FCCS EXAM 2026 CERTIFICATION
EVALUATION PRACTICE SOLUTION
⫸ A patient is neurologically devastated, mechanically ventilated, and
undergoing dialysis. The neurology service says there is no expectation
of neurologic recovery or improvement. The family is resistant to any
decision regarding limiting or stopping any life-sustaining treatment.
Multiple discussions have occurred during the past 6 weeks. Which of
the following is the most appropriate next step? Answer: Begin formal
conflict-resolution process
- Demand by surrogate decision-makers for futile or potentially
medically inappropriate treatments is a challenge in the ICU.
Unilaterally stopping life-sustaining therapy and filing a unilateral do-
not-attempt-resuscitation order are illegal in several states and are
morally problematic. However, it is not necessary for all medical
treatments to be offered (e.g., surgery for perforated bowel in a
neurologically devastated patient, chemotherapy in a patient in a
permanent vegetative state, feeding tubes in end-stage dementia). For
prolonged conflict in the ICU, multiple organizations have outlined a 7-
step process for addressing and resolving potentially inappropriate
treatments.
⫸ A 52-year-old man presents to the emergency department with
shortness of breath and new-onset lower extremity edema. His vital
signs are: temperature 37.0 °C (98.6 °F); heart rate 114 beats/min;
respiratory rate 28 breaths/min; blood pressure 86/62 mm Hg; and
oxygen saturation as measured by pulse oximetry, (SpO2) 92% on
nonrebreather mask. He is transferred to the ICU, intubated, and a
central line is placed. His hemoglobin is 9.2 g/dL, lactic acid is 4.2
,mg/dL, SpO2 has improved to 98%, and central venous oxygen
saturation is (ScvO2) 43%. This Scvo2 level indicates which of the
following findings? Answer: Decrease oxygen delivery and/or increased
oxygen consumption
- Central venous oxygen saturation (Scvo2) is a surrogate for the mixed
venusvenous saturation and is a representation of oxygen delivery minus
the body's oxygen consumption. Normal Svo2 levels are greater than
65% and as the body will normally deliver four times more than it
consumes. ScvO2 will overestimate in cardiogenic shock and
underestimate in septic shock. Low oxygen delivery or increased
consumption will lower the Scvo2.
⫸ A 75-year-old patient with severe chronic obstructive pulmonary
disease (COPD) has a cardiac arrest due to ventricular fibrillation and
requires CPR. The patient is being ventilated at 10 breaths/min as CPR
ensues. A medical student believes the patient has a do-not-resuscitate
(DNR) order on file. The nurse is concerned that the patient has only 1
working IV line. Which of the following is the most appropriate
approach? Answer: Ensure quantitative end-tidal CO2 monitoring during
CPR
- Optimal ventilation in patients undergoing CPR is 8-10 breaths/min to
ensure appropriate ventilation and avoid iatrogenic increase of
intrathoracic pressure. Point-of-care ultrasound can be a useful
diagnostic tool to determine the cause of cardiac arrest but pausing CPR
for a pulse check should not extend beyond 10 seconds. CPR should
continue until proof of the patient's DNR status is obtained. IV access is
important for high-quality CPR, but CPR should never be stopped to
place IV access. Quantitative end-tidal CO2 is recommended during
, cardiac arrest because it is often the first sign of return of spontaneous
circulation.
⫸ **A 52-year-old man presents to the emergency department with
shortness of breath and new-onset lower extremity edema. Vital signs
are: temperature 37.0 °C (98.6 °F), heart rate 114 beats/min, respiratory
rate 28 breaths/min, blood pressure 86/62 mm Hg, and oxygen saturation
as measured by pulse oximetry (Spo2) 92% on nonrebreather mask. He
is transferred to the ICU, intubated, and a central line is placed.
Transthoracic echocardiogram shows significantly reduced left
ventricular function. Hemoglobin is 9.2 g/dL, lactic acid 4.2 mg/dL, and
central venous oxygen saturation 43%. Which of the following
interventions will significantly improve oxygen delivery?
A.Administer a 1-L fluid bolus and starting antibiotics
B.Start inotropes to increase cardiac contractility
C.Start vasopressors to increase systolic blood pressure
D.Transfuse RBCs to a goal of 10 g/dL Answer: B.Start inotropes to
increase cardiac contractility
- The oxygen delivery equation involves cardiac output, hemoglobin,
oxygen saturation, oxygen-carrying capacity of the blood, and cardiac
output. Cardiac output is affected by preload, contractility, and afterload.
Partial pressure of oxygen dissolved in the blood has minimal effect on
oxygen-carrying capacity. Blood pressure is not an indicator of cardiac
output. While increasing hemoglobin can improve oxygen delivery,
anemia is not the underlying cause of the low mixed venous oxygen
saturation. Transfusing from 9- to 10-g/dL has not been shown to be
beneficial and will lead to worsening fluid overload. This patient has
poor left ventricular function and low cardiac output, is in cardiogenic
shock, and would benefit from inotropic therapy.
EVALUATION PRACTICE SOLUTION
⫸ A patient is neurologically devastated, mechanically ventilated, and
undergoing dialysis. The neurology service says there is no expectation
of neurologic recovery or improvement. The family is resistant to any
decision regarding limiting or stopping any life-sustaining treatment.
Multiple discussions have occurred during the past 6 weeks. Which of
the following is the most appropriate next step? Answer: Begin formal
conflict-resolution process
- Demand by surrogate decision-makers for futile or potentially
medically inappropriate treatments is a challenge in the ICU.
Unilaterally stopping life-sustaining therapy and filing a unilateral do-
not-attempt-resuscitation order are illegal in several states and are
morally problematic. However, it is not necessary for all medical
treatments to be offered (e.g., surgery for perforated bowel in a
neurologically devastated patient, chemotherapy in a patient in a
permanent vegetative state, feeding tubes in end-stage dementia). For
prolonged conflict in the ICU, multiple organizations have outlined a 7-
step process for addressing and resolving potentially inappropriate
treatments.
⫸ A 52-year-old man presents to the emergency department with
shortness of breath and new-onset lower extremity edema. His vital
signs are: temperature 37.0 °C (98.6 °F); heart rate 114 beats/min;
respiratory rate 28 breaths/min; blood pressure 86/62 mm Hg; and
oxygen saturation as measured by pulse oximetry, (SpO2) 92% on
nonrebreather mask. He is transferred to the ICU, intubated, and a
central line is placed. His hemoglobin is 9.2 g/dL, lactic acid is 4.2
,mg/dL, SpO2 has improved to 98%, and central venous oxygen
saturation is (ScvO2) 43%. This Scvo2 level indicates which of the
following findings? Answer: Decrease oxygen delivery and/or increased
oxygen consumption
- Central venous oxygen saturation (Scvo2) is a surrogate for the mixed
venusvenous saturation and is a representation of oxygen delivery minus
the body's oxygen consumption. Normal Svo2 levels are greater than
65% and as the body will normally deliver four times more than it
consumes. ScvO2 will overestimate in cardiogenic shock and
underestimate in septic shock. Low oxygen delivery or increased
consumption will lower the Scvo2.
⫸ A 75-year-old patient with severe chronic obstructive pulmonary
disease (COPD) has a cardiac arrest due to ventricular fibrillation and
requires CPR. The patient is being ventilated at 10 breaths/min as CPR
ensues. A medical student believes the patient has a do-not-resuscitate
(DNR) order on file. The nurse is concerned that the patient has only 1
working IV line. Which of the following is the most appropriate
approach? Answer: Ensure quantitative end-tidal CO2 monitoring during
CPR
- Optimal ventilation in patients undergoing CPR is 8-10 breaths/min to
ensure appropriate ventilation and avoid iatrogenic increase of
intrathoracic pressure. Point-of-care ultrasound can be a useful
diagnostic tool to determine the cause of cardiac arrest but pausing CPR
for a pulse check should not extend beyond 10 seconds. CPR should
continue until proof of the patient's DNR status is obtained. IV access is
important for high-quality CPR, but CPR should never be stopped to
place IV access. Quantitative end-tidal CO2 is recommended during
, cardiac arrest because it is often the first sign of return of spontaneous
circulation.
⫸ **A 52-year-old man presents to the emergency department with
shortness of breath and new-onset lower extremity edema. Vital signs
are: temperature 37.0 °C (98.6 °F), heart rate 114 beats/min, respiratory
rate 28 breaths/min, blood pressure 86/62 mm Hg, and oxygen saturation
as measured by pulse oximetry (Spo2) 92% on nonrebreather mask. He
is transferred to the ICU, intubated, and a central line is placed.
Transthoracic echocardiogram shows significantly reduced left
ventricular function. Hemoglobin is 9.2 g/dL, lactic acid 4.2 mg/dL, and
central venous oxygen saturation 43%. Which of the following
interventions will significantly improve oxygen delivery?
A.Administer a 1-L fluid bolus and starting antibiotics
B.Start inotropes to increase cardiac contractility
C.Start vasopressors to increase systolic blood pressure
D.Transfuse RBCs to a goal of 10 g/dL Answer: B.Start inotropes to
increase cardiac contractility
- The oxygen delivery equation involves cardiac output, hemoglobin,
oxygen saturation, oxygen-carrying capacity of the blood, and cardiac
output. Cardiac output is affected by preload, contractility, and afterload.
Partial pressure of oxygen dissolved in the blood has minimal effect on
oxygen-carrying capacity. Blood pressure is not an indicator of cardiac
output. While increasing hemoglobin can improve oxygen delivery,
anemia is not the underlying cause of the low mixed venous oxygen
saturation. Transfusing from 9- to 10-g/dL has not been shown to be
beneficial and will lead to worsening fluid overload. This patient has
poor left ventricular function and low cardiac output, is in cardiogenic
shock, and would benefit from inotropic therapy.
