Advanced Medical-Surgical, Pharmacology &
Critical Care Review Exam 2026 REVIEWS
WITH COMPLETE ACTUAL EXAM
QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
(MOST RECENT!!)
1. A patient with acute decompensated heart failure presents with
cold, clammy skin, crackles in both lungs, and a blood pressure of
82/50 mm Hg. The nurse anticipates which initial intervention?
A. Intravenous furosemide 40 mg
B. Nitroglycerin infusion at 10 mcg/min
C. Dobutamine infusion
D. IV metoprolol 5 mg
Answer: C – Dobutamine is an inotrope that increases cardiac
output and improves perfusion in cardiogenic shock (“cold and
wet”). Furosemide treats volume overload but may worsen
hypotension. Nitroglycerin reduces preload, which can further
drop BP. Metoprolol is contraindicated in acute decompensated
HF with hypotension.
2. A patient on a milrinone infusion develops a new onset of rapid
atrial fibrillation with a ventricular rate of 150 bpm. Which action
is most important?
,A. Increase milrinone dose
B. Administer amiodarone 150 mg IV push
C. Administer digoxin 0.25 mg IV
D. Check potassium and magnesium levels
Answer: D – Milrinone can cause hypokalemia and
hypomagnesemia, predisposing to arrhythmias. Correcting
electrolytes may terminate the arrhythmia. Amiodarone and
digoxin are used for rate/rhythm control but electrolyte imbalance
must be corrected first.
3. A patient post-cardiac arrest has return of spontaneous
circulation (ROSC) but remains unresponsive with a blood
pressure of 88/40 mm Hg. The initial 12-lead ECG shows
ST-elevation in leads V1–V4. What is the priority?
A. Start targeted temperature management (TTM)
B. Transfer for emergent coronary angiography
C. Administer epinephrine 1 mg IV push
D. Obtain a stat echocardiogram
Answer: B – After ROSC, ST-elevation indicates acute coronary
occlusion. Emergency PCI is the priority to restore coronary flow,
even if the patient is comatose. TTM can be initiated after or
during catheterization. Epinephrine is for hypotension
unresponsive to fluids.
4. A patient with septic shock is on norepinephrine (16 mcg/min)
and vasopressin (0.04 units/min). The mean arterial pressure
(MAP) is 58 mm Hg. Which intervention should the nurse
anticipate next?
A. Start phenylephrine infusion
,B. Give a fluid bolus of 500 mL crystalloid
C. Add dobutamine
D. Increase norepinephrine to 20 mcg/min
Answer: B – The patient is on two vasopressors but MAP remains
<65 mm Hg. In septic shock, guidelines suggest additional fluid
bolus if still hypovolemic. Increasing norepinephrine is
appropriate only after fluid status is optimized. Phenylephrine is
second-line.
5. Which finding indicates adequate tissue perfusion in a patient
receiving dobutamine for cardiogenic shock?
A. Central venous pressure (CVP) of 18 mm Hg
B. Urine output of 0.8 mL/kg/hr over 2 hours
C. Heart rate of 55 bpm
D. Mixed venous oxygen saturation (SvO2) of 50%
Answer: B – Urine output ≥0.5 mL/kg/hr, normal lactate, and
improving mental status are signs of adequate perfusion. SvO2
<60% indicates low oxygen delivery. CVP 18 suggests fluid
overload. HR 55 may be bradycardia, but not a direct marker of
perfusion.
6. A patient with a ventricular assist device (LVAD) has a low flow
alarm and reports dizziness. The power module is connected, and
the controller shows normal parameters. What is the nurse’s
priority action?
A. Check the driveline for disconnection
B. Auscultate for heart sounds
C. Obtain a stat blood pressure with Doppler
D. Increase the LVAD speed by 200 rpm
, Answer: C – Low flow alarm with normal controller settings may
indicate hypotension or obstruction. BP assessment (MAP by
Doppler) is essential. Driveline check is standard but not the
priority. Speed changes require provider order.
7. A patient receiving amiodarone IV develops significant
bradycardia (HR 38 bpm) and hypotension. The nurse should
prepare to administer:
A. Atropine 0.5 mg IV
B. Isoproterenol infusion
C. Calcium gluconate
D. Glucagon 3 mg IV
Answer: A – Amiodarone can cause symptomatic bradycardia.
Atropine is first-line for unstable bradycardia. Isoproterenol is
used rarely. Calcium and glucagon are not indicated for
amiodarone-induced bradycardia.
8. A patient with a pulmonary artery catheter has a cardiac output
(CO) of 3.1 L/min, cardiac index (CI) of 1.6 L/min/m², and systemic
vascular resistance (SVR) of 1800 dynes·sec/cm⁵. Which
intervention is most appropriate?
A. Increase norepinephrine
B. Administer a fluid challenge
C. Start dobutamine
D. Give furosemide
Answer: C – Low CI with high SVR indicates cardiogenic shock
(cold, dry). Dobutamine improves inotropy and lowers afterload.
Norepinephrine would increase SVR further. Fluids may worsen
Critical Care Review Exam 2026 REVIEWS
WITH COMPLETE ACTUAL EXAM
QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
(MOST RECENT!!)
1. A patient with acute decompensated heart failure presents with
cold, clammy skin, crackles in both lungs, and a blood pressure of
82/50 mm Hg. The nurse anticipates which initial intervention?
A. Intravenous furosemide 40 mg
B. Nitroglycerin infusion at 10 mcg/min
C. Dobutamine infusion
D. IV metoprolol 5 mg
Answer: C – Dobutamine is an inotrope that increases cardiac
output and improves perfusion in cardiogenic shock (“cold and
wet”). Furosemide treats volume overload but may worsen
hypotension. Nitroglycerin reduces preload, which can further
drop BP. Metoprolol is contraindicated in acute decompensated
HF with hypotension.
2. A patient on a milrinone infusion develops a new onset of rapid
atrial fibrillation with a ventricular rate of 150 bpm. Which action
is most important?
,A. Increase milrinone dose
B. Administer amiodarone 150 mg IV push
C. Administer digoxin 0.25 mg IV
D. Check potassium and magnesium levels
Answer: D – Milrinone can cause hypokalemia and
hypomagnesemia, predisposing to arrhythmias. Correcting
electrolytes may terminate the arrhythmia. Amiodarone and
digoxin are used for rate/rhythm control but electrolyte imbalance
must be corrected first.
3. A patient post-cardiac arrest has return of spontaneous
circulation (ROSC) but remains unresponsive with a blood
pressure of 88/40 mm Hg. The initial 12-lead ECG shows
ST-elevation in leads V1–V4. What is the priority?
A. Start targeted temperature management (TTM)
B. Transfer for emergent coronary angiography
C. Administer epinephrine 1 mg IV push
D. Obtain a stat echocardiogram
Answer: B – After ROSC, ST-elevation indicates acute coronary
occlusion. Emergency PCI is the priority to restore coronary flow,
even if the patient is comatose. TTM can be initiated after or
during catheterization. Epinephrine is for hypotension
unresponsive to fluids.
4. A patient with septic shock is on norepinephrine (16 mcg/min)
and vasopressin (0.04 units/min). The mean arterial pressure
(MAP) is 58 mm Hg. Which intervention should the nurse
anticipate next?
A. Start phenylephrine infusion
,B. Give a fluid bolus of 500 mL crystalloid
C. Add dobutamine
D. Increase norepinephrine to 20 mcg/min
Answer: B – The patient is on two vasopressors but MAP remains
<65 mm Hg. In septic shock, guidelines suggest additional fluid
bolus if still hypovolemic. Increasing norepinephrine is
appropriate only after fluid status is optimized. Phenylephrine is
second-line.
5. Which finding indicates adequate tissue perfusion in a patient
receiving dobutamine for cardiogenic shock?
A. Central venous pressure (CVP) of 18 mm Hg
B. Urine output of 0.8 mL/kg/hr over 2 hours
C. Heart rate of 55 bpm
D. Mixed venous oxygen saturation (SvO2) of 50%
Answer: B – Urine output ≥0.5 mL/kg/hr, normal lactate, and
improving mental status are signs of adequate perfusion. SvO2
<60% indicates low oxygen delivery. CVP 18 suggests fluid
overload. HR 55 may be bradycardia, but not a direct marker of
perfusion.
6. A patient with a ventricular assist device (LVAD) has a low flow
alarm and reports dizziness. The power module is connected, and
the controller shows normal parameters. What is the nurse’s
priority action?
A. Check the driveline for disconnection
B. Auscultate for heart sounds
C. Obtain a stat blood pressure with Doppler
D. Increase the LVAD speed by 200 rpm
, Answer: C – Low flow alarm with normal controller settings may
indicate hypotension or obstruction. BP assessment (MAP by
Doppler) is essential. Driveline check is standard but not the
priority. Speed changes require provider order.
7. A patient receiving amiodarone IV develops significant
bradycardia (HR 38 bpm) and hypotension. The nurse should
prepare to administer:
A. Atropine 0.5 mg IV
B. Isoproterenol infusion
C. Calcium gluconate
D. Glucagon 3 mg IV
Answer: A – Amiodarone can cause symptomatic bradycardia.
Atropine is first-line for unstable bradycardia. Isoproterenol is
used rarely. Calcium and glucagon are not indicated for
amiodarone-induced bradycardia.
8. A patient with a pulmonary artery catheter has a cardiac output
(CO) of 3.1 L/min, cardiac index (CI) of 1.6 L/min/m², and systemic
vascular resistance (SVR) of 1800 dynes·sec/cm⁵. Which
intervention is most appropriate?
A. Increase norepinephrine
B. Administer a fluid challenge
C. Start dobutamine
D. Give furosemide
Answer: C – Low CI with high SVR indicates cardiogenic shock
(cold, dry). Dobutamine improves inotropy and lowers afterload.
Norepinephrine would increase SVR further. Fluids may worsen
