1
2026 NUR 2459 Critical Care Nursing Midterm Exam
Complete Review | 75 ICU Questions and Rationales
Section 1: Hemodynamic Monitoring and Cardiovascular Assessment (Questions
1-15)
1. A patient in the intensive care unit has a pulmonary artery catheter in place.
The nurse notes the following hemodynamic values: Cardiac output (CO) 3.8
L/min, Cardiac index (CI) 1.9 L/min/m², Pulmonary capillary wedge pressure
(PCWP) 22 mmHg, Systemic vascular resistance (SVR) 1,600 dynes/sec/cm⁻⁵.
These findings are MOST consistent with which hemodynamic profile?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock (early/hyperdynamic)
D. Neurogenic shock
Answer: B. Cardiogenic shock
RATIONALE: This hemodynamic profile is classic for CARDIOGENIC SHOCK: (1)
DECREASED cardiac output (CO < 4 L/min) and cardiac index (CI < 2.2 L/min/m²),
indicating pump failure, (2) ELEVATED PCWP (> 18 mmHg), indicating increased
left ventricular filling pressure (pulmonary congestion from the failing left
ventricle), (3) ELEVATED SVR (> 1,200 dynes/sec/cm⁻⁵), reflecting compensatory
vasoconstriction in response to low cardiac output. The failing heart cannot pump
effectively, causing blood to back up into the pulmonary circulation (elevated
PCWP) and a compensatory increase in afterload. Treatment: inotropes
(dobutamine, milrinone), diuretics, vasodilators, and possibly mechanical
circulatory support.
• A: Hypovolemic shock - Incorrect. Hypovolemic shock shows DECREASED
CO, DECREASED PCWP (< 8 mmHg), and INCREASED SVR.
• C: Septic shock (early) - Incorrect. Early septic shock shows INCREASED or
normal CO, DECREASED or normal PCWP, and DECREASED SVR (< 800
dynes/sec/cm⁻⁵).
pg. 1
,2
• D: Neurogenic shock - Incorrect. Neurogenic shock shows DECREASED CO,
DECREASED PCWP, and DECREASED SVR.
2. A patient with an arterial line has the following blood pressure: 90/60 mmHg.
The mean arterial pressure (MAP) is approximately:
A. 50 mmHg
B. 60 mmHg
C. 70 mmHg
D. 75 mmHg
Answer: C. 70 mmHg
RATIONALE: Mean arterial pressure (MAP) is calculated as: MAP = (Systolic BP + 2
× Diastolic BP) / 3. For a BP of 90/60: MAP = (90 + 2 × 60) / 3 = (90 + 120) / 3 = 210
/ 3 = 70 mmHg. MAP reflects the average arterial pressure during a single cardiac
cycle and is a better indicator of organ perfusion than systolic or diastolic
pressure alone. The target MAP is typically ≥ 65 mmHg in most critically ill
patients to ensure adequate cerebral, coronary, and renal perfusion.
• A: 50 mmHg - Incorrect. This is the pulse pressure (90 - 60 = 30) incorrectly
added to diastolic (60 + 30 = 90?), or an incorrect calculation.
• B: 60 mmHg - Incorrect. This is the diastolic pressure, not the MAP.
• D: 75 mmHg - Incorrect. This is (90 + 60) / 2, which is an incorrect formula
for MAP.
3. The nurse is caring for a patient with a pulmonary artery catheter. The PCWP
is 20 mmHg (elevated). This finding indicates:
A. Right ventricular failure
B. Increased left ventricular end-diastolic pressure (LVEDP) and pulmonary venous
congestion
C. Hypovolemia
D. Systemic vasodilation
Answer: B. Increased left ventricular end-diastolic pressure (LVEDP) and
pulmonary venous congestion
pg. 2
,3
RATIONALE: The pulmonary capillary wedge pressure (PCWP) is an indirect
measure of LEFT VENTRICULAR END-DIASTOLIC PRESSURE (LVEDP), which reflects
left ventricular preload. During diastole, when the mitral valve is open, the
pulmonary vasculature, left atrium, and left ventricle form a continuous column
of blood. The balloon at the tip of the PA catheter is inflated, "wedging" it in a
small pulmonary artery branch, and the pressure measured reflects the
downstream pressure in the left atrium and left ventricle. Normal PCWP is 8-12
mmHg. An ELEVATED PCWP (> 18-20 mmHg) indicates: left ventricular failure
(systolic or diastolic), mitral valve disease, or volume overload. It causes increased
hydrostatic pressure in the pulmonary capillaries, leading to pulmonary
congestion and edema.
• A: Right ventricular failure - Incorrect. Right ventricular filling pressure is
reflected by right atrial pressure (RAP) or central venous pressure (CVP),
not PCWP.
• C: Hypovolemia - Incorrect. Hypovolemia causes a LOW PCWP (< 8 mmHg).
• D: Systemic vasodilation - Incorrect. Vasodilation affects SVR, not PCWP
directly.
4. A patient's central venous pressure (CVP) is 2 mmHg (low), and the PCWP is 6
mmHg (low). The patient is tachycardic and hypotensive. The nurse suspects
hypovolemia. The provider orders a 500 mL bolus of 0.9% normal saline. What is
the NORMAL (expected) response to this fluid bolus?
A. Decreased CVP and decreased PCWP
B. Increased CVP and increased PCWP
C. No change in CVP or PCWP
D. Decreased heart rate and increased SVR
Answer: B. Increased CVP and increased PCWP
RATIONALE: A fluid bolus increases intravascular volume, which increases
VENOUS RETURN to the right atrium (increasing CVP/RAP), which increases right
ventricular preload, which increases pulmonary blood flow, which increases left
ventricular preload (increasing PCWP). In a patient with hypovolemia (preload-
dependent), this increase in preload should result in an INCREASE IN STROKE
VOLUME and cardiac output (positive fluid responsiveness). If the patient is NOT
pg. 3
, 4
fluid-responsive (e.g., in cardiogenic shock with a failing, non-compliant ventricle),
the same fluid bolus would increase filling pressures without significantly
increasing cardiac output and could worsen pulmonary congestion.
• A: Decreased CVP and PCWP - Incorrect. A fluid bolus INCREASES filling
pressures.
• C: No change - Incorrect. A fluid bolus will increase filling pressures, though
the magnitude depends on the patient's volume status and compliance.
• D: Decreased HR, increased SVR - Incorrect. A fluid bolus in hypovolemia
should INCREASE stroke volume and may cause a REFLEX DECREASE in
heart rate (and a decrease in compensatory SVR).
5. A patient in the ICU has the following arterial blood gas on a FiO2 of 0.50: pH
7.32, PaCO2 50 mmHg, PaO2 60 mmHg, HCO3- 25 mEq/L. What is the PaO2/FiO2
(P/F) ratio, and what does it indicate?
A. P/F ratio = 120; indicates severe ARDS
B. P/F ratio = 120; indicates normal oxygenation
C. P/F ratio = 300; indicates mild ARDS
D. P/F ratio = 30; indicates normal oxygenation
Answer: A. P/F ratio = 120; indicates severe ARDS
RATIONALE: The PaO2/FiO2 (P/F) ratio is calculated by dividing the arterial PaO2
by the fraction of inspired oxygen (FiO2 expressed as a decimal): P/F = .50 =
120. The Berlin definition of ARDS uses the P/F ratio to classify severity: MILD
ARDS: P/F 200-300 mmHg (on PEEP/CPAP ≥ 5 cm H2O), MODERATE ARDS: P/F
100-200 mmHg, SEVERE ARDS: P/F ≤ 100 mmHg. A P/F ratio of 120 indicates
MODERATE ARDS (some classifications would say 120 is moderate-to-severe). The
normal P/F ratio on room air is > 400-500. This patient has significant hypoxemia
and impaired gas exchange consistent with ARDS.
• B: Normal oxygenation - Incorrect. A P/F ratio of 120 is severely abnormal.
• C: P/F 300 - Incorrect. The calculation is incorrect.
• D: P/F 30 - Incorrect. The calculation is incorrect (this would be PaO2/FiO2
as a percentage: 60/50 = 1.2, not 30).
pg. 4
2026 NUR 2459 Critical Care Nursing Midterm Exam
Complete Review | 75 ICU Questions and Rationales
Section 1: Hemodynamic Monitoring and Cardiovascular Assessment (Questions
1-15)
1. A patient in the intensive care unit has a pulmonary artery catheter in place.
The nurse notes the following hemodynamic values: Cardiac output (CO) 3.8
L/min, Cardiac index (CI) 1.9 L/min/m², Pulmonary capillary wedge pressure
(PCWP) 22 mmHg, Systemic vascular resistance (SVR) 1,600 dynes/sec/cm⁻⁵.
These findings are MOST consistent with which hemodynamic profile?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock (early/hyperdynamic)
D. Neurogenic shock
Answer: B. Cardiogenic shock
RATIONALE: This hemodynamic profile is classic for CARDIOGENIC SHOCK: (1)
DECREASED cardiac output (CO < 4 L/min) and cardiac index (CI < 2.2 L/min/m²),
indicating pump failure, (2) ELEVATED PCWP (> 18 mmHg), indicating increased
left ventricular filling pressure (pulmonary congestion from the failing left
ventricle), (3) ELEVATED SVR (> 1,200 dynes/sec/cm⁻⁵), reflecting compensatory
vasoconstriction in response to low cardiac output. The failing heart cannot pump
effectively, causing blood to back up into the pulmonary circulation (elevated
PCWP) and a compensatory increase in afterload. Treatment: inotropes
(dobutamine, milrinone), diuretics, vasodilators, and possibly mechanical
circulatory support.
• A: Hypovolemic shock - Incorrect. Hypovolemic shock shows DECREASED
CO, DECREASED PCWP (< 8 mmHg), and INCREASED SVR.
• C: Septic shock (early) - Incorrect. Early septic shock shows INCREASED or
normal CO, DECREASED or normal PCWP, and DECREASED SVR (< 800
dynes/sec/cm⁻⁵).
pg. 1
,2
• D: Neurogenic shock - Incorrect. Neurogenic shock shows DECREASED CO,
DECREASED PCWP, and DECREASED SVR.
2. A patient with an arterial line has the following blood pressure: 90/60 mmHg.
The mean arterial pressure (MAP) is approximately:
A. 50 mmHg
B. 60 mmHg
C. 70 mmHg
D. 75 mmHg
Answer: C. 70 mmHg
RATIONALE: Mean arterial pressure (MAP) is calculated as: MAP = (Systolic BP + 2
× Diastolic BP) / 3. For a BP of 90/60: MAP = (90 + 2 × 60) / 3 = (90 + 120) / 3 = 210
/ 3 = 70 mmHg. MAP reflects the average arterial pressure during a single cardiac
cycle and is a better indicator of organ perfusion than systolic or diastolic
pressure alone. The target MAP is typically ≥ 65 mmHg in most critically ill
patients to ensure adequate cerebral, coronary, and renal perfusion.
• A: 50 mmHg - Incorrect. This is the pulse pressure (90 - 60 = 30) incorrectly
added to diastolic (60 + 30 = 90?), or an incorrect calculation.
• B: 60 mmHg - Incorrect. This is the diastolic pressure, not the MAP.
• D: 75 mmHg - Incorrect. This is (90 + 60) / 2, which is an incorrect formula
for MAP.
3. The nurse is caring for a patient with a pulmonary artery catheter. The PCWP
is 20 mmHg (elevated). This finding indicates:
A. Right ventricular failure
B. Increased left ventricular end-diastolic pressure (LVEDP) and pulmonary venous
congestion
C. Hypovolemia
D. Systemic vasodilation
Answer: B. Increased left ventricular end-diastolic pressure (LVEDP) and
pulmonary venous congestion
pg. 2
,3
RATIONALE: The pulmonary capillary wedge pressure (PCWP) is an indirect
measure of LEFT VENTRICULAR END-DIASTOLIC PRESSURE (LVEDP), which reflects
left ventricular preload. During diastole, when the mitral valve is open, the
pulmonary vasculature, left atrium, and left ventricle form a continuous column
of blood. The balloon at the tip of the PA catheter is inflated, "wedging" it in a
small pulmonary artery branch, and the pressure measured reflects the
downstream pressure in the left atrium and left ventricle. Normal PCWP is 8-12
mmHg. An ELEVATED PCWP (> 18-20 mmHg) indicates: left ventricular failure
(systolic or diastolic), mitral valve disease, or volume overload. It causes increased
hydrostatic pressure in the pulmonary capillaries, leading to pulmonary
congestion and edema.
• A: Right ventricular failure - Incorrect. Right ventricular filling pressure is
reflected by right atrial pressure (RAP) or central venous pressure (CVP),
not PCWP.
• C: Hypovolemia - Incorrect. Hypovolemia causes a LOW PCWP (< 8 mmHg).
• D: Systemic vasodilation - Incorrect. Vasodilation affects SVR, not PCWP
directly.
4. A patient's central venous pressure (CVP) is 2 mmHg (low), and the PCWP is 6
mmHg (low). The patient is tachycardic and hypotensive. The nurse suspects
hypovolemia. The provider orders a 500 mL bolus of 0.9% normal saline. What is
the NORMAL (expected) response to this fluid bolus?
A. Decreased CVP and decreased PCWP
B. Increased CVP and increased PCWP
C. No change in CVP or PCWP
D. Decreased heart rate and increased SVR
Answer: B. Increased CVP and increased PCWP
RATIONALE: A fluid bolus increases intravascular volume, which increases
VENOUS RETURN to the right atrium (increasing CVP/RAP), which increases right
ventricular preload, which increases pulmonary blood flow, which increases left
ventricular preload (increasing PCWP). In a patient with hypovolemia (preload-
dependent), this increase in preload should result in an INCREASE IN STROKE
VOLUME and cardiac output (positive fluid responsiveness). If the patient is NOT
pg. 3
, 4
fluid-responsive (e.g., in cardiogenic shock with a failing, non-compliant ventricle),
the same fluid bolus would increase filling pressures without significantly
increasing cardiac output and could worsen pulmonary congestion.
• A: Decreased CVP and PCWP - Incorrect. A fluid bolus INCREASES filling
pressures.
• C: No change - Incorrect. A fluid bolus will increase filling pressures, though
the magnitude depends on the patient's volume status and compliance.
• D: Decreased HR, increased SVR - Incorrect. A fluid bolus in hypovolemia
should INCREASE stroke volume and may cause a REFLEX DECREASE in
heart rate (and a decrease in compensatory SVR).
5. A patient in the ICU has the following arterial blood gas on a FiO2 of 0.50: pH
7.32, PaCO2 50 mmHg, PaO2 60 mmHg, HCO3- 25 mEq/L. What is the PaO2/FiO2
(P/F) ratio, and what does it indicate?
A. P/F ratio = 120; indicates severe ARDS
B. P/F ratio = 120; indicates normal oxygenation
C. P/F ratio = 300; indicates mild ARDS
D. P/F ratio = 30; indicates normal oxygenation
Answer: A. P/F ratio = 120; indicates severe ARDS
RATIONALE: The PaO2/FiO2 (P/F) ratio is calculated by dividing the arterial PaO2
by the fraction of inspired oxygen (FiO2 expressed as a decimal): P/F = .50 =
120. The Berlin definition of ARDS uses the P/F ratio to classify severity: MILD
ARDS: P/F 200-300 mmHg (on PEEP/CPAP ≥ 5 cm H2O), MODERATE ARDS: P/F
100-200 mmHg, SEVERE ARDS: P/F ≤ 100 mmHg. A P/F ratio of 120 indicates
MODERATE ARDS (some classifications would say 120 is moderate-to-severe). The
normal P/F ratio on room air is > 400-500. This patient has significant hypoxemia
and impaired gas exchange consistent with ARDS.
• B: Normal oxygenation - Incorrect. A P/F ratio of 120 is severely abnormal.
• C: P/F 300 - Incorrect. The calculation is incorrect.
• D: P/F 30 - Incorrect. The calculation is incorrect (this would be PaO2/FiO2
as a percentage: 60/50 = 1.2, not 30).
pg. 4
