MOH Prometric · Clinical Practice & Patient Safety

Medical-Surgical Nursing and Critical Care Interventions

61 practice questions, each with the answer and an explanation.

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Random questions from this topic, one at a time. You see the answer and the explanation straight after each one.

All 61 questions

  1. A nurse is caring for an intubated, mechanically ventilated patient in the intensive care unit. According to the Institute for Healthcare Improvement (IHI) Ventilator Bundle, which combination of inte…
  2. A patient who underwent a left-sided mastectomy with axillary lymph node dissection is admitted to the surgical ward. What vital nursing precaution must be observed regarding the patient's left upper…
  3. A nurse is caring for a patient who returned from surgery 6 hours ago with an indwelling urinary catheter. The hourly urine collection bag shows: Hour 1: 15 mL, Hour 2: 12 mL, Hour 3: 18 mL, Hour 4: 1…
  4. A patient with severe acute traumatic brain injury is monitored in the neuro-intensive care unit. The patient's mean arterial pressure (MAP) is 85 mmHg and intracranial pressure (ICP) is 25 mmHg. What…
  5. A patient with acute spinal cord injury at the T4 level presents with sudden throbbing headache, diaphoresis above the level of injury, nasal congestion, and severe hypertension (BP 210/115 mmHg) acco…
  6. A nurse is caring for a patient who had a plaster cast applied to the left lower extremity 4 hours ago for a tibial fracture. The patient reports severe, escalating pain that is refractory to IV opioi…
  7. A nurse is performing intermittent enteral tube feedings via a nasogastric (NG) tube for a comatose adult patient. Which evidence-based bedside method is the gold standard for initially verifying corr…
  8. A patient who underwent a thyroidectomy 12 hours ago suddenly displays high-pitched inspiratory stridor, tachypnea, and restlessness. Inspection of the neck reveals a rapidly expanding, tense, firm su…
  9. A patient is admitted with acute ischemic stroke. In evaluating whether the patient is an eligible candidate for intravenous thrombolysis (tissue plasminogen activator / Alteplase), what is the strict…
  10. A nurse is caring for a patient who has a temporary transvenous cardiac pacemaker following an inferior wall myocardial infarction. On the cardiac telemetry monitor, the nurse notes pacing spikes that…
  11. A nurse is managing a patient who underwent a transurethral resection of the prostate (TURP) with continuous bladder irrigation (CBI). The nurse notes that the drainage tubing has stopped flowing, the…
  12. A patient is admitted to the surgical ward following a right total knee arthroplasty. To prevent deep vein thrombosis and venous stasis, the nurse applies Sequential Compression Devices (SCDs). Under…
  13. A nurse is caring for a patient who had a percutaneous femoral cardiac catheterization 2 hours ago. On assessment, the nurse notes a large, firm, expanding hematoma at the right groin puncture site, a…
  14. A nurse is preparing to administer total parenteral nutrition (TPN) via a central venous catheter. Which clinical monitoring parameter is critical during TPN therapy due to the high dextrose concentra…
  15. A patient who underwent abdominal aortic aneurysm (AAA) repair has an indwelling arterial line for continuous blood pressure monitoring. The nurse performs a fast-flush dynamic response test (square w…
  16. A nurse is caring for a patient who has a chest tube connected to a closed drainage system. While turning the patient, the chest tube accidentally gets dislodged completely from the chest wall. What i…
  17. A 65-year-old male with an acute myocardial infarction is admitted to the cardiac intensive care unit. The nurse notes that the patient's cardiac rhythm displays regular broad, wide QRS complexes (> 0…
  18. A patient is scheduled for an elective surgical procedure. The nurse identifies that the patient takes Dabigatran (a direct oral anticoagulant) for non-valvular atrial fibrillation. Under clinical gui…
  19. A nurse is caring for an adult patient receiving mechanical ventilation. The ventilator high-pressure alarm suddenly sounds. Which physiological or mechanical factor is a common cause of high-pressure…
  20. A patient with an external ventricular drain (EVD) for monitoring intracranial pressure is positioned in bed. To obtain accurate, standardized intracranial pressure readings, at what anatomical refere…
  21. A nurse is assessing a patient 2 days after open colon resection. On inspection, the surgical abdominal dressing is saturated with serosanguinous fluid. When the nurse removes the dressing, loops of b…
  22. A patient is admitted to the intensive care unit with acute pancreatitis. The nurse notices faint bluish ecchymotic discoloration around the umbilicus. What is this physical sign called, and what does…
  23. A nurse is caring for an adult patient receiving continuous intravenous insulin infusion for hyperosmolar hyperglycemic state (HHS). The blood glucose level has decreased from 42 mmol/L down to 14 mmo…
  24. A patient is receiving high-dose intravenous chemotherapy. The nurse observes that the peripheral IV site is red and swollen, and the patient reports severe burning pain. The infusion is Doxorubicin (…
  25. A patient with diabetic ketoacidosis has these arterial blood gas results: pH 7.31, PaCO2 29 mmHg, HCO3 14 mmol/L. What is the interpretation?
  26. A patient with renal failure has potassium 6.8 mmol/L with peaked T waves and a widened QRS. Which drug should be given first to protect the heart?
  27. Two hours after coronary artery bypass surgery, chest tube drainage suddenly stops. The patient is now hypotensive with distended neck veins and muffled heart sounds. What should the nurse do?
  28. A patient with a head injury has a mean arterial pressure of 85 mmHg and an intracranial pressure of 30 mmHg. What is the cerebral perfusion pressure and what should the nurse do?
  29. A 58-year-old patient with acute respiratory distress syndrome is on mechanical ventilation. Which tidal volume setting per predicted body weight adheres to evidence-based lung-protective ventilation…
  30. A patient with acute intracranial hypertension following head trauma is monitored in the neuro-intensive care unit. Which cerebral perfusion pressure range represents the standard therapeutic target?
  31. A postoperative thyroidectomy patient complains of tingling around the mouth and fingers. Chvostek sign is positive. Which immediate electrolyte deficiency should the nurse suspect?
  32. Which arterial blood gas finding is characteristic of an uncompensated respiratory acidosis?
  33. A patient with a central venous catheter exhibits sudden dyspnea, cyanosis, and hypotension. Air embolism is suspected. What is the immediate positioning for this patient?
  34. A patient with acute pancreatitis has persistent epigastric pain radiating to the back. Which intravenous fluid resuscitation strategy is recommended within the initial 24 hours?
  35. In a patient with chest tube drainage, continuous bubbling is observed in the water-seal chamber. What is the primary clinical significance of this finding?
  36. A patient in the intensive care unit has an arterial line placed in the radial artery. Which physical exam maneuver must be documented prior to radial artery cannulation?
  37. Which clinical constellation defines Cushing triad in the presence of life-threatening intracranial hypertension?
  38. A patient admitted with diabetic ketoacidosis has an initial serum potassium level of 3.1 mEq/L. What is the essential immediate action prior to starting intravenous regular insulin infusion?
  39. A patient who sustained blunt chest trauma develops distended neck veins, distant heart sounds, and arterial hypotension. Which diagnosis should the clinician establish?
  40. A critically ill patient with septic shock remains hypotensive despite 30 mL/kg crystalloid administration. Which vasopressor is the first-line agent of choice?
  41. A patient undergoing continuous hemodynamic monitoring has a pulmonary artery catheter. Which parameter best estimates left ventricular end-diastolic pressure?
  42. A trauma patient exhibits paradoxical inward movement of the chest wall during inspiration and outward movement during expiration. Which underlying condition is present?
  43. Which intervention is part of the Institute for Healthcare Improvement ventilator-associated pneumonia bundle?
  44. A patient with cirrhosis and severe ascites develops sudden fever, abdominal tenderness, and altered mental status. Which diagnostic evaluation is essential?
  45. In managing a patient with acute coronary syndrome, which medication is contraindicated if the patient has ingested a phosphodiesterase-5 inhibitor within 24 hours?
  46. A nurse cares for a patient with deep vein thrombosis receiving a continuous heparin infusion. Which laboratory parameter is used to titrate unfractionated heparin?
  47. What is the primary physiologic goal of applying positive end-expiratory pressure in a mechanically ventilated patient?
  48. A patient presenting with acute ischemic stroke arrives within 2 hours of symptom onset. What is the blood pressure threshold required prior to initiating intravenous thrombolytic therapy?
  49. A post-craniotomy patient develops large volumes of dilute urine exceeding 300 mL/h, high serum sodium, and low urine specific gravity. What is the expected diagnosis?
  50. Which clinical assessment score evaluates the depth of sedation and agitation in adult intensive care unit patients?
  51. A patient with acute spinal cord injury at the T4 level presents with severe pounding headache, diaphoresis above the injury level, and profound bradycardia. What is the initial nursing action?
  52. Which intravenous solution is contraindicated for fluid resuscitation in a patient with severe traumatic brain injury and intracranial hypertension?
  53. A patient admitted with acute liver failure shows flapping tremor of extended wrists. What clinical term describes this motor finding?
  54. What is the recommended chest compression rate during adult basic life support resuscitation?
  55. A patient on high-dose furosemide therapy develops flattened T waves, ST segment depression, and prominent U waves on electrocardiogram. Which electrolyte disturbance is present?
  56. In a patient with suspected tension pneumothorax exhibiting hemodynamic instability, what is the immediate lifesaving procedure before obtaining a chest radiograph?
  57. Which clinical finding indicates successful treatment and resolution of diabetic ketoacidosis?
  58. A patient with severe acute pancreatitis develops hypocalcemia. What physical sign is demonstrated by tapping the facial nerve anterior to the earlobe?
  59. What is the recommended head-of-bed elevation angle for reducing intracranial pressure while maintaining cerebral perfusion?
  60. A patient with refractory septic shock requires arterial blood pressure monitoring. Which complication is most commonly associated with indwelling arterial catheters?
  61. Which ventilatory parameter directly determines minute ventilation along with tidal volume?

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