KAPLAN NCLEX-RN CRITICAL CARE NURSING EXAM PRACTICE | COMPREHENSIVE
STUDY GUIDE | ADVANCED TESTBANK | PRACTICE QUESTIONS & ANSWERS | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Hemodynamic Monitoring, Shock & Perfusion — Questions 1–5
ii. Respiratory Failure & Mechanical Ventilation — Questions 6–10
iii. Cardiovascular Emergencies — Questions 11–14
iv. Neurologic Critical Care — Questions 15–17
v. Renal, Metabolic & Endocrine Emergencies — Questions 18–21
vi. Sepsis, Infection & Multisystem Organ Dysfunction — Questions 22–24
vii. Trauma, Burns & Acute Surgical Care — Questions 25–27
viii. Critical Care Pharmacology, Ethics & Prioritization — Questions 28–30
INTRODUCTION
This advanced Kaplan NCLEX-RN Critical Care Nursing practice set evaluates the nurse's
ability to recognize deterioration, prioritize interventions, interpret clinical findings, and
make safe decisions in high-acuity settings. Questions emphasize shock states,
mechanical ventilation, cardiovascular and neurologic emergencies, metabolic
instability, sepsis, trauma, pharmacology, ethical practice, and multisystem dysfunction.
The level is designed for nurses preparing for demanding professional examinations
and advanced clinical practice. Expect complex patient scenarios requiring synthesis of
assessment findings, laboratory values, hemodynamic trends, medication effects, and
response to treatment. Rather than relying on memorization, the questions emphasize
clinical judgment, prioritization, early recognition of life-threatening complications,
evidence-based intervention, and evaluation of whether treatment is producing the
desired physiologic response.
QUESTION 1
A patient with septic shock has received an appropriate initial crystalloid bolus. The
nurse reassesses the patient and notes: blood pressure 82/48 mm Hg, heart rate
126/min, respiratory rate 28/min, urine output 15 mL/hr, cool extremities, and
increasing confusion. Which prescription should the nurse anticipate implementing
next?
A. Administer an additional maintenance dose of crystalloid and reassess in 4 hours.
B. Initiate vasopressor therapy to maintain adequate mean arterial pressure.
,C. Administer a loop diuretic to improve renal perfusion.
D. Place the patient in a high-Fowler position and restrict further fluids.
🔴 Correct Answer: B. Initiate vasopressor therapy to maintain adequate mean
arterial pressure.
🔵 Explanation: Persistent hypotension and evidence of impaired organ perfusion despite
initial fluid resuscitation indicate the need for vasopressor support. Norepinephrine is
generally the preferred first-line vasopressor in septic shock. Diuretics do not correct
shock-related hypoperfusion, and delaying vasoactive support risks progressive organ
dysfunction.
QUESTION 2
A patient with cardiogenic shock has a pulmonary artery catheter in place. The nurse
observes a rising pulmonary artery wedge pressure, decreasing cardiac output,
hypotension, and worsening crackles despite supplemental oxygen. Which
interpretation is most appropriate?
A. The patient is developing severe intravascular volume depletion.
B. The findings indicate improved left ventricular preload and cardiac performance.
C. Left ventricular failure is causing pulmonary venous congestion and inadequate
systemic perfusion.
D. The findings are most consistent with isolated right ventricular failure.
🔴 Correct Answer: C. Left ventricular failure is causing pulmonary venous
congestion and inadequate systemic perfusion.
🔵 Explanation: An elevated pulmonary artery wedge pressure reflects increased left-
sided filling pressure. When accompanied by pulmonary crackles, hypotension, and
reduced cardiac output, the pattern is consistent with left ventricular pump failure
causing pulmonary congestion and systemic hypoperfusion.
QUESTION 3
A patient with hypovolemic shock is receiving rapid isotonic crystalloid administration.
Which finding provides the strongest evidence that tissue perfusion is improving?
A. Heart rate decreases from 132/min to 108/min.
B. Blood pressure increases from 84/46 to 96/58 mm Hg.
C. Urine output increases to approximately 0.5 mL/kg/hr with improving mental status.
D. Respiratory rate decreases from 30/min to 24/min.
,🔴 Correct Answer: C. Urine output increases to approximately 0.5 mL/kg/hr with
improving mental status.
🔵 Explanation: Restoration of urine output and improvement in mental status directly
reflect improved renal and cerebral perfusion. A modest rise in blood pressure or decrease
in heart rate may occur without adequate tissue perfusion, so trends in end-organ
function are particularly important.
QUESTION 4
A patient with septic shock has an arterial blood pressure of 78/42 mm Hg. The nurse
calculates the mean arterial pressure (MAP) to determine whether perfusion is
adequate. What is the approximate MAP?
A. 54 mm Hg
B. 61 mm Hg
C. 68 mm Hg
D. 74 mm Hg
🔴 Correct Answer: B. 54 mm Hg
🔵 Explanation: MAP is approximately calculated as (systolic pressure + 2 × diastolic
pressure) ÷ 3. Thus, (78 + 2[42]) ÷ 3 = 162 ÷ 3 = 54 mm Hg. This is significantly below
the usual minimum target of approximately 65 mm Hg used during initial septic shock
management, indicating inadequate perfusion pressure.
QUESTION 5
A patient with severe sepsis has received fluids and vasopressor therapy. The nurse
notes that the serum lactate remains elevated and the capillary refill is prolonged
despite a blood pressure that has improved. What is the nurse's priority interpretation?
A. The patient is stable because the blood pressure has normalized.
B. Persistent tissue hypoperfusion may still be present despite improved
macrocirculatory pressure.
C. Elevated lactate confirms that the patient has developed liver failure.
D. Capillary refill is irrelevant once vasopressor therapy begins.
🔴 Correct Answer: B. Persistent tissue hypoperfusion may still be present despite
improved macrocirculatory pressure.
🔵 Explanation: Blood pressure is only one component of perfusion assessment.
Persistently elevated lactate and abnormal peripheral perfusion can indicate ongoing
cellular or microcirculatory hypoperfusion even when systemic pressure has improved.
, The nurse should continue evaluating the overall clinical response rather than relying on
a single parameter.
QUESTION 6
A mechanically ventilated patient suddenly becomes agitated and tachycardic. The
high-pressure alarm activates repeatedly. The patient has diminished breath sounds on
the right and oxygen saturation falls rapidly. Which action should the nurse take first?
A. Increase the ventilator tidal volume.
B. Suction the endotracheal tube for 30 seconds.
C. Assess immediately for pneumothorax and notify the critical care team.
D. Silence the alarm and reassess the patient in 15 minutes.
🔴 Correct Answer: C. Assess immediately for pneumothorax and notify the critical
care team.
🔵 Explanation: Sudden hypoxemia, agitation, high airway pressure, and unilateral
diminished breath sounds suggest an acute pneumothorax, potentially tension
pneumothorax. This is a life-threatening emergency requiring immediate assessment and
intervention. Increasing ventilator pressure could worsen the condition.
QUESTION 7
A patient with acute respiratory distress syndrome (ARDS) is mechanically ventilated.
Which ventilator strategy is most consistent with lung-protective management?
A. High tidal volumes to maximize alveolar ventilation.
B. Low tidal volumes based on predicted body weight with appropriate PEEP.
C. Zero PEEP to prevent barotrauma.
D. Routine hyperventilation to maintain a PaCO₂ below normal.
🔴 Correct Answer: B. Low tidal volumes based on predicted body weight with
appropriate PEEP.
🔵 Explanation: Lung-protective ventilation for ARDS uses low tidal volumes based on
predicted body weight to reduce ventilator-induced lung injury. Appropriate PEEP helps
prevent repetitive alveolar collapse. Higher tidal volumes and excessive ventilation can
worsen volutrauma and inflammatory lung injury.
QUESTION 8
A mechanically ventilated patient has a sudden increase in peak airway pressure while
plateau pressure remains unchanged. Which problem is most likely?
STUDY GUIDE | ADVANCED TESTBANK | PRACTICE QUESTIONS & ANSWERS | LATEST
UPDATE 2026/2027
TABLE OF CONTENTS
i. Hemodynamic Monitoring, Shock & Perfusion — Questions 1–5
ii. Respiratory Failure & Mechanical Ventilation — Questions 6–10
iii. Cardiovascular Emergencies — Questions 11–14
iv. Neurologic Critical Care — Questions 15–17
v. Renal, Metabolic & Endocrine Emergencies — Questions 18–21
vi. Sepsis, Infection & Multisystem Organ Dysfunction — Questions 22–24
vii. Trauma, Burns & Acute Surgical Care — Questions 25–27
viii. Critical Care Pharmacology, Ethics & Prioritization — Questions 28–30
INTRODUCTION
This advanced Kaplan NCLEX-RN Critical Care Nursing practice set evaluates the nurse's
ability to recognize deterioration, prioritize interventions, interpret clinical findings, and
make safe decisions in high-acuity settings. Questions emphasize shock states,
mechanical ventilation, cardiovascular and neurologic emergencies, metabolic
instability, sepsis, trauma, pharmacology, ethical practice, and multisystem dysfunction.
The level is designed for nurses preparing for demanding professional examinations
and advanced clinical practice. Expect complex patient scenarios requiring synthesis of
assessment findings, laboratory values, hemodynamic trends, medication effects, and
response to treatment. Rather than relying on memorization, the questions emphasize
clinical judgment, prioritization, early recognition of life-threatening complications,
evidence-based intervention, and evaluation of whether treatment is producing the
desired physiologic response.
QUESTION 1
A patient with septic shock has received an appropriate initial crystalloid bolus. The
nurse reassesses the patient and notes: blood pressure 82/48 mm Hg, heart rate
126/min, respiratory rate 28/min, urine output 15 mL/hr, cool extremities, and
increasing confusion. Which prescription should the nurse anticipate implementing
next?
A. Administer an additional maintenance dose of crystalloid and reassess in 4 hours.
B. Initiate vasopressor therapy to maintain adequate mean arterial pressure.
,C. Administer a loop diuretic to improve renal perfusion.
D. Place the patient in a high-Fowler position and restrict further fluids.
🔴 Correct Answer: B. Initiate vasopressor therapy to maintain adequate mean
arterial pressure.
🔵 Explanation: Persistent hypotension and evidence of impaired organ perfusion despite
initial fluid resuscitation indicate the need for vasopressor support. Norepinephrine is
generally the preferred first-line vasopressor in septic shock. Diuretics do not correct
shock-related hypoperfusion, and delaying vasoactive support risks progressive organ
dysfunction.
QUESTION 2
A patient with cardiogenic shock has a pulmonary artery catheter in place. The nurse
observes a rising pulmonary artery wedge pressure, decreasing cardiac output,
hypotension, and worsening crackles despite supplemental oxygen. Which
interpretation is most appropriate?
A. The patient is developing severe intravascular volume depletion.
B. The findings indicate improved left ventricular preload and cardiac performance.
C. Left ventricular failure is causing pulmonary venous congestion and inadequate
systemic perfusion.
D. The findings are most consistent with isolated right ventricular failure.
🔴 Correct Answer: C. Left ventricular failure is causing pulmonary venous
congestion and inadequate systemic perfusion.
🔵 Explanation: An elevated pulmonary artery wedge pressure reflects increased left-
sided filling pressure. When accompanied by pulmonary crackles, hypotension, and
reduced cardiac output, the pattern is consistent with left ventricular pump failure
causing pulmonary congestion and systemic hypoperfusion.
QUESTION 3
A patient with hypovolemic shock is receiving rapid isotonic crystalloid administration.
Which finding provides the strongest evidence that tissue perfusion is improving?
A. Heart rate decreases from 132/min to 108/min.
B. Blood pressure increases from 84/46 to 96/58 mm Hg.
C. Urine output increases to approximately 0.5 mL/kg/hr with improving mental status.
D. Respiratory rate decreases from 30/min to 24/min.
,🔴 Correct Answer: C. Urine output increases to approximately 0.5 mL/kg/hr with
improving mental status.
🔵 Explanation: Restoration of urine output and improvement in mental status directly
reflect improved renal and cerebral perfusion. A modest rise in blood pressure or decrease
in heart rate may occur without adequate tissue perfusion, so trends in end-organ
function are particularly important.
QUESTION 4
A patient with septic shock has an arterial blood pressure of 78/42 mm Hg. The nurse
calculates the mean arterial pressure (MAP) to determine whether perfusion is
adequate. What is the approximate MAP?
A. 54 mm Hg
B. 61 mm Hg
C. 68 mm Hg
D. 74 mm Hg
🔴 Correct Answer: B. 54 mm Hg
🔵 Explanation: MAP is approximately calculated as (systolic pressure + 2 × diastolic
pressure) ÷ 3. Thus, (78 + 2[42]) ÷ 3 = 162 ÷ 3 = 54 mm Hg. This is significantly below
the usual minimum target of approximately 65 mm Hg used during initial septic shock
management, indicating inadequate perfusion pressure.
QUESTION 5
A patient with severe sepsis has received fluids and vasopressor therapy. The nurse
notes that the serum lactate remains elevated and the capillary refill is prolonged
despite a blood pressure that has improved. What is the nurse's priority interpretation?
A. The patient is stable because the blood pressure has normalized.
B. Persistent tissue hypoperfusion may still be present despite improved
macrocirculatory pressure.
C. Elevated lactate confirms that the patient has developed liver failure.
D. Capillary refill is irrelevant once vasopressor therapy begins.
🔴 Correct Answer: B. Persistent tissue hypoperfusion may still be present despite
improved macrocirculatory pressure.
🔵 Explanation: Blood pressure is only one component of perfusion assessment.
Persistently elevated lactate and abnormal peripheral perfusion can indicate ongoing
cellular or microcirculatory hypoperfusion even when systemic pressure has improved.
, The nurse should continue evaluating the overall clinical response rather than relying on
a single parameter.
QUESTION 6
A mechanically ventilated patient suddenly becomes agitated and tachycardic. The
high-pressure alarm activates repeatedly. The patient has diminished breath sounds on
the right and oxygen saturation falls rapidly. Which action should the nurse take first?
A. Increase the ventilator tidal volume.
B. Suction the endotracheal tube for 30 seconds.
C. Assess immediately for pneumothorax and notify the critical care team.
D. Silence the alarm and reassess the patient in 15 minutes.
🔴 Correct Answer: C. Assess immediately for pneumothorax and notify the critical
care team.
🔵 Explanation: Sudden hypoxemia, agitation, high airway pressure, and unilateral
diminished breath sounds suggest an acute pneumothorax, potentially tension
pneumothorax. This is a life-threatening emergency requiring immediate assessment and
intervention. Increasing ventilator pressure could worsen the condition.
QUESTION 7
A patient with acute respiratory distress syndrome (ARDS) is mechanically ventilated.
Which ventilator strategy is most consistent with lung-protective management?
A. High tidal volumes to maximize alveolar ventilation.
B. Low tidal volumes based on predicted body weight with appropriate PEEP.
C. Zero PEEP to prevent barotrauma.
D. Routine hyperventilation to maintain a PaCO₂ below normal.
🔴 Correct Answer: B. Low tidal volumes based on predicted body weight with
appropriate PEEP.
🔵 Explanation: Lung-protective ventilation for ARDS uses low tidal volumes based on
predicted body weight to reduce ventilator-induced lung injury. Appropriate PEEP helps
prevent repetitive alveolar collapse. Higher tidal volumes and excessive ventilation can
worsen volutrauma and inflammatory lung injury.
QUESTION 8
A mechanically ventilated patient has a sudden increase in peak airway pressure while
plateau pressure remains unchanged. Which problem is most likely?
