ACCS Patient Management and Care 5

Question 1

A patient in distributive shock has MAP of 58 mmHg on norepinephrine 0.3 mcg/kg/min. Which adjunctive agent should be added next?

Accepted Answer

Vasopressin 0.03–0.04 units/min

Answer

Dopamine at low renal dose

Answer

Phenylephrine as sole vasopressor

Answer

Epinephrine at high dose as first add-on

Question 2

A patient with acute kidney injury in the ICU has a potassium of 6.8 mEq/L with peaked T-waves on ECG. What is the most urgent intervention?

Accepted Answer

IV calcium gluconate to stabilize the cardiac membrane

Answer

Sodium polystyrene sulfonate (Kayexalate) orally

Answer

Emergent hemodialysis

Answer

Furosemide IV push

Question 3

A patient on prolonged neuromuscular blockade in the ICU is being weaned. Which test is used to confirm adequate reversal before extubation?

Accepted Answer

Train-of-four (TOF) ratio ≥ 0.9

Answer

Peak inspiratory force (PIF) > -20 cmH2O

Answer

Tidal volume > 300 mL

Answer

Spontaneous breathing trial passage

Question 4

An ICU patient develops abdominal compartment syndrome. Which intra-abdominal pressure value confirms the diagnosis in the presence of new organ dysfunction?

Accepted Answer

> 20 mmHg

Answer

> 10 mmHg

Answer

> 15 mmHg

Answer

> 25 mmHg

Question 5

A patient with acute pancreatitis in the ICU develops respiratory failure. The most likely etiology is:

Accepted Answer

ARDS from systemic inflammatory mediator release

Answer

Aspiration pneumonia from vomiting

Answer

Pulmonary embolism from prolonged bed rest

Answer

Pleural effusion from hypoalbuminemia

Question 6

Which intervention has been shown to reduce ICU-acquired weakness in critically ill patients?

Accepted Answer

Early mobilization and physical therapy initiated in the ICU

Answer

Complete bed rest to minimize oxygen consumption

Answer

High-dose corticosteroids to reduce muscle catabolism

Answer

Prophylactic neuromuscular blockade

Question 7

A patient with chronic liver disease is admitted to the ICU with gastrointestinal bleeding. In addition to vasoactive agents, which prophylactic medication should be started immediately?

Accepted Answer

Short-course prophylactic antibiotics (ceftriaxone)

Answer

Proton pump inhibitor infusion

Answer

Fresh frozen plasma to correct coagulopathy

Answer

Lactulose to prevent hepatic encephalopathy