CEA CRITICAL CARE NURSING EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant Download
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EXAM COVERAGE
1. Cardiovascular Critical Care and Hemodynamic Monitoring
2. Pulmonary Critical Care and Mechanical Ventilation
3. Neurocritical Care and Multimodal Monitoring
4. Critical Care Nephrology and Acid-Base Balance
5. Endocrine, Metabolic, and Gastrointestinal Emergencies
1. A patient in the surgical intensive care unit develops acute hypotension, jugular venous
distention, and muffled heart tones following cardiac surgery. Hemodynamic measurements
show equalization of right atrial, pulmonary artery wedge, and right ventricular end-diastolic
pressures. Which immediate advanced intervention is most critical?
A. Administration of a 500 mL crystalloid bolus to increase preload
B. Initiation of emergency needle decompression or surgical pericardiocentesis
C. Placement of an intra-aortic balloon pump for afterload reduction
D. Administration of high-dose beta-blockers to decrease myocardial oxygen demand
CORRECT ANSWER : B
Rationale: The clinical presentation of hypotension, jugular venous distention, and muffled heart
tones describes Beck's triad, indicative of cardiac tamponade. Equalization of chamber diastolic
pressures confirms this diagnosis. Pericardiocentesis or surgical evacuation is life-saving to
restore cardiac output, whereas fluid boluses only temporarily compensate, and beta-blockers
would dangerously depress contractility.
2. A patient with severe acute respiratory distress syndrome (ARDS) is maintained on mechanical
ventilation with a positive end-expiratory pressure (PEEP) of 14 cm H2O and a fraction of
inspired oxygen (FiO2) of 0.80. Arterial blood gases reveal pH 7.31, PaCO2 50 mmHg, PaO2 58
, mmHg, and HCO3 24 mEq/L. The patient exhibits sudden right-sided absent breath sounds and
tracheal deviation to the left. What is the immediate priority action?
A. Increase the ventilator PEEP level to 18 cm H2O to improve oxygenation
B. Perform immediate needle thoracostomy of the right second intercostal space
C. Administer intravenous sodium bicarbonate to correct the uncompensated acidosis
D. Obtain an urgent stat portable chest radiography to confirm a pulmonary embolism
CORRECT ANSWER : B
Rationale: The patient has developed a tension pneumothorax, a life-threatening complication of
high PEEP and barotrauma in ARDS, marked by tracheal deviation, absent breath sounds, and
hemodynamic collapse. Immediate needle decompression relieves intra-pleural pressure before
obtaining confirmation via radiography. Adjusting PEEP or giving bicarbonate fails to treat the
mechanical obstruction.
3. A patient is admitted following a severe traumatic brain injury with an intracranial pressure
(ICP) of 26 mmHg and a mean arterial pressure (MAP) of 80 mmHg. The critical care nurse
calculates the cerebral perfusion pressure (CPP). What is the calculated CPP, and is it within the
target therapeutic window?
A. CPP is 40 mmHg, which is within the normal therapeutic range
B. CPP is 54 mmHg, which is below the recommended target range
C. CPP is 106 mmHg, which indicates severe intracranial hypertension
D. CPP is 65 mmHg, which meets the standard goal for traumatic brain injury
CORRECT ANSWER : B
Rationale: Cerebral perfusion pressure is calculated as MAP minus ICP (80 - 26 = 54 mmHg).
Current guidelines for traumatic brain injury mandate maintaining CPP between 60 and 70
mmHg to prevent cerebral ischemia and secondary injury. A CPP of 54 mmHg reflects
compromised cerebral perfusion requiring targeted interventions.
4. A patient in septic shock is receiving norepinephrine infusion at 0.2 mcg/kg/min. Despite
adequate fluid resuscitation guided by stroke volume variation, the central venous pressure is 10
mmHg and mean arterial pressure remains 55 mmHg with a serum lactate of 4.2 mmol/L. Which
vasoactive agent should the nurse anticipate adding next?
A. Phenylephrine as a direct alpha-1 agonist for selective peripheral vasoconstriction
, B. Vasopressin at a fixed continuous dose of 0.03 units/min
C. Dobutamine infusion titrated to maintain a cardiac index above 4.0 L/min/m2
D. Low-dose dopamine infusion to promote renal and splanchnic vasodilation
CORRECT ANSWER : B
Rationale: In septic shock refractory to fluid resuscitation and moderate-dose norepinephrine,
adding vasopressin at a fixed non-titrated dose of 0.03 units/min restores vascular tone via V1
receptor stimulation without increasing adrenergic myocardial irritability. Phenylephrine lacks
inotropic support, low-dose dopamine is no longer recommended for renal protection, and
dobutamine is only indicated if myocardial dysfunction is proven.
5. A patient with acute kidney injury secondary to rhabdomyolysis has a serum potassium of 6.8
mEq/L with tall peaked T waves on the electrocardiogram. The intensivist orders immediate
medical management. Which sequence of pharmacological therapy is standard?
A. Oral sodium polystyrene sulfonate, followed by routine hemodialysis
B. IV calcium gluconate, regular insulin with dextrose, and inhaled albuterol
C. Intravenous furosemide bolus combined with aggressive normal saline hydration
D. Subcutaneous regular insulin injection followed by oral potassium binders
CORRECT ANSWER : B
Rationale: Severe hyperthermia with ECG changes mandates emergency stabilization. IV
calcium gluconate stabilizes the cardiac myocardial membrane immediately. Regular insulin
with dextrose shifts potassium intracellularly, while beta-agonists like albuterol provide
synergistic intracellular shifting. Calcium does not lower potassium but prevents lethal
arrhythmias.
6. A mechanically ventilated patient with status asthmaticus develops severe dynamic
hyperinflation, hypotension, and high peak inspiratory pressures. The ventilator mode is volume-
controlled assist-control. Which immediate ventilator adjustment mitigates auto-PEEP?
A. Increase the set respiratory rate to clear accumulated carbon dioxide
B. Decrease the set minute ventilation by lowering rate or tidal volume to prolong
expiratory time
C. Increase the inspiratory flow rate while simultaneously decreasing the tidal volume
D. Add an external PEEP valve matching the estimated level of measured auto-PEEP
, CORRECT ANSWER : B
Rationale: Dynamic hyperinflation and auto-PEEP in status asthmaticus result from incomplete
exhalation due to severe bronchospasm and air trapping. Prolonging expiratory time by
lowering respiratory rate or tidal volume permits fuller exhalation. Increasing rate worsens air
trapping, while matching auto-PEEP with external PEEP adds work of breathing.
7. A patient with aneurysmal subarachnoid hemorrhage on postoperative day 6 develops acute
lethargy, confusion, and right-sided hemiparesis. Transcranial Doppler ultrasound shows a mean
flow velocity of 170 cm/sec in the middle cerebral artery. What is the primary pharmacological
management strategy?
A. Immediate administration of intravenous barbiturates to lower metabolic demand
B. Initiation of hypertension therapy via volume expansion and continuous vasopressors
C. Emergency surgical clipping of the residual aneurysm sac to prevent rebleeding
D. Therapeutic hyperventilation to a target arterial carbon dioxide level of 25 mmHg
CORRECT ANSWER : B
Rationale: The patient exhibits classic signs of cerebral vasospasm leading to delayed cerebral
ischemia, supported by elevated transcranial Doppler velocities. Management involves induced
hypertension (triple-H therapy components, prioritizing hypertension) to maintain collateral
cerebral blood flow. Hyperventilation causes cerebral vasoconstriction and is contraindicated.
8. A patient is being monitored via a pulmonary artery catheter. Hemodynamic variables include:
Cardiac Output 3.2 L/min, Central Venous Pressure 14 mmHg, Pulmonary Artery Wedge
Pressure 18 mmHg, and Systemic Vascular Resistance 1800 dynes/sec/cm-5. What is the most
likely diagnosis?
A. Hypovolemic shock secondary to massive acute hemorrhage
B. Septic shock characterized by profound peripheral vasodilation
C. Cardiogenic shock secondary to acute myocardial infarction
D. Neurogenic shock resulting from upper spinal cord transaction
CORRECT ANSWER : C
Rationale: Elevated filling pressures (CVP 14, PAWP 18), low cardiac output (3.2 L/min), and
elevated systemic vascular resistance (1800 dynes/sec/cm-5) reflect classic cardiogenic shock.
Hypovolemic shock shows low filling pressures, septic shock displays low vascular resistance,
and neurogenic shock features profound bradycardia and low vascular resistance.
Answers/Plus a Rationale Updated 2026 A+/Instant Download
EXAM COVERAGE
1. Cardiovascular Critical Care and Hemodynamic Monitoring
2. Pulmonary Critical Care and Mechanical Ventilation
3. Neurocritical Care and Multimodal Monitoring
4. Critical Care Nephrology and Acid-Base Balance
5. Endocrine, Metabolic, and Gastrointestinal Emergencies
1. A patient in the surgical intensive care unit develops acute hypotension, jugular venous
distention, and muffled heart tones following cardiac surgery. Hemodynamic measurements
show equalization of right atrial, pulmonary artery wedge, and right ventricular end-diastolic
pressures. Which immediate advanced intervention is most critical?
A. Administration of a 500 mL crystalloid bolus to increase preload
B. Initiation of emergency needle decompression or surgical pericardiocentesis
C. Placement of an intra-aortic balloon pump for afterload reduction
D. Administration of high-dose beta-blockers to decrease myocardial oxygen demand
CORRECT ANSWER : B
Rationale: The clinical presentation of hypotension, jugular venous distention, and muffled heart
tones describes Beck's triad, indicative of cardiac tamponade. Equalization of chamber diastolic
pressures confirms this diagnosis. Pericardiocentesis or surgical evacuation is life-saving to
restore cardiac output, whereas fluid boluses only temporarily compensate, and beta-blockers
would dangerously depress contractility.
2. A patient with severe acute respiratory distress syndrome (ARDS) is maintained on mechanical
ventilation with a positive end-expiratory pressure (PEEP) of 14 cm H2O and a fraction of
inspired oxygen (FiO2) of 0.80. Arterial blood gases reveal pH 7.31, PaCO2 50 mmHg, PaO2 58
, mmHg, and HCO3 24 mEq/L. The patient exhibits sudden right-sided absent breath sounds and
tracheal deviation to the left. What is the immediate priority action?
A. Increase the ventilator PEEP level to 18 cm H2O to improve oxygenation
B. Perform immediate needle thoracostomy of the right second intercostal space
C. Administer intravenous sodium bicarbonate to correct the uncompensated acidosis
D. Obtain an urgent stat portable chest radiography to confirm a pulmonary embolism
CORRECT ANSWER : B
Rationale: The patient has developed a tension pneumothorax, a life-threatening complication of
high PEEP and barotrauma in ARDS, marked by tracheal deviation, absent breath sounds, and
hemodynamic collapse. Immediate needle decompression relieves intra-pleural pressure before
obtaining confirmation via radiography. Adjusting PEEP or giving bicarbonate fails to treat the
mechanical obstruction.
3. A patient is admitted following a severe traumatic brain injury with an intracranial pressure
(ICP) of 26 mmHg and a mean arterial pressure (MAP) of 80 mmHg. The critical care nurse
calculates the cerebral perfusion pressure (CPP). What is the calculated CPP, and is it within the
target therapeutic window?
A. CPP is 40 mmHg, which is within the normal therapeutic range
B. CPP is 54 mmHg, which is below the recommended target range
C. CPP is 106 mmHg, which indicates severe intracranial hypertension
D. CPP is 65 mmHg, which meets the standard goal for traumatic brain injury
CORRECT ANSWER : B
Rationale: Cerebral perfusion pressure is calculated as MAP minus ICP (80 - 26 = 54 mmHg).
Current guidelines for traumatic brain injury mandate maintaining CPP between 60 and 70
mmHg to prevent cerebral ischemia and secondary injury. A CPP of 54 mmHg reflects
compromised cerebral perfusion requiring targeted interventions.
4. A patient in septic shock is receiving norepinephrine infusion at 0.2 mcg/kg/min. Despite
adequate fluid resuscitation guided by stroke volume variation, the central venous pressure is 10
mmHg and mean arterial pressure remains 55 mmHg with a serum lactate of 4.2 mmol/L. Which
vasoactive agent should the nurse anticipate adding next?
A. Phenylephrine as a direct alpha-1 agonist for selective peripheral vasoconstriction
, B. Vasopressin at a fixed continuous dose of 0.03 units/min
C. Dobutamine infusion titrated to maintain a cardiac index above 4.0 L/min/m2
D. Low-dose dopamine infusion to promote renal and splanchnic vasodilation
CORRECT ANSWER : B
Rationale: In septic shock refractory to fluid resuscitation and moderate-dose norepinephrine,
adding vasopressin at a fixed non-titrated dose of 0.03 units/min restores vascular tone via V1
receptor stimulation without increasing adrenergic myocardial irritability. Phenylephrine lacks
inotropic support, low-dose dopamine is no longer recommended for renal protection, and
dobutamine is only indicated if myocardial dysfunction is proven.
5. A patient with acute kidney injury secondary to rhabdomyolysis has a serum potassium of 6.8
mEq/L with tall peaked T waves on the electrocardiogram. The intensivist orders immediate
medical management. Which sequence of pharmacological therapy is standard?
A. Oral sodium polystyrene sulfonate, followed by routine hemodialysis
B. IV calcium gluconate, regular insulin with dextrose, and inhaled albuterol
C. Intravenous furosemide bolus combined with aggressive normal saline hydration
D. Subcutaneous regular insulin injection followed by oral potassium binders
CORRECT ANSWER : B
Rationale: Severe hyperthermia with ECG changes mandates emergency stabilization. IV
calcium gluconate stabilizes the cardiac myocardial membrane immediately. Regular insulin
with dextrose shifts potassium intracellularly, while beta-agonists like albuterol provide
synergistic intracellular shifting. Calcium does not lower potassium but prevents lethal
arrhythmias.
6. A mechanically ventilated patient with status asthmaticus develops severe dynamic
hyperinflation, hypotension, and high peak inspiratory pressures. The ventilator mode is volume-
controlled assist-control. Which immediate ventilator adjustment mitigates auto-PEEP?
A. Increase the set respiratory rate to clear accumulated carbon dioxide
B. Decrease the set minute ventilation by lowering rate or tidal volume to prolong
expiratory time
C. Increase the inspiratory flow rate while simultaneously decreasing the tidal volume
D. Add an external PEEP valve matching the estimated level of measured auto-PEEP
, CORRECT ANSWER : B
Rationale: Dynamic hyperinflation and auto-PEEP in status asthmaticus result from incomplete
exhalation due to severe bronchospasm and air trapping. Prolonging expiratory time by
lowering respiratory rate or tidal volume permits fuller exhalation. Increasing rate worsens air
trapping, while matching auto-PEEP with external PEEP adds work of breathing.
7. A patient with aneurysmal subarachnoid hemorrhage on postoperative day 6 develops acute
lethargy, confusion, and right-sided hemiparesis. Transcranial Doppler ultrasound shows a mean
flow velocity of 170 cm/sec in the middle cerebral artery. What is the primary pharmacological
management strategy?
A. Immediate administration of intravenous barbiturates to lower metabolic demand
B. Initiation of hypertension therapy via volume expansion and continuous vasopressors
C. Emergency surgical clipping of the residual aneurysm sac to prevent rebleeding
D. Therapeutic hyperventilation to a target arterial carbon dioxide level of 25 mmHg
CORRECT ANSWER : B
Rationale: The patient exhibits classic signs of cerebral vasospasm leading to delayed cerebral
ischemia, supported by elevated transcranial Doppler velocities. Management involves induced
hypertension (triple-H therapy components, prioritizing hypertension) to maintain collateral
cerebral blood flow. Hyperventilation causes cerebral vasoconstriction and is contraindicated.
8. A patient is being monitored via a pulmonary artery catheter. Hemodynamic variables include:
Cardiac Output 3.2 L/min, Central Venous Pressure 14 mmHg, Pulmonary Artery Wedge
Pressure 18 mmHg, and Systemic Vascular Resistance 1800 dynes/sec/cm-5. What is the most
likely diagnosis?
A. Hypovolemic shock secondary to massive acute hemorrhage
B. Septic shock characterized by profound peripheral vasodilation
C. Cardiogenic shock secondary to acute myocardial infarction
D. Neurogenic shock resulting from upper spinal cord transaction
CORRECT ANSWER : C
Rationale: Elevated filling pressures (CVP 14, PAWP 18), low cardiac output (3.2 L/min), and
elevated systemic vascular resistance (1800 dynes/sec/cm-5) reflect classic cardiogenic shock.
Hypovolemic shock shows low filling pressures, septic shock displays low vascular resistance,
and neurogenic shock features profound bradycardia and low vascular resistance.
