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KAPLAN CRITICAL CARE INTEGRATED EXAM
Comprehensive Practice Questions Advanced/Hard
Difficulty Level Target Audience: Nursing
Students/Professionals
Question 1
A patient with severe ARDS is on mechanical ventilation with PEEP of 15 cm H₂O. The nurse
notices a sudden drop in blood pressure from 110/70 to 82/50 mmHg and decreased breath
sounds on the right side. What is the priority intervention?
A. Administer IV bolus of normal saline
B. Notify the provider immediately for possible chest tube insertion
C. Increase the PEEP to 18 cm H₂O
D. Place the patient in high Fowler's position
Correct Answer: B
Explanation: The sudden hypotension and decreased breath sounds suggest tension
pneumothorax, a life-threatening complication of high PEEP mechanical ventilation. This
requires immediate provider notification for chest tube insertion. Fluid bolus won't address the
,2
underlying problem, increasing PEEP would worsen the pneumothorax, and positioning doesn't
treat the tension pneumothorax .
Question 2
Which hemodynamic parameter is most indicative of left ventricular preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP)
C. Systemic vascular resistance (SVR)
D. Cardiac output (CO)
Correct Answer: B
Explanation: PAWP (also called pulmonary capillary wedge pressure) reflects left ventricular
preload by measuring pressure in the left atrium when the pulmonary artery catheter balloon is
inflated. CVP reflects right ventricular preload, SVR measures afterload, and cardiac output
measures the volume of blood pumped per minute .
Question 3
A patient with septic shock has a lactate level of 5.2 mmol/L. What is the significance of this
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finding?
A. Indicates adequate tissue perfusion
B. Suggests cellular hypoxia and anaerobic metabolism
C. Confirms renal failure
D. Indicates overhydration
Correct Answer: B
Explanation: Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and anaerobic
metabolism due to inadequate oxygen delivery. In septic shock, this reflects cellular hypoxia
despite potentially normal blood pressure. It does not indicate adequate perfusion, renal failure
specifically, or overhydration .
Question 4
Which dysrhythmia requires immediate defibrillation?
A. Atrial fibrillation with rapid ventricular response
B. Pulseless ventricular tachycardia
C. Sinus tachycardia
D. First-degree heart block
, 4
Correct Answer: B
Explanation: Pulseless ventricular tachycardia is a shockable rhythm requiring immediate
defibrillation per ACLS guidelines. Stable atrial fibrillation, sinus tachycardia, and first-degree
heart block are not life-threatening and do not require defibrillation .
Question 5
A patient in the ICU presents with blood pressure 78/40 mmHg, heart rate 128 bpm, and cool
clammy skin after a massive myocardial infarction. Which type of shock is most likely?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Hypovolemic shock
Correct Answer: C
Explanation: Cardiogenic shock occurs when the heart cannot pump adequately, typically after
massive MI. The classic presentation includes hypotension, tachycardia, and cool clammy skin
due to poor perfusion. Septic shock presents with warm skin early; neurogenic shock has
bradycardia; hypovolemic shock shows different history .
KAPLAN CRITICAL CARE INTEGRATED EXAM
Comprehensive Practice Questions Advanced/Hard
Difficulty Level Target Audience: Nursing
Students/Professionals
Question 1
A patient with severe ARDS is on mechanical ventilation with PEEP of 15 cm H₂O. The nurse
notices a sudden drop in blood pressure from 110/70 to 82/50 mmHg and decreased breath
sounds on the right side. What is the priority intervention?
A. Administer IV bolus of normal saline
B. Notify the provider immediately for possible chest tube insertion
C. Increase the PEEP to 18 cm H₂O
D. Place the patient in high Fowler's position
Correct Answer: B
Explanation: The sudden hypotension and decreased breath sounds suggest tension
pneumothorax, a life-threatening complication of high PEEP mechanical ventilation. This
requires immediate provider notification for chest tube insertion. Fluid bolus won't address the
,2
underlying problem, increasing PEEP would worsen the pneumothorax, and positioning doesn't
treat the tension pneumothorax .
Question 2
Which hemodynamic parameter is most indicative of left ventricular preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP)
C. Systemic vascular resistance (SVR)
D. Cardiac output (CO)
Correct Answer: B
Explanation: PAWP (also called pulmonary capillary wedge pressure) reflects left ventricular
preload by measuring pressure in the left atrium when the pulmonary artery catheter balloon is
inflated. CVP reflects right ventricular preload, SVR measures afterload, and cardiac output
measures the volume of blood pumped per minute .
Question 3
A patient with septic shock has a lactate level of 5.2 mmol/L. What is the significance of this
,3
finding?
A. Indicates adequate tissue perfusion
B. Suggests cellular hypoxia and anaerobic metabolism
C. Confirms renal failure
D. Indicates overhydration
Correct Answer: B
Explanation: Elevated lactate (>2 mmol/L) indicates tissue hypoperfusion and anaerobic
metabolism due to inadequate oxygen delivery. In septic shock, this reflects cellular hypoxia
despite potentially normal blood pressure. It does not indicate adequate perfusion, renal failure
specifically, or overhydration .
Question 4
Which dysrhythmia requires immediate defibrillation?
A. Atrial fibrillation with rapid ventricular response
B. Pulseless ventricular tachycardia
C. Sinus tachycardia
D. First-degree heart block
, 4
Correct Answer: B
Explanation: Pulseless ventricular tachycardia is a shockable rhythm requiring immediate
defibrillation per ACLS guidelines. Stable atrial fibrillation, sinus tachycardia, and first-degree
heart block are not life-threatening and do not require defibrillation .
Question 5
A patient in the ICU presents with blood pressure 78/40 mmHg, heart rate 128 bpm, and cool
clammy skin after a massive myocardial infarction. Which type of shock is most likely?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Hypovolemic shock
Correct Answer: C
Explanation: Cardiogenic shock occurs when the heart cannot pump adequately, typically after
massive MI. The classic presentation includes hypotension, tachycardia, and cool clammy skin
due to poor perfusion. Septic shock presents with warm skin early; neurogenic shock has
bradycardia; hypovolemic shock shows different history .
