ACCS Patient Management and Care 2

Question 1

A mechanically ventilated patient with ARDS has a PaO2/FiO2 ratio of 80 mmHg. Which ventilator strategy is most appropriate?

Accepted Answer

Apply low tidal volume (6 mL/kg IBW) with PEEP titration

Answer

Increase tidal volume to 10 mL/kg IBW

Answer

Decrease PEEP to reduce barotrauma

Answer

Switch immediately to high-frequency oscillatory ventilation

Question 2

A critically ill patient on vasopressors develops acute mesenteric ischemia. Which finding is the earliest indicator?

Accepted Answer

Metabolic acidosis with elevated lactate

Answer

Bloody diarrhea

Answer

Abdominal rigidity

Answer

Rising creatinine

Question 3

Which medication is first-line for managing refractory status epilepticus in an ICU patient who has failed benzodiazepines and a second-line AED?

Accepted Answer

Midazolam continuous infusion

Answer

Phenobarbital infusion

Answer

Propofol infusion

Answer

Levetiracetam IV bolus

Question 4

An ICU patient has central DI following traumatic brain injury. Which lab pattern is expected?

Accepted Answer

High serum sodium, low urine osmolality

Answer

Low serum sodium, high urine osmolality

Answer

High serum sodium, high urine osmolality

Answer

Low serum sodium, low urine osmolality

Question 5

A post-cardiac surgery patient develops cardiac tamponade. Which hemodynamic finding is characteristic?

Accepted Answer

Equalization of diastolic pressures across cardiac chambers

Answer

Widened pulse pressure

Answer

Elevated cardiac output with low CVP

Answer

Isolated elevated PAOP

Question 6

A patient with septic shock has a ScvO2 of 58% despite adequate MAP. What is the most appropriate next step?

Accepted Answer

Transfuse RBCs if Hgb < 10 g/dL or optimize cardiac output

Answer

Increase vasopressor dose

Answer

Start empiric antibiotics

Answer

Administer hydrocortisone

Question 7

Which intervention has the strongest evidence for reducing VAP (ventilator-associated pneumonia) incidence in the ICU?

Accepted Answer

Oral chlorhexidine decontamination

Answer

Prophylactic antibiotics

Answer

Supine positioning

Answer

Routine ventilator circuit changes every 48 hours