Acute Care Nurse Practitioner Trivia 3 — Questions and Answers
Question 1: A patient develops sudden dyspnea and hypotension after central line placement. Trachea is deviated. What is the IMMEDIATE intervention?
- Chest X-ray
- CT scan of chest
- Needle decompression of the affected side (Correct answer)
- Endotracheal intubation
Correct answer: Needle decompression of the affected side
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression at the 2nd intercostal space, midclavicular line — do not wait for imaging.
Question 2: Which is the MOST common cause of hospital-acquired pneumonia in mechanically ventilated patients?
- Staphylococcus aureus
- Pseudomonas aeruginosa (Correct answer)
- Klebsiella pneumoniae
- Haemophilus influenzae
Correct answer: Pseudomonas aeruginosa
Pseudomonas aeruginosa is the most common gram-negative organism causing ventilator-associated pneumonia (VAP) in ICU patients.
Question 3: What does a CPOT (Critical-Care Pain Observation Tool) score of 5 or higher indicate?
- Sedation is adequate
- Pain is present and requires intervention (Correct answer)
- Patient is delirious
- Spontaneous breathing trial should be initiated
Correct answer: Pain is present and requires intervention
A CPOT score ≥5 out of 8 indicates significant pain in non-verbal ICU patients, warranting analgesic intervention.
Question 4: A patient with cirrhosis presents with confusion and asterixis after a GI bleed. Which medication is FIRST-LINE treatment?
- Lactulose (Correct answer)
- Rifaximin
- Neomycin
- Zinc supplementation
Correct answer: Lactulose
Lactulose is first-line for acute hepatic encephalopathy; it reduces ammonia absorption by acidifying colonic contents and promoting its excretion.
Question 5: Which ventilator mode allows the patient to trigger breaths but guarantees a set tidal volume with each breath?
- Pressure support ventilation (PSV)
- Assist-control volume control (AC-VC) (Correct answer)
- Synchronized intermittent mandatory ventilation (SIMV)
- Continuous positive airway pressure (CPAP)
Correct answer: Assist-control volume control (AC-VC)
AC-VC delivers a set tidal volume with each breath (patient-triggered or machine-triggered), ensuring consistent volume delivery.
Question 6: A post-op cardiac surgery patient develops Beck's triad. Which condition does this suggest?
- Hypovolemic shock
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
- Right ventricular failure
Correct answer: Cardiac tamponade
Beck's triad (hypotension, muffled heart sounds, JVD) is the classic presentation of cardiac tamponade from pericardial fluid compressing the heart.
Question 7: What is the target glucose range recommended by most critical care guidelines for ICU patients?
- 80-110 mg/dL
- 140-180 mg/dL (Correct answer)
- 100-150 mg/dL
- 180-220 mg/dL
Correct answer: 140-180 mg/dL
Tight glycemic control (80-110) increased mortality per the NICE-SUGAR trial; current guidelines target 140-180 mg/dL to balance glycemic control and hypoglycemia risk.
Acute Care Nurse Practitioner Trivia 3
A patient develops sudden dyspnea and hypotension after central line placement.
Trachea is deviated.
What is the IMMEDIATE intervention?