NCMB 418 Prelim

1. Which of the following best defines critical care nursing?
   a. Care given to stable patients
   b. Care of the seriously ill clients from point of illness until ICU discharge
   c. Care only focused on medical interventions
   d. Care provided exclusively to post-operative patients

b. Care of the seriously ill clients from point of illness until ICU discharge

2. The primary goal of critical care nursing is:
   a. To maximize hospital profits
   b. To reduce patient admissions
   c. Survival of critically ill patients and restoring quality of life
   d. To limit use of medical technology

c. Survival of critically ill patients and restoring quality of life

3. A critically ill client is classified as Level III if:
   a. At risk of deteriorating
   b. Needs more observation or intervention
   c. Has multisystem failure
   d. Normal ward care is enough

c. Has multisystem failure

4. In the ABCDE assessment framework, “C” stands for:
   a. Circulation, cerebral perfusion, chief complaint
   b. Chest expansion, cough, cyanosis
   c. Cardiac monitoring only
   d. Comfort and care

a. Circulation, cerebral perfusion, chief complaint

5. Which ethical principle means “to do no harm”?
   a. Beneficence
   b. Nonmaleficence
   c. Fidelity
   d. Veracity

b. Nonmaleficence

6. Which is NOT part of Virchow’s triad in pulmonary embolism?
   a. Vessel wall injury
   b. Hypercoagulability
   c. Venous stasis
   d. Hypoxemia

d. Hypoxemia

7. A 65-year-old smoker presents with chronic cough and dyspnea on exertion. What is the most likely diagnosis?
   a. Pneumothorax
   b. COPD
   c. Pulmonary embolism
   d. Pneumonia

b. COPD

8. In acute respiratory distress syndrome (ARDS), the chest X-ray typically shows:
   a. Enlarged heart
   b. “White-out” lungs
   c. Normal findings
   d. Pleural effusion

b. “White-out” lungs

9. A PaO2 less than 50 mmHg with a PaCO2 greater than 50 mmHg indicates:
   a. Normal gas exchange
   b. Acute respiratory failure
   c. COPD exacerbation only
   d. Pneumonia

b. Acute respiratory failure

10. Type I respiratory failure is also called:
    a. Hypoxemic
    b. Hypercapnic
    c. Obstructive
    d. Restrictive

a. Hypoxemic

11. The main nursing intervention for a patient with COPD in the ED is:
    a. Maintain oxygen saturation at 100%
    b. O2 therapy to keep saturation 88–92%
    c. Immediate intubation for all patients
    d. Strict bed rest only

b. O2 therapy to keep saturation 88–92%

12. Which microorganism is responsible for about 90% of community-acquired pneumonia?
    a. Haemophilus influenzae
    b. Staphylococcus aureus
    c. Streptococcus pneumoniae
    d. Legionella species

c. Streptococcus pneumoniae

13. In ventilator-associated pneumonia (VAP), which preventive measure is included in the care bundle?
    a. Head of bed elevation 30–45°
    b. Sedation 24/7 without breaks
    c. Tube cuff pressure left unchecked
    d. No oral care needed

a. Head of bed elevation 30–45°

14. A patient with pneumonia presents with dullness on percussion and bronchial breath sounds. These findings are consistent with:
    a. Pleural effusion
    b. Consolidation
    c. Asthma
    d. Pulmonary embolism

b. Consolidation

15. CURB-65 score of 3 indicates:
    a. Mild pneumonia, can be discharged
    b. Moderate risk, admit to ward
    c. High risk, associated with 17% mortality
    d. No need for treatment

c. High risk, associated with 17% mortality

16. Which of the following is a serious symptom of COVID-19?
    a. Headache
    b. Rash on skin
    c. Loss of taste or smell
    d. Chest pain or pressure

d. Chest pain or pressure

17. Which ventilatory mode delivers a preset tidal volume at a preset rate but allows spontaneous breaths between ventilated breaths?
    a. Assist-control ventilation (ACV)
    b. Synchronized intermittent mandatory ventilation (SIMV)
    c. Pressure-controlled ventilation (PCV)
    d. CPAP

b. Synchronized intermittent mandatory ventilation (SIMV)

18. A high-pressure alarm in a mechanical ventilator usually indicates:
    a. Patient disconnection
    b. Leak in the circuit
    c. Obstruction or increased airway resistance
    d. Battery failure

c. Obstruction or increased airway resistance

19. A patient in the ICU develops ventilator-associated pneumonia. Which of the following findings support this diagnosis?
    a. Pyrexia >38°C, new purulent sputum, worsening gas exchange
    b. Normal WBC count, dry cough only
    c. Absence of secretions, no radiological changes
    d. Hyperglycemia and weight loss

a. Pyrexia >38°C, new purulent sputum, worsening gas exchange

20. A nurse observes that a patient’s oxygen saturation suddenly drops to 82%. The first nursing action is to:
    a. Call the physician immediately
    b. Administer high-flow oxygen
    c. Reassess pulse oximeter probe and patient’s condition
    d. Stop IV fluids

c. Reassess pulse oximeter probe and patient’s condition

21. Which diagnostic test detects clot fragments from clot lysis in pulmonary embolism?
    a. ABG
    b. D-dimer test
    c. ECG
    d. Pulmonary angiography

b. D-dimer test

22. A risk factor for ARDS includes:
    a. Controlled hypertension
    b. Cigarette smoking
    c. Mild scoliosis
    d. Chronic anemia

b. Cigarette smoking

23. Which is the gold standard diagnostic test for pulmonary embolism?
    a. Chest X-ray
    b. V/Q scan
    c. Spiral CT scan
    d. Pulmonary angiography

d. Pulmonary angiography

24. Which symptom is most specific for pulmonary embolism?
    a. Fever
    b. Chest pain and tachypnea
    c. Wheezing
    d. Productive cough with green sputum

b. Chest pain and tachypnea

25. A patient is intubated for respiratory distress. Verification of proper ET tube placement includes:
    a. Presence of unilateral breath sounds
    b. Chest X-ray confirmation
    c. No excursion during inspiration
    d. Loud gurgling over stomach

b. Chest X-ray confirmation

26. How long should an endotracheal tube be used before considering tracheostomy?
    a. 2–4 days
    b. 10–14 days
    c. 21–28 days
    d. 1 month

b. 10–14 days

27. Which ABG result indicates respiratory acidosis?
    a. pH 7.48, PaCO2 30 mmHg
    b. pH 7.28, PaCO2 55 mmHg
    c. pH 7.50, PaCO2 33 mmHg
    d. pH 7.36, PaCO2 40 mmHg

b. pH 7.28, PaCO2 55 mmHg

28. Which condition is an example of Type II respiratory failure?
    a. Pneumonia
    b. Pulmonary edema
    c. Drug overdose
    d. ARDS

c. Drug overdose

29. Which nursing intervention is MOST important for a patient with COPD receiving oxygen therapy?
    a. Maintain O2 saturations 100%
    b. Keep O2 saturations between 88–92%
    c. Withhold oxygen to prevent CO2 retention
    d. Start oxygen at 10 L/min via non-rebreather mask

b. Keep O2 saturations between 88–92%

30. Which of the following is considered a non-invasive airway adjunct?
    a. Endotracheal tube
    b. Nasopharyngeal airway
    c. Tracheostomy
    d. Laryngoscope

b. Nasopharyngeal airway

31. The main complication of high levels of PEEP is:
    a. Hypertension
    b. Hypotension and decreased cardiac output
    c. Hypoglycemia
    d. Increased urine output

b. Hypotension and decreased cardiac output

32. Which ventilatory mode provides positive pressure only during spontaneous breathing?
    a. SIMV
    b. CPAP
    c. ACV
    d. PRVC

b. CPAP

33. A nurse hears fine crackles at the lung bases. This sound usually indicates:
    a. Airway obstruction
    b. Fluid in the alveoli
    c. Bronchospasm
    d. Collapsed lung

b. Fluid in the alveoli

34. Which of the following is NOT part of the VAP bundle of care?
    a. Elevation of head of bed
    b. Daily sedation vacations
    c. Stress ulcer prophylaxis for all patients
    d. Daily oral care with chlorhexidine

c. Stress ulcer prophylaxis for all patients

35. A nurse notices the ventilator’s low-pressure alarm is sounding. What does this usually indicate?
    a. Kinked tubing
    b. Patient coughing
    c. Leak or disconnection in circuit
    d. Excess secretions

c. Leak or disconnection in circuit

36. In pneumonia, which finding suggests consolidation?
    a. Hyperresonance on percussion
    b. Bronchial breath sounds in peripheral lung fields
    c. Absent fremitus
    d. Normal chest expansion

b. Bronchial breath sounds in peripheral lung fields

37. A 72-year-old patient with pneumonia has a CURB-65 score of 2. What is the appropriate management?
    a. Discharge home with oral antibiotics
    b. Admit to hospital for close monitoring
    c. ICU admission immediately
    d. No treatment needed

b. Admit to hospital for close monitoring

38. Which medication is recommended by WHO to reduce mortality in severe COVID-19 patients on ventilators?
    a. Aspirin
    b. Dexamethasone
    c. Vitamin C
    d. Hydroxychloroquine

b. Dexamethasone

39. A nurse is preparing to suction a patient with a nasopharyngeal airway. The priority nursing action is to:
    a. Apply continuous suction for 30 seconds
    b. Rotate the catheter while suctioning
    c. Hyperoxygenate the patient before suctioning
    d. Suction as frequently as possible

c. Hyperoxygenate the patient before suctioning

40. In the ABCs of critical care assessment, what is always addressed FIRST?
    a. Circulation
    b. Airway
    c. Breathing
    d. Disability

b. Airway

41. Which breath sound is normally heard over the trachea?
    a. Vesicular
    b. Bronchial
    c. Bronchovesicular
    d. Crackles

b. Bronchial

42. In mechanical ventilation, what does FiO₂ represent?
    a. Fraction of inspired oxygen
    b. Frequency of inspiratory output
    c. Flow inspiratory option
    d. Forced inspiratory oxygen

a. Fraction of inspired oxygen

43. Which lung volume is measured during normal inspiration and expiration?
    a. Tidal volume
    b. Inspiratory reserve volume
    c. Expiratory reserve volume
    d. Vital capacity

a. Tidal volume

44. A patient is on SIMV mode. The purpose of this mode is to:
    a. Provide full ventilatory support without patient effort
    b. Allow spontaneous breathing between mandatory breaths
    c. Deliver breaths only when triggered by the patient
    d. Provide CPAP only

b. Allow spontaneous breathing between mandatory breaths

45. A nurse notes pH 7.52, PaCO₂ 28 mmHg. This indicates:
    a. Respiratory acidosis
    b. Respiratory alkalosis
    c. Metabolic acidosis
    d. Metabolic alkalosis

b. Respiratory alkalosis

46. The main advantage of using a laryngeal mask airway is:
    a. Long-term use
    b. Prevents aspiration and provides ventilatory support
    c. No need for anesthesia
    d. Can be left indefinitely

b. Prevents aspiration and provides ventilatory support

47. Which of the following is a complication of prolonged ET tube intubation?
    a. Improved oxygenation
    b. Vocal cord paralysis
    c. Increased surfactant production
    d. Increased lung compliance

b. Vocal cord paralysis

48. Which diagnostic test directly measures oxygen and carbon dioxide in arterial blood?
    a. Pulse oximetry
    b. Spirometry
    c. Arterial blood gas (ABG)
    d. Chest X-ray

c. Arterial blood gas (ABG)

49. Normal pulse oximetry reading is:
    a. 80–85%
    b. 88–92%
    c. 95–100%
    d. 60–70%

c. 95–100%

50. Which complication of mechanical ventilation involves damage from excessive volume?
    a. Volutrauma
    b. Barotrauma
    c. Atelectrauma
    d. Hypoventilation

a. Volutrauma

51. Which patient would most likely require critical care admission?
    a. Stable diabetic patient
    b. Post-operative patient after major surgery
    c. Patient with mild asthma
    d. Patient with controlled hypertension

b. Post-operative patient after major surgery

52. A client in ICU has sepsis bundle initiated. Which intervention is PRIORITY?
    a. Administer oral fluids
    b. Start broad-spectrum IV antibiotics
    c. Delay treatment until cultures return
    d. Encourage ambulation

b. Start broad-spectrum IV antibiotics

53. The first step in the PDCA cycle for quality improvement is:
    a. Do
    b. Check
    c. Act
    d. Plan

d. Plan

54. Which is an example of a care bundle?
    a. Group of random interventions
    b. Group of 3–5 evidence-based interventions performed together
    c. One intervention only
    d. Only pharmacologic treatments

b. Group of 3–5 evidence-based interventions performed together

55. Which is TRUE about evidence-based nursing practice?
    a. It excludes patient values
    b. It relies only on nurse’s intuition
    c. It integrates research evidence, clinical expertise, and patient preference
    d. It disregards clinical outcomes

c. It integrates research evidence, clinical expertise, and patient preference

56. In the SPIDER tool for research, “PI” refers to:
    a. Patient interest
    b. Phenomenon of interest
    c. Physician involvement
    d. Population indicator

b. Phenomenon of interest

57. A nurse is performing ethical analysis. The FIRST step is:
    a. Implement the plan
    b. Evaluate outcomes
    c. Identify the problem and gather data
    d. Call the legal team

c. Identify the problem and gather data

58. A 17-year-old married and pregnant girl needs surgery. Who gives informed consent?
    a. Her parents
    b. The physician
    c. The patient herself
    d. The nurse

c. The patient herself

59. Which ethical principle means “being truthful or honest”?
    a. Fidelity
    b. Autonomy
    c. Veracity
    d. Privacy

c. Veracity

60. Which law defines the scope of nursing practice in the Philippines?
    a. R.A. 10918
    b. R.A. 9173
    c. R.A. 1080
    d. R.A. 7877

b. R.A. 9173

61. A DNR order means:
    a. Do not recover
    b. Do not resuscitate
    c. Do not respond
    d. Delay nursing response

b. Do not resuscitate

62. A patient on ventilator suddenly develops hypotension. Which is the most likely cause if PEEP is high?
    a. Increased cardiac output
    b. Decreased venous return
    c. Improved lung compliance
    d. Increased oxygen delivery

b. Decreased venous return

63. Which strategy prevents VAP in intubated patients?
    a. Keep cuff pressure <10 cmH₂O
    b. Perform oral care with chlorhexidine
    c. Keep HOB flat for comfort
    d. Sedate continuously without breaks

b. Perform oral care with chlorhexidine

64. The nurse is caring for a patient with ARDS. Which intervention is MOST important?
    a. Encourage ambulation
    b. Fluid management to maintain tissue perfusion
    c. Stop nutrition completely
    d. Delay oxygen therapy

b. Fluid management to maintain tissue perfusion

65. A patient with COPD is being considered for NIV. Which finding makes him unsuitable?
    a. pH 7.28, PaCO₂ >6kPa
    b. GCS score of 6
    c. Cooperative and conscious
    d. Hemodynamically stable

b. GCS score of 6

66. Which is a symptom of hypoxemia?
    a. Restlessness
    b. Hypotension
    c. Cyanosis
    d. All of the above

d. All of the above

67. Which virus caused the 2003 outbreak of severe acute respiratory syndrome?
    a. MERS-CoV
    b. SARS-CoV
    c. SARS-CoV-2
    d. Influenza H1N1

b. SARS-CoV

68. COVID-19 incubation period is usually:
    a. 1–2 days
    b. 2–14 days
    c. 21–30 days
    d. 60 days

b. 2–14 days

69. Which is a serious symptom of COVID-19 requiring immediate attention?
    a. Sore throat
    b. Loss of smell
    c. Difficulty breathing
    d. Headache

c. Difficulty breathing

70. A critically ill patient’s family asks about advance directives. A “living will” is an example of:
    a. Proxy directive
    b. Treatment directive
    c. Institutional policy
    d. Ethical principle

b. Treatment directive

71. Which intervention is included in pneumonia management in the ED?
    a. IV antibiotics
    b. Delay treatment until sputum culture returns
    c. Encourage oral fluids only
    d. Bed rest for all cases

a. IV antibiotics

72. Which is a common complication of pneumothorax?
    a. Hypertension
    b. Lung collapse
    c. Hypoglycemia
    d. Hyperthermia

b. Lung collapse

73. Which step in ethical decision-making ensures learning from outcomes?
    a. Assessment
    b. Planning
    c. Implementation
    d. Evaluation

d. Evaluation

74. Which ABG result indicates metabolic acidosis?
    a. pH 7.28, HCO₃⁻ 18
    b. pH 7.52, HCO₃⁻ 30
    c. pH 7.45, HCO₃⁻ 24
    d. pH 7.38, HCO₃⁻ 22

a. pH 7.28, HCO₃⁻ 18

75. Which condition is considered a respiratory emergency?
    a. Dyspnea
    b. Apnea
    c. Both A and B
    d. None of the above

c. Both A and B

76. In the ICU, which multidisciplinary plan of care category includes “patient education”?
    a. Discharge outcomes
    b. Nutrition
    c. Activity
    d. Education

d. Education

77. A patient with pneumonia has SpO₂ of 90% on room air. The next best step is:
    a. Observe only
    b. Start supplemental oxygen
    c. Send home with follow-up
    d. Start IV steroids only

b. Start supplemental oxygen

78. Which ethical principle means respecting the patient’s independence?
    a. Autonomy
    b. Fidelity
    c. Beneficence
    d. Veracity

a. Autonomy

79. Which nursing role emphasizes speaking up for patients’ rights?
    a. Educator
    b. Manager
    c. Advocate
    d. Care provider

c. Advocate

80. Which test is MOST useful to assess lung compliance?
    a. Spirometry
    b. ABG
    c. Chest X-ray
    d. Pulse oximetry

a. Spirometry

81. Which ventilatory mode is best for patients with weak respiratory muscles?
    a. Assist-control ventilation (ACV)
    b. SIMV
    c. CPAP
    d. PRVC

a. Assist-control ventilation (ACV)

82. Which intervention is part of the VAP prevention bundle?
    a. Subglottic aspiration
    b. Keep cuff pressure <10 cmH₂O
    c. Avoid sedation breaks
    d. Supine position

a. Subglottic aspiration

83. Which principle guides the nurse to “keep promises”?
    a. Fidelity
    b. Privacy
    c. Nonmaleficence
    d. Justice

a. Fidelity

84. A patient is anxious, tachypneic, and has PaO₂ 48 mmHg. This represents:
    a. Normal finding
    b. Acute respiratory failure
    c. COPD exacerbation
    d. Pulmonary embolism only

b. Acute respiratory failure

85. Which is a complication of barotrauma?
    a. Hypoglycemia
    b. Pneumothorax
    c. Hypertension
    d. Tachycardia

b. Pneumothorax

86. Which condition requires emergency intubation?
    a. GCS 15, cooperative
    b. PaO₂ 80 mmHg, breathing comfortably
    c. Unconscious patient with apnea
    d. Mild dyspnea on exertion

c. Unconscious patient with apnea

87. Which ICU quality improvement method is also called the Deming Cycle?
    a. Root cause analysis
    b. PDCA cycle
    c. SWOT analysis
    d. EBN

b. PDCA cycle

88. Which diagnostic test is used to confirm suspected pneumonia?
    a. Spirometry
    b. Chest X-ray
    c. ABG only
    d. CT scan always

b. Chest X-ray

89. Which medication is used for heparin therapy in pulmonary embolism?
    a. Antiplatelet drug
    b. Anticoagulant
    c. Antibiotic
    d. Corticosteroid

b. Anticoagulant

90. A patient with pneumonia develops hypotension and confusion. This indicates:
    a. Normal progression
    b. Sepsis
    c. Mild illness only
    d. Hypoglycemia

b. Sepsis

91. A nurse notes ABG: pH 7.30, PaCO₂ 50 mmHg, PaO₂ 48 mmHg. This indicates:
    a. Respiratory acidosis with hypoxemia
    b. Respiratory alkalosis
    c. Metabolic alkalosis
    d. Normal

a. Respiratory acidosis with hypoxemia

92. In ARDS, hypoxemia persists despite:
    a. High-flow oxygen
    b. Fluid restriction
    c. Nutrition support
    d. Sedation

a. High-flow oxygen

93. Which ethical concept describes deliberate restriction of autonomy by healthcare professionals?
    a. Veracity
    b. Paternalism
    c. Privacy
    d. Justice

b. Paternalism

94. Which is a common clinical manifestation of COPD?
    a. Cyanosis
    b. Wheezing
    c. Accessory muscle use
    d. All of the above

d. All of the above

95. Which virus family does COVID-19 belong to?
    a. Influenza viruses
    b. Adenoviruses
    c. Coronaviruses
    d. Retroviruses

c. Coronaviruses

96. A nurse checks ventilator alarms. High pressure alarm is triggered. The nurse should FIRST:
    a. Call the physician immediately
    b. Check for kinks, coughing, or secretions
    c. Switch ventilator mode
    d. Turn off alarm

b. Check for kinks, coughing, or secretions

97. Which principle is applied when ensuring confidentiality of patient records?
    a. Beneficence
    b. Fidelity
    c. Confidentiality
    d. Justice

c. Confidentiality

98. Which ICU patient would require NIV?
    a. Hemodynamically unstable patient
    b. Unconscious patient with poor gag reflex
    c. Patient with COPD exacerbation and pH 7.30
    d. Moribund patient with no potential recovery

c. Patient with COPD exacerbation and pH 7.30

99. Which best describes the goal of end-of-life care?
    a. To cure the disease
    b. To prolong life at all costs
    c. To provide comfort and improve quality of life
    d. To minimize healthcare costs

c. To provide comfort and improve quality of life

100. A patient suddenly develops shortness of breath, cyanosis, and tachycardia after long bed rest. The nurse suspects:
     a. Pneumonia
     b. Pulmonary embolism
     c. Pneumothorax
     d. COPD

b. Pulmonary embolism