ACCS Patient Management and Care 4

Question 1

A patient develops heparin-induced thrombocytopenia (HIT) confirmed by positive PF4 antibody. What is the appropriate management?

Accepted Answer

Discontinue heparin and start argatroban or bivalirudin

Answer

HIT requires immediate heparin cessation and initiation of a direct thrombin inhibitor (argatroban or bivalirudin) due to thrombotic risk.

Question 2

A critically ill patient on mechanical ventilation has peak airway pressure of 42 cmH2O and plateau pressure of 28 cmH2O. What does this suggest?

Accepted Answer

Increased airway resistance

Answer

A high gradient between peak and plateau pressure with normal plateau indicates elevated airway resistance (e.g., bronchospasm, secretions), not reduced compliance.

Question 3

Which nutritional approach is recommended for critically ill patients who cannot tolerate enteral feeding within 72 hours of ICU admission?

Accepted Answer

Permit permissive underfeeding until day 7-10 before starting PN

Answer

Current guidelines support delaying parenteral nutrition until day 7-10 in low-nutritional-risk patients if enteral feeding is not tolerated, as early PN worsens outcomes.

Question 4

An ICU patient develops acute adrenal insufficiency. Which steroid regimen is preferred in septic shock not responding to vasopressors?

Accepted Answer

Hydrocortisone 200–300 mg/day in divided doses or continuous infusion

Answer

Low-dose hydrocortisone (200–300 mg/day) is recommended for vasopressor-refractory septic shock to provide both glucocorticoid and mineralocorticoid effects.

Question 5

A ventilated ARDS patient is placed in prone position. After 16 hours, SpO2 improves from 88% to 96%. When should prone positioning be discontinued?

Accepted Answer

When PaO2/FiO2 ratio exceeds 150 mmHg on PEEP ≤10 for two consecutive supine assessments

Answer

Prone positioning is discontinued when the patient sustains PaO2/FiO2 >150 on PEEP ≤10 cmH2O during supine trials, indicating respiratory improvement.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Patient Management and Care 4