Download PrepIQ AACN Adult Acute Critica lCare Nursing Certification ACCRN Ultimate Exam and more Exams Technology in PDF only on Docsity!
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Question 1. Which of the following is the first-line reperfusion strategy for a patient presenting with ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset? A) Thrombolytic therapy B) Primary percutaneous coronary intervention (PCI) C) Coronary artery bypass grafting (CABG) D) Medical management with beta-blockers only Answer: B Explanation: Primary PCI restores coronary flow more reliably than thrombolysis and is recommended when it can be performed promptly. Question 2. A 68-year-old man with NSTEMI is started on a loading dose of clopidogrel. Which laboratory value is most important to obtain before giving this medication? A) Serum creatinine B) Platelet count C) Prothrombin time (PT) D) Hemoglobin Answer: B Explanation: Clopidogrel is an antiplatelet; a low platelet count increases bleeding risk. Question 3. Which rhythm is most likely to respond to immediate unsynchronized (defibrillation) shock? A) Monomorphic ventricular tachycardia with pulse B) Ventricular fibrillation C) Torsades de pointes D) Asystole Answer: B
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Explanation: Defibrillation is indicated for shock-able rhythms, VF being the classic example. Question 4. A patient in cardiac arrest shows a narrow complex rhythm with a rate of 180 bpm and no palpable pulse. The most appropriate immediate treatment is: A) Synchronized cardioversion B) Immediate unsynchronized shock C) High-dose epinephrine infusion D) Immediate intravenous amiodarone Answer: A Explanation: This rhythm is likely supraventricular tachycardia with pulselessness; synchronized cardioversion is indicated. Question 5. In acute decompensated heart failure with pulmonary edema, the first pharmacologic agent to reduce preload is: A) Nitroglycerin IV infusion B) Dobutamine infusion C) Furosemide IV bolus D) Norepinephrine infusion Answer: C Explanation: Loop diuretics rapidly decrease intravascular volume, reducing pulmonary congestion. Question 6. Which hemodynamic parameter best reflects left-ventricular afterload? A) Central venous pressure (CVP) B) Pulmonary capillary wedge pressure (PCWP) C) Systemic vascular resistance (SVR) D) Cardiac index (CI)
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Answer: C Explanation: Balloon inflation during diastole increases diastolic pressure and coronary flow. Question 10. Which ventilator mode delivers a set tidal volume with each breath regardless of patient effort? A) Assist-Control (AC) B) Synchronized Intermittent Mandatory Ventilation (SIMV) C) Pressure Support Ventilation (PSV) D) Continuous Positive Airway Pressure (CPAP) Answer: A Explanation: AC mode provides a preset tidal volume for every breath, triggered by the patient or the machine. Question 11. A patient with ARDS has a PaO₂/FiO₂ ratio of 120 mm Hg. Which ventilator strategy is most appropriate? A) Tidal volume 10 mL/kg, PEEP 5 cm H₂O B) Tidal volume 6 mL/kg, PEEP 12 cm H₂O C) Tidal volume 12 mL/kg, zero PEEP D) High-frequency oscillatory ventilation Answer: B Explanation: Lung-protective ventilation (6 mL/kg) with higher PEEP improves oxygenation in moderate-severe ARDS. Question 12. Which maneuver improves oxygenation in a patient with severe ARDS who is already on optimal PEEP? A) Prone positioning B) Increasing tidal volume to 10 mL/kg C) Decreasing FiO₂ to 30%
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D) Adding a bronchodilator Answer: A Explanation: Prone positioning redistributes ventilation-perfusion and improves oxygenation. Question 13. A patient on mechanical ventilation suddenly develops high peak airway pressures, a normal plateau pressure, and a decreased tidal volume. The most likely cause is: A) Endotracheal tube obstruction B) Decreased lung compliance C) Patient-triggered breath stacking D) Pneumothorax Answer: A Explanation: High peak with normal plateau suggests increased airway resistance, most commonly due to tube obstruction. Question 14. Which of the following is the best initial therapy for a massive pulmonary embolism causing hemodynamic instability? A) Low-molecular-weight heparin (LMWH) B) Thrombolytic therapy C) Inferior vena cava filter placement D) Warfarin Answer: B Explanation: Systemic thrombolysis rapidly dissolves clot and restores perfusion in massive PE. Question 15. A tension pneumothorax is suspected in a trauma patient. Which immediate intervention is required? A) Needle thoracostomy in the 2nd intercostal space, mid-clavicular line B) Chest tube insertion in the 5th intercostal space, mid-axillary line
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C) Lactated Ringer’s solution D) Dextrose-containing solution Answer: B Explanation: Isotonic saline rapidly restores intravascular volume in HHS. Question 19. Which clinical sign suggests adrenal crisis in a septic patient? A) Hypernatremia B) Hypoglycemia C) Hypertension D) Polyuria Answer: B Explanation: Acute cortisol deficiency leads to hypoglycemia, hypotension, and electrolyte disturbances. Question 20. A patient receiving vasopressin for septic shock develops hyponatremia. Which mechanism explains this finding? A) Increased renal potassium excretion B) Direct antidiuretic effect on the collecting duct C) Sodium loss through the gastrointestinal tract D) Increased aldosterone secretion Answer: B Explanation: Vasopressin acts as an ADH analog, promoting water reabsorption and dilutional hyponatremia. Question 21. Which laboratory finding is most characteristic of disseminated intravascular coagulation (DIC)? A) Elevated fibrinogen level B) Prolonged PT and aPTT with low fibrinogen C) Isolated thrombocytosis
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D) Normal D-dimer Answer: B Explanation: Consumption of clotting factors and fibrinogen leads to prolonged coagulation times and elevated D-dimer. Question 22. A patient on heparin therapy develops a platelet count drop from 250,000/μL to 120,000/μL after 5 days. Which test confirms heparin-induced thrombocytopenia (HIT)? A) Anti-cardiolipin antibody B) Platelet factor 4 (PF4) ELISA C) Prothrombin fragment 1+2 assay D) D-dimer level Answer: B Explanation: Anti-PF4/heparin antibodies are diagnostic for HIT. Question 23. In a patient with septic shock, which vasopressor is recommended as the first-line agent according to the Surviving Sepsis Campaign? A) Phenylephrine B) Dopamine C) Norepinephrine D) Epinephrine Answer: C Explanation: Norepinephrine is the preferred initial vasopressor for septic shock. Question 24. A 55-year-old woman with a known peptic ulcer presents with hematemesis. Which endoscopic therapy is most effective for active arterial bleeding? A) Injection of epinephrine alone B) Thermal coagulation (heater probe)
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C) Elevated bilirubin D) Prolonged PT/INR Answer: A Explanation: Hyperammonemia directly contributes to cerebral edema and altered mental status. Question 28. In a patient with small-bowel obstruction, the best initial imaging modality is: A) Abdominal X-ray (upright and supine) B) Abdominal CT with oral contrast C) MRI abdomen D) Ultrasound abdomen Answer: A Explanation: Plain radiographs quickly identify dilated loops and air-fluid levels. Question 29. Which of the following is the most common cause of post-renal acute kidney injury (AKI) in critically ill patients? A) Acute tubular necrosis B) Nephrolithiasis C) Urinary catheter obstruction D) Acute interstitial nephritis Answer: C Explanation: Catheter kinking or blockage is a frequent reversible cause of post-renal AKI in the ICU. Question 30. A patient with severe hyperkalemia (K⁺ = 7.2 mEq/L) and ECG changes (peaked T waves) is receiving calcium gluconate. Which additional therapy will most rapidly shift potassium intracellularly? A) Sodium bicarbonate infusion
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B) Insulin with dextrose C) Kayexalate (sodium polystyrene sulfonate) D) Loop diuretic Answer: B Explanation: Insulin drives potassium into cells within minutes; bicarbonate is slower. Question 31. Which continuous renal replacement therapy (CRRT) modality provides solute removal primarily by diffusion? A) Continuous veno-venous hemofiltration (CVVH) B) Continuous veno-venous hemodialysis (CVVHD) C) Continuous veno-venous hemodiafiltration (CVVHDF) D) Sustained low-efficiency dialysis (SLED) Answer: B Explanation: CVVHD uses a dialysate gradient for diffusive clearance. Question 32. A patient with traumatic brain injury (TBI) has a Glasgow Coma Scale (GCS) score of 6. Which intervention is indicated to reduce intracranial pressure (ICP)? A) Hyperventilation to PaCO₂ < 30 mm Hg for prolonged periods B) Administration of mannitol 0.5 g/kg IV bolus C) Elevating the head of the bed to 30° only after ICP is controlled D) Maintaining systolic blood pressure > 140 mm Hg Answer: B Explanation: Mannitol creates an osmotic gradient, decreasing cerebral edema and ICP. Question 33. Which statement best describes the Monro-Kellie doctrine? A) Intracranial pressure is directly proportional to arterial blood pressure.
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B) Phenobarbital infusion C) Levetiracetam loading dose D) Valproic acid infusion Answer: A Explanation: Phenytoin (or fosphenytoin) is the standard second-line agent after benzodiazepines. Question 37. A septic patient has a serum lactate of 4.5 mmol/L after 6 hours of fluid resuscitation. According to the Surviving Sepsis Campaign, the next step is: A) Add a second fluid bolus of 30 mL/kg B) Initiate early vasopressor therapy to maintain MAP ≥ 65 mm Hg C) Begin corticosteroid therapy D) Administer a second dose of broad-spectrum antibiotics Answer: B Explanation: Persistent lactate elevation despite adequate fluids signals refractory shock; vasopressors are indicated. Question 38. Which of the following best defines MODS? A) Failure of a single organ system due to trauma B) Progressive dysfunction of two or more organ systems following a severe insult C) Acute kidney injury with accompanying liver dysfunction only D) Chronic disease exacerbation causing ICU admission Answer: B Explanation: Multiple Organ Dysfunction Syndrome involves at least two organ systems failing sequentially. Question 39. A patient presents after ingestion of a massive acetaminophen overdose. Which antidote should be administered? A) N-acetylcysteine (NAC)
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B) Sodium bicarbonate C) Activated charcoal only D) Flumazenil Answer: A Explanation: NAC replenishes glutathione and prevents hepatic necrosis when given early. Question 40. In a poly-trauma patient, the primary survey follows the ABCDE approach. Which step follows “C” (circulation)? A) Disability (neurologic assessment) B) Exposure/Environment control C) Airway management with cervical spine protection D) Breathing assessment Answer: A Explanation: The sequence is Airway, Breathing, Circulation, Disability, Exposure. Question 41. Which ethical principle primarily supports a nurse’s duty to respect a patient’s “Do Not Resuscitate” (DNR) order? A) Beneficence B) Autonomy C) Justice D) Non-maleficence Answer: B Explanation: Autonomy respects the patient’s right to make informed decisions about their own care. Question 42. A culturally diverse family refuses blood transfusion for a critically ill child. The most appropriate nursing response is to: A) Immediately override the decision to save the child’s life
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Question 45. Which of the following is a hallmark sign of adrenal insufficiency in a critically ill patient? A) Hyperkalemia with metabolic alkalosis B) Hyponatremia with hypotension C) Hypernatremia with hypertension D) Metabolic acidosis with hypoglycemia Answer: B Explanation: Lack of cortisol and aldosterone leads to sodium loss, hyponatremia, and hypotension. Question 46. A 60-year-old man with a history of chronic heart failure presents with sudden shortness of breath and a blood pressure of 70/40 mm Hg. Which bedside test is most useful to differentiate cardiogenic from obstructive shock? A) Serum lactate level B) Bedside echocardiography (focus cardiac ultrasound) C) Central venous pressure measurement D) Urine output over the past hour Answer: B Explanation: Point-of-care echo can assess ventricular function and detect tamponade or massive PE. Question 47. Which medication is most appropriate for rapid control of severe hypertension in a patient with aortic dissection? A) Labetalol IV bolus B) Nitroprusside infusion only C) Hydralazine IV push D) Clonidine oral tablet Answer: A Explanation: Labetalol provides combined α- and β-blockade, reducing shear stress quickly.
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Question 48. In a patient receiving high-dose norepinephrine for septic shock, which electrolyte disturbance is most common? A) Hyperkalemia B) Hypokalemia C) Hypermagnesemia D) Hyponatremia Answer: B Explanation: Norepinephrine causes intracellular shift of potassium, leading to hypokalemia. Question 49. Which of the following best describes the purpose of a “time-out” before a high-risk procedure in the ICU? A) To allow the patient to recover from sedation B) To verify patient identity, procedure, and equipment, reducing errors C) To give the nurse a break before starting a demanding task D) To document the procedure in the electronic health record Answer: B Explanation: A safety “time-out” is a standardized pause to confirm critical information and prevent wrong-site or wrong-procedure errors. Question 50. A patient with severe sepsis is receiving a continuous infusion of vasopressin at 0.03 U/min. Which laboratory parameter should be monitored most closely? A) Serum calcium B) Serum sodium C) Serum magnesium D) Serum phosphate Answer: B
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Answer: C Explanation: Milrinone inhibits PDE-3, raising intracellular cAMP, producing inotropy and vasodilation. Question 54. In a patient with refractory hypoxemia despite optimal ventilator settings, which rescue therapy is most appropriate? A) High-frequency oscillatory ventilation (HFOV) B) Prone positioning for at least 12 hours per day C) Inhaled nitric oxide D) ECMO (extracorporeal membrane oxygenation) Answer: B Explanation: Prone positioning improves V/Q matching and is first-line before more invasive rescue modalities. Question 55. A 45-year-old man with a known history of atrial fibrillation is on warfarin and presents with an intracranial hemorrhage. Which reversal agent should be administered emergently? A) Fresh frozen plasma (FFP) only B) Vitamin K IV and prothrombin complex concentrate (PCC) C) Recombinant factor VIIa alone D) Platelet transfusion Answer: B Explanation: PCC rapidly restores clotting factors; vitamin K ensures sustained reversal. Question 56. Which of the following best describes the physiologic effect of positive end-expiratory pressure (PEEP) on cardiac output? A) Increases preload by augmenting venous return B) Decreases afterload by reducing systemic vascular resistance
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C) May reduce cardiac output by decreasing preload due to increased intrathoracic pressure D) Has no effect on cardiac output Answer: C Explanation: High PEEP raises intrathoracic pressure, potentially impeding venous return and lowering preload. Question 57. A patient with severe hypernatremia (serum Na⁺ = 165 mEq/L) and altered mental status is being treated. Which fluid is most appropriate for gradual correction? A) 0.9% saline B) 5% dextrose in water (D5W) C) 3% hypertonic saline D) Lactated Ringer’s solution Answer: B Explanation: D5W is hypotonic relative to plasma, providing free water to lower serum sodium safely. Question 58. Which of the following is a common early sign of increased intracranial pressure in a sedated, intubated patient? A) Bradycardia and hypertension (Cushing’s triad) B) Hyperthermia C) Diaphoresis D) Hypoglycemia Answer: A Explanation: Cushing’s reflex (hypertension, bradycardia, irregular respirations) indicates rising ICP. Question 59. In a patient receiving continuous veno-venous hemofiltration (CVVH), which parameter primarily determines solute clearance?
