IBSC CCP-C Exam Questions

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81.

You are treating a 34-year-old female complaining of a sudden onset of shortness of breath and palpitations. Her vital signs are P 221, respiration 26, and BP 118/88. The cardiac monitor reveals a narrow, regular complex tachycardia. What should you do first?

  • Attempt vagal maneuvers 

  • Administer adenosine

  • Perform synchronized cardioversion

  • Administer amiodarone

Correct answer: Attempt vagal maneuvers

The patient is not experiencing hypotension, ischemic chest pain, signs of shock, or respiratory distress and is therefore in stable condition. For stable patients in a regular, narrow complex tachycardia, the first step is to have the patient attempt vagal maneuvers. 

If vagal maneuvers fail to convert the patient out of the regular, narrow complex tachycardia, then the next step is to administer adenosine 6 mg IV bolus. If the rhythm fails to convert, you may administer a second dose of adenosine at 12 mg IV bolus. 

If the patient is unstable or the patient does not respond to the adenosine, it is recommended to perform synchronized cardioversion. 

Amiodarone is considered in the treatment of narrow, complex tachycardia, but not in this incident. 

82.

A 22-year-old delivered a full-term infant. The baby is experiencing respiratory distress, absent breath sounds to the left side, and auscultated bowel sounds in the chest. Which of the following complications is the infant most likely experiencing?

  • Congenital diaphragmatic hernia

  • Left-sided pneumothorax

  • Gastroschisis

  • Intestinal obstruction

Correct answer: Congenital diaphragmatic hernia

In Congenital Diaphragmatic Hernia (CDH), the pleuroperitoneal folds fail to close early in gestation (prior to the 10th week), resulting in the migration of the abdominal contents into the thorax. The presence of abdominal contents in the thorax prevents the full development of the lung(s), causing the neonate to be born with hypoplastic, poorly functioning lungs, dependent upon the severity of the CDH. When CDH has not been identified prenatally, it should be suspected in the neonate who presents with the early development of respiratory distress, absence of breath sounds on one side (or unequal breath sounds), bowel sounds auscultated in the chest, and the presence of a scaphoid abdomen. 

While a left-sided pneumothorax would result in decreased breath sounds on the left, it would not result in bowel sounds in the chest. 

Gastroschisis will result in an evisceration of the abdominal contents and does not present with respiratory distress. 

Intestinal obstruction would present with vomiting, abdominal distention, and possibly the lack of an anal opening.

83.

A chest x-ray may be used in the diagnosis of pediatric traumas such as traumatic aortic disruption and abdominal traumas. All the chest x-ray findings below may indicate major vessel injury, except:

  • A narrowed mediastinum

  • Right-side tracheal deviation

  • Left hemothorax

  • Widened paratracheal stripe

Correct answer: A narrowed mediastinum

A widened, not narrowed, mediastinum found in a chest x-ray might indicate major vessel injury. 

Chest x-rays are a key diagnostic tool in traumatic chest and abdominal injuries. Chest x-ray findings that may indicate major vessel injury are:

  • Right-side tracheal deviation
  • Left hemothorax
  • Widened paratracheal stripe
  • Widened mediastinum
  • Obliteration of the aortic arch
  • Obliteration of the space between the pulmonary artery and the aorta
  • Left mainstem bronchus depression
  • Esophageal deviation
  • Widened paraspinal interfaces
  • Pleural cap presence
  • 1st or 2nd rib or scapula fracture

84.

While preparing to intubate your two-year-old asthmatic patient, you are mindful of the airway anatomical differences of the patient's airway in relationship to an adult airway. Of the following, which statement is true regarding pediatric airway anatomy?

  • The larynx is more anterior and palatable

  • The pediatric trachea is more rigid than the adult trachea

  • The narrowest part of the pediatric airway is the cricothyroid membrane

  • The pediatric tongue is smaller, which makes it difficult to control in intubation

Correct answer: The larynx is more anterior and palatable

The pediatric airway anatomy is much different than the adult airway anatomy and may prove to make advanced airway management more difficult in your pediatric patients. One example of the differences in the pediatric airway is the larynx is more anterior and palatable than the adult airway. Other examples are the tonsils are larger and more vascular in pediatrics. Their adenoids are also larger in comparison to the adult airway.

The pediatric trachea is more flexible and even may collapse during periods of agitation or airway obstruction. 

The narrowest part of the pediatric airway is the cricoid membrane. 

The tongue of the pediatric is much larger in relation to the airway. This can make controlling the tongue more difficult in pediatric intubation. 

85.

A CCP is allowed to challenge a physician's order that is unclear or that they feel may cause harm because of a component of which of the following?

  • TeamSTEPPS

  • Just Culture

  • Swiss Cheese Model

  • Crew Resource Management

Correct answer: TeamSTEPPS

TeamSTEPPS was developed by the US Department of Defense and embraces the principles of crew resource management. It teaches healthcare providers to raise safety concerns, challenge orders that are unclear, and "stop the line" if necessary. 

A Just Culture encompasses diversity, equity, and inclusion. 

The Swiss Cheese Model is a model in which errors made by people result in consequences related to flawed systems. 

Crew Resource Management encompasses a culture of safety and teamwork. 

86.

The right coronary artery supplies blood to which structure within the heart?

  • SA node

  • Purkinje fibers

  • Left ventricle

  • Intraventricular septum

Correct answer: SA node

The right coronary artery supplies blood to the SA node, AV node, right ventricle, and right atrium. 

The Purkinje fibers, left ventricle, and intraventricular septum are all supplied by the left anterior descending artery. 

87.

You are treating an unresponsive 56-year-old female who was found on her bathroom floor with an empty bottle of diazepam and alcohol beside her. Her vital signs are BP 76/P, R 6, P 38, and SpO2 78%. You should do which of the following?

  • Provide manual ventilation and prepare to intubate

  • Provide manual ventilation and administer flumazenil 4 mg

  • Administer naloxone 2 mg and oxygen via non-rebreather

  • Administer oxygen 15 lpm via non-rebreather and transport

Correct answer:  Provide manual ventilation and prepare to intubate

The patient is unresponsive with a respiratory rate of 6, which is respiratory failure that requires immediate intervention. You must provide manual ventilation and prepare to intubate the patient. Yes, the patient may have overdosed on diazepam or alcohol, but the most immediate problem is ventilatory failure. 

Flumazenil is indicated in patients suffering from benzodiazepine toxicity, but the dose for this patient would be 0.2 mg. not 4 mg. 

Naloxone is ineffective in benzodiazepine and alcohol toxicities. 

Only providing oxygen via a non-rebreather will not address the ventilatory failure in the patient, as it would only improve oxygenation. 

88.

A 42-year-old female complains of dizziness and palpitations. She informs you she is two months post liver transplant. Vital signs are P 123, R 26, BP 86/44, and SpO2 is 97%. Her blood glucose level is 396 mg/dL, and her temperature is 101.7˚ F. Which of the following is most likely?

  • Sepsis

  • Gestagenic diabetes insipidus

  • Post-transplant liver failure

  • Diabetic ketoacidosis

Correct answer: Sepsis

Transplant patients are at an extremely high risk for infection, leading to sepsis. The risk is increased because of their immunosuppressant medications. Signs and symptoms of sepsis are tachycardia, hypotension, high blood sugar, and fever. 

Gestagenic diabetes insipidus is an increase in ADH breakdown, which develops in pregnant women. Patients present with polyuria and polydipsia. 

Post-transport liver failure is a possibility, but less likely. The most likely cause of the patient's symptoms is sepsis. 

Diabetic ketoacidosis will have a higher blood sugar than this patient's blood sugar. 

89.

You are treating a 48-year-old male who was recently diagnosed with a rare brain cancer. The patient is suffering from a convergence nystagmus. This type of nystagmus is indicative of which of the following?

  • Midbrain lesion

  • Frontal lobe lesion

  • Basilar skull fracture

  • Hemorrhagic stroke

Correct answer: Midbrain lesion

A convergence nystagmus causes a spontaneous and slow drifting ocular divergence with a final and quick convergence jerk. This type of nystagmus is indicative of a midbrain lesion. Other types of nystagmus are retraction, see-saw, optokinetic, vestibular, toxic, and downbeat. Each one is the direct cause of a lesion, toxins, or disease. 

A frontal lobe lesion may cause changes in personality, inhibition of impulse control, sluggishness, weakness, anxiety, and/or confusion. There is not a specific type of nystagmus directly related to a frontal lobe lesion. 

A basilar skull fracture is the direct result of trauma and may not cause nystagmus. 

A hemorrhagic stroke is not associated with nystagmus. 

90.

A 45-year-old female with sepsis has developed Disseminated Intravascular Coagulation (DIC). She now requires urgent intubation due to worsening respiratory failure. 

Which of the following is the most appropriate consideration for performing video-assisted intubation in this patient?

  • Ensure the availability of a surgical airway kit due to potential complications

  • Use a large-bore endotracheal tube to facilitate suctioning

  • Avoid video-assisted intubation due to increased bleeding risk

  • Administer a high dose of a paralytic agent to minimize movement

Correct answer: Ensure the availability of a surgical airway kit due to potential complications.

Intubating a patient with Disseminated Intravascular Coagulation (DIC) presents unique challenges due to the increased risk of bleeding and potential for difficult airway management. Video laryngoscopy provides improved visualization of the vocal cords and surrounding structures, potentially reducing the risk of trauma compared to traditional direct laryngoscopy. Increased first-pass success rate is crucial in critically ill patients to minimize repeated attempts and associated complications.

While suctioning is important, using a large-bore tube may not be necessary and could increase the risk of trauma. 

Video-assisted intubation actually helps in reducing trauma and associated bleeding by providing better visualization and control during the procedure. 

Paralytic agents are necessary, but the dose should be appropriate to the patient’s condition. High doses are not specifically required and may have adverse effects.

91.

A 65-year-old male presents to the ED with chest pain and shortness of breath. An ECG reveals evidence of a multifascicular block. Which of the following ECG findings is characteristic of a multifascicular block?

  • Prolonged PR interval and widened QRS complex

  • Presence of Q waves in leads I, aVL, and V6

  • ST-segment elevation in leads II, III, and AVF

  • Saddle-shaped ST-segment depression in leads V1-V4

Correct answer: Prolonged PR interval and widened QRS complex

Multifascicular block refers to a conduction abnormality involving the bundle branch and/or fascicular branches of the His-Purkinje system. The characteristic ECG findings of multifascicular block include a prolonged PR interval (indicative of AV nodal delay) and a widened QRS complex (indicative of bundle branch block). These abnormalities may manifest as Right Bundle Branch Block (RBBB), Left Bundle Branch Block (LBBB), or both, depending on the specific branches involved. 

Q waves are often indicative of cardiac ischemia in any ECG lead. ST elevation in leads II, III, and aVF is indicative of an inferior wall MI. A saddle-shaped ST segment is not associated with a multifasicular block. 

92.

You are treating a trauma patient in the ED who fell off the roof while putting up Christmas lights. When performing a FAST exam on the patient, what is the first location you should evaluate?

  • Right upper quadrant

  • Left upper quadrant

  • Cardiac

  • Pelvic cavity

Correct answer: Right upper quadrant

The Focused Assessment with Sonography in Trauma (FAST) examination looks for the presence of fluid/blood. The four classic areas that are examined for free fluid are the perihepatic space (Right Upper Quadrant—RUQ), perisplenic space (Left Upper Quadrant—LUQ), pericardium, and the pelvis. The RUQ view uses the liver as an ultrasound window to interrogate the liver and the hepatorenal space for free fluid. 

Next, the LUQ is examined to look at the spleen and diaphragm. Then, the pelvic view allows for the assessment of the peritoneum. The pericardial view uses the left lobe of the liver as an acoustic window for analysis of the heart. 

93.

Which of the following is the formula for oxygen delivery?

  • CO x CaO2

  • IRV + TV + ERV

  • RR x TV

  • RR x (TV - Deadspace)

Correct answer: CO x CaO2

Oxygen delivery consist of cardiac output and total arterial oxygen content (CO x CaO2). CaO2 is derived from the amount of dissolved oxygen plus the total hemoglobin content. 

IRV + TV + ERV is the formula for vital capacity. 

RR + TV = minute volume. 

RR x (TV - Deadspace) is the formula for alveolar minute ventilation.

94.

You are treating a four-year-old male complaining of fever, difficulty breathing, and weakness. The patient's mother states her son has been sick for two days with an upper respiratory infection and had a sudden turn for the worse this morning. She states he was difficult to arouse this morning and now has no energy. Upon assessment, you note audible stridor.

You should suspect which of the following?

  • Laryngotracheobronchitis 

  • Epiglottitis

  • Pneumonia

  • Influenza

Correct answer: Laryngotracheobronchitis

Laryngotracheobronchitis is also known as croup. Croup is common in this patient's age range. It is hallmarked by stridor and a sudden onset. The patient will commonly have a history of upper respiratory infection.

Epiglottitis is the infection of the epiglottis, and the hallmark sign is drooling. The patient does not present with these symptoms. 

Pneumonia and Influenza are both gradual onset, not sudden onset. 

95.

A 70-year-old male with a history of diabetes mellitus and COPD presents to the ED with fever, productive cough with thick, blood-tinged sputum, and shortness of breath. His temperature is 102.2°F, BP 90/60, P 120, and R 28. A chest X-ray reveals a right upper lobe consolidation. Blood cultures are pending, but the initial sputum gram stain shows Gram-negative rods. 

Which of the following is the most appropriate initial treatment for this patient suspected of having a Klebsiella pneumoniae infection?

  • Administer intravenous ceftriaxone and azithromycin

  • Administer oral azithromycin

  • Administer intravenous vancomycin and piperacillin-tazobactam

  • Administer oral levofloxacin

Correct answer: Administer intravenous ceftriaxone and azithromycin

Klebsiella pneumoniae is a Gram-negative bacterium that commonly causes severe community-acquired pneumonia, particularly in individuals with underlying conditions such as diabetes mellitus, COPD, and alcoholism. This type of pneumonia can present with characteristic features and requires prompt and appropriate antibiotic treatment. Ceftriaxone is a broad-spectrum cephalosporin effective against many Gram-negative organisms, including Klebsiella. Azithromycin is added to cover atypical pathogens and provide broader coverage.

Oral azithromycin alone is not sufficient for severe pneumonia caused by Gram-negative rods and is inappropriate for a critically ill patient. 

While providing broad coverage, this combination (intravenous vancomycin and piperacillin-tazobactam) is more suited for nosocomial infections or if MRSA is suspected. It is broader than necessary for initial treatment of community-acquired pneumonia suspected to be due to Klebsiella. 

Oral treatment is not appropriate for severe, potentially life-threatening infections requiring hospitalization.

96.

A patient presents to the ED with sudden onset severe headache, neck stiffness, and altered level of consciousness. Imaging confirms a subarachnoid hemorrhage (SAH). What is the most appropriate initial management strategy?

  • Emergent intubation and mechanical ventilation

  • Immediate administration of anticoagulants

  • Aggressive fluid resuscitation to maintain adequate cerebral perfusion pressure

  • Transfer to the neuro-interventional suite for endovascular coiling

Correct answer: Emergent intubation and mechanical ventilation

Emergent intubation and mechanical ventilation may be necessary in patients with SubArachnoid Hemorrhage (SAH) who present with a decreased level of consciousness, airway compromise, or respiratory failure. The most appropriate initial management strategy for a patient with SAH is to ensure rapid stabilization, monitoring, and supportive care.

Immediate administration of anticoagulants is contraindicated in the acute phase of SAH. 

Aggressive fluid resuscitation is generally not recommended in the initial management of SAH. Excessive fluid administration may lead to cerebral edema and worsen outcomes. 

Transfer to the neuro-interventional suite for endovascular coiling is an appropriate management strategy for patients with SAH caused by a ruptured cerebral aneurysm amenable to endovascular treatment. However, this intervention is typically performed after stabilization and initial management in the emergency department.

97.

Your adult patient with a left ventricular assist device (LVAD) presents to the ED with a chief complaint of dizziness, fatigue, and shortness of breath. Upon your assessment, you note pallor, diaphoresis, and a blood pressure of 84/62. Which of the following interventions is the highest priority?

  • Initiating vasopressor therapy

  • Administering intravenous fluids

  • Checking LVAD function and parameters

  • Obtaining a 12-lead ECG

Correct answer: Initiating vasopressor therapy

Initiating vasopressor therapy is the highest priority intervention in a hypotensive patient with a Left Ventricular Assist Device (LVAD). Vasopressors such as norepinephrine or phenylephrine can help increase systemic vascular resistance and improve perfusion pressure.

Administering intravenous fluids may be necessary to address hypovolemia or dehydration contributing to the patient's symptoms. However, in a hypotensive patient with an LVAD, the primary concern is determining the cause of hypotension, which may not necessarily be hypovolemia. 

Checking LVAD function and parameters is essential in evaluating the device's performance and identifying any malfunctions or alarms. However, while important, this intervention may not immediately address the patient's hemodynamic instability. 

Obtaining an ElectroCardioGram (ECG) is important but, in a hemodynamically unstable patient with an LVAD, immediate intervention to address hypotension and restore perfusion takes precedence over diagnostic testing.

98.

In pediatric patients, what is the hallmark sign of myocarditis?

  • Congestive heart failure

  • A heart murmur

  • Pericardium inflammation

  • Kussmaul respirations

Correct answer: Congestive heart failure

Myocarditis is inflammation of the myocardium and the number one cause of pediatric cardiomyopathy. Congestive Heart Failure (CHF) is the hallmark sign of myocarditis. Myocarditis is the most common cause of CHF in pediatrics. Myocarditis is typically preceded by a 10-14 day viral illness. 

A heart murmur is typically indicative of a congenital heart defect in pediatrics. It can also be a sign of valvular disease. 

Inflammation of the pericardium is the hallmark sign of pericarditis. Pericarditis is typically caused by influenza. 

Kussmaul respirations are a hallmark of diabetic ketoacidosis and are not associated with a specific heart disease. 

99.

You are dispatched to a residence for an infant experiencing shortness of breath and turning blue. You arrive to find a six-month-old male being held by his grandmother. She states the infant's parents are at work, and she is unable to get a hold of them. She states the child has a heart defect consisting of a very small left ventricle and aortic valve stenosis, but she is unable to remember the correct term. 

Which congenital heart defect is she describing? 

  • Hypoplastic left heart syndrome

  • Tetralogy of Fallot

  • Transposition of the Great Vessels

  • Tricuspid atresia

Correct answer: Hypoplastic left heart syndrome

Hypoplastic left heart syndrome is typically caused by an abnormally small left ventricle. This is commonly the result of aortic or mitral valve stenosis. Because the left heart is blocked, this results in heart failure and obstruction to the right side of the heart produces hypoxemia and cyanosis. These patients commonly require a heart transplant.

Tetralogy of Fallot is the combination of four anomalies: ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. 

Transposition of the Great Vessels causes the aorta to receive blood from the right ventricle while the pulmonary artery leaves the left ventricle. 

Tricuspid atresia is caused by a defective or absent tricuspid valve. 

100.

You are treating a 24-year-old female, who was the driver of a vehicle in a head-on collision. She is 35 weeks pregnant and complaining of severe abdominal pain. Upon your secondary assessment, you find that the patient has heavy vaginal bleeding. Of the following, which condition should you be concerned about?

  • Abruptio placentae

  • Placenta previa

  • Hypovolemia shock

  • Eclampsia

Correct answer: Abruptio placentae

Anytime a pregnant patient suffers blunt trauma, the critical care provider should suspect abruptio placenta, especially when the patient complains of pain and there is bleeding. Not all cases of abruptio placenta result in bleeding, but you should still suspect the condition, given the mechanism of injury. 

Placenta previa results in painless bright red bleeding from the vagina. 

While the mechanism of injury could result in hypovolemic shock, the main focus should be on the emergent condition of the possibility of placenta abruption, given the signs and symptoms. 

Eclampsia is marked as seizures of the pregnant woman with hypertension.