NUR 210 CRITICAL CARE NURSING
2026 Q&A
1. A patient in the ICU is receiving mechanical ventilation with
PEEP of 12 cm H2O. The nurse notices a sudden drop in
blood pressure from 120/80 to 85/50 mmHg, increased
heart rate from 88 to 118 bpm, and decreased oxygen
saturation. What is the priority nursing action?
A. Decrease the PEEP to 8 cm H2O
B. Increase the FiO2 to 100%
C. Assess for pneumothorax and notify the provider
immediately
D. Administer a 500 mL fluid bolus
Correct Answer: C
Explanation: The combination of suddenly dropped blood
pressure, tachycardia, and desaturation in a patient with
high PEEP suggests tension pneumothorax, a life-
threatening complication. PEEP increases intrathoracic
pressure which can cause barotrauma. Immediate
assessment for pneumothorax and provider notification is
critical. Decreasing PEEP or giving fluids without
assessment delays definitive treatment. Increasing FiO2
doesn't address the underlying problem
2. A patient with septic shock has a central venous pressure
(CVP) of 3 mmHg, mean arterial pressure (MAP) of 52
mmHg, and mixed venous oxygen saturation (SvO2) of 55%.
Which intervention should the nurse anticipate first?
A. Administer vasopressors
B. Initiate fluid resuscitation with crystalloids
C. Start inotropic support
, D. Transfuse packed red blood cells
Correct Answer: B
Explanation: The low CVP (2-6 mmHg is normal), low MAP
(<65 mmHg is inadequate), and low SvO2 (<60% indicates
inadequate oxygen delivery) suggest hypovolemia in early
septic shock. Fluid resuscitation is the first-line intervention
per sepsis guidelines. Vasopressors are started after
adequate fluid resuscitation if MAP remains <65 mmHg.
Inotropes are for cardiac dysfunction, and transfusion is
for anemia, neither is priority here
3. Which assessment finding in a patient with acute respiratory
distress syndrome (ARDS) requires immediate intervention?
A. PaO2 of 58 mmHg on FiO2 of 60%
B. Bilateral crackles on lung auscultation
C. Respiratory rate of 28 breaths/min
D. Plateau pressure of 32 cm H2O
Correct Answer: D
Explanation: Plateau pressure >30 cm H2O increases risk
of ventilator-induced lung injury in ARDS. Lung protective
ventilation strategy requires keeping plateau pressure <30
cm H2O. While hypoxemia (PaO2 58), crackles, and
tachypnea are expected in ARDS, elevated plateau pressure
requires immediate adjustment of ventilator settings to
prevent further lung damage
4. A patient with a right internal jugular central venous
catheter develops sudden chest pain, dyspnea, and
hypotension. Air is visible under the skin around the
, insertion site. What is the most likely complication?
A. Catheter-related bloodstream infection
B. Pneumothorax
C. Air embolism
D. Hematoma formation
Correct Answer: C
Explanation: Subcutaneous emphysema (air under skin),
chest pain, dyspnea, and hypotension suggest air embolism
from the central line. This is a medical emergency requiring
immediate occlusion of the catheter, positioning patient in
left lateral decubitus with head down (Durant maneuver),
and 100% oxygen. Pneumothorax would show decreased
breath sounds but not subcutaneous air. Infection presents
with fever and drainage, not acute respiratory distress
5. In a patient with cardiogenic shock secondary to acute
myocardial infarction, which hemodynamic profile is most
expected?
A. Low cardiac index, high systemic vascular resistance, high
pulmonary capillary wedge pressure
B. High cardiac index, low systemic vascular resistance, low
pulmonary capillary wedge pressure
C. Low cardiac index, low systemic vascular resistance, high
pulmonary capillary wedge pressure
D. High cardiac index, high systemic vascular resistance, low
pulmonary capillary wedge pressure
Correct Answer: A
Explanation: Cardiogenic shock is characterized by pump
failure: decreased cardiac index (<2.2 L/min/m²),
compensatory vasoconstriction (increased SVR >1200
dynes·sec·cm⁻⁵), and elevated preload (high PCWP >18
mmHg) due to left ventricular failure. Option B describes
, distributive shock (septic), option C describes mixed shock,
and option D is not consistent with any shock type
6. A mechanically ventilated patient has a high-pressure alarm
sounding. The patient is coughing and appears anxious.
Breath sounds are diminished on the right side. What should
the nurse do first?
A. Suction the patient
B. Check for ventilator circuit kinks
C. Assess for pneumothorax and notify provider
D. Increase the sedation level
Correct Answer: C
Explanation: High-pressure alarms indicate increased
airway resistance or decreased compliance. Diminished
breath sounds on one side with tachycardia/anxiety
suggests pneumothorax, especially with mechanical
ventilation. This requires immediate assessment and
provider notification. Suctioning addresses secretions but
not pneumothorax. Checking for kinks is appropriate but
doesn't address the unilateral finding. Increased sedation
without assessment is unsafe
7. A patient with severe sepsis has received 30 mL/kg of
crystalloid fluids but remains hypotensive with MAP of 58
mmHg. Which vasopressor is the first-line choice?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
2026 Q&A
1. A patient in the ICU is receiving mechanical ventilation with
PEEP of 12 cm H2O. The nurse notices a sudden drop in
blood pressure from 120/80 to 85/50 mmHg, increased
heart rate from 88 to 118 bpm, and decreased oxygen
saturation. What is the priority nursing action?
A. Decrease the PEEP to 8 cm H2O
B. Increase the FiO2 to 100%
C. Assess for pneumothorax and notify the provider
immediately
D. Administer a 500 mL fluid bolus
Correct Answer: C
Explanation: The combination of suddenly dropped blood
pressure, tachycardia, and desaturation in a patient with
high PEEP suggests tension pneumothorax, a life-
threatening complication. PEEP increases intrathoracic
pressure which can cause barotrauma. Immediate
assessment for pneumothorax and provider notification is
critical. Decreasing PEEP or giving fluids without
assessment delays definitive treatment. Increasing FiO2
doesn't address the underlying problem
2. A patient with septic shock has a central venous pressure
(CVP) of 3 mmHg, mean arterial pressure (MAP) of 52
mmHg, and mixed venous oxygen saturation (SvO2) of 55%.
Which intervention should the nurse anticipate first?
A. Administer vasopressors
B. Initiate fluid resuscitation with crystalloids
C. Start inotropic support
, D. Transfuse packed red blood cells
Correct Answer: B
Explanation: The low CVP (2-6 mmHg is normal), low MAP
(<65 mmHg is inadequate), and low SvO2 (<60% indicates
inadequate oxygen delivery) suggest hypovolemia in early
septic shock. Fluid resuscitation is the first-line intervention
per sepsis guidelines. Vasopressors are started after
adequate fluid resuscitation if MAP remains <65 mmHg.
Inotropes are for cardiac dysfunction, and transfusion is
for anemia, neither is priority here
3. Which assessment finding in a patient with acute respiratory
distress syndrome (ARDS) requires immediate intervention?
A. PaO2 of 58 mmHg on FiO2 of 60%
B. Bilateral crackles on lung auscultation
C. Respiratory rate of 28 breaths/min
D. Plateau pressure of 32 cm H2O
Correct Answer: D
Explanation: Plateau pressure >30 cm H2O increases risk
of ventilator-induced lung injury in ARDS. Lung protective
ventilation strategy requires keeping plateau pressure <30
cm H2O. While hypoxemia (PaO2 58), crackles, and
tachypnea are expected in ARDS, elevated plateau pressure
requires immediate adjustment of ventilator settings to
prevent further lung damage
4. A patient with a right internal jugular central venous
catheter develops sudden chest pain, dyspnea, and
hypotension. Air is visible under the skin around the
, insertion site. What is the most likely complication?
A. Catheter-related bloodstream infection
B. Pneumothorax
C. Air embolism
D. Hematoma formation
Correct Answer: C
Explanation: Subcutaneous emphysema (air under skin),
chest pain, dyspnea, and hypotension suggest air embolism
from the central line. This is a medical emergency requiring
immediate occlusion of the catheter, positioning patient in
left lateral decubitus with head down (Durant maneuver),
and 100% oxygen. Pneumothorax would show decreased
breath sounds but not subcutaneous air. Infection presents
with fever and drainage, not acute respiratory distress
5. In a patient with cardiogenic shock secondary to acute
myocardial infarction, which hemodynamic profile is most
expected?
A. Low cardiac index, high systemic vascular resistance, high
pulmonary capillary wedge pressure
B. High cardiac index, low systemic vascular resistance, low
pulmonary capillary wedge pressure
C. Low cardiac index, low systemic vascular resistance, high
pulmonary capillary wedge pressure
D. High cardiac index, high systemic vascular resistance, low
pulmonary capillary wedge pressure
Correct Answer: A
Explanation: Cardiogenic shock is characterized by pump
failure: decreased cardiac index (<2.2 L/min/m²),
compensatory vasoconstriction (increased SVR >1200
dynes·sec·cm⁻⁵), and elevated preload (high PCWP >18
mmHg) due to left ventricular failure. Option B describes
, distributive shock (septic), option C describes mixed shock,
and option D is not consistent with any shock type
6. A mechanically ventilated patient has a high-pressure alarm
sounding. The patient is coughing and appears anxious.
Breath sounds are diminished on the right side. What should
the nurse do first?
A. Suction the patient
B. Check for ventilator circuit kinks
C. Assess for pneumothorax and notify provider
D. Increase the sedation level
Correct Answer: C
Explanation: High-pressure alarms indicate increased
airway resistance or decreased compliance. Diminished
breath sounds on one side with tachycardia/anxiety
suggests pneumothorax, especially with mechanical
ventilation. This requires immediate assessment and
provider notification. Suctioning addresses secretions but
not pneumothorax. Checking for kinks is appropriate but
doesn't address the unilateral finding. Increased sedation
without assessment is unsafe
7. A patient with severe sepsis has received 30 mL/kg of
crystalloid fluids but remains hypotensive with MAP of 58
mmHg. Which vasopressor is the first-line choice?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
