ACCS Hemodynamic Monitoring and Shock Management 2

Question 1

In hypovolemic shock, which hemodynamic pattern is expected?

Accepted Answer

Low CVP, low PAWP, low CO with elevated SVR

Answer

Hypovolemic shock presents with decreased intravascular volume causing low filling pressures (CVP, PAWP) and low cardiac output, with compensatory increase in SVR.

Question 2

Passive leg raising (PLR) is used in the ICU primarily to assess which parameter?

Accepted Answer

Fluid responsiveness

Answer

PLR is a reversible, dynamic maneuver that transiently increases venous return by autotransfusing blood from the lower extremities, allowing assessment of fluid responsiveness without giving actual fluid.

Question 3

Which dynamic parameter is MOST reliable for predicting fluid responsiveness in mechanically ventilated patients without arrhythmias?

Accepted Answer

Pulse pressure variation (PPV)

Answer

PPV >13% in mechanically ventilated patients reliably predicts fluid responsiveness, as it measures cyclic changes in arterial pulse pressure caused by mechanical ventilation-induced changes in preload.

Question 4

Massive pulmonary embolism causing obstructive shock primarily impairs hemodynamics by:

Accepted Answer

Blocking pulmonary blood flow and increasing right ventricular afterload

Answer

Massive PE obstructs pulmonary blood flow, acutely increasing RV afterload, causing RV failure and ultimately reducing left-sided cardiac output.

Question 5

Per the Surviving Sepsis Campaign guidelines, which vasopressor is recommended as the FIRST-LINE agent in septic shock?

Accepted Answer

Norepinephrine

Answer

Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-1 adrenergic effects that increase SVR, with less tachycardia than dopamine or epinephrine.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Hemodynamic Monitoring and Shock Management 2