Critical Care Exam Elaboration *Q&A* (100% Correct) 2025/2026 |VERIFIED|

Critical Care Exam Elaboration *Q&A* (100% Correct) 2025/2026 |VERIFIED| 1. A patient in the ICU presents with acute respiratory distress syndrome (ARDS). Which of the following is the most appropriate initial ventilatory strategy? A. Low tidal volume ventilation B. High tidal volume ventilation C. Non-invasive positive pressure ventilation D. Continuous positive airway pressure (CPAP) 2. In managing septic shock, what is the primary goal of administering fluids? A. To increase cardiac afterload B. To correct electrolyte imbalances C. To restore adequate tissue perfusion D. To reduce oxygen consumption 3. What is the recommended target blood glucose range for critically ill patients in the ICU? A. 140-180 mg/dL B. 70-110 mg/dL C. 90-120 mg/dL D. 180-220 mg/dL 4. Which of the following is most indicative of cardiogenic shock? A. Increased cardiac output and low central venous pressure B. Low cardiac output with high systemic vascular resistance C. Decreased systemic vascular resistance with high cardiac output D. Normal cardiac output with low systemic vascular resistance 1 5. A patient with traumatic brain injury has an intracranial pressure (ICP) of 28 mmHg. What is the primary intervention? A. Fluid restriction B. Rapid sequence intubation C. Administration of diuretics D. Hypertonic saline infusion 6. During continuous renal replacement therapy (CRRT), which electrolyte abnormality is most common? A. Hypernatremia B. Hypercalcemia C. Hypomagnesemia D. Hypokalemia 7. Which vasopressor is recommended as the first-line agent in septic shock? A. Epinephrine B. Dopamine C. Norepinephrine D. Vasopressin 8. A patient is receiving mechanical ventilation and develops auto-PEEP. What is the most appropriate corrective action? A. Increase tidal volume B. Decrease inspiratory time C. Increase respiratory rate D. Add external PEEP 9. The preferred diagnostic tool for identifying pulmonary embolism in a critically ill patient is: A. CT pulmonary angiography B. Chest X-ray 2 C. D-dimer assay D. Ventilation-perfusion (V/Q) scan 10. Which parameter is most reliable for assessing tissue perfusion in septic shock? A. Blood pressure B. Central venous oxygen saturation C. Heart rate D. Serum lactate levels 11. A critically ill patient has hyperkalemia with ECG changes. What is the most urgent initial treatment? A. Sodium bicarbonate B. Furosemide C. Calcium gluconate D. Insulin and dextrose 12. What is the primary mechanism of action of dexmedetomidine in ICU sedation? A. Alpha-2 adrenergic agonist B. NMDA receptor antagonist C. GABA receptor agonist D. Dopamine receptor antagonist 13. Which condition is most likely to result in non-cardiogenic pulmonary edema? A. Acute myocardial infarction B. Acute respiratory distress syndrome (ARDS) C. Left ventricular failure D. Pulmonary hypertension 14. In acute liver failure, which clinical finding is most predictive of poor prognosis? 3 A. Elevated ALT/AST levels B. High INR C. Increased serum albumin D. Hyperkalemia 15. A patient with septic shock is found to have ScvO2 70%. What is the next best step? A. Increase fluid administration B. Initiate inotropes C. Add vasopressors D. Decrease mechanical ventilation 16. The primary reason for monitoring plateau pressure in mechanically ventilated patients is to: A. Evaluate lung compliance B. Determine tidal volume settings C. Predict oxygenation levels D. Prevent hypoventilation 17. Which of the following is the most significant risk factor for ICU-acquired delirium? A. Sedation with benzodiazepines B. Advanced age C. Use of corticosteroids D. Hypernatremia 18. The preferred anticoagulant for preventing deep vein thrombosis (DVT) in critically ill patients is: A. Aspirin B. Low-molecular-weight heparin C. Warfarin D. Unfractionated heparin 4 19. Which electrolyte imbalance is most associated with prolonged QT interval? A. Hypernatremia B. Hypokalemia C. Hypercalcemia D. Hypomagnesemia 20. What is the most appropriate treatment for a critically ill patient with a hemoglobin of 6 g/dL? A. Vitamin B12 injection B. Iron supplementation C. Packed red blood cell transfusion D. Recombinant erythropoietin 21. Which of the following medications is most likely to cause propofol infusion syndrome? A. Lorazepam B. Midazolam C. Propofol D. Ketamine 22. A patient on mechanical ventilation has a PaO2/FiO2 ratio of 90. This indicates: A. Mild ARDS B. Severe ARDS C. Moderate ARDS D. Normal oxygenation 23. Which factor is most predictive of a poor outcome in a patient with acute pancreatitis? A. Serum lipase levels B. Persistent organ failure 5 C. Hypercalcemia D. Epigastric pain severity 24. The most appropriate intervention for a patient with a suspected tension pneumothorax is: A. Chest X-ray B. Needle decompression C. CT scan of the chest D. Initiation of mechanical ventilation 25. A critically ill patient develops disseminated intravascular coagulation (DIC). The most appropriate initial treatment is: A. Platelet transfusion B. Addressing the underlying cause C. Heparin infusion D. Vitamin K administration 26. Which of the following medications is the best choice for rapid sedation in an agitated, mechanically ventilated patient? A. Lorazepam B. Propofol C. Midazolam D. Dexmedetomidine 27. A patient presents with metabolic acidosis and an elevated anion gap. Which of the following conditions is most likely? A. Chronic obstructive pulmonary disease (COPD) B. Hypokalemia C. Diabetic ketoacidosis (DKA) D. Acute hyperventilation 6 28. Which of the following is the most sensitive biomarker for acute kidney injury (AKI)? A. Serum creatinine B. Neutrophil gelatinase-associated lipocalin (NGAL) C. Blood urea nitrogen (BUN) D. Urine osmolality 29. What is the primary indication for extracorporeal membrane oxygenation (ECMO) in critically ill patients? A. Septic shock B. Severe refractory hypoxemia C. Acute kidney injury D. Myocardial infarction 30. A critically ill patient has a sudden drop in end-tidal CO2 during CPR. This most likely indicates: A. Hyperventilation B. Cardiac arrest C. Equipment malfunction D. Severe hypoxia You have just received change of shift report. Which patient should you assess first? a. 62 year-old man who is scheduled for a cardiac cath, and is ready to be transported now b. 58 year-old woman with COPD with an O2 saturation of 92% on 2 liters of O2, who is scheduled to be discharged home on O2 c. 36 year-old man admitted with an exacerbation of asthma with RR 36 at rest, and whose wheezing has diminished d. 72 year-old woman with history of asthma with HR 90 and is due for her beta-blocker RR 36 and diminished wheezing indicative of respiratory distress and needs prompt attention C You are about to handover patient care to your on-coming nurse colleague. Which patient requires the most immediate attention? 7 1.) 62 year-old man with COPD who has just completed his scheduled bronchodilator 2.) 68 year-old woman with type 2 diabetes who had CVA 2 days ago 3.) 72 year-old woman with history of asthma with HR 90 and is due for her beta-blocker 4.) 48 year-old man admitted with cellulitis of his right hand after a construction accident, currently on IV antibiotics, with a temperature of 101.8 4 Cellulitis is serious infection, involving swelling of subcutaneous tissue, fluid displacement due to 3rd spacing. What else would you assess? You are assigned to care for a 58 year-old man who is scheduled for a cardiac angiogram during your shift. What actions should you take? Check all that apply. 1-Explain that the patient will receive short-acting anesthesia 2-Review the patient's allergies, specifically checking to see if he has an allergy to contrast dye 3-Inform the patient that his wife should stay at home until the procedure is finished, as family members often distract the team in the cath lab 4-Review and reconcile his medications. Confirm that he did not take his warfarin 5-Check the patient's most recent labs paying particular attention to the PT INR 2, 4, 5 Contrast dyes contain iodine and allergy could lead to anaphylactic response; might receive light sedation but needs to be awake and able to follow directions A 62 year-old man, who is s/p coronary artery bypass surgery, is about to be transferred from the ICU to the cardiac stepdown unit. What is the most effective way for the ICU (reporting) nurse and cardiac stepdown (receiving) nurse to ensure that essential patient information is conveyed? 1- A face-to-face verbal report with both nurses present in a quiet room 2- The ICU nurse will provide an audio-recorded report for future reference and documentation 3- The ICU nurse will document essential transfer information in the patient's medical record 4- The ICU nurse will accompany the patient to the stepdown unit and provide a face-to-face report, using a unit-approved, standardized guide 4 What is the most common outcome associated with poorly managed hospital discharge? Drug events Adverse 8 The nurse is tracking data on a group of patients with heart failure, who have been discharged from the unit where you work and are now being followed in clinic. What is the best indicator that the nursing interventions of monitoring and teaching have been effective? 1- Eighty-five percent of patients have not gained weight 2- Seventy-five percent of family caregivers have reported watching an educational DVD 3- Five percent of patients have been readmitted to the hospital in the last 90 days 4- Eighty percent report that they are taking their medications 3 All are important but lower resource utilization is best indicator and one used by accrediting agencies, payors, etc. You are the nurse preparing to discharge a 46 year-old man with hypertension who was started on chlorothiazide. You ask the patient to share with you his understanding of his new medication. Which of the following statements indicates your teaching has been effective? Select all that apply. 1- I will weigh myself every day at the same time. 2- I will notify Charles, the nurse practitioner in my primary care doctor's office if I gain 3 pounds or more, have increased swelling in my feet and ankles, or feel more tired than usual. 3- I will reduce my medication if I feel very thirsty or dizzy. 4- I will wear sunscreen if I will be out in the sun for a long period of time. 5- If I want to drink alcohol, I will wait and take my medication right before I go to bed. The following should NOT be used to reduce pressure, as it may increase friction injuries: A) rolled towels B) convoluted foam mattress overlay C) foam pads D) viscoelastic overlay A 1, 2, 4 Rolled towels and sheets should not be used and may negate pressure-reducing function of other pads The MOST common cause of delayed surgical wound healing is: A) diabetes B) surgical site infection C) malnutrition 9 D) impaired circulation B Purlent discharge, signs of infection, open wound. Can occur 30 days up to 1 year post op An adult Jehovah's' Witness patient is hemorrhaging and might die without transfusions, but he refused blood products prior to surgery. The correct procedure is? A) use volume replacement and fractionated blood cells only, as permitted by the religion B) contact family and ask permission C) ask legal authorities to grant permission D) give transfusions because the patient may die ANSWER: A This patients religion only permits fractions from red cells, white cells, platelets, and plasma. Some JW request no blood products at all The nurse is taking care of Ms. Smith. She is a 85 year old with severe congestive heart failure and has history of severe dementia and CVA. She has had multiple admissions for CHF exacerbation. Despite aggressive treatment, she remains dyspneic and is requiring high flow oxygen at 10L. During rounds, the team discusses sending the patient to the ICU due to her probable need for mechanical ventilation. As the nurse you are concerned that this plan of care is inappropriate, what is the best action? A. Discuss the concern with the physician and treatment team and recommend consultation with palliative care B. Call the patient's proxy and schedule a meeting with the physician C. Initiate an ethics consult immediately D. Communicate the concerns to the oncoming nurse during hand off of care A Jill Green is a 42-year-old mother of two who has been married for 17 years. She was diagnosed with ovarian cancer 2 years ago. After the initial diagnosis Jill had a total hysterectomy. For the last 2 years she has undergone intensive chemotherapy and radiation. Despite treatment, the ovarian cancer progressed to the late stage and metastasized to the lungs and bones. After collaborating with her healthcare providers, Jill has decided to pursue palliative care with a focus on comfort care.The home hospice RN is assigned to manage Jill's care. During the initial evaluation, the RN establishes a plan of care. Which problem should the nurse address first? 10 A. The client's bowel and urination elimination pattern, the priority concern of the health care provider. B. The problem that the client identifies as the first priority, the problem that most concerns the client. C. The client's need for help with hygienic activit B When Jill is awake, she often seems restless and begins to pull and pick at the bed linen. Jill's sister has concerns about managing her restlessness at home. She asks the nurse if there are non-pharmacological interventions that their family can try. Which interventions for restlessness should the RN encourage Jill's family to try? A. Keep the lights in Jill's room dimmed. B. Read a favorite poem or passage aloud. C. Apply restraints to prevent injury D. Gently rub back or stroke arms E. Play soothing music F. Avoid talking when at the bedside. A, B, D, E Jill says that she felt like she was stamped with an "expiration date" when her physician told her she had 4-6 months to live. She explains to Stacy that she feels overwhelmed because there is so much she still wants to teach her children before she dies. Which intervention should the nurse implement? A. Urge the client not to give up hope because a curse is always a possibility. B. Encourage the client to focus on herself for now and to try not to worry about the children. C. Ask the client if she is interested in having a volunteer help her record her thoughts. D. Assure the client that her husband will be there for the children when she is not. C The nurse is managing the hospice care for the patient (Jill) and her family. Over the next 2 months Jill's physical condition deteriorates and she is unable to get out of bed. Her sister chooses to sleep in a recliner at her bedside. She explains to the nurse that Jill wakes up in the middle of the night in pain, but she is afraid that if she gives Jill pain medication then she might not wake up in the morning. How should the nurse respond to the sister's concerns? 11 A. It is impossible to overdose a client who is dying of cancer because they have built up a tolerance to the medication B. We can collaborate with the primary healthcare provider to try to find a dose of pain medication that works for Jill. C. It is very difficult for clients with terminal cancer to have all of their pain relieved, so Jill may have to endure pain during the night. D. You may give Jill pain medication anytime unless her respirations ar B According to the Institute of Medicine Report (IOM) in 2001 there are 6 core ingredients of high quality health care. Which of the following is (are) NOT on that list? (Check all that apply). A. Patient-centered care B. Highly specialized care delivered exclusively in specialty care clinics C. Care that emphasizes patient safety D. Efficiency E. Care provided exclusively by physician-led teams B, E According to Kitson et al., the following are common core elements of patient centered care (PCC) across health policy, medicine and nursing disciplines. (Check all that apply) A. Patient and family member involvement B. Policies and an environment that support PCC C. Requirement that all patients complete advance directives 12 D. Open, effective communication between patient and provider and among members of health care team E. A "zero tolerance" policy for deviations from established protocols, policies, and procedures B, D Kitson and colleagues concluded that although there was consensus around some facets of PCC, there were differences among the disciplines with respect to areas of focus on PCC. Which statement best summarizes the unique focus of nursing as it applies to PCC? A. Primary importance on the individual nurse-patient relationship A, B. Personal qualities such as politeness, being respectful, and having good manners, are more important than competence in delivering patient care C. Focus on the patient, not on the caregiver or family members D. Protecting the patient from interference by other disciplines E. The need for a systematic and comprehensive assessment of patient needs and respect for patient values and preferences E ased on the readings and your experience to-date, which of the following concepts are essential to patient-centered care planning? (Check all that apply) A. The nurse is the sole expert in the care planning process B. Respect and dignity are foundational to the care planning process; including honoring patient perspectives, values, beliefs, choices, cultural background C. Communication that is timely, transparent, accurate and complete among all members of the health care team 13 D. If patients are non-compliant with care recommendations it is always due to a knowledge deficit on their part E. The patient and family are essential members of the health care team and should be included in the assessment, planning, execution and evaluation of care B, C, E Which of the following are examples of transitions in care (TC)? (Check all that apply). A. Patient is admitted to the hospital from home B. Patient is transferred from the Cardiac Intensive Care Unit to a general medical floor within the same hospital C. Nursing change of shift D. Patient is discharged home E. Patient is transferred to a skilled nursing facility for rehab following a hip replacement. D, E Why has TC emerged as a high priority area in health care reform? A. Hospitals want to reduce the number of lawsuits B. Insurance companies are reluctant to advocate for safe, effective TC A, B, C, C. Effective management of TC has the potential to reduce the cost and improve the quality of health care D. Physician groups are advocating for the creation of a physician sub-specialty designed to manage TC C According to Coleman (2003), which of the following are components of effective TCs? (Check all that apply) 14 A. A detailed follow-up plan B. Effective written and oral communication among health care providers within and across settings C. Medication reconciliation D. Comprehensive patient/caregiver teaching/education E. Each care provider having his/her own specific care plan that addresses only their unique concerns for that patient A, B, C, D In order to manage TCs effectively which of the following are important to include in the teaching plan for the patient? (Check all that apply) A. Signs indicating that the patient's situation has deteriorated and warrants further intervention B. The names, roles, and contact information for who to contact for problems or concerns C. What to expect upon transfer, discharge, or next site of care D. Including family members and/or informal caregivers in the teaching plan E. Instructions for any follow-up care, such as lab work, tests or procedures, appointments ,D, E Which of the following are barriers to effective management of TCs? (Check all that apply) A. Frequent exclusion of patients and caregivers as participants in care planning B. Growing reliance of institution-based care providers A, B, C, 15 C. Lack of professional training in skills needed to effectively manage TCs D. Electronic medical records designed to be shared among various providers and care settings E. Lack of formal, standardized methods of communicating across care settings A, B, C, E Which of the following adverse events are associated with ineffective management of TCs? (Check all that apply). A. Higher hospital readmission rates B. Medication errors C. Failure of patient to seek attention for worsening condition D. Increased stress and burden on caregivers E. Decreased satisfaction among patients, caregivers or family members, and health care providers A, B, C, D, E Which of the following are potential adverse outcomes of ineffective nurse care handovers? Check all that apply. A. Delays in diagnosis B. Increased cost and length of stay C. Patient dissatisfaction D. Nurse's inability to appropriately anticipate future patient events E. Nursing care based on inaccurate or incomplete information A, B, C, D, E 16 The majority of adverse events during transitions of care (TCs) are related to which of the following issues? A. Family members refusal to be involved in patient care B. Ineffective communication and information among caregivers C. Inaccuracy of patient provided information D. Lack of willingness of disciplines to work collaboratively E. Insurance companies' reimbursement policies B According to Holly and Poletick, aside from conveying patient information what other purpose does shift report or intershift handover of care serve? Check all that apply. A. Provides nurses with opportunities to provide and receive support from colleagues B. Increases team cohesion by through social interactions that lead to shared values and development of a group identity C. Provides nurses an opportunity to gossip about other members of the health care team D. Provide a venue to orient new nurses to the unit culture E. Provide opportunities for nurses to develop workarounds of unit policies they don't like Which characteristics of patient care handovers or TCs were most consistently related to adverse outcomes? Check all that apply. A, B, D 17 A. Inconsistency in content included B. Lack of respect for the roles of other disciplines C. Unstructured format D. Including health care providers outside of nursing in information exchange E. Variability in patient health literacy levels A, C According to Ong et al., what challenges are unique to intrahospital transfers (versus intershift handover)? Check all that apply A. The coordination effort required in patient transportation B. The difficulty in sharing information across disciplines and departments C. Lack of standardization in the content and process of information sharing D. Lack of training on handover practices and communication skills E. Differences in expectations, expertise, work processes and culture among different units or departments A, B, E Which of the following interventions has been associated with decreases in adverse events associated with patient care handovers during intrahospital transfers? Check all that apply. A. Use of a dedicated ICU liaison nurse to facilitate transfers to and from the ICU setting 18 B. Having supervisors observe and evaluate in real time, nurses exchange information during patient care handovers C. Use of a specialized transport team for inter- and intrahospital transfers of critical care patients D. Mandating that all information exchange take place in electronic format only E. Having the referring team send a transfer form that must be filled out by the physician before the handover of care A, C Which of the following is the most frequent adverse event experienced by patients after hospital discharge? A. Falls B. Infection C. Medication error or adverse drug event D. Caregiver distress E. Change in primary care doctor C To promote effective TCs during discharge, The Joint Commission requires accredited facilities to do which of the following? A. Include at least one family member in all discharge teaching B. Substitute generic medications for name brands whenever possible 19 C. An evaluation of home safety by a certified homecare nurse if the patient is over 60 years of age D. Accurately and completely reconcile medications across the care continuum E. Assign each patient follow-up with a primary care physician D Which of the following has been associated with the promotion of safe TCs at hospital discharge? Check all that apply. A. Accurate, complete and timely discharge summaries B. Obtaining a thorough medication history C. Comparing and reconciling medication information from a variety of sources D. Using a multidisciplinary discharge team E. Arrange follow-up care prior to discharge A, B, C, D, E Which of the following are nursing responsibilities in the promotion of effective and safe TCs at hospital discharge? Check all that apply. A. Comprehensive assessment of patient and family education needs B. Review and reconciliation of medications C. Advising the patient not to take any medications that he was taking before hospitalization D. Reinforcing signs and symptoms that warrant notification of health care provider; and providing contact information for the appropriate providers 20 E. Suggesting websites the patient might want to consult when he gets home A, B, D A common nerve injury for patients placed in the supine position during an operation is: A. Brachial plexus injury B. Obturator nerve injury C. Heel decubitus D. Pulmonary emobli A In the lateral position, preventive measures INCLUDE: A. Pillows between the knees and feet B. Extra padding if the patient is thin C. Padding under the dependent ankle and knee D. A & C Only E. All of the above but the accepted E later D In the lithotomy position, legs must be raised and lowered slowly in order to: A. Prevent the patient from falling off the bed B. Allow blood volume changes to adjust and prevent torsion injuries C. Reduce the potential for nerve damage to the brachial plexus D. Allow adequate lung expansion B The optimum patient position during the operative procedure is best described as a position that: A. Provides access and exposure, maintains circulatory and respiratory functions, and does not compromise neuromuscular structures 21 B. Provides optimum access and exposure to the surgical site, with no permanent compromise to neuromuscular structures C. Provides access for the surgeon, does not compromise the neuromuscular structures and maintains an adequate airway for the anesthetist D. Provides sustained circulatory and respiratory functions, does not compromise neuromuscular structures, and maintains body alignment A The preprocedure verification process reviews which of the following (SELECT ALL THAT APPLY): A. The patients insurance B. The patients correct identity C. The correct site being operated on D. The correct procedure E. Blood type B, C, D When is the surgical time out performed, this is the second of three checklist performed in the perioperative setting: A. When the patient enters the room B. Immediately before skin incision C. Immediately before draping of the patient D. Immediately before the patient is positioned and prepped E. At the end of the case when suture is being placed When is a surgical site marking performed and by whom: A. In the preop clinic the day before the surgery by the NP B B. In the surgical admission suit by the surgical admission nurse C. In the surgical admission suit by a licensed practitioner that is involved in the surgery D. In the operating room during the first check list by the circulating nurse C 22 Nursing interventions for maintaining normothermia in the perioperative patient takes place (SELECT ALL THAT APPLY): A. Before surgery during in the surgical admission suit (SAS) B. In the surgical waiting area upon check-in at the hospital before going to the surgical admission suit (SAS) C. In the operating room D. In the post anesthesia care unit (PACU) E. C&D Only A, C, D Adverse outcomes that result from hypothermia in the perioperative patient include all of the following EXCEPT: A. Increased blood loss B. Decreased risk of postoperative shivering C. Increased risk of surgical site infections D. Myocardial ischemia B The causes of unplanned perioperative hypothermia include all of the following EXCEPT: A. General anesthesia induced heat loss B. Patient age C. The room temperature being set above 70 degrees F D. Oxygen saturation E. B&C Only C 23