CRITICAL CARE NURSING NUR 210(HEMODYNAMICS)
2026 EDITION
A patient in the ICU suddenly develops profound hypotension,
jugular venous distension, and muffled heart sounds. Which
nursing intervention is the priority?
A. Administer intravenous fluids rapidly
B. Prepare for immediate pericardiocentesis
C. Increase vasopressor infusion rate
D. Obtain a stat portable chest x-ray
Correct Answer: B
Explanation: These findings (Beck’s triad) indicate cardiac
tamponade. Pericardiocentesis is the definitive life-saving
intervention. Fluids and vasopressors are temporizing; chest x-
ray delays critical care.
A mechanically ventilated patient with status asthmaticus has a
plateau pressure of 38 cm H2O and an auto-PEEP of 12 cm
H2O. Which ventilator adjustment is most appropriate?
A. Increase inspiratory time
B. Increase tidal volume to 10 mL/kg
C. Decrease respiratory rate
D. Switch to pressure control mode with inverse ratio
Correct Answer: C
Explanation: Decreasing respiratory rate prolongs expiratory
time, reducing auto-PEEP and dynamic hyperinflation.
, Increasing inspiratory time or tidal volume worsens air
trapping.
Which hemodynamic profile is expected in a patient with
cardiogenic shock?
A. Low cardiac output, high pulmonary artery wedge
pressure
B. High cardiac output, low systemic vascular resistance
C. Low cardiac output, low pulmonary artery wedge pressure
D. High cardiac output, high central venous pressure
Correct Answer: A
Explanation: Cardiogenic shock features pump failure → low
cardiac output with backward failure → elevated PAOP
(preload). High CO/low SVR is distributive shock (e.g., septic).
A patient with severe traumatic brain injury has an ICP of 22
mm Hg and a MAP of 70 mm Hg. What is the cerebral
perfusion pressure (CPP), and what action should the nurse
take?
A. CPP 48 mm Hg; elevate head of bed and notify provider
B. CPP 92 mm Hg; continue current management
C. CPP 70 mm Hg; administer hypertonic saline
D. CPP 52 mm Hg; decrease ventilator rate
Correct Answer: A
*Explanation: CPP = MAP – ICP = 70 – 22 = 48 mm Hg
, (target >60). Interventions to reduce ICP (HOB elevation,
hyperosmolar therapy) are needed.*
Which electrocardiographic finding is most suggestive of acute
pericarditis?
A. Diffuse ST-segment elevation with PR-segment depression
B. ST-segment elevation in contiguous leads with reciprocal
changes
C. Deep Q waves in leads II, III, and aVF
D. Narrow QRS tachycardia with absent P waves
Correct Answer: A
Explanation: Diffuse ST elevation with PR depression is classic
for pericarditis. Contiguous ST elevation with reciprocal
changes suggests myocardial infarction.
A patient with septic shock is on norepinephrine at 20 mcg/min
and remains hypotensive with a MAP of 52 mm Hg. Which
action should the critical care nurse take next?
A. Add vasopressin infusion
B. Administer a 500 mL fluid bolus
C. Increase norepinephrine to 30 mcg/min
D. Start hydrocortisone 100 mg IV
Correct Answer: B
Explanation: Fluid resuscitation is first-line in septic shock
before escalating vasopressors unless contraindicated.
, Vasopressin and steroids are second-line after adequate
volume.
A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with a PEEP of 14 cm H2O. The
SpO2 drops to 84%. Which intervention is most likely to
improve oxygenation?
A. Increase FiO2 to 100%
B. Perform a recruitment maneuver
C. Decrease PEEP to 10 cm H2O
D. Switch to pressure support ventilation
Correct Answer: B
Explanation: Recruitment maneuvers open collapsed alveoli in
ARDS. Increasing FiO2 is temporary; decreasing PEEP worsens
oxygenation. Pressure support is not appropriate for severe
ARDS.
Which laboratory finding is most consistent with a diagnosis of
acute pancreatitis in a critically ill patient?
A. Serum lipase 4 times the upper limit of normal
B. AST/ALT ratio >3
C. Serum amylase within normal range
D. Elevated alkaline phosphatase without jaundice
Correct Answer: A
*Explanation: Lipase is highly specific and sensitive for acute
2026 EDITION
A patient in the ICU suddenly develops profound hypotension,
jugular venous distension, and muffled heart sounds. Which
nursing intervention is the priority?
A. Administer intravenous fluids rapidly
B. Prepare for immediate pericardiocentesis
C. Increase vasopressor infusion rate
D. Obtain a stat portable chest x-ray
Correct Answer: B
Explanation: These findings (Beck’s triad) indicate cardiac
tamponade. Pericardiocentesis is the definitive life-saving
intervention. Fluids and vasopressors are temporizing; chest x-
ray delays critical care.
A mechanically ventilated patient with status asthmaticus has a
plateau pressure of 38 cm H2O and an auto-PEEP of 12 cm
H2O. Which ventilator adjustment is most appropriate?
A. Increase inspiratory time
B. Increase tidal volume to 10 mL/kg
C. Decrease respiratory rate
D. Switch to pressure control mode with inverse ratio
Correct Answer: C
Explanation: Decreasing respiratory rate prolongs expiratory
time, reducing auto-PEEP and dynamic hyperinflation.
, Increasing inspiratory time or tidal volume worsens air
trapping.
Which hemodynamic profile is expected in a patient with
cardiogenic shock?
A. Low cardiac output, high pulmonary artery wedge
pressure
B. High cardiac output, low systemic vascular resistance
C. Low cardiac output, low pulmonary artery wedge pressure
D. High cardiac output, high central venous pressure
Correct Answer: A
Explanation: Cardiogenic shock features pump failure → low
cardiac output with backward failure → elevated PAOP
(preload). High CO/low SVR is distributive shock (e.g., septic).
A patient with severe traumatic brain injury has an ICP of 22
mm Hg and a MAP of 70 mm Hg. What is the cerebral
perfusion pressure (CPP), and what action should the nurse
take?
A. CPP 48 mm Hg; elevate head of bed and notify provider
B. CPP 92 mm Hg; continue current management
C. CPP 70 mm Hg; administer hypertonic saline
D. CPP 52 mm Hg; decrease ventilator rate
Correct Answer: A
*Explanation: CPP = MAP – ICP = 70 – 22 = 48 mm Hg
, (target >60). Interventions to reduce ICP (HOB elevation,
hyperosmolar therapy) are needed.*
Which electrocardiographic finding is most suggestive of acute
pericarditis?
A. Diffuse ST-segment elevation with PR-segment depression
B. ST-segment elevation in contiguous leads with reciprocal
changes
C. Deep Q waves in leads II, III, and aVF
D. Narrow QRS tachycardia with absent P waves
Correct Answer: A
Explanation: Diffuse ST elevation with PR depression is classic
for pericarditis. Contiguous ST elevation with reciprocal
changes suggests myocardial infarction.
A patient with septic shock is on norepinephrine at 20 mcg/min
and remains hypotensive with a MAP of 52 mm Hg. Which
action should the critical care nurse take next?
A. Add vasopressin infusion
B. Administer a 500 mL fluid bolus
C. Increase norepinephrine to 30 mcg/min
D. Start hydrocortisone 100 mg IV
Correct Answer: B
Explanation: Fluid resuscitation is first-line in septic shock
before escalating vasopressors unless contraindicated.
, Vasopressin and steroids are second-line after adequate
volume.
A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with a PEEP of 14 cm H2O. The
SpO2 drops to 84%. Which intervention is most likely to
improve oxygenation?
A. Increase FiO2 to 100%
B. Perform a recruitment maneuver
C. Decrease PEEP to 10 cm H2O
D. Switch to pressure support ventilation
Correct Answer: B
Explanation: Recruitment maneuvers open collapsed alveoli in
ARDS. Increasing FiO2 is temporary; decreasing PEEP worsens
oxygenation. Pressure support is not appropriate for severe
ARDS.
Which laboratory finding is most consistent with a diagnosis of
acute pancreatitis in a critically ill patient?
A. Serum lipase 4 times the upper limit of normal
B. AST/ALT ratio >3
C. Serum amylase within normal range
D. Elevated alkaline phosphatase without jaundice
Correct Answer: A
*Explanation: Lipase is highly specific and sensitive for acute
