Saudi Prometric Nursing Critical Care Nursing 5 — Questions and Answers
Question 1: A patient in cardiogenic shock has a cardiac output of 2 L/min and elevated pulmonary artery wedge pressure (PAWP). Which drug class is most appropriate?
- Beta-blockers
- Inotropes such as dobutamine (Correct answer)
- Calcium channel blockers
- Diuretics alone
Correct answer: Inotropes such as dobutamine
Dobutamine increases myocardial contractility and cardiac output in cardiogenic shock without significantly increasing afterload.
Question 2: A nurse is caring for a patient on continuous renal replacement therapy (CRRT). The circuit clots frequently. Which intervention is most appropriate?
- Increase blood flow rate and review anticoagulation protocol (Correct answer)
- Discontinue CRRT and switch to intermittent hemodialysis
- Reduce filter replacement fluid
- Increase ultrafiltration rate
Correct answer: Increase blood flow rate and review anticoagulation protocol
Increasing blood flow rate and optimizing anticoagulation (e.g., heparin or citrate) prevents circuit clotting in CRRT.
Question 3: A mechanically ventilated patient's ABG shows: pH 7.50, PaCO2 28 mmHg, HCO3 22 mEq/L. How should the ventilator be adjusted?
- Increase respiratory rate
- Decrease respiratory rate or tidal volume (Correct answer)
- Increase FiO2
- Add PEEP
Correct answer: Decrease respiratory rate or tidal volume
The ABG indicates respiratory alkalosis from hyperventilation; decreasing respiratory rate or tidal volume will normalize PaCO2.
Question 4: Which early sign of septic shock differentiates it from other forms of shock?
- Cool, clammy skin with low cardiac output
- Warm, flushed skin with high cardiac output (hyperdynamic state) (Correct answer)
- Severe bradycardia
- Markedly elevated central venous pressure
Correct answer: Warm, flushed skin with high cardiac output (hyperdynamic state)
Early septic shock is characterized by a hyperdynamic state with vasodilation, warm skin, and elevated cardiac output.
Question 5: A patient with a traumatic brain injury has a sudden drop in GCS from 12 to 7 and one dilated fixed pupil. What does this indicate?
- Hypoglycemia
- Uncal herniation with ipsilateral cranial nerve III compression (Correct answer)
- Basilar skull fracture
- Psychogenic unresponsiveness
Correct answer: Uncal herniation with ipsilateral cranial nerve III compression
A unilateral dilated fixed pupil with decreasing GCS in head trauma indicates uncal herniation compressing CN III.
Question 6: Which intervention is MOST important in preventing ventilator-associated pneumonia (VAP) in the ICU?
- Administer prophylactic antibiotics daily
- Maintain head-of-bed elevation at 30–45 degrees (Correct answer)
- Change ventilator circuits every 24 hours
- Use a high-flow nasal cannula instead
Correct answer: Maintain head-of-bed elevation at 30–45 degrees
Semi-recumbent positioning at 30–45 degrees is a core VAP bundle element that reduces aspiration of oropharyngeal secretions.
Question 7: A critically ill patient is receiving norepinephrine infusion. The nurse observes blanching and swelling at the IV site. What is the priority action?
- Slow the infusion rate and apply warm compress
- Stop the infusion, discontinue the IV, and administer phentolamine subcutaneously to the site (Correct answer)
- Switch to dopamine via the same IV
- Flush the IV line with normal saline
Correct answer: Stop the infusion, discontinue the IV, and administer phentolamine subcutaneously to the site
Norepinephrine extravasation causes tissue necrosis; the infusion must be stopped and phentolamine infiltrated to counteract vasoconstriction.
Saudi Prometric Nursing Critical Care Nursing 5
A patient in cardiogenic shock has a cardiac output of 2 L/min and elevated pulmonary artery wedge pressure (PAWP).
Which drug class is most appropriate?