CRITICAL CARE NURSING BASICS EXAM
PRACTICE QUESTIONS & VERIFIED
ANSWERS | ICU, Emergency & Critical Care
Nursing Study Guide | Latest 2026 PDF
Download
CRITICAL CARE NURSING BASICS EXAM PRACTICE QUESTIONS & VERIFIED ANSWERS
ICU, Emergency & Critical Care Nursing Study Guide | Latest 2026
DOCUMENT OVERVIEW
• This comprehensive exam contains verified multiple-choice questions designed to
prepare candidates for critical care nursing certification, ICU competency
assessments, and emergency nursing boards with detailed EXPERT RATIONALE for
each answer.
• Study this material by reviewing questions systematically, focusing on
understanding the EXPERT RATIONALE for correct answers rather than
memorization, and using these questions to identify knowledge gaps in critical care
nursing fundamentals, pathophysiology, and clinical interventions.
QUESTION 1
A 65-year-old male patient admitted to the ICU with septic shock is receiving
vasopressor support. His current blood pressure is 88/52 mmHg and lactate
level is 4.2 mmol/L. Which intervention should be prioritized?
A) Reduce vasopressor dose to allow natural blood pressure recovery
B) Administer 500 mL normal saline bolus and reassess lactate
C) Increase vasopressor dose and administer broad-spectrum antibiotics if not
already given
D) Discontinue all medications and allow supportive care only
E) Transfer patient to palliative care immediately
,✓ CORRECT ANSWER: C) Increase vasopressor dose and administer broad-
spectrum antibiotics if not already given
EXPERT RATIONALE: In septic shock, the priority is aggressive management
including vasopressor escalation to maintain adequate perfusion pressure and
early administration of broad-spectrum antibiotics within the first hour. Lactate of
4.2 mmol/L indicates tissue hypoperfusion and anaerobic metabolism. Reducing
vasopressors would worsen perfusion, 500 mL bolus alone is insufficient in septic
shock, and palliative care is premature without appropriate resuscitation attempts.
QUESTION 2
A patient in the ICU is on mechanical ventilation with PEEP of 12 cmH2O. ABG
shows pH 7.28, PaCO2 58 mmHg, HCO3 26 mEq/L. What is the primary acid-
base disturbance?
A) Respiratory acidosis with metabolic compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis with metabolic compensation
D) Mixed respiratory and metabolic acidosis
E) Acute respiratory acidosis
✓ CORRECT ANSWER: E) Acute respiratory acidosis
EXPERT RATIONALE: The low pH (7.28) indicates acidemia, elevated PaCO2 (58)
indicates respiratory component, and the normal-to-low HCO3 (26) shows
incomplete metabolic compensation. This is acute respiratory acidosis because the
bicarbonate has not risen appropriately to compensate. In acute respiratory
acidosis, HCO3 increases only 3.5 mEq/L for every 10 mmHg rise in PaCO2. Chronic
conditions would show greater HCO3 elevation.
,QUESTION 3
A 58-year-old patient presents with acute coronary syndrome. Which finding
would MOST reliably indicate myocardial infarction in the first 6 hours?
A) ST-segment elevation on ECG
B) Elevated troponin levels
C) Chest pain lasting more than 30 minutes
D) Elevated CK-MB only
E) T-wave inversion alone
✓ CORRECT ANSWER: B) Elevated troponin levels
EXPERT RATIONALE: Troponin is the most sensitive and specific biomarker for
myocardial necrosis and can be detected within 2-4 hours of infarction onset,
earlier than CK-MB. While ST elevation is diagnostic of STEMI, not all MIs present
with ST changes. Troponin elevation is present in all types of MI and is the gold
standard for detecting myocardial injury. Serial troponin measurements improve
diagnostic accuracy.
QUESTION 4
A patient on continuous renal replacement therapy (CRRT) suddenly develops
hypotension despite adequate fluid resuscitation. What is the most likely
complication?
A) Hyperkalemia
B) Filter thrombosis with inadequate ultrafiltration
C) Hypothermia from dialysate temperature
D) Hypokalemia
E) Circuit disconnection
, ✓ CORRECT ANSWER: C) Hypothermia from dialysate temperature
EXPERT RATIONALE: CRRT can cause significant heat loss through the large
volumes of room-temperature dialysate or replacement fluid running through the
circuit continuously. This can lead to iatrogenic hypothermia, which causes
hypotension, bradycardia, and decreased cardiac output. Warming the dialysate
and replacement fluids to 37°C is standard practice. Filter thrombosis would reduce
UF but not typically cause acute hypotension. Hyperkalemia causes cardiac
dysrhythmias, not hypotension.
QUESTION 5
A 72-year-old patient with ARDS (PEEP 15, FiO2 0.8) has worsening
oxygenation. Chest X-ray shows bilateral infiltrates. What is the
recommended next intervention?
A) Increase FiO2 to 1.0 immediately
B) Apply prone positioning protocol
C) Decrease PEEP to reduce barotrauma
D) Initiate high-frequency ventilation
E) Perform immediate intubation
✓ CORRECT ANSWER: B) Apply prone positioning protocol
EXPERT RATIONALE: Prone positioning is a well-established intervention for
moderate-to-severe ARDS that has shown improved oxygenation and survival. It
helps recruit dorsal lung regions and improve ventilation-perfusion matching. With
already high PEEP (15) and FiO2 (0.8), increasing FiO2 to 1.0 has minimal benefit
and risks oxygen toxicity. Decreasing PEEP would worsen oxygenation. Prone
positioning should be attempted before escalating to other advanced interventions.
PRACTICE QUESTIONS & VERIFIED
ANSWERS | ICU, Emergency & Critical Care
Nursing Study Guide | Latest 2026 PDF
Download
CRITICAL CARE NURSING BASICS EXAM PRACTICE QUESTIONS & VERIFIED ANSWERS
ICU, Emergency & Critical Care Nursing Study Guide | Latest 2026
DOCUMENT OVERVIEW
• This comprehensive exam contains verified multiple-choice questions designed to
prepare candidates for critical care nursing certification, ICU competency
assessments, and emergency nursing boards with detailed EXPERT RATIONALE for
each answer.
• Study this material by reviewing questions systematically, focusing on
understanding the EXPERT RATIONALE for correct answers rather than
memorization, and using these questions to identify knowledge gaps in critical care
nursing fundamentals, pathophysiology, and clinical interventions.
QUESTION 1
A 65-year-old male patient admitted to the ICU with septic shock is receiving
vasopressor support. His current blood pressure is 88/52 mmHg and lactate
level is 4.2 mmol/L. Which intervention should be prioritized?
A) Reduce vasopressor dose to allow natural blood pressure recovery
B) Administer 500 mL normal saline bolus and reassess lactate
C) Increase vasopressor dose and administer broad-spectrum antibiotics if not
already given
D) Discontinue all medications and allow supportive care only
E) Transfer patient to palliative care immediately
,✓ CORRECT ANSWER: C) Increase vasopressor dose and administer broad-
spectrum antibiotics if not already given
EXPERT RATIONALE: In septic shock, the priority is aggressive management
including vasopressor escalation to maintain adequate perfusion pressure and
early administration of broad-spectrum antibiotics within the first hour. Lactate of
4.2 mmol/L indicates tissue hypoperfusion and anaerobic metabolism. Reducing
vasopressors would worsen perfusion, 500 mL bolus alone is insufficient in septic
shock, and palliative care is premature without appropriate resuscitation attempts.
QUESTION 2
A patient in the ICU is on mechanical ventilation with PEEP of 12 cmH2O. ABG
shows pH 7.28, PaCO2 58 mmHg, HCO3 26 mEq/L. What is the primary acid-
base disturbance?
A) Respiratory acidosis with metabolic compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis with metabolic compensation
D) Mixed respiratory and metabolic acidosis
E) Acute respiratory acidosis
✓ CORRECT ANSWER: E) Acute respiratory acidosis
EXPERT RATIONALE: The low pH (7.28) indicates acidemia, elevated PaCO2 (58)
indicates respiratory component, and the normal-to-low HCO3 (26) shows
incomplete metabolic compensation. This is acute respiratory acidosis because the
bicarbonate has not risen appropriately to compensate. In acute respiratory
acidosis, HCO3 increases only 3.5 mEq/L for every 10 mmHg rise in PaCO2. Chronic
conditions would show greater HCO3 elevation.
,QUESTION 3
A 58-year-old patient presents with acute coronary syndrome. Which finding
would MOST reliably indicate myocardial infarction in the first 6 hours?
A) ST-segment elevation on ECG
B) Elevated troponin levels
C) Chest pain lasting more than 30 minutes
D) Elevated CK-MB only
E) T-wave inversion alone
✓ CORRECT ANSWER: B) Elevated troponin levels
EXPERT RATIONALE: Troponin is the most sensitive and specific biomarker for
myocardial necrosis and can be detected within 2-4 hours of infarction onset,
earlier than CK-MB. While ST elevation is diagnostic of STEMI, not all MIs present
with ST changes. Troponin elevation is present in all types of MI and is the gold
standard for detecting myocardial injury. Serial troponin measurements improve
diagnostic accuracy.
QUESTION 4
A patient on continuous renal replacement therapy (CRRT) suddenly develops
hypotension despite adequate fluid resuscitation. What is the most likely
complication?
A) Hyperkalemia
B) Filter thrombosis with inadequate ultrafiltration
C) Hypothermia from dialysate temperature
D) Hypokalemia
E) Circuit disconnection
, ✓ CORRECT ANSWER: C) Hypothermia from dialysate temperature
EXPERT RATIONALE: CRRT can cause significant heat loss through the large
volumes of room-temperature dialysate or replacement fluid running through the
circuit continuously. This can lead to iatrogenic hypothermia, which causes
hypotension, bradycardia, and decreased cardiac output. Warming the dialysate
and replacement fluids to 37°C is standard practice. Filter thrombosis would reduce
UF but not typically cause acute hypotension. Hyperkalemia causes cardiac
dysrhythmias, not hypotension.
QUESTION 5
A 72-year-old patient with ARDS (PEEP 15, FiO2 0.8) has worsening
oxygenation. Chest X-ray shows bilateral infiltrates. What is the
recommended next intervention?
A) Increase FiO2 to 1.0 immediately
B) Apply prone positioning protocol
C) Decrease PEEP to reduce barotrauma
D) Initiate high-frequency ventilation
E) Perform immediate intubation
✓ CORRECT ANSWER: B) Apply prone positioning protocol
EXPERT RATIONALE: Prone positioning is a well-established intervention for
moderate-to-severe ARDS that has shown improved oxygenation and survival. It
helps recruit dorsal lung regions and improve ventilation-perfusion matching. With
already high PEEP (15) and FiO2 (0.8), increasing FiO2 to 1.0 has minimal benefit
and risks oxygen toxicity. Decreasing PEEP would worsen oxygenation. Prone
positioning should be attempted before escalating to other advanced interventions.
