BCCCP Certification Exam 2026: Comprehensive Critical Care
Pharmacy Board Practice Test — Critical Illness, ICU
Pharmacotherapy, Treatment Planning, Therapeutic Monitoring &
Patient Safety — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Section 1: Cardiovascular Critical Care (Questions 1–30)
Question 1
A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) is
admitted to the ICU with acute decompensated heart failure. He is currently on a
furosemide infusion. His blood pressure is 88/54 mmHg, heart rate 112 bpm, and he is in
sinus tachycardia. Which of the following agents is most appropriate to initiate for afterload
reduction and symptom relief?
A. Nitroglycerin infusion
B. Hydralazine
C. Milrinone
D. Dopamine
Correct Answer: C
Explanation: Milrinone is an inotrope and vasodilator preferred in HFrEF with low blood
pressure; nitroglycerin and hydralazine are less effective in this hypotensive state.
Question 2
A 55-year-old female is admitted with ST-elevation myocardial infarction (STEMI) and
undergoes percutaneous coronary intervention (PCI). She is started on aspirin, ticagrelor,
and a statin. She develops atrial fibrillation with rapid ventricular response. Which agent is
most appropriate for rate control?
,A. Metoprolol tartrate
B. Diltiazem
C. Digoxin
D. Amiodarone
Correct Answer: A
Explanation: Beta-blockers like metoprolol are first-line for rate control in post-MI atrial
fibrillation; diltiazem is contraindicated in HFrEF.
Question 3
A 72-year-old male with a history of hypertension and chronic kidney disease (CKD) stage 4 is
admitted with a hypertensive emergency. His blood pressure is 220/120 mmHg. Which
intravenous antihypertensive is most appropriate?
A. Sodium nitroprusside
B. Nicardipine
C. Labetalol
D. Enalaprilat
Correct Answer: B
Explanation: Nicardipine is safe in CKD; nitroprusside risks cyanide toxicity, labetalol may
cause bradycardia, and enalaprilat is contraindicated in severe CKD.
Question 4
A 60-year-old male with a history of atrial fibrillation on warfarin is admitted with an acute
GI bleed. His INR is 8.5. He is hemodynamically stable. Which is the most appropriate
management?
,A. Vitamin K 10 mg IV
B. Fresh frozen plasma (FFP)
C. Prothrombin complex concentrate (PCC)
D. Hold warfarin and monitor
Correct Answer: A
Explanation: Vitamin K IV is first-line for asymptomatic INR elevation; PCC is for life-
threatening bleeding or urgent reversal.
Question 5
A 45-year-old female with a history of long QT syndrome is admitted with ventricular
tachycardia. Which antiarrhythmic is contraindicated?
A. Amiodarone
B. Lidocaine
C. Sotalol
D. Magnesium sulfate
Correct Answer: C
Explanation: Sotalol prolongs QT and is contraindicated in long QT syndrome; amiodarone
and lidocaine are safer alternatives.
Question 6
A 70-year-old male with HFrEF (EF 25%) is admitted with worsening dyspnea. He is on
carvedilol, sacubitril/valsartan, spironolactone, and furosemide. Which medication should
be held if his potassium is 5.8 mEq/L?
, A. Carvedilol
B. Sacubitril/valsartan
C. Spironolactone
D. Furosemide
Correct Answer: C
Explanation: Spironolactone is a potassium-sparing diuretic; holding it is critical in
hyperkalemia to prevent arrhythmias.
Question 7
A 65-year-old female is admitted with cardiogenic shock. She is on norepinephrine and
dobutamine. Her blood pressure remains 78/50 mmHg. Which agent should be added?
A. Vasopressin
B. Phenylephrine
C. Epinephrine
D. Milrinone
Correct Answer: A
Explanation: Vasopressin is added in refractory shock to reduce catecholamine
requirements; phenylephrine may worsen cardiac output.
Question 8
A 50-year-old male with a mechanical mitral valve on warfarin is admitted with a subdural
hematoma. His INR is 3.2. Which is the most appropriate reversal agent?
A. Vitamin K 5 mg IV
Pharmacy Board Practice Test — Critical Illness, ICU
Pharmacotherapy, Treatment Planning, Therapeutic Monitoring &
Patient Safety — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Section 1: Cardiovascular Critical Care (Questions 1–30)
Question 1
A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) is
admitted to the ICU with acute decompensated heart failure. He is currently on a
furosemide infusion. His blood pressure is 88/54 mmHg, heart rate 112 bpm, and he is in
sinus tachycardia. Which of the following agents is most appropriate to initiate for afterload
reduction and symptom relief?
A. Nitroglycerin infusion
B. Hydralazine
C. Milrinone
D. Dopamine
Correct Answer: C
Explanation: Milrinone is an inotrope and vasodilator preferred in HFrEF with low blood
pressure; nitroglycerin and hydralazine are less effective in this hypotensive state.
Question 2
A 55-year-old female is admitted with ST-elevation myocardial infarction (STEMI) and
undergoes percutaneous coronary intervention (PCI). She is started on aspirin, ticagrelor,
and a statin. She develops atrial fibrillation with rapid ventricular response. Which agent is
most appropriate for rate control?
,A. Metoprolol tartrate
B. Diltiazem
C. Digoxin
D. Amiodarone
Correct Answer: A
Explanation: Beta-blockers like metoprolol are first-line for rate control in post-MI atrial
fibrillation; diltiazem is contraindicated in HFrEF.
Question 3
A 72-year-old male with a history of hypertension and chronic kidney disease (CKD) stage 4 is
admitted with a hypertensive emergency. His blood pressure is 220/120 mmHg. Which
intravenous antihypertensive is most appropriate?
A. Sodium nitroprusside
B. Nicardipine
C. Labetalol
D. Enalaprilat
Correct Answer: B
Explanation: Nicardipine is safe in CKD; nitroprusside risks cyanide toxicity, labetalol may
cause bradycardia, and enalaprilat is contraindicated in severe CKD.
Question 4
A 60-year-old male with a history of atrial fibrillation on warfarin is admitted with an acute
GI bleed. His INR is 8.5. He is hemodynamically stable. Which is the most appropriate
management?
,A. Vitamin K 10 mg IV
B. Fresh frozen plasma (FFP)
C. Prothrombin complex concentrate (PCC)
D. Hold warfarin and monitor
Correct Answer: A
Explanation: Vitamin K IV is first-line for asymptomatic INR elevation; PCC is for life-
threatening bleeding or urgent reversal.
Question 5
A 45-year-old female with a history of long QT syndrome is admitted with ventricular
tachycardia. Which antiarrhythmic is contraindicated?
A. Amiodarone
B. Lidocaine
C. Sotalol
D. Magnesium sulfate
Correct Answer: C
Explanation: Sotalol prolongs QT and is contraindicated in long QT syndrome; amiodarone
and lidocaine are safer alternatives.
Question 6
A 70-year-old male with HFrEF (EF 25%) is admitted with worsening dyspnea. He is on
carvedilol, sacubitril/valsartan, spironolactone, and furosemide. Which medication should
be held if his potassium is 5.8 mEq/L?
, A. Carvedilol
B. Sacubitril/valsartan
C. Spironolactone
D. Furosemide
Correct Answer: C
Explanation: Spironolactone is a potassium-sparing diuretic; holding it is critical in
hyperkalemia to prevent arrhythmias.
Question 7
A 65-year-old female is admitted with cardiogenic shock. She is on norepinephrine and
dobutamine. Her blood pressure remains 78/50 mmHg. Which agent should be added?
A. Vasopressin
B. Phenylephrine
C. Epinephrine
D. Milrinone
Correct Answer: A
Explanation: Vasopressin is added in refractory shock to reduce catecholamine
requirements; phenylephrine may worsen cardiac output.
Question 8
A 50-year-old male with a mechanical mitral valve on warfarin is admitted with a subdural
hematoma. His INR is 3.2. Which is the most appropriate reversal agent?
A. Vitamin K 5 mg IV
