FCCS EXAM (FUNDAMENTALS OF CRITICAL CARE
SUPPORT) LATEST EXAM 2023-2024 ACTUAL EXAM
150 QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Which type of respiratory failure occurs with CNS depression after an OD? –
ANSWER- Acute hypercapnic respiratory failure –> mixed
A 50 y/o pt is having a COPD exacerbation. You have tried steroids,
bronchodilators, etc. with no improvement. PCO2 is in the 90s, pH is 7.20. You
decide to intubate. Vent settings are: VT 375, RR 20, FiO2 .35, PEEP 5. CXR is
normal. A few minutes later, his BP drops to 70/40. Lungs are clear/equal. Vent
shows peak airway pressure of 55 (high) and plateau pressure of 15. End
expiratory hold gives auto-peep of 15.
What is the cause of this pt’s HoTN and why? – ANSWER- Auto-peep is the cause.
RATIONALE: COPD pts have difficulty exhaling –> pressure buildup in alveoli.
We use PEEP for the pressure and to improve oxygenation. Auto-peep comes from
breath-stacking –> intrinsic peep. Alveoli enlarge –> high peak airway pressure.
All leads to low venous return –> low CO –> HoTN
A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is tx w/
bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but now the peak
airway pressure is up to 55 and plateau pressure is also high at 50. Pt becomes
hypotensive at 70/40. You observe tracheal deviation to the R. Normal breath
sounds on the right, diminished on the left. No wheezing. WBC is normal.
What is the dx and treatment? – ANSWER- Tension pneumothorax
RATIONALE: Needle decompression/chest tube
A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is 88%.
Peak airway pressure and plateau are both high. VT is 5 ml/kg.
How can you decrease the airway pressures? – ANSWER- Decrease the PEEP,
even though it will decrease PaO2.
RATIONALE: (Note: you can’t decrease the VT because it is already on the low
end).
A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC
setting and there is a lot of auto-PEEP. You correct it by reducing the rate, giving
him more time to exhale and making sure he has enough flow. FiO2 is at .50. He is
sedated and seems comfortable. On ABG the pH is 7.24, CO2 is 65, O2 is 80, and
bicarb is 29.
What would you do with the vent settings in this case? – ANSWER- Keep the
settings where they are.
RATIONALE: You can’t hyperventilate the pt to blow off CO2 b/c the asthma will
worsen. As long as the pH is > 7.2, the settings are okay as they are. CO2 will
correct over time.
Which two conditions are the most indicated for BiPAP? – ANSWER- COPD
exacerbation
RATIONALE: Cardiogenic pulmonary edema
A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2
90% on 8L O2. CXR reveals infiltrates in a bat wing pattern. She also has LE
edema. She is dx with a CHF exacerbation w/ respiratory failure. Her ABG shows
pH 7.3, PO2 64, CO2 50.
What is the best tx for this pt? – ANSWER- Non-invasive BiPAP.
A pt comes in w/ a femur fx and a rod is placed. Post-op he develops dyspnea and
fever. HR 140, RR 30, SpO2 92% on non-rebreather. He is transferred to the ICU
where you intubate, place a central line, and start resuscitating him. Hb 8.2, lactate
3.2, SVO2 is 52%.
Why is his SVO2 low? How can we improve it? – ANSWER- Decreased O2
delivery and increased consumption.
RATIONALE: (normal is 65-70)
Administer packed RBCs – 1U of blood will change his Hb from 8.2 to 9.2. O2,
fluid, and VT would not work.
A young pt after an MVA comes to the ER hypotensive and tachycardic. CXR is
clear. He has a contusion on his chest wall and torso. He is unconscious. What will
give you the best insight on what is causing his shock?
Hb
SCV
Urine Output
FAST exam – ANSWER- FAST exam
41 y/o pt in the SICU following debridement of b/l lower extremities for
necrotizing fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46.
ABG shows pH 7.23, PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate
- Dx is metabolic acidosis w/ anion gap d/t infection.
What is the most appropriate intervention?
Increase VT
Continue resuscitation
Decrease RR
Administer bicarb – ANSWER- Continue resuscitation. Don’t need to increase VT
bc the pt doesn’t have respiratory acidosis. If you decrease the RR, the pt will go
into respiratory acidosis.
A pt has obstructive uropathy. A catheter is placed d/t the obstructive kidney
injury. After the cath is placed, he has massive diuresis to the point where he is
hypotensive, tachy, and lactate is 2x the ULN from decreased perfusion.
How would you correct this? – ANSWER- Fluids – LR
When treating hyponatremia, what is the first thing to assess?
When do you give 3% NaCl?
How do you correct it? – ANSWER- 1. fluid status - seizures or changes in mental status
- slowly, 8-12 meq over 24 hr
What are the classifications of hemorrhagic shock? – ANSWER- I: <15%; HR
<100, BP normal, RR normal