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Kaplan Critical Care Integrated Exam |
Questions 1–200 :Advanced / Hard Level |
Critical Care Nurses & Nursing Students Target
| 100% Pass Guaranteed | Graded A+
1 A 68-year-old male is admitted to the ICU with septic shock. He is intubated and sedated. His
blood pressure is 85/50 mmHg, heart rate 120 bpm, and central venous pressure (CVP) is 4
mmHg. Which of the following is the MOST appropriate initial fluid resuscitation strategy?
A. 500 mL bolus of 0.9% normal saline over 15 minutes
B. 30 mL/kg crystalloid bolus
C. 500 mL of 5% albumin over 30 minutes
D. Initiate norepinephrine before fluid resuscitation
Correct Answer: B
Explanation: The Surviving Sepsis Campaign guidelines recommend initial fluid resuscitation
with 30 mL/kg of crystalloid (normal saline or balanced crystalloid) for sepsis-induced
hypoperfusion. A 500 mL bolus (A) is insufficient. Albumin (C) may be used but crystalloids are
first-line. Vasopressors (D) should be initiated if fluid resuscitation fails to restore perfusion.
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2 A 55-year-old male is 2 hours post-cardiac arrest. He is receiving targeted temperature
management (TTM). The nurse notes the patient's temperature is 34.0°C. Which of the
following is a potential complication of TTM that the nurse should monitor for?
A. Hyperglycemia
B. Seizures
C. Cardiac arrhythmias
D. All of the above
Correct Answer: D
Explanation: Targeted temperature management (TTM) is associated with several
complications, including hyperglycemia (due to insulin resistance), seizures, and cardiac
arrhythmias (including bradycardia and hypotension). Electrolyte imbalances and coagulopathy
are also potential complications. The nurse should monitor for all of these.
3 A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with a
tidal volume of 6 mL/kg of ideal body weight. The plateau pressure is 32 cm H₂O. Which of the
following is the MOST appropriate intervention?
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A. Increase the tidal volume to 8 mL/kg
B. Decrease the PEEP
C. Consider neuromuscular blockade
D. Initiate prone positioning
Correct Answer: C
Explanation: In ARDS, lung-protective ventilation aims for plateau pressures < 30 cm H₂O. A
plateau pressure of 32 cm H₂O suggests elevated alveolar pressure. Neuromuscular blockade
may be considered to improve chest wall compliance and allow for lower plateau pressures.
Increasing tidal volume (A) would worsen lung injury. Decreasing PEEP (B) may worsen
oxygenation. Prone positioning (D) is used for oxygenation but does not directly address plateau
pressure.
4 A 72-year-old female with a history of heart failure presents with acute pulmonary edema.
She is on BiPAP with an FiO₂ of 0.8. Which of the following is the MOST appropriate initial
pharmacologic intervention?
A. IV furosemide
B. IV morphine
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C. Sublingual nitroglycerin
D. IV dobutamine
Correct Answer: A
Explanation: In acute pulmonary edema, IV loop diuretics (furosemide) are first-line to reduce
preload and relieve pulmonary congestion. Morphine (B) may be used for anxiety but is not first-
line. Nitroglycerin (C) can be used to reduce preload but is often used after furosemide.
Dobutamine (D) is for cardiogenic shock with reduced cardiac output.
5 A patient is receiving a norepinephrine infusion at 15 mcg/min. The nurse notes that the
patient's blood pressure is 110/70 mmHg, heart rate is 90 bpm, and the patient is awake and
alert. The nurse notices blanching of the skin on the patient's left hand where the IV is located.
Which of the following is the priority nursing action?
A. Increase the rate of the norepinephrine infusion
B. Decrease the rate of the norepinephrine infusion
C. Assess the IV site for infiltration
D. Administer phentolamine
Kaplan Critical Care Integrated Exam |
Questions 1–200 :Advanced / Hard Level |
Critical Care Nurses & Nursing Students Target
| 100% Pass Guaranteed | Graded A+
1 A 68-year-old male is admitted to the ICU with septic shock. He is intubated and sedated. His
blood pressure is 85/50 mmHg, heart rate 120 bpm, and central venous pressure (CVP) is 4
mmHg. Which of the following is the MOST appropriate initial fluid resuscitation strategy?
A. 500 mL bolus of 0.9% normal saline over 15 minutes
B. 30 mL/kg crystalloid bolus
C. 500 mL of 5% albumin over 30 minutes
D. Initiate norepinephrine before fluid resuscitation
Correct Answer: B
Explanation: The Surviving Sepsis Campaign guidelines recommend initial fluid resuscitation
with 30 mL/kg of crystalloid (normal saline or balanced crystalloid) for sepsis-induced
hypoperfusion. A 500 mL bolus (A) is insufficient. Albumin (C) may be used but crystalloids are
first-line. Vasopressors (D) should be initiated if fluid resuscitation fails to restore perfusion.
,2
2 A 55-year-old male is 2 hours post-cardiac arrest. He is receiving targeted temperature
management (TTM). The nurse notes the patient's temperature is 34.0°C. Which of the
following is a potential complication of TTM that the nurse should monitor for?
A. Hyperglycemia
B. Seizures
C. Cardiac arrhythmias
D. All of the above
Correct Answer: D
Explanation: Targeted temperature management (TTM) is associated with several
complications, including hyperglycemia (due to insulin resistance), seizures, and cardiac
arrhythmias (including bradycardia and hypotension). Electrolyte imbalances and coagulopathy
are also potential complications. The nurse should monitor for all of these.
3 A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with a
tidal volume of 6 mL/kg of ideal body weight. The plateau pressure is 32 cm H₂O. Which of the
following is the MOST appropriate intervention?
,3
A. Increase the tidal volume to 8 mL/kg
B. Decrease the PEEP
C. Consider neuromuscular blockade
D. Initiate prone positioning
Correct Answer: C
Explanation: In ARDS, lung-protective ventilation aims for plateau pressures < 30 cm H₂O. A
plateau pressure of 32 cm H₂O suggests elevated alveolar pressure. Neuromuscular blockade
may be considered to improve chest wall compliance and allow for lower plateau pressures.
Increasing tidal volume (A) would worsen lung injury. Decreasing PEEP (B) may worsen
oxygenation. Prone positioning (D) is used for oxygenation but does not directly address plateau
pressure.
4 A 72-year-old female with a history of heart failure presents with acute pulmonary edema.
She is on BiPAP with an FiO₂ of 0.8. Which of the following is the MOST appropriate initial
pharmacologic intervention?
A. IV furosemide
B. IV morphine
, 4
C. Sublingual nitroglycerin
D. IV dobutamine
Correct Answer: A
Explanation: In acute pulmonary edema, IV loop diuretics (furosemide) are first-line to reduce
preload and relieve pulmonary congestion. Morphine (B) may be used for anxiety but is not first-
line. Nitroglycerin (C) can be used to reduce preload but is often used after furosemide.
Dobutamine (D) is for cardiogenic shock with reduced cardiac output.
5 A patient is receiving a norepinephrine infusion at 15 mcg/min. The nurse notes that the
patient's blood pressure is 110/70 mmHg, heart rate is 90 bpm, and the patient is awake and
alert. The nurse notices blanching of the skin on the patient's left hand where the IV is located.
Which of the following is the priority nursing action?
A. Increase the rate of the norepinephrine infusion
B. Decrease the rate of the norepinephrine infusion
C. Assess the IV site for infiltration
D. Administer phentolamine
