NUR 210 CRITICAL CARE NURSING -
EMERGENCY CARE EXAM GUIDE 2026
EDITION
A patient in the ICU develops sudden hypotension, tachycardia, and decreased
breath sounds on the right side after central line placement. What is the most
likely complication?
A. Pneumothorax
B. Hemothorax
C. Air embolism
D. Catheter-related bloodstream infection
Correct Answer: A
Explanation: Pneumothorax is a common complication of central line
placement, especially subclavian approach. The triad of hypotension,
tachycardia, and decreased breath sounds on the insertion side is classic.
Hemothorax would show dullness to percussion, air embolism presents with
neurological symptoms, and infection develops more gradually.
A mechanically ventilated patient with ARDS has a PaO2/FiO2 ratio of 120. What
ventilation strategy is most appropriate?
A. High tidal volumes (10-12 mL/kg) with low PEEP
B. Low tidal volumes (6 mL/kg) with higher PEEP
C. High tidal volumes with high PEEP
D. Pressure control ventilation with low respiratory rate
Correct Answer: B
Explanation: ARDS management requires lung-protective ventilation with low
tidal volumes (6 mL/kg predicted body weight) and higher PEEP to prevent
ventilator-induced lung injury. High tidal volumes worsen barotrauma and
volutrauma in ARDS patients.
A patient with septic shock has a lactate of 5.2 mmol/L and MAP of 58 mmHg
despite 3L crystalloid. What is the next appropriate intervention?
A. Continue fluid resuscitation with another 2L
B. Start norepinephrine infusion
C. Administer broad-spectrum antibiotics
, D. Insert pulmonary artery catheter
Correct Answer: B
Explanation: After initial fluid resuscitation (30 mL/kg), if hypotension persists
with elevated lactate, vasopressors (norepinephrine first-line) should be
initiated to achieve MAP ≥65 mmHg. Antibiotics should already be given within
1 hour. More fluids may cause overload without improving perfusion.
Which electrocardiogram change is most specific for hyperkalemia?
A. ST-segment elevation
B. Peaked T waves
C. Prolonged QT interval
D. U waves
Correct Answer: B
Explanation: Peaked T waves are the earliest and most specific ECG finding in
hyperkalemia. ST elevation suggests ischemia, prolonged QT is seen in
hypocalcemia or certain drugs, and U waves are characteristic of hypokalemia.
A patient with traumatic brain injury has a Glasgow Coma Scale score of 6. What is
the priority intervention?
A. Administer mannitol immediately
B. Secure the airway with endotracheal intubation
C. Order emergent CT head
D. Start hypertonic saline infusion
Correct Answer: B
Explanation: GCS ≤8 indicates severe TBI and requires immediate airway
protection via intubation to prevent hypoxia and hypercapnia, which worsen
cerebral injury. CT and osmotic therapy follow after airway is secured.
What is the primary hemodynamic parameter that distinguishes cardiogenic shock
from other types of shock?
A. Low cardiac output with high systemic vascular resistance
B. High cardiac output with low systemic vascular resistance
C. Low cardiac output with low central venous pressure
D. High pulmonary capillary wedge pressure with low cardiac output
Correct Answer: D
Explanation: Cardiogenic shock is characterized by elevated PCWP (>18
, mmHg) due to left ventricular failure combined with low cardiac output. The
high SVR is compensatory but the distinguishing feature is high PCWP with low
CO.
A patient on continuous renal replacement therapy (CRRT) develops sudden
hypotension and bleeding from IV sites. What complication should be suspected?
A. Catheter malfunction
B. Heparin-induced thrombocytopenia
C. Citrate toxicity
D. Vascular access thrombosis
Correct Answer: C
Explanation: Citrate toxicity presents with hypotension, bleeding, and
metabolic alkalosis due to citrate anticoagulation binding ionized calcium. HIT
causes thrombosis, not bleeding. Catheter malfunction causes treatment
interruption but not bleeding.
Which arrhythmia requires immediate defibrillation in a critically ill patient?
A. Stable monomorphic ventricular tachycardia
B. Unstable atrial fibrillation with rapid ventricular response
C. Pulseless ventricular tachycardia
D. Third-degree heart block with narrow QRS
Correct Answer: C
Explanation: Pulseless VT is a shockable rhythm requiring immediate
defibrillation per ACLS guidelines. Stable VT can be treated with
antiarrhythmics first. Unstable atrial fibrillation requires synchronized
cardioversion, not defibrillation. Third-degree block requires pacing.
A patient with severe acute pancreatitis develops hypocalcemia. What is the
mechanism?
A. Renal calcium wasting
B. Saponification of peripancreatic fat
C. Decreased parathyroid hormone secretion
D. Vitamin D deficiency
Correct Answer: B
Explanation: In pancreatitis, released lipases break down peripancreatic fat,
, releasing fatty acids that bind calcium (saponification), causing hypocalcemia.
This is a classic finding and prognostic indicator in severe pancreatitis.
What is the most appropriate initial sedation strategy for a mechanically ventilated
patient in the ICU?
A. Continuous propofol infusion with daily interruptions
B. Intermittent benzodiazepines every 4 hours
C. Dexmedetomidine monotherapy for all patients
D. No sedation to maintain full wakefulness
Correct Answer: A
Explanation: Current guidelines recommend daily sedation interruptions with
continuous infusions (propofol or dexmedetomidine) to minimize oversedation,
reduce ventilator days, and allow neurological assessment. Benzodiazepines
alone increase delirium risk.
A patient with diabetic ketoacidosis has a pH of 6.92, glucose of 850 mg/dL, and
potassium of 3.2 mEq/L. What is the priority treatment?
A. Start insulin infusion immediately
B. Administer IV potassium before insulin
C. Give IV bicarbonate infusion
D. Administer subcutaneous insulin glargine
Correct Answer: B
Explanation: Insulin drives potassium intracellularly, potentially causing fatal
hypokalemia. With K+ <3.3 mEq/L, potassium must be replaced before starting
insulin. Bicarbonate is rarely indicated and may worsen outcomes. IV insulin is
required, not subcutaneous.
Which finding is most predictive of weaning failure from mechanical ventilation?
A. Rapid shallow breathing index (RSBI) >105
B. Tidal volume of 6 mL/kg
C. Negative inspiratory force of -25 cmH2O
D. PaO2/FiO2 ratio of 200
Correct Answer: A
Explanation: RSBI (frequency/tidal volume) >105 predicts weaning failure
with high sensitivity and specificity. NIF should be more negative than -20
cmH2O for successful weaning. RSBI is the most validated predictor.
EMERGENCY CARE EXAM GUIDE 2026
EDITION
A patient in the ICU develops sudden hypotension, tachycardia, and decreased
breath sounds on the right side after central line placement. What is the most
likely complication?
A. Pneumothorax
B. Hemothorax
C. Air embolism
D. Catheter-related bloodstream infection
Correct Answer: A
Explanation: Pneumothorax is a common complication of central line
placement, especially subclavian approach. The triad of hypotension,
tachycardia, and decreased breath sounds on the insertion side is classic.
Hemothorax would show dullness to percussion, air embolism presents with
neurological symptoms, and infection develops more gradually.
A mechanically ventilated patient with ARDS has a PaO2/FiO2 ratio of 120. What
ventilation strategy is most appropriate?
A. High tidal volumes (10-12 mL/kg) with low PEEP
B. Low tidal volumes (6 mL/kg) with higher PEEP
C. High tidal volumes with high PEEP
D. Pressure control ventilation with low respiratory rate
Correct Answer: B
Explanation: ARDS management requires lung-protective ventilation with low
tidal volumes (6 mL/kg predicted body weight) and higher PEEP to prevent
ventilator-induced lung injury. High tidal volumes worsen barotrauma and
volutrauma in ARDS patients.
A patient with septic shock has a lactate of 5.2 mmol/L and MAP of 58 mmHg
despite 3L crystalloid. What is the next appropriate intervention?
A. Continue fluid resuscitation with another 2L
B. Start norepinephrine infusion
C. Administer broad-spectrum antibiotics
, D. Insert pulmonary artery catheter
Correct Answer: B
Explanation: After initial fluid resuscitation (30 mL/kg), if hypotension persists
with elevated lactate, vasopressors (norepinephrine first-line) should be
initiated to achieve MAP ≥65 mmHg. Antibiotics should already be given within
1 hour. More fluids may cause overload without improving perfusion.
Which electrocardiogram change is most specific for hyperkalemia?
A. ST-segment elevation
B. Peaked T waves
C. Prolonged QT interval
D. U waves
Correct Answer: B
Explanation: Peaked T waves are the earliest and most specific ECG finding in
hyperkalemia. ST elevation suggests ischemia, prolonged QT is seen in
hypocalcemia or certain drugs, and U waves are characteristic of hypokalemia.
A patient with traumatic brain injury has a Glasgow Coma Scale score of 6. What is
the priority intervention?
A. Administer mannitol immediately
B. Secure the airway with endotracheal intubation
C. Order emergent CT head
D. Start hypertonic saline infusion
Correct Answer: B
Explanation: GCS ≤8 indicates severe TBI and requires immediate airway
protection via intubation to prevent hypoxia and hypercapnia, which worsen
cerebral injury. CT and osmotic therapy follow after airway is secured.
What is the primary hemodynamic parameter that distinguishes cardiogenic shock
from other types of shock?
A. Low cardiac output with high systemic vascular resistance
B. High cardiac output with low systemic vascular resistance
C. Low cardiac output with low central venous pressure
D. High pulmonary capillary wedge pressure with low cardiac output
Correct Answer: D
Explanation: Cardiogenic shock is characterized by elevated PCWP (>18
, mmHg) due to left ventricular failure combined with low cardiac output. The
high SVR is compensatory but the distinguishing feature is high PCWP with low
CO.
A patient on continuous renal replacement therapy (CRRT) develops sudden
hypotension and bleeding from IV sites. What complication should be suspected?
A. Catheter malfunction
B. Heparin-induced thrombocytopenia
C. Citrate toxicity
D. Vascular access thrombosis
Correct Answer: C
Explanation: Citrate toxicity presents with hypotension, bleeding, and
metabolic alkalosis due to citrate anticoagulation binding ionized calcium. HIT
causes thrombosis, not bleeding. Catheter malfunction causes treatment
interruption but not bleeding.
Which arrhythmia requires immediate defibrillation in a critically ill patient?
A. Stable monomorphic ventricular tachycardia
B. Unstable atrial fibrillation with rapid ventricular response
C. Pulseless ventricular tachycardia
D. Third-degree heart block with narrow QRS
Correct Answer: C
Explanation: Pulseless VT is a shockable rhythm requiring immediate
defibrillation per ACLS guidelines. Stable VT can be treated with
antiarrhythmics first. Unstable atrial fibrillation requires synchronized
cardioversion, not defibrillation. Third-degree block requires pacing.
A patient with severe acute pancreatitis develops hypocalcemia. What is the
mechanism?
A. Renal calcium wasting
B. Saponification of peripancreatic fat
C. Decreased parathyroid hormone secretion
D. Vitamin D deficiency
Correct Answer: B
Explanation: In pancreatitis, released lipases break down peripancreatic fat,
, releasing fatty acids that bind calcium (saponification), causing hypocalcemia.
This is a classic finding and prognostic indicator in severe pancreatitis.
What is the most appropriate initial sedation strategy for a mechanically ventilated
patient in the ICU?
A. Continuous propofol infusion with daily interruptions
B. Intermittent benzodiazepines every 4 hours
C. Dexmedetomidine monotherapy for all patients
D. No sedation to maintain full wakefulness
Correct Answer: A
Explanation: Current guidelines recommend daily sedation interruptions with
continuous infusions (propofol or dexmedetomidine) to minimize oversedation,
reduce ventilator days, and allow neurological assessment. Benzodiazepines
alone increase delirium risk.
A patient with diabetic ketoacidosis has a pH of 6.92, glucose of 850 mg/dL, and
potassium of 3.2 mEq/L. What is the priority treatment?
A. Start insulin infusion immediately
B. Administer IV potassium before insulin
C. Give IV bicarbonate infusion
D. Administer subcutaneous insulin glargine
Correct Answer: B
Explanation: Insulin drives potassium intracellularly, potentially causing fatal
hypokalemia. With K+ <3.3 mEq/L, potassium must be replaced before starting
insulin. Bicarbonate is rarely indicated and may worsen outcomes. IV insulin is
required, not subcutaneous.
Which finding is most predictive of weaning failure from mechanical ventilation?
A. Rapid shallow breathing index (RSBI) >105
B. Tidal volume of 6 mL/kg
C. Negative inspiratory force of -25 cmH2O
D. PaO2/FiO2 ratio of 200
Correct Answer: A
Explanation: RSBI (frequency/tidal volume) >105 predicts weaning failure
with high sensitivity and specificity. NIF should be more negative than -20
cmH2O for successful weaning. RSBI is the most validated predictor.
