FCCS Exam Questions with Verified
Solutions10
A 70-kg (154-lb), 170-cm (67-inch) patient with emphysema is on mechanical ventilation.
Current ventilator settings are: assist control/volume control, tidal volume 500 mL, respiratory
rate 10 breaths/min, positive end-expiratory pressure (PEEP) 5 cm H2O, Fio2 0.25. The patient is
awake and alert and does not appear to be in any distress. Total respiratory rate is 14
breaths/min. Arterial blood gas analysis results are: pH 7.39, Paco2 54 mm Hg, Pao2 70 mm Hg,
bicarbonate 30 mEq/L. Oxygen saturation as measured by pulse oximetry is 95%. Negative
inspiratory force is -30 cm H2O. This patient is most likely - ANSWERS-ready for a spontaneous
breathing trial
A 72-year-old man presents to the emergency department with congestive heart failure
exacerbation. He is awake and alert but in distress. He is using accessory respiratory muscles
and says it is hard to breathe. His vitals signs are: heart rate, 120 beats/min; blood pressure,
120/80 mm Hg; respiratory rate, 34 breaths/min; and oxygen saturation, 90% on 8 L of oxygen
by simple face mask. Physical examination reveals bilateral lower extremity edema and crackles
in the posterior lung fields. A chest radiograph demonstrates bilateral fluffy infiltrates consistent
with pulmonary edema. Arterial blood gas analysis demonstrates: pH 7.30, PCO2 50 mm Hg,
and PO2 64 mm Hg. In addition to diuresis, which of the following is the best next step in this
patient's management? - ANSWERS-Initiate noninvasive positive pressure ventilation
A 46-year-old man with a history of polysubstance abuse, body mass index of 20, and prominent
thyroid cartilage is found obtunded. He is intubated and admitted to the ICU. He subsequently
regains consciousness, becomes agitated, and violently pulls out his endotracheal tube. He is
unable to breathe; attempts to assist him with bag mask ventilation are unsuccessful. Direct
laryngoscopy reveals swollen, edematous vocal cords with no glottic opening seen. His oxygen
saturation is now 76%. Which of the following methods is most appropriate to re-establish an
airway? - ANSWERS-Attempt placement of a supraglottic airway (laryngeal mask airway) and call
for immediate surgical backup
, A patient arrives in the emergency department with a respiratory rate of 4 breaths/minute. She
is not intubated. Overdose with a centrally acting nervous system depressant is suspected.
Which of the following is the most likely finding on the initial blood gas? - ANSWERS-Acute
hypercapnic respiratory failure only
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? - ANSWERS-Begin formal conflict-resolution process
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? - ANSWERS-Decrease oxygen
delivery and/or increased oxygen consumption
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? - ANSWERS-Ensure quantitative end-tidal CO2
monitoring during CPR
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
Solutions10
A 70-kg (154-lb), 170-cm (67-inch) patient with emphysema is on mechanical ventilation.
Current ventilator settings are: assist control/volume control, tidal volume 500 mL, respiratory
rate 10 breaths/min, positive end-expiratory pressure (PEEP) 5 cm H2O, Fio2 0.25. The patient is
awake and alert and does not appear to be in any distress. Total respiratory rate is 14
breaths/min. Arterial blood gas analysis results are: pH 7.39, Paco2 54 mm Hg, Pao2 70 mm Hg,
bicarbonate 30 mEq/L. Oxygen saturation as measured by pulse oximetry is 95%. Negative
inspiratory force is -30 cm H2O. This patient is most likely - ANSWERS-ready for a spontaneous
breathing trial
A 72-year-old man presents to the emergency department with congestive heart failure
exacerbation. He is awake and alert but in distress. He is using accessory respiratory muscles
and says it is hard to breathe. His vitals signs are: heart rate, 120 beats/min; blood pressure,
120/80 mm Hg; respiratory rate, 34 breaths/min; and oxygen saturation, 90% on 8 L of oxygen
by simple face mask. Physical examination reveals bilateral lower extremity edema and crackles
in the posterior lung fields. A chest radiograph demonstrates bilateral fluffy infiltrates consistent
with pulmonary edema. Arterial blood gas analysis demonstrates: pH 7.30, PCO2 50 mm Hg,
and PO2 64 mm Hg. In addition to diuresis, which of the following is the best next step in this
patient's management? - ANSWERS-Initiate noninvasive positive pressure ventilation
A 46-year-old man with a history of polysubstance abuse, body mass index of 20, and prominent
thyroid cartilage is found obtunded. He is intubated and admitted to the ICU. He subsequently
regains consciousness, becomes agitated, and violently pulls out his endotracheal tube. He is
unable to breathe; attempts to assist him with bag mask ventilation are unsuccessful. Direct
laryngoscopy reveals swollen, edematous vocal cords with no glottic opening seen. His oxygen
saturation is now 76%. Which of the following methods is most appropriate to re-establish an
airway? - ANSWERS-Attempt placement of a supraglottic airway (laryngeal mask airway) and call
for immediate surgical backup
, A patient arrives in the emergency department with a respiratory rate of 4 breaths/minute. She
is not intubated. Overdose with a centrally acting nervous system depressant is suspected.
Which of the following is the most likely finding on the initial blood gas? - ANSWERS-Acute
hypercapnic respiratory failure only
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? - ANSWERS-Begin formal conflict-resolution process
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? - ANSWERS-Decrease oxygen
delivery and/or increased oxygen consumption
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? - ANSWERS-Ensure quantitative end-tidal CO2
monitoring during CPR
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
