Critical Care Exam Questions And
Correct Answers (Verified Answers)
Plus Rationales 2025/2026 Q&A
1. A patient in septic shock has hypotension despite 30 mL/kg
crystalloid fluid resuscitation. What is the first-line vasopressor
recommended?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Phenylephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock
as it primarily acts on alpha-adrenergic receptors to increase vascular
tone without excessive tachycardia.
2. Which of the following is the most sensitive early indicator of
hypovolemic shock?
A) Blood pressure
B) Heart rate
C) Lactate level
D) Urine output
Rationale: Lactate rises early in shock due to tissue hypoperfusion,
even before hypotension or oliguria develops.
3. A patient with ARDS is on mechanical ventilation. Which strategy
reduces mortality?
A) High tidal volume ventilation
B) Low tidal volume ventilation (6 mL/kg predicted body weight)
,C) Hyperoxia
D) Permissive hypercapnia only
Rationale: Low tidal volume ventilation reduces ventilator-induced
lung injury and improves survival in ARDS.
4. In a patient with cardiogenic shock, which intervention is most
likely to improve cardiac output?
A) Aggressive IV fluids
B) Inotropic support (e.g., dobutamine)
C) Vasoconstrictors only
D) Sedation alone
Rationale: Inotropes increase myocardial contractility and improve
cardiac output in cardiogenic shock. Excess fluids may worsen
pulmonary edema.
5. Which of the following is most consistent with early septic
shock?
A) Hypotension, cold extremities
B) Bradycardia, hypotension
C) Hypotension, warm extremities, tachycardia
D) Hypertension, warm extremities
Rationale: Early septic shock is typically “warm” shock with
peripheral vasodilation, hypotension, and tachycardia.
6. What is the preferred initial treatment for a patient with acute
adrenal crisis in the ICU?
A) Oral hydrocortisone
B) IV hydrocortisone
,C) Fludrocortisone only
D) Prednisone
Rationale: IV hydrocortisone provides rapid glucocorticoid
replacement, essential in adrenal crisis to prevent cardiovascular
collapse.
7. A patient on mechanical ventilation develops hypotension and
high peak airway pressures. Which condition should be ruled out
first?
A) Pulmonary embolism
B) Myocardial infarction
C) Tension pneumothorax
D) Sepsis
Rationale: Sudden hypotension and elevated airway pressures
suggest tension pneumothorax, a life-threatening emergency
requiring immediate decompression.
8. Which arterial blood gas pattern is most consistent with early
sepsis?
A) Respiratory acidosis
B) Metabolic acidosis with increased lactate
C) Respiratory alkalosis
D) Metabolic alkalosis
Rationale: Tissue hypoperfusion in sepsis leads to anaerobic
metabolism and elevated lactate, causing metabolic acidosis.
9. In a patient with intracranial hypertension, which intervention
reduces intracranial pressure?
, A) Rapid IV fluids
B) Head elevation to 30 degrees
C) Supine positioning
D) Hypercarbia
Rationale: Elevating the head promotes venous drainage and lowers
ICP. Hypercarbia increases cerebral blood flow and ICP.
10. Which sedation strategy is preferred in critically ill,
mechanically ventilated patients?
A) Deep sedation with benzodiazepines
B) Daily deep sedation
C) Light sedation with daily awakening trials
D) Continuous propofol without interruption
Rationale: Light sedation with daily awakening improves outcomes,
reduces delirium, and shortens ventilation duration.
11. Which electrolyte disturbance is most commonly associated
with digoxin toxicity?
A) Hypernatremia
B) Hypokalemia
C) Hypermagnesemia
D) Hypocalcemia
Rationale: Hypokalemia increases myocardial sensitivity to digoxin,
predisposing to arrhythmias.
12. What is the initial fluid choice in septic shock resuscitation?
A) Albumin
B) Crystalloid (normal saline or balanced solution)
Correct Answers (Verified Answers)
Plus Rationales 2025/2026 Q&A
1. A patient in septic shock has hypotension despite 30 mL/kg
crystalloid fluid resuscitation. What is the first-line vasopressor
recommended?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Phenylephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock
as it primarily acts on alpha-adrenergic receptors to increase vascular
tone without excessive tachycardia.
2. Which of the following is the most sensitive early indicator of
hypovolemic shock?
A) Blood pressure
B) Heart rate
C) Lactate level
D) Urine output
Rationale: Lactate rises early in shock due to tissue hypoperfusion,
even before hypotension or oliguria develops.
3. A patient with ARDS is on mechanical ventilation. Which strategy
reduces mortality?
A) High tidal volume ventilation
B) Low tidal volume ventilation (6 mL/kg predicted body weight)
,C) Hyperoxia
D) Permissive hypercapnia only
Rationale: Low tidal volume ventilation reduces ventilator-induced
lung injury and improves survival in ARDS.
4. In a patient with cardiogenic shock, which intervention is most
likely to improve cardiac output?
A) Aggressive IV fluids
B) Inotropic support (e.g., dobutamine)
C) Vasoconstrictors only
D) Sedation alone
Rationale: Inotropes increase myocardial contractility and improve
cardiac output in cardiogenic shock. Excess fluids may worsen
pulmonary edema.
5. Which of the following is most consistent with early septic
shock?
A) Hypotension, cold extremities
B) Bradycardia, hypotension
C) Hypotension, warm extremities, tachycardia
D) Hypertension, warm extremities
Rationale: Early septic shock is typically “warm” shock with
peripheral vasodilation, hypotension, and tachycardia.
6. What is the preferred initial treatment for a patient with acute
adrenal crisis in the ICU?
A) Oral hydrocortisone
B) IV hydrocortisone
,C) Fludrocortisone only
D) Prednisone
Rationale: IV hydrocortisone provides rapid glucocorticoid
replacement, essential in adrenal crisis to prevent cardiovascular
collapse.
7. A patient on mechanical ventilation develops hypotension and
high peak airway pressures. Which condition should be ruled out
first?
A) Pulmonary embolism
B) Myocardial infarction
C) Tension pneumothorax
D) Sepsis
Rationale: Sudden hypotension and elevated airway pressures
suggest tension pneumothorax, a life-threatening emergency
requiring immediate decompression.
8. Which arterial blood gas pattern is most consistent with early
sepsis?
A) Respiratory acidosis
B) Metabolic acidosis with increased lactate
C) Respiratory alkalosis
D) Metabolic alkalosis
Rationale: Tissue hypoperfusion in sepsis leads to anaerobic
metabolism and elevated lactate, causing metabolic acidosis.
9. In a patient with intracranial hypertension, which intervention
reduces intracranial pressure?
, A) Rapid IV fluids
B) Head elevation to 30 degrees
C) Supine positioning
D) Hypercarbia
Rationale: Elevating the head promotes venous drainage and lowers
ICP. Hypercarbia increases cerebral blood flow and ICP.
10. Which sedation strategy is preferred in critically ill,
mechanically ventilated patients?
A) Deep sedation with benzodiazepines
B) Daily deep sedation
C) Light sedation with daily awakening trials
D) Continuous propofol without interruption
Rationale: Light sedation with daily awakening improves outcomes,
reduces delirium, and shortens ventilation duration.
11. Which electrolyte disturbance is most commonly associated
with digoxin toxicity?
A) Hypernatremia
B) Hypokalemia
C) Hypermagnesemia
D) Hypocalcemia
Rationale: Hypokalemia increases myocardial sensitivity to digoxin,
predisposing to arrhythmias.
12. What is the initial fluid choice in septic shock resuscitation?
A) Albumin
B) Crystalloid (normal saline or balanced solution)
