question 11: A client with acute decompensated heart failure has a
pulmonary artery wedge pressure (PAWP) of 28 mmHg (normal 4-12).
This indicates:
A. Left ventricular failure
B. Right ventricular failure
C. Hypovolemia
D. Normal cardiac function
CORRECT ANSWER: A. Left ventricular failure
Rationale: An elevated PAWP indicates increased left ventricular filling
pressures, consistent with left ventricular failure. Normal PAWP is 4-12
mmHg.
Question 12: A client with cardiogenic shock is most likely to exhibit
which set of clinical findings?
Style Practice Questions & Answers, ATI RN Critical
Care Exam Prep, Intensive Care Nursing Test Bank,
Hemodynamic Monitoring, Respiratory Failure,
Shock, Sepsis, Cardiac Emergencies, Ventilator
Management, Prioritization, and Detailed
Rationales
Question 1: A nurse is caring for a client with acute respiratory distress
syndrome (ARDS). Which ventilator setting should the nurse anticipate
to improve oxygenation by recruiting collapsed alveoli?
A. Low positive end-expiratory pressure (PEEP)
B. High tidal volume
C. Increased PEEP
D. Decreased respiratory rate
CORRECT ANSWER: C. Increased PEEP
Rationale: In ARDS, increased PEEP is used to recruit collapsed alveoli and
improve oxygenation by preventing alveolar collapse at end-expiration.
High tidal volumes can cause further lung injury (volutrauma), and low
PEEP would not effectively recruit collapsed alveoli.
Question 2: A client with a chest tube has continuous bubbling in the
water seal chamber. What does this finding indicate?
A. Normal expected finding
B. An air leak in the system
C. The suction is set too high
D. The lung has fully re-expanded
CORRECT ANSWER: B. An air leak in the system
Rationale: Continuous bubbling in the water seal chamber indicates an air
leak in the chest tube system. Intermittent bubbling may be normal with
respiration, but continuous bubbling requires investigation for leaks at
connection sites or the insertion site.
Question 3: A nurse is preparing to suction a client with a
tracheostomy. Which action should the nurse take first?
A. Instill 5 mL of normal saline into the tracheostomy
B. Hyperoxygenate the client with 100% oxygen
,C. Suction for 30 seconds
D. Apply suction while inserting the catheter
CORRECT ANSWER: B. Hyperoxygenate the client with 100% oxygen
Rationale: Hyperoxygenation before suctioning prevents hypoxemia, which
can occur during the procedure. Saline instillation is no longer routinely
recommended, and suction should only be applied during withdrawal, not
insertion.
Question 4: A client with COPD has an oxygen saturation of 85% on
room air. Which oxygen delivery method is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 1-2 L/min titrated to 88-92%
C. Simple face mask at 8 L/min
D. Venturi mask at 40%
CORRECT ANSWER: B. Nasal cannula at 1-2 L/min titrated to 88-92%
Rationale: Clients with COPD may retain CO2 and rely on hypoxic drive.
Low-flow oxygen via nasal cannula at 1-2 L/min titrated to an SpO2 of 88-
92% is safest to avoid suppressing respiratory drive.
Question 5: A nurse is assessing a client with a suspected pulmonary
embolism. Which finding is most consistent with this condition?
A. Bradycardia and hypertension
B. Sudden onset of dyspnea and pleuritic chest pain
C. Productive cough with green sputum
D. Gradual onset of fever and chills
CORRECT ANSWER: B. Sudden onset of dyspnea and pleuritic chest
pain
Rationale: Pulmonary embolism typically presents with sudden dyspnea,
pleuritic chest pain, tachycardia, and hypoxemia. Bradycardia,
hypertension, and productive cough are not typical findings.
Question 6: A client is admitted with acute respiratory failure. Which
arterial blood gas value indicates respiratory acidosis?
A. pH 7.48, PaCO2 30 mm Hg
B. pH 7.30, PaCO2 55 mm Hg
,C. pH 7.50, PaCO2 40 mm Hg
D. pH 7.35, PaCO2 45 mm Hg
CORRECT ANSWER: B. pH 7.30, PaCO2 55 mm Hg
Rationale: Respiratory acidosis is characterized by a pH below 7.35 and a
PaCO2 above 45 mm Hg due to hypoventilation. The other options do not
demonstrate the expected pattern for respiratory acidosis.
Question 7: A nurse is caring for a client with a left ventricular assist
device (LVAD) who has a low flow alarm. What should the nurse do
first?
A. Assess the client's blood pressure and listen for audible alarms
B. Call the VAD coordinator
C. Administer a fluid bolus
D. Increase the VAD speed
CORRECT ANSWER: A. Assess the client's blood pressure and listen for
audible alarms
Rationale: Low flow can be caused by hypovolemia, tamponade, or inflow
obstruction. The nurse should assess the client first before taking other
actions. VAD settings should not be adjusted independently.
Question 8: A client with a new onset of atrial fibrillation has a heart
rate of 150 bpm and blood pressure of 90/60 mmHg. The nurse should
prepare for which intervention?
A. Synchronized cardioversion
B. Defibrillation
C. Oral amiodarone
D. Vagal maneuvers
CORRECT ANSWER: A. Synchronized cardioversion
Rationale: Unstable atrial fibrillation (hypotension, chest pain, altered
mental status) requires immediate synchronized cardioversion.
Defibrillation is for pulseless rhythms.
Question 9: A client with a permanent pacemaker has a heart rate of 50
bpm and reports dizziness. The ECG shows pacemaker spikes with no
captured QRS complexes. This is called:
, A. Failure to capture
B. Failure to sense
C. Failure to pace
D. Oversensing
CORRECT ANSWER: A. Failure to capture
Rationale: Failure to capture occurs when the pacemaker fires but does not
depolarize the myocardium, resulting in no QRS complex after the spike.
Causes include lead dislodgement, fibrosis, or electrolyte abnormalities.
Question 10: A client with an acute inferior wall myocardial infarction
develops bradycardia (HR 40) and hypotension. The nurse should
anticipate administration of:
A. Atropine 0.5 mg IV
B. Amiodarone 150 mg IV
C. Adenosine 6 mg IV
D. Lidocaine 100 mg IV
CORRECT ANSWER: A. Atropine 0.5 mg IV
Rationale: Symptomatic bradycardia in the setting of inferior wall MI is
often due to increased vagal tone. Atropine is the first-line treatment.
Amiodarone, adenosine, and lidocaine are used for tachyarrhythmias.
Question 11: A client with acute decompensated heart failure has a
pulmonary artery wedge pressure (PAWP) of 28 mmHg (normal 4-12).
This indicates:
A. Left ventricular failure
B. Right ventricular failure
C. Hypovolemia
D. Normal cardiac function
CORRECT ANSWER: A. Left ventricular failure
Rationale: An elevated PAWP indicates increased left ventricular filling
pressures, consistent with left ventricular failure. Normal PAWP is 4-12
mmHg.
Question 12: A client with cardiogenic shock is most likely to exhibit
which set of clinical findings?
