ACCS Clinical Knowledge and Skills 3

Question 1

A patient with septic shock remains hypotensive after 30 mL/kg IV crystalloid. MAP is 58 mmHg. What is the first-line vasopressor?

Accepted Answer

Norepinephrine

Answer

Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines due to its potent alpha-adrenergic effect with less tachycardia than dopamine.

Question 2

Which ventilator setting change is most appropriate when a patient on volume-controlled ventilation develops a sudden increase in peak airway pressure with unchanged plateau pressure?

Accepted Answer

Suction the endotracheal tube for secretions

Answer

An isolated rise in peak pressure with stable plateau pressure indicates increased airway resistance, most commonly from secretions or bronchospasm, not reduced lung compliance.

Question 3

A critically ill patient has serum sodium of 118 mEq/L and is having seizures. What is the immediate treatment?

Accepted Answer

Administer 3% hypertonic saline IV

Answer

Symptomatic severe hyponatremia with seizures requires immediate 3% hypertonic saline to raise sodium by 1-2 mEq/L/hr until symptoms resolve.

Question 4

Which parameter best reflects oxygen delivery adequacy at the tissue level in hemodynamically unstable patients?

Accepted Answer

Mixed venous oxygen saturation (SvO2)

Answer

SvO2 reflects the balance between oxygen delivery and consumption; values below 65% indicate inadequate oxygen delivery relative to tissue demand.

Question 5

A patient on heparin infusion develops a platelet count drop from 280,000 to 80,000 over 5 days with new thrombosis. What is the most appropriate action?

Accepted Answer

Discontinue heparin and start a direct thrombin inhibitor

Answer

This presentation is classic for heparin-induced thrombocytopenia (HIT) with thrombosis; all heparin products must be stopped and a non-heparin anticoagulant initiated.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Clinical Knowledge and Skills 3