ACCS Technological and Procedural Proficiency 2

Question 1

When performing a bronchoscopy-guided percutaneous tracheostomy, which landmark is most critical to identify before dilation?

Accepted Answer

Tracheal rings 2-3 interspace

Answer

The 2-3 tracheal ring interspace is the preferred insertion site for percutaneous tracheostomy to avoid damage to the cricoid cartilage and subglottic stenosis.

Question 2

A patient on volume-controlled ventilation develops a sudden increase in peak airway pressure with unchanged plateau pressure. What is the most likely cause?

Accepted Answer

Increased secretions or bronchospasm

Answer

An isolated rise in peak pressure with stable plateau pressure indicates increased airway resistance, most commonly due to secretions or bronchospasm rather than parenchymal changes.

Question 3

During placement of a pulmonary artery catheter, the waveform transitions from a right ventricular trace to a pulmonary artery waveform. Which change confirms this transition?

Accepted Answer

Appearance of a dicrotic notch and elevated diastolic pressure

Answer

The pulmonary artery waveform shows a dicrotic notch and a higher diastolic value than the RV, confirming passage through the pulmonic valve.

Question 4

Which ventilator setting is MOST directly associated with ventilator-induced lung injury (VILI) in ARDS patients?

Accepted Answer

Tidal volume > 8 mL/kg IBW

Answer

Volutrauma from excessive tidal volumes (>8 mL/kg IBW) is the primary driver of VILI; ARDSNet protocols target 6 mL/kg IBW to reduce stretch injury.

Question 5

An ICU patient's arterial line waveform shows marked respiratory variation in pulse pressure (>13%). What does this most likely indicate?

Accepted Answer

Fluid responsiveness in a mechanically ventilated patient

Answer

Pulse pressure variation >13% during mechanical ventilation correlates strongly with preload dependence and predicts fluid responsiveness.

(ACCS) Adult Critical Care Specialty Practice Test

(ACCS) Adult Critical Care Specialty Practice Test

ACCS Technological and Procedural Proficiency 2