Critical Care Nursing &
Complex Patient Management
Examination 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute respiratory distress syndrome (ARDS). Which
assessment finding is most consistent with this condition?
A. Bilateral crackles and hypoxemia refractory to oxygen therapy
B. Wheezing and prolonged expiratory phase
C. Diminished breath sounds and barrel chest
D. Stridor and use of accessory muscles
💫RATIONALE✔️✔️: ARDS is characterized by diffuse alveolar damage leading to pulmonary edema,
bilateral crackles, and severe hypoxemia that does not improve with oxygen therapy. Wheezing and
prolonged expiration are more consistent with asthma or COPD. Stridor is associated with upper airway
obstruction.
,💫ANSWER✔️✔️: A. Bilateral crackles and hypoxemia refractory to oxygen therapy
---
**Question 2**
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates a tension pneumothorax?
A. Continuous bubbling in the water seal chamber
B. Intermittent bubbling in the water seal chamber
C. Tidaling with respirations
D. Tracheal deviation to the unaffected side
💫RATIONALE✔️✔️: Tension pneumothorax is a life-threatening condition in which air accumulates
in the pleural space and shifts the mediastinum to the unaffected side. Tracheal deviation to the
unaffected side is a classic sign. Continuous bubbling indicates an air leak, and tidaling indicates a patent
chest tube.
💫ANSWER✔️✔️: D. Tracheal deviation to the unaffected side
---
**Question 3**
,The nurse is caring for a client who is receiving mechanical ventilation. Which nursing intervention is
most important to prevent ventilator-associated pneumonia (VAP)?
A. Suction the client's endotracheal tube every 2 hours
B. Maintain the head of the bed at 30-45 degrees
C. Change the ventilator circuit daily
D. Administer prophylactic antibiotics
💫RATIONALE✔️✔️: Elevating the head of the bed to 30-45 degrees is a key intervention to prevent
aspiration and VAP. Suctioning should be done as needed, ventilator circuits should be changed only
when visibly soiled, and prophylactic antibiotics are not recommended.
💫ANSWER✔️✔️: B. Maintain the head of the bed at 30-45 degrees
---
**Question 4**
The nurse is assessing a client who is receiving a continuous infusion of IV fluids. The client develops
shortness of breath and crackles in the lung bases. Which action should the nurse take first?
A. Slow the IV infusion rate
B. Administer oxygen via nasal cannula
C. Notify the healthcare provider
D. Assess the client's oxygen saturation
, 💫RATIONALE✔️✔️: The client is showing signs of fluid overload. The first action is to slow the IV
infusion rate to prevent further fluid accumulation. The nurse should then assess oxygen saturation,
place the client in a high-Fowler's position, and notify the provider.
💫ANSWER✔️✔️: A. Slow the IV infusion rate
---
**Question 5**
The nurse is caring for a client with a pulmonary embolism (PE). Which finding is most consistent with
this condition?
A. Sudden onset of pleuritic chest pain and dyspnea
B. Absent breath sounds on the affected side
C. Prolonged expiratory phase with wheezing
D. Barrel chest and chronic cough
💫RATIONALE✔️✔️: The classic presentation of a pulmonary embolism is sudden onset of pleuritic
chest pain, dyspnea, tachypnea, and tachycardia. Absent breath sounds are more consistent with
pneumothorax, and barrel chest with COPD.
💫ANSWER✔️✔️: A. Sudden onset of pleuritic chest pain and dyspnea
---
**Question 6**
Complex Patient Management
Examination 2026/2027
**Question 1**
The nurse is caring for a client with a diagnosis of acute respiratory distress syndrome (ARDS). Which
assessment finding is most consistent with this condition?
A. Bilateral crackles and hypoxemia refractory to oxygen therapy
B. Wheezing and prolonged expiratory phase
C. Diminished breath sounds and barrel chest
D. Stridor and use of accessory muscles
💫RATIONALE✔️✔️: ARDS is characterized by diffuse alveolar damage leading to pulmonary edema,
bilateral crackles, and severe hypoxemia that does not improve with oxygen therapy. Wheezing and
prolonged expiration are more consistent with asthma or COPD. Stridor is associated with upper airway
obstruction.
,💫ANSWER✔️✔️: A. Bilateral crackles and hypoxemia refractory to oxygen therapy
---
**Question 2**
The nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates a tension pneumothorax?
A. Continuous bubbling in the water seal chamber
B. Intermittent bubbling in the water seal chamber
C. Tidaling with respirations
D. Tracheal deviation to the unaffected side
💫RATIONALE✔️✔️: Tension pneumothorax is a life-threatening condition in which air accumulates
in the pleural space and shifts the mediastinum to the unaffected side. Tracheal deviation to the
unaffected side is a classic sign. Continuous bubbling indicates an air leak, and tidaling indicates a patent
chest tube.
💫ANSWER✔️✔️: D. Tracheal deviation to the unaffected side
---
**Question 3**
,The nurse is caring for a client who is receiving mechanical ventilation. Which nursing intervention is
most important to prevent ventilator-associated pneumonia (VAP)?
A. Suction the client's endotracheal tube every 2 hours
B. Maintain the head of the bed at 30-45 degrees
C. Change the ventilator circuit daily
D. Administer prophylactic antibiotics
💫RATIONALE✔️✔️: Elevating the head of the bed to 30-45 degrees is a key intervention to prevent
aspiration and VAP. Suctioning should be done as needed, ventilator circuits should be changed only
when visibly soiled, and prophylactic antibiotics are not recommended.
💫ANSWER✔️✔️: B. Maintain the head of the bed at 30-45 degrees
---
**Question 4**
The nurse is assessing a client who is receiving a continuous infusion of IV fluids. The client develops
shortness of breath and crackles in the lung bases. Which action should the nurse take first?
A. Slow the IV infusion rate
B. Administer oxygen via nasal cannula
C. Notify the healthcare provider
D. Assess the client's oxygen saturation
, 💫RATIONALE✔️✔️: The client is showing signs of fluid overload. The first action is to slow the IV
infusion rate to prevent further fluid accumulation. The nurse should then assess oxygen saturation,
place the client in a high-Fowler's position, and notify the provider.
💫ANSWER✔️✔️: A. Slow the IV infusion rate
---
**Question 5**
The nurse is caring for a client with a pulmonary embolism (PE). Which finding is most consistent with
this condition?
A. Sudden onset of pleuritic chest pain and dyspnea
B. Absent breath sounds on the affected side
C. Prolonged expiratory phase with wheezing
D. Barrel chest and chronic cough
💫RATIONALE✔️✔️: The classic presentation of a pulmonary embolism is sudden onset of pleuritic
chest pain, dyspnea, tachypnea, and tachycardia. Absent breath sounds are more consistent with
pneumothorax, and barrel chest with COPD.
💫ANSWER✔️✔️: A. Sudden onset of pleuritic chest pain and dyspnea
---
**Question 6**
