CFRN Critical Care Medications and Pharmacology 1 — Questions and Answers
Question 1: Which vasopressor is considered first-line for septic shock in the flight transport environment?
- Epinephrine
- Norepinephrine (Correct answer)
- Dopamine
- Vasopressin
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-adrenergic vasoconstriction with less tachycardia than dopamine.
Question 2: A flight nurse administers adenosine 6 mg IV push for SVT. The patient does not convert. What is the correct next dose?
- 6 mg
- 12 mg (Correct answer)
- 18 mg
- 24 mg
Correct answer: 12 mg
If the initial 6 mg dose of adenosine does not convert SVT, the recommended second dose is 12 mg IV push.
Question 3: Which medication is used to treat hyperkalemia-induced cardiac arrhythmias as the immediate first step?
- Sodium bicarbonate
- Calcium gluconate or calcium chloride (Correct answer)
- Insulin and dextrose
- Sodium polystyrene sulfonate
Correct answer: Calcium gluconate or calcium chloride
Calcium (gluconate or chloride) is given first to stabilize the myocardial membrane and reduce the risk of fatal arrhythmia in hyperkalemia.
Question 4: A patient in the aircraft requires RSI. The flight nurse selects succinylcholine. Which contraindication should be assessed first?
- History of hypertension
- Recent crush injury or burns (Correct answer)
- Mild renal insufficiency
- History of asthma
Correct answer: Recent crush injury or burns
Succinylcholine is contraindicated in crush injuries or burns because depolarization causes dangerous potassium release, which can trigger cardiac arrest.
Question 5: What is the primary mechanism of action of ketamine when used for induction in the flight setting?
- GABA-A receptor agonism
- NMDA receptor antagonism (Correct answer)
- Mu-opioid receptor agonism
- Alpha-2 adrenergic agonism
Correct answer: NMDA receptor antagonism
Ketamine produces dissociative anesthesia by blocking NMDA receptors, while preserving airway reflexes and hemodynamic stability.
Question 6: Which antidysrhythmic drug is preferred for stable wide-complex tachycardia of uncertain origin during air transport?
- Lidocaine
- Procainamide (Correct answer)
- Verapamil
- Digoxin
Correct answer: Procainamide
Procainamide is preferred for stable wide-complex tachycardia of uncertain origin because it can treat both ventricular and supraventricular rhythms.
CFRN Critical Care Medications and Pharmacology 1
Which vasopressor is considered first-line for septic shock in the flight transport environment?