1
2026 NUR 2459 Critical Care Nursing Comprehensive
Practice Exam | 250+ Practice Questions and Rationales
Section 1: Hemodynamics & Monitoring (Questions 1–25)
1. A patient with a pulmonary artery catheter has the following readings: CVP 2
mmHg, PAP 15/5 mmHg, PCWP 4 mmHg, CO 3.5 L/min. These findings are most
consistent with:
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock (early)
D. Obstructive shock
Answer: B
Rationale: Low filling pressures (CVP, PCWP) and low cardiac output indicate
hypovolemia. Cardiogenic shock shows high PCWP and low CO. Early septic shock
shows high CO and low SVR. Obstructive shock (e.g., PE) shows high CVP, high
PAP, normal PCWP, and low CO.
2. The nurse is caring for a patient with a pulmonary artery catheter. The SvO₂
(mixed venous oxygen saturation) drops from 70% to 55%. This indicates:
A. Increased oxygen delivery
B. Decreased oxygen extraction by tissues
C. Inadequate oxygen delivery or increased oxygen consumption
D. Hyperdynamic state
Answer: C
Rationale: SvO₂ reflects the balance between oxygen delivery (DO₂) and
consumption (VO₂). A low SvO₂ suggests decreased delivery (low CO, anemia,
hypoxia) or increased consumption (fever, agitation, shivering). High SvO₂ (>80%)
can indicate sepsis (impaired extraction) or a left-to-right shunt.
3. A patient’s arterial line waveform shows a dicrotic notch on the downslope of
the systolic peak. The nurse knows this represents:
pg. 1
,2
A. Opening of the mitral valve
B. Closure of the aortic valve
C. Opening of the pulmonic valve
D. Closure of the tricuspid valve
Answer: B
Rationale: The dicrotic notch on the arterial waveform corresponds to closure of
the aortic valve and marks the onset of diastole. It is a normal finding.
4. Which of the following best describes the calculation of mean arterial
pressure (MAP)?
A. (SBP + DBP) / 2
B. SBP + (2 × DBP) / 3
C. DBP + 1/3 (SBP – DBP)
D. SBP – DBP
Answer: C
*Rationale: MAP = DBP + 1/3 (pulse pressure). It reflects the average arterial
pressure during one cardiac cycle and is the primary determinant of organ
perfusion. A MAP of at least 60–65 mmHg is needed to perfuse vital organs.*
5. A patient in cardiogenic shock has a cardiac index (CI) of 1.7 L/min/m². The
nurse understands that a normal CI is:
A. 1.0–1.5 L/min/m²
B. 2.5–4.0 L/min/m²
C. 4.0–6.0 L/min/m²
D. 0.5–1.0 L/min/m²
Answer: B
*Rationale: Normal cardiac index is 2.5–4.0 L/min/m². A CI <2.2 L/min/m²
indicates low cardiac output and can contribute to shock.*
6. The nurse notes that a patient’s central venous pressure (CVP) has increased
from 6 to 15 mmHg, and the patient has distended neck veins and hypotension.
This is most suggestive of:
A. Hypovolemia
B. Right ventricular failure or cardiac tamponade
pg. 2
,3
C. Sepsis
D. Acute blood loss
Answer: B
Rationale: Elevated CVP with hypotension and neck vein distension suggests
impaired right ventricular function or obstruction (e.g., tamponade, tension
pneumothorax, massive PE). Hypovolemia would show low CVP. Sepsis often
shows normal or low CVP.
7. When measuring a pulmonary capillary wedge pressure (PCWP), the nurse
knows it reflects:
A. Right atrial pressure
B. Left atrial pressure and left ventricular end-diastolic pressure (preload)
C. Pulmonary artery systolic pressure
D. Right ventricular afterload
Answer: B
Rationale: PCWP is obtained by inflating the balloon at the tip of a pulmonary
artery catheter; it reflects left atrial pressure and, in the absence of mitral valve
disease, left ventricular end-diastolic pressure (LV preload). Normal PCWP is 8–12
mmHg. Elevated PCWP indicates left-sided heart failure or volume overload.
8. A patient on mechanical ventilation has a sudden drop in end-tidal CO₂
(ETCO₂) from 38 to 10 mmHg, along with hypotension. The nurse should
suspect:
A. Endotracheal tube obstruction
B. Massive pulmonary embolism
C. Hyperventilation
D. Mainstem intubation
Answer: B
Rationale: A sudden decrease in ETCO₂ with hypotension suggests a massive
pulmonary embolism, which causes increased dead space and reduces pulmonary
perfusion. Obstruction would increase airway pressures; hyperventilation would
gradually lower ETCO₂; mainstem intubation would show asymmetric breath
sounds.
pg. 3
, 4
9. A patient has a blood pressure of 90/60 mmHg, CVP of 2 mmHg, and urine
output of 15 mL/hour. The nurse anticipates administering:
A. Furosemide
B. Nitroglycerin
C. 0.9% normal saline bolus
D. Dobutamine
Answer: C
Rationale: Low CVP and hypotension with oliguria indicate hypovolemia. The
initial intervention is an isotonic crystalloid fluid bolus to restore intravascular
volume. Furosemide and nitroglycerin would worsen hypotension. Dobutamine is
for cardiogenic shock when fluid is not the primary issue.
10. The nurse is caring for a patient with an intra-aortic balloon pump (IABP).
The balloon inflates during which phase of the cardiac cycle?
A. Atrial systole
B. Ventricular systole
C. Diastole (aortic valve closure)
D. Atrial diastole
Answer: C
Rationale: The IABP inflates at the onset of diastole (after aortic valve closure),
which augments coronary artery perfusion. It deflates just before systole, reducing
afterload and improving cardiac output. The nurse must time the IABP correctly
using the arterial waveform and ECG.
11. A patient with a radial arterial line has a damped waveform. The nurse
should first:
A. Recalibrate the transducer
B. Check the tubing for kinks, clots, or air bubbles, and flush the line
C. Remove the arterial line
D. Reposition the patient
Answer: B
Rationale: A damped waveform may be caused by air bubbles, clots, kinks, or
loose connections. The nurse should assess the system and flush/aspirate to
restore the waveform. Repositioning and recalibration may be done after
pg. 4
2026 NUR 2459 Critical Care Nursing Comprehensive
Practice Exam | 250+ Practice Questions and Rationales
Section 1: Hemodynamics & Monitoring (Questions 1–25)
1. A patient with a pulmonary artery catheter has the following readings: CVP 2
mmHg, PAP 15/5 mmHg, PCWP 4 mmHg, CO 3.5 L/min. These findings are most
consistent with:
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock (early)
D. Obstructive shock
Answer: B
Rationale: Low filling pressures (CVP, PCWP) and low cardiac output indicate
hypovolemia. Cardiogenic shock shows high PCWP and low CO. Early septic shock
shows high CO and low SVR. Obstructive shock (e.g., PE) shows high CVP, high
PAP, normal PCWP, and low CO.
2. The nurse is caring for a patient with a pulmonary artery catheter. The SvO₂
(mixed venous oxygen saturation) drops from 70% to 55%. This indicates:
A. Increased oxygen delivery
B. Decreased oxygen extraction by tissues
C. Inadequate oxygen delivery or increased oxygen consumption
D. Hyperdynamic state
Answer: C
Rationale: SvO₂ reflects the balance between oxygen delivery (DO₂) and
consumption (VO₂). A low SvO₂ suggests decreased delivery (low CO, anemia,
hypoxia) or increased consumption (fever, agitation, shivering). High SvO₂ (>80%)
can indicate sepsis (impaired extraction) or a left-to-right shunt.
3. A patient’s arterial line waveform shows a dicrotic notch on the downslope of
the systolic peak. The nurse knows this represents:
pg. 1
,2
A. Opening of the mitral valve
B. Closure of the aortic valve
C. Opening of the pulmonic valve
D. Closure of the tricuspid valve
Answer: B
Rationale: The dicrotic notch on the arterial waveform corresponds to closure of
the aortic valve and marks the onset of diastole. It is a normal finding.
4. Which of the following best describes the calculation of mean arterial
pressure (MAP)?
A. (SBP + DBP) / 2
B. SBP + (2 × DBP) / 3
C. DBP + 1/3 (SBP – DBP)
D. SBP – DBP
Answer: C
*Rationale: MAP = DBP + 1/3 (pulse pressure). It reflects the average arterial
pressure during one cardiac cycle and is the primary determinant of organ
perfusion. A MAP of at least 60–65 mmHg is needed to perfuse vital organs.*
5. A patient in cardiogenic shock has a cardiac index (CI) of 1.7 L/min/m². The
nurse understands that a normal CI is:
A. 1.0–1.5 L/min/m²
B. 2.5–4.0 L/min/m²
C. 4.0–6.0 L/min/m²
D. 0.5–1.0 L/min/m²
Answer: B
*Rationale: Normal cardiac index is 2.5–4.0 L/min/m². A CI <2.2 L/min/m²
indicates low cardiac output and can contribute to shock.*
6. The nurse notes that a patient’s central venous pressure (CVP) has increased
from 6 to 15 mmHg, and the patient has distended neck veins and hypotension.
This is most suggestive of:
A. Hypovolemia
B. Right ventricular failure or cardiac tamponade
pg. 2
,3
C. Sepsis
D. Acute blood loss
Answer: B
Rationale: Elevated CVP with hypotension and neck vein distension suggests
impaired right ventricular function or obstruction (e.g., tamponade, tension
pneumothorax, massive PE). Hypovolemia would show low CVP. Sepsis often
shows normal or low CVP.
7. When measuring a pulmonary capillary wedge pressure (PCWP), the nurse
knows it reflects:
A. Right atrial pressure
B. Left atrial pressure and left ventricular end-diastolic pressure (preload)
C. Pulmonary artery systolic pressure
D. Right ventricular afterload
Answer: B
Rationale: PCWP is obtained by inflating the balloon at the tip of a pulmonary
artery catheter; it reflects left atrial pressure and, in the absence of mitral valve
disease, left ventricular end-diastolic pressure (LV preload). Normal PCWP is 8–12
mmHg. Elevated PCWP indicates left-sided heart failure or volume overload.
8. A patient on mechanical ventilation has a sudden drop in end-tidal CO₂
(ETCO₂) from 38 to 10 mmHg, along with hypotension. The nurse should
suspect:
A. Endotracheal tube obstruction
B. Massive pulmonary embolism
C. Hyperventilation
D. Mainstem intubation
Answer: B
Rationale: A sudden decrease in ETCO₂ with hypotension suggests a massive
pulmonary embolism, which causes increased dead space and reduces pulmonary
perfusion. Obstruction would increase airway pressures; hyperventilation would
gradually lower ETCO₂; mainstem intubation would show asymmetric breath
sounds.
pg. 3
, 4
9. A patient has a blood pressure of 90/60 mmHg, CVP of 2 mmHg, and urine
output of 15 mL/hour. The nurse anticipates administering:
A. Furosemide
B. Nitroglycerin
C. 0.9% normal saline bolus
D. Dobutamine
Answer: C
Rationale: Low CVP and hypotension with oliguria indicate hypovolemia. The
initial intervention is an isotonic crystalloid fluid bolus to restore intravascular
volume. Furosemide and nitroglycerin would worsen hypotension. Dobutamine is
for cardiogenic shock when fluid is not the primary issue.
10. The nurse is caring for a patient with an intra-aortic balloon pump (IABP).
The balloon inflates during which phase of the cardiac cycle?
A. Atrial systole
B. Ventricular systole
C. Diastole (aortic valve closure)
D. Atrial diastole
Answer: C
Rationale: The IABP inflates at the onset of diastole (after aortic valve closure),
which augments coronary artery perfusion. It deflates just before systole, reducing
afterload and improving cardiac output. The nurse must time the IABP correctly
using the arterial waveform and ECG.
11. A patient with a radial arterial line has a damped waveform. The nurse
should first:
A. Recalibrate the transducer
B. Check the tubing for kinks, clots, or air bubbles, and flush the line
C. Remove the arterial line
D. Reposition the patient
Answer: B
Rationale: A damped waveform may be caused by air bubbles, clots, kinks, or
loose connections. The nurse should assess the system and flush/aspirate to
restore the waveform. Repositioning and recalibration may be done after
pg. 4
