AACN / CCRN / PCCN Critical Care Exam Questions With 100% Correct Answers Grade A Certified 2025/26

Commonly withheld therapy - correct answervasopressors; antibiotics; done when goal of treatment shift to palliation instead of cure; address these before withdrawing or withholding ventilation Ethical Principles for withholding and withdrawing life-sustaining treatment - correct answerlife-sustaining treatment should not be withdrawn while patient is receiving paralytic agents. When paralytic drugs are discontinued, patient must demonstrate sufficient motor activity to allow thorough clinical assessment before withdrawal of support Hemodynamic Assessment - correct answerUsed to titrate therapies to a specific end point; detect inadequate tissue perfusion; quantify severity of disease; and guide therapy normal cardiac output (CO) (hemodynamic values) - correct answer4 to 8 L/minute normal central venous pressure (CVP) and Right atrial pressure (RAP) (hemodynamic values) - correct answer2 to 6 mm Hg Normal stroke volume (SV) (hemodynamic values) - correct answer60 to 130 mL/beat normal mixed venous O2 sat (SvO2) (hemodynamic values) - correct answer60% to 75% Normal central venous O2 sat (ScvO2) - correct answer65% to 85% what affects BP reading - correct answerpresence of cardiac dysrhythmias; respiratory variation; shivering; external cuff compression; decreased peripheral perfusion Jugular Venous Pressure - correct answerProvides an estimate of intravascular volume; an indirect measure of central venous pressure (CVP); Normal is 7 to 9 cm jugular venous distention - correct answeroccurs when CVP is elevated due to fluid overload, RV dysfunction, superior vena cava obstruction, right HF Assessment of jugular venous pressure - correct answerlook for highest point of pulsation; measure the vertical distance between this pulsation and the angle of Louis in cm; add 5 cm to this number for an estimation of CVP Lactate - correct answernormal levels is 0.5 to 1.6 mEq/L; determine tissue hypoperfusion in circulatory shock, establish adequacy of resuscitation; assist in diagnosis of patients who have metabolic acidosis Indication of Arterial Line - correct answerhemodynamic instability; assess efficacy of vasoactive medication; frequent ABG analysis Indication of Central Venous Catheter - correct answermeasure right heart filling pressures; estimate fluid status; guide volume resuscitation; assess central venous O2 sat (ScvO2); administer large-volume fluid resuscitation or irritant medications; access to place transvenous pacemaker Indication of Pulmonary Artery Catheter - correct answeridentify and treat cause of hemodynamic instability; assess pulmonary artery pressures; assess mixed venous O2 sat (SvO2); directly measure cardiac output (CO) Invasive Hemodynamic monitoring nursing dx - correct answerineffective tissue perfusion; decreased cardiac output (CO); fluid volume excess or deficit Complication of Invasive hemodynamic monitoring - correct answerthrombosis; pneumothorax; hemothorax; cardiac dysrhythmias; pericardial tamponade components for validating accuracy of invasive hemodynamic monitoring - correct answerpatient positioning (up to 45 degrees); zeroing the transducer; leveling the air-fluid interface (zeroing stopcock) to the phlebostatic axis; assessing dynamic responsiveness (do the square wave test) Reason why zeroing stopcock must be positioned at phlebostatic axis - correct answerIf below, will result in false elevation; if above, will result in false low reading Accurate hemodynamic data - correct answerIt can be obtained when patient is supine, HOB up to 45 degrees, or lateral positions from 30 to 90 degrees Assessing dynamic responsiveness (doing the square wave test) - correct answeractivate the fast flush valve/actuator on the pressure tubing system for at least 1 second; should be done after catheter insertion; once per shift; and after opening the system Overdamped dynamic responsiveness (square wave test) - correct answersquare wave test results no oscillations, upstroke is slurred, or undershoot is not produced Underdamped dynamic responsiveness (square wave test) - correct answersquare wave test results in excessive oscillations Causes of overdamped dynamic responsiveness (square wave test) - correct answerblood clots, blood left in catheter after getting a blood sample, air bubbles, compliant tubing, loose connections, kinks, PIP will drop suddenly Causes of underdamped dynamic responsiveness (square wave test) - correct answerexcessive tubing length (48 inches); small bore tubing; sometimes unknown Arterial Pressure Monitoring - correct answerFor patients at risk for compromised tissue perfusion and volume status; need frequent lab work; has hypo or hypertension; and takes vasoactive agents (ie. Dopamine); Radial artery is site of choice, also femoral and brachial. Most accurate method of getting systemic BP; pressure should be @ 300 mm Hg; gives beat-by-beat info; NIBP should be lower than invasive Causes of higher NIBP compared to invasive - correct answerair bubbles in catheter; failure to zero the transducer air-fluid interface; blood in catheter; blood clot at catheter tip; kinking; catheter tip lodged against arterial wall; soft, compliant tubing; long tubing; too many stopcocks; improper cuff size and placement RAP/CVP Monitoring - correct answerestimate central venous blood volume and right heart function; pressure is obtained from right atrial port of PAC; assess preload of right side of heart; subclavian and internal jugular veins are common insertion site; CVCs contain multiple lumens; assess and guide fluid resuscitation; must be measured @ end expiration and end of ventricular diastole Methods for Determining Accurate RAP - correct answerPre-e method (method of choice); mean of the a Wave; z-point method Complications of RAP/CVP monitoring - correct answercarotid puncture; pneumothorax; hemothorax; perforation of RA or RV; cardiac dysrhythmias Clinical Considerations of RAP/CVP Monitoring - correct answerIf both RAP and stroke index (SI) are low, hypovolemia is the cause; If RAP is high and SI is low, RV dysfunction is the cause; If RAP is low, cause is upright position; if RAP is high, cause is decrease in RV's ability to eject blood, hypervolemia, severe vasoconstriction, mechanical ventilation, pulmonary HTN, right-sided HF Causes of Abnormalities in RAP/CVP Monitoring - correct answeralterations in venous tone, blood volume, or RV contractility Pulmonary Artery Pressure Monitoring (PAC) - correct answermeasure pressure in left side of heart, continuous CO, RV end diastolic volume, RV ejection fraction, and mixed venous O2 sat; used to administer fluids and electrolytes; obtain intermittent thermodilution CO measurements; measures PAP and PAOP; enable transvenous pacing and CCO capabilites; for ease of insertion of catheter, place patient in Trendelenburg position Hemodynamic Parameters Monitored via the PA Catheter - correct answerLV filling pressure; RAP; PA systolic (PAS); PA diastolic (PAD); PA mean pressure (PAPm); PAOP; pulmonary and systemic vascular resistance (PVR and SVR); cardiac output (CO) Normal PAP - correct answer25/10 mm Hg normal PAPm - correct answer15 mm Hg normal PAOP; Normal left atrial pressure (LAP) (hemodynamic values) - correct answer8 to 12 mm Hg How is PAOP obtained - correct answerInflate balloon no more than 1.5 mL of air for no longer than 8 to 10 seconds