Welcome to your Critical Care Test 9 Which of the following is the primary goal of cardiac output (CO) monitoring in a critically ill patient? To assess the systemic vascular resistance (SVR) To determine the adequacy of tissue perfusion To measure oxygenation levels To evaluate lung compliance None In which of the following scenarios would intra-arterial blood pressure monitoring be most essential? Stable, non-critically ill patient with hypertension A patient undergoing minor surgery with general anaesthesia Critically ill patient with hypotension and in need of vasopressor therapy A healthy patient in a recovery room None What is the most significant complication associated with the use of heparin in critically ill patients? Hypertension Hyperkalemia Heparin-induced thrombocytopenia (HIT) Respiratory acidosis None Which of the following is the primary action of warfarin as an anticoagulant? Direct inhibition of factor Xa Inhibition of vitamin K-dependent clotting factors Activation of antithrombin III Inhibition of platelet aggregation None Which of the following newer oral anticoagulants (NOACs) directly inhibit factor Xa? Dabigatran Rivaroxaban Apixaban Both B and C None In a patient with severe disseminated intravascular coagulation (DIC), which of the following laboratory findings is most commonly observed? Increased fibrinogen levels Elevated D-dimer levels Elevated platelet count Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) None What is the primary indication for the use of thrombolytic therapy in the critical care setting? Acute ischemic stroke Acute myocardial infarction (AMI) Pulmonary embolism with shock All of the above None In the management of acute coronary syndrome (ACS), what is the first-line therapy in patients with ST-elevation myocardial infarction (STEMI)? Oral anticoagulants Thrombolysis Percutaneous coronary intervention (PCI) Oral aspirin alone None Which of the following coagulation tests is most useful for monitoring the therapeutic effects of heparin? Prothrombin time (PT) Activated partial thromboplastin time (aPTT) International normalized ratio (INR) Fibrinogen levels None Which of the following newer oral anticoagulants (NOACs) is a direct thrombin inhibitor? Rivaroxaban Dabigatran Edoxaban Apixaban None Which of the following statements about the reversal of warfarin therapy is correct? Vitamin K should always be given intravenously in cases of major bleeding. Prothrombin complex concentrate (PCC) can be used to rapidly reverse the anticoagulant effect. Activated charcoal can reverse warfarin effects if administered within 24 hours of ingestion. Warfarin reversal is not needed for minor bleeding complications. None In a critically ill patient with deep vein thrombosis (DVT) and renal failure, which anticoagulant would be most appropriate? Warfarin Rivaroxaban Unfractionated heparin Dabigatran None Which of the following anticoagulants does not require routine laboratory monitoring in most patients? Heparin Warfarin Dabigatran Unfractionated heparin None What is the primary role of the antithrombin III in coagulation? Activation of factor Xa Inhibition of thrombin and factor Xa Enhancement of fibrinogen conversion to fibrin Activation of the fibrinolytic pathway None In which of the following scenarios is the use of fibrinolytic therapy contraindicated? Acute ischemic stroke within 3 hours of onset Recent major surgery or trauma Pulmonary embolism with hemodynamic instability Acute myocardial infarction with no contraindications None In the management of critically ill patients with atrial fibrillation (AF), which of the following is the primary goal of anticoagulation therapy? To prevent the formation of arterial thrombi To restore sinus rhythm To increase heart rate To prevent bradycardia None Which of the following is the most appropriate first-line treatment for a patient with acute pulmonary embolism and hemodynamic instability? Oral anticoagulants Thrombolysis Inferior vena cava filter placement Heparin infusion alone None What is the mechanism of action of apixaban? Direct inhibition of thrombin (factor IIa) Inhibition of factor Xa Inhibition of platelet aggregation Vitamin K antagonism None Which of the following is the primary indication for the use of an inferior vena cava (IVC) filter in critically ill patients? To treat thrombocytopenia To prevent deep vein thrombosis (DVT) To prevent recurrent pulmonary embolism in patients who cannot receive anticoagulation To improve venous return in shock None Which of the following best describes the mechanism of action of dabigatran? Direct inhibition of factor Xa Direct inhibition of thrombin (factor IIa) Vitamin K antagonism Inhibition of fibrinolysis None What is the role of protamine sulfate in the management of heparin therapy? It activates factor Xa It inhibits thrombin It reverses the anticoagulant effect of heparin It enhances the effect of heparin None A patient is receiving continuous intravenous unfractionated heparin for deep vein thrombosis (DVT). The aPTT is prolonged. What is the next step in management? Discontinue heparin immediately Administer protamine sulfate Increase the heparin dose Decrease the heparin dose None A critically ill patient is started on warfarin therapy. Which of the following laboratory tests is used to monitor the anticoagulation effect of warfarin? Prothrombin time (PT) and INR Activated partial thromboplastin time (aPTT) Platelet count D-dimer levels None In the context of acute renal failure, which of the following anticoagulants is generally considered safe? Warfarin Rivaroxaban Unfractionated heparin Dabigatran None Which of the following is an important complication of thrombolytic therapy in patients with acute pulmonary embolism? Thrombocytosis Major bleeding complications Hypovolemic shock Hyperkalemia None Which of the following is the primary mechanism of action of fondaparinux in anticoagulation? Direct thrombin inhibition Inhibition of factor Xa via antithrombin III Vitamin K antagonism Platelet aggregation inhibition None A 65-year-old male with a history of atrial fibrillation presents with a life threatening GI bleed. He is on rivaroxaban for stroke prevention. What is the most appropriate action? Administer vitamin K Use activated charcoal for decontamination Administer a prothrombin complex concentrate (PCC) Stop rivaroxaban and monitor None In critically ill patients, what is the most common cause of acquired thrombocytopenia? Warfarin therapy Heparin-induced thrombocytopenia (HIT) Liver failure Disseminated intravascular coagulation (DIC) None In patients with acute coronary syndrome (ACS), which anticoagulant is most commonly used in conjunction with percutaneous coronary intervention (PCI)? Warfarin Rivaroxaban Bivalirudin Enoxaparin None Which of the following is a characteristic feature of disseminated intravascular coagulation (DIC)? Decreased D-dimer levels Low fibrinogen levels Elevated platelet count Normal prothrombin time (PT) None Which of the following anticoagulants is most commonly used in patients with a mechanical heart valve? Apixaban Rivaroxaban Warfarin Dabigatran None A patient receiving long-term anticoagulation with warfarin presents with a major gastrointestinal bleed. What is the best initial approach to manage this? Increase the warfarin dose Administer vitamin K intravenously Administer a direct thrombin inhibitor Continue warfarin and monitor closely None What is the most common side effect of using low-molecular-weight heparin (LMWH) in critically ill patients? Thrombocytopenia Heparin-induced thrombocytopenia (HIT) Hyperkalemia Bleeding complications None Which of the following laboratory tests is most useful for monitoring the effects of dabigatran in a patient with bleeding complications? Prothrombin time (PT) Activated partial thromboplastin time (aPTT) Thrombin time (TT) International normalized ratio (INR) None In a critically ill patient with severe sepsis and disseminated intravascular coagulation (DIC), which of the following is the most appropriate management? Immediate initiation of anticoagulation therapy with heparin Use of platelet transfusion only Supportive care, including blood product transfusions and monitoring of clotting parameters Immediate administration of thrombolytics None In patients on anticoagulant therapy who are undergoing major surgery, what is the most important step in perioperative management? Discontinue anticoagulation 1 week before surgery Bridge therapy with low-molecular-weight heparin (LMWH) Continue anticoagulation throughout surgery Administer activated factor VII None What is the most common cause of thromboembolism in patients with atrial fibrillation? Intra-atrial thrombus formation Hypercoagulability due to cancer Use of oral contraceptives Valve abnormalities None Which of the following anticoagulants is contraindicated in patients with active gastrointestinal bleeding? Apixaban Warfarin Dabigatran All of the above None Which of the following best describes the effect of elevated INR in a patient on warfarin therapy? Increased risk of bleeding Increased risk of thrombosis Decreased effect of warfarin No effect on coagulation None A 70-year-old male patient with atrial fibrillation and chronic kidney disease is prescribed apixaban. Which factor would most likely increase his bleeding risk while on this medication? Age over 75 years History of hypertension Serum creatinine of 2.5 mg/dL History of a previous stroke None Which of the following is the most appropriate anticoagulant for a patient with acute deep vein thrombosis (DVT) who has severe renal impairment (creatinine clearance Apixaban Warfarin Rivaroxaban Enoxaparin None What is the mechanism of action of the newer oral anticoagulant apixaban? Direct inhibition of thrombin (factor IIa) Vitamin K antagonism Direct inhibition of factor Xa Inhibition of platelet aggregation None What is the primary role of protamine sulfate in the management of anticoagulation during cardiac surgery? Reversal of vitamin K antagonism Reversal of unfractionated heparin Reversal of dabigatran Reversal of factor Xa inhibitors None What is the most important adverse effect to monitor for when initiating enoxaparin in a critically ill patient? Thrombocytosis Thrombocytopenia Hypertension Hyperglycemia None In a patient with atrial fibrillation, which of the following factors would most likely require a change in the anticoagulation regimen? INR >4.5 on warfarin Hemoglobin level of 12 g/dL Blood pressure of 130/85 mmHg Creatinine clearance of 60 mL/min None Which of the following is the most common cause of coagulopathy in patients with sepsis? Decreased fibrinogen production Increased platelet count Decreased factor VIII levels Disseminated intravascular coagulation (DIC) None A 60-year-old male with coronary artery disease is admitted for acute myocardial infarction (STEMI) and is started on intravenous unfractionated heparin. His activated partial thromboplastin time (aPTT) is 80 seconds. What is the most appropriate next step? Decrease the heparin infusion rate Administer protamine sulfate Increase the heparin dose Continue current heparin dose without changes None Which of the following anticoagulants is most appropriate for long-term anticoagulation in patients with mechanical heart valves? Dabigatran Apixaban Warfarin Edoxaban None In the setting of acute massive pulmonary embolism, which anticoagulant therapy is considered most appropriate for immediate management? Apixaban Warfarin Unfractionated heparin Fondaparinux None In patients receiving direct oral anticoagulants (DOACs) like apixaban, rivaroxaban, and dabigatran, which of the following is a major concern? Requirement for frequent monitoring of INR Lack of effective reversal agents Elevated risk of major bleeding in patients with renal impairment Potential drug interactions with proton pump inhibitors (PPIs) None Time's up
