ACCS Cheat Sheet 2026

The 30 highest-yield ACCS facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. What is the recommended cerebral perfusion pressure (CPP) target in patients with traumatic brain injury? → 60–70 mmHg
2. Which continuous renal replacement therapy (CRRT) mode removes both solutes by diffusion and convection? → Continuous venovenous hemodiafiltration (CVVHDF)
3. A patient with severe TBI has an ICP of 28 mmHg and CPP of 55 mmHg despite head elevation and sedation. What is the next step? → Administer hyperosmolar therapy (mannitol or hypertonic saline)
4. Which parameter best guides fluid resuscitation in a mechanically ventilated patient with septic shock? → Pulse pressure variation (PPV)
5. What is the primary purpose of standardized procedures in Pharmacology? → To ensure consistency, safety, and quality across all practitioners
6. Which parameter from an esophageal pressure catheter most directly guides PEEP titration in ARDS? → Transpulmonary pressure at end-expiration
7. An ICU patient's arterial line waveform shows marked respiratory variation in pulse pressure (>13%). What does this most likely indicate? → Fluid responsiveness in a mechanically ventilated patient
8. Which bundle element has the strongest evidence for preventing catheter-associated bloodstream infections (CLABSI)? → Chlorhexidine skin antisepsis during insertion
9. The doctrine of double effect is MOST relevant when a critical care nurse administers high-dose opioids to a dying patient primarily to: → Relieve refractory pain, with death as an unintended secondary effect
10. Which finding on a 12-lead ECG is most specific for hyperkalemia at life-threatening levels? → Sine wave pattern
11. In a patient receiving vasopressors via peripheral IV due to lack of central access, which site is PREFERRED to minimize tissue necrosis risk? → Forearm (proximal to antecubital)
12. In neurogenic shock following high spinal cord injury, which hemodynamic pattern is MOST characteristic? → Low SVR, bradycardia, and low CO
13. What is the primary purpose of standardized procedures in Critical Care Assessment? → To ensure consistency, safety, and quality across all practitioners
14. Which intervention is most effective at preventing ventilator-associated events (VAE) in mechanically ventilated ICU patients? → Daily spontaneous awakening and breathing trials
15. A mechanically ventilated patient with ARDS has a PaO2/FiO2 ratio of 80 mmHg. Which ventilator strategy is most appropriate? → Apply low tidal volume (6 mL/kg IBW) with PEEP titration
16. What is the primary goal of osmotic therapy with mannitol in elevated ICP management? → Reduce cerebral edema by creating an osmotic gradient
17. During insertion of a chest tube for hemothorax, initial drainage exceeds 1,500 mL. The MOST appropriate next step is: → Immediate surgical consultation for thoracotomy
18. Which practice BEST prevents communication failures during ICU care transitions? → Using a structured handoff tool such as SBAR or I-PASS
19. During point-of-care ultrasound assessment for pneumothorax, which finding CONFIRMS the absence of pneumothorax at the examined site? → Lung sliding sign
20. A patient's CRRT circuit shows a pre-filter pressure of -250 mmHg (suction side). This most likely indicates: → Catheter malposition or kinking reducing inflow
21. Which antifungal agent is recommended as first-line empiric therapy for suspected candidemia in a critically ill ICU patient? → An echinocandin (caspofungin, micafungin, or anidulafungin)
22. A patient develops heparin-induced thrombocytopenia (HIT) confirmed by positive PF4 antibody. What is the appropriate management? → Discontinue heparin and start argatroban or bivalirudin
23. A patient with acute kidney injury in the ICU has a potassium of 6.8 mEq/L with peaked T-waves on ECG. What is the most urgent intervention? → IV calcium gluconate to stabilize the cardiac membrane
24. Which serum lactate level is used to define occult tissue hypoperfusion (cryptic shock) in sepsis? → ≥2 mmol/L
25. When performing a spontaneous breathing trial (SBT), which finding is the STRONGEST indication to abort and return to full ventilatory support? → Paradoxical abdominal movement
26. A patient develops sudden severe hypertension, diaphoresis, and bradycardia after a spinal cord injury at T4. What is the priority intervention? → Sit the patient upright and identify the noxious stimulus
27. According to the KDIGO criteria, which of the following defines Stage 3 acute kidney injury? → Creatinine increase ≥3× baseline or initiation of renal replacement therapy
28. Which medication is commonly used for sedation in critically ill patients? → Lorazepam
29. A family requests that the ICU team 'do everything' for their loved one. What is the MOST effective initial nursing response? → Explore what 'everything' means to the family and clarify realistic goals of care
30. Which cerebral perfusion pressure target is recommended for traumatic brain injury management? → 60-70 mmHg