FCCN LEVEL 1 EXAM 2025-2026 |
Complete Solutions & Verified
Q&A | Critical Care Nursing | Pass
Guaranteed - A+ Graded
### PART A: MULTIPLE CHOICE (Q1–80)
* *Q1 (Hemodynamics):** A patient with septic shock has a CVP of 3 mmHg, PAP 25/10, PCWP
5 mmHg, CI 3.8 L/min/m². Which intervention is priority?
A. Administer norepinephrine
B. Give a 500 mL fluid bolus
C. Start dobutamine infusion
D. Obtain a stat echocardiogram
**[CORRECT]** B
*Rationale: Low CVP and PCWP indicate hypovolemia; septic shock is distributive but often
requires volume resuscitation first per SCCM Surviving Sepsis 2021/2025 updates.
Norepinephrine (A) is added if hypotension persists after adequate fluids; dobutamine (C) is for
cardiogenic shock with low CI; echo (D) is not first-line in hemodynamically unstable patients
without clear indication.*
* *Q2 (Hemodynamics):** A patient post-CABG has a CVP of 14 mmHg, PAP 35/20, PCWP 18
mmHg, CI 1.9 L/min/m². Which vasoactive agent is most appropriate?
A. Norepinephrine
B. Dobutamine
C. Phenylephrine
D. Nitroprusside
**[CORRECT]** B
*Rationale: Elevated filling pressures (CVP, PCWP) with low cardiac index indicate cardiogenic
shock; dobutamine is the inotrope of choice to improve contractility. Norepinephrine (A) is for
distributive shock; phenylephrine (C) increases afterload and would worsen the low CI;
nitroprusside (D) would further reduce preload in an already failing ventricle.*
* *Q3 (Hemodynamics):** The formula for calculating Mean Arterial Pressure (MAP) is:
A. SBP + 2(DBP) ÷ 3
, . DBP + 1/3(SBP – DBP)
B
C. SBP + DBP ÷ 2
D. 2(SBP) + DBP ÷ 3
**[CORRECT]** B
*Rationale: MAP = DBP + 1/3(SBP – DBP), which represents the average pressure during the
cardiac cycle and is the primary perfusion pressure target in shock resuscitation (target ≥65
mmHg per SCCM). Option A is a common miscalculation; C is the arithmetic mean, not
physiologically accurate; D is mathematically incorrect.*
* *Q4 (Hemodynamics):** A patient has an arterial line with a dampened waveform. The nurse
should first:
A. Check the transducer height
B. Flush the catheter
C. Check for air bubbles in the tubing
D. Replace the transducer
**[CORRECT]** C
*Rationale: Air bubbles in the tubing are the most common cause of waveform dampening and
must be eliminated first; this is a standard arterial line troubleshooting step. Transducer height
(A) affects the numeric value but not waveform quality; flushing (B) may be needed after bubble
removal but not first; transducer replacement (D) is a last resort.*
* *Q5 (Hemodynamics):** The zeroing reference point for an arterial line transducer is:
A. The axilla
B. The phlebostatic axis (4th intercostal space, mid-axillary line)
C. The sternal notch
D. The right atrium
**[CORRECT]** B
*Rationale: The phlebostatic axis (4th ICS, mid-axillary line) is the standard zeroing reference
for all hemodynamic monitoring per AACN standards. The axilla (A) is too variable; sternal notch
(C) is used for some central venous measurements but not arterial; right atrium (D) is the
anatomical reference but not the external landmark.*
* *Q6 (Hemodynamics):** Systemic Vascular Resistance (SVR) is calculated using:
A. MAP – CVP ÷ CO × 80
B. MAP – PCWP ÷ CO × 80
C. PAP – PCWP ÷ CO × 80
D. SBP – DBP ÷ CO × 80
**[CORRECT]** A
*Rationale: SVR = (MAP – CVP) ÷ CO × 80; CVP approximates right atrial pressure (the
downstream pressure). PCWP (B) is used for pulmonary vascular resistance; PAP (C) is
incorrect; SBP-DBP (D) is pulse pressure, not useful for SVR calculation.*
* *Q7 (Hemodynamics):** A patient with a pulmonary artery catheter has a thermodilution
cardiac output of 4.5 L/min and a BSA of 1.8 m². The cardiac index is:
, . 2.5 L/min/m²
A
B. 3.2 L/min/m²
C. 4.5 L/min/m²
D. 8.1 L/min/m²
**[CORRECT]** A
*Rationale: CI = CO ÷ BSA = 4.5 ÷ 1.8 = 2.5 L/min/m². Normal CI is 2.5–4.0 L/min/m²; values
<2.5 indicate low flow state. Option B is a common rounding error; C is the CO value without
BSA correction; D is CO × BSA, which is incorrect.*
* *Q8 (Shock):** A 68-year-old patient presents with BP 78/50, HR 128, RR 28, temp 38.9°C,
and cool, clammy skin. Lactate is 4.2 mmol/L. This presentation is most consistent with:
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock (cold phase)
D. Neurogenic shock
**[CORRECT]** C
*Rationale: Fever, elevated lactate, tachycardia, and hypotension with cool/clammy skin indicate
septic shock in the cold (hypodynamic) phase, which carries higher mortality than warm shock.
Hypovolemic shock (A) lacks fever; cardiogenic shock (B) would show elevated filling pressures;
neurogenic shock (D) presents with warm, dry skin due to loss of sympathetic tone.*
* *Q9 (Shock):** A patient with massive PE has BP 82/60, HR 130, CVP 18, PAP 50/35, PCWP
12. This hemodynamic profile indicates:
A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributive shock
**[CORRECT]** C
*Rationale: Elevated CVP and PAP with relatively normal PCWP indicate right ventricular failure
due to pulmonary vascular obstruction—classic obstructive shock from massive PE.
Hypovolemic shock (A) shows low filling pressures; cardiogenic shock (B) shows elevated
PCWP; distributive shock (D) shows low/normal filling pressures with warm periphery.*
* *Q10 (Shock):** The primary goal in the first hour of sepsis management (Hour-1 Bundle 2025)
is:
A. Obtain blood cultures and start antibiotics within 3 hours
B. Measure lactate, obtain blood cultures, administer broad-spectrum antibiotics, give 30 mL/kg
crystalloid for hypotension or lactate ≥4, and start vasopressors if needed to maintain MAP ≥65
C. Complete source control within 6 hours
D. Start hydrocortisone 200 mg/day
**[CORRECT]** B
*Rationale: The 2021/2025 Surviving Sepsis Campaign Hour-1 Bundle requires all elements to
be initiated within the first hour: lactate measurement, blood cultures, antibiotics, fluid
resuscitation (30 mL/kg), and vasopressors for persistent hypotension. Option A reflects older
Complete Solutions & Verified
Q&A | Critical Care Nursing | Pass
Guaranteed - A+ Graded
### PART A: MULTIPLE CHOICE (Q1–80)
* *Q1 (Hemodynamics):** A patient with septic shock has a CVP of 3 mmHg, PAP 25/10, PCWP
5 mmHg, CI 3.8 L/min/m². Which intervention is priority?
A. Administer norepinephrine
B. Give a 500 mL fluid bolus
C. Start dobutamine infusion
D. Obtain a stat echocardiogram
**[CORRECT]** B
*Rationale: Low CVP and PCWP indicate hypovolemia; septic shock is distributive but often
requires volume resuscitation first per SCCM Surviving Sepsis 2021/2025 updates.
Norepinephrine (A) is added if hypotension persists after adequate fluids; dobutamine (C) is for
cardiogenic shock with low CI; echo (D) is not first-line in hemodynamically unstable patients
without clear indication.*
* *Q2 (Hemodynamics):** A patient post-CABG has a CVP of 14 mmHg, PAP 35/20, PCWP 18
mmHg, CI 1.9 L/min/m². Which vasoactive agent is most appropriate?
A. Norepinephrine
B. Dobutamine
C. Phenylephrine
D. Nitroprusside
**[CORRECT]** B
*Rationale: Elevated filling pressures (CVP, PCWP) with low cardiac index indicate cardiogenic
shock; dobutamine is the inotrope of choice to improve contractility. Norepinephrine (A) is for
distributive shock; phenylephrine (C) increases afterload and would worsen the low CI;
nitroprusside (D) would further reduce preload in an already failing ventricle.*
* *Q3 (Hemodynamics):** The formula for calculating Mean Arterial Pressure (MAP) is:
A. SBP + 2(DBP) ÷ 3
, . DBP + 1/3(SBP – DBP)
B
C. SBP + DBP ÷ 2
D. 2(SBP) + DBP ÷ 3
**[CORRECT]** B
*Rationale: MAP = DBP + 1/3(SBP – DBP), which represents the average pressure during the
cardiac cycle and is the primary perfusion pressure target in shock resuscitation (target ≥65
mmHg per SCCM). Option A is a common miscalculation; C is the arithmetic mean, not
physiologically accurate; D is mathematically incorrect.*
* *Q4 (Hemodynamics):** A patient has an arterial line with a dampened waveform. The nurse
should first:
A. Check the transducer height
B. Flush the catheter
C. Check for air bubbles in the tubing
D. Replace the transducer
**[CORRECT]** C
*Rationale: Air bubbles in the tubing are the most common cause of waveform dampening and
must be eliminated first; this is a standard arterial line troubleshooting step. Transducer height
(A) affects the numeric value but not waveform quality; flushing (B) may be needed after bubble
removal but not first; transducer replacement (D) is a last resort.*
* *Q5 (Hemodynamics):** The zeroing reference point for an arterial line transducer is:
A. The axilla
B. The phlebostatic axis (4th intercostal space, mid-axillary line)
C. The sternal notch
D. The right atrium
**[CORRECT]** B
*Rationale: The phlebostatic axis (4th ICS, mid-axillary line) is the standard zeroing reference
for all hemodynamic monitoring per AACN standards. The axilla (A) is too variable; sternal notch
(C) is used for some central venous measurements but not arterial; right atrium (D) is the
anatomical reference but not the external landmark.*
* *Q6 (Hemodynamics):** Systemic Vascular Resistance (SVR) is calculated using:
A. MAP – CVP ÷ CO × 80
B. MAP – PCWP ÷ CO × 80
C. PAP – PCWP ÷ CO × 80
D. SBP – DBP ÷ CO × 80
**[CORRECT]** A
*Rationale: SVR = (MAP – CVP) ÷ CO × 80; CVP approximates right atrial pressure (the
downstream pressure). PCWP (B) is used for pulmonary vascular resistance; PAP (C) is
incorrect; SBP-DBP (D) is pulse pressure, not useful for SVR calculation.*
* *Q7 (Hemodynamics):** A patient with a pulmonary artery catheter has a thermodilution
cardiac output of 4.5 L/min and a BSA of 1.8 m². The cardiac index is:
, . 2.5 L/min/m²
A
B. 3.2 L/min/m²
C. 4.5 L/min/m²
D. 8.1 L/min/m²
**[CORRECT]** A
*Rationale: CI = CO ÷ BSA = 4.5 ÷ 1.8 = 2.5 L/min/m². Normal CI is 2.5–4.0 L/min/m²; values
<2.5 indicate low flow state. Option B is a common rounding error; C is the CO value without
BSA correction; D is CO × BSA, which is incorrect.*
* *Q8 (Shock):** A 68-year-old patient presents with BP 78/50, HR 128, RR 28, temp 38.9°C,
and cool, clammy skin. Lactate is 4.2 mmol/L. This presentation is most consistent with:
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock (cold phase)
D. Neurogenic shock
**[CORRECT]** C
*Rationale: Fever, elevated lactate, tachycardia, and hypotension with cool/clammy skin indicate
septic shock in the cold (hypodynamic) phase, which carries higher mortality than warm shock.
Hypovolemic shock (A) lacks fever; cardiogenic shock (B) would show elevated filling pressures;
neurogenic shock (D) presents with warm, dry skin due to loss of sympathetic tone.*
* *Q9 (Shock):** A patient with massive PE has BP 82/60, HR 130, CVP 18, PAP 50/35, PCWP
12. This hemodynamic profile indicates:
A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributive shock
**[CORRECT]** C
*Rationale: Elevated CVP and PAP with relatively normal PCWP indicate right ventricular failure
due to pulmonary vascular obstruction—classic obstructive shock from massive PE.
Hypovolemic shock (A) shows low filling pressures; cardiogenic shock (B) shows elevated
PCWP; distributive shock (D) shows low/normal filling pressures with warm periphery.*
* *Q10 (Shock):** The primary goal in the first hour of sepsis management (Hour-1 Bundle 2025)
is:
A. Obtain blood cultures and start antibiotics within 3 hours
B. Measure lactate, obtain blood cultures, administer broad-spectrum antibiotics, give 30 mL/kg
crystalloid for hypotension or lactate ≥4, and start vasopressors if needed to maintain MAP ≥65
C. Complete source control within 6 hours
D. Start hydrocortisone 200 mg/day
**[CORRECT]** B
*Rationale: The 2021/2025 Surviving Sepsis Campaign Hour-1 Bundle requires all elements to
be initiated within the first hour: lactate measurement, blood cultures, antibiotics, fluid
resuscitation (30 mL/kg), and vasopressors for persistent hypotension. Option A reflects older
