ACCS Hemodynamic Monitoring and Shock Management 3

Question 1

When performing thermodilution cardiac output measurement via pulmonary artery catheter, the cold saline injectate is administered into which port?

Accepted Answer

Right atrial (proximal) port

Answer

Distal (pulmonary artery) port

Answer

Balloon inflation port

Answer

Mixed venous sampling port

Question 2

In neurogenic shock following high spinal cord injury, which hemodynamic pattern is MOST characteristic?

Accepted Answer

Low SVR, bradycardia, and low CO

Answer

Elevated SVR, low CO, normal HR

Answer

Elevated CVP, high CO, low SVR

Answer

Low CVP, tachycardia, and low SVR

Question 3

Per the Surviving Sepsis Campaign, what is the recommended initial crystalloid fluid resuscitation volume and time frame for sepsis-induced hypoperfusion?

Accepted Answer

30 mL/kg within 3 hours

Answer

10 mL/kg over 30 minutes

Answer

60 mL/kg over 1 hour

Answer

5 mL/kg boluses repeated to response

Question 4

For a patient with cardiogenic shock and adequate intravascular volume, which hemodynamic intervention is MOST appropriate?

Accepted Answer

Initiate inotropic support with dobutamine

Answer

Administer a 2 L IV fluid bolus

Answer

Start vasopressin infusion

Answer

Administer high-dose norepinephrine alone

Question 5

At the cellular level, shock is BEST defined as:

Accepted Answer

Inadequate oxygen delivery relative to cellular metabolic demands

Answer

Systolic blood pressure below 90 mmHg

Answer

Heart rate greater than 100 beats per minute

Answer

Urine output less than 0.5 mL/kg/hr

Question 6

Elevated serum lactate in shock states primarily reflects:

Accepted Answer

Anaerobic metabolism due to inadequate tissue oxygenation

Answer

Decreased renal clearance of lactate

Answer

Excess glucose intake by the patient

Answer

Isolated hepatic dysfunction

Question 7

A mechanically ventilated patient without cardiac arrhythmias has a stroke volume variation (SVV) of 18%. What does this value indicate?

Accepted Answer

The patient is likely fluid responsive

Answer

The patient is unlikely to respond to fluid administration

Answer

The patient has a normal cardiac output

Answer

The patient has elevated systemic vascular resistance