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ACCS Oakes practice Exam Questions and answers with 100% correct solutions | A+ Grade
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ACCS Oakes practice Exam Questions and answers with 100% correct solutions | A+ Grade
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ACCS Oakes practice Exam Questionsand answers with 100% correct solutions |
A+ Grade
Which of the following pharmacologic agents is MOST indicated in an intubated patient who was
admitted to Trauma ICU with multiple gunshot wounds to the abdomen and upper thigh.
A) propofol
B) ativan
C) norepinephrine
D) vecuronium ✔✔This patient is likely in pain following their injuries. Initially, pain and sedation
are most indicated. Now it is important to pick out the correct medication from those given to you:
vecuronium is a paralytic (not indicated)
ativan is an anti-anxiety medication (not indicated)
norepinephrine is a pressor (not indicated)
propofol is a sedative (correct answer)
You are asked to consult on a patient in the ED who is being admitted to the Medical ICU. ABG is below.
CXR shows flattened diaphragms with hyperlucency in the apices. ABG shows:
Ph 7.29
PaCO2 66
PaO2 56
HCO3 30
What do you recommend as the BEST choice?
A) Intubate patient and place on a Pressure-Control mode of Ventilation
,B) Oxygen by Nasal Cannula, start at 2L
C) NPPV via Face Mask
D) I.V. Steroids, maintain on RA to avoid hypoxic drive ✔✔Correct answer C
First you have to figure out what is going on with this patient. CXR and ABG both support a COPD
diagnosis (remember that COPD is truly diagnosed via a PFT). The pt is sitting up, leaning forward,
complaining of SOB.
The ABG shows Acute on Chronic Respiratory Acidosis, and is mildly hypoxic. The best treatment in this
case is NPPV to help alleviate WOB and treat hypoxia while other treatments are being initiated
(steroids, bronchodilators, etc.). Note that both 2L NC and RA are not appropriate as the pt is in distress
and hypoxic which must be treated. Intubating a pt with COPD, while sometimes necessary, also creates
unique concerns with attempts to wean after such an unload of work of breathing.
On assessment, a patient is noted to have coarse crackles throughout all lung fields, an increased
work of breathing, and steadily increasing FIO2 demand.
Which medication will best address this?
A) Lasix
B) Albuterol sulfate
C) Atropine
D) 1L Normal Saline ✔✔Correct answer is A
The assessment is consistent with fluid overload. Lasix is a diuretic and will address this. Albuterol is a
bronchodilator and may help briefly with dyspnea but will not treat underlying cause. Atropine is a
muscarinic receptor antagonist, an important cardiac medication Normal Saline will potentially worsen
the problem, and would be indicated instead in a patient who needs to be fluid resuscitated (temporary
solution for improving hypotension)
, You have been asked to make a recommendation regarding specialty airways that help prevent
colonization of organisms on it which might lead to VAP. What would you recommend?
A) Microcuff Tube
B) Silver-coated Endotracheal Tube
C) Use of ET Tube with closed suctioning only
D) Mercury-coated Endotracheal Tube ✔✔Correct answer B
Silver-coated endotracheal tubes are designed to help prevent Ventilator Associated Pneumonias.
Mercury-Coated Endotracheal Tubes don't exist (would be harmcul). Use of ET tube with Closed
Suctioning might help prevent VAP but not Colonization on the Tube. Microcuffs are again intended on
preventing VAP by preventing microaspiration, but does not act by reducing colonization.
A 58 y/o is in the cardiac critical care unit. You are called urgently to his room as he has gone into
flash pulmonary edema. You note the following data:
RR: 30 breaths/minute
HR: 132 bpm, gallop noted (S3)
BP: 84/64
GCS: 9T
Disposition: Obtunded
Skin: mottled, clammy
Jugular Veins: distended
ABG
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