ACCS Clinical Knowledge and Skills 2

Question 1

A patient with ARDS is on mechanical ventilation with FiO2 0.8 and PEEP 14 cmH2O. PaO2 is 58 mmHg. What is the most appropriate next intervention?

Accepted Answer

Initiate prone positioning

Answer

Prone positioning improves V/Q matching and oxygenation in moderate-to-severe ARDS (PaO2/FiO2 <150) when conventional ventilation fails.

Question 2

Which hemodynamic pattern is most consistent with cardiogenic shock?

Accepted Answer

Low CO, high SVR, high PCWP

Answer

Cardiogenic shock is characterized by reduced cardiac output, elevated systemic vascular resistance (compensatory), and elevated pulmonary capillary wedge pressure reflecting fluid backup.

Question 3

A patient develops sudden severe hypertension, diaphoresis, and bradycardia after a spinal cord injury at T4. What is the priority intervention?

Accepted Answer

Sit the patient upright and identify the noxious stimulus

Answer

Autonomic dysreflexia requires immediate upright positioning and removal of the precipitating stimulus (e.g., bladder distension) to relieve the hypertensive crisis.

Question 4

Which acid-base disturbance is expected in a patient with prolonged nasogastric suction?

Accepted Answer

Metabolic alkalosis with hypochloremia

Answer

Loss of hydrochloric acid via NG suction causes metabolic alkalosis accompanied by hypochloremia and often hypokalemia.

Question 5

A patient receiving total parenteral nutrition develops hyperglycemia, elevated serum osmolality, and altered mental status without ketosis. What complication is most likely?

Accepted Answer

Hyperosmolar hyperglycemic state

Answer

Hyperosmolar hyperglycemic state presents with extreme hyperglycemia, elevated osmolality, and altered mentation without significant ketoacidosis.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Clinical Knowledge and Skills 2