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

Cold saline is injected into the proximal right atrial port so the thermistor at the catheter tip can detect the downstream temperature change and calculate cardiac output via the Stewart-Hamilton equation.

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

Neurogenic shock results from loss of sympathetic tone, producing vasodilation (low SVR) and loss of cardiac acceleration (bradycardia), distinguishing it from other distributive shock states.

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

The SSC recommends administering at least 30 mL/kg of IV crystalloid within the first 3 hours for patients with sepsis-induced hypoperfusion or septic shock.

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

Dobutamine improves myocardial contractility and cardiac output in cardiogenic shock with adequate preload; giving additional fluids risks worsening pulmonary edema.

Question 5

At the cellular level, shock is BEST defined as:

Accepted Answer

Inadequate oxygen delivery relative to cellular metabolic demands

Answer

Shock is fundamentally a state of cellular hypoxia in which oxygen delivery is insufficient to meet cellular metabolic requirements, regardless of whether blood pressure is measurably low.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Hemodynamic Monitoring and Shock Management 3