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WEST COAST UNIVERSITY NURS 480 – HIGH-
ACUITY AND CRITICAL CARE NURSING
COMPREHENSIVE PRACTICE EXAM 2
QUESTIONS WITH ANSWERS AND RATIONALES
|100% PASS |GRADED A+ 2026/27
1. The nurse is caring for a client in septic shock. Which finding is an
early indicator of sepsis?
a) Hypotension unresponsive to fluids
b) Temperature of 96.8°F (36°C)
c) White blood cell count of 14,000/mm³
d) Tachypnea and altered mental status
Verified Answer: d
Rationale: Early sepsis is characterized by systemic inflammatory
response syndrome (SIRS) criteria, which include tachypnea, altered
mental status, fever or hypothermia, and elevated WBC. Hypotension
unresponsive to fluids is a late sign of septic shock.
2. A client with acute respiratory distress syndrome (ARDS) is on a
mechanical ventilator. The nurse notes a plateau pressure of 35 cm H₂O.
The nurse should:
a) Document this as normal
b) Notify the provider immediately (high risk for barotrauma)
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c) Decrease the PEEP
d) Increase the tidal volume
Verified Answer: b
Rationale: Plateau pressure should be < 30 cm H₂O to prevent
barotrauma and volutrauma. A pressure of 35 cm H₂O indicates
increased risk of lung injury and requires immediate provider
notification.
3. The nurse is caring for a client with a pulmonary artery catheter
(Swan-Ganz). A cardiac output (CO) of 3.5 L/min is documented. The
nurse should:
a) Document the finding
b) Assess for signs of hypoperfusion
c) Administer a fluid bolus
d) Notify the provider
Verified Answer: b
Rationale: Normal cardiac output is 4-8 L/min. A CO of 3.5 L/min is low
and may indicate decreased perfusion. The nurse should first assess the
client for signs of hypoperfusion (e.g., hypotension, tachycardia,
decreased urine output, altered mental status) before notifying the
provider or intervening.
4. A client in the ICU has a central venous pressure (CVP) of 2 mmHg.
This indicates:
a) Fluid overload
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b) Hypovolemia
c) Cardiac tamponade
d) Pulmonary hypertension
Verified Answer: b
Rationale: Normal CVP is 2-6 mmHg. A CVP of 2 mmHg is on the low
end and suggests hypovolemia (decreased intravascular volume). Fluid
overload would present with elevated CVP (> 6-8 mmHg).
5. The nurse is caring for a client with a traumatic brain injury (TBI).
Which intervention is a priority to prevent secondary injury?
a) Maintain systolic blood pressure > 90 mmHg
b) Keep the head of the bed flat
c) Restrict all sedatives
d) Maintain hyperthermia
Verified Answer: a
Rationale: Secondary brain injury is prevented by maintaining adequate
cerebral perfusion pressure (CPP). This requires maintaining systolic BP
> 90 mmHg (or MAP > 70 mmHg). Head of bed should be elevated 30
degrees, not flat. Hyperthermia should be avoided as it increases
metabolic demand.
6. A client is diagnosed with acute myocardial infarction (AMI) and
develops cardiogenic shock. Which hemodynamic parameter is
expected?
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a) Increased cardiac output
b) Decreased systemic vascular resistance (SVR)
c) Elevated pulmonary capillary wedge pressure (PCWP)
d) Normal heart rate
Verified Answer: c
Rationale: In cardiogenic shock, the heart fails as a pump, leading to
increased left ventricular filling pressures (elevated PCWP), decreased
cardiac output, and increased SVR (vasoconstriction).
7. The nurse is assessing a client with a tension pneumothorax. Which
finding requires immediate intervention?
a) Tracheal deviation to the opposite side
b) Diminished breath sounds on the affected side
c) Subcutaneous emphysema
d) Respiratory rate of 24 breaths/min
Verified Answer: a
Rationale: Tracheal deviation to the opposite side is a late and life-
threatening sign of tension pneumothorax indicating mediastinal shift.
This requires immediate needle decompression. Diminished breath
sounds and subcutaneous emphysema are also concerning but tracheal
deviation is the most emergent.
WEST COAST UNIVERSITY NURS 480 – HIGH-
ACUITY AND CRITICAL CARE NURSING
COMPREHENSIVE PRACTICE EXAM 2
QUESTIONS WITH ANSWERS AND RATIONALES
|100% PASS |GRADED A+ 2026/27
1. The nurse is caring for a client in septic shock. Which finding is an
early indicator of sepsis?
a) Hypotension unresponsive to fluids
b) Temperature of 96.8°F (36°C)
c) White blood cell count of 14,000/mm³
d) Tachypnea and altered mental status
Verified Answer: d
Rationale: Early sepsis is characterized by systemic inflammatory
response syndrome (SIRS) criteria, which include tachypnea, altered
mental status, fever or hypothermia, and elevated WBC. Hypotension
unresponsive to fluids is a late sign of septic shock.
2. A client with acute respiratory distress syndrome (ARDS) is on a
mechanical ventilator. The nurse notes a plateau pressure of 35 cm H₂O.
The nurse should:
a) Document this as normal
b) Notify the provider immediately (high risk for barotrauma)
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c) Decrease the PEEP
d) Increase the tidal volume
Verified Answer: b
Rationale: Plateau pressure should be < 30 cm H₂O to prevent
barotrauma and volutrauma. A pressure of 35 cm H₂O indicates
increased risk of lung injury and requires immediate provider
notification.
3. The nurse is caring for a client with a pulmonary artery catheter
(Swan-Ganz). A cardiac output (CO) of 3.5 L/min is documented. The
nurse should:
a) Document the finding
b) Assess for signs of hypoperfusion
c) Administer a fluid bolus
d) Notify the provider
Verified Answer: b
Rationale: Normal cardiac output is 4-8 L/min. A CO of 3.5 L/min is low
and may indicate decreased perfusion. The nurse should first assess the
client for signs of hypoperfusion (e.g., hypotension, tachycardia,
decreased urine output, altered mental status) before notifying the
provider or intervening.
4. A client in the ICU has a central venous pressure (CVP) of 2 mmHg.
This indicates:
a) Fluid overload
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b) Hypovolemia
c) Cardiac tamponade
d) Pulmonary hypertension
Verified Answer: b
Rationale: Normal CVP is 2-6 mmHg. A CVP of 2 mmHg is on the low
end and suggests hypovolemia (decreased intravascular volume). Fluid
overload would present with elevated CVP (> 6-8 mmHg).
5. The nurse is caring for a client with a traumatic brain injury (TBI).
Which intervention is a priority to prevent secondary injury?
a) Maintain systolic blood pressure > 90 mmHg
b) Keep the head of the bed flat
c) Restrict all sedatives
d) Maintain hyperthermia
Verified Answer: a
Rationale: Secondary brain injury is prevented by maintaining adequate
cerebral perfusion pressure (CPP). This requires maintaining systolic BP
> 90 mmHg (or MAP > 70 mmHg). Head of bed should be elevated 30
degrees, not flat. Hyperthermia should be avoided as it increases
metabolic demand.
6. A client is diagnosed with acute myocardial infarction (AMI) and
develops cardiogenic shock. Which hemodynamic parameter is
expected?
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a) Increased cardiac output
b) Decreased systemic vascular resistance (SVR)
c) Elevated pulmonary capillary wedge pressure (PCWP)
d) Normal heart rate
Verified Answer: c
Rationale: In cardiogenic shock, the heart fails as a pump, leading to
increased left ventricular filling pressures (elevated PCWP), decreased
cardiac output, and increased SVR (vasoconstriction).
7. The nurse is assessing a client with a tension pneumothorax. Which
finding requires immediate intervention?
a) Tracheal deviation to the opposite side
b) Diminished breath sounds on the affected side
c) Subcutaneous emphysema
d) Respiratory rate of 24 breaths/min
Verified Answer: a
Rationale: Tracheal deviation to the opposite side is a late and life-
threatening sign of tension pneumothorax indicating mediastinal shift.
This requires immediate needle decompression. Diminished breath
sounds and subcutaneous emphysema are also concerning but tracheal
deviation is the most emergent.
