FCCS EXAM NEWEST ACTUAL EXAM 2025 QUESTIONS AND DETAILED CORRECT ANSWERS (VERIFIED ANSWERS, Exams of Nursing

Download FCCS EXAM NEWEST ACTUAL EXAM 2025 QUESTIONS AND DETAILED CORRECT ANSWERS (VERIFIED ANSWERS and more Exams Nursing in PDF only on Docsity! FCCS EXAM NEWEST ACTUAL EXAM 2024-2025 QUESTIONS AND DETAILED CORRECT ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+ A 56-year-old man is admitted to the ICU for pneumonia. He is intubated, with the following settings: assist control, tidal volume 550 mL, respiratory rate 12 breaths/min, positive end-expiratory pressure 5 cm H2O, FIO2 1.0. Vital signs are: temperature 38.7°C (101.6°F), heart rate 122 beats/min, respiratory rate 20 breaths/min, blood pressure (BP) 88/46 mmHg, SpO2 97%. A central venous line and arterial line have been placed. He has been started on broad-spectrum antibiotics. Which of the following is a clinical indicator that he would benefit from further fluid resuscitation? A. Heart rate persistently greater than 90 beats/min B. Passive leg raise resulting in at least 20% increase in systolic BP C. Urine output of less than 0.5 mL/kg/hour D. Systolic BP less than 90 mm Hg Correct Answer B A 75-year-old man with a history of hypertension is evaluated in the emergency department for nausea, vomiting, and abdominal pain. He is lethargic but can answer questions appropriately. His pulse is 130 beats/min, blood pressure 70/30 mm Hg, and respiratory rate 28 breaths/min. On physical examination, he is noted to have dry mucous membranes, poor capillary refill, and a distended abdomen with rebound tenderness. Arterial blood gas analysis reveals: pH 7.32, PCO2 28 mmHg, PO2 74 mm Hg, bicarbonate 13 mmol/L. Serum lactate is 8.0 mEq/L. Which of the following findings has been shown to correlate with a worse prognosis in a patient with this clinical picture? A. Hypotension B. Acidemia on blood gas analysis C. Elevated serum lactic acid D. Tachypnea Correct Answer C A 65-year-old man is septic, with perforated diverticulitis. He undergoes emergent colectomy with creation of a colostomy. Multiple areas of purulence are identified in the peritoneal cavity. Postoperatively, he continues to be febrile and hypotensive. Chest radiograph is clear. Central venous pressure is 18 mm Hg, and hemoglobin is 13g/dL. Which of the following vasoactive drugs is most appropriate to administer next? A. Epinephrine B. Phenylephrine C. Norepinephrine D. Dobutamine Correct Answer C A 45-year-old man is admitted to the hospital with fever, altered mental status, and swelling and redness in the upper thigh and scrotal area of four days' duration. He has a history of poorly controlled diabetes and chronic renal insufficiency. On examination, he is lethargic. Vital signs are: heart rate 79 beats/min, blood pressure 90/40 mm Hg, respiratory rate 33 breaths/min, SpO2 88%, and temperature 39°C (102.2°F). The right thigh has erythema and cutaneous gangrene. Air is felt by palpation of the soft tissue. Laboratory test results include a white blood cell count of 31,000/µL with 15% bands, hemoglobin 11.5 g/dL, glucose 520 mg/dL, sodium 150 meq/L, potassium 4 meq/L, creatinine 2.5 mg/dL (baseline 2.2 mg/dL), and lactate 4.5 meq/L. IV fluids are started for aggressive resuscitation, and he is intubated. Blood cultures are obtained. Which of the following is the most appropriate strategy in this patient's Correct Answer B A 75-year-old man with alcoholic cirrhosis develops upper gastrointestinal bleeding on postoperative day two following total knee arthroplasty. He has been started on a proton pump inhibitor infusion. Four months ago, he underwent endoscopic banding of esophageal varices. Which of the following is the best medication to add to his regimen until more definitive endoscopy can be performed? A. Protamine sulfate B. Aminocaproic acid C. Somatostatin D. Tranexamic acid Correct Answer C Which of the following would not be an expected laboratory finding associated with preeclampsia? A. Alanine aminotransferase level of 60 U/L B. Normal glucose level C. Decreased fibrinogen level D. Normal bilirubin level Correct Answer C Which of the following parameters may be a late sign of cardiovascular disturbance signaling failure of the compensatory mechanisms? A. Tachycardia B. Bradycardia C. Hypotension D. Hypertension Correct Answer C Investigative tests should be based on the patient's history and physical examination as well as on previous tests. Which of the following is one of the most important indicators of critical illness? A. Respiratory acidosis B. Metabolic acidosis C. Elevated creatinine D. Hyponatremia Correct Answer B A 22-year-old man is brought to the emergency room after falling from a horse. He is awaiting transfer to another facility. He has a chest contusion and a non-displaced femur fracture. He is in spinal motion restriction with a cervical collar and long backboard. He has worsening respiratory distress and hypoxemia requiring endotracheal intubation. Which of the following modifications of the manual assisted ventilation technique is appropriate? A. Place an oral airway one size larger than usual. B. Add additional downward pressure on the face mask once it is sealed. C. Use a jaw thrust technique in place of neck extension. D. Increase the tidal volume with each manual assisted breath. Correct Answer C Which of the following anatomic features is most likely to contribute to difficulty in maintaining a patent airway in a supine patient? A. Edentulous mandible B. Posteriorly displaced tongue C. Deviated nasal septum D. Anteriorly displaced thyroid cartilage Correct Answer B An elderly patient is on the medical ward for respiratory distress. Which of the following is correct regarding airway assessment? A. Laryngeal displacement toward the chest during inspiration occurs only with upper airway obstruction B. Chest rise with inspiration indicates an adequate tidal volume and an expiratory positive airway pressure (EPAP) of 8 cm H2O delivered via full face mask with FIO2 0.5. Two hours after initiating noninvasive positive pressure ventilation (NPPV), the bedside nurse calls the physician to reassess the patient. The patient is now agitated and fails to follow commands. SpO2 is now 85%. Repeat arterial blood gas analysis shows: Correct Answer C An 18-year-old, 55-kg (121-lb) woman has just been intubated for an acute asthma attack. She has been sedated and paralyzed in order to facilitate ventilation. Arterial blood gas analysis immediately before intubation revealed: pH 7.08, PCO2 75 mm Hg, and PO2 63 mm Hg on FIO2 0.4. On bagging, diffuse high-pitched wheezes are heard. Which of the following is the most appropriate initial ventilator mode for this patient? A. Continuous positive airway pressure B. Pressure support ventilation C. Assist control volume ventilation D. Assist control pressure ventilation Correct Answer C A 56-year-old man presents to the emergency department with a three-day history of fever, shaking chills, cough, and sputum production. He was previously in good health and takes only amlodipine for a history of hypertension. In the emergency department, his heart rate is 130 beats/min, respiratory rate 32breaths/min, blood pressure 80/40 mm Hg, temperature 38.8°C (102°F), and oxygen saturation 92% on 6 liters of oxygen by nasal cannula. Pulmonary examination demonstrates crackles and bronchial breath sounds in both lower lobes. A chest radiograph shows multilobar consolidations. Although awake and alert, he appears visibly distressed and has marked accessory muscle use. Apart from antibiotics and resuscitation for sepsis, which of the following is the next best step for management of his respiratory failure? A. Trial of noninvasive mechanical ventilation by face mask B. Intubation and initiation of invasive mecha Correct Answer B Hyponatremia - indications for 3% NS? Correct Answer Seizures or AMS What speed/rate can Na be correct in hyponatremia? Correct Answer 8 mEq/24 hours 43 yo m with hx of CAD comes with left hemiparesis x 1 hour. CT shows no bleed. What do we do? Correct Answer Administer TPA/TNK 22 yo m after MVA; incomprehensible sounds, no eye opening to painful stimuli, CT scan shows increased ICP and subdural bleed; what is the first thing we do? Correct Answer Elevate head of bed to 30-45 degrees Male presents with no breath sounds and tracheal deviation to the left side, what do we do? Correct Answer 16 gauge needle cdecompression BP 86/52, HR 126, RR 29; what class of shock is this? Correct Answer Three/ Progressive Stage Male after MVA; FAST shows bleeding, on way to OR his BP tanks, what do we do to resuscitate? Correct Answer 1:1:1 RBCS, platelets, FFP male presents after MVA in cervical spine collar; while waiting for xray the SpO2 drops to 85%, left pupil is larger than right, he does not respond, only grunts, moves limbs to pain; what do we do? Correct Answer intubate with inline intubation NSTEMI or STEMI what do we want our SpO2 to stay above? Correct Answer > 94% Who should go to cath lab IMMEDIATELY with NSTEMI? Correct Answer If they have shock with NSTEMI =immediate cath lab/CABG After STEMI, what drug has been shown to decrease risk of mortality? Correct Answer ACE inhibitors Loose stools after treatment for UTI with antibiotics; MRI shows pancolitis, what is the tx? Correct Answer IVF, metronidazole, PO Vanco (It's CDIFF) How to confirm intubation? Correct Answer -Wave form capnography -End tidal CO2 monitoring What is the most critical indicator of distress? Correct Answer Tachypnea Causes of pulsus paradoxus Correct Answer Cardiac tamponade (becks triad), increased intrathoracic pressure, pericarditis, pericardial effusion 60 yo with JVD, missed dialysis 2 days ago; in respiratory distress; BP 80/40, rr 35, pulsus paradoxes 20mm, lungs clear, muffled hear sounds; what is the likely cause/dx? Correct Answer Cardiac tamponade Pt is receiving bag mask ventilation over 1 second with 100% O2 15 LPM, 10 compressions per minute; but the chest is NOT rising with ventilations; what do you do? Correct Answer Check seal, listen for leaks A patient has hyperkalemia, which med is contraindicated in intubation? Correct Answer Succinylcholine (neuromuscular blockade med) - it can cause hyperkalemia in itself Vtach/vfib arrest; CPR and shocks administered, now we have achieved ROSC; what is the best treatment? Why? Correct Answer Code Ice/ Targeted temperature management (32-36 degrees) because it preserves brain function Shunt physiology most common examples Correct Answer Pneumonia Atelectasis OD in suicide is what type of respiratory failure? Correct Answer Acute hypercapnic 55 yo with COPD exacerbation; pH 7.2, CO2 92, PO2 108; pt on vent at tidal volume 375, AC mode, FiO2 of 35%, PEEP 5, rate 20, peak airway pressure 55, plateau 18, autopeep 15 BP is now 70/40, why is it low? Treatment? Correct Answer Why low: High auto PEEP, should not have pressure in the lung at the end of exhalation Tx: Increase expiration time so they can empty lung completely with exhalation 45 yo male, vent for ARDs d/t aspiration pneumonia; his vent settings are AC mode, tidal volume 5 mL/kg, RR 20, PEEP 22, peak airway pressure 40, plateau 35, FiO2 100% PH 7.34 PaO2 88 What do we do? Correct Answer Lower PEEP to 18 to Lower pressure inside lung 72 year old male with CHF with accessory muscle use is awake and alert RR 34 BP 120/80 HR 120 SpO2 90% on 8L CXR shows bialteral infiltrate consistent with CHF ABG 7.34 pH, 64 paO2, 50 paCO2 Treamtent? Correct Answer He needs pressure to get air in, so Bi-pap because he is alert and responsive with stable BP (other options are CPAP, vent) What decreases SVO2 Correct Answer Decreased o2 delivery Increased o2 consumption Male presents with SOB and femur fracture Temp 100.4 HR 144 RR 30 BP 100/70 SPO2 92% Hgb 8 SVO2 52%