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Average urine output per hour is approximately? 40 ml According to the berlin criteria, a pa;ent is classified with severe ards when his pao2/fio2 ra;o is? Less than 100 A pa;ent is admiBed to the ed with a possible cva. Which diagnos;c test is most appropriate for iden;fica;on of an acute cerebral infarc;on? Ct scan: checks chest, abdomen and brain (2-3 dimensions) Cerebral angiography Measures abnormal cerebral circula;on Pet scan Checks for cancer, brain disorders and heart diseases A pa;ent has been intubated in the ed and has a end ;dal co2 reading of 4%. The specialist should suspect that the: a. Pa;ent has a pulmonary embolus b. Et tube is in the correct posi;on c. Et tube is in the esophagus d. Et tube is in the right main stem bronchus B. Et tube is in the correct posi;on *etco2 will be > if in the esophagus
ACCS REVIEW PRACTICE
EXAM (ACTUAL QUESTIONS
AND VERIFIED ANSWERS)
Post-opera;vely, mr. Hart has a 2-3 mm st segment eleva;on on his 12 lead electrocardiograph. This is indica;ve of Myocardial injury Which of the following would most accurately provide necessary informa;on regarding fluid management in the care of a cri;cally ill pa;ent with pulmonary edema? A. Bedside pX b. Intake and output measurements c. Daily weights d. Pulmonary artery catheter D. Pulmonary artery catheter A pa;ent who was struck in the head with a blunt object is recovering in the icu. He is angry, comba;ve, and irritable. He opens his eyes, grunts, and withdraws when the sole of his foot is s;mulated with a sharp object. What is his score on the glasgow coma scale? 8 Chest radiograph changes associated with conges;ve heart failure include:
- Bilateral radiolucency
- Increased pulmonary vasculature
- Cardiomegaly a. 1 & 2 only b. 2&3 only c. 1& 3 only d. All of the above
c. Right heart catheteriza;on d. Six minute walk test C. Right heart catheteriza;on A 76 y.o. Male presents to the ed with shortness of breath. Upon entering the room the adult cri;cal care specialist determines that the pa;ent is alert and anxious on oxygen at 5l/min by nasal cannula. He is seated in the tripod posi;on and using accessory muscles to breathe. He has audible crackles bilaterally, jugular venous distension, and +2 peripheral edema. The following pa;ent data is obtained: hr 110/min rr 31/min bp 154/92 mmhg spo2 90% which of the following tests should the specialist recommend to confirm a suspicion of conges;ve heart failure? A. Troponin b. Brain natriure;c pep;de c. Magnesium level d. Mb frac;on of crea;nine phosphokinase B. Brain natriure;c pep;de The adult cri;cal care specialist assigned to the cardiovascular intensive care unit hears an alarm sound in room 4. Upon entering the room, the specialist notes that the pulmonary artery pressure tracing is dampened. The specialist should:
Flush the catheter
- dampening means it's wet and not reading Mrs. Smith is in her third postopera;ve day following repair of fractured hip. A chest radiograph obtained ;s morning reveals a leX lower lobe infiltrate. Pa;ent assessment data includes: temp: 102 f (39 c) hr 100, rr 24, sat 92%, bp 90/ rbc 4, hb 11 hct 39, wbc 20000, platelets 250, what therapy should the specialist recommend? A. An;-infec;ve agent b. Beta agonist aerosol c. Sustained maximal inspira;on d. Oral expectorant A. An;-infec;ve agent A mildly obese 48 year old female presented to the ed complaining of chest discomfort. She denied any cough, fever, night seats, or weight loss. Her physical examina;on revealed: temp 37.8*c, hr 100, rr 14, bp 110/70. She reported that she had a transthoracic echocardiogram two days previously that demonstrated a posi;ve bubble study and an es;mated peak pulmonary arterial systolic pressure of 59. Chest examina;on revealed bilateral vesicular breath sounds and resonance to percussion. Cardiac examina;on revealed a regular rhythm with normal heart sounds and no murmurs or pericardial
glucose 256 na+ 133 k+ 5. cl- 95 hco3 15 abg: 7.28, 35 co2, 88 pao2, 98%, 16 the specialist should ini;ally recommend administra;on of: Insulin norma values: glucose < na+ 135- 145 k+ 35- 45 cl- 95 - 105 hco3 22- 26 Ms. Brown presents with acute shortness of breath and chest pain during the last trimester of her pregnancy. She complains of dizziness and anxiety with a heart rate of 125/min and blood pressure of 80/50 mmhg. Which of the following diagnos;c procedures should the adult cri;cal care specialist recommend?
- Cerebral angiogram
- Ven;la;on-perfusion scan
- Arterial blood gas
- Pet scan
The adult cri;cal care specialist is summoned to the icu where a male pa;ent with a past history of tobacco abuse and tuberculosis recently coughed up approximately 1 cup of bright red blood. He appears uncomfortable and in respiratory distress. Ausculta;on reveals rhonchi that are more pronounced on the right than the leX. The chest radiograph demonstrates diffuse bilateral infiltrates. During the physical exam, the pa;ent coughs up 450 ml of bright red blood. Vital signs: bp 110/ hr 115 rr 33 sat 92 o2 nrb at 12lpm lab results are: wbc 12, hct 12% platelets 375, bun 48 crea;nine 1. electrolytes, serum glucose, inr, and pB are within normal limits. What further tes;ng should the specialist recommend? A. Transesophageal echocardiography
the cri;cal care specialist should recommend inita;on of treatment for: a. Acute renal failure b. Conges;ve heart failure c. Hypervolemia d. Hepa;c failure A. Acute renal failure A 23y.o. Man was admiBed to the ed following a high - speed motor vehicle crash. He is exhibi;ng transient hypotension and tachycardia. The pa;ent has mul;ple orthopedic injuries in addi;on the trauma to the right chest, pelvis and head. The radiologist noted the presence of a deep sulcus sign on the pa;ent's ap supine chest radiograph. The nurse asks the cri;cal care specialist the significance of this finding. The specialist should explain that the deep sulcus sign is indica;ve of: Pneumothorax A 74 y.o. Man with a history of atrial fibrilla;on presents to the d with hemoccult-posi;ve stools. He is on mul;ple medica;ons for diabetes and hypertension, as well as warfarin but he has been noncompliant. He has mild mitral valve regurgita;on and an ejec;on frac;on of 32% and has had episodes of transient cerebral ischemia in the past. The specialist should report which of the following results that indicate ac;ve bleeding?
- Inr of 3.
- Platelet count of 300,
- Prothrombin ;me of 35 sec
- Hematocrit of 42%
B. 3 only hint: "ac;ve bleeding" normal: inr 0.8-1.2 or 2- 3 platelet 150,000-400, prothrombin ;me 12-15 secs hematocrit 40-50% A 50 year old male present to the ed with syncope and shock. He is admiBed to the intensive care and pulmonary artery catheter is inserted. Pa;ent data is as follows: bp 70/ map 50 cvp 20 rv 45/ pap 45/ mean pap 25 pcwp 7 qt 2. svr 18 (1440 dynes) pvr 8.4 (670 dynes) arterial blood gas results on room air are as follows: 7.32, 32, 59 o2, 89%. Mixed venous blood gas results are: 7.28, 38, 28 o2, 49%. Ca-vo2 difference is 8.0 vol%.
An 82 year old man is admiBed to the icu with tachypnea, confusion, and hypotension. Ini;al assessment reveals: bp 80/ map 60 rv 42/ pap 45/ pcwp 8 qt 6. svr 7.4 (590 dynes) pvr 2.6 (210 dynes) abg on ra are: 7.45, 32, 50 o2, sat 85% vbg on ra are: 7.40, 38, 37o2, svo2 70%. Ca-vo2. Difference is 3.0 vol% the adult cri;cal care specialist should recommend that the pa;ent be treated quickly for: a. Pulmonary hypertension b. Mitral valve stenosis c. Sep;c shoc d. Hypervolemia Pulmonary hypertension due to >pap and >cvp indica;ons for:
mitral valve stenosis= lt heart, >pcwp, <map, <qt sep;c shock = hypervolemia = all values are elevated (fluid overloaded) normal: bp 120/ map 90 cvp 10 rv 25/ pap 25/ mean pap 14 pcwp 8- 10 qt 4- 8 svr <20 or 1600dynes (leX heart system) pvr <2.5 or 200 dynes (right heart - pulmonary sytem) The adult cri;cal care specialist is assigned to care for a 55 year old pa;ent with a history of alcoholism who is complaining of abdominal pain. The chest radiograph reveals cardiomegaly and a leX pleural effusion. The cbc is normal. Pa;ent data is as follows: bp 80/ map 60 cvp 1 rv 20/ pap 20/ mean pap 13
pap 25/ mean pap 14 pcwp 8- 10 qt 4- 8 svr <20 or 1600dynes (leX heart system) pvr <2.5 or 200 dynes (right heart - pulmonary sytem) Twenty four hours later the pt in the previous ques;on is anxious and complaining of respiratory distress. Rr 32 bp 80/ map 60 cvp 4 rv 45/ pap 45/ mean pap 13 pcwp 4 qt 3. svr 19.7 (1570dynes) pvr 3.0 (240 dynes) abg on ra are: 7.46, 32, 55 o2, sat 89% vbg on ra are: 7.40, 31, 35o2, sat 65% ca-vo2 difference is 4.8 vol%. The accs should contact the aBending physician and report that the pa;ent has developed:
a. Hypervolemia b. Conges;ve heart failure c. Cor pulmonale d. Pulmonary hypertension D. Pulmonary hypertension indica;ons for: hypervolemia = all values are elevated conges;ve heart failure = lt side of heart, >pcwp, <map, <qt cor pulmonale = rt heart failure, >cvp, <pap pulmonary hypertension = >pap, >pcwp, >pvr = lungs normal: bp 120/ map 90 cvp 10 rv 25/ pap 25/ mean pap 14 pcwp 8- 10 qt 4- 8 svr <20 or 1600dynes (leX heart system) pvr <2.5 or 200 dynes (right heart - pulmonary sytem) An 88 y.o. Woman arrives at the hospital confused and hypotensive. Available pa;ent assessment data:
pulmonary hypertension = pvr is >2 or 200 dynes normal: bp 120/ map 90 cvp 10 rv 25/ pap 25/ mean pap 14 pcwp 8- 10 qt 4- 8 svr <20 or 1600dynes (leX heart system) pvr <2.5 or 200 dynes (right heart - pulmonary sytem) A 55 y.o. Male is admiBed with a two week history of shortness of breath and dyspnea. The chest radiograph reveals a large leX pleural effusion and atelectasis of the leX lower lobe. Which of the following diagnos;c findings should the accs recommend to determine whether the pleural fluid is an exudate or transudate? A. Lateral decubitus radiograph b. Amylase c. Protein d. Ph C. Protein The most serious complica;on associated with airway suc;oning is Hypoxemia
What size endotracheal tube would be appropriate for the average size adult male? 7.5 - 8. For pa;ents on mechanical ven;la;on, the best body posi;on to minimize the risk of aspira;on is: Semi - fowlers When managing the pa;ent's airway, seda;on should be given in order to: a. Decrease the pa;ent's heart rate b. Induce amnesia c. Paralyze the pa;ent d. Relieve pain during laryngoscopy B. Induce amnesia The accs is managing a pa;ent's airway and believes the pa;ent would benefit from a seda;ve-hypno;c. The most appropriate agent would be a. Propofol b. Succinylcholine b. Vecuronium bromide d. Rocuronium A. Propofol (diprivan) succinylcholine (anec;ne) = paraly;c vecuronium bromide (norcuron) = paraly;c rocuronium = paraly;c
