CCRN AACN CRITICAL CARE NURSING PRACTICE QUESTIONS: 100 NCLEX-STYLE
QUESTIONS WITH DETAILED RATIONALES FOR ICU & CRITICAL CARE EXAM
SUCCESS (2026 EDITION)
Question 1
A critically ill patient with septic shock has a blood pressure of 78/40 mmHg after receiving 30
mL/kg of IV fluids. Which medication should the nurse anticipate administering next?
A. Nitroglycerin
B. Norepinephrine
C. Furosemide
D. Metoprolol
Correct Answer:
B. Norepinephrine
Rationale:
Norepinephrine is the first-line vasopressor used in septic shock when hypotension persists
after adequate fluid resuscitation. Septic shock causes widespread vasodilation and poor
tissue perfusion. Norepinephrine increases systemic vascular resistance through
vasoconstriction, improving blood pressure and organ perfusion.
Nitroglycerin would worsen hypotension because it dilates blood vessels. Furosemide is a
diuretic and may further decrease circulating volume. Metoprolol lowers heart rate and blood
pressure and is not appropriate in unstable septic shock.
Question 2
A patient receiving mechanical ventilation suddenly develops severe respiratory distress,
absent breath sounds on the right side, and tracheal deviation. What is the nurse’s priority
action?
A. Increase IV fluids
B. Prepare for emergency needle decompression
,C. Lower the oxygen concentration
D. Reposition the patient flat in bed
Correct Answer:
B. Prepare for emergency needle decompression
Rationale:
These findings indicate a tension pneumothorax, a life-threatening emergency caused by
trapped air in the pleural space that compresses the lung and shifts mediastinal structures.
Immediate decompression is required to restore lung expansion and improve circulation.
Increasing IV fluids will not correct the underlying problem. Lowering oxygen would worsen
hypoxia. Placing the patient flat may impair breathing further.
Question 3
A patient with acute myocardial infarction reports crushing chest pain rated 10/10. Which
intervention should the nurse implement first?
A. Administer morphine sulfate
B. Administer nitroglycerin
C. Encourage ambulation
D. Obtain a urine specimen
Correct Answer:
B. Administer nitroglycerin
Rationale:
Nitroglycerin is commonly administered first to relieve ischemic chest pain because it dilates
coronary arteries and decreases myocardial oxygen demand. Prompt relief of ischemia helps
limit cardiac muscle damage.
Morphine may be given if pain persists after nitroglycerin. Ambulation increases cardiac
workload and is contraindicated during acute chest pain. Obtaining a urine specimen is not a
priority.
Question 4
,Which assessment finding is most concerning in a patient with increased intracranial pressure
(ICP)?
A. Glasgow Coma Scale decreases from 15 to 11
B. Mild headache
C. Heart rate 92 beats/minute
D. Temperature 37°C
Correct Answer:
A. Glasgow Coma Scale decreases from 15 to 11
Rationale:
A declining Glasgow Coma Scale score indicates worsening neurological function and possible
increased intracranial pressure or brain herniation. Rapid intervention is necessary to prevent
permanent brain injury.
Mild headache may occur with many conditions and is less critical. The heart rate and
temperature listed are not immediately alarming.
Question 5
A patient with diabetic ketoacidosis (DKA) is most likely to exhibit which assessment finding?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia
D. Bounding pulses only
Correct Answer:
B. Kussmaul respirations
Rationale:
Kussmaul respirations are deep, rapid breathing patterns that occur as the body attempts to
compensate for metabolic acidosis by eliminating carbon dioxide. DKA commonly presents
with hyperglycemia, dehydration, fruity breath odor, and Kussmaul respirations.
Bradycardia is uncommon because dehydration often causes tachycardia.
Question 6
, Which electrolyte imbalance is associated with peaked T waves on ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer:
B. Hyperkalemia
Rationale:
Hyperkalemia alters cardiac conduction and commonly produces peaked T waves, widened
QRS complexes, and potentially fatal dysrhythmias. Early recognition is essential because
severe hyperkalemia can lead to cardiac arrest.
Hypokalemia typically causes flattened T waves and U waves.
Question 7
A patient with acute respiratory distress syndrome (ARDS) is placed in the prone position.
What is the primary purpose of this intervention?
A. Reduce intracranial pressure
B. Improve oxygenation
C. Decrease urine output
D. Lower heart rate
Correct Answer:
B. Improve oxygenation
Rationale:
Prone positioning improves ventilation-perfusion matching and opens collapsed alveoli,
increasing oxygenation in patients with ARDS. It is commonly used in severe hypoxemia that
does not respond adequately to conventional ventilation.
Question 8
A patient with heart failure suddenly develops frothy pink sputum and severe dyspnea. Which
complication should the nurse suspect?
QUESTIONS WITH DETAILED RATIONALES FOR ICU & CRITICAL CARE EXAM
SUCCESS (2026 EDITION)
Question 1
A critically ill patient with septic shock has a blood pressure of 78/40 mmHg after receiving 30
mL/kg of IV fluids. Which medication should the nurse anticipate administering next?
A. Nitroglycerin
B. Norepinephrine
C. Furosemide
D. Metoprolol
Correct Answer:
B. Norepinephrine
Rationale:
Norepinephrine is the first-line vasopressor used in septic shock when hypotension persists
after adequate fluid resuscitation. Septic shock causes widespread vasodilation and poor
tissue perfusion. Norepinephrine increases systemic vascular resistance through
vasoconstriction, improving blood pressure and organ perfusion.
Nitroglycerin would worsen hypotension because it dilates blood vessels. Furosemide is a
diuretic and may further decrease circulating volume. Metoprolol lowers heart rate and blood
pressure and is not appropriate in unstable septic shock.
Question 2
A patient receiving mechanical ventilation suddenly develops severe respiratory distress,
absent breath sounds on the right side, and tracheal deviation. What is the nurse’s priority
action?
A. Increase IV fluids
B. Prepare for emergency needle decompression
,C. Lower the oxygen concentration
D. Reposition the patient flat in bed
Correct Answer:
B. Prepare for emergency needle decompression
Rationale:
These findings indicate a tension pneumothorax, a life-threatening emergency caused by
trapped air in the pleural space that compresses the lung and shifts mediastinal structures.
Immediate decompression is required to restore lung expansion and improve circulation.
Increasing IV fluids will not correct the underlying problem. Lowering oxygen would worsen
hypoxia. Placing the patient flat may impair breathing further.
Question 3
A patient with acute myocardial infarction reports crushing chest pain rated 10/10. Which
intervention should the nurse implement first?
A. Administer morphine sulfate
B. Administer nitroglycerin
C. Encourage ambulation
D. Obtain a urine specimen
Correct Answer:
B. Administer nitroglycerin
Rationale:
Nitroglycerin is commonly administered first to relieve ischemic chest pain because it dilates
coronary arteries and decreases myocardial oxygen demand. Prompt relief of ischemia helps
limit cardiac muscle damage.
Morphine may be given if pain persists after nitroglycerin. Ambulation increases cardiac
workload and is contraindicated during acute chest pain. Obtaining a urine specimen is not a
priority.
Question 4
,Which assessment finding is most concerning in a patient with increased intracranial pressure
(ICP)?
A. Glasgow Coma Scale decreases from 15 to 11
B. Mild headache
C. Heart rate 92 beats/minute
D. Temperature 37°C
Correct Answer:
A. Glasgow Coma Scale decreases from 15 to 11
Rationale:
A declining Glasgow Coma Scale score indicates worsening neurological function and possible
increased intracranial pressure or brain herniation. Rapid intervention is necessary to prevent
permanent brain injury.
Mild headache may occur with many conditions and is less critical. The heart rate and
temperature listed are not immediately alarming.
Question 5
A patient with diabetic ketoacidosis (DKA) is most likely to exhibit which assessment finding?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia
D. Bounding pulses only
Correct Answer:
B. Kussmaul respirations
Rationale:
Kussmaul respirations are deep, rapid breathing patterns that occur as the body attempts to
compensate for metabolic acidosis by eliminating carbon dioxide. DKA commonly presents
with hyperglycemia, dehydration, fruity breath odor, and Kussmaul respirations.
Bradycardia is uncommon because dehydration often causes tachycardia.
Question 6
, Which electrolyte imbalance is associated with peaked T waves on ECG?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Correct Answer:
B. Hyperkalemia
Rationale:
Hyperkalemia alters cardiac conduction and commonly produces peaked T waves, widened
QRS complexes, and potentially fatal dysrhythmias. Early recognition is essential because
severe hyperkalemia can lead to cardiac arrest.
Hypokalemia typically causes flattened T waves and U waves.
Question 7
A patient with acute respiratory distress syndrome (ARDS) is placed in the prone position.
What is the primary purpose of this intervention?
A. Reduce intracranial pressure
B. Improve oxygenation
C. Decrease urine output
D. Lower heart rate
Correct Answer:
B. Improve oxygenation
Rationale:
Prone positioning improves ventilation-perfusion matching and opens collapsed alveoli,
increasing oxygenation in patients with ARDS. It is commonly used in severe hypoxemia that
does not respond adequately to conventional ventilation.
Question 8
A patient with heart failure suddenly develops frothy pink sputum and severe dyspnea. Which
complication should the nurse suspect?
