Daily bathing of ICU patients with 2% chlorhexidine cloths is used mainly to:

Reduce skin bacteria that cause bloodstream infections

Prevent dehydration of the skin in ICU

Remove the need for routine pressure care

Replace hand hygiene before line access

To lower the risk of ventilator-associated pneumonia, how often should a ventilator circuit be changed?

Only when visibly soiled or faulty

Each time the patient is suctioned

Critical care, emergency, perioperative and burns

50 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Critical care, emergency, perioperative and burns, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Daily bathing of ICU patients with 2% chlorhexidine cloths is used mainly to:
1. APrevent dehydration of the skin in ICU
2. BRemove the need for routine pressure care
3. CReplace hand hygiene before line access
4. DReduce skin bacteria that cause bloodstream infections
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Answer: D · Reduce skin bacteria that cause bloodstream infections
Chlorhexidine has a persistent antiseptic effect on the skin. Daily bathing lowers the skin load of organisms such as MRSA and VRE that colonise patients and contaminate lines and staff hands. Studies show fewer central line-associated bloodstream infections and less spread of resistant organisms. It supports, but never replaces, hand hygiene and line care bundles.
- A: Chlorhexidine is an antiseptic and does not moisturise skin.
- B: Pressure care remains a separate, essential part of ICU nursing.
- C: Hand hygiene is still needed before every line access.
Question 2 · Easy
A recognised adverse effect of silver sulfadiazine cream on burn wounds is:
1. ABlack skin staining
2. BSevere hyponatraemia
3. CMetabolic acidosis
4. DTransient leukopenia
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Answer: D · Transient leukopenia
Silver sulfadiazine is a broad-spectrum topical agent for partial-thickness burns. It can cause a transient fall in white cells within the first days, which usually recovers without stopping the drug. Mafenide causes metabolic acidosis because it inhibits carbonic anhydrase, and silver nitrate causes hyponatraemia and black staining. Silver sulfadiazine is avoided in sulfonamide allergy and in late pregnancy and the newborn.
- A: Black staining of skin and linen is a feature of silver nitrate.
- B: Hyponatraemia comes from hypotonic silver nitrate soaks.
- C: Metabolic acidosis is the classic effect of mafenide acetate.
Question 3 · Easy
In the ATLS primary survey, protection of the cervical spine is carried out as part of:
1. AExposure
2. BBreathing
3. CAirway
4. DDisability
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Answer: C · Airway
The primary survey is ABCDE: Airway with restriction of cervical spine motion, Breathing and ventilation, Circulation with haemorrhage control, Disability, and Exposure with temperature control. The neck is held in line while the airway is opened, because a jaw thrust or intubation can move an unstable spine. Any patient with a blunt injury above the clavicles is treated as having a cervical injury until it is cleared. Each step is managed before moving to the next.
- A: Exposure means undressing the patient and preventing hypothermia.
- B: Breathing assesses ventilation and chest injuries, not spinal protection.
- D: Disability is a rapid neurological check of GCS and pupils.
Question 4 · Easy
A raised, firm scar that spreads beyond the margins of the original incision and does not fade with time is a:
1. AKeloid
2. BGranuloma
3. CContracture
4. DHypertrophic scar
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Answer: A · Keloid
A keloid is an overgrowth of dense collagen that extends past the edges of the original wound and rarely regresses. A hypertrophic scar is also raised but stays within the wound margins and often flattens over months. Keloids are commoner in darker skin and on the earlobes, chest and shoulders, and they often recur after simple excision. Pressure garments, silicone sheets and steroid injection are used to treat them.
- B: A granuloma is a nodule of chronic inflammation, not excess scar collagen.
- C: A contracture is shortening of a scar that limits joint movement.
- D: A hypertrophic scar stays within the wound edges and often regresses.
Question 5 · Medium
To lower the risk of ventilator-associated pneumonia, how often should a ventilator circuit be changed?
1. AEvery 24 hours as a routine
2. BEach time the patient is suctioned
3. COnly when visibly soiled or faulty
4. DEvery 48 hours as a routine
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Answer: C · Only when visibly soiled or faulty
Evidence shows that routine scheduled changes of ventilator circuits do not reduce VAP and may increase it, because each break in the circuit lets contaminated condensate reach the airway. CDC and SHEA guidance therefore change the circuit only when it is visibly soiled or malfunctioning. Condensate is drained away from the patient, and the head of the bed is kept raised. Daily sedation breaks also shorten ventilation.
- A: Daily changes increase circuit breaks without lowering VAP.
- B: Suctioning does not require a new circuit, and frequent changes add risk.
- D: Routine 48-hour changes offer no advantage over changing as needed.
Question 6 · Medium
In a bleeding patient with a penetrating torso injury and no head injury, 'permissive hypotension' before surgical control means aiming for:
1. AA normal BP using several litres of crystalloid
2. BA mean arterial pressure above 90 mmHg
3. CA systolic BP of about 80-90 mmHg
4. DA systolic BP above 120 mmHg
Answer and explanation in LearnFree account
Question 7 · Hard
A 20 kg child has partial-thickness burns of 30% total body surface area. Using the Parkland formula (4 mL/kg/% TBSA) for the burn fluid only, what hourly rate of Ringer's lactate is needed for the first 8 hours, counted from the time of the burn?
1. A300 mL/h
2. B150 mL/h
3. C75 mL/h
4. D100 mL/h
Answer and explanation in LearnFree account
Question 8 · Medium
A patient on long-term prednisolone has a poorly healing laparotomy wound. Which supplement can counter the steroid's effect on healing?
1. AVitamin B12
2. BVitamin K
3. CVitamin E
4. DVitamin A
Answer and explanation in LearnFree account
Question 9 · Easy
Under the Sepsis-3 definition, sepsis is life-threatening organ dysfunction from infection, identified by:
1. ATwo or more SIRS criteria with infection
2. BA serum lactate above 2 mmol/L alone
3. CA systolic BP below 90 mmHg alone
4. DAn acute rise in SOFA score of 2 or more
Answer and explanation in LearnFree account
Question 10 · Medium
During the first 48 hours after a major burn, which electrolyte change does the nurse expect?
1. AHypercalcaemia from bone loss
2. BHyperkalaemia from injured cells
3. CHypokalaemia from diuresis
4. DHypernatraemia from salt gain
Answer and explanation in LearnFree account
Question 11 · Medium
In adult septic shock, the 2021 Surviving Sepsis guidance suggests starting IV hydrocortisone when:
1. ABlood cultures have been taken and sent
2. BVasopressor need continues despite adequate fluids
3. CLactate has fallen to below 2 mmol/L
4. DA random serum cortisol is found to be low
Answer and explanation in LearnFree account
Question 12 · Medium
A patient in the post-anaesthesia care unit is usually fit for transfer to the ward when the modified Aldrete score reaches at least:
1. A15 out of 15
2. B9 out of 10
3. C5 out of 10
4. D7 out of 12
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Question 13 · Hard
A 24-year-old motorcyclist has a C6 fracture with complete tetraplegia. BP 78/40 mmHg, pulse 48/min, skin warm and dry below the injury, no external bleeding, and FAST is negative. Which type of shock is most likely?
1. ANeurogenic shock
2. BSpinal shock
3. CCardiogenic shock
4. DHypovolaemic shock
Answer and explanation in LearnFree account
Question 14 · Hard
In one month a medical ICU recorded 6 ventilator-associated pneumonias, 1,200 ventilator days and 2,000 patient days. The VAP rate is:
1. A5.0 per 1,000 ventilator days
2. B3.0 per 1,000 patient days
3. C0.5 per 1,000 ventilator days
4. D50 per 1,000 ventilator days
Answer and explanation in LearnFree account
Question 15 · Medium
In the hour-1 sepsis bundle, a repeat serum lactate is required when the first lactate is:
1. AAbove 2 mmol/L
2. BBelow 1 mmol/L
3. CAbove 10 mmol/L
4. DAbove 4 mmol/L
Answer and explanation in LearnFree account
Question 16 · Medium
In Jackson's model of a burn wound, the zone of stasis is important to the nurse because its tissue:
1. AIs only mildly inflamed and always recovers
2. BIs already dead and needs immediate excision
3. CCan survive or die depending on resuscitation
4. DLies deep to the fascia and needs fasciotomy
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Question 17 · Medium
During adult CPR, AHA guidance sets the minimum chest compression fraction (time spent compressing as a share of total arrest time) at:
1. A95%
2. B60%
3. C40%
4. D30%
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Question 18 · Hard
A man woke at 4 am in his hut in rural Tamil Nadu with abdominal pain and was brought in 3 hours later. There is no swelling or fang mark that his family can see, but he now has bilateral ptosis and difficulty swallowing. The 20-minute whole blood clotting test shows a clot. Following the Indian national snakebite protocol, what is the correct plan?
1. AGive a subcutaneous test dose of ASV first
2. BWithhold ASV until a fang mark or swelling appears
3. CGive 10 vials of ASV and prepare for ventilation
4. DRepeat the clotting test before deciding on ASV
Answer and explanation in LearnFree account
Question 19 · Medium
In which overdose is a single dose of activated charcoal of little use because the drug is poorly adsorbed?
1. ACarbamazepine
2. BLithium carbonate
3. CPhenobarbitone
4. DAmitriptyline
Answer and explanation in LearnFree account
Question 20 · Hard
At a school bus crash, a nurse uses JumpSTART triage. A 5-year-old cannot walk and is not breathing after the airway is opened, but has a palpable peripheral pulse. After five rescue breaths he begins to breathe on his own. How is he tagged?
1. AMinor (green)
2. BImmediate (red)
3. CDelayed (yellow)
4. DExpectant or deceased (black)
Answer and explanation in LearnFree account
Question 21 · Hard
During an in-hospital arrest, a patient is in VF. A shock was given at the first and second rhythm checks, and adrenaline 1 mg IV was given after the second shock. Two minutes later VF persists, and a third shock is delivered. Which drug should the nurse now prepare?
1. AAmiodarone 300 mg IV
2. BAmiodarone 150 mg IV
3. CAtropine 1 mg IV
4. DAdrenaline 1 mg IV
Answer and explanation in LearnFree account
Question 22 · Hard
A 60 kg adult has fasted for 8 hours before surgery and has no other losses. Using the 4-2-1 rule for hourly maintenance, what is the estimated fluid deficit?
1. A800 mL
2. B1,920 mL
3. C1,200 mL
4. D480 mL
Answer and explanation in LearnFree account
Question 23 · Medium
Early enteral feeding, started within 24 hours after a major burn, is recommended mainly because it:
1. ALowers the risk of an inhalation injury
2. BProtects the gut lining and blunts hypermetabolism
3. CPrevents fluid shift into the burn wound
4. DReplaces the need for IV resuscitation fluids
Answer and explanation in LearnFree account
Question 24 · Hard
A 28-year-old woman comes to the emergency department with 6 hours of right lower abdominal pain, rated 5/10. HR 96/min, BP 122/78 mmHg, RR 18/min, SpO2 98%, temperature 37.8 °C. She is alert, and the doctor will need blood tests, an ultrasound and IV fluids. Using the Emergency Severity Index, her triage level is:
1. ALevel 4
2. BLevel 3
3. CLevel 1
4. DLevel 2
Answer and explanation in LearnFree account
Question 25 · Medium
During a long operation in the lithotomy position, pressure from a leg holder on the lateral knee can injure the common peroneal nerve. This causes:
1. AFoot drop
2. BWrist drop
3. CClaw hand
4. DLoss of knee extension
Answer and explanation in LearnFree account

25 more Critical care, emergency, perioperative and burns questions

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Critical care, emergency, perioperative and burns

Daily bathing of ICU patients with 2% chlorhexidine cloths is used mainly to:

A recognised adverse effect of silver sulfadiazine cream on burn wounds is:

In the ATLS primary survey, protection of the cervical spine is carried out as part of:

A raised, firm scar that spreads beyond the margins of the original incision and does not fade with time is a:

To lower the risk of ventilator-associated pneumonia, how often should a ventilator circuit be changed?

In a bleeding patient with a penetrating torso injury and no head injury, 'permissive hypotension' before surgical control means aiming for:

A 20 kg child has partial-thickness burns of 30% total body surface area. Using the Parkland formula (4 mL/kg/% TBSA) for the burn fluid only, what hourly rate of Ringer's lactate is needed for the first 8 hours, counted from the time of the burn?

A patient on long-term prednisolone has a poorly healing laparotomy wound. Which supplement can counter the steroid's effect on healing?

Under the Sepsis-3 definition, sepsis is life-threatening organ dysfunction from infection, identified by:

During the first 48 hours after a major burn, which electrolyte change does the nurse expect?

In adult septic shock, the 2021 Surviving Sepsis guidance suggests starting IV hydrocortisone when:

A patient in the post-anaesthesia care unit is usually fit for transfer to the ward when the modified Aldrete score reaches at least:

A 24-year-old motorcyclist has a C6 fracture with complete tetraplegia. BP 78/40 mmHg, pulse 48/min, skin warm and dry below the injury, no external bleeding, and FAST is negative. Which type of shock is most likely?

In one month a medical ICU recorded 6 ventilator-associated pneumonias, 1,200 ventilator days and 2,000 patient days. The VAP rate is:

In the hour-1 sepsis bundle, a repeat serum lactate is required when the first lactate is:

In Jackson's model of a burn wound, the zone of stasis is important to the nurse because its tissue:

During adult CPR, AHA guidance sets the minimum chest compression fraction (time spent compressing as a share of total arrest time) at:

In which overdose is a single dose of activated charcoal of little use because the drug is poorly adsorbed?

At a school bus crash, a nurse uses JumpSTART triage. A 5-year-old cannot walk and is not breathing after the airway is opened, but has a palpable peripheral pulse. After five rescue breaths he begins to breathe on his own. How is he tagged?

During an in-hospital arrest, a patient is in VF. A shock was given at the first and second rhythm checks, and adrenaline 1 mg IV was given after the second shock. Two minutes later VF persists, and a third shock is delivered. Which drug should the nurse now prepare?

A 60 kg adult has fasted for 8 hours before surgery and has no other losses. Using the 4-2-1 rule for hourly maintenance, what is the estimated fluid deficit?

Early enteral feeding, started within 24 hours after a major burn, is recommended mainly because it:

During a long operation in the lithotomy position, pressure from a leg holder on the lateral knee can injure the common peroneal nerve. This causes: