Sample practice questions

A few real questions from this free bank, with full explanations. Use the practice tool above for the whole set.

1. 1. Cardiovascular

   Four hours after coronary artery bypass surgery, a patient's heart rate rises to 128/min and blood pressure falls to 80/58 mm Hg, dropping further with each inspiration. Central venous pressure has climbed from 8 to 17 mm Hg, the neck veins are distended, heart sounds are faint, and the lungs are clear. Which complication do these findings most suggest?

   • a.Vasodilation during rewarming
   • b.Cardiac tamponade
   • c.Left ventricular failure
   • d.Hypovolemia from third spacing

   Answer: b

   Explanation: Hypotension with distended neck veins, a rising CVP, faint heart sounds and a blood pressure that falls on inspiration is the picture of fluid compressing the heart; MedlinePlus lists heart surgery as a cause of cardiac tamponade and these as its exam findings. Hypovolemia and rewarming vasodilation both lower the CVP rather than raise it. Left ventricular failure would be expected to bring pulmonary congestion, but the lungs are clear.

2. 2. Cardiovascular

   A 76-year-old woman with diabetes, admitted for pneumonia, reports new fatigue and shortness of breath but denies chest pain. What should the nurse do first?

   • a.Obtain a 12-lead ECG
   • b.Give the ordered PRN anxiolytic
   • c.Request an outpatient stress test
   • d.Walk her in the hall to assess tolerance

   Answer: a

   Explanation: MedlinePlus notes that older adults, people with diabetes and women may have little or no chest pain during a heart attack and may instead have shortness of breath, fatigue and weakness, so an ECG is the first step to look for ischemia. Walking her adds myocardial demand before ischemia is excluded. An anxiolytic masks the symptom, and an outpatient test delays evaluation of a possible acute event.

3. 3. Respiratory

   A patient with heart failure wakes up acutely short of breath, coughing pink frothy sputum, with crackles to the apices. What should the nurse do first?

   • a.Sit the patient upright and give oxygen
   • b.Start a 500 mL normal saline bolus
   • c.Lay the patient flat and elevate the legs
   • d.Walk the patient to help clear secretions

   Answer: a

   Explanation: Acute pulmonary edema fills the alveoli with fluid; MedlinePlus lists oxygen and diuretics as treatment, and sitting upright relieves the orthopnea described. Lying flat with the legs raised increases venous return to a congested heart. A saline bolus adds volume, and exertion raises oxygen demand in a patient who cannot oxygenate.

4. 4. Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary

   A patient who took prednisone for years stopped it abruptly a week ago. The patient is now confused, hypotensive, hypoglycemic and vomiting. Which treatment is the priority?

   • a.IV hydrocortisone
   • b.IV levothyroxine
   • c.IV regular insulin
   • d.IV fludrocortisone

   Answer: a

   Explanation: Stopping long-term glucocorticoids suddenly is a listed cause of acute adrenal crisis, which presents with low blood pressure, low blood sugar, vomiting and confusion; MedlinePlus says hydrocortisone must be given right away IV or IM, with fluids for hypotension. Levothyroxine treats hypothyroidism. Insulin would worsen the hypoglycemia. Fludrocortisone is an oral mineralocorticoid, not an IV emergency treatment.

5. 5. Endocrine, Hematology/Immunology, GI, Renal/GU, Integumentary

   A patient presents with severe epigastric pain radiating to the back. Which laboratory result is the more specific indicator of acute pancreatitis?

   • a.Serum lipase
   • b.Serum bilirubin
   • c.Serum amylase
   • d.Alkaline phosphatase

   Answer: a

   Explanation: MedlinePlus states that an increased serum lipase is a more specific indicator of pancreatitis than amylase. Bilirubin and alkaline phosphatase can rise with biliary obstruction, which may accompany gallstone pancreatitis, but they do not measure pancreatic injury.

6. 6. Musculoskeletal, Neurological, Behavioral/Psychosocial

   A patient with severe traumatic brain injury has a mean arterial pressure of 72 mm Hg and an intracranial pressure of 26 mm Hg. What is the cerebral perfusion pressure, and how does it compare with the SIBICC threshold?

   • a.72 mm Hg, above the 60 mm Hg minimum
   • b.46 mm Hg, below the 60 mm Hg minimum
   • c.98 mm Hg, above the 90 mm Hg maximum
   • d.46 mm Hg, within the 40–70 mm Hg goal

   Answer: b

   Explanation: Cerebral perfusion pressure is MAP minus ICP: 72 − 26 = 46 mm Hg. SIBICC adopted the Brain Trauma Foundation thresholds of ICP 22 mm Hg and a minimum CPP of 60 mm Hg, so this patient's ICP is high and CPP is too low. Adding the values gives 98, which is wrong, and 72 is simply the MAP. SIBICC does not endorse a 40–70 goal.

7. 7. Musculoskeletal, Neurological, Behavioral/Psychosocial

   A 79-year-old in the ICU after surgery is oriented in the morning but agitated and picking at lines each evening. Which intervention should the nurse try first?

   • a.Keep room lights on all night for closer observation
   • b.Reorient with clock, calendar, glasses and day–night lighting
   • c.Apply bilateral soft wrist restraints every evening
   • d.Add a scheduled benzodiazepine dose at bedtime each night

   Answer: b

   Explanation: MedlinePlus lists reality orientation, clocks, calendars, lighting that marks day and night, and hearing aids or glasses as helpful treatments for delirium, and notes that avoiding or minimizing sedatives lowers risk. A scheduled benzodiazepine can worsen delirium, restraints are not a first-line treatment, and constant light disrupts the day–night cycle.

8. 8. Multisystem

   A hospital is choosing a screening tool to identify acutely ill ward patients at risk of sepsis. Which approach does the Surviving Sepsis Campaign 2026 guideline recommend?

   • a.NEWS, NEWS2, MEWS or SIRS rather than qSOFA
   • b.Screening only after cultures return positive
   • c.qSOFA as the single screening tool
   • d.Lactate testing only when hypotension appears

   Answer: a

   Explanation: The 2026 guideline recommends using NEWS, NEWS2, MEWS or SIRS over qSOFA for acutely ill hospital patients, because qSOFA used alone misses many patients. Waiting for hypotension or positive cultures defeats the purpose of early screening.

9. 9. Multisystem

   The daughter of an ICU patient with advanced heart failure asks whether accepting palliative care means stopping all treatment for the heart. Which reply is accurate?

   • a.Palliative care requires a do-not-resuscitate order
   • b.Palliative care can be given alongside disease treatment
   • c.Palliative care begins only after all treatment has stopped
   • d.Palliative care is reserved for the final days of a person's life

   Answer: b

   Explanation: The National Institute on Aging explains that palliative care can begin as early as diagnosis and can occur alongside other treatment for the disease; hospice is the form used when disease-directed treatment is stopped. It is not limited to the final days, and it does not require a DNR order.

10. 10. Professional Caring and Ethical Practice

    A nurse is calling a provider about a deteriorating patient using SBAR. Which statement belongs in the Assessment part?

    • a."I think she is developing sepsis."
    • b."She is 68 and was admitted with pneumonia."
    • c."Please come and see her within 15 minutes."
    • d."Her blood pressure is now 84/46 mm Hg."

    Answer: a

    Explanation: In AHRQ's TeamSTEPPS SBAR, Assessment is what the person communicating thinks the problem is. The patient's age and admitting diagnosis belong to Background, the request to come within 15 minutes is the Recommendation or Request, and the current blood pressure describes the Situation.