NUR 207 CRITICAL CARE NURSING PRACTICE
QUESTIONS AND CORRECT ANSWERS 2026 EDITION
1. A patient in the ICU is being mechanically ventilated with positive
end-expiratory pressure (PEEP) set at 12 cm H₂O. The nurse notes
a sudden drop in blood pressure from 120/80 mmHg to 85/50
mmHg, along with increased heart rate and decreased urine
output. What is the most likely cause of these findings?
A. Pulmonary embolism
B. Hypovolemic shock
C. Decreased venous return due to high PEEP
D. Septic shock
Correct Answer: C
Explanation: High PEEP increases intrathoracic pressure, which
reduces venous return to the heart, leading to decreased cardiac
output and hypotension. Hypovolemia and sepsis would present
with other signs, and pulmonary embolism typically causes sudden
hypoxia and chest pain.
2. A critically ill patient with septic shock is receiving norepinephrine.
The nurse observes that the patient's urine output has decreased
to 0.3 mL/kg/hr over the past 2 hours. What is the most
appropriate next action?
A. Increase the norepinephrine dose
B. Administer a fluid bolus
C. Notify the provider for possible renal evaluation
D. Switch to dopamine
Correct Answer: C
, Explanation: Decreased urine output despite vasopressor therapy
suggests possible acute kidney injury. While fluid resuscitation is
important in septic shock, the patient is already on
norepinephrine, and further intervention should be guided by the
provider. Increasing norepinephrine may worsen renal perfusion.
3. A patient with severe traumatic brain injury (TBI) has an
intracranial pressure (ICP) of 28 mmHg and a cerebral perfusion
pressure (CPP) of 50 mmHg. Which intervention is most
appropriate to improve CPP?
A. Administer mannitol
B. Increase sedation
C. Elevate the head of the bed to 45 degrees
D. Hyperventilate to PaCO₂ of 25 mmHg
Correct Answer: A
Explanation: Mannitol is an osmotic diuretic that reduces ICP,
thereby improving CPP. CPP = MAP - ICP. Increasing sedation may
help but is less immediate. Head elevation beyond 30 degrees may
compromise cerebral blood flow. Hyperventilation is reserved for
acute herniation due to risk of cerebral ischemia.
4. A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation. The nurse notes a plateau pressure of 32
cm H₂O. What is the most appropriate action?
A. Increase tidal volume to improve oxygenation
B. Decrease tidal volume to 6 mL/kg ideal body weight
C. Add more PEEP immediately
, D. Switch to high-frequency ventilation
Correct Answer: B
Explanation: Plateau pressure >30 cm H₂O indicates risk of
ventilator-induced lung injury. Low tidal volume ventilation (6
mL/kg IBW) is the standard of care in ARDS to protect the lungs.
Increasing tidal volume would worsen injury.
5. A patient in the ICU develops new-onset atrial fibrillation with
rapid ventricular response. The patient is hemodynamically stable.
What is the most appropriate initial management?
A. Immediate synchronized cardioversion
B. Administer amiodarone
C. Administer diltiazem
D. Start heparin infusion
Correct Answer: C
Explanation: In hemodynamically stable atrial fibrillation with RVR,
rate control with calcium channel blockers like diltiazem is first-
line. Cardioversion is for unstable patients. Amiodarone is second-
line. Anticoagulation is important but not the immediate priority.
6. A patient with crush injury syndrome is being monitored for
rhabdomyolysis. Which laboratory finding is most concerning for
acute kidney injury?
A. Creatine kinase (CK) of 5,000 U/L
B. Potassium of 5.8 mEq/L
C. Myoglobinuria with urine pH of 5.0
D. Creatinine of 2.1 mg/dL
, Correct Answer: D
Explanation: Elevated creatinine indicates actual kidney
dysfunction. While CK, hyperkalemia, and myoglobinuria are
concerning, creatinine elevation confirms acute kidney injury,
which is the primary complication of rhabdomyolysis.
7. A patient with diabetic ketoacidosis (DKA) is receiving insulin
infusion. The nurse notes the anion gap has decreased from 24 to
16 mEq/L, but glucose remains at 250 mg/dL. What is the next
appropriate step?
A. Continue insulin infusion without changes
B. Add dextrose to IV fluids and continue insulin
C. Stop insulin infusion
D. Increase insulin dose
Correct Answer: B
Explanation: When anion gap closes but glucose is still elevated,
dextrose should be added to prevent hypoglycemia while
continuing insulin to resolve ketosis. Stopping insulin prematurely
can lead to rebound ketoacidosis.
8. A patient with pulmonary embolism is receiving thrombolytic
therapy. Which finding requires immediate intervention?
A. Blood pressure of 90/60 mmHg
B. Heart rate of 110 bpm
C. Oozing from IV site
D. Sudden drop in oxygen saturation to 82%
Correct Answer: D
QUESTIONS AND CORRECT ANSWERS 2026 EDITION
1. A patient in the ICU is being mechanically ventilated with positive
end-expiratory pressure (PEEP) set at 12 cm H₂O. The nurse notes
a sudden drop in blood pressure from 120/80 mmHg to 85/50
mmHg, along with increased heart rate and decreased urine
output. What is the most likely cause of these findings?
A. Pulmonary embolism
B. Hypovolemic shock
C. Decreased venous return due to high PEEP
D. Septic shock
Correct Answer: C
Explanation: High PEEP increases intrathoracic pressure, which
reduces venous return to the heart, leading to decreased cardiac
output and hypotension. Hypovolemia and sepsis would present
with other signs, and pulmonary embolism typically causes sudden
hypoxia and chest pain.
2. A critically ill patient with septic shock is receiving norepinephrine.
The nurse observes that the patient's urine output has decreased
to 0.3 mL/kg/hr over the past 2 hours. What is the most
appropriate next action?
A. Increase the norepinephrine dose
B. Administer a fluid bolus
C. Notify the provider for possible renal evaluation
D. Switch to dopamine
Correct Answer: C
, Explanation: Decreased urine output despite vasopressor therapy
suggests possible acute kidney injury. While fluid resuscitation is
important in septic shock, the patient is already on
norepinephrine, and further intervention should be guided by the
provider. Increasing norepinephrine may worsen renal perfusion.
3. A patient with severe traumatic brain injury (TBI) has an
intracranial pressure (ICP) of 28 mmHg and a cerebral perfusion
pressure (CPP) of 50 mmHg. Which intervention is most
appropriate to improve CPP?
A. Administer mannitol
B. Increase sedation
C. Elevate the head of the bed to 45 degrees
D. Hyperventilate to PaCO₂ of 25 mmHg
Correct Answer: A
Explanation: Mannitol is an osmotic diuretic that reduces ICP,
thereby improving CPP. CPP = MAP - ICP. Increasing sedation may
help but is less immediate. Head elevation beyond 30 degrees may
compromise cerebral blood flow. Hyperventilation is reserved for
acute herniation due to risk of cerebral ischemia.
4. A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation. The nurse notes a plateau pressure of 32
cm H₂O. What is the most appropriate action?
A. Increase tidal volume to improve oxygenation
B. Decrease tidal volume to 6 mL/kg ideal body weight
C. Add more PEEP immediately
, D. Switch to high-frequency ventilation
Correct Answer: B
Explanation: Plateau pressure >30 cm H₂O indicates risk of
ventilator-induced lung injury. Low tidal volume ventilation (6
mL/kg IBW) is the standard of care in ARDS to protect the lungs.
Increasing tidal volume would worsen injury.
5. A patient in the ICU develops new-onset atrial fibrillation with
rapid ventricular response. The patient is hemodynamically stable.
What is the most appropriate initial management?
A. Immediate synchronized cardioversion
B. Administer amiodarone
C. Administer diltiazem
D. Start heparin infusion
Correct Answer: C
Explanation: In hemodynamically stable atrial fibrillation with RVR,
rate control with calcium channel blockers like diltiazem is first-
line. Cardioversion is for unstable patients. Amiodarone is second-
line. Anticoagulation is important but not the immediate priority.
6. A patient with crush injury syndrome is being monitored for
rhabdomyolysis. Which laboratory finding is most concerning for
acute kidney injury?
A. Creatine kinase (CK) of 5,000 U/L
B. Potassium of 5.8 mEq/L
C. Myoglobinuria with urine pH of 5.0
D. Creatinine of 2.1 mg/dL
, Correct Answer: D
Explanation: Elevated creatinine indicates actual kidney
dysfunction. While CK, hyperkalemia, and myoglobinuria are
concerning, creatinine elevation confirms acute kidney injury,
which is the primary complication of rhabdomyolysis.
7. A patient with diabetic ketoacidosis (DKA) is receiving insulin
infusion. The nurse notes the anion gap has decreased from 24 to
16 mEq/L, but glucose remains at 250 mg/dL. What is the next
appropriate step?
A. Continue insulin infusion without changes
B. Add dextrose to IV fluids and continue insulin
C. Stop insulin infusion
D. Increase insulin dose
Correct Answer: B
Explanation: When anion gap closes but glucose is still elevated,
dextrose should be added to prevent hypoglycemia while
continuing insulin to resolve ketosis. Stopping insulin prematurely
can lead to rebound ketoacidosis.
8. A patient with pulmonary embolism is receiving thrombolytic
therapy. Which finding requires immediate intervention?
A. Blood pressure of 90/60 mmHg
B. Heart rate of 110 bpm
C. Oozing from IV site
D. Sudden drop in oxygen saturation to 82%
Correct Answer: D
