MCQ Quiz: Acute Care/Critical Care

Acute and critical care pharmacy represents one of the most dynamic and challenging areas of practice, placing pharmacists at the bedside as essential members of the interprofessional team. Managing critically ill patients requires a deep understanding of complex disease states, advanced pharmacotherapy, and rapid decision-making. The Patient Care VII curriculum for PharmD students provides a capstone experience in this area, covering key topics such as sepsis and septic shock, pain, agitation, and delirium (PAD) management, cardiovascular emergencies, and parenteral nutrition. This quiz will test your knowledge on these vital acute care topics, preparing you to handle the complexities of the intensive care unit.

1. In the management of septic shock, what is the first-line vasopressor recommended by the Surviving Sepsis Campaign guidelines for patients who remain hypotensive after fluid resuscitation?

• a) Vasopressin
• b) Dopamine
• c) Norepinephrine
• d) Phenylephrine Answer: c) Norepinephrine

2. The Richmond Agitation-Sedation Scale (RASS) is a tool used to assess which of the following in ICU patients?

• a) Level of pain
• b) Level of consciousness and agitation
• c) Presence of delirium
• d) Risk of developing a stroke Answer: b) Level of consciousness and agitation

3. When managing Pain, Agitation, and Delirium (PAD) in the ICU, which component should generally be addressed first?

• a) Pain
• b) Agitation
• c) Delirium
• d) Sleep Answer: a) Pain

4. A patient in the ICU develops refeeding syndrome after the initiation of parenteral nutrition. This condition is characterized by a severe decrease in which electrolyte?

• a) Sodium
• b) Calcium
• c) Phosphorus
• d) Chloride Answer: c) Phosphorus

5. According to the Advanced Cardiovascular Life Support (ACLS) guidelines, what is the standard dose of intravenous epinephrine administered during adult cardiac arrest?

• a) 1 mg every 3-5 minutes
• b) 0.5 mg every 10 minutes
• c) 3 mg as a one-time dose
• d) 0.1 mg/kg every 2 minutes Answer: a) 1 mg every 3-5 minutes

6. Which sedative agent used in the ICU has analgesic properties, does not cause significant respiratory depression, and is associated with a more cooperative state of sedation?

• a) Propofol
• b) Lorazepam
• c) Midazolam
• d) Dexmedetomidine Answer: d) Dexmedetomidine

7. In a patient with acute decompensated heart failure (ADHF) who presents as “wet and cold” (congested and hypoperfused), the initial management would likely include a diuretic and what other class of agent?

• a) A beta-blocker
• b) An inotropic agent (e.g., dobutamine)
• c) An ACE inhibitor
• d) A calcium channel blocker Answer: b) An inotropic agent (e.g., dobutamine)

8. The Confusion Assessment Method for the ICU (CAM-ICU) is a tool used to screen for what common critical care complication?

• a) Delirium
• b) Stroke
• c) Pain
• d) Agitation Answer: a) Delirium

9. Propofol, a commonly used sedative, is formulated in a lipid emulsion, which provides a significant caloric load and can lead to what metabolic abnormality?

• a) Hyperglycemia
• b) Hypoglycemia
• c) Hypertriglyceridemia
• d) Hyponatremia Answer: c) Hypertriglyceridemia

10. What is a key component of the “sepsis bundle” that should be completed within the first hour of recognition?

• a) Administration of broad-spectrum antibiotics
• b) Obtaining blood cultures
• c) Measuring lactate level
• d) All of the above Answer: d) All of the above

11. A patient in the ICU is started on parenteral nutrition (PN). Which of the following is NOT a standard component of a total parenteral nutrition (TPN) formulation?

• a) Dextrose
• b) Amino acids
• c) Fiber
• d) Intravenous lipid emulsion Answer: c) Fiber

12. The introduction to critical care in the Patient Care VII curriculum emphasizes the pharmacist’s role in:

• a) Performing surgical procedures.
• b) Optimizing pharmacotherapy and ensuring medication safety.
• c) Diagnosing medical conditions.
• d) Managing the ventilator settings. Answer: b) Optimizing pharmacotherapy and ensuring medication safety.

13. In the ACLS algorithm for pulseless ventricular fibrillation (VF) or ventricular tachycardia (pVT), what is the first-line antiarrhythmic agent to be administered after epinephrine?

• a) Lidocaine
• b) Atropine
• c) Adenosine
• d) Amiodarone Answer: d) Amiodarone

14. A patient is classified as having distributive shock. Which of the following is the most common cause?

• a) Massive pulmonary embolism
• b) Myocardial infarction
• c) Sepsis
• d) Hemorrhage Answer: c) Sepsis

15. Which of the following is a non-pharmacologic strategy to manage and prevent delirium in the ICU?

• a) Keeping the patient heavily sedated
• b) Using physical restraints at all times
• c) Early mobility and reorientation
• d) Keeping the room dark and quiet 24 hours a day Answer: c) Early mobility and reorientation

16. In the management of hypertensive emergencies, the goal is to lower the mean arterial pressure (MAP) by no more than what percentage in the first hour?

• a) 5-10%
• b) 10-25%
• c) 50%
• d) 100% Answer: b) 10-25%

17. The primary treatment for hypovolemic shock is:

• a) Administration of vasopressors.
• b) Administration of intravenous crystalloid fluids.
• c) Administration of diuretics.
• d) Administration of an inotrope. Answer: b) Administration of intravenous crystalloid fluids.

18. Stress ulcer prophylaxis in the ICU is indicated for high-risk patients. Which of the following is a common agent used for this purpose?

• a) Sucralfate
• b) A proton pump inhibitor (e.g., pantoprazole)
• c) A bulk-forming laxative
• d) An antacid Answer: b) A proton pump inhibitor (e.g., pantoprazole)

19. What is the reversal agent for dexmedetomidine?

• a) Flumazenil
• b) Naloxone
• c) Atipamezole (not commonly used in humans)
• d) There is no specific reversal agent. Answer: d) There is no specific reversal agent.

20. A patient presenting with acute decompensated heart failure (ADHF) who is “wet and warm” (congested but well-perfused) would benefit most from which initial therapy?

• a) Intravenous loop diuretics
• b) An inotropic agent
• c) A vasopressor
• d) Intravenous fluids Answer: a) Intravenous loop diuretics

21. The qSOFA (quick Sequential Organ Failure Assessment) score includes which three criteria?

• a) Heart rate, temperature, and white blood cell count
• b) Respiratory rate ≥ 22/min, altered mental status, and systolic blood pressure ≤ 100 mmHg
• c) Serum lactate, bilirubin, and creatinine
• d) Blood pressure, oxygen saturation, and pain score Answer: b) Respiratory rate ≥ 22/min, altered mental status, and systolic blood pressure ≤ 100 mmHg

22. Which of the following is a potential complication of TPN therapy?

• a) Hyperglycemia
• b) Electrolyte abnormalities
• c) Liver dysfunction (steatosis)
• d) All of the above Answer: d) All of the above

23. According to the ACLS algorithm, atropine is the first-line drug for treating what condition?

• a) Symptomatic bradycardia
• b) Ventricular fibrillation
• c) Asystole
• d) Tachycardia with a pulse Answer: a) Symptomatic bradycardia

24. The management of pain in a critically ill, non-verbal patient can be assessed using which tool?

• a) The RASS scale
• b) The CAM-ICU
• c) A 0-10 numeric rating scale
• d) The Critical-Care Pain Observation Tool (CPOT) Answer: d) The Critical-Care Pain Observation Tool (CPOT)

25. In the management of septic shock, if a patient remains hypotensive despite adequate norepinephrine, what is a common second-line agent to add?

• a) Vasopressin
• b) Dobutamine
• c) Milrinone
• d) Dopamine Answer: a) Vasopressin

26. The “Stop the Bleed” training, as mentioned in the Patient Care VII syllabus, is designed to empower individuals to manage what type of acute emergency?

• a) Cardiogenic shock
• b) Anaphylactic shock
• c) Septic shock
• d) Hemorrhagic/hypovolemic shock from trauma Answer: d) Hemorrhagic/hypovolemic shock from trauma

27. A major difference between propofol and benzodiazepines for sedation in the ICU is that propofol:

• a) Has a much longer half-life.
• b) Has a very rapid onset and short duration of action, allowing for quick “neuro checks”.
• c) Is not associated with hypotension.
• d) Is safe to use in patients with a soy or egg allergy. Answer: b) Has a very rapid onset and short duration of action, allowing for quick “neuro checks”.

28. An important non-pharmacologic intervention for a critically ill patient is VTE (venous thromboembolism) prophylaxis, which can include:

• a) Early ambulation
• b) Sequential compression devices (SCDs)
• c) Subcutaneous heparin or enoxaparin
• d) Both B and C are common strategies Answer: d) Both B and C are common strategies

29. What is a key role for a pharmacist in a “code blue” (cardiac arrest) situation?

• a) To perform chest compressions.
• b) To prepare and label emergency medications like epinephrine and amiodarone.
• c) To operate the defibrillator.
• d) To document the entire event. Answer: b) To prepare and label emergency medications like epinephrine and amiodarone.

30. The management of cardiogenic shock, often caused by a myocardial infarction, is focused on:

• a) Administering large volumes of intravenous fluids.
• b) Improving cardiac output with inotropes and potentially vasopressors, while addressing the underlying cause.
• c) Administering broad-spectrum antibiotics.
• d) Providing deep sedation with benzodiazepines. Answer: b) Improving cardiac output with inotropes and potentially vasopressors, while addressing the underlying cause.

31. In the Patient Care VIII curriculum, “Adjusting Medication for Changing Renal Function in the Hospital” is a key skill because:

• a) Renal function is always stable in ICU patients.
• b) Acute kidney injury (AKI) is a common complication in critical illness that necessitates dose adjustments.
• c) All medications are cleared by the liver.
• d) Pharmacists are not responsible for dose adjustments. Answer: b) Acute kidney injury (AKI) is a common complication in critical illness that necessitates dose adjustments.

32. A patient with diabetic ketoacidosis (DKA) is managed in the ICU. A critical component of their management, besides insulin, is:

• a) Aggressive intravenous fluid resuscitation and electrolyte correction.
• b) Administration of oral diabetes medications.
• c) A high-carbohydrate diet.
• d) Administration of vasopressors. Answer: a) Aggressive intravenous fluid resuscitation and electrolyte correction.

33. What is the rationale for using hydrocortisone in patients with septic shock who are refractory to vasopressors?

• a) To treat the underlying infection.
• b) To address potential “relative adrenal insufficiency” and improve hemodynamic stability.
• c) To prevent stress ulcers.
• d) To manage pain. Answer: b) To address potential “relative adrenal insufficiency” and improve hemodynamic stability.

34. A spontaneous awakening trial (“sedation vacation”) is a daily practice in the ICU designed to:

• a) Increase the total amount of sedative used.
• b) Decrease ventilator time and length of ICU stay.
• c) Ensure the patient remains deeply sedated.
• d) Make the nurse’s job more difficult. Answer: b) Decrease ventilator time and length of ICU stay.

35. A patient on a continuous infusion of lorazepam for a week is at risk for what complication upon discontinuation?

• a) Severe hypertension
• b) Withdrawal syndrome
• c) Hypertriglyceridemia
• d) Anaphylaxis Answer: b) Withdrawal syndrome

36. The ethical principles of Palliative Care, as discussed in the Patient Care VII curriculum, are important in the ICU to:

• a) Focus on curative therapy only.
• b) Manage symptoms and align treatment with the patient’s goals of care, especially in end-of-life situations.
• c) Ensure every patient receives the most aggressive treatment possible.
• d) Limit communication with the patient’s family. Answer: b) Manage symptoms and align treatment with the patient’s goals of care, especially in end-of-life situations.

37. Which of the following is a primary goal when managing a patient with pulmonary hypertension in the ICU?

• a) To increase pulmonary artery pressure
• b) To decrease pulmonary vascular resistance and manage right ventricular failure
• c) To administer broad-spectrum antibiotics
• d) To provide deep sedation Answer: b) To decrease pulmonary vascular resistance and manage right ventricular failure

38. The pharmacist’s role in managing TPN includes ensuring the compatibility of all additives. Which two electrolytes are most likely to precipitate if added improperly?

• a) Sodium and chloride
• b) Calcium and phosphate
• c) Potassium and magnesium
• d) Sodium and potassium Answer: b) Calcium and phosphate

39. A patient is experiencing asystole. According to ACLS, which intervention is indicated?

• a) Synchronized cardioversion
• b) High-quality CPR and epinephrine
• c) Defibrillation
• d) Amiodarone Answer: b) High-quality CPR and epinephrine

40. In the “Introduction to Critical Care” unit, a key focus is on the interprofessional team. This highlights the importance of:

• a) The pharmacist working in isolation.
• b) Clear and respectful communication between pharmacists, physicians, nurses, and respiratory therapists.
• c) A strict hierarchical structure where only the physician can speak.
• d) Each discipline creating its own separate care plan. Answer: b) Clear and respectful communication between pharmacists, physicians, nurses, and respiratory therapists.

41. Which of the following is NOT a type of shock?

• a) Distributive
• b) Cardiogenic
• c) Anaphylactic (which is a type of distributive shock)
• d) Hypertensive Answer: d) Hypertensive

42. A patient on TPN needs their electrolytes monitored daily because:

• a) The TPN bag is changed daily.
• b) Fluid shifts and refeeding syndrome can cause rapid and dangerous electrolyte changes.
• c) It is a hospital policy with no clinical reason.
• d) The dextrose in the TPN binds to electrolytes. Answer: b) Fluid shifts and refeeding syndrome can cause rapid and dangerous electrolyte changes.

43. The first “D” in the ACLS “Hs and Ts” mnemonic for reversible causes of cardiac arrest stands for:

• a) Dehydration
• b) Dextrose (low)
• c) Defibrillation
• d) Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia Answer: d) Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia

44. The use of balanced crystalloids (e.g., Lactated Ringer’s) over normal saline for large-volume resuscitation in sepsis is favored by some clinicians to avoid:

• a) Hypernatremia
• b) Hyperchloremic metabolic acidosis
• c) Hypochloremia
• d) Hyponatremia Answer: b) Hyperchloremic metabolic acidosis

45. A major task for a pharmacist on ICU rounds is to perform medication reconciliation, which is crucial for:

• a) Preventing medication errors during transitions of care.
• b) Billing the patient’s insurance correctly.
• c) Determining the patient’s diet order.
• d) Ensuring the patient has a ride home. Answer: a) Preventing medication errors during transitions of care.

46. A patient with supraventricular tachycardia (SVT) who is hemodynamically stable should be treated with which medication that has an extremely short half-life?

• a) Amiodarone
• b) Diltiazem
• c) Adenosine
• d) Metoprolol Answer: c) Adenosine

47. When managing a patient in the ICU, “source control” refers to:

• a) Controlling the source of hospital funding.
• b) Controlling the patient’s pain.
• c) Physically eliminating the source of an infection (e.g., draining an abscess, removing an infected line).
• d) Controlling the information given to the patient’s family. Answer: c) Physically eliminating the source of an infection (e.g., draining an abscess, removing an infected line).

48. In the “Cardiovascular Emergencies” unit, a key management principle is to differentiate between hypertensive urgency and emergency. An emergency is defined by the presence of:

• a) A systolic blood pressure > 180 mmHg
• b) A diastolic blood pressure > 120 mmHg
• c) A severe headache
• d) Acute, ongoing end-organ damage Answer: d) Acute, ongoing end-organ damage

49. Propofol-related infusion syndrome (PRIS) is a rare but fatal complication associated with high doses and prolonged use, characterized by metabolic acidosis, rhabdomyolysis, and:

• a) Hypertension
• b) Bradycardia and cardiovascular collapse
• c) Hyperglycemia
• d) Respiratory alkalosis Answer: b) Bradycardia and cardiovascular collapse

50. The capstone experience of Patient Care VIII, which includes this Acute Care module, is designed to prepare students for:

• a) Community pharmacy practice only.
• b) APPE rotations and the ability to manage complex patients in a hospital setting.
• c) A career in pharmaceutical research.
• d) The administrative aspects of pharmacy only. Answer: b) APPE rotations and the ability to manage complex patients in a hospital setting.