Critical Care and Emergency Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Shock, Sepsis, Resuscitation, Ventilated Patients, Triage, Trauma and Burns

Critical care and emergency nursing is 8 to 10% of the registered nurse paper, 12 to 15 questions, and the exam asks it the way an ICU charge nurse would: what does this patient need first. Ward nurses lose marks here on ventilator care and lines; ICU nurses lose marks on triage and burns. This set covers both ends.

Recognising deterioration

Question 1

A ward patient has a respiratory rate of 26, saturations of 91% on air, heart rate 115, systolic blood pressure 95 mmHg, temperature 38.4 °C and new confusion. The nurse should:

1. Document and recheck in four hours
2. Calculate the early warning score, recognise a high-risk patient, escalate immediately to the medical team or rapid response, start oxygen and prepare for the sepsis pathway
3. Give paracetamol only
4. Wait for the consultant round

Answer: B. Multiple abnormal parameters with new confusion trigger urgent escalation. Every Gulf hospital uses an early warning system and audits response times.

Question 2

Which set of findings is most consistent with hypovolaemic shock?

1. Warm flushed skin, bounding pulse, wide pulse pressure
2. Cool pale clammy skin, tachycardia, narrow pulse pressure, delayed capillary refill, reduced urine output and anxiety
3. Bradycardia with warm dry skin
4. Hypertension with headache

Answer: B. Warm shock with bounding pulses suggests early septic or anaphylactic (distributive) shock; bradycardia with warm skin suggests neurogenic shock.

Question 3

Within the first hour of recognising sepsis, the nurse's bundle actions include:

1. Oral antibiotics and fluids by mouth
2. Measuring lactate, taking blood cultures before antibiotics, administering broad-spectrum intravenous antibiotics, starting 30 mL/kg crystalloid for hypotension or lactate of 4 or more, and monitoring urine output
3. Waiting for culture results before antibiotics
4. Giving diuretics

Answer: B. Vasopressors follow if mean arterial pressure stays below 65 mmHg after fluids.

Resuscitation

Question 4

An adult collapses on the ward with no pulse and no normal breathing. The correct sequence is:

1. Check blood pressure, then call the doctor
2. Confirm unresponsiveness and absent normal breathing, call the arrest team and get the defibrillator, start compressions at 100 to 120 per minute and 5 to 6 cm depth with a 30:2 ratio until an advanced airway is placed, and attach the defibrillator as soon as it arrives
3. Give two rescue breaths and wait
4. Place in the recovery position

Answer: B. Minimising interruptions in compressions and early defibrillation of shockable rhythms are the two determinants of survival.

Question 5

During a cardiac arrest the monitor shows pulseless electrical activity. The nurse expects:

1. Immediate defibrillation
2. Continued CPR, adrenaline 1 mg IV every 3 to 5 minutes, and a search for reversible causes (the Hs and Ts: hypoxia, hypovolaemia, hypo- or hyperkalaemia, hypothermia, thrombosis, tamponade, tension pneumothorax, toxins)
3. Amiodarone first
4. Atropine as first-line

Answer: B. PEA and asystole are non-shockable; the reversible causes are the treatment.

Question 6

After return of spontaneous circulation, the post-resuscitation care the nurse anticipates includes:

1. Discharge to the ward
2. 12-lead ECG, targeted temperature management per protocol, avoiding hyperoxia and hypotension, glucose control, and transfer to intensive care, with urgent coronary angiography if a cardiac cause is suspected
3. No monitoring
4. Immediate feeding

Answer: B. Preventing fever and secondary brain injury improves neurological outcome.

The ventilated patient

Question 7

The ventilator high-pressure alarm sounds and the patient is coughing and biting the tube. The nurse's first actions are:

1. Silence the alarm and leave
2. Assess the patient, check for tube obstruction, kinking or secretions, suction if needed, insert a bite block, assess sedation and pain, and if the cause is unclear disconnect and bag with 100% oxygen while calling for help
3. Increase the tidal volume
4. Extubate

Answer: B. The DOPE approach (displacement, obstruction, pneumothorax, equipment) structures the assessment.

Question 8

Which measures form the ventilator-associated pneumonia bundle?

1. Lying flat and changing the circuit daily
2. Head of bed elevated 30 to 45 degrees, daily sedation interruption and readiness-to-wean assessment, oral care, subglottic suction where available, cuff pressure 20 to 30 cmH₂O, and stress ulcer and VTE prophylaxis
3. Prophylactic antibiotics for all
4. Deep suctioning every hour

Answer: B. Circuits are changed only when soiled; routine changes increase infection.

Question 9

A ventilated patient on propofol has a Richmond Agitation-Sedation Scale score of −4. The nurse interprets this as:

1. Agitated and pulling at lines
2. Deep sedation with no response to voice but movement to physical stimulation, which is usually deeper than the target of light sedation (0 to −2) and should prompt review of the infusion
3. Alert and calm
4. Combative

Answer: B. Light sedation with daily interruption shortens ventilation and delirium; the CAM-ICU screens for delirium.

Question 10

The nurse zeroes and levels an arterial line transducer at the:

1. Level of the wrist
2. Phlebostatic axis, the fourth intercostal space at the mid-axillary line, with the stopcock open to air during zeroing, and checks the waveform and a square-wave test for damping
3. Top of the head
4. Level of the feet

Answer: B. An over- or under-damped trace gives false pressures; a transducer placed below the heart reads falsely high.

Question 11

Which finding indicates a possible central line-associated complication requiring immediate action?

1. A dressing dated yesterday
2. Sudden breathlessness and chest pain during line insertion or disconnection (air embolism or pneumothorax), fever with redness at the site, or arm swelling on the line side
3. A heparin lock in place
4. A securement device

Answer: B. Air embolism is prevented by clamping, Trendelenburg positioning during removal and occlusive dressings over the site after removal.

Emergency department

Question 12

Four patients arrive at once: a man with crushing chest pain and sweating; a child with a forearm deformity and good circulation; a woman with a laceration that has stopped bleeding; a man who is unresponsive with gurgling respirations. Who is seen first?

1. The child with the fracture
2. The unresponsive man with a compromised airway, then the man with chest pain
3. The woman with the laceration
4. Whoever arrived first

Answer: B. Triage follows airway, breathing, circulation; five-level triage systems such as ESI or CTAS are used across Gulf emergency departments.

Question 13

A trauma patient arrives after a road traffic collision. The primary survey sequence is:

1. History, then x-rays, then examination
2. Catastrophic haemorrhage control, airway with cervical spine protection, breathing, circulation with haemorrhage control, disability (GCS, pupils, glucose), exposure with prevention of hypothermia
3. Full secondary survey first
4. Pain relief before any assessment

Answer: B. Life threats are treated as they are found; the secondary survey follows once the patient is stable.

Question 14

A patient with blunt chest trauma has absent breath sounds on the left, hypotension, distended neck veins and tracheal deviation to the right. The nurse anticipates:

1. A chest x-ray before any intervention
2. Immediate needle decompression of the left chest followed by a chest drain, because this is tension pneumothorax, a clinical diagnosis
3. Intravenous diuretics
4. Pericardiocentesis

Answer: B. Waiting for imaging can be fatal; the nurse prepares the decompression equipment immediately.

Question 15

An adult has burns to the entire front of both legs and the anterior trunk. Using the rule of nines the burned area is approximately:

1. 18%
2. 36%
3. 27%
4. 45%

Answer: B. Anterior trunk 18% plus the front of each leg 9% each gives 36%. Fluid resuscitation by the Parkland formula (4 mL/kg per % burn over 24 hours, half in the first 8 hours) is titrated to urine output of about 0.5 mL/kg/h in adults.

Question 16

Which burn patient most needs assessment for inhalation injury and early airway protection?

1. A patient with a small scald to the hand
2. A patient rescued from an enclosed-space fire with singed nasal hairs, soot in the sputum, hoarseness and facial burns
3. A sunburned patient
4. A patient with a chemical burn to the foot

Answer: B. Airway oedema progresses over hours; early intubation prevents a lost airway. Carbon monoxide poisoning is treated with high-flow oxygen regardless of saturation readings.

Emergencies on the ward and in ICU

Question 17

A patient develops stridor, facial swelling and hypotension minutes after an intravenous antibiotic. The nurse's first drug action is:

1. Intravenous hydrocortisone
2. Stop the infusion, call for help, and give adrenaline 0.5 mg intramuscularly into the anterolateral thigh, repeated after 5 minutes if no improvement, with high-flow oxygen and a fluid bolus
3. Oral antihistamine
4. Wait for the doctor before any drug

Answer: B. Nurses in most Gulf hospitals administer intramuscular adrenaline for anaphylaxis under standing protocol.

Question 18

A patient on the ward has a blood glucose of 1.9 mmol/L and is unconscious. The nurse should:

1. Give a sugary drink by mouth
2. Protect the airway, call for help, give intravenous dextrose (for example 10% dextrose bolus) or intramuscular glucagon if there is no IV access, recheck glucose in 10 to 15 minutes and investigate the cause
3. Give insulin
4. Wait for the glucose to recover on its own

Answer: B. Nothing is given by mouth to an unconscious patient; concentrated 50% dextrose is avoided where possible because of extravasation injury.

Question 19

A ventilated ICU patient's family asks to be present during a resuscitation attempt. The appropriate response is:

1. Refuse in all cases
2. Offer family presence where unit policy allows, with a dedicated staff member to support and explain, because it is associated with better family outcomes and does not impair resuscitation
3. Leave the family alone in the corridor
4. Ask them to sign a waiver first

Answer: B. Family-centred care and culturally sensitive communication, including with Arabic-speaking families and religious needs, are tested on the paper.

Question 20

A patient with a GCS of 7 after a head injury is intubated and has an intracranial pressure of 28 mmHg. Nursing measures to reduce intracranial pressure include:

1. Lying flat with the neck flexed
2. Head of bed at 30 degrees with the head in neutral alignment, avoiding hypoxia and hypercapnia, minimising suctioning and clustering care, controlling fever and pain, maintaining cerebral perfusion pressure, and administering hyperosmolar therapy as prescribed
3. Frequent deep suctioning
4. Restricting all analgesia

Answer: B. Sustained pressures above 20 to 22 mmHg are treated; pupil changes and Cushing's response are reported immediately.

How to practise

• Learn the algorithms: BLS, ALS shockable and non-shockable, sepsis hour-one bundle, anaphylaxis, primary survey.
• Know the numbers: compression rate and depth, cuff pressure, MAP target, Parkland formula, ICP thresholds.
• Practise prioritisation: who first, what first, when to escalate.

Critical care chapters with explanations are in the Registered Nurse bank; related sets are the ECG questions, medical-surgical questions and pharmacology questions. The plan is in DHA nursing exam preparation online.

Frequently asked questions

How many critical care questions are in the Prometric nursing exam?

About 12 to 15 of 150, within the critical care and emergency domain, with related items in medical-surgical nursing.

Which topics come up most?

Recognising deterioration and sepsis, resuscitation, care of the ventilated patient, shock, triage and anaphylaxis.

Which guidelines does the exam follow?

Current international resuscitation and sepsis guidance, as taught in BLS, ACLS and sepsis bundle training.

Do ward nurses need ventilator knowledge?

Yes, at the level of alarms, the VAP bundle and basic sedation assessment; the registered nurse paper covers the whole blueprint.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.