NUR 445 Final Exam Study Guide 2026 –
Critical Care Nursing Practice Questions &
Answers (DKA, Sepsis, ARDS, MODS)
Description:
Ace your NUR 445 final exam with this targeted 2026 study guide. Designed for nursing
students in the US and Canada, this resource includes updated practice questions, detailed
answers, and clear explanations for high-yield critical care topics like DKA, sepsis, ARDS,
MODS, Cushing’s, SIADH, burns, and trauma. Based on the latest NCLEX® and clinical
guidelines, this guide helps you review complex concepts quickly and confidently—whether
you're preparing for finals, certification, or clinical rotations.
Stop stressing over your critical care exam. Download your free study guide now and pass with
confidence!
, NUR 445 Final Exam Questions & Answers (2026) – Critical Care
Nursing Review
1. A patient with diabetes is suspected to be in diabetic ketoacidosis (DKA). Which clinical
findings would the nurse expect to assess?
o a) Hypoglycemia, bradycardia, and oliguria
o b) Polydipsia, hypertension, and bounding pulses
o c) Presence of urinary ketones, Kussmaul respirations, and an acetone breath odor
o d) Hyponatremia, bradypnea, and warm, flushed skin
Answer: c) Presence of urinary ketones, Kussmaul respirations, and an acetone breath odor.
Explanation: DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis.
Kussmaul respirations are a compensatory mechanism for acidosis, and ketones in the urine and
on the breath (acetone/fruity odor) are direct results of fat metabolism due to insulin deficiency.
2. When educating a patient with Type 1 Diabetes Mellitus on preventing diabetic ketoacidosis
(DKA), which instruction is essential?
o a) Stop all insulin if you are unable to eat due to illness.
o b) Maintain hydration and continue taking insulin even during illness.
o c) Only check blood glucose if symptoms of hyperglycemia occur.
o d) Restrict fluid intake if blood glucose is elevated.
Answer: b) Maintain hydration and continue taking insulin even during illness.
Explanation: Illness increases stress hormones, which raise blood glucose. Stopping insulin can
precipitate DKA. Continued insulin, frequent glucose and ketone monitoring, and maintaining
hydration with sugar-free or prescribed fluids are critical "sick day" rules to prevent DKA.
3. For a patient with diabetes who is experiencing vomiting, what is the priority nursing action
regarding insulin management?
o a) Withhold all insulin until the patient can tolerate solid food.
o b) Administer the prescribed insulin as scheduled.
o c) Double the insulin dose to counteract rising glucose.
o d) Switch to oral antihyperglycemic agents temporarily.
Answer: b) Administer the prescribed insulin as scheduled.
Explanation: Insulin is essential for preventing ketosis. Vomiting does not negate the body's
, need for insulin; in fact, stress from illness often increases insulin requirements. The patient
should follow sick-day protocols, which include taking insulin, checking blood glucose every 2-4
hours, and contacting their provider.
4. Which set of assessment findings is most indicative of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
o a) Low urine output, dilute urine, and hypernatremia
o b) Polyuria, polydipsia, and low urine specific gravity
o c) Fluid retention, concentrated urine, and hyponatremia
o d) Hypertension, peripheral edema, and high serum sodium
Answer: c) Fluid retention, concentrated urine, and hyponatremia.
Explanation: SIADH results from excessive ADH secretion, causing water retention,
concentrated urine (high osmolality), dilutional hyponatremia (low serum sodium), and low urine
output. The body retains water, leading to these hallmark signs.
5. A patient is diagnosed with Cushing's syndrome. The nurse understands this condition is
primarily caused by:
o a) A deficiency of adrenocortical hormones.
o b) An autoimmune destruction of the adrenal gland.
o c) An excess of circulating cortisol.
o d) A tumor of the pituitary gland suppressing ADH.
Answer: c) An excess of circulating cortisol.
Explanation: Cushing's syndrome is a cluster of clinical abnormalities caused by chronic
exposure to excessive levels of cortisol, either from endogenous overproduction or exogenous
administration (e.g., long-term steroid therapy).
6. Which patient outcome best indicates effective treatment and improvement in a patient with
Cushing's syndrome?
o a) Weight gain and improved appetite
o b) A return of electrolyte levels to normal ranges and decreased edema
o c) Development of a bronze skin tone
o d) Increased blood pressure and blood glucose
Answer: b) A return of electrolyte levels to normal ranges and decreased edema.
, Explanation: Effective management of Cushing's syndrome reduces excessive cortisol, which
should correct associated fluid and electrolyte imbalances (e.g., hypokalemia, fluid retention),
leading to decreased edema and stabilized vital signs like hypertension.
7. A patient receiving high-dose corticosteroid therapy (for a condition like Cushing's syndrome) is
at increased risk for which complication?
o a) Hypoglycemia and bradycardia
o b) Hyperglycemia and increased susceptibility to infection
o c) Hypotension and hypothermia
o d) Blood clots and hypercalcemia
Answer: b) Hyperglycemia and increased susceptibility to infection.
Explanation: Corticosteroids increase blood glucose by promoting gluconeogenesis and
reducing glucose utilization. They also have an immunosuppressive effect, impairing the body's
inflammatory and immune responses, thereby increasing infection risk.
8. A patient's arterial blood gas (ABG) results are: pH 7.50, PaCO2 28 mm Hg, HCO3- 24 mEq/L.
The nurse interprets this as:
o a) Metabolic acidosis
o b) Metabolic alkalosis
o c) Respiratory acidosis
o d) Respiratory alkalosis
Answer: d) Respiratory alkalosis.
Explanation: The pH is alkalotic (>7.45). The primary disturbance is a low PaCO2
(hypocapnia), which is respiratory in origin. The bicarbonate is normal, indicating an acute
respiratory alkalosis without metabolic compensation.
9. Which clinical presentation is most characteristic of Acute Respiratory Distress Syndrome
(ARDS)?
o a) Gradual onset of dyspnea relieved with rest
o b) Severe dyspnea, refractory hypoxemia, and decreased lung compliance
o c) Productive cough, fever, and localized crackles
o d) Barrel chest and prolonged expiratory phase
Answer: b) Severe dyspnea, refractory hypoxemia, and decreased lung compliance.
Critical Care Nursing Practice Questions &
Answers (DKA, Sepsis, ARDS, MODS)
Description:
Ace your NUR 445 final exam with this targeted 2026 study guide. Designed for nursing
students in the US and Canada, this resource includes updated practice questions, detailed
answers, and clear explanations for high-yield critical care topics like DKA, sepsis, ARDS,
MODS, Cushing’s, SIADH, burns, and trauma. Based on the latest NCLEX® and clinical
guidelines, this guide helps you review complex concepts quickly and confidently—whether
you're preparing for finals, certification, or clinical rotations.
Stop stressing over your critical care exam. Download your free study guide now and pass with
confidence!
, NUR 445 Final Exam Questions & Answers (2026) – Critical Care
Nursing Review
1. A patient with diabetes is suspected to be in diabetic ketoacidosis (DKA). Which clinical
findings would the nurse expect to assess?
o a) Hypoglycemia, bradycardia, and oliguria
o b) Polydipsia, hypertension, and bounding pulses
o c) Presence of urinary ketones, Kussmaul respirations, and an acetone breath odor
o d) Hyponatremia, bradypnea, and warm, flushed skin
Answer: c) Presence of urinary ketones, Kussmaul respirations, and an acetone breath odor.
Explanation: DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis.
Kussmaul respirations are a compensatory mechanism for acidosis, and ketones in the urine and
on the breath (acetone/fruity odor) are direct results of fat metabolism due to insulin deficiency.
2. When educating a patient with Type 1 Diabetes Mellitus on preventing diabetic ketoacidosis
(DKA), which instruction is essential?
o a) Stop all insulin if you are unable to eat due to illness.
o b) Maintain hydration and continue taking insulin even during illness.
o c) Only check blood glucose if symptoms of hyperglycemia occur.
o d) Restrict fluid intake if blood glucose is elevated.
Answer: b) Maintain hydration and continue taking insulin even during illness.
Explanation: Illness increases stress hormones, which raise blood glucose. Stopping insulin can
precipitate DKA. Continued insulin, frequent glucose and ketone monitoring, and maintaining
hydration with sugar-free or prescribed fluids are critical "sick day" rules to prevent DKA.
3. For a patient with diabetes who is experiencing vomiting, what is the priority nursing action
regarding insulin management?
o a) Withhold all insulin until the patient can tolerate solid food.
o b) Administer the prescribed insulin as scheduled.
o c) Double the insulin dose to counteract rising glucose.
o d) Switch to oral antihyperglycemic agents temporarily.
Answer: b) Administer the prescribed insulin as scheduled.
Explanation: Insulin is essential for preventing ketosis. Vomiting does not negate the body's
, need for insulin; in fact, stress from illness often increases insulin requirements. The patient
should follow sick-day protocols, which include taking insulin, checking blood glucose every 2-4
hours, and contacting their provider.
4. Which set of assessment findings is most indicative of Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)?
o a) Low urine output, dilute urine, and hypernatremia
o b) Polyuria, polydipsia, and low urine specific gravity
o c) Fluid retention, concentrated urine, and hyponatremia
o d) Hypertension, peripheral edema, and high serum sodium
Answer: c) Fluid retention, concentrated urine, and hyponatremia.
Explanation: SIADH results from excessive ADH secretion, causing water retention,
concentrated urine (high osmolality), dilutional hyponatremia (low serum sodium), and low urine
output. The body retains water, leading to these hallmark signs.
5. A patient is diagnosed with Cushing's syndrome. The nurse understands this condition is
primarily caused by:
o a) A deficiency of adrenocortical hormones.
o b) An autoimmune destruction of the adrenal gland.
o c) An excess of circulating cortisol.
o d) A tumor of the pituitary gland suppressing ADH.
Answer: c) An excess of circulating cortisol.
Explanation: Cushing's syndrome is a cluster of clinical abnormalities caused by chronic
exposure to excessive levels of cortisol, either from endogenous overproduction or exogenous
administration (e.g., long-term steroid therapy).
6. Which patient outcome best indicates effective treatment and improvement in a patient with
Cushing's syndrome?
o a) Weight gain and improved appetite
o b) A return of electrolyte levels to normal ranges and decreased edema
o c) Development of a bronze skin tone
o d) Increased blood pressure and blood glucose
Answer: b) A return of electrolyte levels to normal ranges and decreased edema.
, Explanation: Effective management of Cushing's syndrome reduces excessive cortisol, which
should correct associated fluid and electrolyte imbalances (e.g., hypokalemia, fluid retention),
leading to decreased edema and stabilized vital signs like hypertension.
7. A patient receiving high-dose corticosteroid therapy (for a condition like Cushing's syndrome) is
at increased risk for which complication?
o a) Hypoglycemia and bradycardia
o b) Hyperglycemia and increased susceptibility to infection
o c) Hypotension and hypothermia
o d) Blood clots and hypercalcemia
Answer: b) Hyperglycemia and increased susceptibility to infection.
Explanation: Corticosteroids increase blood glucose by promoting gluconeogenesis and
reducing glucose utilization. They also have an immunosuppressive effect, impairing the body's
inflammatory and immune responses, thereby increasing infection risk.
8. A patient's arterial blood gas (ABG) results are: pH 7.50, PaCO2 28 mm Hg, HCO3- 24 mEq/L.
The nurse interprets this as:
o a) Metabolic acidosis
o b) Metabolic alkalosis
o c) Respiratory acidosis
o d) Respiratory alkalosis
Answer: d) Respiratory alkalosis.
Explanation: The pH is alkalotic (>7.45). The primary disturbance is a low PaCO2
(hypocapnia), which is respiratory in origin. The bicarbonate is normal, indicating an acute
respiratory alkalosis without metabolic compensation.
9. Which clinical presentation is most characteristic of Acute Respiratory Distress Syndrome
(ARDS)?
o a) Gradual onset of dyspnea relieved with rest
o b) Severe dyspnea, refractory hypoxemia, and decreased lung compliance
o c) Productive cough, fever, and localized crackles
o d) Barrel chest and prolonged expiratory phase
Answer: b) Severe dyspnea, refractory hypoxemia, and decreased lung compliance.
