Advanced CCRN Critical Care Registered
Nurse Multiple Choice Questions (MCQs)
with Answers and Explanations for AACN
Certification and Professional Nursing
Exams
1. A client with septic shock has received adequate fluid resuscitation but continues to have
a mean arterial pressure (MAP) of 58 mm Hg. Which vasoactive medication should the
nurse anticipate administering first?
A. Dobutamine
B. Vasopressin
C. Dopamine
D. Norepinephrine
Explanation: Norepinephrine is the first-line vasopressor recommended for septic shock when
hypotension persists despite adequate fluid resuscitation because it effectively increases
vascular tone and MAP.
2. A mechanically ventilated client develops sudden hypotension, absent breath sounds on
the right side, and tracheal deviation to the left. Which intervention should the nurse
anticipate?
A. Increase positive end-expiratory pressure
B. Administer intravenous furosemide
C. Obtain a portable chest radiograph
D. Emergency needle decompression
Explanation: These findings are consistent with tension pneumothorax, a life-threatening
emergency requiring immediate decompression before confirmatory imaging.
3. Which hemodynamic profile is most consistent with cardiogenic shock?
A. Low central venous pressure and low pulmonary artery occlusion pressure
, B. High cardiac output and low systemic vascular resistance
C. High pulmonary artery occlusion pressure with decreased cardiac output
D. Increased cardiac output with decreased preload
Explanation: Cardiogenic shock results in impaired ventricular function, causing elevated filling
pressures and reduced cardiac output.
4. A client with acute respiratory distress syndrome (ARDS) has worsening hypoxemia
despite receiving 100% oxygen. Which intervention has been shown to improve
oxygenation and survival?
A. Continuous nebulized bronchodilators
B. Hyperventilation therapy
C. Routine corticosteroid administration
D. Prone positioning
Explanation: Prone positioning improves ventilation-perfusion matching and decreases
mortality in severe ARDS.
5. Which finding most strongly suggests increased intracranial pressure in a client with
traumatic brain injury?
A. Tachycardia and hypotension
B. Polyuria and bradycardia
C. Hypertension, bradycardia, and irregular respirations
D. Fever and tachypnea
Explanation: Cushing's triad is a late sign of increased intracranial pressure and indicates
impending brain herniation.
6. A client receiving intravenous unfractionated heparin develops thrombocytopenia and
new-onset digital ischemia. Which complication should the nurse suspect?
A. Disseminated intravascular coagulation
B. Warfarin necrosis
C. Thrombotic thrombocytopenic purpura
Nurse Multiple Choice Questions (MCQs)
with Answers and Explanations for AACN
Certification and Professional Nursing
Exams
1. A client with septic shock has received adequate fluid resuscitation but continues to have
a mean arterial pressure (MAP) of 58 mm Hg. Which vasoactive medication should the
nurse anticipate administering first?
A. Dobutamine
B. Vasopressin
C. Dopamine
D. Norepinephrine
Explanation: Norepinephrine is the first-line vasopressor recommended for septic shock when
hypotension persists despite adequate fluid resuscitation because it effectively increases
vascular tone and MAP.
2. A mechanically ventilated client develops sudden hypotension, absent breath sounds on
the right side, and tracheal deviation to the left. Which intervention should the nurse
anticipate?
A. Increase positive end-expiratory pressure
B. Administer intravenous furosemide
C. Obtain a portable chest radiograph
D. Emergency needle decompression
Explanation: These findings are consistent with tension pneumothorax, a life-threatening
emergency requiring immediate decompression before confirmatory imaging.
3. Which hemodynamic profile is most consistent with cardiogenic shock?
A. Low central venous pressure and low pulmonary artery occlusion pressure
, B. High cardiac output and low systemic vascular resistance
C. High pulmonary artery occlusion pressure with decreased cardiac output
D. Increased cardiac output with decreased preload
Explanation: Cardiogenic shock results in impaired ventricular function, causing elevated filling
pressures and reduced cardiac output.
4. A client with acute respiratory distress syndrome (ARDS) has worsening hypoxemia
despite receiving 100% oxygen. Which intervention has been shown to improve
oxygenation and survival?
A. Continuous nebulized bronchodilators
B. Hyperventilation therapy
C. Routine corticosteroid administration
D. Prone positioning
Explanation: Prone positioning improves ventilation-perfusion matching and decreases
mortality in severe ARDS.
5. Which finding most strongly suggests increased intracranial pressure in a client with
traumatic brain injury?
A. Tachycardia and hypotension
B. Polyuria and bradycardia
C. Hypertension, bradycardia, and irregular respirations
D. Fever and tachypnea
Explanation: Cushing's triad is a late sign of increased intracranial pressure and indicates
impending brain herniation.
6. A client receiving intravenous unfractionated heparin develops thrombocytopenia and
new-onset digital ischemia. Which complication should the nurse suspect?
A. Disseminated intravascular coagulation
B. Warfarin necrosis
C. Thrombotic thrombocytopenic purpura
