Critical Care Nursing Practice Exam – 2026
Updated Q&A Bank
Section 1: Hemodynamics & Shock States
(Questions 1-25)
1. The nurse is caring for a patient with septic shock. Which hemodynamic finding is expected?
A) Decreased cardiac output and increased systemic vascular resistance (SVR)
B) Increased cardiac output and decreased SVR
C) Decreased cardiac output and decreased SVR
D) Increased cardiac output and increased SVR
Answer: B) Increased cardiac output and decreased SVR
Rationale: In the hyperdynamic phase of septic shock, cardiac output is increased (or normal) and
systemic vascular resistance is decreased due to vasodilation. This is characterized by warm, flushed skin
and bounding pulses.
2. A patient in cardiogenic shock has a pulmonary artery wedge pressure (PAWP) of 22 mmHg. The
nurse interprets this as:
A) Normal PAWP
B) Low PAWP indicating hypovolemia
C) Elevated PAWP indicating left-sided heart failure
D) Elevated PAWP indicating right-sided heart failure
Answer: C) Elevated PAWP indicating left-sided heart failure
Rationale: Normal PAWP is 4-12 mmHg. An elevated PAWP (>18 mmHg) indicates left ventricular failure
and fluid overload, which is characteristic of cardiogenic shock.
3. The nurse is caring for a patient with a pulmonary artery catheter. Which finding indicates a normal
cardiac index?
A) 1.5 L/min/m²
B) 2.5 L/min/m²
C) 3.5 L/min/m²
, D) 5.5 L/min/m²
Answer: C) 3.5 L/min/m²
Rationale: Normal cardiac index (CI) is 2.5-4.0 L/min/m². A CI below 2.2 L/min/m² indicates cardiogenic
shock. The cardiac index is cardiac output adjusted for body surface area.
4. A patient with hypovolemic shock has a central venous pressure (CVP) of 2 mmHg. Which
intervention is appropriate?
A) Administer diuretics
B) Administer IV fluids
C) Administer vasopressors
D) Administer inotropes
Answer: B) Administer IV fluids
Rationale: Normal CVP is 2-8 mmHg. A low CVP (<2 mmHg) indicates hypovolemia and requires fluid
resuscitation. Diuretics would worsen hypovolemia, and vasopressors may be needed after fluid
resuscitation.
5. The nurse is assessing a patient in shock. Which finding is an early sign of hypovolemic shock?
A) Hypotension and bradycardia
B) Tachycardia and cool extremities
C) Oliguria and altered mental status
D) Metabolic acidosis and hypoxemia
Answer: B) Tachycardia and cool extremities
Rationale: Early signs of hypovolemic shock include tachycardia, cool extremities, delayed capillary refill,
and decreased urine output. Hypotension is a late sign. Oliguria and altered mental status indicate
progression.
6. A patient with septic shock is receiving norepinephrine. Which finding indicates the medication is
effective?
A) Decreased blood pressure
B) Increased blood pressure and improved perfusion
C) Decreased cardiac output
D) Increased heart rate
Answer: B) Increased blood pressure and improved perfusion
Rationale: Norepinephrine is a vasopressor that increases blood pressure by causing vasoconstriction.
Effectiveness is indicated by improved blood pressure, perfusion, and urine output.
,7. The nurse is caring for a patient with distributive shock. Which type of shock is classified as
distributive?
A) Hypovolemic shock
B) Cardiogenic shock
C) Septic shock and anaphylactic shock
D) Obstructive shock
Answer: C) Septic shock and anaphylactic shock
Rationale: Distributive shock includes septic shock, anaphylactic shock, and neurogenic shock. These are
characterized by vasodilation and decreased SVR.
8. A patient with cardiogenic shock is prescribed dobutamine. The nurse understands that
dobutamine works by:
A) Causing vasoconstriction and increasing SVR
B) Increasing myocardial contractility (positive inotrope)
C) Decreasing preload and afterload
D) Increasing heart rate (chronotrope)
Answer: B) Increasing myocardial contractility (positive inotrope)
Rationale: Dobutamine is a positive inotrope that increases myocardial contractility and cardiac output
with minimal effect on SVR. It is used in cardiogenic shock to improve cardiac function.
9. The nurse is assessing a patient with neurogenic shock. Which finding is characteristic?
A) Tachycardia and hypertension
B) Bradycardia and hypotension
C) Tachycardia and hypotension
D) Bradycardia and hypertension
Answer: B) Bradycardia and hypotension
Rationale: Neurogenic shock (spinal cord injury above T6) is characterized by bradycardia, hypotension,
and warm, dry skin due to loss of sympathetic tone and unopposed vagal stimulation.
10. A patient in shock has a mixed venous oxygen saturation (SvO2) of 50%. The nurse interprets this
as:
A) Normal SvO2
B) Increased oxygen extraction indicating inadequate oxygen delivery
C) Decreased oxygen extraction indicating adequate oxygen delivery
D) Sepsis with increased oxygen delivery
, Answer: B) Increased oxygen extraction indicating inadequate oxygen delivery
Rationale: Normal SvO2 is 60-80%. A low SvO2 (<60%) indicates increased oxygen extraction due to
inadequate oxygen delivery (low cardiac output or hypoxemia).
11. The nurse is caring for a patient with an intra-aortic balloon pump (IABP). Which finding indicates
proper timing?
A) Balloon inflates during systole and deflates during diastole
B) Balloon inflates during diastole and deflates during systole
C) Balloon inflates continuously
D) Balloon deflates continuously
Answer: B) Balloon inflates during diastole and deflates during systole
Rationale: The IABP inflates during diastole to increase coronary perfusion and deflates during systole to
decrease afterload. Proper timing is essential for optimal effect.
12. A patient with obstructive shock has a cardiac tamponade. Which finding is characteristic of
cardiac tamponade?
A) Beck's triad (hypotension, muffled heart sounds, JVD)
B) Cushing's triad (hypertension, bradycardia, irregular respirations)
C) Elevated CVP and clear lung sounds
D) Both A and C
Answer: D) Both A and C
Rationale: Cardiac tamponade presents with Beck's triad (hypotension, muffled heart sounds, JVD),
elevated CVP, clear lung sounds, and pulsus paradoxus. Cushing's triad indicates increased ICP.
13. The nurse is monitoring a patient with shock. Which laboratory finding indicates tissue hypoxia?
A) Elevated lactate
B) Elevated bicarbonate
C) Decreased lactate
D) Normal arterial blood gas
Answer: A) Elevated lactate
Rationale: Elevated lactate (>2 mmol/L) indicates tissue hypoxia and anaerobic metabolism. It is a
marker of poor tissue perfusion and is associated with increased mortality in shock states.
14. A patient with septic shock is prescribed vasopressin. The nurse understands that vasopressin
works by:
A) Increasing cardiac contractility
B) Causing vasoconstriction via V1 receptors
Updated Q&A Bank
Section 1: Hemodynamics & Shock States
(Questions 1-25)
1. The nurse is caring for a patient with septic shock. Which hemodynamic finding is expected?
A) Decreased cardiac output and increased systemic vascular resistance (SVR)
B) Increased cardiac output and decreased SVR
C) Decreased cardiac output and decreased SVR
D) Increased cardiac output and increased SVR
Answer: B) Increased cardiac output and decreased SVR
Rationale: In the hyperdynamic phase of septic shock, cardiac output is increased (or normal) and
systemic vascular resistance is decreased due to vasodilation. This is characterized by warm, flushed skin
and bounding pulses.
2. A patient in cardiogenic shock has a pulmonary artery wedge pressure (PAWP) of 22 mmHg. The
nurse interprets this as:
A) Normal PAWP
B) Low PAWP indicating hypovolemia
C) Elevated PAWP indicating left-sided heart failure
D) Elevated PAWP indicating right-sided heart failure
Answer: C) Elevated PAWP indicating left-sided heart failure
Rationale: Normal PAWP is 4-12 mmHg. An elevated PAWP (>18 mmHg) indicates left ventricular failure
and fluid overload, which is characteristic of cardiogenic shock.
3. The nurse is caring for a patient with a pulmonary artery catheter. Which finding indicates a normal
cardiac index?
A) 1.5 L/min/m²
B) 2.5 L/min/m²
C) 3.5 L/min/m²
, D) 5.5 L/min/m²
Answer: C) 3.5 L/min/m²
Rationale: Normal cardiac index (CI) is 2.5-4.0 L/min/m². A CI below 2.2 L/min/m² indicates cardiogenic
shock. The cardiac index is cardiac output adjusted for body surface area.
4. A patient with hypovolemic shock has a central venous pressure (CVP) of 2 mmHg. Which
intervention is appropriate?
A) Administer diuretics
B) Administer IV fluids
C) Administer vasopressors
D) Administer inotropes
Answer: B) Administer IV fluids
Rationale: Normal CVP is 2-8 mmHg. A low CVP (<2 mmHg) indicates hypovolemia and requires fluid
resuscitation. Diuretics would worsen hypovolemia, and vasopressors may be needed after fluid
resuscitation.
5. The nurse is assessing a patient in shock. Which finding is an early sign of hypovolemic shock?
A) Hypotension and bradycardia
B) Tachycardia and cool extremities
C) Oliguria and altered mental status
D) Metabolic acidosis and hypoxemia
Answer: B) Tachycardia and cool extremities
Rationale: Early signs of hypovolemic shock include tachycardia, cool extremities, delayed capillary refill,
and decreased urine output. Hypotension is a late sign. Oliguria and altered mental status indicate
progression.
6. A patient with septic shock is receiving norepinephrine. Which finding indicates the medication is
effective?
A) Decreased blood pressure
B) Increased blood pressure and improved perfusion
C) Decreased cardiac output
D) Increased heart rate
Answer: B) Increased blood pressure and improved perfusion
Rationale: Norepinephrine is a vasopressor that increases blood pressure by causing vasoconstriction.
Effectiveness is indicated by improved blood pressure, perfusion, and urine output.
,7. The nurse is caring for a patient with distributive shock. Which type of shock is classified as
distributive?
A) Hypovolemic shock
B) Cardiogenic shock
C) Septic shock and anaphylactic shock
D) Obstructive shock
Answer: C) Septic shock and anaphylactic shock
Rationale: Distributive shock includes septic shock, anaphylactic shock, and neurogenic shock. These are
characterized by vasodilation and decreased SVR.
8. A patient with cardiogenic shock is prescribed dobutamine. The nurse understands that
dobutamine works by:
A) Causing vasoconstriction and increasing SVR
B) Increasing myocardial contractility (positive inotrope)
C) Decreasing preload and afterload
D) Increasing heart rate (chronotrope)
Answer: B) Increasing myocardial contractility (positive inotrope)
Rationale: Dobutamine is a positive inotrope that increases myocardial contractility and cardiac output
with minimal effect on SVR. It is used in cardiogenic shock to improve cardiac function.
9. The nurse is assessing a patient with neurogenic shock. Which finding is characteristic?
A) Tachycardia and hypertension
B) Bradycardia and hypotension
C) Tachycardia and hypotension
D) Bradycardia and hypertension
Answer: B) Bradycardia and hypotension
Rationale: Neurogenic shock (spinal cord injury above T6) is characterized by bradycardia, hypotension,
and warm, dry skin due to loss of sympathetic tone and unopposed vagal stimulation.
10. A patient in shock has a mixed venous oxygen saturation (SvO2) of 50%. The nurse interprets this
as:
A) Normal SvO2
B) Increased oxygen extraction indicating inadequate oxygen delivery
C) Decreased oxygen extraction indicating adequate oxygen delivery
D) Sepsis with increased oxygen delivery
, Answer: B) Increased oxygen extraction indicating inadequate oxygen delivery
Rationale: Normal SvO2 is 60-80%. A low SvO2 (<60%) indicates increased oxygen extraction due to
inadequate oxygen delivery (low cardiac output or hypoxemia).
11. The nurse is caring for a patient with an intra-aortic balloon pump (IABP). Which finding indicates
proper timing?
A) Balloon inflates during systole and deflates during diastole
B) Balloon inflates during diastole and deflates during systole
C) Balloon inflates continuously
D) Balloon deflates continuously
Answer: B) Balloon inflates during diastole and deflates during systole
Rationale: The IABP inflates during diastole to increase coronary perfusion and deflates during systole to
decrease afterload. Proper timing is essential for optimal effect.
12. A patient with obstructive shock has a cardiac tamponade. Which finding is characteristic of
cardiac tamponade?
A) Beck's triad (hypotension, muffled heart sounds, JVD)
B) Cushing's triad (hypertension, bradycardia, irregular respirations)
C) Elevated CVP and clear lung sounds
D) Both A and C
Answer: D) Both A and C
Rationale: Cardiac tamponade presents with Beck's triad (hypotension, muffled heart sounds, JVD),
elevated CVP, clear lung sounds, and pulsus paradoxus. Cushing's triad indicates increased ICP.
13. The nurse is monitoring a patient with shock. Which laboratory finding indicates tissue hypoxia?
A) Elevated lactate
B) Elevated bicarbonate
C) Decreased lactate
D) Normal arterial blood gas
Answer: A) Elevated lactate
Rationale: Elevated lactate (>2 mmol/L) indicates tissue hypoxia and anaerobic metabolism. It is a
marker of poor tissue perfusion and is associated with increased mortality in shock states.
14. A patient with septic shock is prescribed vasopressin. The nurse understands that vasopressin
works by:
A) Increasing cardiac contractility
B) Causing vasoconstriction via V1 receptors
