NUR 445 EXAM 1 NEWEST 2026 ACTUAL
EXAM COMPLETE 150 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) | ALREADY GRADED A+
Core Domains:
- Hemodynamics and Hemodynamic Monitoring
- Shock States (Cardiogenic, Hypovolemic, Distributive, Obstructive)
- Respiratory Failure and Mechanical Ventilation
- Endocrine Emergencies (DKA, HHS, Thyroid, Adrenal)
- Cardiac Emergencies and Dysrhythmias
- Neurological Critical Care (ICP, Stroke, Seizures)
- Electrolyte and Acid-Base Imbalances
Introduction:
This comprehensive examination is designed to assess the candidate's
mastery of essential critical care concepts required for safe nursing
practice. It evaluates foundational theory, applied professional
knowledge, and real-world decision-making capabilities in high-acuity
settings. The assessment consists of multiple-choice questions that
challenge the candidate to integrate knowledge across domains.
Emphasis is placed on practical application, critical analysis, and the
ability to prioritize interventions in complex clinical situations.
SECTION ONE: QUESTIONS 1–150
Question 1
A patient with septic shock has a mean arterial pressure (MAP) of
55 mmHg despite fluid resuscitation. What is the priority
intervention?
,A. Administer vasopressors as ordered
B. Increase the rate of IV fluids
C. Reposition the patient supine
D. Obtain a blood culture
A. Administer vasopressors as ordered
RATIONALE: A MAP < 65 mmHg indicates inadequate organ
perfusion. After fluid resuscitation, vasopressors (e.g., norepinephrine)
are indicated to restore MAP to ≥ 65 mmHg and maintain tissue
perfusion .
Question 2
Which hemodynamic parameter is most indicative of left ventricular
preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP)
C. Cardiac output (CO)
D. Systemic vascular resistance (SVR)
B. Pulmonary artery wedge pressure (PAWP)
RATIONALE: PAWP (also called pulmonary capillary wedge
pressure) reflects left atrial pressure and is the best measure of left
ventricular preload. CVP reflects right ventricular preload .
Question 3
A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m²
(normal: 2.5-4.0). Which finding would the nurse expect?
A. Bounding pulses and warm extremities
B. Cool, clammy skin and decreased urine output
C. Increased urine output and clear lung sounds
D. Flushed skin and bounding pulses
B. Cool, clammy skin and decreased urine output
, RATIONALE: Low cardiac index indicates poor tissue perfusion,
resulting in compensatory vasoconstriction (cool, clammy skin) and
decreased renal perfusion (low urine output) .
Question 4
Which type of shock is characterized by a low CVP, low PAWP, and
low SVR?
A. Cardiogenic shock
B. Obstructive shock
C. Distributive shock (septic)
D. Hypovolemic shock
C. Distributive shock (septic)
RATIONALE: Septic (distributive) shock typically shows low
CVP/PAWP (relative hypovolemia) and low SVR (vasodilation).
Cardiogenic shock shows high filling pressures. Hypovolemic shock
shows low filling pressures but normal or high SVR .
Question 5
A patient in hypovolemic shock receives 2 L of lactated Ringer's
solution. MAP increases from 48 to 62 mmHg. What does this
indicate?
A. The patient is fluid responsive
B. The patient needs blood transfusion
C. Vasopressors are now contraindicated
D. The patient has developed fluid overload
A. The patient is fluid responsive
RATIONALE: A positive response to fluid challenge (increase in
MAP, improvement in heart rate, urine output > 0.5 mL/kg/hr) indicates
the patient is fluid responsive and hypovolemia is a contributing factor .
, Question 6
Which medication is the first-line vasopressor for septic shock?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
C. Norepinephrine
RATIONALE: Norepinephrine is the first-line vasopressor for septic
shock per Surviving Sepsis Campaign guidelines due to its potent
vasoconstrictive effects with less tachycardia than dopamine .
Question 7
A patient with an intra-aortic balloon pump (IABP) has a waveform
with early deflation. What is the most likely consequence?
A. Increased afterload
B. Decreased coronary perfusion
C. Increased cardiac output
D. Decreased left ventricular workload
B. Decreased coronary perfusion
RATIONALE: Early deflation of the IABP balloon causes the
balloon to deflate before the aortic valve opens, reducing diastolic
augmentation and decreasing coronary artery perfusion pressure .
Question 8
Which finding is most consistent with obstructive shock?
A. Widened pulse pressure and bounding pulses
B. Elevated jugular venous distension (JVD) and muffled heart sounds
C. Warm, dry skin and low CVP
D. Crackles and frothy sputum
EXAM COMPLETE 150 QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) | ALREADY GRADED A+
Core Domains:
- Hemodynamics and Hemodynamic Monitoring
- Shock States (Cardiogenic, Hypovolemic, Distributive, Obstructive)
- Respiratory Failure and Mechanical Ventilation
- Endocrine Emergencies (DKA, HHS, Thyroid, Adrenal)
- Cardiac Emergencies and Dysrhythmias
- Neurological Critical Care (ICP, Stroke, Seizures)
- Electrolyte and Acid-Base Imbalances
Introduction:
This comprehensive examination is designed to assess the candidate's
mastery of essential critical care concepts required for safe nursing
practice. It evaluates foundational theory, applied professional
knowledge, and real-world decision-making capabilities in high-acuity
settings. The assessment consists of multiple-choice questions that
challenge the candidate to integrate knowledge across domains.
Emphasis is placed on practical application, critical analysis, and the
ability to prioritize interventions in complex clinical situations.
SECTION ONE: QUESTIONS 1–150
Question 1
A patient with septic shock has a mean arterial pressure (MAP) of
55 mmHg despite fluid resuscitation. What is the priority
intervention?
,A. Administer vasopressors as ordered
B. Increase the rate of IV fluids
C. Reposition the patient supine
D. Obtain a blood culture
A. Administer vasopressors as ordered
RATIONALE: A MAP < 65 mmHg indicates inadequate organ
perfusion. After fluid resuscitation, vasopressors (e.g., norepinephrine)
are indicated to restore MAP to ≥ 65 mmHg and maintain tissue
perfusion .
Question 2
Which hemodynamic parameter is most indicative of left ventricular
preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP)
C. Cardiac output (CO)
D. Systemic vascular resistance (SVR)
B. Pulmonary artery wedge pressure (PAWP)
RATIONALE: PAWP (also called pulmonary capillary wedge
pressure) reflects left atrial pressure and is the best measure of left
ventricular preload. CVP reflects right ventricular preload .
Question 3
A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m²
(normal: 2.5-4.0). Which finding would the nurse expect?
A. Bounding pulses and warm extremities
B. Cool, clammy skin and decreased urine output
C. Increased urine output and clear lung sounds
D. Flushed skin and bounding pulses
B. Cool, clammy skin and decreased urine output
, RATIONALE: Low cardiac index indicates poor tissue perfusion,
resulting in compensatory vasoconstriction (cool, clammy skin) and
decreased renal perfusion (low urine output) .
Question 4
Which type of shock is characterized by a low CVP, low PAWP, and
low SVR?
A. Cardiogenic shock
B. Obstructive shock
C. Distributive shock (septic)
D. Hypovolemic shock
C. Distributive shock (septic)
RATIONALE: Septic (distributive) shock typically shows low
CVP/PAWP (relative hypovolemia) and low SVR (vasodilation).
Cardiogenic shock shows high filling pressures. Hypovolemic shock
shows low filling pressures but normal or high SVR .
Question 5
A patient in hypovolemic shock receives 2 L of lactated Ringer's
solution. MAP increases from 48 to 62 mmHg. What does this
indicate?
A. The patient is fluid responsive
B. The patient needs blood transfusion
C. Vasopressors are now contraindicated
D. The patient has developed fluid overload
A. The patient is fluid responsive
RATIONALE: A positive response to fluid challenge (increase in
MAP, improvement in heart rate, urine output > 0.5 mL/kg/hr) indicates
the patient is fluid responsive and hypovolemia is a contributing factor .
, Question 6
Which medication is the first-line vasopressor for septic shock?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
C. Norepinephrine
RATIONALE: Norepinephrine is the first-line vasopressor for septic
shock per Surviving Sepsis Campaign guidelines due to its potent
vasoconstrictive effects with less tachycardia than dopamine .
Question 7
A patient with an intra-aortic balloon pump (IABP) has a waveform
with early deflation. What is the most likely consequence?
A. Increased afterload
B. Decreased coronary perfusion
C. Increased cardiac output
D. Decreased left ventricular workload
B. Decreased coronary perfusion
RATIONALE: Early deflation of the IABP balloon causes the
balloon to deflate before the aortic valve opens, reducing diastolic
augmentation and decreasing coronary artery perfusion pressure .
Question 8
Which finding is most consistent with obstructive shock?
A. Widened pulse pressure and bounding pulses
B. Elevated jugular venous distension (JVD) and muffled heart sounds
C. Warm, dry skin and low CVP
D. Crackles and frothy sputum
