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MARYLAND CRITICAL CARE NURSE CERTIFICATION
EXAM QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) Q&A 2026 |INSTANT
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- Which vital sign change is the earliest indicator of shock? A. Blood pressure drop B. Altered mental status C. Bradycardia D. Cyanosis Rationale: Early shock causes decreased perfusion to the brain leading to confusion before BP drops. Correct answer: B
- Normal central venous pressure (CVP) range is: A. 0–2 mmHg B. 2–6 mmHg C. 6–12 mmHg D. 12–18 mmHg Rationale: CVP reflects right atrial pressure; normal is 2– 6 mmHg. Correct answer: B
- Which drug is first-line for cardiogenic shock with hypotension? A. Furosemide B. Dopamine
C. Atropine D. Heparin Rationale: Dopamine supports cardiac output and blood pressure. Correct answer: B
- Which ABG result indicates respiratory acidosis? A. pH 7.48, CO₂ low B. pH 7.30, CO₂ high C. pH 7.50, HCO₃ high D. pH 7.40, normal gases Rationale: Elevated CO₂ with low pH indicates respiratory acidosis. Correct answer: B
- Most accurate method to measure arterial oxygenation is: A. Pulse oximetry B. ABG analysis C. Respiratory rate D. Capillary refill Rationale: ABGs directly measure PaO₂. Correct answer: B
- Normal adult urine output per hour is: A. 10 mL/hr B. 20 mL/hr C. 30–50 mL/hr D. 100 mL/hr
B. Bradycardia and hypertension C. Tachycardia D. Fever Rationale: Cushing’s triad indicates increased ICP. Correct answer: B
- First action in suspected anaphylactic shock: A. IV antibiotics B. Epinephrine C. Steroids D. Antihistamines only Rationale: Epinephrine reverses airway swelling and vasodilation. Correct answer: B
- Normal PaCO₂ range is: A. 20–30 mmHg B. 35–45 mmHg C. 50– 60 mmHg D. 60–70 mmHg Rationale: Normal ventilation maintains 35–45 mmHg. Correct answer: B
- Best indicator of tissue perfusion: A. Heart rate B. Blood pressure C. Serum lactate D. Temperature
Rationale: Lactate rises with anaerobic metabolism. Correct answer: C
- Most common cause of acute respiratory distress syndrome (ARDS): A. Asthma B. Sepsis C. Hypertension D. Diabetes Rationale: Sepsis triggers inflammatory lung injury. Correct answer: B
- PEEP is used to: A. Decrease oxygenation B. Prevent alveolar collapse C. Reduce heart rate D. Increase CO₂ removal only Rationale: Positive end-expiratory pressure keeps alveoli open. Correct answer: B
- Normal serum potassium level: A. 2.5–3. B. 3.5–5. C. 5.5–6. D. 6.5–7. Rationale: Potassium is tightly regulated in this range. Correct answer: B
Rationale: Normal adult CO is 4–8 L/min. Correct answer: C
- Which medication is a vasopressor? A. Dopamine B. Morphine C. Furosemide D. Heparin Rationale: Dopamine increases vascular tone and BP. Correct answer: A
- Shock index is calculated as: A. BP/HR B. HR/SBP C. RR/HR D. MAP/HR Rationale: HR divided by systolic BP indicates shock severity. Correct answer: B
- Normal respiratory rate in adults: A. 8– 10 B. 10– 12 C. 12– 20 D. 20– 30 Rationale: 12–20 is normal adult range. Correct answer: C
- Most sensitive indicator of kidney injury: A. BUN
B. Creatinine C. Urine output D. Sodium Rationale: Creatinine reflects glomerular filtration. Correct answer: B
- Best position for a patient with increased ICP: A. Flat supine B. Trendelenburg C. Head elevated 30° D. Prone Rationale: Elevation improves venous drainage. Correct answer: C
- Primary goal in septic shock management: A. Increase glucose B. Maintain perfusion C. Reduce temperature D. Restrict fluids Rationale: Perfusion preservation prevents organ failure. Correct answer: B
- Initial fluid for septic shock resuscitation: A. D5W B. Normal saline C. Albumin only D. Hypertonic saline Rationale: Isotonic crystalloids restore volume. Correct answer: B
Rationale: Low sodium causes cerebral edema. Correct answer: A
- Best marker of oxygen delivery to tissues: A. PaO₂ B. Hemoglobin C. Cardiac output D. All of the above Rationale: Oxygen delivery depends on all three. Correct answer: D
- Normal hemoglobin range (female): A. 8–10 g/dL B. 10–12 g/dL C. 12–16 g/dL D. 16–20 g/dL Rationale: Females typically 12–16 g/dL. Correct answer: C
- First step in airway obstruction: A. Intubation B. Heimlich maneuver C. Chest x-ray D. Oxygen mask Rationale: Immediate obstruction relief is priority. Correct answer: B
- Normal pH range: A. 7.10–7. B. 7.25–7.
C. 7.35–7.
D. 7.45–7.
Rationale: Physiological pH is tightly regulated. Correct answer: C
- Metabolic acidosis is compensated by: A. Kidneys retaining CO₂ B. Lungs blowing off CO₂ C. Liver metabolism D. Heart rate increase Rationale: Hyperventilation reduces CO₂. Correct answer: B
- Best indicator of fluid overload: A. Dry mucosa B. Weight gain C. Tachycardia D. Hypotension Rationale: Rapid weight gain reflects fluid retention. Correct answer: B
- Most common ICU infection source: A. Skin B. Urinary catheter C. Brain D. Eyes Rationale: Catheter-associated infections are common. Correct answer: B
D. Glucometer Rationale: Continuous cardiac monitoring is critical. Correct answer: B
- Early sign of hypoxia: A. Bradycardia B. Restlessness C. Cyanosis D. Hypotension Rationale: CNS agitation is early hypoxia sign. Correct answer: B
- Normal lactate level: A. 0.5–1 mmol/L B. 1–2 mmol/L C. 2–4 mmol/L D. 5–6 mmol/L Rationale: Elevated lactate indicates hypoperfusion. Correct answer: B
- Best ventilation mode for acute respiratory failure: A. CPAP B. Assist-control ventilation C. Nasal cannula D. Simple mask Rationale: Full ventilatory support required. Correct answer: B
- Oxygen toxicity risk occurs with prolonged use of: A. Room air
B. High FiO₂ C. Nitrogen D. Helium Rationale: High oxygen concentrations damage lungs. Correct answer: B
- Normal magnesium level: A. 0.5–1. B. 1.5–2. C. 3.0–4. D. 4.5–5. Rationale: Magnesium supports neuromuscular function. Correct answer: B
- Hypomagnesemia may cause: A. Hypertension B. Arrhythmias C. Hyperglycemia D. Bradycardia only Rationale: Low magnesium destabilizes cardiac rhythm. Correct answer: B
- Most common cause of cardiac arrest in adults: A. Hypothermia B. Ventricular fibrillation C. Stroke D. Infection Rationale: VF is primary arrest rhythm. Correct answer: B
C. Platelets D. D-dimer Rationale: INR evaluates warfarin effect. Correct answer: B
- Signs of DVT include: A. Bradycardia B. Swollen limb C. Cough only D. Hypotension Rationale: Venous obstruction causes swelling. Correct answer: B
- Pulmonary embolism symptom: A. Chest pain and dyspnea B. Headache C. Jaundice D. Abdominal pain Rationale: PE affects pulmonary circulation. Correct answer: A
- Most accurate cardiac output measurement: A. Pulse B. Thermodilution C. BP cuff D. ECG Rationale: Swan-Ganz catheter provides accurate CO. Correct answer: B
- Normal MAP range: A. 30–40 mmHg B. 50–60 mmHg C. 70–100 mmHg D. 110–130 mmHg Rationale: MAP ≥65 is needed for perfusion. Correct answer: C
- Severe hypotension defined as MAP <: A. 100 B. 90 C. 65 D. 50 Rationale: <65 indicates organ hypoperfusion. Correct answer: C
- Early sepsis sign: A. Hypothermia B. Fever and tachycardia C. Bradycardia D. Cyanosis Rationale: Systemic inflammatory response occurs early. Correct answer: B
- Most important sepsis marker: A. Hemoglobin B. Lactate C. Sodium D. Potassium
C. Infection only D. Hypertension Rationale: Multiple factors, sleep deprivation major. Correct answer: B
- Best prevention of ICU delirium: A. Isolation B. Sedation increase C. Early mobilization D. Fluid restriction Rationale: Mobilization reduces cognitive decline. Correct answer: C
- Normal glucose range: A. 40–60 mg/dL B. 70–110 mg/dL C. 120–160 mg/dL D. 160–200 mg/dL Rationale: Normal fasting glucose range. Correct answer: B
- Hyperglycemia in ICU is associated with: A. Faster healing B. Increased infection risk C. Lower mortality D. No effect Rationale: High glucose impairs immunity. Correct answer: B
- Insulin administration requires monitoring of: A. Sodium B. Potassium C. Calcium D. Magnesium Rationale: Insulin shifts potassium intracellularly. Correct answer: B
- Most common electrolyte imbalance in ICU: A. Hypernatremia B. Hypokalemia C. Hypercalcemia D. Hypermagnesemia Rationale: Potassium imbalance is frequent. Correct answer: B
- Hypokalemia ECG change: A. Peaked T waves B. U waves C. Wide QRS D. ST elevation Rationale: Low potassium produces U waves. Correct answer: B
- Best indicator of shock improvement: A. BP only B. Urine output C. Skin color D. Temperature
