FCCN LEVEL 1 (FELLOW OF CRITICAL CARE NURSING)
— BASIC Actual Exam 2026/2027 Complete Questions
and Answers Detailed Rationales Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Critical Care | Q1 – Q10
Section 2 | Respiratory & Ventilator Management | Q11 – Q20
Section 3 | Neurologic & Sedation | Q21 – Q30
Section 4 | Renal, Metabolic & Infectious Disease | Q31 – Q40
Section 5 | Multisystem & Professional Practice | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR CRITICAL CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male is in the CTICU four hours after coronary artery bypass grafting.
Mediastinal chest tube drainage was 50 mL per hour but suddenly increases to 280 mL
in the past hour. His blood pressure is 88/56 mmHg, heart rate is 118 bpm, and central
venous pressure is 14 mmHg. He is cool and clammy with weak peripheral pulses.
A. Administer a 500 mL crystalloid bolus and reassess hemodynamics before notifying
the surgeon.
B. Clamp the mediastinal chest tube to prevent further blood loss and tamponade.
C. Immediately notify the surgeon and prepare the patient for emergent mediastinal
exploration. ✓ CORRECT
D. Increase the norepinephrine infusion to maintain a mean arterial pressure above 65
mmHg.
Correct Answer: C
,Rationale: Sudden drainage exceeding 200 to 250 mL per hour post-CABG indicates
active hemorrhage or tamponade and mandates emergent surgical re-exploration rather
than temporizing measures. Clamping a chest tube in this setting can precipitate fatal
tamponade and is absolutely contraindicated. The CTICU nurse must recognize
hemorrhage thresholds because delays in returning to the operating room significantly
increase mortality from compressive physiology.
Question 2 of 50
A 54-year-old female is admitted to the CCU on day three after an anterior STEMI. She
develops sudden severe dyspnea, blood pressure 78/52 mmHg, heart rate 130 bpm, and
respiratory rate 32 per minute. Lung sounds are clear bilaterally, jugular venous pressure
is elevated, and the ECG shows a new right axis deviation with an S1Q3T3 pattern.
A. Acute left ventricular failure with cardiogenic pulmonary edema.
B. Acute right ventricular infarction with secondary left heart failure.
C. Massive pulmonary embolism causing acute right heart strain. ✓ CORRECT
D. Cardiac tamponade from post-infarction ventricular free wall rupture.
Correct Answer: C
Rationale: The combination of clear lungs, elevated jugular venous pressure,
hypotension, tachycardia, and the classic S1Q3T3 pattern is diagnostic of massive
pulmonary embolism with acute right heart strain. Right ventricular infarction typically
shows inferior ST-segment changes rather than right axis deviation with S1Q3T3, and
tamponade presents with muffled heart sounds and electrical alternans. Nurses in the
CCU must distinguish these presentations rapidly because thrombolysis or
embolectomy is indicated for massive PE, whereas fluids could worsen RV infarction.
Question 3 of 50
A 72-year-old male with decompensated heart failure and an ejection fraction of 20% is
receiving milrinone at 0.5 mcg/kg/min. His blood pressure is 92/64 mmHg, heart rate is
,95 bpm in sinus rhythm, and telemetry shows frequent premature ventricular
contractions in bigeminy. He reports new palpitations and mild lightheadedness.
A. Continue milrinone and start a lidocaine bolus and infusion for suppression of
ventricular ectopy.
B. Reduce the milrinone infusion by 50% and monitor for resolution of the arrhythmia. ✓
CORRECT
C. Administer amiodarone 150 mg IV bolus for suppression of malignant ventricular
rhythms.
D. Increase norepinephrine to support blood pressure and suppress ischemic ectopy.
Correct Answer: B
Rationale: Milrinone is a phosphodiesterase inhibitor that increases intracellular calcium
and is profoundly arrhythmogenic; reducing the dose is the priority when new ventricular
ectopy appears. Lidocaine and amiodarone may suppress the rhythm but do not
address the underlying drug toxicity, and increasing vasopressors can worsen
myocardial oxygen demand without treating the milrinone effect. Heart failure patients
on inotropes require continuous telemetry because even minor dose adjustments can
precipitate sustained ventricular arrhythmias.
Question 4 of 50
A 55-year-old female is on postoperative day one after mitral valve replacement. Her
pulmonary artery catheter shows a right atrial pressure of 8 mmHg, pulmonary artery
pressure of 28/18 mmHg, pulmonary artery occlusion pressure of 14 mmHg, and
cardiac index of 2.4 L/min/m². Her blood pressure is 148/92 mmHg and she reports a
severe frontal headache.
A. Right ventricular failure from acute pulmonary hypertension.
B. Hypertensive crisis causing afterload mismatch and suture line stress. ✓ CORRECT
C. Cardiac tamponade from postoperative mediastinal bleeding.
D. Hypovolemia from aggressive postoperative diuresis.
, Correct Answer: B
Rationale: Hypertension after mitral valve surgery places dangerous stress on the
prosthetic annulus suture line and increases left ventricular afterload, which can
precipitate paravalvular leak or dehiscence. The hemodynamic profile shows elevated
afterload with preserved filling pressures rather than right heart failure, tamponade, or
hypovolemia. Nurses must treat post-valve replacement hypertension aggressively
because a single hypertensive episode can cause catastrophic structural failure
requiring emergent reoperation.
Question 5 of 50
An 81-year-old female with atrial fibrillation and a rapid ventricular response at 150 bpm
is admitted to the CCU. Her blood pressure is 110/70 mmHg and she is alert. The
physician orders diltiazem 20 mg IV push followed by an infusion. Before
administration, the nurse notes she takes metoprolol 50 mg twice daily at home and her
current blood pressure is 98/62 mmHg.
A. Administer the diltiazem as ordered to achieve rapid ventricular rate control.
B. Hold the diltiazem and obtain a 12-lead ECG to assess for an accessory pathway.
C. Hold the diltiazem and notify the physician given the borderline blood pressure and
home beta-blocker use. ✓ CORRECT
D. Administer metoprolol 5 mg IV push instead for more reliable rate control.
Correct Answer: C
Rationale: Combining diltiazem with a home beta-blocker creates a high risk for
synergistic atrioventricular nodal blockade, bradycardia, and hypotension, especially
when the blood pressure is already marginal. While assessing for Wolff-Parkinson-White
is always prudent before giving AV nodal blockers, the immediate issue is
hemodynamic compromise from dual negative chronotropic agents. The CCU nurse
must always reconcile home medications with new orders because polypharmacy in
elderly patients frequently causes iatrogenic bradyarrhythmias.
— BASIC Actual Exam 2026/2027 Complete Questions
and Answers Detailed Rationales Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Critical Care | Q1 – Q10
Section 2 | Respiratory & Ventilator Management | Q11 – Q20
Section 3 | Neurologic & Sedation | Q21 – Q30
Section 4 | Renal, Metabolic & Infectious Disease | Q31 – Q40
Section 5 | Multisystem & Professional Practice | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR CRITICAL CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old male is in the CTICU four hours after coronary artery bypass grafting.
Mediastinal chest tube drainage was 50 mL per hour but suddenly increases to 280 mL
in the past hour. His blood pressure is 88/56 mmHg, heart rate is 118 bpm, and central
venous pressure is 14 mmHg. He is cool and clammy with weak peripheral pulses.
A. Administer a 500 mL crystalloid bolus and reassess hemodynamics before notifying
the surgeon.
B. Clamp the mediastinal chest tube to prevent further blood loss and tamponade.
C. Immediately notify the surgeon and prepare the patient for emergent mediastinal
exploration. ✓ CORRECT
D. Increase the norepinephrine infusion to maintain a mean arterial pressure above 65
mmHg.
Correct Answer: C
,Rationale: Sudden drainage exceeding 200 to 250 mL per hour post-CABG indicates
active hemorrhage or tamponade and mandates emergent surgical re-exploration rather
than temporizing measures. Clamping a chest tube in this setting can precipitate fatal
tamponade and is absolutely contraindicated. The CTICU nurse must recognize
hemorrhage thresholds because delays in returning to the operating room significantly
increase mortality from compressive physiology.
Question 2 of 50
A 54-year-old female is admitted to the CCU on day three after an anterior STEMI. She
develops sudden severe dyspnea, blood pressure 78/52 mmHg, heart rate 130 bpm, and
respiratory rate 32 per minute. Lung sounds are clear bilaterally, jugular venous pressure
is elevated, and the ECG shows a new right axis deviation with an S1Q3T3 pattern.
A. Acute left ventricular failure with cardiogenic pulmonary edema.
B. Acute right ventricular infarction with secondary left heart failure.
C. Massive pulmonary embolism causing acute right heart strain. ✓ CORRECT
D. Cardiac tamponade from post-infarction ventricular free wall rupture.
Correct Answer: C
Rationale: The combination of clear lungs, elevated jugular venous pressure,
hypotension, tachycardia, and the classic S1Q3T3 pattern is diagnostic of massive
pulmonary embolism with acute right heart strain. Right ventricular infarction typically
shows inferior ST-segment changes rather than right axis deviation with S1Q3T3, and
tamponade presents with muffled heart sounds and electrical alternans. Nurses in the
CCU must distinguish these presentations rapidly because thrombolysis or
embolectomy is indicated for massive PE, whereas fluids could worsen RV infarction.
Question 3 of 50
A 72-year-old male with decompensated heart failure and an ejection fraction of 20% is
receiving milrinone at 0.5 mcg/kg/min. His blood pressure is 92/64 mmHg, heart rate is
,95 bpm in sinus rhythm, and telemetry shows frequent premature ventricular
contractions in bigeminy. He reports new palpitations and mild lightheadedness.
A. Continue milrinone and start a lidocaine bolus and infusion for suppression of
ventricular ectopy.
B. Reduce the milrinone infusion by 50% and monitor for resolution of the arrhythmia. ✓
CORRECT
C. Administer amiodarone 150 mg IV bolus for suppression of malignant ventricular
rhythms.
D. Increase norepinephrine to support blood pressure and suppress ischemic ectopy.
Correct Answer: B
Rationale: Milrinone is a phosphodiesterase inhibitor that increases intracellular calcium
and is profoundly arrhythmogenic; reducing the dose is the priority when new ventricular
ectopy appears. Lidocaine and amiodarone may suppress the rhythm but do not
address the underlying drug toxicity, and increasing vasopressors can worsen
myocardial oxygen demand without treating the milrinone effect. Heart failure patients
on inotropes require continuous telemetry because even minor dose adjustments can
precipitate sustained ventricular arrhythmias.
Question 4 of 50
A 55-year-old female is on postoperative day one after mitral valve replacement. Her
pulmonary artery catheter shows a right atrial pressure of 8 mmHg, pulmonary artery
pressure of 28/18 mmHg, pulmonary artery occlusion pressure of 14 mmHg, and
cardiac index of 2.4 L/min/m². Her blood pressure is 148/92 mmHg and she reports a
severe frontal headache.
A. Right ventricular failure from acute pulmonary hypertension.
B. Hypertensive crisis causing afterload mismatch and suture line stress. ✓ CORRECT
C. Cardiac tamponade from postoperative mediastinal bleeding.
D. Hypovolemia from aggressive postoperative diuresis.
, Correct Answer: B
Rationale: Hypertension after mitral valve surgery places dangerous stress on the
prosthetic annulus suture line and increases left ventricular afterload, which can
precipitate paravalvular leak or dehiscence. The hemodynamic profile shows elevated
afterload with preserved filling pressures rather than right heart failure, tamponade, or
hypovolemia. Nurses must treat post-valve replacement hypertension aggressively
because a single hypertensive episode can cause catastrophic structural failure
requiring emergent reoperation.
Question 5 of 50
An 81-year-old female with atrial fibrillation and a rapid ventricular response at 150 bpm
is admitted to the CCU. Her blood pressure is 110/70 mmHg and she is alert. The
physician orders diltiazem 20 mg IV push followed by an infusion. Before
administration, the nurse notes she takes metoprolol 50 mg twice daily at home and her
current blood pressure is 98/62 mmHg.
A. Administer the diltiazem as ordered to achieve rapid ventricular rate control.
B. Hold the diltiazem and obtain a 12-lead ECG to assess for an accessory pathway.
C. Hold the diltiazem and notify the physician given the borderline blood pressure and
home beta-blocker use. ✓ CORRECT
D. Administer metoprolol 5 mg IV push instead for more reliable rate control.
Correct Answer: C
Rationale: Combining diltiazem with a home beta-blocker creates a high risk for
synergistic atrioventricular nodal blockade, bradycardia, and hypotension, especially
when the blood pressure is already marginal. While assessing for Wolff-Parkinson-White
is always prudent before giving AV nodal blockers, the immediate issue is
hemodynamic compromise from dual negative chronotropic agents. The CCU nurse
must always reconcile home medications with new orders because polypharmacy in
elderly patients frequently causes iatrogenic bradyarrhythmias.
