BCCCP Critical Care Pharmacy Certification Exam 2026:
Comprehensive Board Practice Test — Critical Illness,
Pharmacotherapy, Treatment Planning, Monitoring, Quality of Care
& Practice Management — 190 Multiple-Choice Questions with
Answers & Detailed Rationales
Question 1
A 58-year-old male with a history of type 2 diabetes and hypertension is admitted to the ICU
with a diagnosis of septic shock secondary to urosepsis. His initial lactate is 4.2 mmol/L, and
blood pressure is 82/48 mmHg despite 30 mL/kg crystalloid. According to the Surviving
Sepsis Campaign, which vasopressor should be initiated first?
A. Vasopressin 0.03 units/min
B. Norepinephrine 0.05 mcg/kg/min
C. Epinephrine 0.1 mcg/kg/min
D. Dopamine 5 mcg/kg/min
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock due to superior
efficacy and lower arrhythmia risk compared to dopamine. Vasopressin is added as a second
agent for norepinephrine-sparing.
Question 2
A 72-year-old female is admitted to the ICU with acute respiratory distress syndrome (ARDS)
secondary to influenza pneumonia. Her PaO2/FiO2 ratio is 120 mmHg on PEEP of 12 cm
H2O. Which intervention has demonstrated mortality benefit in moderate-to-severe ARDS?
A. High-frequency oscillatory ventilation
B. Inhaled nitric oxide
,C. Prone positioning for 16 hours daily
D. Recruitment maneuvers with sustained inflation
Correct Answer: C
Explanation: Prone positioning for at least 16 hours daily reduces mortality in moderate-to-
severe ARDS by improving ventilation-perfusion matching and reducing ventral alveolar
overdistension.
Question 3
A 45-year-old male with a history of alcohol use disorder is admitted with acute pancreatitis.
On hospital day 3, he develops hypotension refractory to fluids, and his hemoglobin drops
from 11.2 to 7.8 g/dL. He has a positive Cullen's sign. Which type of shock is most likely?
A. Septic shock
B. Cardiogenic shock
C. Hemorrhagic shock
D. Neurogenic shock
Correct Answer: C
Explanation: Cullen's sign (periumbilical ecchymosis) suggests retroperitoneal hemorrhage
from pancreatic necrosis or pseudoaneurysm, causing hemorrhagic shock unresponsive to
crystalloid alone.
Question 4
A 67-year-old female is admitted to the ICU after a cardiac arrest. She is post-cardiac arrest
and comatose. According to current guidelines, which temperature management strategy is
recommended?
,A. Immediate rewarming to 37°C
B. Targeted temperature management at 32–36°C for at least 24 hours
C. Hypothermia at 28°C for 48 hours
D. No temperature intervention; allow spontaneous regulation
Correct Answer: B
Explanation: Targeted temperature management (32–36°C) for at least 24 hours is
recommended for comatose survivors of cardiac arrest to improve neurologic outcomes.
Question 5
A 34-year-old male with a BMI of 42 kg/m² is admitted with severe acute pancreatitis. He
develops respiratory failure requiring mechanical ventilation. Which ventilator strategy is
most appropriate to minimize ventilator-induced lung injury?
A. Tidal volume 10 mL/kg predicted body weight
B. Tidal volume 6 mL/kg predicted body weight
C. Tidal volume 8 mL/kg actual body weight
D. High-frequency oscillatory ventilation
Correct Answer: B
Explanation: Lung-protective ventilation with 6 mL/kg predicted body weight reduces
mortality in ARDS and is recommended for at-risk patients, regardless of actual body weight.
Question 6
A 28-year-old female is admitted with diabetic ketoacidosis (DKA). Her initial glucose is 512
mg/dL, pH 7.12, bicarbonate 8 mEq/L, and potassium 5.8 mEq/L. After initiating insulin
infusion, her potassium drops to 3.1 mEq/L. What is the most appropriate management?
, A. Continue insulin without potassium replacement
B. Hold insulin and administer potassium 40 mEq IV
C. Add potassium 20–30 mEq/L to IV fluids and continue insulin
D. Decrease insulin rate by 50% and recheck potassium in 4 hours
Correct Answer: C
Explanation: Insulin drives potassium intracellularly; replacement is required when K⁺ <5.2
mEq/L. Add 20–30 mEq/L to fluids to maintain K⁺ 4–5 mEq/L.
Question 7
A 55-year-old male is admitted with severe traumatic brain injury (TBI). His ICP is elevated at
28 mmHg. Which medication is most appropriate for acute ICP reduction?
A. Dexamethasone 10 mg IV
B. Mannitol 20% 0.5–1 g/kg IV
C. Furosemide 40 mg IV
D. Acetazolamide 500 mg IV
Correct Answer: B
Explanation: Mannitol is the preferred osmotic agent for acute ICP elevation in TBI.
Corticosteroids are contraindicated in TBI due to increased mortality.
Question 8
A 63-year-old female with a history of COPD is admitted with hypercapnic respiratory failure.
She is somnolent and her ABG shows pH 7.22, PaCO2 72 mmHg. Which intervention is most
appropriate initially?
Comprehensive Board Practice Test — Critical Illness,
Pharmacotherapy, Treatment Planning, Monitoring, Quality of Care
& Practice Management — 190 Multiple-Choice Questions with
Answers & Detailed Rationales
Question 1
A 58-year-old male with a history of type 2 diabetes and hypertension is admitted to the ICU
with a diagnosis of septic shock secondary to urosepsis. His initial lactate is 4.2 mmol/L, and
blood pressure is 82/48 mmHg despite 30 mL/kg crystalloid. According to the Surviving
Sepsis Campaign, which vasopressor should be initiated first?
A. Vasopressin 0.03 units/min
B. Norepinephrine 0.05 mcg/kg/min
C. Epinephrine 0.1 mcg/kg/min
D. Dopamine 5 mcg/kg/min
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock due to superior
efficacy and lower arrhythmia risk compared to dopamine. Vasopressin is added as a second
agent for norepinephrine-sparing.
Question 2
A 72-year-old female is admitted to the ICU with acute respiratory distress syndrome (ARDS)
secondary to influenza pneumonia. Her PaO2/FiO2 ratio is 120 mmHg on PEEP of 12 cm
H2O. Which intervention has demonstrated mortality benefit in moderate-to-severe ARDS?
A. High-frequency oscillatory ventilation
B. Inhaled nitric oxide
,C. Prone positioning for 16 hours daily
D. Recruitment maneuvers with sustained inflation
Correct Answer: C
Explanation: Prone positioning for at least 16 hours daily reduces mortality in moderate-to-
severe ARDS by improving ventilation-perfusion matching and reducing ventral alveolar
overdistension.
Question 3
A 45-year-old male with a history of alcohol use disorder is admitted with acute pancreatitis.
On hospital day 3, he develops hypotension refractory to fluids, and his hemoglobin drops
from 11.2 to 7.8 g/dL. He has a positive Cullen's sign. Which type of shock is most likely?
A. Septic shock
B. Cardiogenic shock
C. Hemorrhagic shock
D. Neurogenic shock
Correct Answer: C
Explanation: Cullen's sign (periumbilical ecchymosis) suggests retroperitoneal hemorrhage
from pancreatic necrosis or pseudoaneurysm, causing hemorrhagic shock unresponsive to
crystalloid alone.
Question 4
A 67-year-old female is admitted to the ICU after a cardiac arrest. She is post-cardiac arrest
and comatose. According to current guidelines, which temperature management strategy is
recommended?
,A. Immediate rewarming to 37°C
B. Targeted temperature management at 32–36°C for at least 24 hours
C. Hypothermia at 28°C for 48 hours
D. No temperature intervention; allow spontaneous regulation
Correct Answer: B
Explanation: Targeted temperature management (32–36°C) for at least 24 hours is
recommended for comatose survivors of cardiac arrest to improve neurologic outcomes.
Question 5
A 34-year-old male with a BMI of 42 kg/m² is admitted with severe acute pancreatitis. He
develops respiratory failure requiring mechanical ventilation. Which ventilator strategy is
most appropriate to minimize ventilator-induced lung injury?
A. Tidal volume 10 mL/kg predicted body weight
B. Tidal volume 6 mL/kg predicted body weight
C. Tidal volume 8 mL/kg actual body weight
D. High-frequency oscillatory ventilation
Correct Answer: B
Explanation: Lung-protective ventilation with 6 mL/kg predicted body weight reduces
mortality in ARDS and is recommended for at-risk patients, regardless of actual body weight.
Question 6
A 28-year-old female is admitted with diabetic ketoacidosis (DKA). Her initial glucose is 512
mg/dL, pH 7.12, bicarbonate 8 mEq/L, and potassium 5.8 mEq/L. After initiating insulin
infusion, her potassium drops to 3.1 mEq/L. What is the most appropriate management?
, A. Continue insulin without potassium replacement
B. Hold insulin and administer potassium 40 mEq IV
C. Add potassium 20–30 mEq/L to IV fluids and continue insulin
D. Decrease insulin rate by 50% and recheck potassium in 4 hours
Correct Answer: C
Explanation: Insulin drives potassium intracellularly; replacement is required when K⁺ <5.2
mEq/L. Add 20–30 mEq/L to fluids to maintain K⁺ 4–5 mEq/L.
Question 7
A 55-year-old male is admitted with severe traumatic brain injury (TBI). His ICP is elevated at
28 mmHg. Which medication is most appropriate for acute ICP reduction?
A. Dexamethasone 10 mg IV
B. Mannitol 20% 0.5–1 g/kg IV
C. Furosemide 40 mg IV
D. Acetazolamide 500 mg IV
Correct Answer: B
Explanation: Mannitol is the preferred osmotic agent for acute ICP elevation in TBI.
Corticosteroids are contraindicated in TBI due to increased mortality.
Question 8
A 63-year-old female with a history of COPD is admitted with hypercapnic respiratory failure.
She is somnolent and her ABG shows pH 7.22, PaCO2 72 mmHg. Which intervention is most
appropriate initially?
