A
A medical emergency team is called to assess desaturation in a patient with bilateral femur fractures following a motor vehicle crash. SpO2 is 92% while receiving O2 by nasal cannula at 6 L/min. A PCA pump with morphine is in use, but the patient has also been verbally requesting pain relief hourly. A nurse administered 2 mg of midazolam HCl (Versed) in divided doses over the past 30 minutes. Physiologic data are:
HR 82/min
RR 8/min, shallow
BP 110/60 mm Hg
The patient is arousable, but confused. The MOST appropriate initial action is to
A. temporarily stop narcotics.
B. give IV haloperidol (Haldol).
C. change midazolam HCl (Versed) to lorazepam (Ativan).
D. change from morphine to hydromorphone HCl (Dilaudid).
A. temporarily stop narcotics
A 56-year-old male patient with terminal lung cancer has severe dyspnea. The patient has persistent nausea and vomiting and refuses IV insertion. The physician asks an adult critical care specialist to recommend aerosolized medication to relieve dyspnea. The specialist should suggest
aerosolized morphine
A patient who has pneumonia exhibits diaphoresis, tachypnea, hypotension, and elevated serum lactate. An adult critical care specialist should anticipate that this patient will receive treatment for
A. DKA.
B. sepsis.
C. renal failure.
D. hepatic failure.
B. sepsis
An adult patient arrives with an acute exacerbation of cystic fibrosis. Sputum culture reveals many gram-negative rods. Which of the following is the MOST likely organism?
A. Aspergillus fumigatus
B. Staphylococcus aureus
C. Haemophilus influenzae
D. Pseudomonas aeruginosa
D. Pseudomonas aeruginosa
A 55-year-old patient develops a left lower lobe infiltrate, fever, and elevated WBC count following colon resection. Which of the following treatments should an adult critical care specialist anticipate?
A. an antitussive
B. a beta blocker
C. a beta2-agonist
D. an antimicrobial
D. an antimicrobial
A 30-year-old female suffered cardiac arrest, and the duration of resuscitation lasted 20 minutes. Seventy-two hours after CPR, the results of a neurological exam showed fixed pupils and absent cranial reflexes. The mandatory rate of mechanical ventilation is 12 and total RR is 12/min. Sedation has been stopped and the patient is normothermic and normotensive. Which of the following should an adult critical care specialist anticipate NEXT?
A. apnea testing
B. MRI of the brain
C. therapeutic hypothermia
D. pentobarbital (Nembutal) coma
a. apnea testing
Initial therapy of treating shock:
a. Infuse electrolytes
b. aggressive rapid infusion of large quantities of fluid
c. vasoconstrictors
d. intubate and ventilate
b. aggressive rapid infusion of large quantities of fluid
A 27-year-old male is admitted to an ICU with a TBI following an unhelmeted motorcycle collision with a fixed object. The patient arrives with nonreactive pupils. High ICP is unresponsive to treatment. Cranial nerve testing is negative. The physician asks an adult critical care specialist to help assess criteria for brain death. Vital signs are:
Temperature 37º C (98.6º F)
HR 90/min
RR 18/min (ventilator breaths)
BP 100/70 mm Hg
SpO2 98%
The specialist should FIRST assess the patient's
A. calorimetry.
B. RSBI.
C. apnea test result.
D. deep tendon reflex.
C. apnea test result
Septic shock is usually _____ caused.
a. loss of blood volume
b. allergic reaction
c. bacterial
d. viral
bacterial
All of the following are clinical signs of shock except:
a. hypertension
b. narrow pulse pressure
c. delayed capillary refil
d. oliguria
a. hypertension
A patient is admitted to the ED following complaints of nausea, vomiting, abdominal pain, and tarry stools for 3 days. SpO2 reading is absent from a finger probe. After an adult critical care specialist moves the probe to the right ear, an SpO2 of 85% is observed with an intermittent signal while the patient is breathing O2 from a nonrebreathing mask. Physiologic data are:
HR 110/min
RR 20/min
BP 90/65 mm Hg
Serum lactate 4 mmol/L
pH 7.30
PaCO2 30 torr
PaO2 125 torr
HCO3- 15 mEq/L
BE -10 mEq/L
SaO2 (calc) 98%
Which of the following should the specialist recommend?
A. normal saline bolus
B. methylene blue injection
C. sodium bicarbonate administration
D. dobutamine HCl (Dobutrex) infusion
A. normal saline bolus
Septic shock is accompanied by hypotension which is defined as Systolic B.P. _____.
a. >100 mm Hg
b. <50 mmHg
c. <90 mmHg
d. >60 mmHg
c. <90 mmHg
A 48-year-old male patient is 3-hours post-gastric resection. The patient is somnolent with a decrease in SpO2 to 89%. An adult critical care specialist is called to evaluate the patient who has a RR of 6/min. A review of the anesthetic record shows general inhalational anesthesia, 4 mg of midazolam HCl (Versed), and a single dose of rocuronium bromide (Zemuron) 4 hours earlier. The patient has been receiving hydromorphone HCl (Dilaudid) by PCA. Which of the following is MOST likely to improve the patient's status?
A. naloxone HCl (Narcan)
B. flumazenil (Romazicon)
C. neostigmine bromide (Prostigmin)
D. physostigmine (Antilirium)
A. naloxone HCl (Narcan)
A 47 year-old female patient with 3rd degree burns over 80% of her body requires intubation in the ED. Succinylcholine is given for rapid induction intubation. The major complication of this medication is:
a. Upper airway edema
b. An uncooperative patient
c. Hypovolemia
d. Hyperkalemia
d. Hyperkalemia
A 23-year-old male patient who is 7-days post-TBI is receiving mechanical ventilation. The following data are available:
Temperature 35.6º C (96º F)
HR 90/min
BP 80/50 mm Hg
Urine output 400 mL/hr
To diagnose brain death, an adult critical care specialist should recommend
A. an EEG.
B. apnea testing.
C. a brain perfusion study.
D. transcranial Doppler ultrasonography.
C. a brain perfusion study
A 28 year-old man with status asthmaticus has had an incomplete response to continuous nebulization of Albuterol in the ED. What additional medication should be added to the nebulizer?
a. Salmeterol
b. Ipratropium bromide
c. Atropine
d. Montelukast
b. Ipratropium bromide
A patient with COPD presents to the ED with marked confusion. A chest radiograph shows bilateral infiltrates and lung hyperinflation. An echocardiogram shows a good left ventricular function. While the patient is receiving an FIO2 of 0.40, ABG analysis results are:
Temperature 38.5º C (101.3º F)
HR 125/min
RR 36/min
SpO2 73%
Serum lactate 1.8 mmol/L
pH 7.35
PCO2 51 torr
PO2 41 torr
HCO3- 28 mEq/L
BE +1 mEq/L
SO2 (calc) 75%
An adult critical care specialist should expect a physician to identify which of the following as the MOST likely etiology?
A. sepsis-induced ARDS
B. bronchospasm
C. congestive heart failure
D. acute bronchitis
A. sepsis-induced ARDS
A multidisciplinary care team is evaluating a 67-year-old patient who is 5-days post-hip replacement. Physiologic values while receiving O2 by nasal cannula at 5 L/min are:
Temperature 38.5º C (101.3º F)
HR 107/min
RR 24/min
BP 90/60 mm Hg
SpO2 90%
Serum lactate 3.2 mmol/L
Serum troponin 0.2 ng/mL
BNP 25 pg/mL
WBC 12,500/µL
pH 7.36
PaCO2 26 torr
PaO2 78 torr
HCO3- 15 mEq/L
BE -9 mEq/L
SaO2 (calc) 96%
Mild scattered crackles are auscultated. Which of the following is the MOST likely cause of this patient's condition?
A. fat embolism
B. systemic sepsis
C. pulmonary edema
D. myocardial infarction
B. systemic sepsis
A 46-year-old male who is lethargic is admitted to the ED with an initial diagnosis of status asthmaticus. The patient is receiving a beta2-agonist by continuous nebulization. While receiving O2 by nasal cannula at 6 L/min, vital signs are:
Temperature 37º C (98.6º F)
HR 110/min
RR 40/min
BP 134/88 mm Hg
SpO2 98%
Which of the following should be included in this patient's care?
A. NPPV
B. invasive mechanical ventilation
C. IV corticosteroids
D. IV antibiotics
C. IV corticosteroids
A patient is improving after receiving VC, A/C ventilation for 4 days due to respiratory failure. Ventilator settings are:
FIO2 0.50
Mandatory rate 8
Total rate 8
PEEP 5 cm H2O
SpO2 is 95%. The patient is receiving continuous infusion of lorazepam (Ativan). The patient responds to verbal stimuli, but appears somnolent. The physician wants to proceed towards weaning. Which of the following should an adult critical care specialist conclude?
A. The patient is ready to wean.
B. The mandatory rate is too high.
C. A CT of the head is indicated.
D. Oversedation is causing somnolence.
D. Oversedation is causing somnolence
This type of shock can sometimes be referred to as "warm" shock due to the patients flushed appearance.
Neurologic shock
A 30-year-old male involved in a motorcycle crash was intubated en route to the ED. The patient presents with a Glasgow Coma Scale score of 8. A CT showed a fractured sternum, an occipital skull fracture with subdural hematoma, and a cervical spine subluxation at C5. The patient has a liver laceration and is able to move both lower extremities spontaneously. Patient monitoring in the ICU reveals:
HR 130/min
BP 90/60 mm Hg
CVP 2 mm Hg
ICP 15 mm Hg
Hb 11.8 g/dL
Which of the following is the MOST appropriate intervention?
A. rapid fluid infusion
B. cervical spine fixation
C. decompression craniectomy
D. IV dobutamine HCl (Dobutrex)
A. rapid fluid infusion
A 42-year-old male patient has a C5 cervical spine injury with dense quadriplegia on ED admission following a shallow water diving accident. The patient is oriented to time and place. The cardiac monitor shows a normal sinus rhythm with a rate of 72/min. Respirations are 32/min, and vital capacity is 7 mL/kg. While receiving O2 by nasal cannula at 2 L/min, ABG analysis results are:
pH 7.34
PCO2 47 torr
PO2 95 torr
HCO3- 25 mEq/L
BE -1 mEq/L
SO2 (calc) 97%
Which of the following should an adult critical care specialist recommend FIRST?
A. NPPV
B. intubation
C. IV doxapram HCl (Dopram)
D. IV naloxone HCl (Narcan) bolus
B. intubation
A 39-year-old female is in the ICU 10-days post-total hysterectomy with significantly decreased urine output, decreased platelet count, and difficulty breathing. Vital signs are as follows:
Temperature 38.6º C (101.5º F)
HR 97/min
RR 22/min
BP 80/50 mm Hg
SpO2 90%
Which of the following should an adult critical care specialist expect?
A. severe sepsis
B. fluid overload
C. basilar atelectasis
D. acute pulmonary embolism
A. severe sepsis
What blood gas result is commonly seen in a septic patient?
a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis
c. metabolic acidosis