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

Lung-protective ventilation with low tidal volume (6 mL/kg IBW) and optimized PEEP is the evidence-based standard for ARDS management.

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

Elevated lactate from anaerobic metabolism is often the earliest sign of mesenteric ischemia before overt peritoneal signs develop.

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

Continuous midazolam infusion is a first-line anesthetic agent for refractory status epilepticus when second-line AEDs fail.

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

Central DI causes hypernatremia (high serum Na) with dilute urine (low urine osmolality) due to ADH deficiency.

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

Cardiac tamponade causes equalization of diastolic pressures (CVP ≈ PAOP ≈ PAD) due to external cardiac compression.

(ACCS) Adult Critical Care Specialty Practice Test