Mixed Deck — All ACCS Topics Flashcards

A critically ill patient has a Glasgow Coma Scale (GCS) score of 8. What is the priority intervention?

Answer: Secure the airway with endotracheal intubation

A GCS of 8 or below indicates inability to protect the airway, making immediate intubation the priority.

For a patient with cardiogenic shock and adequate intravascular volume, which hemodynamic intervention is MOST appropriate?

Answer: Initiate inotropic support with dobutamine

Dobutamine improves myocardial contractility and cardiac output in cardiogenic shock with adequate preload; giving additional fluids risks worsening pulmonary edema.

Which intervention has the strongest evidence for reducing VAP (ventilator-associated pneumonia) incidence in the ICU?

Answer: Oral chlorhexidine decontamination

Oral chlorhexidine decontamination is part of VAP bundles and has strong evidence for reducing oropharyngeal colonization and VAP rates.

What is the importance of communication skills in Pharmacology?

Answer: Clear communication prevents errors, builds relationships, and ensures understanding among all parties

Effective communication is essential for coordination, error prevention, and stakeholder relationships.

Which communication strategy is MOST effective when delivering a sudden unexpected death notification to a family in the ICU waiting room?

Answer: Bring the family to a private room, sit down, and speak in person using clear, direct language

In-person notification in a private setting with a seated, compassionate approach is the gold standard for death notification.

Which statement BEST describes the concept of therapeutic privilege in the ICU context?

Answer: Withholding information from a patient when disclosure would cause serious psychological harm

Therapeutic privilege allows withholding information if disclosure would directly harm the patient, but it is considered ethically controversial and rarely justified.

Per the Surviving Sepsis Campaign guidelines, which vasopressor is recommended as the FIRST-LINE agent in septic shock?

Answer: Norepinephrine

Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-1 adrenergic effects that increase SVR, with less tachycardia than dopamine or epinephrine.

During an arterial blood gas draw from a radial arterial line, the specimen appears bright red and the pO2 is 450 mmHg on room air. What error has most likely occurred?

Answer: Air bubble contamination

Air bubbles in an ABG sample equilibrate with atmospheric O2 (~150 mmHg), falsely elevating pO2; the bright red color and very high pO2 on room air indicate air contamination.

Which acid-base disturbance is expected in a patient with prolonged nasogastric suction?

Answer: Metabolic alkalosis with hypochloremia

Loss of hydrochloric acid via NG suction causes metabolic alkalosis accompanied by hypochloremia and often hypokalemia.

Which hemodynamic parameter best reflects left ventricular preload in a critically ill patient?

Answer: Pulmonary artery wedge pressure (PAWP)

PAWP (pulmonary capillary wedge pressure) reflects left ventricular end-diastolic pressure and is the most reliable indirect measure of left ventricular preload.

A burn patient in the ICU develops wound infection with pseudomonas. Which antibiotic class provides the most reliable anti-pseudomonal coverage?

Answer: Antipseudomonal beta-lactams (e.g., piperacillin-tazobactam)

Antipseudomonal beta-lactams such as piperacillin-tazobactam or cefepime are the cornerstone of Pseudomonas aeruginosa treatment.

How should risk be managed in Respiratory Management?

Answer: Through identification, assessment, mitigation strategies, and ongoing monitoring of potential risks

Effective risk management involves a systematic process of identifying, evaluating, and addressing potential threats.

How should a critically ill patient with a high risk of deep vein thrombosis (DVT) be managed?

Answer: Use compression stockings and/or anticoagulants

Critically ill patients are at a high risk for deep vein thrombosis (DVT) due to immobility, inflammation, and hypercoagulability. Prophylactic measures are essential to prevent this potentially life-threatening complication. The use of compression stockings (e.g., graduated compression stockings or intermittent pneumatic compression devices) and/or anticoagulants (e.g., low molecular weight heparin) are standard practices to reduce the risk of clot formation.

How should a healthcare team approach the issue of cultural or religious beliefs that may influence a patient's or family’s healthcare decisions?

Answer: Respect and consider cultural or religious beliefs while providing evidence-based medical care, and work collaboratively with the patient or family to find a mutually acceptable plan of care.

Culturally competent care acknowledges that cultural and religious beliefs significantly influence healthcare decisions and patient adherence. By respecting and integrating these beliefs into the care plan, while still providing evidence-based medicine, healthcare providers can build trust and achieve better outcomes. This collaborative approach ensures care is both medically sound and personally meaningful to the patient and family.

What is the primary purpose of standardized procedures in Pharmacology?

Answer: To ensure consistency, safety, and quality across all practitioners

Standardized procedures ensure that all practitioners deliver consistent, safe, and high-quality outcomes.

What is the primary purpose of standardized procedures in Cardiovascular Support?

Answer: To ensure consistency, safety, and quality across all practitioners

Standardized procedures ensure that all practitioners deliver consistent, safe, and high-quality outcomes.

In a patient with acute liver failure and grade III hepatic encephalopathy, what ammonia-related intervention is recommended?

Answer: Administer lactulose to reduce intestinal ammonia absorption

Lactulose reduces ammonia production and absorption in the gut, lowering serum ammonia and improving encephalopathy grade.

What quality metrics are most important in Cardiovascular Support?

Answer: Measurable outcomes, process compliance, and stakeholder satisfaction

Quality in Cardiovascular Support is measured through multiple dimensions including outcomes, processes, and satisfaction.

A ventilated patient develops sudden unilateral absent breath sounds, tracheal deviation, hypotension, and SpO2 decline. What is the immediate intervention?

Answer: Needle decompression of the affected side

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression at the second intercostal space, midclavicular line — do not wait for imaging.

Which complication is MOST specific to femoral vein central venous catheter placement compared to subclavian placement?

Answer: Higher infection and thrombosis rates

Femoral CVCs carry significantly higher rates of deep vein thrombosis and catheter-related bloodstream infections compared to subclavian sites.