NCLEX CRITICAL CARE PRACTICE EXAM – PRACTICE QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD
PDF.
Core Domains
Hemodynamic Monitoring and Management
Advanced Airway and Ventilatory Support
Cardiovascular Emergencies and ACLS
Neurological Crises and ICP Management
Endocrine Emergencies (DKA/HHS)
Renal Replacement Therapy and Electrolyte Imbalance
Shock States and Vasoactive Titration
Multisystem Organ Dysfunction Syndrome (MODS)
Ethical and Legal Issues in End-of-Life Care
Introduction
This comprehensive assessment is designed to evaluate the clinical judgment and advanced
nursing skills required for the care of critically ill patients. The exam focuses on the integration of
complex physiological data, rapid assessment, and the implementation of life-saving
interventions within high-acuity settings. Through a mix of foundational theory and scenario-
based multiple-choice questions, candidates are tested on their ability to prioritize care, manage
advanced technology, and adhere to ethical standards under pressure. Emphasis is placed on
real-world application, pharmacological safety, and the critical thinking necessary to improve
patient outcomes in intensive care units and emergency departments.
, 1. A patient in the ICU with a pulmonary artery catheter has a pulmonary artery wedge
pressure (PAWP) of 22 mmHg. Which clinical finding should the nurse anticipate?
A. Dehydration
B. Bilateral crackles in the lungs
C. Decreased central venous pressure
D. Flat neck veins
🟢 B. Bilateral crackles in the lungs
🔴 RATIONALE: An elevated PAWP (normal 6–12 mmHg) indicates left ventricular end-diastolic
pressure overload, commonly resulting in pulmonary congestion and crackles.
2. A nurse is caring for a patient with increased intracranial pressure (ICP) following a
traumatic brain injury. Which nursing intervention is most appropriate?
A. Encouraging the patient to cough and deep breathe
B. Keeping the head of the bed flat
C. Maintaining the head and neck in a neutral, midline position
D. Suctioning the patient every hour to keep the airway clear
🟢 C. Maintaining the head and neck in a neutral, midline position
🔴 RATIONALE: Midline positioning facilitates venous drainage from the brain via the jugular
veins, helping to reduce ICP. Neck flexion or rotation can obstruct drainage.
3. Which of the following is the priority intervention for a patient in hypovolemic shock?
A. Administering dopamine at a high dose
B. Starting a rapid infusion of isotonic crystalloids
C. Placing the patient in a high-Fowler’s position
D. Administering broad-spectrum antibiotics
🟢 B. Starting a rapid infusion of isotonic crystalloids
🔴 RATIONALE: The primary goal in hypovolemic shock is to restore intravascular volume.
Isotonic fluids like Normal Saline or Lactated Ringer's are the first-line treatment.
, 4. A patient’s arterial blood gas (ABG) results are: pH 7.30, PaCO2 55 mmHg, HCO3 26
mEq/L. How should the nurse interpret these findings?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
🟢 C. Respiratory acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis, and an elevated PaCO2 (above 45 mmHg)
confirms the cause is respiratory in nature.
5. When titrating a norepinephrine infusion for a patient in septic shock, which mean arterial
pressure (MAP) is typically the minimum goal?
A. 50 mmHg
B. 65 mmHg
C. 85 mmHg
D. 100 mmHg
🟢 B. 65 mmHg
🔴 RATIONALE: Clinical guidelines for sepsis management generally target a MAP of at least 65
mmHg to ensure adequate end-organ perfusion.
6. A patient on a mechanical ventilator in Assist-Control (AC) mode is "fighting" the ventilator
and has a respiratory rate of 32. The nurse notes the peak inspiratory pressure is high.
What is the first action?
A. Sedate the patient immediately
B. Manually bag the patient with 100% oxygen
C. Assess the patient’s lung sounds and airway patency
D. Increase the set tidal volume
, 🟢 C. Assess the patient’s lung sounds and airway patency
🔴 RATIONALE: Assessment is always the first step. The nurse must determine if the high
pressure is due to secretions, kinking, or a change in patient status before intervening.
7. Which rhythm is characterized by a "sawtooth" pattern on the EKG?
A. Ventricular fibrillation
B. Atrial flutter
C. Atrial fibrillation
D. Third-degree heart block
🟢 B. Atrial flutter
🔴 RATIONALE: Atrial flutter is classic for its rapid, regular "F" waves that resemble a sawtooth
pattern on the monitor.
8. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse should prioritize which
medication?
A. Subcutaneous long-acting insulin
B. Intravenous Regular insulin
C. Oral hypoglycemic agents
D. Intravenous bicarbonate
🟢 B. Intravenous Regular insulin
🔴 RATIONALE: Continuous IV infusion of Regular insulin is the standard of care for DKA to
reverse ketosis and lower blood glucose levels safely.
9. The nurse identifies a "u-wave" on a patient's EKG. Which electrolyte abnormality should
the nurse suspect?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD
PDF.
Core Domains
Hemodynamic Monitoring and Management
Advanced Airway and Ventilatory Support
Cardiovascular Emergencies and ACLS
Neurological Crises and ICP Management
Endocrine Emergencies (DKA/HHS)
Renal Replacement Therapy and Electrolyte Imbalance
Shock States and Vasoactive Titration
Multisystem Organ Dysfunction Syndrome (MODS)
Ethical and Legal Issues in End-of-Life Care
Introduction
This comprehensive assessment is designed to evaluate the clinical judgment and advanced
nursing skills required for the care of critically ill patients. The exam focuses on the integration of
complex physiological data, rapid assessment, and the implementation of life-saving
interventions within high-acuity settings. Through a mix of foundational theory and scenario-
based multiple-choice questions, candidates are tested on their ability to prioritize care, manage
advanced technology, and adhere to ethical standards under pressure. Emphasis is placed on
real-world application, pharmacological safety, and the critical thinking necessary to improve
patient outcomes in intensive care units and emergency departments.
, 1. A patient in the ICU with a pulmonary artery catheter has a pulmonary artery wedge
pressure (PAWP) of 22 mmHg. Which clinical finding should the nurse anticipate?
A. Dehydration
B. Bilateral crackles in the lungs
C. Decreased central venous pressure
D. Flat neck veins
🟢 B. Bilateral crackles in the lungs
🔴 RATIONALE: An elevated PAWP (normal 6–12 mmHg) indicates left ventricular end-diastolic
pressure overload, commonly resulting in pulmonary congestion and crackles.
2. A nurse is caring for a patient with increased intracranial pressure (ICP) following a
traumatic brain injury. Which nursing intervention is most appropriate?
A. Encouraging the patient to cough and deep breathe
B. Keeping the head of the bed flat
C. Maintaining the head and neck in a neutral, midline position
D. Suctioning the patient every hour to keep the airway clear
🟢 C. Maintaining the head and neck in a neutral, midline position
🔴 RATIONALE: Midline positioning facilitates venous drainage from the brain via the jugular
veins, helping to reduce ICP. Neck flexion or rotation can obstruct drainage.
3. Which of the following is the priority intervention for a patient in hypovolemic shock?
A. Administering dopamine at a high dose
B. Starting a rapid infusion of isotonic crystalloids
C. Placing the patient in a high-Fowler’s position
D. Administering broad-spectrum antibiotics
🟢 B. Starting a rapid infusion of isotonic crystalloids
🔴 RATIONALE: The primary goal in hypovolemic shock is to restore intravascular volume.
Isotonic fluids like Normal Saline or Lactated Ringer's are the first-line treatment.
, 4. A patient’s arterial blood gas (ABG) results are: pH 7.30, PaCO2 55 mmHg, HCO3 26
mEq/L. How should the nurse interpret these findings?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
🟢 C. Respiratory acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis, and an elevated PaCO2 (above 45 mmHg)
confirms the cause is respiratory in nature.
5. When titrating a norepinephrine infusion for a patient in septic shock, which mean arterial
pressure (MAP) is typically the minimum goal?
A. 50 mmHg
B. 65 mmHg
C. 85 mmHg
D. 100 mmHg
🟢 B. 65 mmHg
🔴 RATIONALE: Clinical guidelines for sepsis management generally target a MAP of at least 65
mmHg to ensure adequate end-organ perfusion.
6. A patient on a mechanical ventilator in Assist-Control (AC) mode is "fighting" the ventilator
and has a respiratory rate of 32. The nurse notes the peak inspiratory pressure is high.
What is the first action?
A. Sedate the patient immediately
B. Manually bag the patient with 100% oxygen
C. Assess the patient’s lung sounds and airway patency
D. Increase the set tidal volume
, 🟢 C. Assess the patient’s lung sounds and airway patency
🔴 RATIONALE: Assessment is always the first step. The nurse must determine if the high
pressure is due to secretions, kinking, or a change in patient status before intervening.
7. Which rhythm is characterized by a "sawtooth" pattern on the EKG?
A. Ventricular fibrillation
B. Atrial flutter
C. Atrial fibrillation
D. Third-degree heart block
🟢 B. Atrial flutter
🔴 RATIONALE: Atrial flutter is classic for its rapid, regular "F" waves that resemble a sawtooth
pattern on the monitor.
8. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse should prioritize which
medication?
A. Subcutaneous long-acting insulin
B. Intravenous Regular insulin
C. Oral hypoglycemic agents
D. Intravenous bicarbonate
🟢 B. Intravenous Regular insulin
🔴 RATIONALE: Continuous IV infusion of Regular insulin is the standard of care for DKA to
reverse ketosis and lower blood glucose levels safely.
9. The nurse identifies a "u-wave" on a patient's EKG. Which electrolyte abnormality should
the nurse suspect?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
