FCCS Pretest & Post Test Exam
2025/2026 | Actual Fundamentals of
Critical Care Support Exams with
Complete Questions | Society of Critical
Care Medicine
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?
A.Chronic hypercapnic respiratory failure only
B.Acute hypoxemic respiratory failure only
C.Mixed hypoxemic and hypercapnic respiratory failure
D.Acute hypercapnic respiratory failure only -CORRECTANSWER Acute hypercapnic
respiratory failure only
- Respiratory depressing agents cause a decrease in minute ventilation (minute
ventilation = respiratory rate x tidal volume), and minute ventilation is inversely
proportional to PCO2. This patients is presenting with acute hypercapnic respiratory
failure after an overdose. Although acute hypoxemic respiratory failure also occurs, this
is a late finding.
,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? -CORRECTANSWER 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? -CORRECTANSWER 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? -
CORRECTANSWER 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 -CORRECTANSWER 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
2025/2026 | Actual Fundamentals of
Critical Care Support Exams with
Complete Questions | Society of Critical
Care Medicine
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?
A.Chronic hypercapnic respiratory failure only
B.Acute hypoxemic respiratory failure only
C.Mixed hypoxemic and hypercapnic respiratory failure
D.Acute hypercapnic respiratory failure only -CORRECTANSWER Acute hypercapnic
respiratory failure only
- Respiratory depressing agents cause a decrease in minute ventilation (minute
ventilation = respiratory rate x tidal volume), and minute ventilation is inversely
proportional to PCO2. This patients is presenting with acute hypercapnic respiratory
failure after an overdose. Although acute hypoxemic respiratory failure also occurs, this
is a late finding.
,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? -CORRECTANSWER 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? -CORRECTANSWER 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? -
CORRECTANSWER 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 -CORRECTANSWER 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
