KAPLAN CRITICAL CARE NURSING EXAM PRACTICE TEST QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Cardiovascular Emergencies and Critical Care
Respiratory Failure and Mechanical Ventilation
Shock States and Hemodynamic Monitoring
Neurological Critical Care and Stroke Management
Multisystem Disorders (Sepsis, Trauma, Burns)
Endocrine, Renal, and Gastrointestinal Critical Care
Pharmacology in Critical Care Settings
Ethical Practice and Professional Caring
Emergency Response and Code Situations
ICU Assessment and Clinical Decision-Making
<center>
<i>This comprehensive practice exam is designed to prepare nursing professionals for the critical care nursing certification assessment. The test
evaluates essential skills including clinical judgment, hemodynamic interpretation, emergency response prioritization, mechanical ventilation
management, shock state recognition, and ethical decision-making in high-acuity situations. The multiple-choice and scenario-based structure
mirrors real certification exams, emphasizing critical thinking over rote memorization. Questions span foundational theory, applied professional
knowledge, regulatory compliance, and ethics while focusing on real-world ICU application. Success requires mastering both pathophysiology and
bedside decision-making to ensure patient safety and optimal outcomes in critical care environments.</i>
</center>
,SECTION ONE: QUESTIONS 1–100
Question 1
A patient in the ICU presents with blood pressure 78/40 mmHg, heart rate 128 bpm, and cool clammy skin after a massive myocardial infarction.
Which type of shock is most likely?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Hypovolemic shock
🟢 Correct answer: C. Cardiogenic shock
🔴 RATIONALE: Cardiogenic shock occurs when the heart cannot pump adequately, typically after massive MI. The classic presentation includes
hypotension, tachycardia, and cool clammy skin due to poor perfusion. Septic shock presents with warm skin early; neurogenic shock has
bradycardia; hypovolemic shock shows different history.
Question 2
A mechanically ventilated patient has an arterial blood gas showing pH 7.28, PaCO₂ 52 mmHg, PaO₂ 68 mmHg, HCO₃ 24 mEq/L. What is the
primary acid-base disturbance?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
🟢 Correct answer: B. Respiratory acidosis
🔴 RATIONALE: pH < 7.35 indicates acidosis. Elevated PaCO₂ (> 45 mmHg) with normal HCO₃ confirms respiratory acidosis due to inadequate
ventilation. The patient needs increased ventilator rate or tidal volume to reduce CO₂.
,Question 3
Which finding requires immediate intervention in a patient with suspected pulmonary embolism?
A. Oxygen saturation 92% on 2L
B. Sudden onset dyspnea with BP 88/50 mmHg
C. Heart rate 108 bpm
D. Clear lung sounds bilaterally
🟢 Correct answer: B. Sudden onset dyspnea with BP 88/50 mmHg
🔴 RATIONALE: Hemodynamic instability (hypotension) with sudden dyspnea indicates massive PE causing obstructive shock. This requires
immediate anticoagulation, possible thrombolytics, and hemodynamic support. Other findings are less urgent.
Question 4
A patient with severe sepsis has lactate 6.8 mmol/L. What does this indicate?
A. Adequate tissue perfusion
B. Mild metabolic disturbance
C. Significant tissue hypoperfusion
D. Liver dysfunction only
🟢 Correct answer: C. Significant tissue hypoperfusion
🔴 RATIONALE: Elevated lactate (> 4 mmol/L) indicates anaerobic metabolism from poor tissue perfusion in sepsis. Lactate 6.8 suggests severe
hypoperfusion and increased mortality risk. It requires aggressive fluid resuscitation and source control.
Question 5
Which medication is the first-line vasopressor for septic shock after adequate fluid resuscitation?
, A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
🟢 Correct answer: B. Norepinephrine
🔴 RATIONALE: Norepinephrine is the recommended first-line vasopressor for septic shock per Surviving Sepsis Guidelines. It increases mean
arterial pressure with less tachycardia than epinephrine. Dopamine has higher arrhythmia risk.
Question 6
A patient with acute respiratory distress syndrome (ARDS) requires mechanical ventilation. Which ventilator setting is most appropriate initially?
A. High tidal volume (10-12 mL/kg)
B. Low tidal volume (6-8 mL/kg)
C. Plateau pressure > 35 cmH₂O
D. No PEEP requirement
🟢 Correct answer: B. Low tidal volume (6-8 mL/kg)
🔴 RATIONALE: ARDS Net protocol mandates low tidal volume ventilation (6-8 mL/kg predicted body weight) to prevent ventilator-induced lung
injury. High tidal volumes worsen lung damage. PEEP is typically needed.
Question 7
Which assessment finding is most concerning for a patient with a Glasgow Coma Scale (GCS) score of 8?
A. Pupils equal and reactive
B. Requires intubation for airway protection
C. Temperature 37.8°C
D. Heart rate 92 bpm
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Cardiovascular Emergencies and Critical Care
Respiratory Failure and Mechanical Ventilation
Shock States and Hemodynamic Monitoring
Neurological Critical Care and Stroke Management
Multisystem Disorders (Sepsis, Trauma, Burns)
Endocrine, Renal, and Gastrointestinal Critical Care
Pharmacology in Critical Care Settings
Ethical Practice and Professional Caring
Emergency Response and Code Situations
ICU Assessment and Clinical Decision-Making
<center>
<i>This comprehensive practice exam is designed to prepare nursing professionals for the critical care nursing certification assessment. The test
evaluates essential skills including clinical judgment, hemodynamic interpretation, emergency response prioritization, mechanical ventilation
management, shock state recognition, and ethical decision-making in high-acuity situations. The multiple-choice and scenario-based structure
mirrors real certification exams, emphasizing critical thinking over rote memorization. Questions span foundational theory, applied professional
knowledge, regulatory compliance, and ethics while focusing on real-world ICU application. Success requires mastering both pathophysiology and
bedside decision-making to ensure patient safety and optimal outcomes in critical care environments.</i>
</center>
,SECTION ONE: QUESTIONS 1–100
Question 1
A patient in the ICU presents with blood pressure 78/40 mmHg, heart rate 128 bpm, and cool clammy skin after a massive myocardial infarction.
Which type of shock is most likely?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Hypovolemic shock
🟢 Correct answer: C. Cardiogenic shock
🔴 RATIONALE: Cardiogenic shock occurs when the heart cannot pump adequately, typically after massive MI. The classic presentation includes
hypotension, tachycardia, and cool clammy skin due to poor perfusion. Septic shock presents with warm skin early; neurogenic shock has
bradycardia; hypovolemic shock shows different history.
Question 2
A mechanically ventilated patient has an arterial blood gas showing pH 7.28, PaCO₂ 52 mmHg, PaO₂ 68 mmHg, HCO₃ 24 mEq/L. What is the
primary acid-base disturbance?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
🟢 Correct answer: B. Respiratory acidosis
🔴 RATIONALE: pH < 7.35 indicates acidosis. Elevated PaCO₂ (> 45 mmHg) with normal HCO₃ confirms respiratory acidosis due to inadequate
ventilation. The patient needs increased ventilator rate or tidal volume to reduce CO₂.
,Question 3
Which finding requires immediate intervention in a patient with suspected pulmonary embolism?
A. Oxygen saturation 92% on 2L
B. Sudden onset dyspnea with BP 88/50 mmHg
C. Heart rate 108 bpm
D. Clear lung sounds bilaterally
🟢 Correct answer: B. Sudden onset dyspnea with BP 88/50 mmHg
🔴 RATIONALE: Hemodynamic instability (hypotension) with sudden dyspnea indicates massive PE causing obstructive shock. This requires
immediate anticoagulation, possible thrombolytics, and hemodynamic support. Other findings are less urgent.
Question 4
A patient with severe sepsis has lactate 6.8 mmol/L. What does this indicate?
A. Adequate tissue perfusion
B. Mild metabolic disturbance
C. Significant tissue hypoperfusion
D. Liver dysfunction only
🟢 Correct answer: C. Significant tissue hypoperfusion
🔴 RATIONALE: Elevated lactate (> 4 mmol/L) indicates anaerobic metabolism from poor tissue perfusion in sepsis. Lactate 6.8 suggests severe
hypoperfusion and increased mortality risk. It requires aggressive fluid resuscitation and source control.
Question 5
Which medication is the first-line vasopressor for septic shock after adequate fluid resuscitation?
, A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
🟢 Correct answer: B. Norepinephrine
🔴 RATIONALE: Norepinephrine is the recommended first-line vasopressor for septic shock per Surviving Sepsis Guidelines. It increases mean
arterial pressure with less tachycardia than epinephrine. Dopamine has higher arrhythmia risk.
Question 6
A patient with acute respiratory distress syndrome (ARDS) requires mechanical ventilation. Which ventilator setting is most appropriate initially?
A. High tidal volume (10-12 mL/kg)
B. Low tidal volume (6-8 mL/kg)
C. Plateau pressure > 35 cmH₂O
D. No PEEP requirement
🟢 Correct answer: B. Low tidal volume (6-8 mL/kg)
🔴 RATIONALE: ARDS Net protocol mandates low tidal volume ventilation (6-8 mL/kg predicted body weight) to prevent ventilator-induced lung
injury. High tidal volumes worsen lung damage. PEEP is typically needed.
Question 7
Which assessment finding is most concerning for a patient with a Glasgow Coma Scale (GCS) score of 8?
A. Pupils equal and reactive
B. Requires intubation for airway protection
C. Temperature 37.8°C
D. Heart rate 92 bpm
