DOH Nursing Critical Care and Emergency Nursing 2 — Questions and Answers
Question 1: A high peak airway pressure alarm sounds on a mechanically ventilated patient. What should the nurse do FIRST?
- Increase the FiO2 setting
- Check the ventilator circuit for kinks or obstruction (Correct answer)
- Administer a bronchodilator via the ventilator circuit
- Call the physician immediately
Correct answer: Check the ventilator circuit for kinks or obstruction
Kinked or obstructed tubing is the most common, easily correctable cause of high peak airway pressure and should be ruled out first.
Question 2: Which electrolyte imbalance is most commonly associated with life-threatening cardiac dysrhythmias in ICU patients?
- Hypernatraemia
- Hypomagnesaemia
- Hypokalamia (Correct answer)
- Hypercalcaemia
Correct answer: Hypokalamia
Hypokalaemia reduces myocardial cell membrane stability and significantly increases the risk of ventricular dysrhythmias including VF.
Question 3: According to the Surviving Sepsis Campaign guidelines, what is the recommended initial IV fluid bolus for septic shock?
- 10 mL/kg of 5% dextrose
- 20 mL/kg of colloid (albumin 5%)
- 30 mL/kg of crystalloid within 3 hours (Correct answer)
- 1 litre of 0.45% normal saline over 4 hours
Correct answer: 30 mL/kg of crystalloid within 3 hours
The Surviving Sepsis Campaign recommends at least 30 mL/kg of IV crystalloid within the first 3 hours of recognising septic shock.
Question 4: A Glasgow Coma Scale (GCS) score of 8 or less indicates which level of neurological impairment?
- Mild brain injury — close monitoring required
- Moderate brain injury — consider CT scan
- Severe brain injury — airway protection is a priority (Correct answer)
- Minimal impairment — routine observations
Correct answer: Severe brain injury — airway protection is a priority
GCS ≤8 defines severe brain injury and typically warrants immediate airway protection, often through endotracheal intubation.
Question 5: What is the recommended chest compression-to-ventilation ratio for single-rescuer adult CPR per AHA/ERC guidelines?
- 15:2
- 30:2 (Correct answer)
- 5:1
- 50:2
Correct answer: 30:2
Current guidelines recommend a 30:2 compression-to-ventilation ratio for single-rescuer adult CPR to minimise interruptions to chest compressions.
Question 6: A patient develops sudden stridor immediately after endotracheal tube extubation. What is the nurse's priority action?
- Encourage the patient to cough and take deep breaths
- Apply high-flow oxygen and notify the physician immediately (Correct answer)
- Administer an oral antihistamine for suspected allergy
- Reposition the patient to a prone position
Correct answer: Apply high-flow oxygen and notify the physician immediately
Post-extubation stridor signals upper airway obstruction; applying oxygen and immediately alerting the physician is the priority while preparing for potential reintubation.
Question 7: Which laboratory parameter BEST reflects adequate tissue oxygenation at the cellular level in a critically ill patient?
- SpO2 > 95%
- Normal PaO2 on arterial blood gas
- Serum lactate < 2 mmol/L (Correct answer)
- Normal systolic blood pressure
Correct answer: Serum lactate < 2 mmol/L
Serum lactate reflects cellular oxygen utilisation; a lactate < 2 mmol/L indicates aerobic metabolism and adequate tissue oxygenation.
DOH Nursing Critical Care and Emergency Nursing 2
A high peak airway pressure alarm sounds on a mechanically ventilated patient.
What should the nurse do FIRST?