Critical Care Paramedic Certification
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1. A patient with severe traumatic brain injury (TBI) shows signs of
increased intracranial pressure (ICP). Which intervention is most
appropriate initially?
A. Hyperventilation to PaCO₂ of 20 mmHg
B. Administer mannitol
C. Elevate head of bed to 30 degrees
D. Administer corticosteroids
Answer: C
Rationale: Elevating the head improves venous drainage and
reduces ICP; aggressive hyperventilation is avoided initially due
to risk of cerebral ischemia.
2. Which arterial blood gas (ABG) finding indicates uncompensated
metabolic acidosis?
A. pH 7.25, PaCO₂ 40, HCO₃⁻ 18
B. pH 7.35, PaCO₂ 30, HCO₃⁻ 18
C. pH 7.45, PaCO₂ 35, HCO₃⁻ 24
D. pH 7.30, PaCO₂ 50, HCO₃⁻ 26
Answer: A
, Rationale: Low pH and low bicarbonate with normal CO₂
indicates metabolic acidosis without compensation.
3. A septic shock patient remains hypotensive after fluid
resuscitation. Which vasopressor is first-line?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Answer: C
Rationale: Norepinephrine is the first-line vasopressor in septic
shock due to its strong alpha-adrenergic effects.
4. What is the target SpO₂ in most critically ill patients?
A. 85–88%
B. 88–92%
C. 94–98%
D. 100%
Answer: C
Rationale: Maintaining oxygen saturation between 94–98%
ensures adequate oxygenation while avoiding hyperoxia.
5. Which ECG change is most indicative of hyperkalemia?
A. ST elevation
B. Flattened T waves
C. Peaked T waves
D. Prolonged QT interval
Answer: C
Rationale: Hyperkalemia classically presents with tall, peaked T
waves.
6. A patient in cardiogenic shock has pulmonary edema. Which
medication is most appropriate?
, A. Normal saline bolus
B. Furosemide
C. Atropine
D. Adenosine
Answer: B
Rationale: Diuretics reduce fluid overload and pulmonary
congestion in cardiogenic shock.
7. Which condition is characterized by decreased preload, decreased
cardiac output, and increased SVR?
A. Septic shock
B. Cardiogenic shock
C. Hypovolemic shock
D. Neurogenic shock
Answer: C
Rationale: Hypovolemic shock leads to low preload and
compensatory vasoconstriction.
8. What is the primary effect of positive end-expiratory pressure
(PEEP)?
A. Decrease cardiac output
B. Improve alveolar recruitment
C. Increase airway resistance
D. Reduce oxygen diffusion
Answer: B
Rationale: PEEP prevents alveolar collapse and improves
oxygenation.
9. Which medication is used to reverse opioid overdose?
A. Flumazenil
B. Naloxone
C. Atropine
Exam With Actual Questions & Verified
Answers, Plus Explained
Rationales/Expert Verified For
Guaranteed 100% Pass 2026/Latest
Update/Instant Download Pdf
1. A patient with severe traumatic brain injury (TBI) shows signs of
increased intracranial pressure (ICP). Which intervention is most
appropriate initially?
A. Hyperventilation to PaCO₂ of 20 mmHg
B. Administer mannitol
C. Elevate head of bed to 30 degrees
D. Administer corticosteroids
Answer: C
Rationale: Elevating the head improves venous drainage and
reduces ICP; aggressive hyperventilation is avoided initially due
to risk of cerebral ischemia.
2. Which arterial blood gas (ABG) finding indicates uncompensated
metabolic acidosis?
A. pH 7.25, PaCO₂ 40, HCO₃⁻ 18
B. pH 7.35, PaCO₂ 30, HCO₃⁻ 18
C. pH 7.45, PaCO₂ 35, HCO₃⁻ 24
D. pH 7.30, PaCO₂ 50, HCO₃⁻ 26
Answer: A
, Rationale: Low pH and low bicarbonate with normal CO₂
indicates metabolic acidosis without compensation.
3. A septic shock patient remains hypotensive after fluid
resuscitation. Which vasopressor is first-line?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Answer: C
Rationale: Norepinephrine is the first-line vasopressor in septic
shock due to its strong alpha-adrenergic effects.
4. What is the target SpO₂ in most critically ill patients?
A. 85–88%
B. 88–92%
C. 94–98%
D. 100%
Answer: C
Rationale: Maintaining oxygen saturation between 94–98%
ensures adequate oxygenation while avoiding hyperoxia.
5. Which ECG change is most indicative of hyperkalemia?
A. ST elevation
B. Flattened T waves
C. Peaked T waves
D. Prolonged QT interval
Answer: C
Rationale: Hyperkalemia classically presents with tall, peaked T
waves.
6. A patient in cardiogenic shock has pulmonary edema. Which
medication is most appropriate?
, A. Normal saline bolus
B. Furosemide
C. Atropine
D. Adenosine
Answer: B
Rationale: Diuretics reduce fluid overload and pulmonary
congestion in cardiogenic shock.
7. Which condition is characterized by decreased preload, decreased
cardiac output, and increased SVR?
A. Septic shock
B. Cardiogenic shock
C. Hypovolemic shock
D. Neurogenic shock
Answer: C
Rationale: Hypovolemic shock leads to low preload and
compensatory vasoconstriction.
8. What is the primary effect of positive end-expiratory pressure
(PEEP)?
A. Decrease cardiac output
B. Improve alveolar recruitment
C. Increase airway resistance
D. Reduce oxygen diffusion
Answer: B
Rationale: PEEP prevents alveolar collapse and improves
oxygenation.
9. Which medication is used to reverse opioid overdose?
A. Flumazenil
B. Naloxone
C. Atropine
