HFHS Critical Care Exam Actual A+ Graded Solutions |
Complete Questions & Rationales | Advanced ICU
Nursing | Pass Guaranteed - A+ Graded
Hemodynamics & Shock Management
Q1: A pulmonary artery catheter is in place and the nurse is verifying normal pressure
ranges. Which of the following represents the expected normal pulmonary artery
pressure?
A. 5––8 mmHg
B. 15––15 mmHg [CORRECT]
C. 20––20 mmHg
D. 8––5 mmHg
Correct Answer: B
Rationale: The correct answer is B. In HFHS critical care, we expect normal PA
pressures to fall around 15–30 mmHg systolic and 5–15 mmHg diastolic, with a mean
of 10–20 mmHg. Anything outside that range tells you the patient is drifting into trouble.
Q2: The nurse is reviewing systemic vascular resistance on a hemodynamic profile.
What is the expected normal range for SVR?
A. 200–500 dynes·sec·cm⁻⁵
B. 500–800 dynes·sec·cm⁻⁵
C. 800–1200 dynes·sec·cm⁻⁵ [CORRECT]
D. 1500–2500 dynes·sec·cm⁻⁵
Correct Answer: C
Rationale: The correct answer is C. Normal SVR runs about 800–1200 dynes·sec·cm⁻⁵.
When you see it climbing above 1200, think vasoconstriction or hypovolemia; when it
drops below 800, suspect distributive shock.
,Q3: A patient in the ICU meets criteria for suspected sepsis. The nurse is calculating the
qSOFA score at the bedside. Which three parameters make up the qSOFA criteria?
A. Heart rate >90, temperature >38°C, white blood cell count >12,000
B. Respiratory rate ≥22, altered mentation, systolic blood pressure ≤100 mmHg
[CORRECT]
C. Lactate >2, creatinine >1.5, platelet count <150,000
D. Mean arterial pressure <65, urine output <0.5 mL/kg/hr, bilirubin >2
Correct Answer: B
Rationale: The correct answer is B. qSOFA is a quick bedside screen using only
respiratory rate ≥22, altered mentation, and systolic BP ≤100. Two or more of those
flags should make you worry about bad outcomes and push for a full SOFA assessment.
Q4: A 58-year-old patient meets sepsis criteria with a lactate of 4.2 mmol/L and blood
pressure of 88/52 mmHg. According to the Sepsis-1 hour bundle, which intervention
takes the highest immediate priority?
A. Administering 1 gram of acetaminophen for fever
B. Initiating vasopressors through a peripheral IV
C. Obtaining blood cultures, administering broad-spectrum antibiotics, and giving 30
mL/kg crystalloid resuscitation [CORRECT]
D. Placing a pulmonary artery catheter before giving fluids
Correct Answer: C
Rationale: The correct answer is C. In HFHS critical care, the sepsis bundle requires
antibiotics and fluid resuscitation within one hour of recognition, and you never delay
antibiotics to wait for cultures beyond the two sets you draw right up front. That 30
mL/kg bolus and early antibiotics save lives.
Q5: The nurse notices the arterial line waveform has a slurred upstroke, the dicrotic
notch is absent, and the systolic pressure reads lower than expected. Which of the
following best explains this finding?
A. The transducer is positioned below the level of the phlebostatic axis
B. The system is overdamped [CORRECT]
C. The patient is experiencing severe aortic regurgitation
D. The catheter is positioned in the distal aorta
Correct Answer: B
Rationale: The correct answer is B. That slurred upstroke and loss of the dicrotic notch
is classic overdamping, usually from air bubbles, loose connections, or compliant
, tubing. It falsely lowers the systolic and raises the diastolic, so you’re not seeing the
true picture until you flush the system and check your setup.
Q6: A trauma patient presents with the following hemodynamics: MAP 58 mmHg, CVP 2
mmHg, PAOP 4 mmHg, cardiac index 1.8 L/min/m², and SVR 1800 dynes·sec·cm⁻⁵.
Which shock state is most consistent with this profile?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: The correct answer is B. That hemodynamic profile is classic for hypovolemic
shock because the filling pressures are tanked, the cardiac index is low, and the SVR is
sky-high as the body tries to compensate for absolute volume loss.
Q7: A patient in septic shock has received 30 mL/kg of crystalloid but remains
hypotensive with a MAP of 58 mmHg. Which vasopressor is the recommended first-line
agent?
A. Phenylephrine
B. Epinephrine
C. Norepinephrine [CORRECT]
D. Vasopressin
Correct Answer: C
Rationale: The correct answer is C. Norepinephrine is the first-line vasopressor for
septic shock in HFHS critical care because it provides potent alpha-1 agonism with
some beta-1 activity to support both vascular tone and cardiac output without the
arrhythmogenic punch of epinephrine.
Q8: The nurse performs a passive leg raise on a hypotensive patient and notes the
stroke volume increases by 14% on the NICOM monitor. What is the clinical significance
of this finding?
A. The patient is likely in cardiogenic shock
B. The patient will not respond to additional fluid
C. The patient is fluid responsive [CORRECT]
D. The patient requires immediate vasopressor initiation
Correct Answer: C
Complete Questions & Rationales | Advanced ICU
Nursing | Pass Guaranteed - A+ Graded
Hemodynamics & Shock Management
Q1: A pulmonary artery catheter is in place and the nurse is verifying normal pressure
ranges. Which of the following represents the expected normal pulmonary artery
pressure?
A. 5––8 mmHg
B. 15––15 mmHg [CORRECT]
C. 20––20 mmHg
D. 8––5 mmHg
Correct Answer: B
Rationale: The correct answer is B. In HFHS critical care, we expect normal PA
pressures to fall around 15–30 mmHg systolic and 5–15 mmHg diastolic, with a mean
of 10–20 mmHg. Anything outside that range tells you the patient is drifting into trouble.
Q2: The nurse is reviewing systemic vascular resistance on a hemodynamic profile.
What is the expected normal range for SVR?
A. 200–500 dynes·sec·cm⁻⁵
B. 500–800 dynes·sec·cm⁻⁵
C. 800–1200 dynes·sec·cm⁻⁵ [CORRECT]
D. 1500–2500 dynes·sec·cm⁻⁵
Correct Answer: C
Rationale: The correct answer is C. Normal SVR runs about 800–1200 dynes·sec·cm⁻⁵.
When you see it climbing above 1200, think vasoconstriction or hypovolemia; when it
drops below 800, suspect distributive shock.
,Q3: A patient in the ICU meets criteria for suspected sepsis. The nurse is calculating the
qSOFA score at the bedside. Which three parameters make up the qSOFA criteria?
A. Heart rate >90, temperature >38°C, white blood cell count >12,000
B. Respiratory rate ≥22, altered mentation, systolic blood pressure ≤100 mmHg
[CORRECT]
C. Lactate >2, creatinine >1.5, platelet count <150,000
D. Mean arterial pressure <65, urine output <0.5 mL/kg/hr, bilirubin >2
Correct Answer: B
Rationale: The correct answer is B. qSOFA is a quick bedside screen using only
respiratory rate ≥22, altered mentation, and systolic BP ≤100. Two or more of those
flags should make you worry about bad outcomes and push for a full SOFA assessment.
Q4: A 58-year-old patient meets sepsis criteria with a lactate of 4.2 mmol/L and blood
pressure of 88/52 mmHg. According to the Sepsis-1 hour bundle, which intervention
takes the highest immediate priority?
A. Administering 1 gram of acetaminophen for fever
B. Initiating vasopressors through a peripheral IV
C. Obtaining blood cultures, administering broad-spectrum antibiotics, and giving 30
mL/kg crystalloid resuscitation [CORRECT]
D. Placing a pulmonary artery catheter before giving fluids
Correct Answer: C
Rationale: The correct answer is C. In HFHS critical care, the sepsis bundle requires
antibiotics and fluid resuscitation within one hour of recognition, and you never delay
antibiotics to wait for cultures beyond the two sets you draw right up front. That 30
mL/kg bolus and early antibiotics save lives.
Q5: The nurse notices the arterial line waveform has a slurred upstroke, the dicrotic
notch is absent, and the systolic pressure reads lower than expected. Which of the
following best explains this finding?
A. The transducer is positioned below the level of the phlebostatic axis
B. The system is overdamped [CORRECT]
C. The patient is experiencing severe aortic regurgitation
D. The catheter is positioned in the distal aorta
Correct Answer: B
Rationale: The correct answer is B. That slurred upstroke and loss of the dicrotic notch
is classic overdamping, usually from air bubbles, loose connections, or compliant
, tubing. It falsely lowers the systolic and raises the diastolic, so you’re not seeing the
true picture until you flush the system and check your setup.
Q6: A trauma patient presents with the following hemodynamics: MAP 58 mmHg, CVP 2
mmHg, PAOP 4 mmHg, cardiac index 1.8 L/min/m², and SVR 1800 dynes·sec·cm⁻⁵.
Which shock state is most consistent with this profile?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: The correct answer is B. That hemodynamic profile is classic for hypovolemic
shock because the filling pressures are tanked, the cardiac index is low, and the SVR is
sky-high as the body tries to compensate for absolute volume loss.
Q7: A patient in septic shock has received 30 mL/kg of crystalloid but remains
hypotensive with a MAP of 58 mmHg. Which vasopressor is the recommended first-line
agent?
A. Phenylephrine
B. Epinephrine
C. Norepinephrine [CORRECT]
D. Vasopressin
Correct Answer: C
Rationale: The correct answer is C. Norepinephrine is the first-line vasopressor for
septic shock in HFHS critical care because it provides potent alpha-1 agonism with
some beta-1 activity to support both vascular tone and cardiac output without the
arrhythmogenic punch of epinephrine.
Q8: The nurse performs a passive leg raise on a hypotensive patient and notes the
stroke volume increases by 14% on the NICOM monitor. What is the clinical significance
of this finding?
A. The patient is likely in cardiogenic shock
B. The patient will not respond to additional fluid
C. The patient is fluid responsive [CORRECT]
D. The patient requires immediate vasopressor initiation
Correct Answer: C
