NGN HESI RN CRITICAL CARE V4
COMPREHENSIVE EXAM QUESTIONS
AND CORRECT ANSWERS
1. A patient in the ICU has a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg and a
Cardiac Index (CI) of 1.8 L/min/m². Which physiological state is most likely represented by
these findings?
A. Septic shock
B. Hypovolemic shock
C. Cardiogenic shock
D. Neurogenic shock
Answer: C
Conceptual Explanation: A high PAWP (>18 mmHg) combined with a low Cardiac Index
(<2.2 L/min/m²) is classic for cardiogenic shock, indicating left ventricular failure and
pulmonary congestion.
2. When managing a patient with ARDS on mechanical ventilation, the nurse notes the PEEP
is increased from 10 to 18 cm H2O. What is the most critical assessment following this
change?
A. Increased urine output
,B. Improved skin turgor
C. Decrease in blood pressure
D. Increased bowel sounds
Answer: C
Conceptual Explanation: High PEEP levels increase intrathoracic pressure, which
decreases venous return (preload) and can lead to decreased cardiac output and
hypotension.
3. A patient with a traumatic brain injury (TBI) has an ICP of 24 mmHg and a MAP of 65
mmHg. What is the Cerebral Perfusion Pressure (CPP), and what is the nurse’s priority?
A. CPP 89; continue to monitor
B. CPP 65; increase sedation
C. CPP 41; notify the physician immediately
D. CPP 39; lower the head of the bed
Answer: C
Conceptual Explanation: CPP = MAP - ICP. 65 - 24 = 41 mmHg. A CPP below 50-60 mmHg
indicates inadequate cerebral perfusion, requiring immediate intervention.
4. A patient is receiving a continuous infusion of Nitroprusside. Which symptom should the
nurse monitor for most closely to detect early cyanide toxicity?
A. Hyperreflexia
, B. Bradycardia
C. Metabolic acidosis and altered mental status
D. Hypertension
Answer: C
Conceptual Explanation: Nitroprusside metabolism produces thiocyanate. Cyanide
toxicity presents as unexplained metabolic acidosis, tachycardia, and mental status
changes.
5. In the treatment of Septic Shock, which is the priority goal within the first hour of care (1-
hour bundle)?
A. Administering a loading dose of Furosemide
B. Starting a corticosteroid infusion
C. Initiating broad-spectrum antibiotics after obtaining blood cultures
D. Achieving a CVP of 15 mmHg
Answer: C
Conceptual Explanation: The Surviving Sepsis Campaign 1-hour bundle emphasizes
obtaining cultures and starting broad-spectrum antibiotics immediately to reduce
mortality.
6. A patient exhibits Beck’s Triad. Which procedure should the nurse anticipate?
A. Pericardiocentesis
COMPREHENSIVE EXAM QUESTIONS
AND CORRECT ANSWERS
1. A patient in the ICU has a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg and a
Cardiac Index (CI) of 1.8 L/min/m². Which physiological state is most likely represented by
these findings?
A. Septic shock
B. Hypovolemic shock
C. Cardiogenic shock
D. Neurogenic shock
Answer: C
Conceptual Explanation: A high PAWP (>18 mmHg) combined with a low Cardiac Index
(<2.2 L/min/m²) is classic for cardiogenic shock, indicating left ventricular failure and
pulmonary congestion.
2. When managing a patient with ARDS on mechanical ventilation, the nurse notes the PEEP
is increased from 10 to 18 cm H2O. What is the most critical assessment following this
change?
A. Increased urine output
,B. Improved skin turgor
C. Decrease in blood pressure
D. Increased bowel sounds
Answer: C
Conceptual Explanation: High PEEP levels increase intrathoracic pressure, which
decreases venous return (preload) and can lead to decreased cardiac output and
hypotension.
3. A patient with a traumatic brain injury (TBI) has an ICP of 24 mmHg and a MAP of 65
mmHg. What is the Cerebral Perfusion Pressure (CPP), and what is the nurse’s priority?
A. CPP 89; continue to monitor
B. CPP 65; increase sedation
C. CPP 41; notify the physician immediately
D. CPP 39; lower the head of the bed
Answer: C
Conceptual Explanation: CPP = MAP - ICP. 65 - 24 = 41 mmHg. A CPP below 50-60 mmHg
indicates inadequate cerebral perfusion, requiring immediate intervention.
4. A patient is receiving a continuous infusion of Nitroprusside. Which symptom should the
nurse monitor for most closely to detect early cyanide toxicity?
A. Hyperreflexia
, B. Bradycardia
C. Metabolic acidosis and altered mental status
D. Hypertension
Answer: C
Conceptual Explanation: Nitroprusside metabolism produces thiocyanate. Cyanide
toxicity presents as unexplained metabolic acidosis, tachycardia, and mental status
changes.
5. In the treatment of Septic Shock, which is the priority goal within the first hour of care (1-
hour bundle)?
A. Administering a loading dose of Furosemide
B. Starting a corticosteroid infusion
C. Initiating broad-spectrum antibiotics after obtaining blood cultures
D. Achieving a CVP of 15 mmHg
Answer: C
Conceptual Explanation: The Surviving Sepsis Campaign 1-hour bundle emphasizes
obtaining cultures and starting broad-spectrum antibiotics immediately to reduce
mortality.
6. A patient exhibits Beck’s Triad. Which procedure should the nurse anticipate?
A. Pericardiocentesis
