BCCCP Board Certified Critical Care Pharmacist Practice Test

In the ICU, a 60-year-old kidney transplant recipient on tacrolimus is being discussed on rounds for invasive aspergillosis. The bedside data show BP 82/46 mmHg after 30 mL/kg crystalloid, HR 124/min, lactate 5.1 mmol/L, creatinine rising from 0.9 to 1.8 mg/dL, and urine output 0.2 mL/kg/hr. Current therapies include tacrolimus, prednisone, meropenem, TMP-SMX prophylaxis, and continuous kidney replacement therapy with interruptions. The active problem requires voriconazole/isavuconazole, TDM, and interactions. The most recent albumin is low, but the value has been stable for three days. What should the critical care pharmacist recommend next?

In the ICU, a 69-year-old woman taking apixaban for atrial fibrillation is being discussed on rounds for precepting ICU learners. At a Thursday ICU operations meeting, a quality officer, a PGY2 critical care resident, a patient safety analyst, and the sepsis program manager review precepting ICU learners. The dashboard shows that the proposed policy must be ready before the next Joint Commission tracer visit. Email comments from two clinicians conflict with the medication-use data, and the implementation window is 14 days. The active problem requires entrustable tasks, feedback timing, and patient safety. A medication history includes an over-the-counter sleep aid used twice last week. What should the critical care pharmacist recommend next?

In the ICU, a 55-year-old man with alcohol-associated liver disease is being discussed on rounds for DOAC reversal monitoring. The bedside data show temperature 39.3 C, ANC 90 cells/uL, platelets 38,000/uL, bilirubin 2.4 mg/dL, and a tunneled catheter with mild tenderness. Current therapies include norepinephrine, intermittent fentanyl boluses, cefepime, stress-ulcer prophylaxis, and renal-dose adjusted enoxaparin. The active problem requires clinical hemostasis, renal clearance, timing, and lab limitations. The patient missed one outpatient follow-up appointment last month. Which interpretation should drive the medication plan?

In the ICU, a 60-year-old kidney transplant recipient on tacrolimus is being discussed on rounds for quality improvement run chart. At a Thursday ICU operations meeting, the ICU medical director, a night-shift charge nurse, an antimicrobial stewardship pharmacist, and a resident physician review quality improvement run chart. The dashboard shows that two near misses occurred after midnight during a seven-day shortage period. Email comments from two clinicians conflict with the medication-use data, and the implementation window is 14 days. The active problem requires distinguishing common-cause from special-cause variation. The bedside monitor also shows occasional premature atrial contractions. Which pharmacist recommendation best fits the available data?

In the ICU, a 72-year-old man from a skilled nursing facility is being discussed on rounds for CDS renal dosing alert. At a Thursday ICU operations meeting, the pharmacy and therapeutics subcommittee, two bedside nurses, the respiratory therapy lead, and a finance analyst review CDS renal dosing alert. The dashboard shows that a trainee recommendation reached the order queue before the attending had countersigned it. Email comments from two clinicians conflict with the medication-use data, and the implementation window is 14 days. The active problem requires specificity, workflow timing, and override analysis. The most recent albumin is low, but the value has been stable for three days. Which plan best balances benefit, harm, and monitoring?