KAPLAN CRITICAL CARE B PRACTICE TEST 100 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A |STUDY GUIDE| INSTANT DOWNLOAD PDF
*
CORE DOMAINS *
*
Cardiovascular Critical Care *
Respiratory Failure & Mechanical Ventilation *
Neurologic Critical Care & ICP Management *
Acute Kidney Injury & Renal Replacement *
Gastrointestinal & Hepatic Failure *
Endocrine Crisis & Metabolic Disorders *
Infection, Sepsis & Immunologic Response *
Ethics, Legal Compliance & Professional Standards *
Pain Management & Sedation in Critical Care *
Trauma, Shock & Hemodynamic Monitoring *
,*
INTRODUCTION *
*
This practice test is designed to assess your mastery of critical care nursing concepts and your ability to apply them in high-stakes clinical scenarios.
The exam evaluates core knowledge including hemodynamic monitoring, ventilator management, pharmacologic interventions, crisis recognition,
and interdisciplinary decision-making. All questions use multiple-choice and scenario-based formats that mirror real certification exams,
emphasizing clinical judgment over rote memorization. Success requires integrating foundational theory with applied professional knowledge,
regulatory compliance, and ethical standards. The questions prioritize real-world application, testing your capacity to prioritize interventions,
recognize complications early, and make sound decisions under pressure—skills essential for safe, effective critical care practice. *
*
*
Section One: Questions 1–100
Question 1
A patient with acute myocardial infarction develops sudden hypotension (BP 78/40), tachycardia, and cool clammy skin. The nurse notes a new
systolic murmur. Which complication should the nurse suspect first?
A. Ventricular septal rupture
B. Papillary muscle dysfunction
C. Pericardial tamponade
D. Aortic dissection
🟢 Correct answer: A
🔴 RATIONALE: Ventricular septal rupture presents with sudden hypotension, new systolic murmur, and signs of cardiogenic shock post-MI.
Papillary muscle dysfunction causes mitral regurgitation with a different murmur pattern. Tamponade presents with muffled heart sounds and
Beck's triad. Aortic dissection typically has tearing chest pain and pulse deficits.
,Question 2
A mechanically ventilated patient has arterial blood gas results: pH 7.28, PaCO₂ 52 mmHg, PaO₂ 68 mmHg, HCO₃ 24 mEq/L. What ventilation
adjustment is most appropriate?
A. Increase tidal volume
B. Increase respiratory rate
C. Decrease PEEP
D. Increase FiO₂
🟢 Correct answer: B
🔴 RATIONALE: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO₂). Increasing respiratory rate will enhance CO₂
elimination. Tidal volume increases risk of ventilator-induced lung injury. Decreasing PEEP worsens oxygenation. Increasing FiO₂ addresses PaO₂
but not the acidosis.
Question 3
A patient with severe traumatic brain injury has an intracranial pressure of 28 mmHg. Which intervention should the nurse implement first?
A. Administer IV mannitol
B. Elevate head of bed to 30 degrees
C. Administer IV dexamethasone
D. Perform immediate lumbar puncture
🟢 Correct answer: B
🔴 RATIONALE: Head elevation to 30 degrees is the first-line, non-invasive intervention to reduce ICP by promoting venous drainage. Mannitol is
used but requires monitoring and is second-line. Dexamethasone is not recommended for traumatic brain injury. Lumbar puncture is
contraindicated with elevated ICP due to herniation risk.
, Question 4
A patient with acute kidney injury has urine output of 15 mL over 4 hours, BUN 88 mg/dL, and creatinine 4.2 mg/dL. Which finding indicates
progression to oliguric phase?
A. Urine sodium 12 mEq/L
B. Urine osmolality 520 mOsm/kg
C. Serum potassium 6.8 mEq/L
D. BUN/creatinine ratio 22:1
🟢 Correct answer: C
🔴 RATIONALE: Hyperkalemia (K⁺ 6.8 mEq/L) is a critical complication of the oliguric phase indicating impaired renal excretion. Urine sodium
<20 and high osmolality suggest prerenal azotemia. BUN/Cr ratio >20:1 also indicates prerenal etiology, not intrinsic AKI progression.
Question 5
A patient with status epilepticus receives lorazepam 4 mg IV. After 5 minutes, the patient continues seizing. What is the next appropriate medication?
A. Diazepam 10 mg IV
B. Phenytoin 20 mg/kg IV
C. Midazolam 5 mg IM
D. Levetiracetam 60 mg/kg IV
🟢 Correct answer: B
🔴 RATIONALE: Phenytoin (or fosphenytoin) is the standard second-line agent after benzodiazepines in status epilepticus. Diazepam is another
benzodiazepine and not preferred after lorazepam failure. Midazolam IM is for prehospital use. Levetiracetam is an alternative but phenytoin
remains first second-line choice.
RATIONALES 2026 Q&A |STUDY GUIDE| INSTANT DOWNLOAD PDF
*
CORE DOMAINS *
*
Cardiovascular Critical Care *
Respiratory Failure & Mechanical Ventilation *
Neurologic Critical Care & ICP Management *
Acute Kidney Injury & Renal Replacement *
Gastrointestinal & Hepatic Failure *
Endocrine Crisis & Metabolic Disorders *
Infection, Sepsis & Immunologic Response *
Ethics, Legal Compliance & Professional Standards *
Pain Management & Sedation in Critical Care *
Trauma, Shock & Hemodynamic Monitoring *
,*
INTRODUCTION *
*
This practice test is designed to assess your mastery of critical care nursing concepts and your ability to apply them in high-stakes clinical scenarios.
The exam evaluates core knowledge including hemodynamic monitoring, ventilator management, pharmacologic interventions, crisis recognition,
and interdisciplinary decision-making. All questions use multiple-choice and scenario-based formats that mirror real certification exams,
emphasizing clinical judgment over rote memorization. Success requires integrating foundational theory with applied professional knowledge,
regulatory compliance, and ethical standards. The questions prioritize real-world application, testing your capacity to prioritize interventions,
recognize complications early, and make sound decisions under pressure—skills essential for safe, effective critical care practice. *
*
*
Section One: Questions 1–100
Question 1
A patient with acute myocardial infarction develops sudden hypotension (BP 78/40), tachycardia, and cool clammy skin. The nurse notes a new
systolic murmur. Which complication should the nurse suspect first?
A. Ventricular septal rupture
B. Papillary muscle dysfunction
C. Pericardial tamponade
D. Aortic dissection
🟢 Correct answer: A
🔴 RATIONALE: Ventricular septal rupture presents with sudden hypotension, new systolic murmur, and signs of cardiogenic shock post-MI.
Papillary muscle dysfunction causes mitral regurgitation with a different murmur pattern. Tamponade presents with muffled heart sounds and
Beck's triad. Aortic dissection typically has tearing chest pain and pulse deficits.
,Question 2
A mechanically ventilated patient has arterial blood gas results: pH 7.28, PaCO₂ 52 mmHg, PaO₂ 68 mmHg, HCO₃ 24 mEq/L. What ventilation
adjustment is most appropriate?
A. Increase tidal volume
B. Increase respiratory rate
C. Decrease PEEP
D. Increase FiO₂
🟢 Correct answer: B
🔴 RATIONALE: The ABG shows uncompensated respiratory acidosis (low pH, high PaCO₂). Increasing respiratory rate will enhance CO₂
elimination. Tidal volume increases risk of ventilator-induced lung injury. Decreasing PEEP worsens oxygenation. Increasing FiO₂ addresses PaO₂
but not the acidosis.
Question 3
A patient with severe traumatic brain injury has an intracranial pressure of 28 mmHg. Which intervention should the nurse implement first?
A. Administer IV mannitol
B. Elevate head of bed to 30 degrees
C. Administer IV dexamethasone
D. Perform immediate lumbar puncture
🟢 Correct answer: B
🔴 RATIONALE: Head elevation to 30 degrees is the first-line, non-invasive intervention to reduce ICP by promoting venous drainage. Mannitol is
used but requires monitoring and is second-line. Dexamethasone is not recommended for traumatic brain injury. Lumbar puncture is
contraindicated with elevated ICP due to herniation risk.
, Question 4
A patient with acute kidney injury has urine output of 15 mL over 4 hours, BUN 88 mg/dL, and creatinine 4.2 mg/dL. Which finding indicates
progression to oliguric phase?
A. Urine sodium 12 mEq/L
B. Urine osmolality 520 mOsm/kg
C. Serum potassium 6.8 mEq/L
D. BUN/creatinine ratio 22:1
🟢 Correct answer: C
🔴 RATIONALE: Hyperkalemia (K⁺ 6.8 mEq/L) is a critical complication of the oliguric phase indicating impaired renal excretion. Urine sodium
<20 and high osmolality suggest prerenal azotemia. BUN/Cr ratio >20:1 also indicates prerenal etiology, not intrinsic AKI progression.
Question 5
A patient with status epilepticus receives lorazepam 4 mg IV. After 5 minutes, the patient continues seizing. What is the next appropriate medication?
A. Diazepam 10 mg IV
B. Phenytoin 20 mg/kg IV
C. Midazolam 5 mg IM
D. Levetiracetam 60 mg/kg IV
🟢 Correct answer: B
🔴 RATIONALE: Phenytoin (or fosphenytoin) is the standard second-line agent after benzodiazepines in status epilepticus. Diazepam is another
benzodiazepine and not preferred after lorazepam failure. Midazolam IM is for prehospital use. Levetiracetam is an alternative but phenytoin
remains first second-line choice.
