Saudi Prometric Nursing Critical Care Nursing 4 — Questions and Answers
Question 1: A patient in the ICU develops acute respiratory distress syndrome (ARDS). Which ventilator strategy is most appropriate?
- High tidal volume (12 mL/kg IBW)
- Low tidal volume (6 mL/kg IBW) with permissive hypercapnia (Correct answer)
- Pressure-controlled ventilation with FiO2 of 1.0
- Spontaneous breathing mode only
Correct answer: Low tidal volume (6 mL/kg IBW) with permissive hypercapnia
Lung-protective ventilation with low tidal volumes (6 mL/kg IBW) reduces ventilator-induced lung injury in ARDS.
Question 2: A critically ill patient has a serum potassium of 6.8 mEq/L with peaked T-waves on ECG. Which intervention takes priority?
- Administer sodium polystyrene sulfonate (Kayexalate)
- Administer IV calcium gluconate (Correct answer)
- Initiate hemodialysis immediately
- Give IV furosemide
Correct answer: Administer IV calcium gluconate
Calcium gluconate stabilizes the cardiac membrane and is the first-line emergency treatment for severe hyperkalemia with ECG changes.
Question 3: Which parameter best reflects global tissue oxygen delivery and consumption in a critically ill patient?
- Central venous pressure (CVP)
- Mixed venous oxygen saturation (SvO2) (Correct answer)
- Mean arterial pressure (MAP)
- Serum lactate clearance
Correct answer: Mixed venous oxygen saturation (SvO2)
Mixed venous oxygen saturation (SvO2) reflects the balance between oxygen delivery and consumption at the tissue level.
Question 4: A nurse caring for a mechanically ventilated patient notices the high-pressure alarm is triggering repeatedly. What is the FIRST action?
- Increase the pressure limit on the ventilator
- Manually ventilate the patient with a bag-valve mask (Correct answer)
- Silence the alarm and continue monitoring
- Increase the sedation dose
Correct answer: Manually ventilate the patient with a bag-valve mask
Manual ventilation ensures the patient receives adequate breaths while the cause of the high-pressure alarm is investigated.
Question 5: A patient receiving total parenteral nutrition (TPN) via central line develops fever, chills, and hypotension. The nurse suspects catheter-related bloodstream infection (CRBSI). What should be done FIRST?
- Remove the central line immediately
- Obtain blood cultures from the central line and a peripheral site (Correct answer)
- Start broad-spectrum antibiotics without cultures
- Change the TPN bag and tubing
Correct answer: Obtain blood cultures from the central line and a peripheral site
Blood cultures from both the central line and a peripheral vein are essential to confirm CRBSI before initiating treatment.
Question 6: In a patient with increased intracranial pressure (ICP), which nursing position is most appropriate?
- Trendelenburg position
- Head of bed elevated 30–45 degrees with head midline (Correct answer)
- Prone position
- Flat supine with no head elevation
Correct answer: Head of bed elevated 30–45 degrees with head midline
Elevating the head of bed 30–45 degrees with the head in midline promotes venous drainage and reduces ICP.
Question 7: Which acid-base disturbance is most commonly seen in a patient with prolonged nasogastric suctioning?
- Metabolic acidosis
- Respiratory acidosis
- Metabolic alkalosis (Correct answer)
- Respiratory alkalosis
Correct answer: Metabolic alkalosis
Loss of hydrochloric acid through NG suctioning causes metabolic alkalosis due to excess bicarbonate relative to acid.
Saudi Prometric Nursing Critical Care Nursing 4
A patient in the ICU develops acute respiratory distress syndrome (ARDS).
Which ventilator strategy is most appropriate?