ICU NURSE QUESTIONS

CASE 1
Mr. Jackle, 68 yrs old, is admitted with hypotension and respiratory distress requiring intubation following a large ST elevation anterior-lateral wall myocardial infarction.

1. Shortly after insertion of a rights subclavian catheter, he develops worsening shortness of breath and
bibasilar crackles. Blood is noted to be backing up from the central venous catheter and his oxygen
saturation decreases with supine positioning. Which one of the following problems is consistent with
these findings?
a. Pulmonary embolus
b. Right heart failure
c. Cardiac pulmonary edema
d. Hemopneumothorax

2. Mr. Jackle’s will be monitored for signs of reinfarction. Which one of the following lab tests would best
indicate reinfarction?
a. Creatinine kinase
b. Cardiac troponin
c. Lactate dehydrogenase
d. Venous oxygen saturation

3. Mr. Jackle develops cardiogenic shock, respiratory failure and acute kidney injury. He is receiving
epinephrine at 2 ug/min and is fully ventilated on an FiO2 .6 with PEEP 10. His SpO2 is 95%, HR 93
(sinus rhythm), BP 110/72 (MAP 66), CVP 14 mmHg, Hb 82 and central venous oxygen saturation
(ScvO2) 42%. Which one of the following interventions is most appropriate?
a. Metoprolol
b. Captopril
c. Increased FiO2
d. Packed cells

4. Mr. Jackle has a right chest tube inserted for a large pneumothorax. Immediately following insertion, the nurse notes that there is no fluctuation or bubbling in the underwater seal. Which one of the following interventions is the priority?
a. Increase the level of suction
b. Increase the volume in the water seal

c. Strip the chest tube
d. Obtain a STAT chest xray

Case 2
Mohammad is an 18 yr old man who was struck by a baseball bat in the L temple while playing baseball. He sustained a depressed skull fracture and is started on a dopamine infusion to support his BP.
Case 2: Question 1
5. On his way to the CT scanner, Mohammad’s L pupil suddenly becomes fixed and dilated. Which one
of the following problems is consistent with these findings?
a. Epidural hematoma with compression of CN V
b. Pupillary dilation secondary to dopamine administration
c. Left mass effect with tentorial herniation
d. Bleeding from the ophthalmic artery
Case 2: Question 2
6. Mohammad’s pupil remains dilated and his blood pressure has increased to 180/70 with a HR of 45.
Which one of the following interventions is the priority?
a. Position head of bed flat
b. Administer lasix
c. Hyperventilation
d. Administer labetolol
Case 2: Question 3
7. Which pharmacological agent would you anticipate to treat Mohammad’s raised intracranial pressure
with a BP of 180/55 and HR 45?
a. Dobutamine
b. Nimodipine
c. Hypertonic saline
d. Atropine
Case 2: Question 4
8. Mohammad undergoes an emergency craniectomy, evacuation of epidural hematoma and insertion
of external intraventricular drainage catheter. When zeroing the cerebral spinal fluid collecting system, what landmark will you use?
a. Mid axillary line
b. Base of occiput
c. Foramen of Monro
d. Cleft of chin

Case 2: Question 5
9. Mohammad’s condition deteriorates and he no longer responds to stimulation. Which one of the
following lab tests is mandatory to confirm the diagnosis of neurological death (brain death)?
a. PaO2
b. Lactate
c. PaCO2
d. Ammonia

Case 2: Question 6

10. Mohammad aspirated at the time of intubation and develops ARDS with worsening hypoxemia, with SpO2 of 85% on FiO2 0.8 and PEEP 5 cmH20. Which one of the following interventions is a priority.

a. Increase his FiO2 to 1.0 and accept SpO2 of 90%

b. Increase the level of PEEP as required and monitor ICP

c. Initiate low tidal volume ventilation

d. Prepare for urgent bronchoscopy

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