CCNE Critical Care Nursing Exam Independent
Revision Guide and Practice
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-40)
Q1. A patient with acute myocardial infarction develops hypotension, tachycardia,
and jugular venous distention. Which complication should the nurse suspect?
A) Cardiac tamponade
B) Cardiogenic shock
C) Pulmonary embolism
D) Aortic dissection
Answer: B
Rationale: Cardiogenic shock presents with hypotension, tachycardia, and JVD due
to pump failure. Cardiac tamponade (A) presents with muffled heart sounds and
pulsus paradoxus. Pulmonary embolism (C) presents with sudden dyspnea and
pleuritic chest pain.
Q2. Which hemodynamic parameter is most indicative of left ventricular preload?
A) Cardiac output (CO)
B) Central venous pressure (CVP)
1
,C) Pulmonary artery wedge pressure (PAWP)
D) Systemic vascular resistance (SVR)
Answer: C
Rationale: PAWP reflects left ventricular end-diastolic pressure, which is a measure
of left ventricular preload. CVP (B) reflects right ventricular preload.
Q3. A patient with heart failure has a PAWP of 25 mmHg. This indicates:
A) Fluid volume deficit
B) Fluid volume overload
C) Adequate perfusion
D) Pulmonary hypertension
Answer: B
Rationale: Normal PAWP is 6-12 mmHg. A PAWP of 25 mmHg indicates
significant fluid volume overload and left-sided heart failure.
Q4. The nurse is caring for a patient with an intra-aortic balloon pump (IABP).
Which finding requires immediate action?
A) Augmented diastolic pressure 10 mmHg below systolic
B) Urine output 30 mL/hr
C) Heart rate 90 bpm
D) Left pedal pulse 2+
2
,Answer: A
Rationale: IABP should augment diastolic pressure higher than systolic. If not, the
IABP is not providing adequate coronary perfusion. Urine output 30 mL/hr (B) is
adequate.
Q5. A patient with sepsis has a cardiac output of 8 L/min and SVR of 400
dynes/sec/cm⁻⁵. Which type of shock is this?
A) Cardiogenic shock
B) Distributive shock (septic)
C) Hypovolemic shock
D) Obstructive shock
Answer: B
Rationale: Septic shock presents with high cardiac output and low SVR due to
vasodilation. Cardiogenic shock (A) presents with low CO and high SVR.
Hypovolemic shock (C) presents with low CO and high SVR.
Q6. Which of the following medications is used in septic shock to improve
perfusion to vital organs?
A) Norepinephrine
B) Digoxin
C) Lidocaine
D) Metoprolol
3
, Answer: A
Rationale: Norepinephrine is a first-line vasopressor used to increase SVR in septic
shock. Digoxin (B) is used for heart failure. Lidocaine (C) is used for arrhythmias.
Metoprolol (D) is a beta-blocker.
Q7. Which of the following ECG changes is most concerning in a patient with
chest pain?
A) ST-segment elevation in leads V1-V4
B) T-wave inversion in lead III
C) Prolonged PR interval
D) Sinus bradycardia
Answer: A
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior STEMI. T-
wave inversion (B) may indicate ischemia but is less urgent. Prolonged PR interval
(C) indicates first-degree heart block.
Q8. A patient on a vasopressor infusion has extravasation at the IV site. The nurse
should prepare which medication?
A) Phentolamine
B) Naloxone
C) Flumazenil
D) Protamine sulfate
4
Revision Guide and Practice
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-40)
Q1. A patient with acute myocardial infarction develops hypotension, tachycardia,
and jugular venous distention. Which complication should the nurse suspect?
A) Cardiac tamponade
B) Cardiogenic shock
C) Pulmonary embolism
D) Aortic dissection
Answer: B
Rationale: Cardiogenic shock presents with hypotension, tachycardia, and JVD due
to pump failure. Cardiac tamponade (A) presents with muffled heart sounds and
pulsus paradoxus. Pulmonary embolism (C) presents with sudden dyspnea and
pleuritic chest pain.
Q2. Which hemodynamic parameter is most indicative of left ventricular preload?
A) Cardiac output (CO)
B) Central venous pressure (CVP)
1
,C) Pulmonary artery wedge pressure (PAWP)
D) Systemic vascular resistance (SVR)
Answer: C
Rationale: PAWP reflects left ventricular end-diastolic pressure, which is a measure
of left ventricular preload. CVP (B) reflects right ventricular preload.
Q3. A patient with heart failure has a PAWP of 25 mmHg. This indicates:
A) Fluid volume deficit
B) Fluid volume overload
C) Adequate perfusion
D) Pulmonary hypertension
Answer: B
Rationale: Normal PAWP is 6-12 mmHg. A PAWP of 25 mmHg indicates
significant fluid volume overload and left-sided heart failure.
Q4. The nurse is caring for a patient with an intra-aortic balloon pump (IABP).
Which finding requires immediate action?
A) Augmented diastolic pressure 10 mmHg below systolic
B) Urine output 30 mL/hr
C) Heart rate 90 bpm
D) Left pedal pulse 2+
2
,Answer: A
Rationale: IABP should augment diastolic pressure higher than systolic. If not, the
IABP is not providing adequate coronary perfusion. Urine output 30 mL/hr (B) is
adequate.
Q5. A patient with sepsis has a cardiac output of 8 L/min and SVR of 400
dynes/sec/cm⁻⁵. Which type of shock is this?
A) Cardiogenic shock
B) Distributive shock (septic)
C) Hypovolemic shock
D) Obstructive shock
Answer: B
Rationale: Septic shock presents with high cardiac output and low SVR due to
vasodilation. Cardiogenic shock (A) presents with low CO and high SVR.
Hypovolemic shock (C) presents with low CO and high SVR.
Q6. Which of the following medications is used in septic shock to improve
perfusion to vital organs?
A) Norepinephrine
B) Digoxin
C) Lidocaine
D) Metoprolol
3
, Answer: A
Rationale: Norepinephrine is a first-line vasopressor used to increase SVR in septic
shock. Digoxin (B) is used for heart failure. Lidocaine (C) is used for arrhythmias.
Metoprolol (D) is a beta-blocker.
Q7. Which of the following ECG changes is most concerning in a patient with
chest pain?
A) ST-segment elevation in leads V1-V4
B) T-wave inversion in lead III
C) Prolonged PR interval
D) Sinus bradycardia
Answer: A
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior STEMI. T-
wave inversion (B) may indicate ischemia but is less urgent. Prolonged PR interval
(C) indicates first-degree heart block.
Q8. A patient on a vasopressor infusion has extravasation at the IV site. The nurse
should prepare which medication?
A) Phentolamine
B) Naloxone
C) Flumazenil
D) Protamine sulfate
4
