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

Vasopressin added to norepinephrine is the recommended second vasopressor in septic shock to achieve MAP goals or spare norepinephrine dose.

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

Calcium gluconate stabilizes the cardiac membrane immediately and is the first-line treatment for hyperkalemia with ECG changes, buying time for definitive therapy.

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

A train-of-four ratio ≥0.9 on peripheral nerve stimulation confirms adequate reversal of neuromuscular blockade before safe extubation.

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

Abdominal compartment syndrome is defined as sustained IAP >20 mmHg with new or progressive organ dysfunction.

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

Severe acute pancreatitis triggers massive cytokine release that causes systemic inflammation and ARDS as a common pulmonary complication.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Patient Management and Care 5