Saudi Prometric Nursing Critical Care Nursing 1 — Questions and Answers
Question 1: A nurse assesses a patient in the ICU and notes a central venous pressure (CVP) of 2 mmHg. What does this finding most likely indicate?
- Fluid overload
- Hypovolemia (Correct answer)
- Right ventricular failure
- Cardiac tamponade
Correct answer: Hypovolemia
A CVP below the normal range of 2–8 mmHg indicates decreased venous return, which is consistent with hypovolemia.
Question 2: Which arterial blood gas result indicates uncompensated metabolic acidosis?
- pH 7.50, PaCO2 30 mmHg, HCO3 22 mEq/L
- pH 7.30, PaCO2 55 mmHg, HCO3 24 mEq/L
- pH 7.30, PaCO2 38 mmHg, HCO3 16 mEq/L (Correct answer)
- pH 7.48, PaCO2 40 mmHg, HCO3 30 mEq/L
Correct answer: pH 7.30, PaCO2 38 mmHg, HCO3 16 mEq/L
Uncompensated metabolic acidosis is characterized by a low pH and low HCO3 with a normal PaCO2, indicating a primary metabolic problem without respiratory compensation.
Question 3: A mechanically ventilated patient develops sudden hypotension, absent breath sounds on the left side, and tracheal deviation to the right. The nurse should first suspect:
- Pulmonary embolism
- Hemothorax
- Tension pneumothorax (Correct answer)
- Pleural effusion
Correct answer: Tension pneumothorax
Tension pneumothorax presents with tracheal deviation away from the affected side, unilateral absent breath sounds, and hemodynamic instability requiring immediate needle decompression.
Question 4: Which nursing intervention is most appropriate for a patient with increased intracranial pressure (ICP)?
- Place patient in prone position
- Position patient in Trendelenburg (head-down)
- Keep patient supine with head flat
- Elevate head of bed to 30–45 degrees (Correct answer)
Correct answer: Elevate head of bed to 30–45 degrees
Elevating the head of the bed 30–45 degrees promotes cerebral venous drainage, which reduces intracranial pressure.
Question 5: A patient in the ICU develops sudden, regular tachycardia at 180 bpm with narrow QRS complexes. What is the first-line management for this stable patient?
- Immediate synchronized cardioversion
- Vagal maneuvers (Correct answer)
- Amiodarone infusion
- Insertion of a temporary pacemaker
Correct answer: Vagal maneuvers
Vagal maneuvers (e.g., Valsalva, carotid sinus massage) are the first-line treatment for stable supraventricular tachycardia as they can slow or terminate the re-entrant circuit.
Question 6: A malnourished patient receiving total parenteral nutrition (TPN) develops confusion, muscle cramps, and a phosphate level of 0.4 mmol/L. The nurse recognizes this as:
- Hypercalcemia
- Hyperglycemia
- Refeeding syndrome (Correct answer)
- Hyperosmolar hyperglycemic state
Correct answer: Refeeding syndrome
Refeeding syndrome occurs in malnourished patients receiving aggressive nutrition support and is characterized by severe hypophosphatemia, causing neurological and muscular complications.
Question 7: A patient who has been on mechanical ventilation for 7 days develops a new pulmonary infiltrate on chest X-ray, fever (38.6°C), purulent sputum, and leukocytosis. The nurse recognizes this as:
- Cardiogenic pulmonary edema
- Atelectasis
- Spontaneous pneumothorax
- Ventilator-associated pneumonia (VAP) (Correct answer)
Correct answer: Ventilator-associated pneumonia (VAP)
VAP is diagnosed by a new radiographic infiltrate appearing after ≥48 hours of mechanical ventilation combined with clinical signs of infection such as fever, purulent secretions, and leukocytosis.
Saudi Prometric Nursing Critical Care Nursing 1
A nurse assesses a patient in the ICU and notes a central venous pressure (CVP) of 2 mmHg.
What does this finding most likely indicate?