Saudi Prometric Nursing Critical Care Nursing 2 — Questions and Answers
Question 1: A patient develops hypotension, tachycardia, warm flushed skin, and a widened pulse pressure following a severe anaphylactic reaction. This presentation is most characteristic of:
- Hypovolemic shock
- Cardiogenic shock
- Distributive shock (Correct answer)
- Obstructive shock
Correct answer: Distributive shock
Distributive shock, as seen in anaphylaxis, is caused by massive vasodilation leading to a relative hypovolemia with warm skin and widened pulse pressure.
Question 2: According to current Surviving Sepsis Campaign guidelines, which fluid is recommended as first-line resuscitation for a patient in septic shock?
- 5% dextrose in water (D5W)
- 5% albumin solution
- Crystalloid solution at 30 mL/kg (Correct answer)
- 3% hypertonic saline
Correct answer: Crystalloid solution at 30 mL/kg
Current guidelines recommend 30 mL/kg of crystalloid (normal saline or lactated Ringer's) within the first 3 hours of sepsis recognition as the first-line resuscitation fluid.
Question 3: A patient remains hypotensive despite receiving 30 mL/kg of IV fluid resuscitation for septic shock. Which vasopressor is the recommended first-line agent?
- Epinephrine
- Dopamine
- Vasopressin
- Norepinephrine (Correct answer)
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock because its potent alpha-adrenergic activity effectively counteracts the vasodilation characteristic of septic shock.
Question 4: A patient post-cardiac surgery develops hypotension, tachycardia, cool extremities, decreased urine output, and an elevated pulmonary capillary wedge pressure (PCWP) of 22 mmHg. These findings are consistent with:
- Distributive shock
- Obstructive shock
- Cardiogenic shock (Correct answer)
- Hypovolemic shock
Correct answer: Cardiogenic shock
Cardiogenic shock is characterized by decreased cardiac output (poor peripheral perfusion) and elevated filling pressures (high PCWP) due to failure of the heart as a pump.
Question 5: A critically ill patient's serum lactate measures 6 mmol/L. The nurse interprets this finding as indicating:
- Adequate tissue perfusion
- Compensated respiratory alkalosis
- Metabolic alkalosis
- Tissue hypoperfusion with anaerobic metabolism (Correct answer)
Correct answer: Tissue hypoperfusion with anaerobic metabolism
A serum lactate above 4 mmol/L indicates anaerobic metabolism resulting from inadequate tissue oxygen delivery, which is commonly seen in shock states.
Question 6: A patient develops urticaria, stridor, hypotension, and angioedema minutes after receiving IV contrast dye. What is the FIRST treatment the nurse should administer?
- Diphenhydramine 50 mg IV
- Epinephrine 0.5 mg IM (1:1000 solution) (Correct answer)
- Methylprednisolone 125 mg IV
- Normal saline 1 L bolus
Correct answer: Epinephrine 0.5 mg IM (1:1000 solution)
Epinephrine IM is the life-saving first-line treatment for anaphylaxis; it reverses bronchospasm, reduces angioedema, and restores vascular tone.
Question 7: The nurse is monitoring fluid resuscitation in a patient with 40% total body surface area (TBSA) burns. Which parameter BEST indicates adequate resuscitation?
- Heart rate below 60 bpm
- Mean arterial pressure above 120 mmHg
- Urine output of 0.5–1 mL/kg/hour (Correct answer)
- Central venous pressure above 15 mmHg
Correct answer: Urine output of 0.5–1 mL/kg/hour
Urine output of 0.5–1 mL/kg/hour is the gold standard for assessing adequate fluid resuscitation in burn patients, as it reflects end-organ (renal) perfusion.
Saudi Prometric Nursing Critical Care Nursing 2
A patient develops hypotension, tachycardia, warm flushed skin, and a widened pulse pressure following a severe anaphylactic reaction.
This presentation is most characteristic of: