CRITICAL CARE NURSING EXAM (REAL EXAM 2025) EXACT EXAM
QUESTIONS, CLINICAL SCENARIOS & HIGH-YIELD CCRN AND ICU
EXPERT VERIFIED FOR A GUARANTEED PASS!!
LATEST FOR 202-2026
A client with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is admitted to the intensive
care unit with a serum sodium level of 112 mEq/L or mmol/L. Which protocol prescription should the nurse
implement first?
Obtain serum sodium every 4 hours
The nurse is caring for a client who is demonstrating signs of impending death. The family is experiencing
emotional distress as the client's condition declines. Which information should the nurse provide the family to
facilitate the process?
Encourage the family to give the patient permission to die
The nurse is caring for a client with severe sepsis related to a ruptured appendix.The clientis diaphoretic and
reports lower extremity spasms. The nurse observes respirations that are uneven and labored. Arterial blood gas
(ABG) results are pH 7.60, PaCO2 25 mmHg, HCO3 24 mEq/L, and PaO2 24 mmHg. Which assessment
finding warrants immediate intervention by the nurse?
Intercostal muscle contraction
Define: Intercostal muscle contraction
Critical sign of respiratory muscle fatigue which is likely to lead to acute respiratory failure
Define: Cistacurium
Paralytic during surgery
A client who experienced an intracranial hemorrhage is receiving cistracurium to induce a pharmacological state
of paralysis. Which intervention should the nurse implement during the therapeutic paralysis?
Administer a sedating medication
A client returns to the intensive care unit (ICU) after having a permanent pacemaker inserted. Which finding
should the nurse observe for during the immediate hours after insertion?
Beck's Triad
What are pacemakers & defibrillators able to cause?
Bleeding into the pericardial sac which causes a high risk for cardiac tamponade
Define: Cardiac tamponade
Blood or fluid fills the space between the heart & its sac
Define: Beck's triad
,Signs of pericardial tamponade with low arterial BP, distended neck veins, & muffled heart sounds
What is a normal arterial BP?
70-100mmHg
A client with a demand pacemaker has a telemetry tracing with a pacing spike but no corresponding QRS
complex. The client's myocardium is illiciting a QRS after a delay of several seconds. Which telemetry
interpretation should the nurse conclude?
Loss of capture
What is indicated if there is a pacemaker spike that does not produce a QRS complex?
Loss of capture
A client who arrived in the emergency department is experiencing status epilepticus. Which medication should
the nurse administer immediately?
Lorazepam IV
What should you give a client experiencing epilepsy?
CNS depressant
Define: Thyroidectomy
Surgical removal of the thyroid gland
The triage nurse is assessing a victim of a stab wound. According to the paramedics, the victim was stabbed by
a male attacker. The knife blade is 6 inches (7.2 cm) in length and 1 inch (2.5 cm) in width. The "point of entry"
of the stab wound is two inches above and left of the victim's xiphoid process. Which vital organ(s) are at an
increased risk of being in the direct path of injury?
Heart
Lungs
Diaphragm
What way do females stab?
Downwards
What way do males stab?
Upwards
A client reports to the nurse feeling achy and weak, being tired and coughing all the time, frequent headaches
and experiencing night sweats. The client's assessment is significant for crackles scattered throughout the lungs,
dependent peripheral edema +3/+4, S3 and S4 heart sounds, temperature of 102.4° F(39.1° C), heart rate of 110
beats/minute, respirations of 20 breaths/minute, and blood pressure of 105/60 mmHg with a mean arterial
pressure of (75). Which diagnostic procedure should the nurse prepare to do first?
Blood culture
Define: Infective endocarditis
, Infection of the endocardial surface of the heart, usually the heart valves
What indicates ineffective endocarditis?
Edema & S1/S3 sounds
According to the paramedic's report, the victim of a motor vehicle collision was sitting in the passenger seat on
the left side of the vehicle. The vehicle was stopped at a traffic light when the vehicle was hit on the left side by
another vehicle traveling at speeds exceeding 60 mph (97 kmh). The client reports slight tenderness and
achiness on (L) side of thorax and body. The significant assessment findings include: weak and thready pulse;
diffuse abdominal pain, tenderness and guarding present upon palpation; skin is diaphoretic and extremities cool
to touch, capillary refill +4 in extremities, and bruising is present in the (L) flank area and progresses towards
the abdomen. Vital signs are temperature- 97.2° F (36.2° C), pulse- 110 beats/minute, respirations- 22
breaths/minute, blood pressure 84/46 mmHg, MAP- (57), and pulse oximetry 90% on 2 lpm O2 via nasal
cannula.
Fractured liver & ruptured spleen
The nurse is analyzing an arterial blood gas (ABG) of a client who is mechanicallly ventilated. The ABG results
are pH- 7.52; paCO2- 30 mmHg; HCO3- 28 mEq/liter. How should the nurse interpret this blood gas?
Respiratory alkalosis
Define: Respiratory alkalosis
HCO3 & pH is increased while the CO2 is decreased
What is the effect if blood sugar continues to rise?
Change in level of consciousness
What precaution should a patient be on with a high sodium?
Seizure precautions
Why do people with diabetes have an increased urinary output?
Low ADH
What is the effect of a low ADH?
Dehydration & increased serum Sodium
A client who returns to the postoperative unit after a total thyroidectomy suddenly becomes short of breath and
develops stridor. What action should the nurse implement first?
Call the rapid response team for emergency assistance
What complication can happen after a thyroidectomy?
Bleeding into the soft tissue around the incision site causing inspiratory stridor & laryngospasm
Define: Stridor
Strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx
QUESTIONS, CLINICAL SCENARIOS & HIGH-YIELD CCRN AND ICU
EXPERT VERIFIED FOR A GUARANTEED PASS!!
LATEST FOR 202-2026
A client with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is admitted to the intensive
care unit with a serum sodium level of 112 mEq/L or mmol/L. Which protocol prescription should the nurse
implement first?
Obtain serum sodium every 4 hours
The nurse is caring for a client who is demonstrating signs of impending death. The family is experiencing
emotional distress as the client's condition declines. Which information should the nurse provide the family to
facilitate the process?
Encourage the family to give the patient permission to die
The nurse is caring for a client with severe sepsis related to a ruptured appendix.The clientis diaphoretic and
reports lower extremity spasms. The nurse observes respirations that are uneven and labored. Arterial blood gas
(ABG) results are pH 7.60, PaCO2 25 mmHg, HCO3 24 mEq/L, and PaO2 24 mmHg. Which assessment
finding warrants immediate intervention by the nurse?
Intercostal muscle contraction
Define: Intercostal muscle contraction
Critical sign of respiratory muscle fatigue which is likely to lead to acute respiratory failure
Define: Cistacurium
Paralytic during surgery
A client who experienced an intracranial hemorrhage is receiving cistracurium to induce a pharmacological state
of paralysis. Which intervention should the nurse implement during the therapeutic paralysis?
Administer a sedating medication
A client returns to the intensive care unit (ICU) after having a permanent pacemaker inserted. Which finding
should the nurse observe for during the immediate hours after insertion?
Beck's Triad
What are pacemakers & defibrillators able to cause?
Bleeding into the pericardial sac which causes a high risk for cardiac tamponade
Define: Cardiac tamponade
Blood or fluid fills the space between the heart & its sac
Define: Beck's triad
,Signs of pericardial tamponade with low arterial BP, distended neck veins, & muffled heart sounds
What is a normal arterial BP?
70-100mmHg
A client with a demand pacemaker has a telemetry tracing with a pacing spike but no corresponding QRS
complex. The client's myocardium is illiciting a QRS after a delay of several seconds. Which telemetry
interpretation should the nurse conclude?
Loss of capture
What is indicated if there is a pacemaker spike that does not produce a QRS complex?
Loss of capture
A client who arrived in the emergency department is experiencing status epilepticus. Which medication should
the nurse administer immediately?
Lorazepam IV
What should you give a client experiencing epilepsy?
CNS depressant
Define: Thyroidectomy
Surgical removal of the thyroid gland
The triage nurse is assessing a victim of a stab wound. According to the paramedics, the victim was stabbed by
a male attacker. The knife blade is 6 inches (7.2 cm) in length and 1 inch (2.5 cm) in width. The "point of entry"
of the stab wound is two inches above and left of the victim's xiphoid process. Which vital organ(s) are at an
increased risk of being in the direct path of injury?
Heart
Lungs
Diaphragm
What way do females stab?
Downwards
What way do males stab?
Upwards
A client reports to the nurse feeling achy and weak, being tired and coughing all the time, frequent headaches
and experiencing night sweats. The client's assessment is significant for crackles scattered throughout the lungs,
dependent peripheral edema +3/+4, S3 and S4 heart sounds, temperature of 102.4° F(39.1° C), heart rate of 110
beats/minute, respirations of 20 breaths/minute, and blood pressure of 105/60 mmHg with a mean arterial
pressure of (75). Which diagnostic procedure should the nurse prepare to do first?
Blood culture
Define: Infective endocarditis
, Infection of the endocardial surface of the heart, usually the heart valves
What indicates ineffective endocarditis?
Edema & S1/S3 sounds
According to the paramedic's report, the victim of a motor vehicle collision was sitting in the passenger seat on
the left side of the vehicle. The vehicle was stopped at a traffic light when the vehicle was hit on the left side by
another vehicle traveling at speeds exceeding 60 mph (97 kmh). The client reports slight tenderness and
achiness on (L) side of thorax and body. The significant assessment findings include: weak and thready pulse;
diffuse abdominal pain, tenderness and guarding present upon palpation; skin is diaphoretic and extremities cool
to touch, capillary refill +4 in extremities, and bruising is present in the (L) flank area and progresses towards
the abdomen. Vital signs are temperature- 97.2° F (36.2° C), pulse- 110 beats/minute, respirations- 22
breaths/minute, blood pressure 84/46 mmHg, MAP- (57), and pulse oximetry 90% on 2 lpm O2 via nasal
cannula.
Fractured liver & ruptured spleen
The nurse is analyzing an arterial blood gas (ABG) of a client who is mechanicallly ventilated. The ABG results
are pH- 7.52; paCO2- 30 mmHg; HCO3- 28 mEq/liter. How should the nurse interpret this blood gas?
Respiratory alkalosis
Define: Respiratory alkalosis
HCO3 & pH is increased while the CO2 is decreased
What is the effect if blood sugar continues to rise?
Change in level of consciousness
What precaution should a patient be on with a high sodium?
Seizure precautions
Why do people with diabetes have an increased urinary output?
Low ADH
What is the effect of a low ADH?
Dehydration & increased serum Sodium
A client who returns to the postoperative unit after a total thyroidectomy suddenly becomes short of breath and
develops stridor. What action should the nurse implement first?
Call the rapid response team for emergency assistance
What complication can happen after a thyroidectomy?
Bleeding into the soft tissue around the incision site causing inspiratory stridor & laryngospasm
Define: Stridor
Strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx
