COMPREHENSIVE NUR 210 CRITICAL CARE NURSING
EXAM GUIDE 2026 EDITION Q&A
A patient with septic shock has a mean arterial pressure (MAP)
of 52 mm Hg despite adequate fluid resuscitation. Which
vasopressor is considered the first-line agent according to
current Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Vasopressin
C. Epinephrine
D. Norepinephrine
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor in
septic shock due to its potent alpha-adrenergic effects with
less tachyarrhythmia risk compared to dopamine. Dopamine is
no longer preferred. Vasopressin is an adjunctive agent, and
epinephrine is second-line.
A critically ill patient’s arterial blood gas (ABG) on a 40%
Venturi mask shows: pH 7.32, PaCO2 52 mm Hg, PaO2 68
mm Hg, HCO3- 26 mEq/L. Which acid-base disturbance is
present?
A. Acute respiratory acidosis
B. Metabolic acidosis with respiratory compensation
C. Chronic respiratory acidosis
D. Mixed metabolic alkalosis and respiratory acidosis
, Correct Answer: A
*Explanation: pH is acidic (7.32), PaCO2 is elevated (52)
indicating respiratory acidosis. HCO3- is normal (26),
suggesting no metabolic compensation yet, so this is acute
respiratory acidosis. Chronic respiratory acidosis would show
elevated HCO3-.*
A nurse is caring for a patient with an intracranial pressure (ICP)
monitor. Which assessment finding requires immediate
intervention?
A. ICP 16 mm Hg for 10 minutes
B. Cerebral perfusion pressure (CPP) 85 mm Hg
C. ICP 22 mm Hg with a sudden increase to 40 mm Hg
during suctioning
D. ICP 12 mm Hg with normal waveform
Correct Answer: C
*Explanation: Normal ICP is 5–15 mm Hg. Sustained ICP >20–
22 mm Hg requires intervention. A sudden rise to 40 mm Hg
during suctioning indicates possible inadequate
sedation/preoxygenation and risks herniation. CPP 85 mm
Hg is normal (target >60–70).*
A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 6 mL/kg
predicted body weight. The plateau pressure is 32 cm H2O.
Which adjustment is most appropriate?
, A. Increase tidal volume to 8 mL/kg to recruit alveoli
B. Decrease PEEP to 5 cm H2O to lower plateau pressure
C. Further reduce tidal volume to 4 mL/kg and accept
hypercapnia
D. Switch to pressure-controlled ventilation only
Correct Answer: C
*Explanation: Lung-protective ventilation in ARDS targets
plateau pressure <30 cm H2O to prevent ventilator-induced
lung injury. Plateau pressure of 32 requires further tidal
volume reduction (even to 4 mL/kg) with permissive
hypercapnia if necessary.*
A patient post-cardiac arrest has a Glasgow Coma Scale (GCS)
score of 7. Targeted temperature management (TTM) is
initiated. Which core temperature goal is currently
recommended for the first 24 hours?
A. 31–32°C
B. 32–36°C
C. 36–37.5°C
D. 37.5–38°C
Correct Answer: B
*Explanation: Current guidelines recommend maintaining
core temperature between 32–36°C (typically 33–36°C) for at
least 24 hours after cardiac arrest. Fixed 32–34°C is no longer
mandatory; a range of 32–36°C is evidence-supported.*
, A patient with massive upper gastrointestinal bleeding has a
nasogastric tube. Lavage returns bright red blood with clots.
The nurse notes the patient becomes confused and develops
tachycardia. What is the priority action?
A. Increase the rate of IV fluids
B. Administer IV pantoprazole
C. Notify the provider for possible emergent endoscopy
D. Place the patient in Trendelenburg position
Correct Answer: C
Explanation: Confusion with active bleeding suggests
hypovolemic shock and ongoing hemorrhage. Emergent
endoscopy is the priority for diagnosis and intervention. IV
fluids and PPIs are supportive but do not stop active bleeding.
Trendelenburg position is no longer recommended.
A patient on continuous venovenous hemofiltration (CVVH) has
a filter pressure drop from 150 mm Hg to 70 mm Hg over 2
hours, with no other alarms. What is the most likely cause?
A. Clotted hemofilter
B. Access line kinking
C. Patient hypotension
D. Increased ultrafiltration rate
Correct Answer: A
Explanation: A significant drop in filter pressure (pre-pump to
post-filter gradient) without alarms indicates loss of resistance
due to filter clotting. Clotted filter allows blood to bypass
membrane resistance. Kinking or hypotension would trigger
alarms or flow issues.
EXAM GUIDE 2026 EDITION Q&A
A patient with septic shock has a mean arterial pressure (MAP)
of 52 mm Hg despite adequate fluid resuscitation. Which
vasopressor is considered the first-line agent according to
current Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Vasopressin
C. Epinephrine
D. Norepinephrine
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor in
septic shock due to its potent alpha-adrenergic effects with
less tachyarrhythmia risk compared to dopamine. Dopamine is
no longer preferred. Vasopressin is an adjunctive agent, and
epinephrine is second-line.
A critically ill patient’s arterial blood gas (ABG) on a 40%
Venturi mask shows: pH 7.32, PaCO2 52 mm Hg, PaO2 68
mm Hg, HCO3- 26 mEq/L. Which acid-base disturbance is
present?
A. Acute respiratory acidosis
B. Metabolic acidosis with respiratory compensation
C. Chronic respiratory acidosis
D. Mixed metabolic alkalosis and respiratory acidosis
, Correct Answer: A
*Explanation: pH is acidic (7.32), PaCO2 is elevated (52)
indicating respiratory acidosis. HCO3- is normal (26),
suggesting no metabolic compensation yet, so this is acute
respiratory acidosis. Chronic respiratory acidosis would show
elevated HCO3-.*
A nurse is caring for a patient with an intracranial pressure (ICP)
monitor. Which assessment finding requires immediate
intervention?
A. ICP 16 mm Hg for 10 minutes
B. Cerebral perfusion pressure (CPP) 85 mm Hg
C. ICP 22 mm Hg with a sudden increase to 40 mm Hg
during suctioning
D. ICP 12 mm Hg with normal waveform
Correct Answer: C
*Explanation: Normal ICP is 5–15 mm Hg. Sustained ICP >20–
22 mm Hg requires intervention. A sudden rise to 40 mm Hg
during suctioning indicates possible inadequate
sedation/preoxygenation and risks herniation. CPP 85 mm
Hg is normal (target >60–70).*
A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 6 mL/kg
predicted body weight. The plateau pressure is 32 cm H2O.
Which adjustment is most appropriate?
, A. Increase tidal volume to 8 mL/kg to recruit alveoli
B. Decrease PEEP to 5 cm H2O to lower plateau pressure
C. Further reduce tidal volume to 4 mL/kg and accept
hypercapnia
D. Switch to pressure-controlled ventilation only
Correct Answer: C
*Explanation: Lung-protective ventilation in ARDS targets
plateau pressure <30 cm H2O to prevent ventilator-induced
lung injury. Plateau pressure of 32 requires further tidal
volume reduction (even to 4 mL/kg) with permissive
hypercapnia if necessary.*
A patient post-cardiac arrest has a Glasgow Coma Scale (GCS)
score of 7. Targeted temperature management (TTM) is
initiated. Which core temperature goal is currently
recommended for the first 24 hours?
A. 31–32°C
B. 32–36°C
C. 36–37.5°C
D. 37.5–38°C
Correct Answer: B
*Explanation: Current guidelines recommend maintaining
core temperature between 32–36°C (typically 33–36°C) for at
least 24 hours after cardiac arrest. Fixed 32–34°C is no longer
mandatory; a range of 32–36°C is evidence-supported.*
, A patient with massive upper gastrointestinal bleeding has a
nasogastric tube. Lavage returns bright red blood with clots.
The nurse notes the patient becomes confused and develops
tachycardia. What is the priority action?
A. Increase the rate of IV fluids
B. Administer IV pantoprazole
C. Notify the provider for possible emergent endoscopy
D. Place the patient in Trendelenburg position
Correct Answer: C
Explanation: Confusion with active bleeding suggests
hypovolemic shock and ongoing hemorrhage. Emergent
endoscopy is the priority for diagnosis and intervention. IV
fluids and PPIs are supportive but do not stop active bleeding.
Trendelenburg position is no longer recommended.
A patient on continuous venovenous hemofiltration (CVVH) has
a filter pressure drop from 150 mm Hg to 70 mm Hg over 2
hours, with no other alarms. What is the most likely cause?
A. Clotted hemofilter
B. Access line kinking
C. Patient hypotension
D. Increased ultrafiltration rate
Correct Answer: A
Explanation: A significant drop in filter pressure (pre-pump to
post-filter gradient) without alarms indicates loss of resistance
due to filter clotting. Clotted filter allows blood to bypass
membrane resistance. Kinking or hypotension would trigger
alarms or flow issues.
