Adult Critical Care Specialty (ACCS) Practice Exam

What initial therapy should be considered for a patient diagnosed with pulmonary arterial hypertension?

1. A left to right cardiac shunt

2. Refractory hypoxemia

3. Increased systemic vascular resistance

4. Pulmonary arterial hypertension

The correct answer is: Pulmonary arterial hypertension

The appropriate initial therapy for a patient diagnosed with pulmonary arterial hypertension (PAH) involves specific treatments aimed at addressing the pathophysiological changes associated with this condition. Pulmonary arterial hypertension is characterized by elevated blood pressure in the pulmonary arteries, leading to symptoms such as shortness of breath, fatigue, and exertional intolerance. Treatment options typically include medications that can dilate pulmonary and systemic arterial vascular beds, improving cardiac output and reducing the heart's workload. The correct approach centers on using targeted therapies designed specifically for PAH, which may include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, or prostacyclin analogs. These treatments work by relaxing the blood vessels in the lungs, lowering pulmonary blood pressure, and improving blood flow. The other options presented do not serve as appropriate initial therapies for PAH. A left to right cardiac shunt is a congenital heart defect that could lead to increased pulmonary blood flow but does not address the underlying issues of PAH. Refractory hypoxemia indicates an extreme lack of oxygen that is usually a result of various pulmonary or cardiac conditions rather than a treatment strategy. Increased systemic vascular resistance relates more to systemic hypertension rather than the treatment of PAH specifically. Therefore, the chosen answer