AACN CRITICAL CARE EXAM MASTERY: 100 NCLEX-STYLE PRACTICE QUESTIONS
WITH DETAILED RATIONALES FOR CCRN & CRITICAL CARE NURSING SUCCESS
(2026 EDITION)
Question 1
A patient with septic shock has a blood pressure of 82/48 mmHg despite adequate fluid
resuscitation. Which medication should the nurse anticipate administering first?
A. Dopamine
B. Norepinephrine
C. Furosemide
D. Nitroglycerin
Correct Answer:
B. Norepinephrine
Rationale:
Norepinephrine is the first-line vasopressor for septic shock because it causes
vasoconstriction and improves systemic vascular resistance, thereby increasing blood
pressure and organ perfusion. Dopamine is less preferred due to increased risk of
dysrhythmias. Furosemide is a diuretic and would worsen hypotension. Nitroglycerin causes
vasodilation and would further decrease blood pressure.
Question 2
A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation.
Which assessment finding indicates improvement?
A. PaO₂ 55 mmHg
B. Increased crackles bilaterally
,C. Oxygen saturation of 95%
D. Respiratory rate of 38 breaths/minute
Correct Answer:
C. Oxygen saturation of 95%
Rationale:
An oxygen saturation of 95% indicates improved oxygenation and gas exchange. ARDS
commonly causes severe hypoxemia; therefore, improved oxygen saturation suggests therapy
is effective. A PaO₂ of 55 mmHg reflects continued hypoxemia. Increased crackles indicate
worsening pulmonary fluid accumulation. Tachypnea may reflect respiratory distress.
Question 3
Which laboratory value is most concerning in a patient receiving heparin therapy?
A. Platelet count of 75,000/mm³
B. Hemoglobin of 13 g/dL
C. Sodium of 140 mEq/L
D. Potassium of 4.0 mEq/L
Correct Answer:
A. Platelet count of 75,000/mm³
Rationale:
A platelet count of 75,000/mm³ may indicate heparin-induced thrombocytopenia (HIT), a
potentially life-threatening complication of heparin therapy. Immediate evaluation is
necessary. The remaining values are within normal or expected ranges.
Question 4
A patient develops ventricular tachycardia without a pulse. What is the nurse’s priority
action?
A. Administer atropine
B. Begin chest compressions
C. Obtain a 12-lead ECG
D. Administer oxygen via nasal cannula
,Correct Answer:
B. Begin chest compressions
Rationale:
Pulseless ventricular tachycardia is a cardiac arrest rhythm. High-quality CPR should begin
immediately while preparing for defibrillation. Atropine is used primarily for symptomatic
bradycardia. A 12-lead ECG is not the priority during cardiac arrest. Nasal cannula oxygen is
insufficient during resuscitation.
Question 5
Which finding is most characteristic of left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Pulmonary crackles
D. Hepatomegaly
Correct Answer:
C. Pulmonary crackles
Rationale:
Left-sided heart failure leads to pulmonary congestion due to backup of blood into the lungs,
causing crackles, dyspnea, and hypoxia. Peripheral edema, jugular vein distention, and
hepatomegaly are more commonly associated with right-sided heart failure.
Question 6
A nurse is caring for a patient with increased intracranial pressure (ICP). Which intervention is
appropriate?
A. Keep the patient flat in bed
B. Suction frequently every hour
C. Elevate the head of the bed 30 degrees
D. Flex the patient’s neck forward
Correct Answer:
C. Elevate the head of the bed 30 degrees
, Rationale:
Elevating the head of the bed promotes venous drainage from the brain and helps reduce ICP.
Keeping the patient flat or flexing the neck impairs venous return and increases ICP. Frequent
suctioning may also increase ICP and should be minimized.
Question 7
Which electrolyte imbalance is commonly seen in patients with diabetic ketoacidosis (DKA)?
A. Hyperkalemia
B. Hypercalcemia
C. Hypermagnesemia
D. Hypernatremia
Correct Answer:
A. Hyperkalemia
Rationale:
Patients with DKA often present with hyperkalemia due to acidosis and insulin deficiency
causing potassium to shift out of cells. Although serum potassium may initially appear
elevated, total body potassium is usually depleted.
Question 8
A patient receiving blood transfusion develops fever, chills, and low back pain. What should
the nurse do first?
A. Slow the infusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Document the findings
Correct Answer:
B. Stop the transfusion immediately
Rationale:
WITH DETAILED RATIONALES FOR CCRN & CRITICAL CARE NURSING SUCCESS
(2026 EDITION)
Question 1
A patient with septic shock has a blood pressure of 82/48 mmHg despite adequate fluid
resuscitation. Which medication should the nurse anticipate administering first?
A. Dopamine
B. Norepinephrine
C. Furosemide
D. Nitroglycerin
Correct Answer:
B. Norepinephrine
Rationale:
Norepinephrine is the first-line vasopressor for septic shock because it causes
vasoconstriction and improves systemic vascular resistance, thereby increasing blood
pressure and organ perfusion. Dopamine is less preferred due to increased risk of
dysrhythmias. Furosemide is a diuretic and would worsen hypotension. Nitroglycerin causes
vasodilation and would further decrease blood pressure.
Question 2
A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation.
Which assessment finding indicates improvement?
A. PaO₂ 55 mmHg
B. Increased crackles bilaterally
,C. Oxygen saturation of 95%
D. Respiratory rate of 38 breaths/minute
Correct Answer:
C. Oxygen saturation of 95%
Rationale:
An oxygen saturation of 95% indicates improved oxygenation and gas exchange. ARDS
commonly causes severe hypoxemia; therefore, improved oxygen saturation suggests therapy
is effective. A PaO₂ of 55 mmHg reflects continued hypoxemia. Increased crackles indicate
worsening pulmonary fluid accumulation. Tachypnea may reflect respiratory distress.
Question 3
Which laboratory value is most concerning in a patient receiving heparin therapy?
A. Platelet count of 75,000/mm³
B. Hemoglobin of 13 g/dL
C. Sodium of 140 mEq/L
D. Potassium of 4.0 mEq/L
Correct Answer:
A. Platelet count of 75,000/mm³
Rationale:
A platelet count of 75,000/mm³ may indicate heparin-induced thrombocytopenia (HIT), a
potentially life-threatening complication of heparin therapy. Immediate evaluation is
necessary. The remaining values are within normal or expected ranges.
Question 4
A patient develops ventricular tachycardia without a pulse. What is the nurse’s priority
action?
A. Administer atropine
B. Begin chest compressions
C. Obtain a 12-lead ECG
D. Administer oxygen via nasal cannula
,Correct Answer:
B. Begin chest compressions
Rationale:
Pulseless ventricular tachycardia is a cardiac arrest rhythm. High-quality CPR should begin
immediately while preparing for defibrillation. Atropine is used primarily for symptomatic
bradycardia. A 12-lead ECG is not the priority during cardiac arrest. Nasal cannula oxygen is
insufficient during resuscitation.
Question 5
Which finding is most characteristic of left-sided heart failure?
A. Peripheral edema
B. Jugular vein distention
C. Pulmonary crackles
D. Hepatomegaly
Correct Answer:
C. Pulmonary crackles
Rationale:
Left-sided heart failure leads to pulmonary congestion due to backup of blood into the lungs,
causing crackles, dyspnea, and hypoxia. Peripheral edema, jugular vein distention, and
hepatomegaly are more commonly associated with right-sided heart failure.
Question 6
A nurse is caring for a patient with increased intracranial pressure (ICP). Which intervention is
appropriate?
A. Keep the patient flat in bed
B. Suction frequently every hour
C. Elevate the head of the bed 30 degrees
D. Flex the patient’s neck forward
Correct Answer:
C. Elevate the head of the bed 30 degrees
, Rationale:
Elevating the head of the bed promotes venous drainage from the brain and helps reduce ICP.
Keeping the patient flat or flexing the neck impairs venous return and increases ICP. Frequent
suctioning may also increase ICP and should be minimized.
Question 7
Which electrolyte imbalance is commonly seen in patients with diabetic ketoacidosis (DKA)?
A. Hyperkalemia
B. Hypercalcemia
C. Hypermagnesemia
D. Hypernatremia
Correct Answer:
A. Hyperkalemia
Rationale:
Patients with DKA often present with hyperkalemia due to acidosis and insulin deficiency
causing potassium to shift out of cells. Although serum potassium may initially appear
elevated, total body potassium is usually depleted.
Question 8
A patient receiving blood transfusion develops fever, chills, and low back pain. What should
the nurse do first?
A. Slow the infusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen
D. Document the findings
Correct Answer:
B. Stop the transfusion immediately
Rationale:
