ACCS General Critical Care Practice Exam

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• If a catheter site shows signs of infection, what should be done immediately?
• Which strategies are recommended to minimize ventilator-associated pneumonia?
• What is the primary purpose of a passive leg raise test in assessing fluid responsiveness?
• If a patient is given this drug and feels better, the patient is positive for myasthenia gravis.
• If the end-tidal CO2 (PetCO2) is more than 10 mmHg below the arterial PaCO2, what condition is most likely?
• Which unit is used for reporting normal RBC count in the given reference range?
• An anti-cholinergic crisis should be treated with what?
• What does the thyromental distance measure?
• What type of x-ray is helpful in detecting pleural effusions?
• A thyromental distance of 7 cm or greater suggests what?
• How should sedation be managed in relation to mechanical ventilation in the ICU?
• Which radiographic view is described as helpful for detecting pleural effusions?
• What type of x-ray should you use to determine proper position of an endotracheal tube?
• Which approach best supports reducing atelectrauma while balancing oxygenation?
• What is the normal INR when the patient is not on anticoagulant medication?
• What is the normal troponin value?
• What is normal ejection fraction?
• Arterial blood appearing chocolate brown is indicative of which condition?
• Which renal replacement therapy modality involves venous access and uses convection for solute removal?
• Which of the following shifts potassium intracellular?
• A deterioration after Tensilon administration is called which crisis?
• Pressure dampening on a PA catheter waveform most likely indicates what?
• In COPD patients requiring mechanical ventilation, which is a key consideration?
• What is the normal creatinine range in mg/dL?
• Which approach is highlighted as the most helpful in preserving myocardial tissue when a heart attack occurs?
• What are the key differences between CRRT and intermittent hemodialysis in the ICU?
• How should you respond to a suspected transfusion reaction?
• What does PCWP stand for?
• Which scales are used to assess sedation and delirium in ICU patients?
• Which EKG change is associated with hypokalemia?
• Which ABG pattern is commonly seen in critical illness and what is its primary driver?
• Which describes appropriate criteria for a spontaneous breathing trial readiness in weaning from ventilation?
• The description 'concave superior border or interface' describes what?
• Which parameter is most directly associated with risk of volutrauma during mechanical ventilation?
• A central strategy in preventing VAP is:
• The pulmonary artery catheter tip should be positioned where on chest radiograph?
• How does myocardial injury typically appear on the EKG?
• In regional citrate anticoagulation for CRRT, which parameter should be monitored to detect citrate accumulation?
• To minimize atelectrauma, which ventilator strategy is recommended?
• What is the therapeutic INR range when taking Coumadin?
• What is the normal BNP value?
• What is the target CPP in traumatic brain injury and how is it achieved?
• During apnea testing, the patient's temperature should be what?
• In non-communicative ICU patients, which tool is used to assess pain?
• A patient on mechanical ventilation in PC mode has peak pressure of 47 cmH2O and a plateau pressure of 30 cmH2O. The patient is becoming harder to ventilate and is not oxygenating adequately. What should be done?
• A patient crashes after Tensilon administration. This is called what?
• Hypertrophy typically causes QRS axis deviation toward which direction?
• In septic shock, what does persistent elevation or rising lactate despite initial resuscitation most likely indicate?
• What action should you take if the suction catheter cannot pass beyond the endotracheal tube tip and you suspect cuff pressure is excessive?
• The inability to pass a suction catheter beyond the distal tip of the endotracheal tube most suggests what?
• What electrocardiogram change is associated with myocardial ischemia?
• Three key criteria for brain death include which of the following?
• The endotracheal tube should be positioned how many centimeters above the carina on chest radiograph?
• What type of items are allowed near the MRI machine?
• What is the normal PT (prothrombin time) range?
• A thyromental distance less than 6 cm indicates what?
• The best lead to determine the overall electrical condition of the heart is which?
• If the dicrotic notch is not present on the waveform, the situation is called?
• TRALI presents within what time frame after a transfusion?
• Among acute MI interventions, which protocol is specifically highlighted as most helpful in preserving cardiac tissue?
• Which imaging view is described as helpful for spotting internal issues such as masses, blebs, or lesions?
• Which value is within the normal creatinine range?
• Which parameter is reported as a percentage in the given reference values?
• Among options for managing a current heart attack, which protocol is identified as the most helpful for preserving myocardial tissue?
• A sulcus sign on chest X-ray is associated with which condition?
• In the context of myocardial infarction, which protocol is deemed most helpful to limit injury to heart tissue?
• What should be included when documenting withdrawal of life-sustaining treatment decisions with a family?
• A chest tube must be clamped for how long to be discontinued?
• In early ARDS, which of the following ventilator strategies minimizes ventilator-induced lung injury?
• Which ethical principles underpin decisions to withdraw life-sustaining treatment in the ICU?
• Which combination of treatments is described as part of the management for fulminating pulmonary edema?
• Which is the normal platelet count range?
• Which of the following is NOT a brain death criterion?
• Which statement best describes fever management in ICU patients?
• Myocardial injury is best described as which?
• When is pharmacologic VTE prophylaxis contraindicated in ICU patients?
• Which sign indicates intolerance to enteral feeding?
• What is the typical target oxygen saturation for most ICU patients on mechanical ventilation?
• In a V/Q scan, wedge-shaped perfusion defects are most suggestive of which condition?
• Where should you draw a mixed venous sample from in a catheter system?
• The best lead to determine the left ventricle status is which?
• Within six hours after a transfusion, acute bilateral crackles, wheezing, and fever most likely indicate which complication?
• Which adverse effect is associated with dexmedetomidine?
• In the event of chest tube removal during transport, which dressing approach is recommended?
• What is the normal central venous pressure (CVP) range?
• Which nonpharmacologic strategy is a key measure to reduce delirium in the ICU?
• What type of x-ray is helpful in spotting internal issues such as masses, blebs, or lesions?
• In resolving pressure dampening, which action is performed second?
• Which value is within the normal stroke volume range?
• Which elements are essential to a comprehensive burn care plan to support recovery?
• In sepsis management, what does source control entail?
• If a chest tube is accidentally removed during transport, what should be done immediately?
• How do you estimate a critically ill patient’s energy needs and why indirect calorimetry is preferred?
• What intervention is cited as the most helpful in preserving cardiac tissue during an acute MI?
• Which measurement is commonly used to assess potential airway difficulty?
• Shortening inspiratory time (i-time) will have what effect on systemic hemodynamics?
• Which sign indicates that wall suction is adequately set for suction control in a chest drainage system?
• To address pressure dampening, which action should be avoided when handling a catheter?
• Myocardial infarction refers to what?
• In a patient who recently had a heart attack or is currently having a heart attack, which intervention is MOST helpful in preserving cardiac tissue?
• What is the first-line vasopressor in septic shock and its typical dosing consideration?
• Which imaging modality is used to detect the functionality of organs?
• How does continuous renal replacement therapy compare to intermittent dialysis in hemodynamically unstable patients?
• Aside from low tidal volume ventilation, which intervention is recommended in moderate to severe ARDS to improve oxygenation and outcomes?
• During a V/Q scan, what gas does the patient breathe?
• What is a typical target range for targeted temperature management after cardiac arrest?
• What is the normal CK-MB value?
• Which of the following is NOT one of the three key strategies in the management of refractory hypoxemia?
• What is the normal right atrial pressure?
• One of the primary goals of targeted temperature management after ROSC?
• Which statement defines KDIGO stage 3 AKI?
• Myocardial ischemia is defined as which of the following?
• Which combination correctly matches the best leads for LV status and overall electrical condition?
• What is the normal hemoglobin range?
• What is a common cause of hospital-acquired infection related to medical devices?
• Which statement about right atrial pressure is correct?
• In ARDS, which statement best describes lung-protective ventilation?
• Which statement best describes antimicrobial stewardship in the ICU?
• If arterial line pressure differs from the blood pressure cuff, which pressure should you trust?
• Which of the following is NOT recommended in the management of fulminating pulmonary edema?
• Which sequence correctly lists the four steps to resolve pressure dampening?
• Leftward QRS axis deviation is most classically associated with which condition according to the material?
• In resolving pressure dampening, which action is performed fourth?
• A BNP value of 350 pg/mL is within the normal reference range (<300).
• What is the recommended frequency range for VEST therapy?
• Which statement about lactate kinetics is most accurate for prognosis in critical care?
• The presence of serum protein in pleural fluid indicates what?
• Which adverse effect is associated with propofol used for ICU sedation?
• Which describes essential venous thromboembolism prophylaxis in ICU patients?
• What is a first step in STEMI management in the ICU?
• If myocardial tissue is infarcted or dead, the QRS axis deviates away from the infarcted tissue. Which option best describes this?
• On x-ray, where should the central venous catheter be positioned?
• A troponin value of 0.15 ug/L is within the normal reference range (<0.2).
• Dark tea colored urine can indicate which condition?
• In the setting of myocardial injury, which protocol is noted as most helpful for tissue preservation?
• Which protocol is described as the most helpful measure to preserve cardiac tissue during a myocardial infarction?
• When is renal replacement therapy considered in ICU acute kidney injury?
• If system flush pressure on an arterial line system is too high, what will happen?
• On x-ray, where should the pulmonary artery catheter be positioned?
• What is a typical mean arterial pressure target during septic shock resuscitation?
• _____ is a medication often used with organ preservation because it helps to prevent hypotension.
• Once vital capacity falls below 1.0 L, what should you do?
• In emergency airway management, what does RSI stand for and what is its main purpose?
• What is the target cerebral perfusion pressure (CPP) in raised intracranial pressure scenarios?
• In a critically ill patient with metabolic acidosis and elevated lactate, which approach best assesses the disorder?
• Which of the following represents a typical systolic/diastolic pressure that is considered normal for pulmonary artery pressure?
• What is the first-line agent in the initial management of status epilepticus?
• What is the normal cardiac output range?
• If the dicrotic notch is missing from the pulmonary artery waveform and the pressure reading is 25/2 mmHg, what needs to be done?
• If you are unable to pass a suction catheter beyond the distal tip of the ETT, what should you do?
• What are key safety considerations during transport of a critically ill patient?
• What is the most helpful protocol for preserving cardiac tissue in a patient with an ongoing heart attack?
• Which PaCO2 change indicates a positive apnea test?
• To reduce oxygen toxicity in refractory hypoxemia, which approach is recommended?
• During norepinephrine administration in septic shock, which parameter is most critical to monitor to guide dosing?
• Which value is within the normal BUN range?
• A key strategy in antimicrobial stewardship is de-escalation based on culture results.
• Which statement best differentiates myocardial ischemia from myocardial injury?
• If the CSF comes back positive for protein, the patient is positive for which condition?
• On x-ray, where should the end of the endotracheal tube be positioned?
• What is a commonly used transfusion threshold for non-bleeding, stable ICU patients?
• Once the PA catheter is in the right atrium, what is the next step?
• Which statement best describes the use of high-flow nasal cannula or noninvasive ventilation in the ICU?
• In a patient on CRRT with high bleeding risk, what is the recommended anticoagulation approach?
• When a patient is on paralytic medications and on a ventilator, which alarm should you monitor most closely?
• The dicrotic notch on a pulmonary artery waveform indicates what?
• What is a commonly cited value for the mean pulmonary artery pressure in a healthy individual?
• Which approach is cited as the most helpful in preserving cardiac tissue when a patient has had a recent heart attack or is currently having one?
• Which statement is true regarding ECG leads?
• A large gradient where PetCO2 is more than 10 mmHg lower than PaCO2 is most associated with which finding?
• What color is arterial blood in methemoglobinemia?
• In ICU, how is metabolic alkalosis approached?
• In resolving pressure dampening, which action is performed first?
• If there is no bubbling in the water-seal chamber, what is occurring?
• A glomerular filtration rate (GFR) less than 15 mL/min indicates which condition?
• The diagnostic outcome of Tensilon administration in suspected myasthenia gravis is immediate improvement of symptoms.
• Which pharmacologic agent is listed as a treatment for central sleep apnea?
• Which of the following is described as the most helpful to preserve myocardium during or after a heart attack?
• Where is the best place to obtain a mixed venous sample?
• How is delirium managed in the ICU?
• Which of the following is a safe item near MRI?
• What are key ethical considerations when discussing withdrawal of life-sustaining treatment with a patient's family?
• What is the most common complication of pulmonary artery catheter insertion?
• Which term describes irreversible death of myocardial tissue due to prolonged ischemia?
• IPV frequency should be set at what pressure?
• What is the role of prone positioning in moderate to severe ARDS?
• How should fever affect energy target in ICU nutrition planning?
• Which measure is described as the most helpful to protect heart tissue after a myocardial infarction?
• Which are early signs that a patient is not tolerating a spontaneous breathing trial?
• Which device setting is commonly used to reduce hypotension during organ preservation?
• Winter's formula for metabolic acidosis interpretation?
• What are common complications of mechanical ventilation and how can they be minimized?
• Normal pulmonary arterial pressure (PAP) can be described as which of the following?
• What is normal stroke volume?
• The wall suction vacuum should be set high enough to cause what in the suction control bottle?
• What is the purpose of daily sedation interruption or sedation holidays in ICU protocols?
• For tissue preservation in the setting of a recent heart attack, which protocol is considered most helpful?
• What is the normal hematocrit value?
• Which statement correctly differentiates ischemia from infarction?
• Which statement best characterizes septic shock pathophysiology and its initial management?
• In acute coronary syndrome management, what protocol is considered most helpful in preserving cardiac tissue?
• Which drug is used to treat anti-cholinergic crisis according to the material?
• During an acute coronary event, what intervention is identified as most beneficial for protecting heart tissue?
• In severe acute pancreatitis management in the ICU, which fluid strategy is recommended?
• What is a key principle in managing disseminated intravascular coagulation (DIC) in critical care?
• Hyperkalemia will cause what on EKG?
• Which energy planning components should be adjusted during early enteral nutrition to meet goals?
• In AFib with rapid ventricular response, what is indicated if the patient is hemodynamically unstable?
• In atrial fibrillation with rapid ventricular response, which management is appropriate for rate control in a hemodynamically stable patient?
• What is the normal mean arterial pressure (MAP) range?
• What is the normal BUN range in mg/dL?
• What is considered normal work of breathing?
• What does the ABCD approach to emergency airway management in the ICU emphasize?
• In burn critical care, which of the following is a priority in initial management?
• An AHI score greater than 30 indicates which condition?
• How can you assess fluid responsiveness at the bedside in the ICU?
• What INR range is desirable when thinner blood is requested for therapeutic purposes?
• What method of pulmonary hygiene can be used when suctioning and other efforts are insufficient?
• A pH value that indicates respiratory failure is:
• Which parameters are commonly monitored to assess tolerance of enteral nutrition in the ICU?
• VEST therapy should be set at what frequency?
• Which GFR value would indicate kidney failure according to the provided information?
• What is the normal pulmonary capillary wedge pressure (PCWP) range?
• Which of the following is a method to remove potassium from the body in severe hyperkalemia?
• What is the target range for blood glucose in ICU patients receiving insulin infusions?
• Initial management of severe hyperkalemia with ECG changes in the ICU includes stabilizing the myocardium with calcium. Which of the following is the appropriate first step?
• Which principle best guides nutrition support for critically ill patients?
• In resolving pressure dampening, which action is performed third?
• Which lab value is most directly related to the oxygen-carrying capacity of blood?
• Sepsis acquired in hospitals is most commonly from what?
• What does the description 'wedge shaped' indicate on a V/Q scan?
• Pt with kidney failure, in need of renal replacement therapy would benefit from what?
• If an infection is suspected at a catheter insertion site, what is the safest immediate management?
• To address pressure dampening during catheter use, which of the following actions should be avoided?
• Which ECG finding is most characteristic of myocardial infarction?
• A key principle of early enteral nutrition in the ICU is?
• What is the normal RBC (red blood cell) count range?
• In a V/Q scan, what do dark areas of the lungs indicate?
• Why is lactate used as a prognostic marker in critical care and what are its limitations?