BCCCP Critical Care Pharmacy Certification Exam 2026: Advanced
Professional Practice Test — Hemodynamic, Shock, Infectious
Diseases, Pulmonary Disorders, Neurocritical Care, Sedation &
Toxicology — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
SECTION 1: HEMODYNAMICS AND SHOCK (Questions 1-20)
Question 1
A 62-year-old male with septic shock remains hypotensive with a mean arterial pressure
(MAP) of 58 mmHg after receiving 30 mL/kg of IV crystalloid. Which vasopressor is
recommended as first-line therapy per the Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock due to superior
efficacy and lower arrhythmia risk compared to dopamine . It primarily stimulates alpha-1
receptors causing vasoconstriction with some beta-1 activity.
Question 2
A 55-year-old female with cardiogenic shock has a cardiac index of 1.8 L/min/m², elevated
systemic vascular resistance, and elevated filling pressures. Which agent provides both
inotropic support and afterload reduction?
A. Norepinephrine
B. Phenylephrine
,C. Dobutamine
D. Vasopressin
Correct Answer: C
Explanation: Dobutamine is a beta-1 agonist with some beta-2 activity, providing inotropy
and mild vasodilation, making it ideal for cardiogenic shock with low cardiac output and
elevated SVR .
Question 3
A patient with anaphylactic shock has not responded to two doses of intramuscular
epinephrine. What is the most appropriate next intervention?
A. Administer diphenhydramine 50 mg IV
B. Start epinephrine intravenous infusion
C. Give methylprednisolone 125 mg IV
D. Administer albuterol nebulizer treatment
Correct Answer: B
Explanation: Refractory anaphylaxis requires intravenous epinephrine infusion for
continuous hemodynamic support. Antihistamines and corticosteroids are adjuncts but do
not reverse shock .
Question 4
A 48-year-old male in septic shock is receiving norepinephrine at 0.35 mcg/kg/min with MAP
of 62 mmHg. Which agent should be added next per current guidelines?
A. Phenylephrine
B. Dopamine
,C. Vasopressin
D. Angiotensin II
Correct Answer: C
Explanation: Vasopressin is recommended as the second-line agent to add to norepinephrine
in septic shock. It acts on V1 receptors and has a norepinephrine-sparing effect at fixed
doses of 0.03-0.04 units/min .
Question 5
Which hemodynamic pattern is characteristic of distributive shock?
A. Low cardiac output, high SVR
B. High cardiac output, low SVR
C. Low cardiac output, low SVR
D. Normal cardiac output, high SVR
Correct Answer: B
Explanation: Distributive shock features profound vasodilation causing low SVR, with
compensatory increases in cardiac output. This contrasts with cardiogenic and hypovolemic
shock which have low output .
Question 6
A patient with acute decompensated heart failure and cardiogenic shock requires
vasopressor support. Which agent provides the most balanced vasoconstriction without
excessive chronotropy?
A. Dopamine
B. Epinephrine
, C. Norepinephrine
D. Isoproterenol
Correct Answer: C
Explanation: Norepinephrine provides alpha-1 mediated vasoconstriction with modest beta-
1 activity, raising MAP without excessive heart rate increase, making it preferred for
cardiogenic shock with hypotension.
Question 7
A 70-year-old female on chronic beta-blocker therapy presents with septic shock refractory
to fluids. Which vasopressor may be particularly beneficial due to its beta-1 activity?
A. Vasopressin
B. Phenylephrine
C. Norepinephrine
D. Epinephrine
Correct Answer: D
Explanation: Epinephrine provides both alpha and beta agonism. In patients with beta-
blockade, the beta-1 activity of epinephrine helps overcome the blunted chronotropic
response to catecholamines.
Question 8
What is the target MAP for initial resuscitation in septic shock per Surviving Sepsis Campaign
guidelines?
A. ≥55 mmHg
B. ≥60 mmHg
Professional Practice Test — Hemodynamic, Shock, Infectious
Diseases, Pulmonary Disorders, Neurocritical Care, Sedation &
Toxicology — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
SECTION 1: HEMODYNAMICS AND SHOCK (Questions 1-20)
Question 1
A 62-year-old male with septic shock remains hypotensive with a mean arterial pressure
(MAP) of 58 mmHg after receiving 30 mL/kg of IV crystalloid. Which vasopressor is
recommended as first-line therapy per the Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock due to superior
efficacy and lower arrhythmia risk compared to dopamine . It primarily stimulates alpha-1
receptors causing vasoconstriction with some beta-1 activity.
Question 2
A 55-year-old female with cardiogenic shock has a cardiac index of 1.8 L/min/m², elevated
systemic vascular resistance, and elevated filling pressures. Which agent provides both
inotropic support and afterload reduction?
A. Norepinephrine
B. Phenylephrine
,C. Dobutamine
D. Vasopressin
Correct Answer: C
Explanation: Dobutamine is a beta-1 agonist with some beta-2 activity, providing inotropy
and mild vasodilation, making it ideal for cardiogenic shock with low cardiac output and
elevated SVR .
Question 3
A patient with anaphylactic shock has not responded to two doses of intramuscular
epinephrine. What is the most appropriate next intervention?
A. Administer diphenhydramine 50 mg IV
B. Start epinephrine intravenous infusion
C. Give methylprednisolone 125 mg IV
D. Administer albuterol nebulizer treatment
Correct Answer: B
Explanation: Refractory anaphylaxis requires intravenous epinephrine infusion for
continuous hemodynamic support. Antihistamines and corticosteroids are adjuncts but do
not reverse shock .
Question 4
A 48-year-old male in septic shock is receiving norepinephrine at 0.35 mcg/kg/min with MAP
of 62 mmHg. Which agent should be added next per current guidelines?
A. Phenylephrine
B. Dopamine
,C. Vasopressin
D. Angiotensin II
Correct Answer: C
Explanation: Vasopressin is recommended as the second-line agent to add to norepinephrine
in septic shock. It acts on V1 receptors and has a norepinephrine-sparing effect at fixed
doses of 0.03-0.04 units/min .
Question 5
Which hemodynamic pattern is characteristic of distributive shock?
A. Low cardiac output, high SVR
B. High cardiac output, low SVR
C. Low cardiac output, low SVR
D. Normal cardiac output, high SVR
Correct Answer: B
Explanation: Distributive shock features profound vasodilation causing low SVR, with
compensatory increases in cardiac output. This contrasts with cardiogenic and hypovolemic
shock which have low output .
Question 6
A patient with acute decompensated heart failure and cardiogenic shock requires
vasopressor support. Which agent provides the most balanced vasoconstriction without
excessive chronotropy?
A. Dopamine
B. Epinephrine
, C. Norepinephrine
D. Isoproterenol
Correct Answer: C
Explanation: Norepinephrine provides alpha-1 mediated vasoconstriction with modest beta-
1 activity, raising MAP without excessive heart rate increase, making it preferred for
cardiogenic shock with hypotension.
Question 7
A 70-year-old female on chronic beta-blocker therapy presents with septic shock refractory
to fluids. Which vasopressor may be particularly beneficial due to its beta-1 activity?
A. Vasopressin
B. Phenylephrine
C. Norepinephrine
D. Epinephrine
Correct Answer: D
Explanation: Epinephrine provides both alpha and beta agonism. In patients with beta-
blockade, the beta-1 activity of epinephrine helps overcome the blunted chronotropic
response to catecholamines.
Question 8
What is the target MAP for initial resuscitation in septic shock per Surviving Sepsis Campaign
guidelines?
A. ≥55 mmHg
B. ≥60 mmHg
