ADVANCED MED-SURG AND CRITICAL
CARE EXAM QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE. JUST RELEASED
1. A patient with ARDS is on mechanical ventilation with a PEEP of 15 cm H2O. Which
assessment finding most urgently requires intervention?
A. SpO2 of 92% on FiO2 60%
B. Plateau pressure of 25 cm H2O
C. Blood pressure drop from 120/80 to 90/60 mmHg
D. Respiratory rate of 24 breaths per minute
Answer: C
Conceptual Explanation: High PEEP levels increase intrathoracic pressure, which can
decrease venous return and cardiac output, leading to hypotension.
2. In the hypermetabolic phase of a major burn injury, which nutritional strategy is
prioritized?
A. High-protein, high-calorie diet via enteral route
,B. Low-calorie, high-fiber diet
C. Fluid restriction to prevent edema
D. Exclusive use of Total Parenteral Nutrition (TPN)
Answer: A
Conceptual Explanation: Hypermetabolism after burns requires significant protein and
caloric intake to support healing and prevent muscle wasting; enteral nutrition is preferred
to maintain gut integrity.
3. A patient’s hemodynamic monitor shows a Pulmonary Artery Occlusion Pressure (PAOP) of
22 mmHg. Which condition is most consistent with this finding?
A. Hypovolemic shock
B. Left-sided heart failure
C. Septic shock
D. Right-sided heart failure
Answer: B
Conceptual Explanation: Normal PAOP is 8-12 mmHg. An elevated PAOP (22 mmHg)
indicates increased pressure in the left atrium and ventricle, typical of left heart failure or
fluid overload.
4. Which clinical manifestation is a hallmark sign of the compensatory stage of shock?
A. Refractory hypotension
, B. Narrowing pulse pressure and cool, clammy skin
C. Metabolic acidosis and anuria
D. Decreased level of consciousness and bradycardia
Answer: B
Conceptual Explanation: During compensation, the body uses the SNS to maintain
perfusion, leading to tachycardia, vasoconstriction (cool skin), and a narrowing pulse
pressure.
5. A patient with a head injury has a GCS of 7, BP 160/60, and HR 45. Which intervention is
the priority?
A. Administering a bolus of IV Heparin
B. Starting a Nicardipine drip to lower blood pressure
C. Preparation for immediate endotracheal intubation
D. Placing the patient in Trendelenburg position
Answer: C
Conceptual Explanation: A GCS of 8 or less indicates a need for airway protection
(intubation). Furthermore, Cushing’s triad (widened pulse pressure/bradycardia) suggests
increased ICP.
CARE EXAM QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE. JUST RELEASED
1. A patient with ARDS is on mechanical ventilation with a PEEP of 15 cm H2O. Which
assessment finding most urgently requires intervention?
A. SpO2 of 92% on FiO2 60%
B. Plateau pressure of 25 cm H2O
C. Blood pressure drop from 120/80 to 90/60 mmHg
D. Respiratory rate of 24 breaths per minute
Answer: C
Conceptual Explanation: High PEEP levels increase intrathoracic pressure, which can
decrease venous return and cardiac output, leading to hypotension.
2. In the hypermetabolic phase of a major burn injury, which nutritional strategy is
prioritized?
A. High-protein, high-calorie diet via enteral route
,B. Low-calorie, high-fiber diet
C. Fluid restriction to prevent edema
D. Exclusive use of Total Parenteral Nutrition (TPN)
Answer: A
Conceptual Explanation: Hypermetabolism after burns requires significant protein and
caloric intake to support healing and prevent muscle wasting; enteral nutrition is preferred
to maintain gut integrity.
3. A patient’s hemodynamic monitor shows a Pulmonary Artery Occlusion Pressure (PAOP) of
22 mmHg. Which condition is most consistent with this finding?
A. Hypovolemic shock
B. Left-sided heart failure
C. Septic shock
D. Right-sided heart failure
Answer: B
Conceptual Explanation: Normal PAOP is 8-12 mmHg. An elevated PAOP (22 mmHg)
indicates increased pressure in the left atrium and ventricle, typical of left heart failure or
fluid overload.
4. Which clinical manifestation is a hallmark sign of the compensatory stage of shock?
A. Refractory hypotension
, B. Narrowing pulse pressure and cool, clammy skin
C. Metabolic acidosis and anuria
D. Decreased level of consciousness and bradycardia
Answer: B
Conceptual Explanation: During compensation, the body uses the SNS to maintain
perfusion, leading to tachycardia, vasoconstriction (cool skin), and a narrowing pulse
pressure.
5. A patient with a head injury has a GCS of 7, BP 160/60, and HR 45. Which intervention is
the priority?
A. Administering a bolus of IV Heparin
B. Starting a Nicardipine drip to lower blood pressure
C. Preparation for immediate endotracheal intubation
D. Placing the patient in Trendelenburg position
Answer: C
Conceptual Explanation: A GCS of 8 or less indicates a need for airway protection
(intubation). Furthermore, Cushing’s triad (widened pulse pressure/bradycardia) suggests
increased ICP.
