EPIC NURSE EXAM 2025|ACTUAL
EXAM WITH 100% VERIFIED
QUESTIONS AND CORRECT
SOLUTIONS|EXCELLENT SCORES
What is the most important sign in a critically ill pt? Why? - CORRECT-
ANSWER-Tachypnea
Indicates metabolic acidosis w/ respiratory alkalosis compensation
A pt misses dialysis for a few days and comes in with fluid overload.
He's tachycardic and tachypneic. On physical exam, you find JVD, pulsus
paradoxus (20 mmHg drop during inspiration), and HoTN (80/40) with
distant, muffled heart sounds. Lungs are clear to auscultation. What is
the dx? - CORRECT-ANSWER-Cardiac tamponade; obstructive shock
,If a pt has a thyromental distance of 2 cm, what can you expect about
their airway? - CORRECT-ANSWER-Difficult airway w/ an anteriorly
displaced larynx
A 50 y/o pt is having a COPD exacerbation. You have tried steroids,
bronchodilators, etc. with no improvement. PCO2 is in the 90s, pH is
7.20. You decide to intubate. Vent settings are: VT 375, RR 20, FiO2 .35,
PEEP 5. CXR is normal. A few minutes later, his BP drops to 70/40. Lungs
are clear/equal. Vent shows peak airway pressure of 55 (high) and
plateau pressure of 15. End expiratory hold gives auto-peep of 15.
What is the cause of this pt's HoTN and why? - CORRECT-ANSWER-
Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in alveoli.
We use PEEP for the pressure and to improve oxygenation. Auto-peep
comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high
peak airway pressure. All leads to low venous return --> low CO -->
HoTN
, A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is
tx w/ bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but
now the peak airway pressure is up to 55 and plateau pressure is also
high at 50. Pt becomes hypotensive at 70/40. You observe tracheal
deviation to the R. Normal breath sounds on the right, diminished on
the left. No wheezing. WBC is normal.
What is the dx and treatment? - CORRECT-ANSWER-Tension
pneumothorax
Needle decompression/chest tube
A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is
88%. Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures? - CORRECT-ANSWER-
Decrease the PEEP, even though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
EXAM WITH 100% VERIFIED
QUESTIONS AND CORRECT
SOLUTIONS|EXCELLENT SCORES
What is the most important sign in a critically ill pt? Why? - CORRECT-
ANSWER-Tachypnea
Indicates metabolic acidosis w/ respiratory alkalosis compensation
A pt misses dialysis for a few days and comes in with fluid overload.
He's tachycardic and tachypneic. On physical exam, you find JVD, pulsus
paradoxus (20 mmHg drop during inspiration), and HoTN (80/40) with
distant, muffled heart sounds. Lungs are clear to auscultation. What is
the dx? - CORRECT-ANSWER-Cardiac tamponade; obstructive shock
,If a pt has a thyromental distance of 2 cm, what can you expect about
their airway? - CORRECT-ANSWER-Difficult airway w/ an anteriorly
displaced larynx
A 50 y/o pt is having a COPD exacerbation. You have tried steroids,
bronchodilators, etc. with no improvement. PCO2 is in the 90s, pH is
7.20. You decide to intubate. Vent settings are: VT 375, RR 20, FiO2 .35,
PEEP 5. CXR is normal. A few minutes later, his BP drops to 70/40. Lungs
are clear/equal. Vent shows peak airway pressure of 55 (high) and
plateau pressure of 15. End expiratory hold gives auto-peep of 15.
What is the cause of this pt's HoTN and why? - CORRECT-ANSWER-
Auto-peep is the cause.
COPD pts have difficulty exhaling --> pressure buildup in alveoli.
We use PEEP for the pressure and to improve oxygenation. Auto-peep
comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high
peak airway pressure. All leads to low venous return --> low CO -->
HoTN
, A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is
tx w/ bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but
now the peak airway pressure is up to 55 and plateau pressure is also
high at 50. Pt becomes hypotensive at 70/40. You observe tracheal
deviation to the R. Normal breath sounds on the right, diminished on
the left. No wheezing. WBC is normal.
What is the dx and treatment? - CORRECT-ANSWER-Tension
pneumothorax
Needle decompression/chest tube
A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is
88%. Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures? - CORRECT-ANSWER-
Decrease the PEEP, even though it will decrease PaO2.
(Note: you can't decrease the VT because it is already on the low end).
